5. The evolution of treatments

2017 ◽  
Author(s):  
Mary Jane Tacchi ◽  
Jan Scott
Keyword(s):  
Electroconvulsive Therapy ◽  
Real World ◽  
18Th Century ◽  
Mood Stabilizer ◽  
Psychological Interventions ◽  
The Real ◽  
Potential Barriers ◽  
Insulin Coma ◽  
Physical Treatments ◽  
Insulin Coma Therapy

For many centuries, the only intervention for melancholia involved admission into an asylum, initially to keep individuals away from society and then, from the 18th century, to provide therapeutic care. ‘The evolution of treatments’ discusses the crude treatments that were first introduced for inpatients such as sedation (barbiturates and insulin coma therapy) and physical treatments (electroconvulsive therapy and psychosurgery). Next, it discusses the development of the medications that are used today for inpatients and outpatients, such as antidepressants and the mood stabilizer lithium. Finally, it looks at the evolution of psychotherapies from early Freudian models through to mindfulness and the potential barriers to providing psychological interventions in the real world.

Studies on the Physiology of Awareness: An Oximetric Investigation of the Anoxaemia Accompanying Insulin Coma Therapy

1952 ◽  
Vol 98 (412) ◽  
pp. 411-420 ◽  
Author(s):  
John W. Lovett Doust ◽  
Robert A. Schneider
Keyword(s):  
Clinical Symptoms ◽  
Venous Blood ◽  
Insulin Injection ◽  
Personal Contact ◽  
Blood Oxygen Saturation ◽  
The Real ◽  
Arterial Blood ◽  
Schizophrenic Patients ◽  
Insulin Coma ◽  
Insulin Coma Therapy

This investigation deals with the measurement, by a peripheral method of discontinuous spectroscopic oximetry, of the arterial blood oxygen saturation levels in a group of schizophrenic patients undergoing insulin coma therapy.The association between tissue anoxia and insulin hypoglycaemia was first established by Campbell and Dudley in 1924. Dameshek and Meyerson (1935), using the arterio-venous oxygen difference method with the internal jugular vein as the source of venous blood, showed that the injection of insulin in coma doses was accompanied by an anoxaemia in the schizophrenic patients they studied. This work was confirmed by Himwich, Bowmanet al.(1939), and in another paper Himwich (1951, p. 277) and his co-workers found that the correlation of progressively developing clinical symptoms with the decrease of cerebral oxygen uptake was a closer one than the correlation with the more acute fall in the blood-sugar curve. An important symptomatic aspect of insulin hypoglycaemia includes the progressive changes in the levels of consciousness accompanying the approach towards coma. Wilder (1943) has outlined some of these changes, and Frostig (1940) and Himwich (1951, pp. 258-265) have delineated these awareness thresholds and discussed their relationship to the Hughlings Jackson theory of the phyletic organization of the central nervous system. Thus, during thefirst hourfollowing insulin injection, somnolence and lassitude appear to be associated with suppression of cortical and cerebellar activity; in thesecond hourfurther clouding of consciousness, sometimes with excitement, perceptual disturbances, periods of confusion, exacerbations of previously existing hallucinations and latent psychotic syndromes are seen; in thethird hourmotor restlessness and loss of consciousness suggest the release of basal ganglia and hypothalamus; in thefourth hourdeepening stupor and depression of exteroceptive sensitivity indicate a probable release of the midbrain and suppression of pyramidal function; in thefifth hourthe deep pre-mortal coma presages medullary release. Similarly, it is with awareness changes that many workers prefer to diagnose the “real coma” level in a patient under treatment. Thus Sakel (1937) held that coma was to be diagnosed when no further personal contact with the patient was possible, and Kalinowsky and Hoch (1946) agree that the real coma level is reached when it is completely impossible to awaken the patient.

