November 29, 2022

Drugs and Behavior? Discussion Topic – Rohypnol Rohypnol is marketed as a sleeping pill in Europe and Latin America, has also been used to relieve cocaine side effects, a

Drugs and Behavior

Discussion Topic – Rohypnol

Rohypnol is marketed as a sleeping pill in Europe and Latin America, has also been used to relieve cocaine side effects, and is legal in over 60 countries. However, in the United States, it is illegal and has never been approved by the FDA for medical use here. Yet it is currently classified by the DEA as a Schedule IV drug, meaning it has low potential for abuse or dependence relative to that of Schedule III drugs; the only lower potential is in Schedule V drugs. How can you explain this?

Discussion Requirements:

At least 250 words

**LO1, LO6, LO7, LO9**

https://www.goodtherapy.org/drugs/psychotropic-medication.html

https://youtu.be/_KsaWpeCj98

https://youtu.be/w2efaHgJ93A

Course Materials:Required Text or E-Book: Drug Use and AbuseISBN-13:978-0-357-37595-2Authors : Stephen Maisto • Mark Galizio • Gerard Connors

Chapter 13: Psychotherapeutic Medications

Key Terms

agitated depression: Depressed mood accompanied by a state of tension or restlessness. People with agitated depression show excessive motor activity, as they may, for example, be unable to sit still or may pace, wring their hands, or pull at their clothes.

akinesia: Slowness of movement and underactivity.

anterograde amnesia: Loss or limitation of the ability to form new memories.

anxiolytic: Anxiety-reducing.

barbiturates: Depressant drugs formerly used as sleeping pills; currently used in anesthesia and treatment for epilepsy.

benzodiazepines: Currently the most widely prescribed anxiolytic drugs.

dyskinesia: Disordered movements.

endogenous: Developed from within. When applied to depression, the term means that depressive symptoms seem to be due to genetic factors.

exogenous: Developed from without. When applied to depression, the term means that depressive symptoms seem to be in reaction to a particular situation or event.

extrapyramidal: Outside the pyramidal tracts, with origin in the basal ganglia. These cell bodies are involved with starting, stopping, and smoothing out movements.

general anesthesia: The reduction of pain by rendering the subject unconscious.

manic: Relating to mania, a mood disturbance that typically includes hyperactivity, agitation, excessive elation, and pressured speech.

narcoleptic: A state characterized by brief but uncontrollable episodes of sleep.

neuroleptics: Tranquilizing drugs used to treat psychoses; a synonym is major tranquilizer.

neuroses: Nonpsychotic emotional disturbance, pain, or discomfort beyond what is appropriate in the conditions of one’s life.

paranoid schizophrenia: A type of schizophrenia distinguished by systematic delusions or auditory hallucinations related to one theme.

psychosurgery: Surgery that entails the cutting of fibers connecting particular parts of the brain or the removal or destruction of areas of brain tissue with the goal of modifying severe behavioral or emotional disturbances.

psychotherapeutic: Exerting a special or unique action on psychological functioning.

rebound insomnia: Inability to sleep produced as a withdrawal symptom associated with some depressant drugs.

REM rebound: An increase in the rapid eye movement or REM stage of sleep when withdrawing from drugs that suppress REM time.

sedative-hypnotic effects: The calming and sleep-inducing effects of some drugs.

tardive dyskinesia: An extrapyramidal complication characterized by involuntary movements of the mouth and tongue, trunk, and extremities; a side effect of long-term (2 or more years) use of antipsychotic drugs.

teratogenic: Producing abnormalities in the fetus.

True or False Questions Answer Key

1. One of the first successful attempts to treat the symptoms of psychological disorders with psychotherapeutic drugs occurred in the 1840s, when Moreau used cannabis to treat individuals with both depressive and manic symptoms.

TRUE. Individuals with depression who were treated with cannabis became more talkative and happy, whereas individuals with manic symptoms calmed down and relaxed. Unfortunately, these effects were temporary.

2. Since the 1950s, the number of individuals hospitalized for psychiatric conditions has decreased significantly.

TRUE. The introduction of chlorpromazine was the starting point of this trend. Other contributing factors include the development of other psychotherapeutic drugs and the movement toward deinstitutionalization.

3. Almost half of the adults in the United States will meet the criteria for a psychological disorder at some point in their lives.

TRUE. Most of these cases, though, are mild, not severe, and typically do not require treatment.

4. The prevalence of psychotherapeutic medication is twice as high among men as among women.

FALSE. The use of psychotherapeutic medication is twice as high among women as among men.

