Psych Chapter 12

an idea of what you are not h1earing from the drug companies

(1) placebo effects (only about half of all depressed patients respond posi- tively to any given antidepressant medication, and of those, only about 40 percent are actually re- sponding to the specific biological effects of the drug ) (2) High relapse and dropout rates (in part because of these drugs' unpleasant side effects, anywhere from one-half to two-thirds of people stop taking them) (3) Disregard for effective, possibly better non medical treatment (4) Dosage problems (5) Unknown risks over time and in combination. ("cocktails" of medications—this one for anxiety, plus this one for depression, plus another to manage the side effects) (6) Untested off-label uses

Match these treatments with the problems for which they are typically used. Study and Review on mypsychlab.com 1. antipsychotic drugs 2. antidepressant drugs 3. lithium carbonate 4. electroconvulsive therapy a. suicidal depression b. bipolar disorder c. schizophrenia d. depression and anxiety e. obsessive-compulsive disorder

1. c 2. d, e 3. b 4. a

1. transference 2. systematic desensitization 3. facing the fear of death 4. reappraisal of thoughts 5. unconditional positive regard 6. exposure to feared situation 7. avoidance of "catastrophizing" 8. assessment of family patterns Answers: a. b. c. d. e. f. cognitive therapy psychodynamic therapy humanist therapy behavior therapy family therapy existential therapy

1.b 2.d 3.f 4.a 5.c 6.d 7.a 8.e

transcranial magnetic stimulation (TMS)

A different method of electrically stimulating the brains of individuals suffering from severe de- pression, still largely experimental; involves the use of a pulsing magnetic coil held to a person's skull over the left prefrontal cortex, an area of the brain that is less active in people with depression. Like ECT, the benefits of TMS, when they occur, are short-lived. At present, its benefits seem to depend more on who is doing it than on what is being done, suggesting the placebo effect is at work rather than the technology itself. Until controlled studies are done, we need to tolerate some uncertainty about whether TMS will prove to be effective.

behavior therapy

A form of therapy that applies principles of classical and operant conditioning to help people change self-defeating or problematic behaviors; methods: (1) exposure (2) Systematic desensitization (3) behavioral self-monitoring (4) Skills training

flooding

A more dramatic form of exposure in which the therapist takes the client directly into the feared situation and remains there until the client's panic and anxiety decline. Thus a person suffering from agoraphobia might be taken into a department store or a subway, an action that would normally be terrifying to contemplate.

lithium carbonate

A special category of drug, a salt called lithium carbonate, often helps people who suffer from bipolar disorder. It may produce its effects by moderating levels of norepinephrine or by protect- ing brain cells from being overstimulated by another neurotransmitter, glutamate. Lithium must be given in exactly the right dose, and bloodstream levels of the drug must be carefully monitored, be- cause too little will not help and too much is toxic; in some people, lithium produces short-term side effects (tremors) and long-term problems (kidney damage). Other drugs commonly prescribed for people with bipolar disorder include Depakote and Tegretol.

are new antipsychotic drugs safer?

Although the newer drugs now comprise 90 percent of the market for antipsychotics, a large federally funded study found that they are not significantly safer or more effective than the older, less expensive medications for schizophrenia—the only disorder for which they were originally approved; And although antipsychotics are sometimes used to treat impulsive aggressiveness associated with attention deficit disorder, dementia, and mental retardation, they are ineffective for these disorders. One study followed 86 people, ages 18 to 65, who were given Risperdal, Haldol, or a placebo to treat their ag- gressive outbursts; The placebo group improved the most.

Antidepressant side effects

Antidepressants are nonaddictive and about equally effective, but they all tend to produce some unpleasant physical reactions, including dry mouth, headaches, constipation, nausea, restlessness, gas-trointestinal problems, weight gain, and, in as many as one-third of all patients, decreased sexual desire and blocked or delayed orgasm; The specific side effects may vary with the particular drug.

antipsychotic drugs and schizophrenia

Antipsychotic drugs can reduce agitation, delusions, and hallucinations, and they can shorten schizophrenic episodes. But they offer little relief from other symptoms of schizophrenia, such as jumbled thoughts, difficulty concentrating, apathy, emotional flatness, or inability to interact with others.

