BIOMEDICAL TECHNIQUES

DRUG THERAPY
ELECTROCONVULSIVE THERAPY
 BIOMEDICAL TECHNIQUES
▪ BIOMEDICAL MODEL OF MENTAL ILLNESS TREATMENT
▪ FOCUS OF THE BIOMEDICAL APPROACH
▪ DRUG THERAPY
– ANTIPSYCHOTICS
– ANTIDEPRESSANTS
– MOOD STABILIZERS
– ANTI-ANXIETY (Hypno-anxiolytics)
▪ ELECTROCONLVULSIVE THERAPY
The Biomedical Model of Mental Illness Treatment

▪ The biomedical model of abnormal

psychology is built on the assumption that
mental disorders have a physical cause.
Supporters consider the symptoms associated
with conditions like major depressive disorder
and anxiety disorder to be caused by a
physical problem in the brain.
The Focus of the Biomedical Approach:

1. Genetics -is the study of the traits people and other animals inherit from their
family through DNA.
2. Neurotransmitters - also called chemical transmitter or chemical
messenger, any of a group of chemical agents released by neurons (nerve cells) to
stimulate neighbouring neurons or muscle or gland cells, thus allowing impulses to
be passed from one cell to the next throughout the nervous system.
3. Neurophysiology - deals with the functions of the nervous system.
4. Neuroanatomy - the anatomical organization of the nervous system. In
vertebrate animals, the routes that the myriad nerves take from the brain to the rest
of the body (or "periphery"), and the internal structure of the brain in particular, are
both extremely elaborate.
 NEUROTRANSMITTERS

▪ ACETYLCHOLINE

The chemical compound acetylcholine, often abbreviated as ACh, was

the first neurotransmitter to be identified. It is a chemical transmitter in
both the peripheral nervous system (PNS) and central nervous system
(CNS) in many organisms including humans. Acetylcholine is the
neurotransmitter in all autonomic ganglia. In layman's terms, it is a
chemical that allows neurons to communicate with each other within
humans and other organisms.
NEUROTRANSMITTERS

▪ NOREPINEPHRINE
Norepinephrine is a chemical released from the sympathetic
nervous system in response to stress. It is classified as
a neurotransmitter, a chemical that is released from
neurons. Because the release of norepinephrine affects other
organs of the body, it is also referred to as a stress hormone.
The sympathetic nervous system triggers a response that is
commonly referred to as our 'fight or flight response.
NEUROTRANSMITTERS

▪ DOPAMINE
The severe mental illness schizophrenia has been shown to
involve excessive amounts of dopamine in the frontal lobes,
and drugs that block dopamine are used to help
schizophrenics. 
Dopamine is a neurotransmitter that helps control the brain's
reward and pleasure centers. Dopamine also helps regulate
movement and emotional responses, and it enables us not
only to see rewards, but to take action to move toward
them. 
NEUROTRANSMITTERS

▪ GABA
GABA (gamma aminobutyric acid), which is also usually an
inhibitory neurotransmitter.
GABA acts like a brake to the excitatory neurotransmitters
that lead to anxiety.  People with too little GABA tend to
suffer from anxiety disorders, and drugs like Valium work by
enhancing the effects of GABA.  Lots of other drugs influence
GABA receptors, including alcohol and barbituates.  If GABA
is lacking in certain parts of the brain, epilepsy results.
NEUROTRANSMITTERS

▪ SEROTONIN
Serotonin is an inhibitory neurotransmitter that has been found
to be intimately involved in emotion and mood. 
Too little serotonin has been shown to lead to depression,
problems with anger control, obsessive-compulsive disorder,
and suicide.  Too little also leads to an increased appetite for
carbohydrates (starchy foods) and trouble sleeping, which are
also associated with depression and other emotional disorders. 
It has also been tied to migraines, irritable bowel syndrome, and
fibromyalgia. 
NEUROTRANSMITTERS

▪ ENDORPHIN
Endorphin is short for "endogenous morphine."  It is structurally
very similar to the opioids (opium, morphine, heroin, etc.) and
has similar functions:  Inhibitory, it is involved in pain reduction
and pleasure, and the opioid drugs work by attaching to
endorphin's receptor sites.  It is also the neurotransmitter that
allows bears and other animals to hibernate. 
Consider:  Heroin slows heart-rate, respiration, and metabolism
in general - exactly what you would need to hibernate. 
The Focus of the Biomedical Approach:

It argues that mental disorders are related to the physical

structure and functioning of the brain. This means that
behaviors such as hallucinations and suicidal thoughts are
symptoms, and clusters of symptoms that commonly
appear together to allow psychiatrists to diagnose a
particular condition.
PSYCHIATRISTS

▪ Psychiatrists are the mental health professionals who

primarily work under the biomedical model.
▪ They are medical doctors who specialize in “the diagnosis,
treatment and prevention of mental illness, including
substance use disorders,” (American Psychiatric
Association).
▪ The diagnoses psychiatrists make are based on paradigms
established in the Diagnostic and Statistical Manual of
Mental Disorders (DSM).
 DRUG THERAPY
Drug therapy, or psychopharmacotherapy, aims to
treat psychological disorders with medications.
ANTIPSYCHOTICS
Antipsychotic drugs (also called major tranquilizers or
neuroleptics) are used primarily to treat schizophrenia and to
reduce psychotic symptoms such as hyperactivity, hallucinations,
delusions, and mental confusion. Antipsychotics are also useful
at stabilizing episodes of mania in people with Bipolar Disorder.

