OCR Psychology A Level Book 2 sample

Biological treatments The medical model considers mental disorders to be an illness resulting from underlying biological factors. There are various biological treatments, including drug therapy, electroconvulsive shock therapy and psychosurgery. It is important to note that unlike some medications for physical disorders, medications for mental illness do not ‘cure’ the illness — they merely alleviate the symptoms. Biological treatment for depression – Electroconvulsive therapy (ECT) ECT is a controversial physiological therapy used to treat depression . It was first introduced as a treatment for schizophrenia when it was noted that schizophrenia was rarely observed in people with epilepsy. Therefore, it was thought that inducing a seizure might reduce the symptoms of the disorder. Today ECT is mainly used to treat depression, for example those in immediate danger to themselves, or those for whom medication has been unsuccessful. How ECT is administered The patient is usually an inpatient in hospital due to the severity of their depression. A full medical examination is carried out including heart monitoring, blood tests and X-rays. Then the patient is given a general anaesthetic and muscle relaxant to prevent physical injury, as well as oxygen to prevent brain damage. The patient will then be attached to various monitors to check blood pressure, heart rate and oxygen levels during the treatment. Once the patient is unconscious, the doctor will turn on the ECT machine to initiate the electrical current. Electrodes are placed on the patient’s head and a small amount of electric current (approximately 0.6 amps), lasting about half a second, is passed through the brain. The current causes a convulsion (seizure) that can last for between 20 and 50 seconds. Usually six to eight treatments are given over a three- to four-week period (two per week). How ECT works Doctors are not sure exactly how ECT works. Some research suggests that the electric current changes the activity of the neurotransmitters that are implicated in depression such as serotonin and dopamine. Other research suggests that the blood flow in various areas of the brain that are linked with depression, such as the limbic system , are stimulated. More recent research suggests that ECT may even stimulate the growth of new cells and new pathways in the brain (Barnes 2015). Types of ECT There are two types of ECT used in the UK. In unilateral ECT electrodes are attached to only one temple. In bilateral ECT, electrodes are attached to both temples. Bilateral ECT is the preferred method because it works more quickly and effectively but it is reported that it may cause more side-effects. Unilateral ECT is used less in the UK. Research has shown that larger doses of electricity are necessary in order to make it as effective as bilateral ECT. Does ECT work for depression? Usefulness ECT was used quite widely for various disorders during the 1950s and 1960s, but its use has reduced to just treating severe conditions, mainly severe depression. In fact 86% of ECT treatments in the UK are for depression (Cresswell and Hodge 2013). ECT is more likely to be used for people whose depression is so severe that they cannot wait several weeks for drug treatment to take effect, for patients who are at serious risk of suicide or for when drug treatment has not succeeded in reducing the depression. Effectiveness The UK ECT Review Group (2013) looked at 73 trials of ECT and found that ECT is significantly more effective at reducing the symptoms of depression than pharmacotherapy (drugs) and simulated ECT (where the patient doesn’t actually undergo ECT treatment, but they experience every other stage of the ECT procedure). The review also found that bilateral ECT is slightly more effective than unilateral, and that high doses are more effective than low doses. This demonstrates that ECT is an effective treatment for severe depression. However, there appears to be a relatively high relapse rate. Ana Jelovac et al . (2013) conducted a meta-analysis of research into the effectiveness of ECT and found that 51.1% of the people studied had developed the symptoms of depression again, most within six months of the treatment. This shows that although ECT may be initially effective, many patients develop further depressive symptoms. Practicalities Side effects include headaches, aching muscles, feeling dizzy and being distressed. Most patients also report temporary memory loss of the time immediately before and after the treatment. According to the UK ECT Review Group (2013) these memory problems occur particularly when someone has had bilateral and/or more frequent treatments. This suggests that the more effective forms of ECT treatments are more harmful. As with any treatment involving general anaesthetic there are risks of death or serious injury. According to the NHS, this occurs in fewer than 1 in 10,000 general anaesthetics (NHS 2015). ECT was originally given without muscle relaxant or anaesthetic. Due to the severity and intensity of the muscle spasm, it was not unusual for patients to break bones. Nowadays it is done under much more controlled circumstances—not like you may have seen in films. check your understanding 1. Describe one example of each of the two main types of antipsychotic medication. 2. Describe the two types of ECT. 3. Explain the process of administering ECT to a patient. 4. Explain how antipsychotic medications work. 5. Outline one study that supports the use of biological treatments for one particular disorder. 6. Briefly outline the key side effects of each of the biological treatments described. 33 Application: Biological treatment of one specific disorder