To understand the exact role of drugs it is necessary to examine a few other treatment methods. There is the psychoanalytic theory pushed forward by Freud at the beginning of the 20th century. The suggestion is that there are stages for the development of the mind and of psychosexual development. Whilst growing up if you stick in one of the developmental stages it could result in various psychological disorders (Bee, 2000). From this is the development of its own therapy, including free association and dream analysis, (Davidson et al, 2004). The whole idea around the psychoanalytic approach is that psychological disorders are of psychological cause and so should be treated thus. It does not escape criticism; Freud neglected to conduct any research into causes and treatments but believed that information obtained from therapy sessions was enough to validate his theory, (Davidson et al, 2004).
Another approach to treating psychiatric disorders is cognitive therapy. This focuses on how people structure their experiences, make sense of them and how they relate their current experiences to past ones, (Walker, 1984). Following on from the depression example the cognitive approach has claimed that sense of hopelessness is the key. Therefore, the approach gives these thoughts and senses causal status rather than being merely part of the symptoms as would be the case with the biological approach. The cognitive approach tries to change the view of the patient. Be that as it may the cognitive approach does neglect to state where these thoughts originated, (Davidson et al, 2004). It would seem that the cognitive approach is growing rapidly as a form of treatment and seriously challenging the biological approaches, (D, Loggenberg, psychopathology lecture, November 2003)
Although drug treatments still have a huge role it is gaining some challenging opponents, (Davidson et al, 2004). There is no denying that cognitive therapy is gaining notoriety for effectiveness. The problem lies within the availability of this treatment. Waiting lists for cognitive therapy are so that psychiatrists may be reduced to prescribing drugs as the only alternative, (D, Loggenberg, psychopathology lecture, November 2003). Therefore in order to evaluate the role of drugs successfully we need to look at several psychiatric disorders. These will include Schizophrenia, Depression including Bipolar, Autism and Parkinson’s.
Schizophrenia is one of the most severe psychopathologies known. It is a psychotic disorder characterised by major disturbances in thought and behaviour. The characteristics are many and varied, from positive to negative symptoms and even catatonia, (Holmes, 1998). Due to the nature of such a disorder a cure has been sort after for decades. As mentioned already the first anti-psychotics were discovered by accident in the 1950’s, (Horrobin, 2001). When the drugs were first used it was understood that symptoms were alleviated but initially how this was the case was unknown. Eventually Arvid Carlsson from Sweden noticed that interference with the action of the neurotransmitter dopamine was the key effect, (Horrobin, 2001). The idea being that blocking the effects of dopamine would be the basis for anti-psychotic drugs, the role of drugs being given huge importance. It soon became the belief that if blocking dopamine worked therapeutically then the problem with schizophrenia must be excess dopamine, the dopamine hypothesis.
The most common anti-psychotic drug for schizophrenia was introduced in 1954, Thorazine, only alleviates positive symptoms leaving other symptoms to treat. The majority of anti-schizophrenia drugs only relieve 20% of the symptoms leaving 80% unchecked, (Horrobin, 2001). It is still hard to deny that the use of such drugs does actually help. Be that as it may the drugs do have side effects. With schizophrenia the most commonly reported side effects include dizziness, sexual dysfunction etc. Of more concern are the side effects often termed extra pyramidal side effects which are a result of dysfunctions in the nerve tracts descending from the brain to the spinal motor neurons, (Davidson et al, 2004). New drugs are being produced in response, one of which has gained good results in treatments, Clozapine, (Rosenheck, Cramer, Allan, Erdos, Frisman, 1999). Drugs still have a dominating role.
Depression and Bipolar depression are forms of mood disorders. They are often characterised by great sadness and feelings of helplessness. Bipolar disorder also has stages of mania, (Davidson et al, 2004). Again, as with schizophrenia, the most common form of treatment is by drugs. The discovery of anti-depressants was by accident. The original antidepressant drug was termed thus in 1957 but was originally meant to treat tuberculosis, (Pinel, 2000). The most common drugs for depression do not always work. They include Prozac and Tofranil. They have been known to be quite effective relieving between 50-70% of symptoms (Davidson et al, 2004). Bipolar, however, has the main drug of Lithium and around 80% of patients gain some benefit from this drug, (Prien and Potter, 1993). The drugs also bring along the risk of side effects e.g. Tofranil could increase the risk of heart attacks and strokes. Even worse is the drug lithium for bipolar as a side effect could be as serious as death, (Davidson et al, 2004). It would seem that an effective method is in fact combining biological and psychological treatments; this could help in changing patient outlooks, (Davidson et al, 2004). This results in drugs still having a big role.
Autism is characterised by an inability to socialise effectively, (Holmes, 1998). There is a belief that it is a biologically based disorder, although there is no actual cause known, (Holmes, 1998). In the treatment of autism the most common drug is Haloperidol, not a lot of patients actually respond positively to this. There is huge concern as drugs are administered to children, a fear of giving too much drugs. Side effects are of a lot of concern as a result, Haloperidol being one of many to cause problems (Posey and McDougle, 2000). Of more concern was the data from a longitudinal study that found 30% of patients developed drug related dyskinesia, (Campbell, Armenteros, Malone, Adams, Eisenberg and Overall, 1997). This effect stopped as soon as the drugs stopped. It would seem that “pharmacological treatment of autism is, at this point, less effective than behavioural interventions” (Davidson et al, 2004, pg 517).
Parkinson’s disease symptoms include tremors and akinesia. Drug treatment is quite dominant for its treatment. It was first established what could be wrong through examining the brains of deceased patients, e.g. Hornykiewicz (1966) realised that low levels of dopamine was connected to Parkinson symptoms. Thus drugs were developed through this understanding, (Stirling, 2001). The main drugs used are those containing L-dopa, a form of dopamine. This treatment is not always effective and certainly no cure. However, the drug treatment is currently the only partially effective method to be used, making their role big, (Stirling, 2001). As a result there has been limited focus on possible side-effects and more on improving effectiveness.
In conclusion to evaluating the role of drugs in the treatment of psychiatric disorders it would seem safe to say that their role is fairly big. However, the effectiveness of the drugs used does leave much to be desired. Their effectiveness may be actually down to disorder diagnosis (see appendix). There are concerns about side effects of which can be and are very serious. It has been noted that drug therapies are being caught up to by alternative therapies such as the cognitive approach. Yet alternative approaches may not be the answer, as with autism for example, (Davidson et al, 2004). However, it still is the case that until the availability of other treatment methods increase then drug treatments will continue to have a dominant role. Therefore, when the time comes that alternative methods are freely available the psychiatrist has to be seen to be doing something. Ultimately the answer will not lie in treatment effectives but rather in the causal factors of psychiatric disorders.
