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.

0% 0%0%0%

Response

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%0%0%

Response

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

0% 0%0%0%

Response

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

0% 0%0%0%

Response

“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...

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

makes s

ense.

Pretty

well,

but I

’m go

ing...

Mich

elle, I

’m lo

st.

0% 0%0%

Response

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

0%0% Response

Repeatedly washing one’s hands

is an example of an obsession.

A. True

B. False

True

False

0%0% Response

People with panic

disorder alter their

behavior to avoid

another panic attack

A. True

B. False

True

False

0%0% Response

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)

o Atypical 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. False

True

False

0%0% Response

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

Video• http://youtu.be/p9hbXPVaOuk

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% 0%0%

Response

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 threshold

Patie

nts are

hallu

cinatin

g

Patie

nts lik

e the fe

eling .

.

It ta

kes severa

l month

s f..

0% 0%0%

Response

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..

.

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

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

0% 0%0%0%

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