Psychological disorders are physical illnesses...

1. Psychological disorders are physical illnesses... Think BING ! 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

2. Biological/medical model dominates the diagnosis and treatment of psychopathology • Psychosurgery • ECT • Drugs

3. 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. Trepanning

4. 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. What is psychosurgery? "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."

5. 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.

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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.

12. 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?

13. 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

14. Drug Treatments There are four main groups to treat mental abnormality: Anti-depressants Anti-anxiety (benzodiazepines) Anti-psychotics Anti-manics

15. Neurotransmitter Imbalance 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

17. How do Anti-Depressants work? SSRI selective serotonin reuptake inhibitor

18. 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

19. 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

20. Do anti-anxiety drugs work? 70% success rate for panic disorders BUT highly addictive!

21. 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

22. 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 http://www.youtube.com/watch?v=cKiAz6ndUbU&feature=related