Their main action is on dopamine receptors,

reducing levels of excess dopamine. They may also
affect levels of other neurotransmitters, namely
acetylcholine, noradrenaline, and serotonin.
TYPES OF ANTIPSYCHOTICS

Typical Antipsychotics, or Atypical Antipsychotics, or

First Generation Second Generation
Antipsychotic Drugs Antipsychotic Drugs.

▪ first developed in the 1950s ▪ approved for use in the 1990s

▪ high risk of side effects ▪ less likely to produce
extrapyramidal effects
FIRST GENERATION / TYPICAL ANTIPSYCHOTICS
1. CHLORPROMAZINE
Chlorpromazine is a psychiatric
medication that belongs to the class
of drugs called phenothiazine
antipsychotics. It works by helping
to restore the balance of certain
natural substances in the brain
SIDE EFFECTS
Extrapyramidal Effects: Dystonias,
akathisia, tardive dyskinesia,
Parkinson’s-like symptoms,
unwanted movements, ataxia,
muscle breakdown, rigidity,
tremors, and seizures are some
major effects of this category of
drugs. Neuroleptic malignant
syndrome may occur as well.
FIRST GENERATION / TYPICAL ANTIPSYCHOTICS
2. HALOPERIDOL SIDE EFFECTS
Dizziness
Lightheadedness
Drowsiness
difficulty urinating
sleep disturbances
headache
Haloperidol, marketed under the trade name anxiety
Haldol among others, is a typical
antipsychotic medication. Haloperidol is a For females, this increase in prolactin may
psychiatric medication (antipsychotic-type) result in unwanted breast milk, missed/stopped
that works by helping to restore the balance periods, or difficulty becoming pregnant
of certain natural substances in the brain For males, in the unlikely event you have a
(neurotransmitters). painful or prolonged erection (lasting more
than 4 hours)
SECOND GENERATION /ATYPICAL ANTIPSYCHOTICS
1. CLOZAPINE SIDE EFFECTS
Drooling
Drowsiness
Dizziness
Lightheadedness
Headache
• decreases hallucinations shaking (tremor)
• helps prevent suicide in people who are likely vision problems (e.g., blurred
to try to harm themselves vision)
• It helps you to think more clearly and
weight gain
positively about yourself
• feel less nervous and take part in everyday constipation
life
SECOND GENERATION /ATYPICAL ANTIPSYCHOTICS
2. RISPERIDONE SIDE EFFECTS
Drowsiness
Dizziness
Lightheadedness
Drooling
Nausea
weight gain
tiredness
SERIOUS SIDE EFFECTS
Risperidone is used to treat certain mental/mood difficulty swallowing
disorders (such as schizophrenia, bipolar disorder, muscle spasms
irritability associated with autistic disorder). shaking (tremor)
This medication can help you to think clearly and mental/mood changes (such as anxiety, restlessness)
take part in everyday life. signs of infection (such as fever, persistent sore
It works by helping to restore the balance of certain throat)
natural substances in the brain. interrupted breathing during sleep
SECOND GENERATION /ATYPICAL ANTIPSYCHOTICS
3. PALIPERIDONE SIDE EFFECTS

Drowsiness
Dizziness
Lightheadedness
This medication is used to treat certain Drooling
mental/mood disorders (such as schizophrenia,
schizoaffective disorder).
Nausea
This medication can decrease hallucinations and
help you to think more clearly and positively about
weight gain
yourself, feel less agitated, and take a more active tiredness
part in everyday life.
It works by helping to restore the balance of certain
natural substances in the brain.
ANTIDEPRESSANTS
Antidepressants are used to treat major and bipolar depression, panic
attacks, phobias, and obsessive-compulsive disorder. The most commonly
used antidepressants primarily affect the norepinephrine and serotonin
(monoamine) neurotransmitter systems. Most antidepressants increase the
available amount of norepinephrine or serotonin (or sometimes both) at the
neuronal synapse, by decreasing the reuptake of these neurotransmitters
into the pre-synaptic cell.

