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SOC 204 Drugs & Society
Week 5
Goldberg Chapter 9 Sedative-Hypnotic Drugs
Chapter 10 Psychotherapeutic Drugs
02/03/2015 Agenda• In-class Discussion 4 20 min
• Sedative-hypnotic drugs 25 min
• Break 10 min
• Psychotherapeutic Medications 35 min
• Check in 10 min
• Student Evaluation of Instruction 10 min
In-class Discussion• What is stigma?
• How does stigma impact
those with mental illness?
• How is stigma reinforced in
our society?
• Briefly discuss the use of drugs
in the treatment of mental
illness. How has this changed
over time? What factors are
part of this change?
Michelle, that discussion:A. Rocked. I
learned a lot.
B. Was pretty ok.
C. Frustrated me.
D. Was not worth
my time.
Rocked. I
learn
ed a lot.
Was
pre
tty o
k.
Frust
rate
d me.
Was
not w
orth m
y tim
e.
60%
0%
10%
30%
Sedative-Hypnotic Drugs• Sedative-hypnotic drugs are central nervous
system depressants that produce relaxing to
sleep-inducing effects
• Three main types of
sedative-hypnotic
drugs:o Barbiturates
o Nonbarbiturate sedatives
o Minor tranquilizers
Classification• Classified based on potency and the length of time
they act:
o Ultra-short-acting
o Short-acting (less than 4 hours)
o Intermediate-acting (4 to 6 hours)
o Long-acting (more than 6 hours)
• Drugs that take effect rapidly
have a higher abuse potential
than slow-acting drugs
Sedative-Hypnotic DrugsA. Increase energy
B. Depress the CNS
C. Are very quick-acting
D. Have little potential
for abuse
Incr
ease energ
y
Depress
the C
NS
Are v
ery q
uick-a
ctin
g
Have little
pote
ntial f
or ...
0% 0%10%
90%
Effects of Barbiturates• Produce a depressed, mood-altering action on the
central nervous system – act on GABA
• Slow activity of the cardiovascular, muscular and
respiratory systems
• Can cause confusion, inadequate emotional
control, slurred speech, poor judgment, and
intoxication
Dangers• Tolerance
• Lethal in combination with alcohol
• Withdrawal severe, can be fatal
Medical Uses
• Used primarily to treat
o Anxiety
o Insomnia
o Convulsive disorders
• Short-acting barbiturates
continue to be used for
anesthetic purposes
Medical uses for barbiturates do NOT include:
A. Treating
depression
B. Reducing
anxiety
C. Controlling
seizures
D. Inducing sleep
Treatin
g depre
ssio
n
Reducing an
xiety
Controllin
g seizu
res
Inducin
g sleep
91%
9%0%0%
Non-barbiturate Sedatives• Older drugs with similar actions to barbiturates
• With the advent of safer drugs, rarely used now
Minor Tranquilizers• Benzodiazepines
(Librium and Valium)
o Used primarily to treat anxiety
o Addictive; produces tolerance and withdrawal
symptoms
o Have a wider margin of safety, fewer side effects,
and less severe side effects than barbiturates
Hypnotics
• Non-benzodiazepines (Ambien, Lunesta, Sonata)
o Short-term treatment of
insomnia
o Short half-life
o Less dependency, less
tolerance, less carry-
over
In comparison to barbiturates,
benzodiazepines A. Have more severe
side effects
B. Are not addictive
C. Do not cause
withdrawal
symptoms
D. Have a wider
safety margin
Have more
seve
re si
de ef...
Are n
ot addict
ive
Do not c
ause w
ithdra
wal..
.
