Lecture 12 Flashcards
what was the beginning of modern psychiatry
- 18th century
- rationalism
- madness was not a punishment or an illness it was a moral condition affecting a persons soul
- the mad must be treated as potentially recoverable
- phillippe pinel
how was the moral treatment of a patients
- patients were allowed to move around
- treated as normal people
- kept occupied
- restraint and seclusion were the two forms of punishment
who discovered the first mental illness
jean martin charcot
- investigated hysteria vua hypnotism
how did the 19th century treat madness
- lunacy was associated with physical illness
- heredity madness
- dementia, physical illness, neurological conditions ect
how did they determine if someone was mad
- Doctors would rely on their experience and best
judgement - They would also consult with the person’s relatives, jailers, spouses, neighbours and other
doctors
when did a standardised cirteria get invented
- 1952
what are the different ways to tell if someone is ‘mad’
- Mania: wild, uncontrollable behaviour or obsessions
- Melancholia: sadness, inertia
- Confusional insanity: person appears very confused by normal events, cannot understand what is going on
- Delusional insanity: person experiencing hallucinations or delusions
- Epilepsy: fitting, collapses, unconsciousness, choking
- Senility / softening of the brain: elderly
- Idiocy / Imbecile: children with developmental
disabilities
what are the crtiques of DSM-IV
- evidence base lacks reliability
- lacks validity
- DSM disgnoses is not correlated with length of stay
- Allen Frances critiqued saying that you can define a mental illness
what is the main physical treatment for mental illness
- ECT
what drugs were used to treat mental illness
- John Cade
- Lithium
- found it had a calmin effect
- killed on patient in a trial an made two others very ill
- published in 1949
what were the first anti psychotics
- developed 1950s
- anaesthetics and antihistamines
- chlorpromazine
- slow repsonse and control agitatation
what were first generation anti psychotics
- Haldol (haloperidol)
- Mellaril (thioridazine)
- Prolixin (fluphenazine)
- Thorazine, Largactil
(chlorpromazine)
what were second generation anti psychotics
- Clozaril (clozapine)
- Zyprexa (olanzapine)
- Risperdal (risperidone)
- Seroquel (quetiapine)
what were side effects to anti psychtoics
- cruel and unusual doses
- taradive dyskinesia a neurological disorder
what are the positive and negatve symptoms of schizophrenia
- Positive symptoms: excess of normal function, eg.
delusions, inappropriate affect, speech disruptions,
odd behaviour - Negative symptoms: absence of normal function,
eg. lack of emotion, lack of speech, lack of motivation
how many people does schizophrenia effect
- Sz affects around 1% of population
- Chance of a relative with Sz is around 10%
- Identical twin concordance rates of only 45%
what are envionmental factors that affect schiozphrenia
- Early environmental factors include: parental malnutrition, birth complications, parental stress, infection, autoimmune reactions, toxins, traumatic
injury - Later environmental factors include: recreational drug use, stress, migratio
what is the dopamine theory of Schizophrenia
parkinsons disease research suggested that antipsychotics worked by disrupting dopaminergic transmission
- Sz was caused by high levels of activity at dopamine receptors
what are dopamine receptors
- Phenothiazines (like chlorpromazine) bind to D1
and D2 receptors - Butyrophenones (like haloperidol) bind to D2
receptors
what is off label prescription?
- A drug is prescribed for an indication, a route of
administration, or a patient group that is not included in
the approved product information document for that
drug.
what was the impact of anti psychtoic medication
- Increased use of outpatient facilities (rather than
lifelong inpatient custodial care) - Increased discharges from large psychiatric hospitals
- Introduction of step-down programs to help ex-patients
readjust to living independently - Increased visibility of former and current psychiatric
patients in the community
why do people stop taking psychartric medication
- unpleasant and unwanted side effects
- serious physical health problems
- side effects can be more unpleasant than psychiatric symptoms
- hate the feeling of dependance
- forget to take it
- believe they no longer need it
what did dr thomas szasz believe
Psychiatry was too medicalised
- treats people as if they had physical illnesses that needed hospitalisation and drugs
- Acting out by people with a diagnosis always has a strongly symbolic aspect
- The individual patient is the one who has the most control over their mental and emotional health
- Szasz’s ideas drove a number of subsequent reforms within psychiatry
what are two drug free ways forward
1- neuroplaciticy
2- trauma informed diganois