They do this by inhibiting the norepinephrine

transporter or the serotonin transporter, or by
decreasing the metabolism of these
neurotransmitters. Other antidepressants have direct
effects on monoamine receptors.
BIOGRAPHICAL SKETCH

KLAUS K. SCHMIEGEL
KLAUS K. SCHMIEGEL

▪ Born in Chemitz, Germany on June 28, 1939,

Schmiegel immigrated to the United States in 1951
to pursue higher education, earning a BS degree in
chemistry from the University of Michigan, an MA
in organic chemistry from Dartmouth College, and a
PhD in organic chemistry from Stanford University.
Upon graduation he accepted a position with Eli
Lilly as a senior organic chemistry. He stayed at Eli
Lilly from 1968 until his retirement.
KLAUS K. SCHMIEGEL
▪ At Eli Lilly, Schmiegel worked with Bryan Molloy to create a new
set of compounds, which include a substance called fluoxetine
hydrochloride. This would become the active ingredient in the
world’s first commercially available selective serotonin reuptake
inhibitor, or SSRI. Serotonin, a neurotransmitter, or chemical that
carries messages between nerve cells, is secreted by one cell and
received by another. When the message is received, a
neurotransmitter is received by the original secreting cell in a
process called “reuptake.” The SSRI known as Prozac is able to
inhibit this process, which contributes to the relief of the anxious
feelings suffered by those afflicted with depression disorders.
KLAUS K. SCHMIEGEL
▪ Prozac was first introduced in 1988, and has since revolutionized
treatment for depression, as well as for compulsive/obsessive
disorders, and premenstrual dysproic disorders. It has been
prescribed for more than 35 million patients. Schmiegel, with
Molloy, received Patent No. 4,314,081 for their new class of
“aryloxyphenylpropylamines.” Schmiegel received a total of 18
patents related to the synthesis of compounds over the course of
his career.
▪ In 1999, Schmiegel and Molloy were inducted in the Inventors’ Hall
of Fame, and that year they also received the American Innovator
Award for their contributions to improved quality of life in the 20th
Century. Schmiegel retired from Eli Lilly in 1993.
TYPES OF ANTIDEPRESSANTS
1. SSRI
2. SNRI
3. ATYPICAL ANTIDPRESSANTS
4. TRICYCLIC ANTIDEPRESSANTS
5. MAOI
Selective serotonin reuptake inhibitors (SSRIs)

▪ Selective serotonin reuptake inhibitors (SSRIs) are the most

commonly prescribed antidepressants.
▪ They are highly effective and generally cause fewer side effects than
the other antidepressants. SSRIs help to alleviate symptoms of
depression by blocking the reabsorption or reuptake of serotonin in
the brain. Serotonin is a naturally occurring neurotransmitter
 (chemical) that is used by brain cells to communicate.
▪ As SSRIs mainly affect the levels of serotonin and not levels of other
neurotransmitters, they are referred to as “selective.”
Selective serotonin reuptake inhibitors (SSRIs)

SIDE EFFECTS
Side effects of SSRIs may
include nausea, vomiting, 
diarrhea, sexual dysfunction, 
headache, weight gain, anxiety, 
dizziness, dry mouth, and
trouble sleeping.
Selective serotonin reuptake inhibitors (SSRIs)
▪ Abnormal bleeding: Use of SSRIs with certain pain
relievers (aspirin, ibuprofen [Motrin, Advil], naproxen [
Naprosyn, Aleve], and blood thinners such as warfarin
 [Coumadin]) may increase the risk of bleeding.
RARE SIDE ▪ Serotonin syndrome: Serotonin syndrome is a serious
EFFECTS medical condition that can occur when medications
that alter the concentration of serotonin in the brain
are taken together. Symptoms of serotonin syndrome
may include anxiety, restlessness, sweating, 
muscle spasms, shaking, fever, rapid heartbeat,
vomiting, and diarrhea
Serotonin and norepinephrine reuptake inhibitors (SNRIs)

▪ Serotonin norepinephrine reuptake inhibitors

(SNRIs) work by blocking the reabsorption of the
neurotransmitters serotonin and norepinephrine in the
brain. They may also have an effect on other
neurotransmitters.
▪ Serotonin-Norepinephrine Reuptake inhibitors (SNRIs)
include desvenlafaxine (Pristiq), duloxetine(Cymbalta
), venlafaxine (Effexor), venlafaxine XR (Effexor XR),
milnacipran (Savella), and levomilnacipran (Fetzima).
Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Side effects most common to

