A tribute to Johann Gottlieb Burckhardt-Heussler (1836–1907), the pioneer of psychosurgery

2016 ◽  
Vol 33 (S1) ◽  
pp. S553-S553 ◽  
Author(s):  
M. Arts ◽  
P. Michielsen ◽  
S. Petrykiv ◽  
L. de Jonge
Keyword(s):  
Significant Contribution ◽  
Psychiatric Patients ◽  
Brain Regions ◽  
Medical Community ◽  
Psychiatric Illnesses ◽  
Scientific Papers ◽  
Show Evidence ◽  
Competing Interest ◽  
Chronic Psychiatric Patients ◽  
Deep Brain

IntroductionJohann Gottlieb Burckhardt-Heussler was a Swiss psychiatrist, who pioneered controversial psychosurgical procedures. Burckhardt-Heussler extirpated various brain regions from six chronic psychiatric patients under his care. By removing cortical tissue he aimed to relieve the patients of symptoms, including agitation, rather than effect a cure.ObjectivesTo present the scientific papers of Johann Gottlieb Burckhardt-Heussler on psychosurgery.AimsTo review available literature and to show evidence that Burckhardt-Heussler made a significant contribution to the development of psychosurgery.MethodsA biography and private papers are presented and discussed, followed by a literature review.ResultsThe theoretical basis of Burckhardt-Heussler's psychosurgical procedure was influenced by the zeitgeist and based on his belief that psychiatric illnesses were the result of specific brain lesions. His findings were ignored by scientists to make them disappear into the mists of time, while the details of his experiments became murky. Decades later, it was the American neurologist Walter Freeman II, performing prefrontal lobotomies since 1936, who found it inconceivable that the medical community had forgotten Burckhardt-Heussler and who conceded that he was familiar with, and probably even influenced by, Burckhardt's work.ConclusionIt is partly thanks to Burckhardt-Heussler's pioneering work that modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The legacy of Walter Jackson Freeman II (1896–1972): The lobotomist

2017 ◽  
Vol 41 (S1) ◽  
pp. S767-S767
Author(s):  
M. Arts ◽  
P. Michielsen ◽  
S. Petrykiv ◽  
L. De Jonge
Keyword(s):  
Literature Review ◽  
Significant Contribution ◽  
Well Being ◽  
Doctor Who ◽  
Scientific Papers ◽  
Show Evidence ◽  
Mental Abilities ◽  
Medical Career ◽  
Competing Interest ◽  
Human Brains

IntroductionWalter Jackson Freeman II was born the grandchild of William Williams Keen, one of world's most renowned surgeons from Philadelphia and the son of an otorhinolaryngist, which may have been contributed to his interest in medicine. Freeman started his medical career in a psychiatric hospital and over the years, he operated thousands of patients. He was a protagonist in American psychosurgery and therefore, he often has been referred as the “lobotomist”.ObjectivesTo present the scientific papers of Walter Jackson Freeman on psychosurgery.AimsTo review available literature and to show evidence that Freeman made a significant though controversial contribution to the development of psychosurgery.MethodsA biography is presented and discussed followed by a literature review.ResultsIn this whole career, “the lobotomist” operated more than 3500 patients and performed mainly operations on the frontal areas. However, he operated human brains without due regard for his patient's mental abilities and emotional well-being after their lobotomy. Despite his work was praised, there was also a lot of criticism on his methods.ConclusionDespite the dubious reputation, Freeman can be remembered as an ambitious doctor who made a significant contribution to the development of psychosurgery. However, unfortunately he crossed medical and legal boundaries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anti-psychotics: To withdraw or not to withdraw?

2017 ◽  
Vol 41 (S1) ◽  
pp. S752-S752
Author(s):  
C. Ferreira ◽  
S. Alves ◽  
C. Oliveira ◽  
M.J. Avelino
Keyword(s):  
Side Effects ◽  
Scientific Literature ◽  
Psychiatric Patients ◽  
Careful Consideration ◽  
Online Searching ◽  
Cardiac Side Effects ◽  
Scientific Papers ◽  
Competing Interest ◽  
Few Data

IntroductionAnti-psychotics constitute a class of psychotropic drugs used for the treatment and prophylaxis of several disorders, including schizophrenia, bipolar disorder and psychotic depression. Frequently, clinicians are asked by their patients to withdraw this medication. In some cases, that may be related to notable side effects. However, it may actually indicate an inadequate control of the psychiatric disorder with poor insight.AimsThe goal of this work is to systematically review the scientific literature in order to understand if there are consistent data that support anti-psychotics withdraw in specific clinical situations.MethodsThe literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “anti-psychotics” and “withdraw” in the title and/or abstract, published in English.Results and discussionAnti-psychotics improve prognosis and enhance patients’ quality of life. There are few data in the literature regarding recommendations that support anti-psychotic withdraw in psychiatric patients. Very specific conditions must exist for withdrawing anti-psychotics, like neuroleptic malignant syndrome, cardiac side effects, and change of diagnosis or prolonged remission after a first and single psychotic event. When that decision is made, it should be done slowly and carefully and both the patient and his family should be involved.ConclusionsThere is no evidence in the literature that supports withdraw of anti-psychotics for the majority of psychiatric situations. When specific conditions are present that possibility must then be considered, however, with careful consideration and after discussion with the patient and parties involved in patient's care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