5. Psychotherapeutic drugs are rarely misused.

FALSE. The nonprescribed use and misuse of psychotherapeutic drugs are a significant problem.

6. As with most drugs, the age group least likely to misuse psychotherapeutic drugs is older adults (>age 65 years).

FALSE. Older adults are the age group most likely to misuse psychotherapeutic drugs.

7. Most psychotherapeutic medications are taken orally, allowing for rapid absorption into the bloodstream.

FALSE. Most psychotherapeutic medications are taken orally. However, absorption occurs in the gastrointestinal tract followed by modification in the liver before being absorbed into the bloodstream.

8. Schizophrenia is one of the most common psychiatric disorders in the United States.

FALSE. Schizophrenia affects only about 1% of the population.

9. Stimulants are often used to treat chronic depression.

FALSE. Although stimulants were once used as a treatment for depression, their effectiveness is limited. Antidepressant medications are generally used to treat depression.

10. Because antidepressants are absorbed rapidly, their effects are often immediate.

FALSE. Despite the rapid absorption, the effects of antidepressant medications take 2 to 3 weeks to become apparent.

11. Nitrous oxide (laughing gas) is no longer used by the medical profession.

FALSE. Nitrous oxide is still widely used in dentistry and some types of surgery.

12. The effects of a moderate dose of a barbiturate drug resemble the effects of alcohol.

TRUE. Barbiturate effects closely resemble those of alcohol, as do most depressant drugs.

13. Withdrawal from depressant sleeping pills can trigger rebound insomnia.

TRUE. Insomnia and REM sleep rebound occur after barbiturates or benzodiazepines are used to induce sleep.

14. Withdrawal from barbiturates is similar to alcohol withdrawal.

TRUE. Delirium tremens-like effects characterize withdrawal from all depressants.

15. Benzodiazepines (such as Valium) are one of the most commonly prescribed categories of drugs in the United States.

TRUE. A recent survey revealed that four different benzodiazepines (Valium, Dalmane, Ativan, and Tranxene) are among the most commonly prescribed drugs in the United States.

16. Benzodiazepines are known on the street as “bennies.”

FALSE. “Bennies” are a type of amphetamine, whereas benzodiazepines are considered a depressant. Also, although benzodiazepines do turn up on the street, their prevalence is less widespread than other depressant drugs.

17. Individuals who have a drink of wine at dinner while also taking a benzodiazepine are at increased risk of harmful additive effects.

T Potentiation, or the additive effects of drugs, is a dangerous consequence of consuming more than one depressant drug.

18. The main depressant drugs (barbiturates, benzodiazepines, and alcohol) all act by vastly different physiological mechanisms and affect different areas of the body.

FALSE. Substantial evidence indicates a common mechanism of action for depressant drugs. GABA is one of the primary inhibitory neurotransmitters of the brain, and many depressants are thought to act through this system.

19. Depressant drugs may show cross-tolerance with cocaine.

FALSE. Depressant drugs show cross-tolerance with other depressant drugs, such as barbiturates or alcohol.

20. Alcohol in combination with other depressant drugs is the leading cause of drug overdose deaths in the United States.

TRUE. Alcohol and other depressant drugs produce strong potentiation.

21. Lithium, a natural alkaline metal, is often used to treat manic episodes.

TRUE. Although lithium may have some value in treating other disorders, its use in the United States is approved only for treatment of manic episodes.

22. Psychotherapeutic drugs pose little or no threat to the fetus and may be used safely during pregnancy.

FALSE. There is a considerable range in the relative risks associated with the parent’s use of psychotherapeutic medications while pregnant. Most psychotherapeutic medications have been classified at least as “risk cannot be ruled out.” A few have been classified as “no evidence of risk,” providing some guidance to decision making on this issue.