the class of SNRIs include:
nausea, dizziness, and sweating.
SIDE SNRIs, particularly duloxetine,
EFFECTS venlafaxine, and desvenlafaxine
may cause sexual dysfunction.
Other side effects include 
tiredness, constipation, 
insomnia, anxiety, headache,
and loss of appetite.
Atypical antidepressants
▪ Atypical antidepressants are considered “atypical” because these
agents do not fit into any of the other classes of antidepressants.
Each medicine in this category has a unique mechanism of action
in the body. However, like other antidepressants, atypical
antidepressants affect the levels of dopamine, serotonin, and
norepinephrine in the brain. Brintellix and Viibryd inhibit
reuptakeof serotonin but also act on serotonin receptors.
▪ Atypical antidepressants include bupropion (Wellbutrin), 
mirtazapine (Remeron), nefazodone (Serzone), trazodone (
Desyrel, Oleptro), vilazodone (Viibryd), and vortioxetine
(Brintellix).
SIDE EFFECTS
• dry mouth
• Constipation
• dizziness
•  lightheadedness.
• Mirtazapine and trazodone cause drowsiness and
are usually taken at bedtime.
• Mirtazapine and trazodone may cause 
abnormal heart rhythms that can be life
threatening.
• Trazodone may cause a rare sexual disorder
called priapism, painful and prolonged erection in
males.
• Nefazodone may cause life-threatening 
liver failure. Generally, use of nefazodone is not
 Tricyclic antidepressants
▪ Tricyclic antidepressants (TCAs) were one of the first approved
antidepressants. Although they are effective, they have been replaced by
newer antidepressants that generally cause fewer side effects. Like
SNRIs, TCAs work by blocking the reabsorption of the neurotransmitters
serotonin and norepinephrine in the brain. Additionally, they block
muscarinic M1, histamine H1, and alpha-adrenergic receptors.
▪ Tricyclic antidepressants (TCAs) include amitriptyline (Elavil), 
desipramine (Norpramin), doxepine (Sinequan), Imipramine (Tofranil), 
nortriptyline (Pamelor), amoxapine, clomipramine (Anafranil),
maprotiline (Ludiomil), trimipramine (Surmontil), and protriptyline (
Vivactil).
SIDE EFFECTS
TCAs affect several neurotransmitters in the brain
and, as a result, cause numerous side effects.
• The most common side effects include dry 
mouth, constipation, blurred vision, 
urinary retention, dizziness, tachycardia, 
memory impairment, and delirium.
• Other side effects include 
orthostatic hypotension, weight gain, seizures, 
bone fractures, sexual dysfunction, increased
sweating, and increased or irregular heartbeats.
Monoamine oxidase inhibitors (MAOIs)

▪ Monoamine oxidase inhibitors (MAOIs) block the activity of

monoamine oxidase, an enzyme that breaks down norepinephrine,
serotonin, and dopamine in the brain and other parts of the body.
MAOIs have many drug and food interactions and cause significant
side effects in comparison to the new antidepressants. As such,
MAOIs have been replaced by newer antidepressants that are safer
and cause fewer side effects.
▪ MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil)
and isocarboxazid (Marplan) — may be prescribed, often when
other medications haven't worked, because they can have serious
side effects
SIDE EFFECTS

Common side effects

include:
• postural hypotensi
on
• weight gain
• sexual side effects
MOOD STABILIZERS
▪ A mood stabilizer is a psychiatric
pharmaceutical drug used to treat mood
disorders characterized by intense and
sustained mood shifts, typically bipolar
disorder type I or type II, the borderline
personality disorder (BPD) and schizophrenia.
BIOGRAPHICAL SKETCH OF THE AUTHOR

JOHN FREDERICK JOSEPH CADE

JOHN FREDERICK JOSEPH CADE

▪ John Frederick Joseph Cade (1912-1980), medical

scientist, was born on 18 January 1912 at Horsham,
Victoria, son of David Duncan Cade, medical
practitioner, and his wife Ellen, née Edwards, both
Victorian born. David commanded the 3rd Field
Ambulance, Australian Imperial Force, during World
War I and was awarded the Distinguished Service
Order. In 1932 he became medical superintendent
at Sunbury Mental Hospital.
JOHN FREDERICK JOSEPH CADE

▪ Educated at Scotch College and the University of

Melbourne (M.B., B.S., 1934; M.D., 1938), John was a
resident medical officer at St Vincent's Hospital in 1935
and at the Royal Children's Hospital in 1936. That year he
joined the mental hygiene branch of the Department of
the Chief Secretary and was appointed medical officer at
Mont Park Mental Hospital. At St Patrick's Catholic
Cathedral, Melbourne, on 1 November 1937 he married
Estana Evelyn Jean Charles, a double-certificated nurse;
they were to have four sons and a daughter.
JOHN FREDERICK JOSEPH CADE

▪ Having served in the Militia from 1935, Cade

was appointed captain, Australian Army Medical
Corps, A.I.F., on 1 July 1940 and posted to the
2nd/9th Field Ambulance. He arrived in
Singapore in February 1941 and was promoted
major in September. From February 1942 to
September 1945 he suffered the privations of a
prisoner of war in Changi camp.
JOHN FREDERICK JOSEPH CADE

▪ Demobilized on 2 January 1946, Cade returned to the

mental hygiene branch, now in the Department of
Health, becoming medical superintendent and
psychiatrist at the Repatriation Mental Hospital,
Bundoora. Suspecting that some excessive toxin in the
urine of manic patients was a product of metabolic
disorder, he experimented on guinea-pigs with a
disused hospital kitchen as his laboratory. He found
that the animals became extremely lethargic and were
protected from the toxicity of injected urea when
lithium carbonate was given simultaneously.
JOHN FREDERICK JOSEPH CADE

