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1. Biomedical Approaches to Treatment 2. Trepanning: drilling holes into the skull to relieve intracranial problems and mental disorders; evidence of this practice dates…
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  • 1. Biomedical Approaches to Treatment
  • 2. 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). Bosch c. 1494 The Extraction of the Stone of Madness Iron age skull
  • 3. Lobotomy <ul><li>Moniz (1935) </li></ul><ul><li>Walter Freeman (1936) </li></ul>http://www.youtube.com/watch?v=_0aNILW6ILk  
  • 4. <ul><li>Severing connection between frontal lobes and deeper underlying structures </li></ul><ul><li>Tens of thousands were given lobotomies up until70s for range of disorders: mood, anxiety, personality, psychoses etc. </li></ul><ul><li>Particularly used in schizophrenia for which there were no effective drug treatments at the time </li></ul><ul><li>Cheap, effective (brought about calm behaviour!) </li></ul><ul><li>Long term ineffective in treating precise symptoms </li></ul><ul><li>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 </li></ul><ul><li>Today only used for severe depression and OCD </li></ul>
  • 5. Insulin Coma therapy <ul><li>introduced 1930s, mainly for schizophrenia </li></ul><ul><li>used extensively through the 40s and 50s </li></ul><ul><li>coma induced by injecting large amounts of insulin </li></ul><ul><li>Seizures sometimes occurred before or during the coma </li></ul><ul><li>patients would toss and turn, moan, twitch and spasm </li></ul><ul><li>No detailed theory ever proposed regarding how this helped, though success rates of up to 80% were claimed </li></ul><ul><li>some claimed that the process “jolted” patients out of their mental illness! </li></ul><ul><li>http://www.youtube.com/watch?v=JwL6vW5iekY   7 minute clip of a man who was treated using this little understood procedure. </li></ul><ul><li>http://www.youtube.com/watch?v=Tn-4-5hgecw   a 16 second clip of a person undergoing treatment </li></ul>
  • 6. Electro-Convulsive Therapy <ul><li>http://www.youtube.com/watch?v=1JG9eQsjaZY  Longer 8 minute clip about a woman with severe depression and ECT. </li></ul><ul><li>http://www.youtube.com/watch?v=y8K37POBojs&NR=1 Short 2-3 minute clip about ECT and depression </li></ul><ul><li>Less risky and more controlled than insulin coma therapy </li></ul><ul><li>originally pioneered by Cerletti and Bini (1938) as a treatment for schizophrenia. </li></ul><ul><li>now used as a last-resort for treatment resistant, severe depression/suicide risk; </li></ul><ul><li>Electrodes on temples shock the brain with approx. 100 volts (can be unilateral or bilateral). </li></ul>
  • 7. ECT cont’d... <ul><li>Results in seizure. </li></ul><ul><li>Early days process was painful/distressing-nowadays anaesthetics and muscle relaxants are used to make the process more humane. </li></ul><ul><li>Patients remember nothing of the procedure </li></ul><ul><li>60-80% achieve relief from symptoms </li></ul><ul><li>side effect of severe memory loss (robs a person of their sense of self) </li></ul>
  • 8. More on ECT <ul><li>6 treatments in the space of 3-4 weeks. </li></ul><ul><li>Mortality rate= 3 in 10,000 (fairly acceptable given the risk of suicide without treatment?) </li></ul><ul><li>Discuss: If ECT can save lives of depressed patients should practitioners be allowed to administer the procedure without patient consent?   </li></ul>
  • 9. How does it work? <ul><li>Nobody sure how it works </li></ul><ul><ul><li>shocks destroy neuronal circuits linked to emotion </li></ul></ul><ul><ul><li>Shocks affect neurotransmitter levels in brain regions associated with emotion </li></ul></ul><ul><ul><li>treatment is negative reinforcement of recovery behaviour (avoidance of unpleasant stimulus (shocks) or punishment for depressive behaviour </li></ul></ul><ul><ul><li>memory loss aspect allows restructuring of thinking patterns. </li></ul></ul><ul><li>Discuss: When doctors don't know how and why a treatment works, should they be allowed to use it? </li></ul>
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