Biomedical Approaches to Treatment

Biomedical Approaches.ppt Powerpoint on psychosurgery, insulin coma therapy and ECT.

implementing-treatments-booklet-2-1Booklet on biomedical treatments
Psychosurgery
 
”http://www.youtube.com/watch?v=_0aNILW6ILk” 5 minute clip about transorbital lobotomy pioneered by Walter Freeman, AKA The Lobotomist
 
Prefrontal lobotomy/leucotomy involved severing the connections to and from the prefrontal cortex, a part of the frontal lobe of the brain that carries out many ‘higher’ cognitive functions. Again, there was little theory behind this intervention. Egas Moniz, a Portuguese psychiatrist, pioneered the technique and was awarded a Nobel Prize for it! Needless to say, much evidence was presented to support the technique, and the side-effects such as chances of severe personality change, loss of language and death were ignored. Poetically, Moniz was shot dead by one of his former patients!
 
Insulin induced coma treatment
 
http://www.youtube.com/watch?v=JwL6vW5iekY 7 minute clip of a man who was treated using this little understood procedure.
 
http://www.youtube.com/watch?v=Tn-4-5hgecw a 16 second clip of a person undergoing treatment
 
Insulin coma therapy was a technique introduced in the 1930s, mainly for the treatment of schizophrenia, and was used extensively through the 1940s and 1950s. It involved injecting patients with large amounts of insulin in order to induce coma. Seizures sometimes occurred before or during the coma, and many patients would be tossing, rolling, moaning, twitching, spasming or thrashing around. No detailed theory was ever proposed regarding how this helped, though success rates of up to 80% were claimed. It was sometimes said that the process “jolted” patients out of their mental illness. Needless to say, this is not a very scientific explanation.
Electro-convulsive shock therapy
Less risky and more controlled than insulin coma therapy, Electro-Convulsive Therapy (ECT) was originally pioneered by Cerletti and Bini (1938) as a treatment for schizophrenia. ECT is now used as a last-resort treatment for people with severe depression who are at risk of suicide and cannot be treated successfully with medication. It involves passing an electric current of around 100 volts through electrodes attached to the scalp, either to one side or both sodes of the brain (unilateral or bilateral). This brings about a seizure. In the early days this process would be extremely painful and distressing – the patients’ bodies would convulse as the current passed through them and they would have to be held down. Nowadays anaesthetics and muscle relaxants are used to make the process more humane. Patients remember nothing of the procedure and 60-80% achieve relief from symptoms however the side effect of severe memory loss can be said to rob the individual of self knowledge which in itself can be extremely debilitating. Patients generally receive around 6 treatments in the space of 3-4 weeks. There is still a risk of death but it is low 3 in 10,000 which is fairly acceptable given the risk of suicide without treatment.
Discuss: If ECT can save lives of depressed patients should practitioners be allowed to administer the procedure without patient consent?
Nobody is sure how this treatment works however it has been said that the shocks destroy neuronal circuits linked to emotion, that they affect neurotransmitter levels in brain regions associated with emotion, one explanation is that the treatment acts as negative reinforcement of recovery behaviour (avoidance of unpleasant stimulus (shocks) or punishment for depressive behaviour, the memory loss aspect allows restructuring of thinking patterns.
Discuss: When doctors don’t know how and why a treatment works, should they be allowed to use it?
”’http://www.youtube.com/watch?v=1JG9eQsjaZY”’ Longer 8 minute clip about a woman with severe depression and ECT.
http://www.youtube.com/watch?v=y8K37POBojs&NR=1 Short 2-3 minute clip about ECT and depression
Deep brain stimulation
 
See Gross, p 730 now being trialed for anorexia and depression amongst other things
Drug treatments
 
There is more understanding about how drug treatments for mental illnesses work. For example:
 
  • Many antidepressants increase serotonin and/or noradrenaline transmission
  • Most antipsychotics target the brain’s dopamine system

  • Most anxiolytics

     

    work on benzodiazapine receptors in the brain

However, the drugs were not developed on the basis of theories about biological abnormalities in mental illnesses. More often, the process was the other way round: discoveries of useful drugs led to theories about brain dysfunctions:
  • Chlorpromazine, the first antipsychotic, was discovered when French doctors were looking for new sedative drugs for use during operations
  • The antidepressant properties of imipramine were discovered when Swiss doctors were trying to improve chlorpromazine
  • Lithium was discovered as a treatment for bipolar depression when a researcher were working with a completely false theory about uric acid levels in mentally ill patients
     
Psychiatric drugs, particularly antidepressants, are prescribed in huge quantities. In 2007, 36 million prescriptions were written in the UK for antidepressants, nearly one for each member of the adult population However, the biomedical approach to treatment has been criticised on a number of grounds:
  • Many drugs, particularly antidepressants, have questionable efficacy.
    • There are problems with negative studies not being published (publication bias) and about drug companies sponsoring trials of their own drugs.
    • Drug trials sponsored by drug companies are far more likely to come up with positive results than independent studies
  • It is claimed that drugs do not tackle the real problems in mental illness, which are social and psychological.
    • It is argued that drugs merely tackle the symptoms rather than the root of the illness
    • As we have seen with depression, there is probably truth in this criticism. Support for this criticism comes from the fact that there are often high relapse rates when a patient is only given drug therapy.
  • However, this does not mean that drugs have no role to play in treatment, just that they should be combined with other sorts of therapy
  • Drugs have side-effects, which can be extremely negative requiring further drugs to treat the side effects (see sheets on antidepressants and antipsychotics)

Anti-depressants

 

Drug treatments for schizophrenia