▪ Taking lithium himself with no ill effect, he then used it to treat

ten patients with chronic or recurrent mania, on whom he found
it to have a pronounced calming effect. Cade's remarkably
successful results were detailed in his paper, 'Lithium salts in the
treatment of psychotic excitement', published in the Medical
Journal of Australia (1949). He subsequently found that lithium
was also of some value in assisting depressives. His discovery of
the efficacy of a cheap, naturally occurring and widely available
element in dealing with manic-depressive disorders provided an
alternative to the existing therapies of shock treatment or
prolonged hospitalization.
JOHN FREDERICK JOSEPH CADE

▪ In 1985 the American National Institute of Mental

Health estimated that Cade's discovery of the
efficacy of lithium in the treatment of manic
depression had saved the world at least $US 17.5
billion in medical costs.
VALPROIC ACID

▪ (Depakine), valproate semisodium (Depakote), and

sodium valproate (Depacon, Epilim)
▪ This medication is used to treat seizure disorders,
mental/mood conditions (such as manic phase of
bipolar disorder), and to prevent migraine
headaches. It works by restoring the balance of
certain natural substances (neurotransmitters) in
the brain.
SIDE EFFECTS
▪ This drug can be very irritating to the stomach,
especially when taken as valproic acid. Liver
function and CBC should be monitored.
▪ Diarrhea, dizziness, drowsiness, hair loss,
blurred/double vision, change in menstrual periods,
ringing in the ears, shakiness (tremor),
unsteadiness, weight changes may occur. If any of
these effects persist or worsen, tell your doctor or
pharmacist promptly.
LAMOTRIGINE
▪ Particularly effective for bipolar depression. Usual dose is
100–200 mg daily, which can be built up by 25 mg every 2
weeks. The patient should be monitored for signs and
symptoms of Stevens–Johnson syndrome, a very rare but
potentially fatal skin condition.
SIDE EFFECTS
▪ Dizziness, drowsiness, headache,
blurred/double vision, loss of coordination,
shaking (tremor), nausea, vomiting, or upset
stomach may occur. If any of these effects
persist or worsen, tell your doctor or
pharmacist promptly.
CARBAMAZEPINE
▪ Carbamazepine is an anticonvulsant. It works by
decreasing nerve impulses that cause seizures and pain.
Carbamazepine is used to treat seizures and nerve pain
such as trigeminal neuralgia and diabetic neuropathy.
Carbamazepine is also used to treat bipolar disorder. CBC
should be monitored, as carbamazepine can lower white
blood cell count. Therapeutic drug monitoring is required.
SIDE EFFECTS
▪ Dizziness, drowsiness, headache,
blurred/double vision, loss of
coordination, shaking (tremor), nausea,
vomiting, or upset stomach may occur.
 ANTI-ANXIETY
▪ Hypnoanxiolytics include antianxiety agents (also known as
anxiolytics), hypnotics, atypical anxiolytics, and atypical hypnotics.
Together, hypnoanxiolytics have a general effect of calming
individuals, alleviating anxiety, and causing sleep. Unlike the other
classes of psychomedication, hypnoanxiolytics have general effects
that work on all individuals.
An anxiolytic is a drug that inhibits anxiety (in contrast to anxiogenic
agents, which increase anxiety). Anxiolytic medications have been
used for the treatment of anxiety, anxiety disorders, and their related
psychological and physical symptoms.
ANTI-ANXIETY
▪ Hypnotic drugs are a class of psychoactives whose
primary function is to induce sleep and to be used in
the treatment of insomnia, as well as in surgical
anesthesia. Because drugs in this class generally
produce dose-dependent effects, ranging from
anxiolysis to production of unconsciousness, they
are often referred to collectively as sedative-
hypnotic drugs.
BIOGRAPHICAL SKETCH OF THE AUTHOR

LEO STERNBACH
LEO STERNBACH
▪ Leo Sternbach was born on May 7, 1908, in Opatija, to an upper
middle class Jewish family. He had a younger brother, Giusi. His
father Michael Abracham Sternbach was from Polish city of
Przemyśl in Galicia (then part of Austria-Hungary), and his mother
Piroska (née Cohn) Sternbach was from Orosháza, Hungary.
▪ Sternbach's parents met and married in Opatija where they both
lived. The family lived in modest conditions, in a rented four-room
apartment on the third floor of the "Vila Jadran" (Villa Adriatic),
near the pharmacy owned by Sternbach's father.
LEO STERNBACH

▪ He received his master's degree in pharmacy in 1929 and

his doctoral degree in organic chemistry in 1931 from the
Jagiellonian University in Krakow. In 1937 he received a
scholarship from Feliks Wislicki Foundation
▪ While working for Hoffmann-La Roche in Nutley, New
Jersey, Sternbach did significant work on new drugs. He
is credited with the discovery of chlordiazepoxide
(Librium), diazepam (Valium), flurazepam (Dalmane),
nitrazepam (Mogadon), flunitrazepam (Rohypnol),
clonazepam (Klonopin), and trimethaphan (Arfonad).
LEO STERNBACH