Summary of Drug uses

Antipsychotics (neuroleptics): Schizophrenia Other psychoses Impulsive anger Bipolar disorder Antidepressants: Depression, Anxiety disorders, Panic disorder, Obsessive-compulsive disorder Anti-anxiety drugs: Mood disorders, Panic disorder, Acute anxiety Lithium Carbonate: Bipolar disorder

antipsychotic drug side effects

Antipsychotics often cause troubling side effects, especially muscle rigidity, hand tremors, and other involuntary muscle movements that can develop into a neurological disorder. In addition, Zyprexa, Risperdal, and other antipsychotics, which manufacturers have been targeting for children and the elderly, often carry unacceptable risks for these very groups. The immediate side effect is extreme weight gain, anywhere from 24 to 100 extra pounds a year, which has led to the develop- ment of thousands of cases of diabetes. Other risks include strokes and death from sudden heart failure

The most famous modern effort to cure mental illness by intervening directly in the brain was in- vented

António Egas Moniz, a Portuguese neurologist, in 1935

Albert Ellis' rational emotive behavior therapy (REBT)

In this approach, the therapist uses rational arguments to directly challenge a client's unrealistic beliefs or expecta- tions. Ellis pointed out that people who are emotionally upset often overgeneralize: They decide that one annoying act by someone means that per- son is bad in every way, or that a normal mistake they made is evidence that they are rotten to the core. Many people also catastrophize, transforming a small problem into disaster: "I failed this test, and now I'll flunk out of school, and no one will ever like me, and even my cat will hate me, and I'll never get a job." Many people drive themselves crazy with notions of what they "must" do. The therapist challenges these thoughts directly, showing the client why they are irrational and misguided

which antidepressants have the most risk?

MAOIs Monoamine oxidase inhibitors

Salvador Minuchin

One of the most famous early family therapists, Salvador Min- uchin (1984), compared the family to a kaleido- scope, a changing pattern of mosaics in which the pattern is larger than any one piece. In this view, ef- forts to isolate and treat one member of the family without the others are doomed.

What are six cautions about taking medications for psychological disorders?

Placebo effects are common; dropout and relapse rates are high; the availability of medication may pre- vent people from trying a possibly better nonmedical solution first; appropriate dosages can be difficult to determine and can vary by sex, age, and ethnicity; some drugs have unknown or long-term risks; and some drugs are prescribed off label for conditions for which they were never tested

the FDA now warns against prescribing ___ to anyone under 18.

SSRIs

SSRIs

Selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, Zoloft, Lexapro, Paxil, and Celexa, work on the same prin- ciple as the tricyclics but specifically target sero- tonin. Cymbalta and Remeron target both serotonin and norepinephrine. Wellbutrin is chemically unrelated to the other antidepressants but is often prescribed for depression and sometimes as an aid to quitting smoking.

Ferdie is spending too much time playing softball and not enough time studying, so he signs up for "sportaholic therapy" (ST). The therapist tells him the cure for his "addiction" is to quit softball cold turkey and tap his temples three times whenever he feels the urge to play. After a few months, Ferdie announces that ST isn't helping and he's going to stop coming. The therapist gives him testimonials of clients who swear by ST, adding that Ferdie's doubts are actually a sign that the therapy is working. What is the major scientific flaw in this argument? (Bonus: What kind of therapy might help Ferdie manage his time better?)

The therapist has violated the principle of falsifiability (see Chapter 1). If Ferdie is helped by the treatment, that shows it works; if he is not helped, that still shows it works and Ferdie is simply denying its benefits. Also, Ferdie is not hearing testimonials from people who have dropped out of ST and were not helped by it. (Bonus: A good behavioral time-management program might help, so Ferdie can play softball and get other things done, too.)