Chapter 13: Psychotherapeutic Medications

Table of Contents Purpose and Perspective of the Chapter…………………………………………………………..1

Cengage Supplements…………………………………………………………………………………..1

Learning Objectives……………………………………………………………………………………….1

Complete List of Chapter Activities and Assessments…………………………………………2

Key Terms……………………………………………………………………………………………………3

What’s New in This Chapter……………………………………………………………………………4

Chapter Outline…………………………………………………………………………………………….4

True or False Questions Answer Key………………………………………………………………..5

Discussion Questions……………………………………………………………………………………..7

Appendix…………………………………………………………………………………………………….. 8

Generic Rubrics………………………………………………………………………………………….8

Standard Discussion Rubric………………………………………………………………………….8

Purpose and Perspective of the Chapter We open this chapter with an overview of the use of psychotherapeutic drugs. Following a brief historical overview, we discuss some epidemiological features of what are called psychotherapeutic drugs. The term psychotherapeutic describes those drugs that have a special or unique effect on the mind or mental functioning. (In the field of psychiatry, these psychotherapeutic drugs are often called psychotropics.) We discuss mechanisms of drug action and provide an overview of four major classes of psychotherapeutic drugs: antipsychotics, antidepressants, antianxiety agents, and mood-stabilizing drugs. We supplement this material with case examples to give you a feeling for the problems or disorders these drugs are intended to relieve.

Cengage Supplements The following product-level supplements provide additional information that may help you in preparing your course. They are available in the Instructor Resource Center.

 Educator’s Guide  Transition Guide  Cognero Test Banks  PowerPoints

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Learning Objectives The following objectives are addressed in this chapter:

13-1 Describe the history of psychotherapeutic medications and the significance of chlorpromazine 13-2 Summarize the recent patterns of psychological disorders and the use of psychotherapeutic medications in the United States 13-3 Discuss the four classes of drugs used to treat psychological disorders and the disorders each class treats 13-4 Evaluate whether the effectiveness of antipsychotic medications supports the dopamine hypothesis of schizophrenia 13-5 Compare and contrast how the types of antianxiety medications exert their effects 13-6 Compare and contrast the mechanism of action for the five classes of antidepressants 13-7 Discuss the side effects associated with specific psychotherapeutic medications to their mechanism of action 13-8 Describe how psychotherapeutic medications are absorbed, distributed, metabolized, and excreted from the body 13-9 Evaluate the evidence concerning whether physical or psychological dependence occurs with psychotherapeutic medications 13-10 Summarize the potential benefits and costs for the use of psychotherapeutic medication during pregnancy

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Complete List of Chapter Activities and Assessments For additional guidance refer to the Teaching Online Guide.

Chapter Objective PPT Slide Activity/Assessment Duration All Objectives PPT: #2 PPT: Icebreaker 5 minutes 13-1 Describe the history of psychotherapeutic medications and the significance of chlorpromazine

PPT: #4 PPT: #11–12 PPT, IM: Knowledge Check

1: Historical Overview 5 minutes

13-2 Summarize the recent patterns of psychological disorders and the use of psychotherapeutic medications in the United States

PPT: #14–15 PPT: #16–17 PPT, IM: Knowledge Check

2: Epidemiology 5 minutes

13-3 Discuss the four classes of drugs used to treat psychological disorders and the disorders each class treats

PPT: #19 PPT: #37–38 PPT, IM: Knowledge Check

3: Classes of Drugs and Their Actions 10 minutes

13-4 Evaluate whether the effectiveness of antipsychotic medications supports the dopamine hypothesis of schizophrenia

PPT: #22–23

13-5 Compare and contrast how the types of antianxiety medications exert their effects

PPT: #30– 31, 33–35

13-6 Compare and contrast the mechanism of action for the five classes of antidepressants

PPT: #24

13-7 Discuss the side effects associated with specific psychotherapeutic medications to their mechanism of action

PPT: #22– 24, 30–31, 33–35, 40

13-8 Describe how psychotherapeutic medications are absorbed, distributed, metabolized, and excreted from the body

PPT: #36, 40

13-9 Evaluate the evidence concerning whether physical or psychological dependence occurs with psychotherapeutic medications

PPT: #30– 31, 33, 40

13-10 Summarize the potential benefits and costs for the use of psychotherapeutic medication during pregnancy

PPT: #40 PPT: #41–42 PPT, IM: Knowledge Check

4: Psychotherapeutic Drugs and Pregnancy 5 minutes

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Key Terms agitated depression: Depressed mood accompanied by a state of tension or restlessness. People with agitated depression show excessive motor activity, as they may, for example, be unable to sit still or may pace, wring their hands, or pull at their clothes. akinesia: Slowness of movement and underactivity. anterograde amnesia: Loss or limitation of the ability to form new memories. anxiolytic: Anxiety-reducing. barbiturates: Depressant drugs formerly used as sleeping pills; currently used in anesthesia and treatment for epilepsy. benzodiazepines: Currently the most widely prescribed anxiolytic drugs.

