DRUG THERAPIES

Antipsychotic Drugs

• helps reduce symptoms of psychosis, which include hallucinations (unreal perceptual experiences) and delusions (fantastic, unrealistic beliefs)

• First Group: Phenothiazines

  • Extremely helpful in reducing psychotic symptoms, but they carry a number of dangerous side effects

  • Side effects include: severe sedation, visual disturbances, and tardive dyskinesia (a neurological disorder characterized by involuntary movements of the tongue, face, mouth, or jaw)

• Atypical Antipsychotics: seem to be effective in treating psychosis without inducing some of the side effects

Antidepressant Drugs

• reduce symptoms of depression (sadness, low motivation, and sleep and appetite disturbance)

• Selective Serotonin Reuptake Inhibitors: most frequently used antidepressants; affect the serotonin neurotransmitter system

• Selective Serotonin-norepinephrine Reuptake Inhibitors (SNRIs): designed to target both serotonin and norepinephrine

  • Common Side Effects of SSRIs and SNRIs: nausea, diarrhea, headache, tremor, daytime sedation, sexual dysfunction, and agitation

• Lithium

  • a metallic element present in the sea, in natural springs, and in animal and plant tissue

  • Widely used as a mood stabilizer, particularly in the treatment of bipolar disorder, which involves swings back and forth from depression to mania (highly elevated mood, irritability, grandiosity, and involvement in dangerous activities)

  • Side Effects: extreme nausea, blurred vision, diarrhea, tremors, and twitches

  • Anticonvulsants

    • used in the treatment of mania and has fewer side effects than lithium

Antianxiety Drugs

• First Group: Barbiturates

  • Effective in inducing relaxation and sleep

  • Highly addictive

  • Withdrawal from them can cause life-threatening symptoms such as increased heart rate, delirium, and convulsions

• Benzodiazepines

  • Appears to reduce the symptoms of anxiety without interfering substantially with an individual’s ability to function in daily life

  • Sleeping pills: most frequent use of this drug

  • Highly addictive

  • Withdrawal symptoms include: heart rate acceleration, irritability, and profuse sweating

Electroconvulsive Therapy and Newer Brain Stimulation Techniques

Electroconvulsive Therapy (ECT):

• introduced as a treatment for schizophrenia

• consists of a series of treatments in which a brain seizure is induced by passing electrical current through the patient's brain

• Full series of treatments consists of 6 to 12 sessions

• Side Effects: confusion and memory loss

Repetitive Transcranial Magnetic Stimulation (rTMS)

• exposes patients to repeated, high-intensity magnetic pulses focused on particular brain structures

Deep Brain Stimulation

• electrodes are surgically implanted in specific areas of the brain

• These electrodes are then connected to a pulse generator placed under the skin that delivers stimulation to the specific brain areas

Vagus Nerve Stimulation

• electrodes are attached to the vagus nerve, a part of the nervous system that carries information to several areas of the brain, including the hypothalamus and amygdala

• These electrodes are connected to a pulse generator that delivers stimulation to the vagus nerve, which in turn travels to targeted areas of the brain

Psychosurgery

• Prefrontal Lobotomy

  • Antonio de Egas Moniz

  • the frontal lobes of the brain are severed from the lower centers of the brain in people with psychosis

  • Patients would often experience severe and permanent side effects: inability to control impulses or an inability to initiate activity, extreme listlessness and loss of emotions, seizures, and sometimes even death

PSYCHOLOGICAL APPROACHES

Behavioral Approaches

• focus on the influence of reinforcements and punishments in producing behavior

• 2 core principles:

  • Classical Conditioning

    • Ivan Pavlov

    • Unconditioned Stimulus (US): stimulus that naturally produces a response

    • Unconditioned Response (UR): response created by the unconditioned stimulus

    • Conditioned Stimulus (CS): previously neutral stimulus

    • Conditioned Response (CR): response that CS elicits

    • has been used to explain people's seemingly irrational responses to a host of neutral stimuli