In 2006, a news story reported that scientists had high hopes for new pills that would help people quit smoking, lose weight, and kick addictions to alcohol and cocaine. The pills supposedly worked by blocking pleasure centers in the brain that make people feel good when they smoke, overeat, or drink liquor. Based on what you have read in this section, what might you expect to have read in a follow-up story two years later? Why?

You might expect to read that there were unexpected side effects of the new pills or their lack of effectiveness. One subsequent news story on this particular line of research concluded: "Now it seems the drugs may block pleasure too well, possibly raising the risk of depression and suicide." Indeed, a pill from one major drug company to help people quit smoking has been linked to dozens of reports of suicides and suicide attempts, and two obesity pills have been tied to higher rates of suicide and depression. Early reports of drugs in the testing pipeline usually promise exciting results, but many of these drugs do not pan out.

Beta-blockers

a class of drugs primarily used to manage heart irreg- ularities and hypertension, are sometimes prescribed to relieve acute anxiety—for example, caused by stage fright or athletic competition— which they do by slowing the heart rate and lower- ing blood pressure. But beta-blockers are not approved for anxiety disorders.

transference

a major element of most psychodynamic therapies; the client's transfer (displacement) of emotional elements of his or her inner life—usually feelings about the client's parents—outward onto the analyst.

antipsychotic drugs

also called neuroleptics; older ones such as Thorazine and Haldol and second-generation ones such as Clozaril, Risperdal, Zyprexa, and Seroquel—are used primarily in the treatment of schizophrenia and other psychoses. However, antipsychotic drugs are increasingly being prescribed "off label" for people with nonpsychotic disorders, such as major depression, bipolar disorder, autism, attention deficit disorder, and dementia. block or reduce the sensitivity of brain receptors that respond to dopamine. Some also increase lev- els of serotonin, a neurotransmitter that inhibits dopamine activity.

MAOIs

antidepressants; Monoamine oxidase inhibitors (MAOIs), such as Nardil, elevate the levels of norepinephrine and serotonin in the brain by blocking or inhibiting an enzyme that deactivates these neurotransmitters. MAOIs interact with certain foods (such as cheese) and have the most risks, such as elevating blood pressure in some indi- viduals to dangerously high levels, so they are pre- scribed least often.

The main classes of drugs used in the treatment of mental and emotional disorders

antipsychotic drugs antidepressant drugs Antianxiety drugs (tranquilizers) lithium carbonate

Which of the following is the most important predictor of successful therapy? (a) how long it lasts, (b) the insight it provides the client, (c) the bond between therapist and client, (d) whether the therapist and client are matched according to gender

c

In general, which type of psychotherapy is most effective for anxiety and depression?

cog beh

many psychoses are thought to be caused by an excess of the neurotransmitter

dopamine; most antipsychotic drugs are therefore designed to block or reduce the sensitivity of brain receptors that respond to dopamine

António Egas Moniz and prefrontal lobotomy

drilled two holes into the skull of a mental patient and used an instrument to crush nerve fibers running from the prefrontal lobes to other areas. This operation, called a prefrontal lobot- omy, was supposed to reduce the patient's emotional symptoms without impairing intellectual ability. The procedure—which, incredibly, was never assessed or validated scientifically—was performed on more than 40,000 people in the United States. Tragically, lobotomies left many patients apathetic, withdrawn, and unable to care for themselves; Yet Moniz won a Nobel Prize for his work.

If a disorder appears to have biological origins or involve bio- chemical abnormalities, then biological treat- ments must be most appropriate. t/f

false

client-centered (nondirective) therapy

humanist; devel- oped by Carl Rogers, the therapist's role is to listen to the client's needs in an accepting, nonjudgmental way and to offer what Rogers called unconditional positive regard. Whatever the client's specific com- plaint is, the goal is to build the client's self-esteem and self-acceptance and help the client find a more productive way of seeing his or her problems

electroconvulsive therapy (ECT)

oldest method; "shock therapy," which is used for the treatment of severe depression, although no one knows how or why it works. An electrode is placed on one side of the head and a brief current is turned on. The current triggers a seizure that typically lasts one minute, causing the body to convulse. In the past, there were many horror stories about the misuse of ECT and its dire effects on memory. Today, however, patients are given muscle relaxants and anesthesia, so they sleep through the procedure and their convulsions are minimized. The World Psychiatric Association has endorsed ECT as safe and effective, especially for people with crippling depression and suicidal impulses and for those who have not responded to other treatments; Still, the mood-improving effect of ECT is usually short-lived, and the depression almost always returns within a few weeks or months ECT is ineffective with other disorders, such as schizophrenia or alcoholism, although it is occasionally misused for these conditions.

