biomedical therapies lecture

Biomedical Therapy Overview

  • Definition: Biomedical therapies involve the use of drugs, surgical methods, electric shock treatments, and non-invasive stimulation techniques.

  • Purpose: These therapies often alleviate or eliminate symptoms of psychological disorders but are typically paired with psychotherapy to address underlying issues.

  • Interaction: Both biomedical therapies and psychotherapy can complement each other's effects to improve an individual's functioning and quality of life.

Psychopharmacology

  • Definition: The field that deals with the use of drugs to control or relieve symptoms of psychological disorders.

  • Usage: Medications can be used alone, in combination with psychotherapy, simultaneously, or sequenced with non-pharmacological treatments.

  • Focus: The discussion includes four basic categories of psychotropic medications:

    Antipsychotics

    • Purpose: Treat psychotic symptoms such as delusions, hallucinations, or bizarre behavior.

    • Categories:

    • Typical (First Generation): e.g., Chlorpromazine

      • Effects: Can cause neuronal seizures and reduced emotionality.

      • Mechanism: Block dopamine receptors (primarily D2 receptors), acting as dopamine antagonists.

      • Side Effects: Long-term use can lead to movement disorders such as Parkinson's disease and tardive dyskinesia (characterized by involuntary movements, such as grimacing and tongue protrusion).

    • Atypical (Second Generation):

      • Mechanism: Suppress dopamine and block serotonin receptors, leading to fewer side effects and improvement in negative symptoms of schizophrenia.

      • Side Effects: Potential for weight gain, type II diabetes, changes in blood lipid levels, and alterations in heart rhythm. Rare cases may cause agranulocytosis (an immune system condition affecting white blood cells).

      • Examples: Newer atypical antipsychotics include partial dopamine agonists and drugs targeting glutamate.

    Anti-anxiety Drugs

    • Definition: These drugs are used to calm anxiety reactions, often categorized as minor tranquilizers or benzodiazepines (e.g., Xanax, Valium).

    • Onset: Typically relieve symptoms within 20-30 minutes with oral administration but come with a high risk of addiction and abuse.

    • Alternatives: Antihistamines (e.g., Benadryl), atypical benzodiazepines (e.g., Ambien, Lunesta), and mood-stabilizing anti-manic drugs (e.g., Lithium).

    Anti-manic Drugs

    • Lithium:

    • Purpose: Historically a first-line treatment for bipolar disorder, effective in stabilizing mood.

    • Mechanism: Affects sodium ion transport in neurons, though its precise mechanism on mood is unclear.

    • Side Effects: Associated with weight gain, requires monitoring due to potential toxicity when sodium levels drop due to dietary restrictions.

    • Alternative Drugs: Anticonvulsants (e.g., Valproic Acid) can also control mood swings effectively.

    Antidepressants

    • Monoamine Oxidase Inhibitors (MAOIs):

    • Function: Block the enzyme monoamine oxidase, thus allowing neurotransmitters (norepinephrine, serotonin, dopamine) to remain active longer.

    • Side Effects: May involve dietary restrictions (risk of hypertensive crisis) and other side effects (weight gain, insomnia, sexual dysfunction).

    • Tricyclic Antidepressants (TCAs):

    • Structure: Characterized by a three-ring molecular structure, increase norepinephrine and serotonin action by preventing reuptake.

    • Side Effects: Similar to MAOIs plus skin rashes and blurred vision.

    • Selective Serotonin Reuptake Inhibitors (SSRIs):

    • Function: Specifically inhibit serotonin reuptake, causing fewer side effects and safer overall profile.

    • Examples: Prozac, Zoloft, Paxil.

    • Onset: Usually takes 2 to 6 weeks to see effects.

    • New Classes: Include SNRIs, SARIs, NDRIs, and others emerging for additional efficacy.{

    • Concerns: Caution advised for children/teens due to increased suicide risk.

Electroconvulsive Therapy (ECT)

  • Definition: A biomedical therapy for severe depression, involving electrically induced seizures.

  • Application: Used when other treatments (drugs/therapy) are ineffective or side effects are intolerable.

  • Side Effects: Memory disruptions can include retrograde amnesia (loss of past memories) and anterograde amnesia (difficulty forming new memories). Effects vary; some are temporary and some may resolve over months.

    • Memory Recovery: Older memories can gradually return post-ECT.

  • ECT Techniques: Muscle relaxants and anesthetics are now used to minimize discomfort. Modern approaches may utilize ultra-brief pulses, though efficacy may differ.

  • Observations: Racial disparities in ECT utilization are evident, and the overall trend of ECT usage is declining.

Psychosurgery

  • Definition: Surgical procedures that involve altering brain structures to alleviate severe psychological symptoms.

  • Historical Example: Prefrontal lobotomy, developed by Egas Moniz, severed connections in the prefrontal cortex but often led to personality and cognitive decline.

  • Modern Techniques: Bilateral anterior cingulotomy involves guided lesioning in the cingulate gyrus to treat severe, treatment-resistant disorders such as OCD and major depression, reserved as a last resort, ensuring informed consent.

Emerging Techniques and Future Directions

  • Non-invasive methods for modifying brain function are under exploration, including:

    • Transcranial Magnetic Stimulation (TMS)

    • Deep Brain Stimulation (DBS): Evaluated for use in disorders like depression and OCD, may aid neuropsychological function in affected patients.

  • Research is ongoing into the applications of these techniques for various disorders, signaling future advancements in treatment methodologies.

Lifestyle Factors and Self-Diagnosis in Mental Health

  • Recognition of evolving conversations surrounding self-diagnosis through social media, with an emphasis on establishing comprehensive understanding amidst new therapeutic avenues.