Biological Therapies & Eclectic Approaches (College Board AP® Psychology): Revision Note

Psychopharmacology

• Psychopharmacology is the treatment of psychological and behavioral maladaptations with drugs

  • Psychoactive medications interact with specific neurotransmitters in the CNS to address possible biochemical causes of mental disorders

• There are three broad classes of psychoactive medication:

  • antipsychotics

  • antidepressants

  • antianxiety drugs

• Lithium is also used as a mood stabilizer for some conditions

• Psychopharmacology is typically used in conjunction with one or more psychological therapies rather than as a standalone treatment

Antipsychotics

• Antipsychotics reduce the symptoms of schizophrenia by blocking the neural receptors for dopamine in the brain

• First-generation (typical) antipsychotics, such as Thorazine and Haldol, are effective but carry significant side effects such as:

  • jerky movements

  • tremors

  • muscle stiffness

  • tardive dyskinesia

• Second-generation (atypical) antipsychotics, such as Risperidone, Clozapine, Abilify, and Seroquel, have fewer side effects than first-generation medications

Antidepressants

• Antidepressants are grouped into three main types based on their mechanism of action:

  • MAO inhibitors (MAOIs), such as Elavil, work by blocking monoamine oxidase, the enzyme responsible for the breakdown of neurotransmitters in the synapse

    • This increases the amount of norepinephrine and serotonin available

    • MAOIs are effective but toxic and are rarely a first-line treatment

  • Tricyclics, such as Norpramin, Amitriptyline, and Imipramine, increase the amount of serotonin and norepinephrine in the synapse

    • They are effective but have more side effects than SSRIs

  • Selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine), work by blocking the reuptake of serotonin in the synaptic cleft

    • This increases the amount of serotonin available to the receiving neuron

    • SSRIs are the most frequently prescribed antidepressant drugs in the United States due to their relative effectiveness and fewer side effects

  • Serotonin norepinephrine reuptake inhibitors (SNRIs), such as Effexor and Cymbalta, work similarly to SSRIs but also increase norepinephrine

Antianxiety drugs

• Antianxiety drugs depress the central nervous system, reducing anxiety, insomnia, and stress-related conditions. Two types of antianxiety drugs are:

  • Barbiturates, such as Miltown, which are an older class of antianxiety drugs

    • They are rarely used today due to their high potential for addiction and dangerous interactions with other drugs

  • Benzodiazepines, such as Valium (diazepam) and Librium (chlordiazepoxide), cause muscle relaxation and a feeling of tranquility

    • They are more commonly prescribed than barbiturates but still carry addiction risk

  • Xanax is one of the most commonly prescribed antianxiety medications

Lithium

• Lithium is a naturally occurring metal used to treat bipolar disorder, specifically to stabilize the manic phase

  • Lithium is often used to treat many of the disorders discussed in this unit alongside other medications

  • The precise mechanism by which lithium stabilizes mood is not fully understood

Side effects & cost-benefit analysis

• The use of psychoactive medication requires doctors and patients to conduct a careful cost-benefit analysis

  • This is where they will consider the therapeutic benefits against potential side effects

• Tardive dyskinesia is among the most serious side effects, particularly associated with long-term antipsychotic use

• Weight gain and extreme sleepiness are also common side effects of some antipsychotic medications

Surgical & invasive interventions

• Surgical or invasive biological interventions are used in treatment-resistant cases

  • Treatment resistance refers to cases in which psychological therapies and medication have both failed to produce adequate results

• These procedures directly target the brain's structure or electrical activity rather than working through neurotransmitter systems

Electroconvulsive therapy (ECT)

• ECT involves passing a fairly high voltage of electricity across a patient's head, causing a brief seizure

  • In bilateral ECT, electric current is passed through both hemispheres of the brain

  • In unilateral ECT, electric current passes through one hemisphere and is generally thought to have fewer cognitive side effects

  • Prior to administering ECT, patients are given a muscle relaxant to reduce the physical effects of the seizure

• ECT causes temporary amnesia and can result in memory loss

  • This significant side effect limits its use to treatment-resistant cases

• ECT has has been successfully used in the treatment of major depression when other approaches have failed

Transcranial magnetic stimulation (TMS)

• TMS involves using a magnet to stimulate nerve cells in the brain

  • TMS is a non-invasive procedure, as it does not require surgery or passing electricity through the brain

• TMS has been demonstrated to be effective in many cases of treatment-resistant depression

  • It is considered preferable to ECT in many cases because it does not produce seizures or significant memory loss

Psychosurgery

• Psychosurgery refers to surgical procedures that directly alter brain structure to change behavior or treat psychological disorders

  • Psychosurgery may involve lesioning (destroying) parts of the brain

• The prefrontal lobotomy is the most well-known form of psychosurgery

  • It is a procedure in which the main neurons leading to the frontal lobe of the brain were cut off from the rest of the brain

• The lobotomy was designed to reduce patients' level of functioning and awareness, which reduced their distress

  • However, it frequently left patients in a vegetative or catatonic state

• The lobotomy was popular in the mid-20th century but is rarely, if ever, performed today

  • It represents a controversial chapter in the history of psychiatry

• Modern surgical procedures are far more precise and are used only as an absolute last resort in treatment-resistant cases

Eclectic therapies

• An eclectic approach to therapy involves drawing on techniques from more than one therapeutic orientation, rather than adhering strictly to a single school of thought

  • Therapeutic orientations are combined based on the client's needs, the disorder being treated, and the available evidence

    • This reflects the broader trend toward evidence-based practice in modern treatment

Examples of eclectic combinations

• Cognitive behavioral therapies such as systematic desensitization (behavioral) combined with talk therapy (cognitive) to help a client understand irrational cognitions about the source of their anxiety

  • E.g. a therapist treating a client with a fear of flying might use systematic desensitization to reduce the anxiety response, while also using cognitive restructuring to challenge the client's belief that the plane will crash

• Somatic cognitive therapy is a commonly used eclectic combination in which clients receiving drug therapy for mood disorders also engage in cognitive talk therapy to explore negative cognitions that may be contributing to their depression

  • This reflects the broader trend of how therapists now prefer to treat in decentralized ways, often with a combination of medication and psychological therapy