BIOLOGICAL Therapy - Psychosurgery Flashcards
What is psychosurgery?
Psychosurgery is a surgical procedure for treating mentally disordered behaviour
By removing or destroying part of the brain, the aim is to eradicate the undesirable behaviour
PSYCHOSURGERY AND THE ASSUMPTIONS
Localisation of brain functions
Certain areas have different jobs, destroying/removing certain areas of the brain that are thought to contribute to psychological problems
Neurotransmitters
Involves stimulating the brain which has an effect on neurotransmitters in the long term
Aim
The aim of psychosurgery to relieve stress, anxiety and depression in patients who have not responded to any other treatments
EARLY PSYCHOSURGERY
Egas Moniz who in 1935 came to the conclusion that the removal of the frontal lobes would result in a reduction of aggression and distress in patients prefrontal leucotomy
Was awarded the Nobel Prize in 1949 for his work
In the US Walter Freeman popularised the transorbital lobotomy during the 1940s and 1950s
He alone carried out 2500 lobotomies in the US
Estimated that up to 50,000 lobotomies were carried out, but when the side effects were found out, the procedure fell out of popularity
The rise of Psychotherapy and psychoactive drugs as a treatment for mental disorders meant that lobotomies were obsolete
There are still risks involved with modern psychosurgery, it is usually a treatment of last resort
Prefrontal Leucotomy
Drilling a hole into each side of the skull and inserting a ‘ice pick’ instrument to destroy the nerve fibres underneath
Later refined as a leucotone and instrument with a retractable wire loop that could cut into the brain and saw nerve fibres
Hoped that cutting nerve pass ways that carried thoughts , from one part of the brain to the other would relieve patients of their distressing thoughts and behaviours
Transorbital Lobotomy
Selective destruction of nerve fibres
Performed in the frontal lobe of brain
Involved in impulse control and mood regulation
Inserted a sharp instrument into brain via the eye socket
Frontal lobe is therefore damaged and thought to reduce aggressive behaviour
Alleviated some of the severe symptoms of mental illness
The severity of the illness was a more important factor than the type of illness, along with how dangerous the patient was
Biateral Cingulotomy
Surgeons can either burn away tissue by heating the tip of the electrode or use a non invasive tool known as a gamma knife to focus beams of radiation at the target site
Capsulotomy
Surgeons insert probes through the tops of the skull and down into the capsule, a region of the brain near the hypothalamus
They heat the tips of the probes, burning away tiny portions of tissue
Deep Brain Stimulation (DBS)
Surgeons thread wires through the skull, which remain embedded in the brain are connected to a battery pack in the patient’s chest
High frequency current that interrupts the brains circuit
Involves no tissue destruction and can be temporary
Evaluation - Early psychosurgery
Both Moniz and Freeman claimed high success rates
Pippard (1955) reported worthwhile or good results with 50% of those with mood disorders
Many other sources reported severe side effects and the original procedures were abandoned in favour of alternative treatments
Comer (2002) found that 6% of people who had a lobotomy died
Possible side effects : Socially withdrawn, change in personality, irresponsibility, apathy
Evaluation - Modern Psychosugery
Cosgrove and Rauch (2001) found that cingulotomies were effective in 56% of OCD patients and capsulotomies in 67%
Psychosurgery is not appropriate for all illnesses
Deep brain Stimulation however has been found to have positive effects in a small trial of 6 patients, 4 of which showed improvements (Mayberg et al, 2005)
Ethical Issues
Not always consensual
Lobotomised against their will
More about making violent and aggressive patients easier to handle
Howard Dully was 12 years old when he forcefully received a lobotomy
He was defiant at times, a little unruly and daydreamedHe experienced trauma and feeling of loss after his lobotomy
Walter Freeman had a mobile surgery where he would travel around the US performing lobotomies on anyone who asked without much consultation
But psychosurgery may be the lesser of two evils?
Better than doing nothing at all
Someone who is chronically depressed may be at a high risk of suicide
Long term side effects and irreversible damage
Once destroyed, it will not grow back
Many people who underwent early lobotomies would have lived their entire lives with side effects such as memory loss and the blunting of emotions