▪ Librium, based on the R0 6-690 compound

discovered by Sternbach in 1956, was approved for
use in 1960. In 1963, its improved version, Valium,
was released and became astonishingly popular:
between 1969 and 1982, it was the most prescribed
drug in America, with over 2.3 billion doses sold in
its peak year of 1978. With Moses Wolf Goldberg,
Sternbach also developed "the first commercially
applicable" method for synthesizing biotin.
 BENZODIAZEPINES
1. VALIUM (DIAZEPAM)
– Valium is indicated for the management of anxiety disorders
or for the shortterm relief of the symptoms of anxiety. Anxiety
or tension associated with the stress of everyday life usually
does not require treatment with an anxiolytic. In acute alcohol
withdrawal, Valium may be useful in the symptomatic relief of
acute agitation, tremor, impending or acute delirium tremens
and hallucinosis.
– Valium is a useful adjunct for the relief of skeletal muscle
spasm due to reflex spasm to local pathology (such as
inflammation of the muscles or joints, or secondary to
trauma), spasticity caused by upper motor neuron disorders
(such as cerebral palsy and paraplegia), athetosis, and stiff-
man syndrome.
SIDE EFFECTS
▪ confusion, hallucinations, unusual thoughts or behavior;
▪ unusual risk-taking behavior, decreased inhibitions, no fear of danger;
▪ depressed mood, thoughts of suicide or hurting yourself;
▪ hyperactivity, agitation, aggression, hostility;
▪ new or worsening seizures;
▪ weak or shallow breathing;
▪ a feeling like you might pass...
 BENZODIAZEPINES
2. XANAX (ALPRAZOLAM)
-Alprazolam affects chemicals in the brain that
may be unbalanced in people with anxiety. Xanax
 is used to treat anxiety disorders, 
panic disorders, and anxiety caused by
depression.
 SIDE EFFECTS
▪ lightheadedness
▪ loss of interest or pleasure
▪ relaxed and calm
▪ shakiness and unsteady
walk
▪ sleepiness or unusual
drowsiness
▪ slurred speech
▪ tiredness
▪ Being forgetful
▪ changes in patterns and
rhythms of speech
▪ clumsiness or unsteadiness
▪ difficulty with coordination
▪ discouragement
▪ drowsiness
▪ feeling sad or empty
▪ irritability
▪ lack of appetite
▪ trouble concentrating
▪ trouble performing routine
tasks
▪ trouble sleeping
▪ trouble speaking
▪ unsteadiness, trembling, or
other problems with muscle
control or coordination
▪ unusual tiredness or
weakness
 BENZODIAZEPINES
3. LIBRIUM (CHLORDIAZEPOXIDE)
This medicine affects chemicals in the brain that
may be unbalanced in people with anxiety.
Librium is used to treat anxiety disorders. This
medicine may be used short-term to treat
anxiety you may have before a surgery. This
medicine is also used to treat anxiety or
withdrawal symptoms of alcoholism.
 SIDE EFFECTS
Rare Incidence not known Incidence not known
▪ Fainting ▪ Abdominal and muscle ▪ difficulty in speaking
cramps
▪ mood or mental changes ▪ dizziness
▪ chills
▪ shakiness and unsteady ▪ drooling
walk ▪ clay-colored stools
▪ fever with or without chills
▪ unsteadiness, trembling, ▪ convulsions
or other problems with ▪ general feeling of
muscle control or ▪ cough or hoarseness tiredness or weakness
coordination ▪ dark urine ▪ headache
 BARBITURATES