Have a wid
er safe
ty m
argin
9%
73%
9%9%
“Date-Rape” Drugs• Gamma-hydroxybutyrate (GHB)
• Rohypnol
Inhalants
• Most frequently used class
of illegal drugs among
adolescents aged 12 and
13
• Sudden Sniffing Death
Syndrome
Inhalants
• Glue (volatile hydrocarbon
solvents)
• Anesthetic inhalants
• Nitrite inhalants
Psychotherapeutic Drugs
Goldberg Chapter 10
Mental Illness• The National Alliance on Mental Illness defines
mental illnesses as: “medical conditions that disrupt
a person’s thinking, feeling, mood, ability to relate
to others and daily functioning”
History
• Before 1950, people with
mental illness were
subjected to abysmal
treatment
• Depression was treated
with amphetamines;
other types of mental
illnesses were treated
with sedatives
History• Electroconvulsive therapy (ECT), first developed in
1938, was used to treat depression and psychosis
• Electrical activity in the brain is temporarily interrupted and a seizure within the brain is triggered
• Many patients experienced adverse cognitive effects
• Despite concerns, ECT is still a treatment option
Demographics• 10-15% of the general population receive drugs for
emotional problems each year
• 43% of people with mental disorders reside in the US
and Europe
• 1 in 3 Americans suffer from a mental disorder
• Antidepressants are the medication most frequently
used by people aged 18–44
Disorders• Anxiety disorders
• Obsessive-compulsive
disorders
• Mood disorderso Depression
o Mania/Bipolar
• Psychosis
Diagnosis of Mental Disorders
• DSM-5 criteria
• Clinically significant distress or impairment in social,
academic (occupational) or other important areas
of functioning
• Not attributable to the physiological effects of a
substance or another medical condition
• Dual-diagnosis
• VERY QUICK OVERVIEW – YOU WILL NOT BE ABLE TO
DIAGNOSE ANYONE, EVEN YOURSELF!
It is important to rule out substance use
as a cause of symptoms because
A. Patients could be lying about their use of drugs
B. Intoxication can resemble some symptoms of mental disorders
C. A patient can’t be diagnosed with both mental illness and substance abuse
Patie
nts co
uld b
e lyin
g ...
Into
xicatio
n can re
sem
bl...
A patie
nt can’t
be dia
g...
27%
9%
64%
How are you keeping up?A. Great, this makes
sense.
B. Pretty well, but
I’m going to
need to do some
reading.
C. Michelle, I’m lost.
Great,
this
makes s
ense.
Pretty
well,
but I
’m go
ing...
Mich
elle, I
’m lo
st.
73%
0%
27%
Disorders with Anxiety Symptoms
• Anxiety Disorderso Panic Disorder
o Social Anxiety
o Phobias
• Obsessive Compulsive Disorder
• Post-traumatic Stress
Disorder
• Treatment often includes
use of sedative-hypnotic
drugs
Most people have a phobia of some sort
A.True
B. False
True
False
18%
82%
Repeatedly washing one’s hands
is an example of an obsession.
A. True
B. False
True
False
45%
55%
People with panic
disorder alter their
behavior to avoid
another panic attack
A.True
B. False
True
False
0%
100%
Videos• Panic Attack:
http://digital.films.com/PortalViewVideo.aspx?xtid=
6788
• OCD:
http://digital.films.com/PortalViewVideo.aspx?xtid=
41357
Depression• Depressed mood most of the day, nearly every day
• Diminished interest or pleasure in activities
• Disturbances in appetite
• Disturbances in sleep
• Psychomotor agitation or retardation
• Fatigue/loss of energy
• Feelings of worthlessness/ guilt
• Diminished ability to concentrate
• Recurrent thoughts of death
Video• Depressive episode:
http://digital.films.com/PortalViewVideo.aspx?xtid=
41085#
• http://www.halfofus.com/video/scott/
Anti-depressant Medications
oMonoamine oxidase inhibitors (MAOIs)
o Tricyclic antidepressants
o Selective serotonin reuptake inhibitors
(SSRIs)
o Serotonin and norepinephrine reuptake
inhibitors (SNRIs)
oAtypical antidepressants that do not fall
into one of the above categories
Monoamine Oxidase Inhibitors
• Monoamine oxidase (MAO) is an enzyme on the
outer membranes of mitochondria – inactivates the
neurotransmitters serotonin, dopamine, and
norepinephrine
• MAOIs block the action of monoamine oxidase
• Interact dangerously with dextromethorphan,
Demerol and SSRIs and some foods
Tricyclic Antidepressants
• Tricyclics are also effective in moderating pain, and can be beneficial in treatment of the eating disorder bulimia
• Common side effects are distorted vision, tachycardia, dry mouth, constipation, sleepiness, and urinary retention
• If patients cease taking tricyclics abruptly, they demonstrate withdrawal symptoms
• Even at low dosage, tricyclics can be toxic – excessive levels can be fatal, alcohol intensifies this effect
SSRIs• Selective serotonin reuptake
inhibitors (SSRIs) o Antidepressant medications that increase the
concentration of serotonin in the brain
o Reduce aggressive and violent behavior
o Adverse effects include sexual dysfunction,
increase in weight, and altered sleep patterns
o Not much more effective than placebos
Although
antidepressants are only
slightly more effective
than placebos, most
patients feel they help.
