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SOC 204 Drugs & Society
Chapter 10 Psychotherapeutic medicationGoldberg
What percentage of people with a mental illness seek professional help?
A. 90%B. 55%C. 40%D. 10%
90%55%
40%10%
0% 0%0%0%
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”
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
Early Treatment of Mental Disorders 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
Disorders Anxiety disorders Obsessive-compulsive
disorders Mood disorders
DepressionMania/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 becauseA. Patients could be lying
about their use of drugsB. Intoxication can
resemble some symptoms of mental disorders
C. A patient can’t be diagnosed with both mental illness and substance abuse Pati
ents co
uld be lying ...
Intoxication ca
n resembl...
A patient can’t b
e diag...
0% 0%0%
Response
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 m
akes sense.
Pretty well,
but I’m go
ing...
Michelle
, I’m lo
st.
0% 0%0%
Response
Disorders with Anxiety Symptoms Anxiety Disorders
Panic DisorderSocial AnxietyPhobias
Obsessive Compulsive Disorder
Post-traumatic Stress Disorder
Treatment often includes use of sedative-hypnotic drugs
Anxiety Videos Panic Attack: http://
digital.films.com/PortalViewVideo.aspx?xtid=6788
OCD: http://digital.films.com/PortalViewVideo.aspx?xtid=41357
Medications for Anxiety Long-acting benzodiazepines
Most people have a phobia of some sort
A. TrueB. False
TrueFa
lse
0%0% Response
Repeatedly washing one’s hands is an example of an obsession.
A. TrueB. False
TrueFa
lse
0%0% Response
People with panic disorder alter their behavior to avoid another panic attack
A. TrueB. False
TrueFa
lse
0%0% Response
Mood Disorders Major Depression Manic Episodes Bipolar Disorder
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/
Before giving antidepressants to children:
A. The medications were tested for effectiveness
B. The medications were tested for safety
C. The medications were not tested on children
The medica
tions were te
...
The medica
tions were te
...
The medica
tions were no...
0% 0%0%
Medications for Mood Disorders Antidepressants
Monoamine Oxidase InhibitorsTricyclic AntidepressantsSelective Serotonin Reuptake Inhibitors
Electroconvulsive therapy (not medication)
Mood stabilizers
Anti-depressant Medications
Monoamine oxidase inhibitors (MAOIs)Tricyclic antidepressantsSelective serotonin reuptake inhibitors
(SSRIs)Serotonin and norepinephrine reuptake
inhibitors (SNRIs)Atypical antidepressants that do not fall
into one of the above categories
SSRIs Selective serotonin reuptake
inhibitors (SSRIs) Antidepressant medications that increase the
concentration of serotonin in the brainReduce aggressive and violent behaviorAdverse effects include sexual dysfunction,
increase in weight, and altered sleep patternsNot much more effective than placebos
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 drunkB. Being high on
marijuanaC. Being high on
cocaineBeing d
runk
Being high on m
arijuana
Being high on co
caine
0% 0%0%
Response
Medications for Bipolar Disorder/Manic Episode Lithium
Effective for acute mania and prevents recurrence Maximal benefit is achieved in one to two weeksEffective for unipolar depression not responsive to
other antidepressant drugsThe therapeutic window is small – three to four
times the therapeutic level can cause grave consequences
ChlorpromazineFewer 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 threshold Pati
ents are hallu
cinating
Patients
like th
e feelin
g ..
It takes s
everal months f
..
0% 0%0%
Response
Psychosis Psychosis
Severe mental condition marked by loss of contact with reality
Organic psychoses Have physical causes such as excessive drug use, brain
infections, metabolic or endocrine disorders, brain tumors, and neurological diseases
Functional psychoses Have no known or apparent cause (e.g. schizophrenia)
Schizophrenia Psychosis• Delusions• Hallucinations• Disorganized Speech• Disorganized Behavior• Negative Symptoms
The number of children taking antipsychotic drugs has increased in the US. In Europe:
A. Rates have slightly increased as well
B. Rates have remained the same
C. Rates have decreasedD. Rates have increased
at an alarming rate, doubling the numbers Rates h
ave slightly
incre
...
Rates have re
mained the...
Rates have decre
ased
Rates have in
creased at a
...
0% 0%0%0%
Psychosis isA. Blunting of
emotional expression
B. A loss of touch with reality
C. Always marked by hallucinations
Blunting of emotional e
x...
A loss
of touch
with
reali
ty
Alway
s marke
d by halluc..
.
0% 0%0%
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=bWaFqw8XnpA 7:12
Antipsychotic Drugs Antipsychotic drugs (neuroleptics) used
particularly for schizophrenia
Pharmacologically different from other sedative-hypnotic drugs 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
Parkinsonismtremor, slow movement, impaired speech or
muscle stiffness — especially resulting from the loss of dopamine
Tardive dyskinesiaMotor 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
effectB. Side-effects are mild and
easily reversedC. They are absorbed
unevenlyD. They block dopamine
Takes 4-6 w
eeks for m
ax ...
Side-effects ar
e mild
and...
They are abso
rbed unevenly
They block
dopamine
0% 0%0%0%
Response
Dual Diagnosis• Two or more
co-existing mental illnesses
• Common Example:
• Substance Use Disorder & Depression
Increased Medication Use = Consequences for 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
Psychotherapeutic Drug Abuse• 7 million Americans• Unintentional poisoning deaths
increased by 84% (1999-2004)
