Biological treatments for Psychopathology

Drug treatment

Drug therapy (chemotherapy) is the main treatment for psychopathology and is based on the assumption that chemical imbalance is the cause of the problem. Drugs for mental disorders include the following:

Anti-depressant drugs, e.g. MAOIs (monoamine-oxidase inhibitors), TCAs (tricyclics) and SSRIs (selective serotonin re- uptake inhibitors). MAOIs and trycyclics were the first drugs used to treat depression and raise levels of serotonin and noradrenaline in the brain. MAOIs block the action of an enzyme that breaks down serotonin, so increasing its availability in the nervous system. However, a newer group of drugs – SSRIs – were introduced in the 1990s (e.g. Prozac) which selectively raise levels of serotonin in the brain (and thought to be more effective and safer than MAOIs and trycyclics).

Anti-psychotic drugs, e.g. major tranquillizers such as the chlorpromazine – these sedate patients and alleviate symptoms (e.g. hallucinations and delusions) of the person suffering from psychotic disorders such as schizophrenia. They work by reducing dopamine activity in the brain. Chlorpromazine was the first drug used to treat schizophrenia but can have unpleasant side effects. Newer drugs such as clozapine have fewer side effects than chlorpromazine and act on a wide range of neurotransmitters in the brain such as dopamine and serotonin.

Anti-anxiety drugs, e.g. minor tranquillizers called benzodiazepines (BZs) such as Valium. These have a calming effect by inhibiting the nervous system and causing muscles to relax. BZs work by enhancing the action of the neurotransmitter, GABA, which acts to calm brain activity.

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Electro-convulsive therapy [ECT]

The patient lies on a bed and receives an anaesthetic and muscle relaxant before treatment. A current is passed through the brain for about half a second which is done by fixing electrodes to the patient’s temples. In the past, electrodes were put on each side of the forehead. Nowadays it is more common to use ECT on one side of the brain as this reduces side effects. The current induces convulsions that last for approximately one minute. Once the patient comes round from the anaesthetic they recall nothing about the procedure.

ECT is now used mainly to treat people with severe depression when all other treatments have failed. Treatments are given typically two or three times a week for three or four weeks. ECT was particularly popular in the 1940s, fell out of favour during the 1960s but is still widely used today.

Evaluation of ECT

Effectiveness – ECT is a quick form of treatment compared with drugs or psychological therapies. It can be an effective short-term treatment for depression with 60-70 per cent of patients showing improvement (Sackheim 1988). However, approximately 60 per cent of patients will become depressed again within a year (Sackheim et al. 1993).

Side effects – When ECT was first introduced there were serious side effects including bone fractures and memory loss. Side effects have been reduced but opinions are divided regarding the severity of cognitive and emotional impairments following treatment.

Ethical issues – ECT has a history of abuse, being used as a means of punishing or controlling people in mental hospitals. However, the Mental Health Act (2007) states that ECT is prohibited if the patient is capable of making a decision and refuses treatment unless it is immediately necessary to save life.

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Psychosurgery

Psychosurgery is brain surgery to treat psychological disorders. It is the most invasive form of biological therapy because in involves removal of brain tissue and the effects are irreversible. The first modern psychosurgery technique was the pre-frontal lobotomy, developed in the 1940s as a cure for schizophrenia. This method involved cutting pathways between the higher thought centres of the frontal cortex and the lower centres of the brain by inserting a scalpel through a drilled hole in the skull. There was no evidence that it improved the specific symptoms of schizophrenia, but it made patients more manageable.

Nowadays, psychosurgery techniques involve less damage to neural tissue and precise localisation of damaged brain areas. Psychosurgery is rarely used, and is only offered as a last resort for treating severe depression when other treatments have been ineffective.

Evaluation of psychosurgery

Controversial treatment – In the 1950s, psychosurgery was performed on thousands of people in the absence of other effective treatments and in an attempt to reduce the numbers of people crammed into mental institutions. People with severe disorders are unlikely to fully understand the procedure and be able to give informed consent.

A last resort – Although psychosurgery is rarely performed today and is seen as a treatment of last resort, some procedures, carried out to alleviate the symptoms of severe anxiety or obsessive- compulsive disorders, have been beneficial (Beck and Cowley 1990).

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