A. True
B. FalseTru
eFa
lse
10%
90%
Atypical Antidepressants• Nefazodone (Serzone)
o No longer available in the US
o Reported as causing severe liver failure
• Trazodoneo Mood elevator
o Side effects may include confusion, concentration difficulties, headaches, and nervousness
• Mirtazapine o May cause mood changes, unusual thought processes, seizures, lowered
libido, and changes in menstrual cycle
• Bupropion (Wellbutrin)o Inhibits uptake of dopamine and norepinephrine.
o Also used for smoking cessation and seasonal affective disorder
o Side effects are usually mild
SNRIs
• Serotonin and norepinephrine reuptake inhibitors
(SNRIs)o Work by decreasing the reabsorption of both serotonin and
norepinephrine in the brain
o Side effects may include pain in the eyes, vision blurring, or blindness
o May cause a variety of other side effects, from diarrhea and agitation to
irregular heartbeats and convulsion
Manic Episode• Inflated self-esteem
• Decreased need for sleep
• Talkative
• Flight of ideas
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in risky behavior
A manic episode can resemble:
A. Being drunk
B. Being high on
marijuana
C. Being high on
cocaine
Being d
runk
Being h
igh o
n marij
uana
Being h
igh o
n coca
ine
0%
90%
10%
Medications for Bipolar Disorder/Manic Episode
• Lithium o Effective for acute mania and prevents
recurrence
o Maximal benefit is achieved in one to two weeks
o Effective for unipolar depression not responsive to other antidepressant drugs
o The therapeutic window is small – three to four times the therapeutic level can cause grave consequences
• Chlorpromazineo Fewer toxic side effects
Non-compliance with med
schedules is a problem with
lithium because
A. Patients are
hallucinating
B. Patients like the feeling
of a manic episode
C. It takes several months
for the dose to reach
therapeutic thresholdPat
ients
are h
allucin
ating
Patie
nts lik
e the fe
eling .
.
It ta
kes severa
l month
s f..
0% 0%0%
Psychosis• Psychosis
o Severe mental condition marked by loss of contact with
reality
• Organic psychoseso Have physical causes such as excessive drug use, brain
infections, metabolic or endocrine disorders, brain tumors,
and neurological diseases
• Functional psychoses o Have no known or apparent cause (e.g. schizophrenia)
Schizophrenia
• Delusions
• Hallucinations
• Disorganized speech
• Disorganized or
catatonic behavior
• Negative symptoms
Psychosis isA. Blunting of
emotional
expression
B. A loss of touch
with reality
C. Always marked
by hallucinations
Bluntin
g of e
motio
nal ex...
A loss
of t
ouch w
ith re
ality
Alway
s mark
ed by h
alluc..
.
33% 33%33%
Response
Video• Schizophrenia:
http://digital.films.com/PortalViewVideo.aspx?xtid=
11024#
• Schizophrenia:
http://digital.films.com/PortalViewVideo.aspx?xtid=
42758
• 4 patients
https://www.youtube.com/watch?v=bWaFqw8Xnp
A 7:12
Antipsychotic Drugs • Antipsychotic drugs (neuroleptics) used particularly
for schizophrenia
• Pharmacologically different from other sedative-
hypnotic drugso They block dopamine
• Four to six weeks for maximum effectiveness
Antipsychotic Drugs
• Absorbed erratically
• Sometimes given by injection so the drug can be
released slowly into the bloodstream
• Build up in fatty areas of brain and lungs, and cross
the placenta to affect the fetus
Antipsychotic Drugs• Patients almost always show improvement, but a
small percentage gets worse
• Improvement is most rapid during the first several
weeks of treatment
• Although many people taking antipsychotic drugs
relapse, it appears that these drugs reduce violent
behavior
Side Effects
• Parkinsonismo tremor, slow movement, impaired speech or
muscle stiffness — especially resulting from the
loss of dopamine
• Tardive dyskinesiao Motor disorders such as involuntary repetitive
facial movements, lip smacking, involuntary
movement of trunk and limbs, and twitching
Which is not true of antipsychotic drugs?
A. Takes 4-6 weeks for
max effect
B. Side-effects are mild
and easily reversed
C. They are absorbed
unevenly
D. They block dopamine
Takes 4-6
weeks f
or max .
..
Side-e
ffect
s are
mild
and...
They are
abso
rbed u
nevenly
They blo
ck d
opamin
e
25% 25%25%25%
Response
How the increased use of
medications impacts society• Number of hospitalizations decreased
• Lack of outpatient services
• Psychiatrists spend much time
prescribing/managing medications
• Civil Rights issues around hospitalization
• Non-compliance with medication regimen
• Jail
• Homelessness