(3) behavioral self-monitoring

one of four methods of behavior therapy;

(4) Skills training

one of four methods of behavior therapy;

(1) Exposure

one of four methods of behavior therapy; The most widely used behavioral approach for treating fears and panic is graduated exposure. When people are afraid of some situation, object, or upsetting memory, they usually do everything they can to avoid confronting or thinking of it. Naturally, this only makes the fear worse. Exposure treatments, either in the client's imagination or in actual sit- uations, are aimed at reversing this tendency. In graduated exposure, the client controls the degree of confrontation with the source of the fear: Someone who is trying to avoid thinking of a traumatic event might be asked to imagine the event over and over, until it no longer evokes the same degree of panic. A more dramatic form of exposure is flooding

(2) Systematic desensitization

one of four methods of behavior therapy; an older behavioral method, a step-by-step process of breaking down a client's conditioned associations with a feared object or experience; based on the classical-conditioning procedure of counterconditioning

Aaron Beck

pioneered in the ap- plication of cognitive therapy for depression, which often arises from specific pessimistic thoughts that the sources of your misery are permanent and that nothing good will ever happen to you again. For Beck, these beliefs are not "irrational"; rather, they are unproductive or based on misinformation. A therapist using Beck's approach would ask you to test your beliefs against the evidence. If you say, "But I know no one likes me," the therapist might say, "Oh, yes? How do you know? Do you really not have a single friend? Has anyone in the past year been nice to you?"

Biological treatments

primarily provided by psychiatrists or other physicians, include medications or intervention in brain function

deep brain stimulation (DBS)

riskier approach; originally approved for patients with Parkinson's disease and epilepsy, and now is being used for at least a dozen mental disorders, although no one knows how or why it might be helpful. DBS requires surgery to implant electrodes into the brain and to embed a small box, like a pace-maker, under the collarbone. But it also is still exper- imental and claims of its success are based only on patients' self-reports, so the powerful placebo effect of surgery cannot be ruled out

Tricyclic antidepressants

such as Elavil and Tofranil, boost norepinephrine and serotonin levels by preventing the normal reab- sorption, or "reuptake," of these substances by the cells that have released them.

Antianxiety drugs (tranquilizers)

such as Valium, Xanax, Ativan, and Klonopin, increase activity of the neurotransmitter gamma-aminobu- tyric acid (GABA). Tranquilizers may temporarily help individuals who are having an acute anxiety at- tack, but they are not considered the treatment of choice over a long period of time. Symptoms almost always return if the medication is stopped, and a sig- nificant percentage of people who take tranquilizers overuse them and develop problems with with- drawal and tolerance (that is, they need larger and larger doses to get the same effect) Beta-blockers

counterconditioning

systematic desensitization; in which a stimulus (such as a dog) for an unwanted response (such as fear) is paired with some other stimulus or situation that elicits a response incom- patible with the undesirable one virtual reality

Psychotherapy

the major approaches: psychodynamic therapies, cognitive and behavior therapies, human- ist therapies, and family or couples therapy

publication bias

the tendency for journals to publish positive findings rather than negative or ambiguous ones;

What are four possible sources of harm in psychotherapy?

the use of empirically unsupported techniques, inappropriate or coercive influence, the therapist's prej- udice or biased treatment, and unethical behavior

once the FDA approves a drug, doctors are permitted to prescribe it for other conditions and to populations other than those on which it was originally tested T/f

true

antidepressant drugs

used in treatment of depression, anxiety, phobias, and obsessive-compulsive disorder; MAOIs, Tricyclic antidepressants, SSRIs