Monday, 25 July 2016

The Psychology of Drugs

Ecstasy


Background Information


Definition: Methylenedioxymethamphetamine (MDMA), which is more commonly known as ecstasy, is chemical made drug.  It acts as both a stimulant and a hallucinogen due to its molecular structure, which is similar to that of amphetamines and LSD. Stimulant drugs typically speed up the messages travelling between the brain and the body. It can contain both amphetamines and some hallucinogens. Amphetamines are stimulant drugs, meaning they speed up the brain and the central nervous system. Hallucinogens are drugs that can cause people to see, hear, feel or smell things that do not exist (To have hallucinations). Other names for ecstasy include E, XTC, eccy, eckies, pills, pingers, bikkies, flippers and molly. 

Ecstasy is a synthetic drug, containing the drug MDMA. However, many pills sold as ecstasy only have a small amount of MDMA or none at all, instead, other drugs and 'fillers' such as household cleaning products are often used. Thus making it hard to know exactly what reactions to expect after taking ecstasy or how bad the side effects will be.

Ecstasy comes in a tablet form and is usually swallowed. The pills come in different colours and sizes and are often imprinted with a picture or symbol. It can also come as capsules, powder (usually snorted) or crystal/rock. Ecstasy is currently illegal in Australia. Currently in Victoria, penalties range from $2,000 fines and/or one year imprisonment for cultivation, to fines of up to $250,000 and/or 25 years imprisonment for commercial trafficking.


Effects of Ecstasy

Ecstasy is both a hallucinogenic and a stimulant drug due to its molecular structure. Users will experience a ‘high’, meaning a rush of good feeling as well as intensified feelings, both good and bad feelings. Like most drugs, there is no safe level of drug use, and use of any types of drugs carries some risks.

The neocortex (which is in yellow), is important in cognition, memory and altered perceptions. 

The limbic system is another part of the brain that is affected by the use of ecstasy. 
The amygdala (which is in red) is linked to both fear and pleasure.
Hippocampus (which is in blue) is thought to be the centre of emotion, memory.
Basal ganglia (which is in purple) is responsible for voluntary motor control, procedural learning, eye movement, and cognitive, emotional functions.
Hypothalamus (which is in green) is involved in changes in mood, emotions, and the production of anxiety it is also involved in memory. 

Ecstasy affects everyone differently, based on:
  • Size, weight and health
  • Whether the person is used to taking it
  • Whether other drugs are taken around the same time
  • The amount taken
  • The strength of the drug (varies from batch to batch)


The effects of ecstasy are usually taken into effect about 20 minutes to an hour after it's taken and lasts for around 6 hours.  

There are many effects that can be experienced, as well as various sections of the brain that are linked to these specific occurrences. For example:
  • feelings of confidence, happiness and empathy
  • accelerated heart rate and breathing
  • rise in blood pressure
  • sweating and dehydration
  • nausea
  • jaw clenching and teeth grinding
  • loss of appetite
  • hallucinations 
  • an increased urge for sex
  • loss of inhibitions
These short term effects are generally linked to the neocortex or the limbic system.

The long term effects that have been observed due to a lack of proper functioning of the neurotransmitters, show that conditions such as depression, anxiety, insomnia, and memory loss are more likely to occur.

Ecstasy can make some users feel anxious, confused, and paranoid, as though someone is trying to hurt them or is plotting against them. Ecstasy affects cognition (thinking), mood, and memory.

One of the most desirable effects of ecstasy is its ability to provide feelings of warmth and empathy. As of right now, scientists are unsure which area of the brain is involved in the ability of ecstasy to generate feelings of empathy. However, researchers believe that it is the release of extravagant amounts of serotonin that produces the “high” effects that are typically experienced by ecstasy users.


Parts of the Brain Effected by Ecstasy
The use of ecstasy predominantly affects the serotonin pathway. It causes the release of serotonin, a neurotransmitter that is synthesised, stored, and released by specific neurons. It is crucial in the regulation of processes within the brain, including mood, emotions, aggression, sleep, appetite, anxiety, memory, and perceptions. Serotonin pathways connect to various regions of the brain. Similar to most psychoactive drugs that produces a sensation of pleasure, ecstasy also increases the release of dopamine into the reward circuit as well as norepinephrine. Thus, resulting in an increase in neurotransmitter activity in the brain.

Serotonin helps maintain a stable mood and other emotional functions and also is involved in the regulation of sleep cycles, pain control, digestion, etc.

Dopamine is a transmitter involved with regulating mood and focus as well as other central nervous system functions.

Norepinephrine is a neurotransmitter that is involved in the "fight and flight" response and in the regulation of mood, anxiety, sleep, energy and focus.