An Evaluation of the Rorschach Test As a Prognostic Aid in the Treatment of Schizophrenia by Insulin Coma Therapy, Electronarcosis, Electroconvulsive Therapy and Leucotomy

1951 ◽  
Vol 97 (409) ◽  
pp. 681-689 ◽  
Author(s):  
W. Linford Rees ◽  
A. M. Jones
Keyword(s):  
Electroconvulsive Therapy ◽  
Rorschach Test ◽  
Insulin Coma ◽  
Insulin Coma Therapy

The possibility of using the Rorschach test to predict outcome of insulin coma treatment of schizophrenia has been investigated by Piotrowski (1938, 1939 and 1941).

scholarly journals Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness

2018 ◽  
Vol 52 (15) ◽  
pp. 967-971 ◽  
Author(s):  
Adam Gledhill ◽  
Dale Forsdyke ◽  
Eliot Murray
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Injury Prevention ◽  
Real World ◽  
Sports Injuries ◽  
Psychological Interventions ◽  
Moderate Risk ◽  
Eligibility Criteria ◽  
Injury Rates ◽  
The Real

ObjectiveTo systematically review studies examining the role of psychological interventions in injury prevention. The primary research question was: What is the real-world effectiveness of psychological intervention in preventing sports injuries?DesignMixed methods systematic review with best evidence synthesis.Data sourcesCINAHL, MEDLINE, PsycARTICLES, PsycINFO, SPORTDiscus, Science Direct and PubMed.Eligibility criteria for selecting studiesRandomised controlled trials (RCT), non-RCTs that included a comparison group, before and after study designs and qualitative methods. Studies were required to outline specific unimodal or multimodal psychological interventions used in relation to injury prevention in the real-world setting.Outcome measureStudies were independently appraised with the Mixed Methods Appraisal Tool.ResultsThirteen papers (incorporating 14 studies) met the eligibility criteria, of which 93% (13/14) reported a decrease in injury rates (effect size range=0.2–1.21). There was an overall moderate risk of bias in reporting (52%). There is a dominance of stress management-based interventions in literature due to the prominence of the model of stress and athletic injury within the area.Summary/conclusionsPsychological interventions demonstrate small (0.2) to large (1.21) effects on sports injury rates. The research area demonstrates a cumulative moderate risk in reporting bias (52%).PROSPERO registration numberCRD42016035879.

A Retrospective Controlled Study of Leucotomy in Schizophrenia and Affective Disorders

1958 ◽  
Vol 104 (437) ◽  
pp. 1025-1042 ◽  
Author(s):  
A. A. Robin
Keyword(s):  
Affective Disorders ◽  
Controlled Study ◽  
Insulin Coma ◽  
Psychiatric Conditions ◽  
Ethical Objection ◽  
Physical Treatments ◽  
Insulin Coma Therapy ◽  
Forward Looking

The controlled study of the major physical treatments in schizophrenia (and other psychiatric conditions) has been retarded by the view that it is unethical to withhold treatment from the patient. Although this argument is clearly dubious until a treatment is proved, the number of forward-looking controlled studies of E.C.T., insulin coma therapy and leucotomy may nevertheless be counted on the fingers of two hands. Not all schizophrenics have, however, received every possible treatment, and if it were possible to make comparisons of treated and untreated cases retrospectively, there would be no ethical objection to overcome.

scholarly journals Advances in the practice of electroconvulsive therapy

1994 ◽  
Vol 1 (2) ◽  
pp. 47-56 ◽  
Author(s):  
Toni Lock
Keyword(s):  
Electroconvulsive Therapy ◽  
Poor Prognosis ◽  
Significant Risk ◽  
Electroconvulsive Treatment ◽  
Military Operation ◽  
Objective Evidence ◽  
Insulin Coma ◽  
Insulin Coma Therapy ◽  
Treatment Alternatives ◽  
Physical Morbidity

The first electroconvulsive treatment was administered by Cerletti and Bini in 1938. The event was essentially an experiment, carried out like a military operation (Endler, 1988). The patient was stimulated three times, each time increasing the intensity of the stimulus before a generalised seizure was induced. He had been suffering from an acute psychosis with a poor prognosis, but responded to a course of 11 treatments and was discharged free of symptoms two months later. The first paper on electroconvulsive therapy (ECT) in English was published in theLancet(Kalinowski) in 1939. At that time, somatic treatment alternatives for the severely ill in large mental institutions included lobotomy and insulin coma therapy. In comparison, unmodified ECT (albeit associated with a significant risk of serious physical morbidity) was predictable, efficient, quick and effective. It is understandable why the treatment became widely and fairly indiscriminately adopted before systematic objective evidence of its efficacy was collected.

