Medical Therapies-Psychiatric Care Assignment

Medical Therapies-Psychiatric Care Assignment

Medical Therapies-Psychiatric Care Assignment

Gateway Question 15.8: How do psychiatrists treat psychological disorders? Psychotherapy may be applied to anything from a brief crisis to a full-scale psychosis. However, most psychotherapists do not treat patients with major depressive disorders, schizophrenia, or other severe conditions. Major mental disorders are more often treated medically, although combinations of medication and psychotherapy are also often helpful (Beck, et al., 2009).

Three main types of somatic (bodily) therapy are pharmacotherapy, electrical stimulation therapy, and psychosurgery. Somatic therapy is often done in the context of psychiatric hospitalization. All the somatic approaches have a strong medical slant and are typically administered by psychiatrists, who are trained as medical doctors. Medical Therapies-Psychiatric Care Assignment.

Drug Therapies The atmosphere in psychiatric wards and mental hospitals changed radically in the mid-1950s with the widespread adoption of pharmacotherapy (FAR-meh-koe-THER-eh-pea), the use of drugs to treat psychopathology. Drugs may relieve the anxiety attacks and other discomforts of milder psychological disorders. More often, however, they are used to combat schizophrenia and major mood disorders ( Julien, 2008).

What sort of drugs are used in pharmacotherapy? Three major types of drugs are used. All achieve their effects by influencing the activity of different brain neurotransmitters (Freberg, 2010). Anxiolytics (ANG-zee-eh LIT-iks), such as Valium, produce relaxation or reduce anxiety. Antidepressants, such as Prozac, are mood-elevating drugs that combat depression. Antipsychotics (also called major tranquilizers), such as Risperdal, have tranquilizing effects and reduce hallucinations and delusions. See ? Table 15.2 for examples of each class of drugs.

Are drugs a valid approach to treatment? Yes. Drugs have shortened hospital stays, and they have greatly improved the chances that people will recover from major psychological disorders. Drug therapy has also made it possible for many people to return to the community, where they can be treated on an outpatient basis.

Limitations of Drug Therapy Regardless of their benefits, all drugs involve risks as well. For example, 15 percent of patients taking major tranquilizers for long periods develop a neurological disorder that causes rhythmic facial

Commonly Prescribed Psychiatric Drugs

Class Examples (Trade Names) Effects Main Mode of Action

Anxiolytics (minor tranquilizers)

Ativan, Halcion, Librium, Restoril, Valium, Xanax

Reduce anxiety, tension, fear Enhance effects of GABA

Antidepressants Anafranil, Elavil, Nardil, Norpramin, Parnate, Paxil, Prozac, Tofranil, Zoloft

Counteract depression Enhance effects of serotonin or dopamine

Antipsychotics (major tranquilizers)

Clozaril, Haldol, Mellaril, Navane, Risperdal, Thorazine

Reduce agitation, delusions, hallucinations, thought disorders

Reduce effects of dopamine

? TABLE 15.2

Source: Adapted from Freberg, 2010; Julien, 2008; Kalat, 2009.

The work of artist Rodger Casier illustrates the value of psychiatric care. Despite having a form of schizophrenia, Casier produces artwork that has received public acclaim and has been featured in professional journals.

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.

Similarly, although the drug clozapine (Clozaril) can relieve the symptoms of schizo- phrenia, 2 out of 100 patients taking the drug suffer from a poten- tially fatal blood disease (Ginsberg, 2006).

Is the risk worth it? Many experts think it is, because chronic schizophrenia robs people of almost everything that makes life worth living. It’s possible, of course, that newer drugs will improve the risk/benefit ratio in the treatment of severe problems like schizophrenia. For example, the drug risperidone (Risperdal) appears to be as effective as Clozaril, without the same degree of lethal risk.

But even the best new drugs are not cure-alls. They help some people and relieve some problems, but not all. It is noteworthy that for serious mental disorders a combination of medication and psychotherapy almost always works better than drugs alone (Manber et al., 2008). Nevertheless, when schizophrenia and major mood disorders are concerned, drugs will undoubtedly remain the primary mode of treatment (Vasa, Carlino, & Pine, 2006; Walker et al., 2004).

Electrical Stimulation Therapy In contrast to drug therapies, electrical stimulation therapies achieve their effects by altering the electrical activity of the brain. Electroconvulsive therapy is the first, and most dramatic, of these therapies. Widely used since the 1940s, it remains controversial to this day (Hirshbein & Sarvananda, 2008).

Electroshock In electroconvulsive therapy (ECT), a 150-volt electrical current is passed through the brain for slightly less than a second. This rather drastic medical treatment for depression triggers a convulsion and causes the patient to lose consciousness for a short time. Muscle relaxants and sedative drugs are given before ECT to soften its impact. Treatments are given in a series of sessions spread over several weeks or months. Medical Therapies-Psychiatric Care Assignment

How does shock help? Actually, it is the seizure activity that is believed to be helpful. Proponents of ECT claim that shock- induced seizures alter or “reset” the biochemical and hormonal balance in the brain and body, bringing an end to severe depression and suicidal behavior (Medda et al., 2009) as well as improving long-term quality of life (McCall et al., 2006). Others have charged that ECT works only by confusing patients so they can’t remember why they were depressed.

Not all professionals support the use of ECT. However, most experts seem to agree on the following: (1) At best, ECT produces only temporary improvement—it gets the patient out of a bad spot, but it must be combined with other treatments; (2) ECT can cause memory loss in some patients (Sienaert et al., 2010); (3) ECT should be used only after other treatments have failed; and (4) to lower the chance of a relapse, ECT should be followed by antidepressant drugs (Sackeim et al., 2001). All told, ECT is considered by many to be a valid treatment for selected cases of depression— especially when it rapidly ends wildly self-destructive or suicidal behavior (Medda et al., 2009; Pagnin et al., 2004). It’s interesting to note that most ECT patients feel that the treatment helped them. Most, in fact, would have it done again (Bernstein et al., 1998; Smith et al., 2009).

Implanted Electrodes Unlike ECT, implanting electrodes requires surgery but allows for electrical stimulation of precisely targeted brain regions. In some studies, depressed patients who hadn’t benefited from drug therapy and ECT improved when a specific brain region was stimulated (Mayberg et al., 2005; Sartorius et al., 2010). Stimulating pleasure centers in the brains of another group of patients also relieved depression (Schlaepfer et al., 2008). Also, unlike ECT, implanted electrodes can be used to treat disorders other than depression, such as obsessive-compulsive disorder (Haq et al., 2010).

Electrical stimulation of the brain is one of several methods used to investigate the brain’s inner workings. For more information, see Chapter 2, pages 60–63.