Naturally, the release of neurotransmitters such as serotonin and dopamine occurs in cycles, although, upon the influence of ecstasy, it blocks the absorption of serotonin and dopamine by the synaptic terminal (where they are usually taken back in) and is instead absorbed in unnatural amounts by the biochemical cascade. Thus, the use of ecstasy will block the natural reabsorption of serotonin. The excessive release of serotonin, dopamine and norepinephrine can cause the brain to become naturally depleted of these chemical messengers. As a result, when there is a stoppage of intake of the drug, what is considered to be too much turns into a shortage.

It has been challenging for scientists to study the actual effects of the use of ecstasy in the human brain due to the unavailability of the imaging technology that is needed to carry out these specific experiments. Thus, most of the research based on the effects of ecstasy has been completed with laboratory animals. However, the research that has been done has shown that ecstasy produces a greater release of serotonin and less dopamine release than other stimulants, such as methamphetamine. It has also shown that continual high doses of ecstasy will lead to direct damage to brain cells that are involved in thinking and memory.




Addiction

Definition: Addiction is the state of being physically and mentally dependent on a particular substance.


Behaviours Observed by Addicts

1. They lie.
In order to mislead people about where they were when buying or using drugs, addicts usually have to tell lies. Purchasing drugs can be costly, thus someone who is addicted to drugs will have to lie about where the hundreds or thousands of dollars that has been put into purchasing these narcotics have gone to.

2. They manipulate.
Generally, family and close friends of an addicted person will seek happiness, success and safety for that individual. Usually this will take the form of promises such as, promising “to do better”, “to go to meetings”, “to start going to church”, “to get another job”, “to stop seeing drug dealers or other drug users”, especially after the individual has been caught.

3. They are very likely to be engaged in criminal acts.
This isn’t particularly true for every addict, but it is a typical pattern for a person who has been addicted for a considerable time. This is because eventually the money runs out, they have pawned or sold everything of value, they owe friends and family money. Thus, turning to crime seems to be the only resort to obtain the substances they are addicted to.

4. An addict will shift the blame.
This is also not true for every addict, however, it is usually observed in individuals who are addicts. Those who are addicts typically shift the blame for any misconduct to anyone, as they as though they are never responsible for any wrong.

5. An addict is very likely to become abusive.
It is very unfortunate and devastating that an addict’s blame can even take a violent and abusive form. With the delusional thinking common to most addicts, they can perceive those around them as being threatening, dangerous or malicious. As they shifts the blame, they may physically, mentally or emotionally attack those they blames.


Treating Addiction


No one treatment is suitable and applicable to every addict. However, there are a few successful treatments, such as:
  • Allow for detoxification, which is the process in which the body rids itself of the drug
  • Attend behavioural counselling or psychotherapy. Psychologists and specialists will assist in coping with cravings, avoiding the substance, and dealing with possible relapses, which are all key to effective addiction programs. Counselling can take the form of one-to-one (one-on-one) or family sessions with a psychologist or specialist. It has been seen that if the patient’s family can become involved, there is a better probability of positive outcomes.
  • Attend self-help groups. Self-help groups may help the patient meet other people with the same problem, which often boosts motivation. Self-help groups can also be a useful source of education and information.
  • Change habits, whether this is meeting with the same people who may influence the addiction, or even ceasing a particular process that may be undertaken involving the drug. For example, stopping a habit in which an individual needs to have a Panadol tablet in the morning before completing any work.
  • Take medication (for opioid, tobacco, or alcohol addiction)
  • Undergo evaluation and treatment for mental health issues such as depression and anxiety
  • Consistently attend long-term follow-up to prevent relapse



Role Psychiatrists play in Treating Addiction

Psychiatrists will assist in engaging people in drug abuse treatment, providing then with incentives to remain abstinent, as well as modify their attitudes and behaviours related to drug abuse, and increase their life skills to handle stressful circumstances and environmental prompts that may trigger cravings for drugs and thus induce another cycle of compulsive abuse.



Bibliography:


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Wednesday, 7 October 2015

Radiation Therapy

Radiation Therapy

What is Radiation Therapy?
X-rays, gamma rays, and charged particles are types of radiation used for cancer treatment.

Radiation therapy uses precisely targeted X-rays to shrink and destroy cancer cells so they cannot multiply. Radiation therapy can be used to treat primary cancers or advanced cancers in many sites of the body. It may be the only treatment used, or used in combination with surgery and/or chemotherapy. It can also be used to reduce the size of the cancer and relieve pain, discomfort or other symptoms.

The radiation may be delivered by a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy, also called brachytherapy).

Systemic radiation therapy uses radioactive substances, such as radioactive iodine, that travel in the blood to kill cancer cells.

