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drugs that change the world > Lecture 12 > Flashcards

Lecture 12 Flashcards

1
Q

what was the beginning of modern psychiatry

A
  • 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
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2
Q

how was the moral treatment of a patients

A
  • patients were allowed to move around
  • treated as normal people
  • kept occupied
  • restraint and seclusion were the two forms of punishment
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3
Q

who discovered the first mental illness

A

jean martin charcot

- investigated hysteria vua hypnotism

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4
Q

how did the 19th century treat madness

A
  • lunacy was associated with physical illness
  • heredity madness
  • dementia, physical illness, neurological conditions ect
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5
Q

how did they determine if someone was mad

A
  • Doctors would rely on their experience and best
    judgement
  • They would also consult with the person’s relatives, jailers, spouses, neighbours and other
    doctors
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6
Q

when did a standardised cirteria get invented

A
  • 1952
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7
Q

what are the different ways to tell if someone is ‘mad’

A
  • 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
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8
Q

what are the crtiques of DSM-IV

A
  • 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
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9
Q

what is the main physical treatment for mental illness

A
  • ECT
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10
Q

what drugs were used to treat mental illness

A
  • John Cade
  • Lithium
  • found it had a calmin effect
  • killed on patient in a trial an made two others very ill
  • published in 1949
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11
Q

what were the first anti psychotics

A
  • developed 1950s
  • anaesthetics and antihistamines
  • chlorpromazine
  • slow repsonse and control agitatation
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12
Q

what were first generation anti psychotics

A
  • Haldol (haloperidol)
  • Mellaril (thioridazine)
  • Prolixin (fluphenazine)
  • Thorazine, Largactil
    (chlorpromazine)
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13
Q

what were second generation anti psychotics

A
  • Clozaril (clozapine)
  • Zyprexa (olanzapine)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
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14
Q

what were side effects to anti psychtoics

A
  • cruel and unusual doses

- taradive dyskinesia a neurological disorder

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15
Q

what are the positive and negatve symptoms of schizophrenia

A
  • 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
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16
Q

how many people does schizophrenia effect

A
  • Sz affects around 1% of population
  • Chance of a relative with Sz is around 10%
  • Identical twin concordance rates of only 45%
17
Q

what are envionmental factors that affect schiozphrenia

A
  • 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
18
Q

what is the dopamine theory of Schizophrenia

A

parkinsons disease research suggested that antipsychotics worked by disrupting dopaminergic transmission
- Sz was caused by high levels of activity at dopamine receptors

19
Q

what are dopamine receptors

A
  • Phenothiazines (like chlorpromazine) bind to D1
    and D2 receptors
  • Butyrophenones (like haloperidol) bind to D2
    receptors
20
Q

what is off label prescription?

A
  • 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.
21
Q

what was the impact of anti psychtoic medication

A
  • 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
22
Q

why do people stop taking psychartric medication

A
  • 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
23
Q

what did dr thomas szasz believe

A

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
24
Q

what are two drug free ways forward

A

1- neuroplaciticy

2- trauma informed diganois

drugs that change the world (21 decks)

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