▪ Barbiturate, any of a class of organic compounds used in

medicine as sedatives (to produce a calming effect), as
hypnotics (to produce sleep), or as an adjunct in anesthesia.
Barbiturates are derivatives of barbituric acid (malonyl urea),
which is formed from malonic acid and urea.
▪ A barbiturate is a drug that acts as a central nervous system
depressant, and can therefore produce a wide spectrum of
effects, from mild sedation to total anesthesia. They are also
effective as anxiolytics, hypnotics, and anticonvulsants.
 HYPNOTICS
1. HALCION (TRIAZOLAM)
▪ Triazolam is a central nervous system
depressant in the benzodiazepine class. It
possesses pharmacological properties similar
to those of other benzodiazepines, but it is
generally only used as a sedative to treat severe
insomnia.
▪ Triazolam belongs to a class of drugs called
sedative-hypnotics. It acts on your brain to
produce a calming effect.
 SIDE EFFECTS
▪ feeling like you might pass out;
▪ staggering walk, loss of balance or coordination, very stiff (rigid) muscles;
▪ agitation, anxiety, confusion, slurred speech, hallucinations, feelings of
extreme happiness or sadness;
▪ chest pain, fast or pounding heartbeats, feeling short of breath;
▪ problems with urination;
▪ vision problems, burning in your eyes; or
▪ nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-
colored stools, jaundice (yellowing of the skin or eyes).
SIDE EFFECTS
▪ dizziness, tired feeling, daytime drowsiness (or during hours
when you are not normally sleeping);
▪ headache, depressed mood, memory problems;
▪ numbness or tingly feeling;
▪ feeling nervous, excited, or irritable;
▪ changes in your menstrual periods;
▪ mild itching; or
▪ increased or decreased interest in sex.
 HYPNOTICS
2. DALMANE (FLURAZEPAM)
▪ Flurazepam is officially indicated for mild
to moderate insomnia and as such it is used
for short-term treatment of patients with
mild to moderate insomnia such as
difficulty falling asleep, frequent
awakening, early awakenings or a
combination of each. Flurazepam is a long-
acting benzodiazepine and is sometimes
used in patients who have difficulty in
maintaining sleep.
 SIDE EFFECTS
▪ feeling like you might pass out;
▪ staggering walk, loss of balance or coordination;
▪ agitation, confusion, slurred speech, hallucinations, feelings of extreme happiness or
sadness;
▪ chest pain, fast or pounding heartbeats, feeling short of breath;
▪ fever, chills, body aches, flu symptoms;
▪ problems with urination;
▪ vision problems, burning in your eyes; or
▪ nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, 
jaundice (yellowing of the skin or eyes).
 SIDE EFFECTS
▪ dizziness, weakness, daytime drowsiness (or during hours when you are not
normally sleeping);
▪ headache, blurred vision, depressed mood;
▪ stomach pain, heartburn, upset stomach, nausea, vomiting, diarrhea, 
constipation;
▪ feeling nervous, excited, or irritable;
▪ increased sweating;
▪ flushing (warmth, redness, or tingly feeling);
▪ mild itching or rash; or
▪ dry mouth, unpleasant taste in your mouth.
ELECTROCONVULSIVE
THERAPY
BIOGRAPHICAL SKETCH OF THE AUTHORS

UGO CERLETTI
▪ Ugo Cerletti was born in Conegliano, in the region of Veneto, Italy, on
September 26th, 1877. He studied Medicine at Rome and Turin, later
specializing in neurology and neuropsychiatry. He studied with the
most eminent neurologists of his time, first in Paris, France, with 
Pierre Marie and Dupré, then in Munich, Germany, with 
Emil Kraepelin (the "father" of modern scientific psychiatry) ) and 
Alois Alzheimer (the discoverer of senile dementia, which today
bears his name); and in Heidelberg, with Franz Nissl (a
neuropathologist)
▪ After his studies, he was appointed head of the Neurobiological
Institute, at the Mental Institute of Milan. In 1924 he was given a
lecturing post in Neuropsychiatry in Bari; then, in 1928, he took over
the post of Prof. Enrico Morselli, at the University of Genoa. Finally, in
1935, he became the Chair of the Department of Mental and
Neurological Diseases at the University of Rome, where he
developed electroconvulsive shock for the treatment of several kinds
of mental disorder, a discovery which made him world-famous.
▪ Cerletti came to the first use of electroshock for therapeutic purposes
in human beings by way of his experiments with animals on the
neuropathological consequences of repeated epilepsy attacks. In
Genoa, and later in Rome, he used a electroshock apparatus to
provoke repeatable, reliable epileptic fits in dogs and other animals.
The idea to use ECT in humans came first to him by watching pigs
being anesthetised with electroshock before being butchered, in
Rome.
▪ Cerletti first used ECT in a human patient, a diagnosed schizophrenic
with dellusions, hallucinations and confusion, in April 1938, in
collaboration with Lucio Bini. A series of electroshocks were able to
return the patient to a normal state of mind. Thereafter, in the
suceeding years, Cerletti and his coworkers experimented with
thousands of electroshocks in hundreds of animals and patients, and
were able to determine its usefulness and safety in clinical practice,
with several indications, such as in acute schizophrenia, manic-
depressive illness, major depression episodes, etc. His work was very
influential, and ECT quickly spread out as a therapeutic procedure all
over the world.
▪ In his long activity as a psychiatrist and neurologist, Cerletti published
113 original papers, about the pathology of senile plaques in
Alzheimer's disease, on the structure of neuroglia, the blood-brain
barrier, neurosyphillis, etc. In 1950, he received a honorary degree by
the Sorbonne (University of Paris), in addition to a long list of awards
and degrees.
▪ Cerletti died in Rome, on July 25th, 1963.
BIOGRAPHICAL SKETCH OF THE AUTHORS

LUCIO BINI
 LUCIO BINI

▪ Lucio Bini (1908–1964) was an Italian

psychiatrist and professor at the University of
Rome La Sapienza, Italy. Together with Ugo
Cerletti, a neurophysiologist and a
psychiatrist, he researched and discovered
the method of electroconvulsive therapy, a
type of shock therapy for mental diseases.
ELECTROCONVULSIVE THERAPY