The length of treatment can vary depending on factors such as the location, type and stage of the cancer, and whether or not the radiotherapy is combined with other treatments, such as chemotherapy or surgery.

About half of all cancer patients receive some form of radiation therapy sometime during the course of their treatment.


Why is Radiation Therapy given?
Radiation therapy may aim to:
  • Cure. 
    • Some cancers can be cured by radiation therapy alone or combined with other treatments.
  • Control. 
    • Radiation therapy can control some cancers by making them smaller or stopping them from spreading.
  • Relieve symptoms. 
    • If a cure is not possible, radiation therapy may be used to reduce cancer symptoms and prolong a good quality of life.


What are the potential side effects of radiation therapy?
Radiation therapy can cause both early (acute) and late (chronic) side effects. Acute side effects occur during treatment, and chronic side effects occur months or even years after treatment ends. The side effects that develop depend on the area of the body being treated, the dose given per day, the total dose given, the patient’s general medical condition, and other treatments given at the same time.

Side-effects vary and will depend on which area of your body is being treated. Possible side-effects include:
  • fatigue (tiredness)
  • dry, red or itchy skin
  • swelling
  • loss of appetite
  • nausea (feeling sick)
  • digestive problems
  • dry or sore throat or mouth
  • cough or shortness of breath.
Most side-effects can be managed and will gradually disappear once the treatment has finished.

Possible Side Effects of Radiation Therapy


Does radiation therapy kill only cancer cells?
No, radiation therapy can also damage normal cells, leading to side effects.

The potential damage to normal cells are taken into account by doctors when planning a patient’s course of radiation therapy. The amount of radiation that normal tissue can safely receive is known for all parts of the body. This information is used by doctors to assist them in deciding where to aim radiation during treatment.

Cancer Cells During Radiation Therapy


How does radiation therapy kill cancer cells?
Radiation therapy kills cancer cells by damaging their DNA (the molecules inside cells that carry genetic information and pass it from one generation to the next) Radiation therapy can either damage DNA directly or create charged particles (free radicals) within the cells that can in turn damage the DNA.

Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and eliminated by the body’s natural processes.


Other Methods of Radiation Therapy
Many other methods of external-beam radiation therapy are currently being tested and used in cancer treatment. These include:

Intensity-modulated radiation therapy (IMRT): 
IMRT hundreds of collimators which are tiny radiation beam-shaping devices. These are used to deliver a single dose of radiation. The collimators can be stationary or can move during treatment, thus allowing the intensity of the radiation beams to change during treatment sessions. This kind of dose modulation allows different areas of a tumor or nearby tissues to receive different doses of radiation.

IMRT is planned in reverse, known as inverse treatment planning which is unlike other types of radiation therapy. During the process of inverse treatment planning, the radiation oncologist chooses the radiation doses to different areas of the tumour and surrounding tissue, then a high-powered computer program calculates the required number of beams and angles of the radiation treatment that is needed to treat the tumour. In contrast, during traditional (forward) treatment planning, the radiation oncologist chooses the number and angles of the radiation beams in advance and computers calculate how much dose will be delivered from each of the planned beams.

The goal of IMRT is to increase the radiation dose to the specific areas that are in need and reduce radiation exposure to specific sensitive areas of surrounding normal tissue. Compared with 3D-CRT, IMRT can reduce the risk of some side effects, such as damage to the salivary glands (which can cause dry mouth, or xerostomia), when the head and neck are treated with radiation therapy. However, with IMRT, a larger volume of normal tissue is exposed to radiation. Whether IMRT leads to improved control of tumor growth and better survival compared with 3D-CRT is not yet completely known.

Image-guided radiation therapy (IGRT): 
In IGRT, repeated imaging scans (CT, MRI, or PET) are performed during treatment. These imaging scans are processed by computers to identify changes in a tumor’s size and location due to treatment and to allow the position of the patient or the planned radiation dose to be adjusted during treatment as needed. The increase in accuracy go radiation treat can be achieved by repeated imaging and may allow reductions in the planned volume of tissue to be treated, thus decreasing the total radiation dose to normal tissue.

Tomotherapy: 
Tomotherapy is a type of image-guided IMRT. A tomotherapy machine is a combination of a CT imaging scanner and an external-beam radiation therapy machine. The part of the tomotherapy machine that delivers radiation for both imaging and treatment can rotate completely around the patient in the same manner as a normal CT scanner.
Very precise tumour targeting and sparing of normal tissue can be achieved as Tomotherapy machines can capture CT images of the patient’s tumour immediately before treatment sessions.