From theory to practice: The contribution of John Farquhar Fulton (1899–1960) to psychosurgery

2017 ◽  
Vol 41 (S1) ◽  
pp. S374-S375
Author(s):  
P. Michielsen ◽  
L. De Jonge ◽  
S. Petrykiv ◽  
M. Arts
Keyword(s):  
Frontal Lobe ◽  
Limbic System ◽  
Human Subjects ◽  
Animal Experiments ◽  
Delayed Response ◽  
Scientific Papers ◽  
Show Evidence ◽  
Correct Location ◽  
Competing Interest

IntroductionJohn Farquhar Fulton was an American neurophysiologist and historian, who pioneered psychosurgery based on animal experiments. Together with psychologist Carlyle Jacobsen, Fulton presented the results of bilateral frontal lobe ablation in chimpanzees. This study prompted neurologist Egas Moniz and neurologist Walter Freeman to perform similar brain surgery on human subjects.ObjectivesTo present the scientific papers of John Farquhar Fulton on psychosurgery.AimsTo review available literature and to show evidence that John Farquhar Fulton made a significant contribution to the development of psychosurgery.MethodsA biography and research papers are presented and discussed.ResultsFulton and Jacobsen experimented with ‘delayed response tasks’ in chimpanzees. The aim was to test the animal's capability to memorize the correct location of the food. They found that after sequential ablations of the left and right frontal association cortices these memory tasks became significantly difficult for the monkeys to perform. The researchers saw parallel conclusions in clinical cases of human frontal lobe damage.ConclusionsAn investigation into the role of the limbic system is one of the crowning achievements of John Farquhar Fulton, as this has influenced even today's thinking about the role of the limbic system. We should thank Fulton for his pioneering work as modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Ethical examination of deep brain stimulation’s ‘last resort’ status

2021 ◽  
pp. medethics-2020-106609
Author(s):  
Ian Stevens ◽  
Frederic Gilbert
Keyword(s):  
Neurological Diseases ◽  
Psychiatric Patients ◽  
Symptom Relief ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Psychiatric Illnesses ◽  
Early Implementation ◽  
Life Years ◽  
Deep Brain

Deep brain stimulation (DBS) interventions are novel devices being investigated for the management of severe treatment-resistant psychiatric illnesses. These interventions require the invasive implantation of high-frequency neurostimulatory probes intracranially aiming to provide symptom relief in treatment-resistant disorders including obsessive-compulsive disorder and anorexia nervosa. In the scientific literature, these neurostimulatory interventions are commonly described as reversible and to be used as a last resort option for psychiatric patients. However, the ‘last resort’ status of these interventions is rarely expanded upon. Contrastingly, usages of DBS devices for neurological symptoms (eg, Parkinson’s disease, epilepsy or dystonia) have paved the way for established safety and efficacy standards when used earlier in a disease’s timeline. As DBS treatments for these neurological diseases progress to have earlier indications, there is a parallel ethical concern that early implementation may one day become prescribed for psychiatric illnesses. The purpose of this article is to build off contemporary understandings of reversible neurostimulatory interventions to examine and provide clarifications on the ‘last resort’ status of DBS to better address its ethically charged use in psychiatric neurosurgery. To do this, evaluative differences between DBS treatments will be discussed to demonstrate how patient autonomy would be a paramount guiding principle when one day implementing these devices at various points along a psychiatric disease’s timeline. In presenting the clarification of ‘last resort’ status, the ethical tensions of early DBS interventions will be better understood to assist in providing psychiatric patients with more quality of life years in line with their values.

scholarly journals Rare disruptive variants in the DISC1 Interactome and Regulome: association with cognitive ability and schizophrenia

2016 ◽  
Author(s):  
Shaolei Teng ◽  
Pippa A. Thomson ◽  
Shane E. McCarthy ◽  
Melissa Kramer ◽  
Stephanie Muller ◽  
...  
Keyword(s):  
Cognitive Ability ◽  
Rare Variants ◽  
Psychiatric Patients ◽  
Large Set ◽  
Altered Expression ◽  
Psychiatric Illnesses ◽  
Genetic Overlap ◽  
Show Evidence ◽  
Complete Sequencing ◽  
Recurrent Major Depressive Disorder