▪ Electroconvulsive therapy (ECT) is a procedure,

done under general anesthesia, in which small
electric currents are passed through the brain,
intentionally triggering a brief seizure. ECT
seems to cause changes in brain chemistry that
can quickly reverse symptoms of certain
mental illnesses.
▪
USES OF ELECTROCONVULSIVE THERAPY

▪ Severe depression, particularly when accompanied by

detachment from reality (psychosis), a desire to commit
suicide or refusal to eat.
▪ Treatment-resistant depression, a severe depression that
doesn't improve with medications or other treatments.
▪ Severe mania, a state of intense euphoria, agitation or
hyperactivity that occurs as part of bipolar disorder. Other
signs of mania include impaired decision-making, impulsive or
risky behavior, substance abuse, and psychosis.
USES OF ELECTROCONVULSIVE THERAPY

▪ Catatonia, characterized by lack of movement, fast or strange

movements, lack of speech, and other symptoms. It's
associated with schizophrenia and certain other psychiatric
disorders. In some cases, catatonia is caused by a medical
illness.
▪ Agitation and aggression in people with dementia, which
can be difficult to treat and negatively affect quality of life.
 RISKS/SIDE EFFECTS
▪ Confusion. Immediately after treatment, you may experience confusion, which
can last from a few minutes to several hours. You may not know where you are
or why you're there. Rarely, confusion may last several days or longer.
Confusion is generally more noticeable in older adults.
▪ Memory loss. Some people have trouble remembering events that occurred
right before treatment or in the weeks or months before treatment or, rarely,
from previous years. This condition is called retrograde amnesia. You may also
have trouble recalling events that occurred during the weeks of your treatment.
For most people, these memory problems usually improve within a couple of
months after treatment ends.
 RISKS/SIDE EFFECTS
▪ Physical side effects. On the days of an ECT treatment, some
people experience nausea, headache, jaw pain or muscle ache.
These generally can be treated with medications.
▪ Medical complications. As with any type of medical procedure,
especially one that involves anesthesia, there are risks of medical
complications. During ECT, heart rate and blood pressure
increase, and in rare cases, that can lead to serious heart
problems. If you have heart problems, ECT may be more risky.
 PREPARATION
Before having your first ECT treatment, you'll need a full evaluation, which usually
includes:
▪ A medical history
▪ A complete physical exam
▪ A psychiatric assessment
▪ Basic blood tests
▪ An electrocardiogram (ECG) to check your heart health
▪ Anesthesiologist review to go over the risks of anesthesia
▪ These exams help make sure that ECT is safe for you.
DURATION

▪ The ECT procedure takes about five

to 10 minutes, with added time for
preparation and recovery. ECT can be
done while you're hospitalized or as
an outpatient procedure.
 PROCEDURE
▪ You'll have general anesthesia. So you can expect dietary restrictions before the
procedure. Typically, this means no food or water after midnight and only a sip of
water to take any morning medications. Your health care team will give you specific
instructions before your procedure.
▪ You may have a brief physical exam.This is basically to check your heart and lungs.
▪ You'll have an intravenous (IV) line inserted. Your nurse or other team member
inserts an IV tube into your arm or hand through which medications or fluids can be
given.
▪ Your nurse places electrode pads on your head. Each pad is about the size of a
silver dollar. ECT can be unilateral, in which electric currents focus on only one side of
the brain, or bilateral, in which both sides of the brain receive focused electric
currents.
 PROCEDURE
At the start of the procedure, you'll receive these
medications through your IV:
▪ An anesthetic to make you unconscious and unaware of
the procedure
▪ A muscle relaxant to help minimize the seizure and
prevent injury
▪ You may receive other medications, depending on any
health conditions you have or your previous reactions to
ECT.
 PROCEDURE
During the procedure:
▪ A blood pressure cuff placed around your ankle stops the muscle
relaxant medication from entering the foot and affecting the
muscles there. When the procedure begins, your doctor can monitor
seizure activity by watching for movement in that foot.
▪ Monitors check your brain, heart, blood pressure and oxygen use.
▪ You may be given oxygen through an oxygen mask.
▪ You may also be given a mouth guard to help protect your teeth and
tongue from injury.
 OTHER FORMS OF ECT

The least invasive of these techniques is called:

▪ TRANSCRANIAL MAGNETIC STIMULATION (TMS): in which a magnetic
field is created by a device held above the head, causing a weak electrical
signal to be applied to the prefrontal cortex, the region of the brain that is
connected to mood.
▪ VAGUS NERVE STIMULATION (VNS): is another treatment for depression
that uses a surgically implanted pacemaker-like device that electrically
stimulates a nerve that runs up the neck into the brain. The nerve is called
the vagus nerve. 
Thank You!
Have a good day!