dyskinesia: Disordered movements. endogenous: Developed from within. When applied to depression, the term means that depressive symptoms seem to be due to genetic factors. exogenous: Developed from without. When applied to depression, the term means that depressive symptoms seem to be in reaction to a particular situation or event. extrapyramidal: Outside the pyramidal tracts, with origin in the basal ganglia. These cell bodies are involved with starting, stopping, and smoothing out movements. general anesthesia: The reduction of pain by rendering the subject unconscious. manic: Relating to mania, a mood disturbance that typically includes hyperactivity, agitation, excessive elation, and pressured speech. narcoleptic: A state characterized by brief but uncontrollable episodes of sleep. neuroleptics: Tranquilizing drugs used to treat psychoses; a synonym is major tranquilizer. neuroses: Nonpsychotic emotional disturbance, pain, or discomfort beyond what is appropriate in the conditions of one’s life. paranoid schizophrenia: A type of schizophrenia distinguished by systematic delusions or auditory hallucinations related to one theme. psychosurgery: Surgery that entails the cutting of fibers connecting particular parts of the brain or the removal or destruction of areas of brain tissue with the goal of modifying severe behavioral or emotional disturbances. psychotherapeutic: Exerting a special or unique action on psychological functioning. rebound insomnia: Inability to sleep produced as a withdrawal symptom associated with some depressant drugs. REM rebound: An increase in the rapid eye movement or REM stage of sleep when withdrawing from drugs that suppress REM time. sedative-hypnotic effects: The calming and sleep-inducing effects of some drugs. tardive dyskinesia: An extrapyramidal complication characterized by involuntary movements of the mouth and tongue, trunk, and extremities; a side effect of long- term (2 or more years) use of antipsychotic drugs. teratogenic: Producing abnormalities in the fetus.

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What’s New in This Chapter The following elements are improvements in this chapter from the previous edition:

 Each chapter of the ninth edition has been updated to represent findings from the latest research, as well as to reflect social and legal changes related to drugs. Among the many revisions, we present the latest survey data available at this writing on patterns of drug use in the United States and other countries worldwide.

 Chapter 13, “Psychotherapeutic Medications,” includes the most recent data on the nature and extent of mental illness in the United States. It also includes the latest information on newly prescribed psychotherapeutic medications, with discussion of their benefits and side effects. Chapter 13 also provides coverage of the use of psychotherapeutic medications during

pregnancy, which often has been a difficult and challenging issue for pregnant women and their physicians alike.

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Chapter Outline I. Historical Overview

a. The Pre-Chlorpromazine Era b. The Age of Chlorpromazine c. Knowledge Check 1: Historical Overview (13.1, PPT Slides #11–12),

5 minutes total, multiple-choice question and answer. Question: Which of the following drugs was systematically studied for

treating psychological disorders during the 19th century? Answer: b. Marijuana was systematically studied in the 1840s in

Paris by Moreau for treating depressive and manic symptoms. Lithium, amphetamines, and chlorpromazine were not tested or introduced as psychotherapeutic treatments until the 20th century. II. Epidemiology

a. Knowledge Check 2: Epidemiology (13.2, PPT Slides #16–17), 5 minutes total, multiple-choice question and answer. Question: Which of the following groups are found to use psychotherapeutic drugs more? Answer: People who live by themselves. National surveys have found that the use of psychotherapeutic drugs is more prevalent among people with higher incomes, more education, those who live alone, and older adults. Also, about twice as many women as men use psychotherapeutic medications.

III. Classes of Drugs and Their Actions a. Antipsychotics b. Antidepressants c. Antianxiety Agents d. Nonbenzodiazepine Treatment e. Mood-Stabilizing Drugs f. Knowledge Check 3: Classes of Drugs and Their Actions (13.3, PPT

Slides #37–38), 10 minutes total, fill-in-the-blanks question and answers. Question: Fill in the blanks for each drug listed to identify which class it belongs to: Antipsychotics, antidepressants, antianxiety agents, or mood- stabilizing medications. Answers: 1. Lithium: Mood-stabilizing 2. Valium: Antianxiety 3. Chlorpromazine (Thorazine): Antipsychotic 4. Fluoxetine (Prozac): Antidepressant 5. Phenobarbital: Antianxiety 6. Clozapine (Clozaril): Antipsychotic 7. Amitriptyline (Elavil): Antidepressant 8. Clonazepam (Klonopin): Mood-stabilizing

