Treatment



Treatment |Use of treatment |Mode of action |Appropriateness |Effectiveness |Ethics | |

|Psychosurgery |- Psychosurgery is an extreme form of |- The first technique was the |In the 1950s and 1960s some |Psychosurgery continues to be regarded|It is irreversible, and the |

| |somatic treatment and was mainly used |lobotomy, developed in the 1940s as a |amygdalotomies resulted in patients |as the most controversial of all |effects are not consistent. |

| |before the introduction of drug |cure for schizophrenia. This involved |who were confused, lacking in |treatments for mental disorders. The |Informed consent is an issue |

| |therapy. It involves the cutting of |removing large portions of the frontal|motivation and unable to work (Eysenck|procedure is irreversible because once| |

| |neural tissue in the brain and was |cortex or severing the connection |and Eysenck,1989). |neural tissue has been destroyed it | |

| |designed to change a psychological |between the frontal cortex and the | |stays destroyed and there is no | |

| |condition. |lower centres of the brain. In the UK,| |guarantee that the procedure will have| |

| |- Jacobsen et al. (1935) removed the |10,000 were performed between 1942-52.| |a beneficial effect. | |

| |frontal lobes of an emotionally | | |- Significant bad effects were found | |

| |disturbed chimpanzee called Becky, |- In the 1960s this procedure was | |with the earlier lobotomy operation, | |

| |reducing her temper tantrums. Moniz |replaced by the pre-frontal leucotomy,| |such as withdrawal, stupors, seizures | |

| |(1937) was inspired to reduce |thought to be less extreme, which | |and even death. The more recent | |

| |anti-social behaviour in humans in a |involved drilling two holes in either | |leucotomy procedure is less severe, | |

| |similar manner. |side of the skull and inserting a | |but there are still dangers involved. | |

| | |pointed instrument to cut specific | |- Prefrontal leucotomies are | |

| | |nerve fibres. | |occasionally used in cases of severe | |

| | |- A more recent procedure is the | |depression, obsessive-compulsive | |

| | |cingulotomy, where a tiny cut is made | |disorder or pain where all other | |

| | |in the cingulum nerve fibres, using an| |treatment has failed (Griest, 1992). | |

| | |electrode needle which is guided by | |Minimal intellectual damage is caused | |

| | |magnetic resonance imaging, making the| |because of refined techniques. | |

| | |procedure much more precise. | |- osgrove et al. (1996) report | |

| | |Alternatively, amygdalotomies, where | |successful treatment of patients with | |

| | |the amygdala is cut. Both of which are| |depressive or anxiety disorders using | |

| | |areas involved in anger and emotion. | |cingulotomies. These patients had not | |

| | | | |benefited from all other available | |

| | | | |therapies. It is possible that | |

| | | | |psychosurgery can be effective if it | |

| | | | |is performed precisely and on the | |

| | | | |right patients. | |

|Electro-convulsive therapy (ECT) |ECT is generally used in severely |A patient is given an anaesthetic and |There is some discomfort about using a|ECT is a controversial treatment, not |In the past ECT involved |

| |depressed patients for whom |muscle relaxant. A sub-lethal (70-130 |method which cannot be explained; it |least because the people who use it |broken bones and severe |

| |psychosurgery and medication have |volt) electric shock is applied to the|may not be the seizure which is |are still unsure of how it works - a |memory loss, the treatment |

| |proven to be ineffective. It can also|non-dominant cerebral hemisphere |important at all (Abrams, 1997). |comparison has been drawn with kicking|today is more humane but is |

| |be used for those who suffer from |(unilateral) to produce a seizure. The|- The method has some risk. Drug |the side of the television set to make|still regarded by some as |

| |schizophrenia and manic depression. |individual awakens and remembers |therapies are safer but ECT offers |it work. |abusive. |

| |ECT is employed when there’s a risk of|nothing of the treatment, but may |faster relief than drugs, which is |When ECT was first introduced there |- The Department of Health |

| |suicide as they are much quicker than |suffer long-term memory loss. A course|important for suicidal patients. |were dangerous side effects, such as |(1999) considered 700 |

| |drugs. ECT should only be used when |of treatment usually involves six | |bone fractures, memory loss and |patients who received ECT |

| |all else fails! |sessions. |There are physical side effects such |confusion. There are no detectable |were sectioned; 59% had not |

| | |- It is thought that the convulsion |as impaired memory, headaches. 1/3 of |changes in brain structure with the |consented to treatment. |

| | |causes chemical changes in the brain |patients suffer from memory loss. |newer unilateral procedure and, as the| |

| | |in a way that improves the person’s | |technique is continually improved, | |

| | |mood state. The shock activates | |side effects are being reduced. | |

| | |nonadrenaline transmission, reduces | |- ECT remains controversial; it | |

| | |serotonin re-uptake and increases | |requires consent from the patient or | |

| | |sensitivity of dopamine receptors, all| |close relative and is only used when | |

| | |of which may help alleviate depression| |other methods have failed. | |

| | |The original procedure was bilateral, | |- ECT is now rarely used for | |

| | |i.e. the current passed through both | |schizophrenia; however, it appears to | |

| | |cerebral hemispheres of the brain. The| |be successful for cases of severe | |