Like standard IMRT, tomotherapy may be better than 3D-CRT at sparing normal tissue from high radiation doses. However, clinical trials comparing 3D-CRT with tomotherapy have not been conducted.
Computed Tomography Scanner

Stereotactic radio surgery: 
Stereotactic radiosurgery (SRS) can deliver one or more high doses of radiation to a small tumour. SRS uses extremely accurate image-guided tumor targeting and patient positioning. Therefore, a high dose of radiation can be given without excess damage to normal tissue.
SRS can be used to treat only small tumors with well-defined edges. It is most commonly used in the treatment of brain or spinal tumors and brain metastases from other cancer types. For the treatment of some brain metastases, patients may receive radiation therapy to the entire brain (called whole-brain radiation therapy) in addition to SRS.

SRS requires the use of a head frame or other device to immobilize the patient during treatment to ensure that the high dose of radiation is delivered accurately.

Stereotactic body radiation therapy: Stereotactic body radiation therapy (SBRT) delivers radiation therapy in fewer sessions, using smaller radiation fields and higher doses than 3D-CRT in most cases. SBRT treats tumors that lie outside the brain and spinal cord. SBRT id typically given in more than one dose as these tumours outside the brain and spinal cord are more likely to move with the normal motion of the body, and therefore cannot be targeted as accurately as tumors within the brain or spine. SBRT can be used to treat only small, isolated tumours, such as cancers in the lung and liver.
Many doctors refer to SBRT systems by their brand names, such as the CyberKnife®.


Proton therapy: 
External-beam radiation therapy can be delivered by proton beams.
Proton beams differ from photon beams mainly in the way they deposit energy in living tissue. Photons deposit energy in small packets all along their path through tissue, whereas protons deposit much of their energy at the end of their path (called the Bragg peak) and deposit less energy along the way.

Use of protons should reduce the exposure of normal tissue to radiation, possibly allowing the delivery of higher doses of radiation to a tumour. Proton therapy has not yet been compared with standard external-beam radiation therapy in clinical trials as of yet.

Proton Therapy Gantry

Other charged particle beams: Electron beams are used to irradiate surface tumours, such as skin cancer or tumours near the surface of the body, but they cannot travel very far through tissue. Thus, not being able to treat tumours deep within the body.
Patients can discuss these different methods of radiation therapy with their doctors to see if any is appropriate for their type of cancer and if it is available in their community or through a clinical trial.


When will a patient get radiation therapy?
Radiation therapy may be given to a patient before, during, or after surgery. Some patients may receive radiation therapy alone, without surgery or other treatments. Whereas others may receive radiation therapy and chemotherapy at the same time. The timing of radiation therapy depends on the type of cancer being treated and the goal of treatment (cure or palliation).


Does radiation therapy make a patient radioactive?
External-beam radiation does not make a patient radioactive.
However during temporary brachytherapy treatments, the patient may is radioactive when the radioactive material is inside the body however, as soon as the material is removed, the patient is no longer radioactive. For temporary brachytherapy, the patient will usually stay in the hospital in a special room that shields other people from the radiation.

During permanent brachytherapy, the implanted material will be radioactive for several days, weeks, or months after the radiation source is put in place. During this time, the patient is radioactive. However, the amount of radiation reaching the surface of the skin is usually very low. Nonetheless, this radiation can be detected by radiation monitors and contact with pregnant woman and young children may be restricted for a few days or weeks.

Some types of systemic radiation therapy may temporarily make a patient’s bodily fluids (such as saliva, urine, sweat) emit a low level of radiation. Patients receiving systemic radiation therapy may need to limit their contact with other people during this time, and especially avoid contact with children younger than 18 and pregnant women.

A patient’s doctor or nurse will provide more information to family members and caretakers if any of these special precautions are needed. Over time (usually days or weeks), the radioactive material retained within the body will break down so that no radiation can be measured outside the patient’s body.
Bibliography
"Radiation Therapy for Cancer", <http://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/radiation-fact-sheet>, June 30 2010 (28/9/15)

“Radiotherapy”, <http://www.cancer.org.au/about-cancer/treatment/radiotherapy.html>, October 1 2015 (28/9/15)

“What to Expect From Radiation Therapy”, <http://www.webmd.com/cancer/what-to-expect-from-radiation-therapy>, 2015 (28/9/15)

“Radiation Therapy”, <http://www.ranzcr.edu.au/radiation-oncology/what-is-radiation-therapy>, 2014 (28/9/15)

“What to Expect When Having Radiation Therapy", <http://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/what-expect-when-having-radiation-therapy>, 2013 (28/9/15)

“Cancer Treatments - Radiotherapy”, <http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cancer_treatments_radiotherapy>, August 2013 (28/9/15)


SERO Staff, “The Difference Between Chemotherapy and Radiation Treatment”, <http://www.treatcancer.com/blog/difference-chemotherapy-radiation/>, 2014 (28/9/15)
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