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Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical...

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Biological Therapies
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Page 1: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Biological Therapies

Page 2: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Helping Professionals Who Can Administer Biological Therapies

• Medical specialists– Psychiatrists M.D.– Neurosurgeon M.D.

• Other Medical Practitioners– General practitioners M.D.– Psychiatric nurses (M.S.N. + M.S in

psychopharmacology)

• Clinical psychologists Ph.D./Psy.D. ??

Page 3: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Assumptions of Biological Therapies• Psychological phenomena are associated

with brain functions• Psychopathology is associated with

abnormality of brain functions• Intervention lies in changing brain function• Easiest way to change brain function is

with drugs– Influence rather than eliminating neural

connections– May be reversible

Page 4: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.
Page 5: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.
Page 6: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.
Page 7: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Types of Biological Therapies

• Psychopharmacological • Psychosurgical• Other procedures (e.g.

electroconvulsive therapy)

Page 8: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychopharmacology:Side Effects• As with most biological therapies,

psychoactive drugs have side effects– Don’t know enough about brain function – Don’t know enough about mechanics of the drugs

• Main effects, side effects, toxic effects• “therapeutic window” of psychoactive drugs

is very small• State of the art for drug therapies is not

“cure”– Enhancing therapeutic effects– Minimizing toxic effects

Page 9: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychopharmocology: Antipsychotics• Dopamine receptor blockers

– Based on “the dopamine hypothesis”• Overactive dopamine systems result in positive symptoms

of schizophrenia• Dopamine is involved in CNS control of behavioral attention

and activation of movement• Appears to be a correlation between positive symptoms of

schizophrenia and attention to stimuli most can ignore– Ongoing internal dialogue– Aspects of the environment– Unusual memory events

– Side effects of dopamine receptor blockers• Tardive dyskinesia (involuntary muscle movement; ex.

mouth, lips, tongue)• Parkinsonian tremors

Page 10: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychopharmacology: Antidepressants

• 3 major categories • Similar functions • Increase synaptic level of

norepinephrine and/or serotonin– Norepinephrine - ANS functions like

bronchodilation and heart rate; CNS control of arousal and vigilance

– Serotonin - CNS mechanisms of sleep and dreaming

Page 11: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychopharmacology: Antidepressants (cont.)

• Tricyclics– Mechanism is unclear– May sensitize monoamine receptors– Block reuptake of norepinephrine and serotonin after fired– 1-6 weeks for antidepressant effects

• MAO Inhibitors– Prevent the breakdown of neurotransmitters – Keeps more around for uptake– Dangerous interaction with tyramine (natural enzyme)

• Selective Serotonin Reuptake Inhibitors (SSRI’s)– Blocks reuptake of serotonin; more serotonin available– Not so selective– Associated with increased sleep and sexual difficulties

Page 12: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Next Generations of Antidepressants• Wellbutrin

– Increases norepinephrine in synaptic cleft– Reduces incidence of sexual dysfunction found in

SSRI’s– May cause seizures

• Desyrel– Counteracts some of the sleep difficulties found in

SSRI’s– May cause constant erection

• Serzone– Decreased sleep and sexual dysfunctions– Other toxic effects unknown yet

Page 13: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Alternative Treatment for Mood Disorders

• For Seasonal Affective Disorder (SAD) -Light therapy

• For SAD - Melatonin • For Dysthymia – St. John’s Wort

(herb)

Page 14: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychopharmacology: Anxiety• Anxiolytics

– Based on the assumption that anxiety disorders are the result of excessive activity in neural circuits of anxiety response/vigilance

– Too much GABA (Gamma Amino Butyric Acid)• The central nervous system’s primary inhibitory

neurotransmitter; keeps general levels of neural activity “in check”

– Benzodiazapines– SSRI’s– Buspirone

Page 15: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychopharmacology: Psychostimulants

• Ritalin, Cylert, Dexedrine• Used in the treatment of ADHD• Stimulates the part of the brain

that selectively attends

Page 16: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Combined Therapies

• Debate is still on about whether psychotherapy alone may be effective and in the treatment of what disorders

• Many studies are showing that combination of psychotherapy and pharmacological therapy is more effective that drugs alone

• Meds used alone primarily for insurance reasons

Page 17: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Psychosurgery• “Frontal lobotomy” has been

replaced with more precise targeting of specific areas of the brain– Ex. Cingulotomy

• Disconnects the cingulate gyrus of the frontal lobe from the limbic areas of the temporal lobe

• Still very controversial• Only used as experimental treatment for

severe OCD that doesn’t respond to behavioral and drug therapies

Page 18: Biological Therapies. Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical.

Other Biological Procedures• Electroconvulsive therapy (ECT)

– Used to be known as shock treatment– Administered only as last resort; only in severe,

unrelenting major depression unresponsive to other therapies

– Treatment mechanics have improved; still unclear about the mechanics of how it works

• Generally increases neurotransmitter turnover• Requires several treatments to influence symptoms• Side effects include memory loss• Recent experimentation with unilateral ECT suggests

that memory loss difficulties may be ameliorated with continuing sophistication in the administration of ECT


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