introductory psychology: biomedical therapies
DESCRIPTION
lecture 28 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. ([email protected]) at Willamette University, includes drugs, electroconvulsive therapyTRANSCRIPT
Biomedical Therapies
Brian J. Piper, Ph.D.
Goals
• Psychopharmacology– Antipsychotics– Antianxiety– Antidepressants
• Brain Stimulation– Transcranial Magnetic Stimulation– Electroconvulsive Therapy
• Psychosurgery
Prevalence of Psychopharmacology
http://online.wsj.com/article/SB10001424052970203503204577040431792673066.html?mod=WSJ_WSJ_US_News_5
Decreases in child antidepressants &anti-anxiety meds in elderly
Overall: 22% increase
Psychopharmacology
• Most psychological drugs target neurotransmitters – Dopamine– Norepinephrine– 5-hydroxytryptamine (5-HT or serotonin)– Gamma Aminobutyric Acid (GABA)
• It is not known if these mechanisms are responsible for the therapeutic effects
History of Antipsychotics (aka Neuroleptics/Major Tranquilizers)
• 1950s: Typical (D2 antagonist) antipsychotic chlorpromazine developed as a anesthetic but helps against hallucinations & delusions
• 1950s (late): tardive dyskinesia identified• 1970s: Atypical (D2/5-HT2A antagonist)
clozapine antipsychotic introduced.• 2000s: substantial weight gain recognized
Psychological Disorders & Reduced Lifespan (N = 5,036,662)!
Male Life Expectancy
MaleYears Lost
FemaleLifeExpectancy
FemaleYears Lost
All (Psychiatric History - )
76.5 NA 80.9 NA
Schizophrenia 57.8 18.7 64.6 16.3
Bipolar 62.9 13.6 68.8 12.1
Laursen (2011). Schizophrenia Research, 131, 101-104.
Reduced Lifespan
Male Life Expectancy
MaleYears Lost
FemaleLifeExpectancy
FemaleYears Lost
All (Psychiatric History - )
76.5 NA 80.9 NA
Schizophrenia 57.8 18.7 64.6 16.3
Bipolar 62.9 13.6 68.8 12.1
Laursen (2011). Schizophrenia Research, 131, 101-104.
Contributing Factorssuicide, accident, homicides, self-care, metabolic (?)
Antidepressants
• Monoamine Oxidase (MAO) is an enzyme that breaks down 5-HT, NE, & DA
MAO-Is
• Monoamine Oxidase (MAO) is an enzyme that breaks down 5-HT, NE, & DA; peak use in 1970s
• Food Interactions: Tyramine rich foods (aged cheese, beer, wine) + MAO-I results in increased blood pressure & headaches (“cheese effect”)
• Moderate effectiveness but moderate side-effects
Antidepressants: Serotonin Reuptake Inhibitors
• Prozac (fluoxetine) was the original SRI• Greater affinity for SERT than NET• Not Selective (sigma receptors)• Anorgasmia• Low effectiveness but low side-effects
Cognitive Behavioral Therapy
• Short, evidence based, therapy• Developed by Aaron T. Beck• Instruction in how thoughts & feelings
influence behavior
1921-
CBT + Medication• Patients randomized to receive Nefazodone (5-
HT2A/1 antagonist), CBT, or both for 3 months
Nef CBT Nef +CBTCompleters 69.5% 72.2% 76.5%
No Response 44% 48% 15%Remission 22% 24% 42%
Keller et al (2000). New England J of Medicine, 342, 1462-1470.
Electroconvulsive Therapy
• Brief seizure is induced• Peak use in 1940s-1950s, resurgence• Conditions: Major Depressive Disorder,
schizophrenia, bipolar• Very effective for MDD but memory loss
1940s Present
Wave sinusoidal pulse
Anesthetic no yes
Consent ? yes
Biomedical Therapies & Neurogenesis
• New neurons are produced in the hippocampus in adults
ECS: electroconvulsive therapy; TCP: trancyclpromine (MAO-I), or Reboxetine (SNRI)
Mahlberg (2000). J Neurosciece, 20, 9104-9110.
Electroconvulsive Therapy Video
• Caitlin & Meghan Davies• Season 1: Episode 2
– 1:05:00-1:08:00– 1:29:30-1:50:00
Zofran (Ondansetron): 5-HT3 antagonist
Transcranial Magnetic Stimulation
• pulse of electromagnetic field• very low risk of seizures & syncope• Control condition?• Repeated TMS shows moderate utility for
MDD• Mechanism unknown
Psychosurgery
• 1949: Antonio Egas Moniz received Nobel prize for frontal leucotomy
• 1940s-1967: Walter Freeman develops frontal lobotomy (transorbital)
• Current: lesioning & deep brain stimulation is a last resort
1874-1955
Who prescribes?
• Mostly MDs– Psychiatrists– Pediatricians– General Practitioners
• Some clinical psychologists– New Mexico (2002)– Louisiana (2004)
Tanya Tompkins