ABSTRACTSchizophrenia (SCZ), bipolar disorder (BD) and recurrent major depressive disorder (rMDD) are common psychiatric illnesses. All have been associated with lower cognitive ability, and show evidence of genetic overlap and substantial evidence of pleiotropy with cognitive function and neuroticism. Disrupted in schizophrenia 1 (DISC1) protein directly interacts with a large set of proteins (DISC1 Interactome) that are involved in brain development and signaling. Modulation of DISC1 expression alters the expression of a circumscribed set of genes (DISC1 Regulome) that are also implicated in brain biology and disorder. Here, we report targeted sequencing of 59 DISC1 Interactome genes and 154 Regulome genes in 654 psychiatric patients and 889 cognitively-phenotyped control subjects, on whom we previously reported evidence for trait association from complete sequencing of the DISC1 locus. Burden analyses of rare and singleton variants predicted to be damaging were performed for psychiatric disorders, cognitive variables and personality traits. The DISC1 Interactome and Regulome showed differential association across the phenotypes tested. After family-wise error correction across all traits (FWERacross), an increased burden of singleton disruptive variants in the Regulome was associated with SCZ (FWERacrossP=0.0339). The burden of singleton disruptive variants in the DISC1 Interactome was associated with low cognitive ability at age 11 (FWERacrossP=0.0043). These results suggest that variants in the DISC1 Interactome effect the risk of psychiatric illness through altered expression of schizophrenia-associated genes. The biological impact of rare variants highlighted here merit further study.

Non-compliance in the Emergency Department: Is there a Difference Between Medical and Psychiatric Patient's Reasons and use of the Emergency Department

2016 ◽  
Vol 33 (S1) ◽  
pp. S445-S445 ◽  
Author(s):  
L. Zun
Keyword(s):  
Emergency Department ◽  
Psychiatric Patients ◽  
Admission Rate ◽  
Medical Patients ◽  
Emergency Room Visits ◽  
Drug Compliance ◽  
Psychiatric Illnesses ◽  
Significant Difference ◽  
Competing Interest ◽  
Two Populations

BackgroundIt is estimated that on average up to 50% of patients are non-compliant with their medication, resulting in 28% emergency room visits costing about $8.5 billion annually.ObjectivesThe purpose of this study was to examine, what, if any, differences there are between medical versus psychiatric non-compliant patients with regard to use of the emergency department (ED).Methodsa random sample of patients who present to the ED for medical or psychiatric illnesses and who state that they were non-compliant with their medicine were given the National Health access Survey. They were asked about sources of medical care, drug compliance and reason for non-compliance.ResultsThere were a total of 300 participants in the study. There was no significant difference in the reason both medical and psychiatric patients gave for being non-compliant with their medications that resulted in their ED visit. Each group cited cost as the number one reason for not taking their medication as prescribed. The psychiatric participants who were more likely to get admitted disposition (P = .00), not afford mental health care (P = .01), were not able to get care from other places and used the ED for their psychiatric care (P = .02).ConclusionThere was no difference between the two populations with regards to their reasons for non-compliance that brought them to the ED. Non-compliance of the psychiatric patients compared to the medical patients lead to a higher admission rate.Disclosure of interestThe author has not supplied his declaration of competing interest.

Comparison of Self-reported to Observational Agitation Scales

2017 ◽  
Vol 41 (S1) ◽  
pp. S151-S151
Author(s):  
L. Zun ◽  
L. Downey
Keyword(s):  
Psychiatric Patients ◽  
Likert Scale ◽  
The Self ◽  
Assessment Tools ◽  
Self Assessment ◽  
Convenience Sample ◽  
Ed Visits ◽  
Competing Interest ◽  
A Prospective Study ◽  
Age Range

BackgroundIncreasingly, psychiatric patients are presenting to the emergency department (ED) with agitation. ED staff rarely, if ever, use scale to assess agitation or use any self-assessment tools to determine a patient's level of agitation.ObjectivesTo evaluate the relationship between a patient's self-reported level of agitation and other validated agitation assessment tools.MethodsThis is a prospective study using a convenience sample of patients presenting to the ED with a psychiatric complaint. This study was conducted in an urban, inner-city trauma level 1 center with 55,000 ED visits a year. After obtaining consent, a research fellow administered observational tools, PANSS-EC and ACES and BAM and Likert scale self assessment tools on arrival to the ED. SPSS version 24 was used. The study was IRB approved.ResultsA total of 139 patients were enrolled. The most common ED diagnoses were depression, schizophrenia, or bipolar. Majority of patients were African-American (59%), falling in the 25–44 year old age range (56%) 52% male. Self-reported agitation was rated as moderate to high in 72.4% of these patients on the Likert scale and 76.3% on the BAM. There was a significant correlation between the self-reported score versus the BAM (F = 11.2, P = 0.00). However, the self-reported scores were significantly different from the scores assessed by observational tools (P < 0.05).ConclusionsED providers should assess a patient's self-reported level of agitation because a patient could be feeling markedly agitated without expressing outward signs detected by observational tools.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Social stigma in severe mental illness in Tunisia: Clinical and socio-demographic correlates

2017 ◽  
Vol 41 (S1) ◽  
pp. S577-S577 ◽  
Author(s):  
U. Ouali ◽  
R. Jomli ◽  
R. Nefzi ◽  
H. Ouertani ◽  
F. Nacef
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Cultural Context ◽  
Social Inclusion ◽  
Psychiatric Patients ◽  
Social Stigma ◽  
Cross Sectional Study ◽  
Local Context ◽  
Cross Sectional ◽  
Competing Interest

IntroductionMental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.ObjectivesTo evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)MethodsThis is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)ResultsWe included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.ConclusionOur results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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