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TREATMENT AND THERAPY What to do about mental illness? Two major schools of thought - Biological/chemical – drug treatment, shock treatment - “Talk” therapy or behavior therapy - Often most effective when combined for some disorders (e.g., depression) - Must always be evidence based - Going beyond mental illness to mental well-being Biological Approaches - Early approaches o Primitive man – cut holes in the skull to release evil spirits – if you were lucky (if unlucky, often just killed) people could survive trepanning o American doctor Benjamin Rush (18-19 th century) – advocated physical and perceptual restraints, as well as “spinning” and cold water baths - More modern times o Egaz Moniz (1930-1970s) – Nobel Prize winner for pioneering the frontal lobotomy . The frontal lobes are severed using an icepick -like instrument inserted through the eye sockets. Leads to lethargy. 50,000 in USA alone. Violent, clinically depressed, hyperactive (children). o Electroconvulsive therapy (1940-today) – shock causes convulsions 25-120s long. Works very quickly, but mechanism still unclear. Patients suffer temporary memory loss for recent experiences, mostly recovered over time. Despite serious side effects, it is 80% effective in treating severe depression that has been resistant to all other treatment. - Cutting edge o TMS – used to temporarily ‘knockout’ the function of brain areas and allow for causal inferences in research, and can be used therapeutically. TMS over the left frontal lobe has been approved for use in severe depression. Fewer side effects than ECT, long term benefits. o DBS – deep brain stimulation with electrodes. Successfully used in Parkinson’s, but now also experimental treatment for severe OCD. DBS of caudate appears successful for 2/3 of severe OCD patients for whom other therapies have failed. Pharmacological Approaches - Antipsychotics, Antidepressants, Anti-anxiety drugs o Three classes of drugs that alter neurochemistry o Useful in schizophrenia, mood disorders, and anxiety disorders o All part of standard treatment for these disorders, and all most successful when complemented by cognitive or behavioral therapy - Antipsychotics for schizophrenia o Haloperidol: dopamine antagonist; decreases positive symptoms of schizophrenia , also can lead to ‘pseudo-Parkinson’s’ (tremors) and tardive dyskenesia (motor tics)
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o Clozapine: acts on dopamine, norepinephrine and serotonin; works on BOTH positive and negative symptoms . No motor tics or pseudo-Parkinson’s, but can cause serious seizure, cardiovascular, and immune problem - Antidepressants for mood disorders o MAO inhibitors: increase the time norepinephrine, dopamine, and serotonin are in the system by blocking the enzymes that usually break them down. . must be cautious not to ingest tyramine (in cheese and red wine) or can have fatal BP increase o SSRIs: slow the reuptake processes at serotonin receptors specifically Often, a depressed person who does not respond to one type of drug will
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