  • Operant Conditioning

    • E.L. Thorndike observed that behaviors that are followed by a reward are strengthened, whereas behaviors that are followed by a punishment are weakened

    • Shaping of behaviors by providing rewards for desired behaviors and providing punishments for undesired behaviors

    • B.F. Skinner showed that a pigeon will learn to press on a bar if pressing it is associated with the delivery of food and will learn to avoid pressing another bar if pressing it is associated with an electric shock

    • Continuous Reinforcement Schedule: behaviors will be learned most quickly if they are paired with the reward or punishment every time the behavior is emitted; consistent response

    • Partial Reinforcement Schedule: behaviors can be learned and maintained in which the reward or punishment occurs only sometimes in response to the behavior

    • Extinction: eliminating a learned behavior; more difficult when the behavior was learned through a partial reinforcement schedule than when the behavior was learned through a continuous reinforcement schedule

  • Learning can occur through modeling and observational learning

    • Albert Bandura argued that people also learn behaviors by watching other people, a view that came to be known as social learning theory

    • Modeling:

      • People learn new behaviors from imitating the behaviors modeled by important people in their lives

      • more likely to occur when the person modeling the behavior is seen as an authority figure or is perceived to be like oneself

    • Observational Learning:

      • takes place when a person observes the rewards and punishments that another person receives for his or her behavior and then behaves in accordance with those rewards and punishments

Behavioral Therapies:

• focus on identifying those reinforcements and punishments that contribute to a person's maladaptive behaviors and on changing specific behaviors

• Behavioral Assessment: foundation of behavioral therapy

• Systematic Desensitization Therapy: a gradual method for extinguishing anxiety responses to stimuli and the maladaptive behavior that often accompanies this anxiety

  • Often combined with modeling

  • Vivo Exposure: asked to experience these stimuli directly; generally has stronger results than exposure only in the client’s imagination

COGNITIVE APPROACHES

• Argue that it is not simply rewards and punishments that motivate human behavior

• Cognitions (thoughts or beliefs) shape our behavior and the emotions we experience

• Causal Attribution: the “why”

• Global Assumptions: broad beliefs about ourselves, our relationships, and the world

• Aaron Beck and Albert Ellis

Cognitive Therapies

• help clients identify and challenge their negative thoughts and dysfunctional belief systems

• Designed to be short-term, on the order of 12 to 20 weeks in duration with 1-2 sessions per week

• 3 Main Goals in Cognitive Therapy

  • Assist clients in. Identifying their irrational and maladaptive thoughts. A client might be asked to keep a diary of thoughts she has whenever she feels anxious.

  • Teach clients to challenge their irrational or maladaptive thoughts and to consider alternative ways of thinking. A client might be asked to evaluate the evidence for a belief or to consider how other people might think about a difficult situation.

  • Encourage clients to face their worst fears about a situation and recognize ways they could cope.

• Often combined with behavioral techniques known as cognitive-behavioral therapy (CBT)

PSYCHODYNAMIC APPROACHES

• suggest that all behaviors, thoughts, and emotions, whether normal or abnormal, are influenced to a large extent by unconscious processes

• Began with Sigmund Freud; developed psychoanalysis

• Psychoanalysis

  • A theory of personality and psychopathology

  • A method of investigating the mind

  • A form of treatment for psychopathology

• Anna O.

  • Extensive symptoms of hysteria—physical ailments with no apparent physical cause—including paralysis of the legs and right arm, deafness, and disorganized speech

  • hysteria is the result of traumatic memories that have been repressed from consciousness because they are too painful

  • defined repression as the motivated forgetting of a difficult experience

    • Does not dissolve the emotion associated with the memory or wish

• ID, EGO, AND SUPEREGO

  • 2 basic drives that motivate human behavior

    • Libido: sexual drive

    • Aggressive drive