Lecture 10: Doctors, Science and Patients Flashcards
Who is Wilder Penfield? What did he do?
Neurosurgeon inMontreal, mapped the brain ins search of the scientific basis for the human soul.
What was the rise in brain dissections due to?
- large patient populations
- you’ve got overcrowding and abandoned bodies
- overcrowding provided large populations for observation and bodies for experiments.
What was cerebral localization?
tendency to look for lesions in the brain with the 19the century craze for studying parts of the brain under microscope to see the brain as a place where mental diseases existed.
What were 6 somatic (bodily) therapies?
- Hydrotherapy
- Malaria fever therapy
- Insulin coma therapy
- Metrazol/cardiazol convulsion therapy
- Electroconvulsive therapy
- Psychosurgery
What are the two types of hydrotherapy?
- the back
2. shock treatment (spray therapy)
When was hydrotherapy implemented in Canada?
1900-1910
Was was the bath with hydrotherapy?
soaking and ‘continuous baths’ used to calm agitated and aggressive patients.
What was hydrotherapy as shock treatment?
- shock by spraying
- immediate impact of relief by no long-term reduction in symptoms
- sometimes used as punishment
Who invented fever therapy?
‘invented’ by Julius Wagner-Jauregg, an Austrian psychiatrist, in 1883
What did Wagner-Jauregg suggest a relationship between? Explain.
- a relationship between ‘fever’ and psychosis
- fever would reduce psychosis
- when people got other illnesses, they would observe that fevers reduced mental symptoms
When was malaria therapy instituted?
1917
What happened with malaria therapy?
injected patient with malaria-infected blood to produce fever
Who invested malaria therapy?
Wagner-Jauregg
What did Wagner-Jauregg receive for malaria therapy in 1927?
The Novel Prize
How did Wagner-Jauregg discover malaria therapy?
One of his patients was a soldier suffering form shell shock who also contracted malaria. WJ took some of his soldier’s malaria infected blood and injected it into one of his patients with near-syphillis. After sever attacks of fever, the patient’s psychotic symptoms subsided.
What did malaria fever therapy reinforce?
Reinforced that made this was a medical problem, not behavioural.
When was insulin discovered and by whom?
Insulin was discovered in 1922 by Banting and Best.
Where was insulin discovered?
In Canada
How did insulin therapy work? What were they given rouse them from their comas?
Insulin causes the muscles to take up glucose from the blood if too much glucose is withdrawn, the patients will go into a hypoglycaemic coma. The com seemed to have therapeutic benefits that relieved patients of some their symptoms. They were given a sugar solution to rouse them from their coma.
When did insulin coma therapy become a treatment modality?
In the 1920s
Who was insulin often given to?
Insulin was often given to patients with depression, or those with little or no appetites (insulin would stimulate healthy responses).
Who was Manfred Sakel?
Austrian medical graduate who studied diabetic morphine addicts in the 1930s.
What did Sakel observe?
That 4-5 comas calmed 70% of schizophrenic patients. He noticed that comas produced by too much insult seemed to provide relief. He determined that the coma reduced symptoms and also had long term social benefits.
What was the first true ‘convulsive therapy’?
metrazol (cardiazol) therapy
Who is Ladislas von Meduna?
A Budapest psychiatrist who practiced convulsive therapy in 1934. He studied epilepsy and schizophrenia, finding that the two disorders and a curious relationship, the onset of an epileptic reaction seemed to reduce symptoms of schizophrenia and vice versa.
-idea was that patients with epilepsy did not have psychotic symptoms
What drug was first used to induce seizures?
Camphor
By 1935, __of__patients improved with convulsive therapy with camphor.
10 of 26
What were the side effects of convulsive therapy with camphor?
vomiting, pain, unpredictability
What happened with convulsive therapy switched to using metrazol or cardiazol?
Found similar rates of success, with fewer side effects. The problem was that the drug had a lower rate of reliability in terms of inducing a convulsion (why it never caught on).
Who was Ugo Cerletti?
Professor of psychiatry in Rom in the 1930s. He studied epilepsy and schizophrenia and effect of convulsion on psychotic symptoms. (Electroconvulsive Therapy)
Describe the early experiments of Ugo Cerletti?
Experiments on stray dogs for 6-7 years
When was Ugo Cerletti’s first human ECT case?
1938
-man suffering from hallucinations recovered after three sessions
Which had a better recovery rate: ECT or Metrazol therapy?
ECT
What were the side effects of ECT? When did this change?
Similar side effects to Metrazol Therapy until the introduction of anaesthesia.
When is ECT used widely throughout asylums?
1950s
What is ECT used for today?
major depressive disorder with psychosis
The was ECT uncommon? When did it begin to rise?
Uncommon in 1930s and rises towards 1940s.
Who is Egaz Moniz?
Head of Neurological Institute of Lisbon (Portugal) who was interested in the frontal lobe.
Why was Egaz Moniz interested in the frontal lobe?
Not just apparent relief offered by convulsions, fevers, or comas, but in cerebral localization: relationship between brain and activity. Led Moniz to study frontal loves. Relationship between frontal loves an behaviour. He wonders if altering the frontal lobe will effect behaviour.
What did Egaz Moniz call his frontal lobe alteration?
leukotomy (leech = white tissue; tome = cutting instrument).
How many cures, ameloriations, and no changes did Moniz claim for leukotomy?
- 7 cures
- 7 ameliorations
- 6 no changes
Who did Egaz Moniz practice leukotomy on? What did it involve?
- Tried this technique on human subjects: individuals suffering from major depression and psychosis.
- Rather than a full lobotomy, Moniz gave his patients leucotomies which involved cutting the white tissue with a tome or cutting instrument.
Who are Walter Freeman and James Watts?
- Walter Freeman (US neurologist)
- James Watts (US neurosurgeon)
- 1940s
- Freeman-Watts Transorbital
- Trans-orbital incision through the orbital cavity.
Who were Freeman and Watts influenced by?
Moniz after he ran out of funding and was unable to continue
How would Freeman and Watts perform their procedure?
Would make an incision in the eye cavity and perform the operation with a long scalpel inserted through the skull membrane and into the frontal lobe.
When were lobotomies popular?
1940-1970
How many lobotomies were approximately performed in the US in the 1940s?
Approximately 20 000
Who were lobotomies used for?
Lobotomies were not only used for poor patients, people from all classes suffering from mental disorders became the subjects of lobotomies.
When and why did lobotomies begin to decline?
With the onset of new psychotropic drugs of 1955+
When was the era of medical experimentation without (modern) consent rules?
1900-1960
What were they searching for from 1900-1960?
Search for a magic bullet for mental disorders.
What was there a growth of from 1900-1960?
Growth of anti-psychiatry movements, sociological critiques of psychiatry, and negative popular culture portrayals of psychiatry.