Drugs and other physical treatments

2017 ◽  
pp. 709-776
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Deep Brain Stimulation ◽  
Transcranial Magnetic Stimulation ◽  
Adverse Effects ◽  
Electroconvulsive Therapy ◽  
Direct Current ◽  
Magnetic Stimulation ◽  
Brain Activity ◽  
Mood Stabilizer ◽  
Clinical Use ◽  
Physical Treatments

‘Drugs and other physical treatments’ provides coverage of the current drug and physical treatments used in the management of general psychiatric disorders. Following a historical introduction and general principles governing drug use and prescription, agents are considered according to the major psychotropic classes, namely: anxiolytic and hypnotic, antipsychotic, antidepressant, mood stabilizer, and psychostimulant. Each class is described according to its pharmacology, followed by the indications, pharmacokinetics, adverse effects and clinical use of individual compounds. Subsequent sections describe the indications, practical management, and adverse effects of electroconvulsive therapy, as well as other treatments designed to influence brain activity directly. Included here are descriptions of neurosurgery and various neurostimulation techniques (deep brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, and vagal nerve stimulation), together with the evidence for their effectiveness as well as their proposed indications and adverse effects.

A Controlled Trial of Hypothermia in Chronic Schizophrenia

1960 ◽  
Vol 106 (442) ◽  
pp. 344-351 ◽  
Author(s):  
Peter Hays ◽  
Gerald Woolfson ◽  
Berenice Krikler ◽  
Brian Day
Keyword(s):  
Electroconvulsive Therapy ◽  
Psychiatric Treatment ◽  
Controlled Trial ◽  
Chronic Schizophrenia ◽  
Physical Methods ◽  
Insulin Coma ◽  
Insulin Coma Therapy

Physical methods play an important part in psychiatric treatment. The roles of electroconvulsive therapy and, to a lesser extent, insulin coma therapy, are fairly well-defined and their effectiveness recognized, though different authorities qualify their recognition in various ways.

“To suit the occasion, I wore my schizophrenic fancy dress”1 – the life of Janet Frame

2019 ◽  
Vol 27 (5) ◽  
pp. 469-471
Author(s):  
Xinhui Lim ◽  
Cherrie Galletly
Keyword(s):  
Everyday Life ◽  
Interpersonal Relationships ◽  
Electroconvulsive Therapy ◽  
Psychiatric Patient ◽  
Life Story ◽  
Psychiatric Treatment ◽  
Prolonged Hospitalisation ◽  
Insulin Coma ◽  
Janet Frame ◽  
Insulin Coma Therapy

Objective: Janet Frame (1924–2004) was one of New Zealand’s most celebrated authors. Much of her work stems from her experiences as a psychiatric patient. She was hospitalised for about eight years with a diagnosis of schizophrenia. Treatments included insulin coma therapy and unmodified electroconvulsive therapy. Her doctors then planned for her to have a leucotomy, which was cancelled upon discovery that one of her works had won a prestigious literary award. She subsequently moved to England and was assessed at the Maudsley Hospital by Sir Aubrey Lewis. She was found to never have suffered from schizophrenia; her condition was instead attributed to the effects of overtreatment and prolonged hospitalisation. She reflected profoundly on these experiences in her writing, and those who are interested in psychiatry are truly fortunate to have access to her autobiographies, fiction and poetry. Conclusions: Janet Frame has written both autobiographical and fictional accounts of her many years of psychiatric treatment, describing individuals, interpersonal relationships, and everyday life in these institutions. Her own life story demonstrates extraordinary recovery and achievement.

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