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When the same symptoms frequently occur
together, they represent a syndrome or
disorder. The cause, or ‘aetiology’ may
be one or more of the following:
•
•
•
•
Brain injury
Infection
Neurotransmitters
Genetics
Think
BING !
Biological/medical model
dominates the diagnosis and
treatment of psychopathology
– Psychosurgery
– ECT
– Drugs
Trepanning
• In the Neolithic times, 40,000
years ago, man performed
skull surgery.
• This surgery, called trepanning
was probably carried out to
"liberate" demons and bad
spirits which the ancient
doctors believed were
responsible for madness and
brain disease.
• Many skulls have signs of the
skull structure healing;
suggesting that those
subjected to the surgery could
and did survive.
What is psychosurgery?
• The systematic damage
of the brain in order to
change behaviour.
• The mode of action
involves the cutting of
neural tissue in the brain
and was designed to alter
the symptoms of severe
psychological disorders.
• Psychosurgery is a
treatment of last resort.
"She is with me in body but her soul is in some way lost. The deeper
feelings, the tenderness, are gone. She is hard, somehow."
Lobotomy
•
A leukotomy refers to what is now more
commonly known as a prefrontal
lobotomy.
•
The first human leukotomy was
performed by Antonio Egas Moniz in
1936. He won the Nobel Prize for
medicine in 1949 for this work.
•
The procedure was popularized in the US
by Dr. Walter Freeman, who travelled the
country performing "ice pick lobotomies"
on patients with psychiatric disorders.
•
Eventually he began performing this
procedure on anyone who wished to have
one .
Lobotomy: the severing of the
connection between the frontal
cortex and the lower parts of
the brain.
Prefrontal lobotomy: drilling
two holes in the skull and
inserting an instrument that
severs nerves in the brain.
Cingulotomy: an incision is
made in the nerves of the brain
and a MRI (Magnetic
Resonance Imaging) scan aids
the guidance of surgical
instruments.
Research •
In 1977, the US Congress investigated allegations that psychosurgery, including
lobotomy techniques, was used to control minorities, restrain individual rights or that it
had unethical after-effects. It concluded that, in general, psychosurgery had positive
effects.
•
Concerns about lobotomy steadily grew, some countries such as Germany, Japan
and several US states prohibited it.
•
Leukotomy is legally practiced in controlled and regulated US centers, or in Finland,
Sweden, United-Kingdom, Spain, India, Belgium and Netherlands.
•
In France, 32 lobotomies were made between 1980 and 1986 according to a IGAS
report; about 15 each year in the UK, 70 in Belgium, and about 15 for the
Massachusetts General Hospital of Boston.
•
Very rarely used, only when disorder has proved resistant to all other treatments.
Nowadays, precise area of brain is located (MRI) which limits amount of damage to brain,
using non-invasive electrical/laser treatment
Studies of Psychosurgery
• As recently as the 1990s, Psychosurgery was reported
to be beneficial in some cases of severe anxiety,
depression and obsessive-compulsive disorders (Beck
and Cowley, 1990).
• Another key advantage is that Psychosurgical
techniques reduce the risk of suicide in severe
depression from 15 percent to one percent (Verkaik,
1995).
• But Psychosurgery produces inconsistent outcomes.
Behaviour change occurs in some individuals and not in
others, so it is difficult to predict who will be affected and
how.
• The main ethical problem with psychosurgery is that the
procedures are irreversible because neural tissue has
been destroyed.
Electro-Convulsive Therapy (ECT)
• First used in 1938, originally
as a treatment for
schizophrenia
• Original techniques involved a
strong electrical current being
passed through two electrodes
attached to either side of the
forehead, causing loss of
consciousness and convulsive
seizures
ELECTRO-CONVULSIVE THERAPY
(ECT)
• Used to treat severe depression
• Modern techniques involve a mild current of
between 70-130 volts, whilst patient is under
anaesthetic and a muscle relaxant. Fewer
spasms occur and the patient is at less risk of
harm
• Typically patients receive 6-9 treatments over a
month
Side effects of ECT
• Memory loss in at least 1/3 of patients,
sometimes long term
• Cardiovascular change (e.g. irregular
heartbeat)
• Headaches
• EEG studies have shown general slowing of
brain patterns following ECT, which takes
weeks to return to normal
• Dept of Health found 30% ECT patients
suffered fear and anxiety following ECT
Is it an appropriate treatment?
• Doctors have little idea of WHY it works,
but just because it works does that make it
appropriate?
• However, it is quick compared with drug
therapy and sometimes might be the only
option if patients fails to respond to other
treatments.
Ethical Issues?
• Dept of Health checked 700 patients who
had been ‘sectioned’. 59% had not
consented to treatment
• Even where consent is obtained, is it fully
informed? Do patients know all of the
side-effects?
Is there a safer alternative?
• Repetitive transcranial magnetic
stimulation (rTMS)
• Involves passing high intensity magnetic
pulses through the skull
• Focuses on regions of the brain which
have been associated with depression
• Shows fewer side effects and is as
effective as ECT
Drug Treatments
•
1.
2.
3.
4.
There are four main groups to treat
mental abnormality:
Anti-depressants
Anti-anxiety (benzodiazepines)
Anti-psychotics
Anti-manics
Too much or too little of a particular
neurotransmitter can lead to
psychopathology
•
One of the factors involved in schizophrenia is an excessive
amount of dopamine
•
Too little serotonin is associated with depression and some
anxiety disorders, especially obsessive-compulsive disorder.
•
Too little GABA is associated with anxiety and anxiety disorders
How do Anti-Depressants work?
SSRI
selective
serotonin
reuptake
inhibitor
Do anti depressants work?
• 50-65% of patients given an SSRI for three
months showed signs of improvement in tests
HOWEVER the other test group
were given a PLACEBO
(pretend drug) and this group
showed a 25-30% improvement
Are there any issues with
SSRIs?
• Side effects = range from dry mouth to suicidal
thoughts (prozac)
• Not addictive …BUT person
can become psychologically
dependent on them
Do anti-anxiety drugs work?
• 70% success rate for panic disorders
BUT highly addictive!
Anxiolytic - relief
of anxiety
Anxiety and panic
disorders, phobias
Hypnotic promotion of
sleep
Insomnia
Myorelaxant muscle relaxation
Muscle spasms
Anticonvulsant stop fits,
convulsions
Fits due to drug
poisoning, some
forms of epilepsy
Amnesia - impair
short-term
Premedication for
operations, sedation
for minor surgical
procedures
memory
Do anti-psychotic drugs work?
• 60% success rate for symptoms of hallucinations and
psychotic episodes
• BUT no effect on the
symptoms of social
withdrawal
• HOWEVER, they are
the only drugs that
appear to work for
schizophrenia
Do anti-manic drugs work?
Prior to the introduction of lithium carbonate,
there was a 15% suicide rate amongst people
with bi-polar disorder.
The drugs significantly reduced that rate.
Success rate of 80%
BUT many sufferers refuse to take the
drug because it leaves them feeling ‘flat’
Gitlin’s five year study found a 70% relapse rate
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