IV. Psychotherapeutic Drugs and Pregnancy

a. Knowledge Check 4: Psychotherapeutic Drugs and Pregnancy (13.4, PPT Slides #41–42), 5 minutes total, multiple-choice question and answer. Question: Which of the following statements is most accurate regarding the use of psychotherapeutic drugs during pregnancy? Answer: Drug risks versus benefits must be weighed for each mother and baby. Lack of sufficient evidence makes decisions difficult. Although conclusions range from no drugs being safe during pregnancy to all psychotherapeutics being relatively safe during pregnancy, and although a few of these drugs are classified “no evidence of risk,” ultimately, the risks versus benefits to each individual mother and baby must be weighed in every case to decide whether to use them or not.

b. Summary

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True or False Questions Answer Key 1. One of the first successful attempts to treat the symptoms of psychological disorders with psychotherapeutic drugs occurred in the 1840s, when Moreau used cannabis to treat individuals with both depressive and manic symptoms. TRUE. Individuals with depression who were treated with cannabis became more talkative and happy, whereas individuals with manic symptoms calmed down and relaxed. Unfortunately, these effects were temporary. 2. Since the 1950s, the number of individuals hospitalized for psychiatric conditions has decreased significantly. TRUE. The introduction of chlorpromazine was the starting point of this trend. Other contributing factors include the development of other psychotherapeutic drugs and the movement toward deinstitutionalization. 3. Almost half of the adults in the United States will meet the criteria for a psychological disorder at some point in their lives. TRUE. Most of these cases, though, are mild, not severe, and typically do not require treatment. 4. The prevalence of psychotherapeutic medication is twice as high among men as among women. FALSE. The use of psychotherapeutic medication is twice as high among women as among men. 5. Psychotherapeutic drugs are rarely misused. FALSE. The nonprescribed use and misuse of psychotherapeutic drugs are a significant problem. 6. As with most drugs, the age group least likely to misuse psychotherapeutic drugs is older adults (>age 65 years). FALSE. Older adults are the age group most likely to misuse psychotherapeutic drugs. 7. Most psychotherapeutic medications are taken orally, allowing for rapid absorption into the bloodstream. FALSE. Most psychotherapeutic medications are taken orally. However, absorption occurs in the gastrointestinal tract followed by modification in the liver before being absorbed into the bloodstream.

8. Schizophrenia is one of the most common psychiatric disorders in the United States. FALSE. Schizophrenia affects only about 1% of the population. 9. Stimulants are often used to treat chronic depression. FALSE. Although stimulants were once used as a treatment for depression, their effectiveness is limited. Antidepressant medications are generally used to treat depression. 10. Because antidepressants are absorbed rapidly, their effects are often immediate. FALSE. Despite the rapid absorption, the effects of antidepressant medications take 2 to 3 weeks to become apparent. 11. Nitrous oxide (laughing gas) is no longer used by the medical profession. FALSE. Nitrous oxide is still widely used in dentistry and some types of surgery. 12. The effects of a moderate dose of a barbiturate drug resemble the effects of alcohol. TRUE. Barbiturate effects closely resemble those of alcohol, as do most depressant drugs. 13. Withdrawal from depressant sleeping pills can trigger rebound insomnia. TRUE. Insomnia and REM sleep rebound occur after barbiturates or benzodiazepines are used to induce sleep. 14. Withdrawal from barbiturates is similar to alcohol withdrawal. TRUE. Delirium tremens-like effects characterize withdrawal from all depressants. 15. Benzodiazepines (such as Valium) are one of the most commonly prescribed categories of drugs in the United States. TRUE. A recent survey revealed that four different benzodiazepines (Valium, Dalmane, Ativan, and Tranxene) are among the most commonly prescribed drugs in the United States. 16. Benzodiazepines are known on the street as “bennies.” FALSE. “Bennies” are a type of amphetamine, whereas benzodiazepines are considered a depressant. Also, although benzodiazepines do turn up on the street, their prevalence is less widespread than other depressant drugs. 17. Individuals who have a drink of wine at dinner while also taking a benzodiazepine are at increased risk of harmful additive effects. T Potentiation, or the additive effects of drugs, is a dangerous consequence of consuming more than one depressant drug. 18. The main depressant drugs (barbiturates, benzodiazepines, and alcohol) all act by vastly different physiological mechanisms and affect different areas of t

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Drugs and Behavior? Discussion Topic – Rohypnol Rohypnol is marketed as a sleeping pill in Europe and Latin America, has also been used to relieve cocaine side effects, a

Discussion Topic – Rohypnol

Key Terms

True or False Questions Answer Key

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