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Biomedical Approaches to Treatment

Biomedical Approaches to Treatment. Iron age skull. Bosch c. 1494 The Extraction of the Stone of Madness. Trepanning: drilling holes into the skull to relieve intracranial problems and mental disorders; evidence of this practice dates back to the Neolithic period (9500 BC). Lobotomy.

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Biomedical Approaches to Treatment

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  1. Biomedical Approaches to Treatment

  2. Iron age skull Bosch c. 1494 The Extraction of the Stone of Madness Trepanning: drilling holes into the skull to relieve intracranial problems and mental disorders; evidence of this practice dates back to the Neolithic period (9500 BC).

  3. Lobotomy • Moniz (1935) • Walter Freeman (1936) http://www.youtube.com/watch?v=_0aNILW6ILk

  4. Severing connection between frontal lobes and deeper underlying structures • Tens of thousands were given lobotomies up until70s for range of disorders: mood, anxiety, personality, psychoses etc. • Particularly used in schizophrenia for which there were no effective drug treatments at the time • Cheap, effective (brought about calm behaviour!) • Long term ineffective in treating precise symptoms • 1976 review by National Commission in USA said it is effective in treating some conditions such as severe depression that is resistant to all other treatments • Today only used for severe depression and OCD

  5. Insulin Coma therapy • introduced 1930s, mainly for schizophrenia • used extensively through the 40s and 50s • coma induced by injecting large amounts of insulin • Seizures sometimes occurred before or during the coma • patients would toss and turn, moan, twitch and spasm • No detailed theory ever proposed regarding how this helped, though success rates of up to 80% were claimed • some claimed that the process “jolted” patients out of their mental illness! • http://www.youtube.com/watch?v=JwL6vW5iekY7 minute clip of a man who was treated using this little understood procedure. • http://www.youtube.com/watch?v=Tn-4-5hgecwa 16 second clip of a person undergoing treatment

  6. Electro-Convulsive Therapy • 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 • Less risky and more controlled than insulin coma therapy • originally pioneered by Cerletti and Bini (1938) as a treatment for schizophrenia. • now used as a last-resort for treatment resistant, severe depression/suicide risk; • Electrodes on temples shock the brain with approx. 100 volts (can be unilateral or bilateral).

  7. ECT cont’d... • Results in seizure. • Early days process was painful/distressing-nowadays anaesthetics and muscle relaxants are used to make the process more humane. • Patients remember nothing of the procedure • 60-80% achieve relief from symptoms • side effect of severe memory loss (robs a person of their sense of self)

  8. More on ECT • 6 treatments in the space of 3-4 weeks. • Mortality rate= 3 in 10,000 (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?

  9. How does it work? • Nobody sure how it works • shocks destroy neuronal circuits linked to emotion • Shocks affect neurotransmitter levels in brain regions associated with emotion • treatment is negative reinforcement of recovery behaviour (avoidance of unpleasant stimulus (shocks) or punishment for depressive behaviour • 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?

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