- Explain and compare biomedical therapies
Humans have a long, and sometimes disturbing history of biomedical treatment of disorders. In ancient and medieval times, the process of trepanation – a drilling or cracking of a hole in the skull to expose the brain – was sometimes used to free evil spirits or demons from within a person’s head.
Trepanation ultimately fell out of favor as a treatment for psychological disorders. However, in the 20th century another biomedical procedure, lobotomy, gained in use. Lobotomy is a form of psychosurgery in which parts of the frontal lobe of the brain are destroyed or their connections to other parts of the brain severed. The goal of lobotomy was usually to calm symptoms in people with serious psychological disorders, such as schizophrenia. Lobotomy was widely used during the twentieth century – indeed, it was so mainstream that Antonio Moniz won a Nobel Prize in physiology for his work on one lobotomy procedure. However, lobotomy was always highly controversial, and widely criticized as a tool of behavioral control of people who were engaged in behaviors that were not clinical in nature. By the 1960s and 1970s lobotomy fell out of favor in the United States.
One of the reasons lobotomy fell out of favor was the development in the 1950s and 1960s of new medications for the treatment of psychological disorders; these are now the most widely used forms of biological treatment. While these are often used in combination with psychotherapy, they also are taken by individuals not in therapy. This is known as biomedical therapy. Medications used to treat psychological disorders are called psychotropic medications and are prescribed by medical doctors, including psychiatrists. In Louisiana and New Mexico, psychologists are able to prescribe some types of these medications (American Psychological Association, 2014).
Different types and classes of medications are prescribed for different disorders. A depressed person might be given an antidepressant, a bipolar individual might be given a mood stabilizer, and a schizophrenic individual might be given an antipsychotic. These medications treat the symptoms of a psychological disorder. They can help people feel better so that they can function on a daily basis, but they do not cure the disorder. Some people may only need to take a psychotropic medication for a short period of time. Others with severe disorders like bipolar disorder or schizophrenia may need to take psychotropic medication for a long time. Table 1 shows the types of medication and how they are used.
|Table 1. Commonly Prescribed Psychotropic Medications|
|Type of Medication||Used to Treat||Brand Names of Commonly Prescribed Medications||How They Work||Side Effects|
|Antipsychotics (developed in the 1950s)||Schizophrenia and other types of severe thought disorders||Haldol, Mellaril, Prolixin, Thorazine||Treat positive psychotic symptoms such as auditory and visual hallucinations, delusions, and paranoia by blocking the neurotransmitter dopamine||Long-term use can lead to tardive dyskinesia, involuntary movements of the arms, legs, tongue and facial muscles, resulting in Parkinson’s-like tremors|
|Atypical Antipsychotics (developed in the late 1980s)||Schizophrenia and other types of severe thought disorders||Abilify, Risperdal, Clozaril||Treat the negative symptoms of schizophrenia, such as withdrawal and apathy, by targeting both dopamine and serotonin receptors; newer medications may treat both positive and negative symptoms||Can increase the risk of obesity and diabetes as well as elevate cholesterol levels; constipation, dry mouth, blurred vision, drowsiness, and dizziness|
|Anti-depressants||Depression and increasingly for anxiety||Paxil, Prozac, Zoloft (selective serotonin reuptake inhibitors, [SSRIs]); Tofranil and Elavil (tricyclics)||Alter levels of neurotransmitters such as serotonin and norepinephrine||SSRIs: headache, nausea, weight gain, drowsiness, reduced sex drive
Tricyclics: dry mouth, constipation, blurred vision, drowsiness, reduced sex drive, increased risk of suicide
|Anti-anxiety agents||Anxiety and agitation that occur in OCD, PTSD, panic disorder, and social phobia||Xanax, Valium, Ativan (Benzodiazepines) Buspar (non-Benzodiazepine)||Depress central nervous system activity||Drowsiness, dizziness, headache, fatigue, lightheadedness|
|Mood Stabilizers||Bipolar disorder||Lithium, Depakote, Lamictal, Tegretol||Treat episodes of mania as well as depression||Excessive thirst, irregular heartbeat, itching/rash, swelling (face, mouth, and extremities), nausea, loss of appetite|
|Stimulants||ADHD||Adderall, Ritalin||Improve ability to focus on a task and maintain attention||Decreased appetite, difficulty sleeping, stomachache, headache|
Link to Learning
Watch this CrashCourse video to learn more about research, biomedical therapy and drug treatments, as well as alternative biological treatments.
Another biologically based treatment that continues to be used, although infrequently, is electroconvulsive therapy (ECT) (formerly known by its unscientific name as electroshock therapy). It involves using an electrical current to induce seizures to help alleviate the effects of severe depression. The exact mechanism is unknown, although it does help alleviate symptoms for people with severe depression who have not responded to traditional drug therapy (Pagnin, de Queiroz, Pini, & Cassano, 2004). About 85% of people treated with ECT improve (Reti, n.d.). However, the memory loss associated with repeated administrations has led to it being implemented as a last resort (Donahue, 2000; Prudic, Peyser, & Sackeim, 2000). A more recent alternative is transcranial magnetic stimulation (TMS), a procedure approved by the FDA in 2008 that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms; it is used when other treatments have not worked (Mayo Clinic, 2012).
Dig Deeper: Evidence-based Practice
A buzzword in therapy today is evidence-based practice. However, it’s not a novel concept but one that has been used in medicine for at least two decades. Evidence-based practice is used to reduce errors in treatment selection by making clinical decisions based on research (Sackett & Rosenberg, 1995). In any case, evidence-based treatment is on the rise in the field of psychology. So what is it, and why does it matter? In an effort to determine which treatment methodologies are evidenced-based, professional organizations such as the American Psychological Association (APA) have recommended that specific psychological treatments be used to treat certain psychological disorders (Chambless & Ollendick, 2001). According to the APA (2005), “Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (p. 1).
The foundational idea behind evidence based treatment is that best practices are determined by research evidence that has been compiled by comparing various forms of treatment (Charman & Barkham, 2005). These treatments are then operationalized and placed in treatment manuals—trained therapists follow these manuals. The benefits are that evidence-based treatment can reduce variability between therapists to ensure that a specific approach is delivered with integrity (Charman & Barkham, 2005). Therefore, clients have a higher chance of receiving therapeutic interventions that are effective at treating their specific disorder. While EBPP is based on randomized control trials, critics of EBPP reject it stating that the results of trials cannot be applied to individuals and instead determinations regarding treatment should be based on a therapist’s judgment (Mullen & Streiner, 2004).