| | |patient was awake prior to the | |depression. Klerman (1988) maintains | |

| | |seizure. Later, a strong muscle | |that ECT may be the best treatment for| |

| | |relaxant and an anaesthetic were given| |severe depression. Janicak et al. | |

| | |prior to treatment in order to reduce | |(1985) found that 80% of all severely | |

| | |the body being out of control and the | |depressed patients respond well to | |

| | |damage that could be caused as a | |ECT, compared with 64% given drug | |

| | |result. The procedure used now is also| |therapy. ECT has been successful in | |

| | |unilateral, passing the current | |treating severe depression in patients| |

| | |through the non-dominant hemisphere | |where all other methods have failed | |

| | |only (Abrams et al. 1991). It was | |and many argue that this is sufficient| |

| | |thought that memory loss allows | |justification for its use, especially | |

| | |restructuring of disordered thinking. | |if it prevents suicide. | |

| | |However, unilateral ECT leads to | |- However, Sackheim et al. (1993) | |

| | |minimal memory disruption yet is still| |found that there was a high relapse | |

| | |effective. | |rate within a year suggesting that | |

| | |- ECT is still used today, though the | |relief was temporary and not a cure. | |

| | |mortality rate is now very low at 3.6 | | | |

| | |per 100,000 treatments. This is about | | | |

| | |the same number of people who die from| | | |

| | |anaesthetic in minor surgery. | | | |

|Chemotherapy/Drugs |Anti-anxiety drugs: includes the minor tranquillisers such as Librium and |The use of drug therapies has offered |Effectiveness varies between |Drug therapies are |

| |Valium. They were introduced in the 1950s and 1960s and soon became the most |significant relief to many sufferers, |individuals, detracting from its power|chemical-straitjackets, |

| |prescribed drugs in the world. They are used to reduce the symptoms of |leading to deinstitutionalisation. In |as a therapy. For example, Spiegel |infringing individual rights.|

| |generalised anxiety disorders and to combat withdrawal symptoms from alcohol |1955 there were 560000 patients in |(1989) found 65% of depressed patients| |

| |addiction, etc. Side effects include drowsiness and addiction. Buspirone has |American psychiatric institutions. By |improved using tricyclics. | |

| |fewer side effects. |1977 this had declined to 160000. | |The use of chemotherapy may |

| |Anti-depressant drugs: These are stimulants e.g. monoamine oxidase inhibitors | |Gerbino et al. (1978) report that |prevent the use of other |

| |(MAOls), tricyclics, selective serotonin reuptake inhibitors (SSRls, e.g. |Drugs are reasonably effective for |manic-depression is controlled by |methods. Alternatively it may|

| |Prozac). Prozac is the newest of the anti-depressant drugs. [It has been |treating certain mental disorders and |lithium in about 80% of patients and |enable patients to be |

| |called the ‘happy pill’, 500,000 people in Britain take it.] They promote |are readily available, easily |has considerably reduced the suicide |receptive to other methods. |

| |activity of nonadrenaline and/or serotonin, leading to increased arousal but |administered and cost-effective. It |rate. | |

| |can be affected by rebound (depression after initial euphoria). It regulates |can be easier and quicker for GP’s to | |Drugs may be necessary as a |

| |mood, causes relaxation and controls aggression. They can be effective in |prescribe drugs than to engage in |Drugs can be effective when used in |means of protecting society |

| |treating depression, but they do not work for all patients. They can also be |counselling [for which they may not be|conjunction with psychotherapy; they |at large from individuals who|

| |used to treat phobias. Side effects include dizziness. |trained]. |relieve disabling symptoms, allowing |are dangerous. However, |

| | | |the contributing psychological factors|patients living outside |

| |Anti-manic drugs: These are used to control the mania in those suffering from |Drugs have worked where all other |to be dealt with. |institutions may fail to take|

| |manic-depression. They were discovered through the work of John Cade, an |treatments have failed. | |their medication and pose a |

| |Australian physician. He conducted lithium carbonate tests on guinea pigs, | |Drugs may have a placebo effect - the |serious danger. |

| |after inducing mania by injecting urine from manic patients. Cade then tested |However, there are problems of |person feels that they are better | |

| |his lithium preparation on manic patients and found that their manic euphoria |addiction and dangerous side-effects |because they are taking a pill, | |

| |had calmed within a few days. By the 1970s lithium carbonate had become the |(as indicated above). Drugs are not |irrespective of what is in the pill. | |

| |routine treatment for manic-depression. Within two weeks of taking them, 70 - |cures; they are short-term remedies |Has the drug helped, or has the person| |

| |80 % of manic individuals show an improvement in mood. Side effects include |that may become long-term. |helped themselves? | |

| |damage to the cardiovascular system. |Chemotherapy leads to the | | |

| | |revolving-door phenomenon, patients |Alternatively, the person may have got| |

| |Anti-Psychotic drugs: These are used in the treatment of schizophrenia. They |being continually discharged and |better without the drug. Their | |

| |are major tranquillisers, which sedate the person and reduce such symptoms as |readmitted. |improvement coincided with taking the | |

| |thought disorder, withdrawal, delusions and hallucinations. They tranquillise | |tablet. Drugs may be effective because| |

| |without impairing consciousness. The result of these drugs is that they |Also, drugs do not necessarily provide|the patient believes that the doctor | |

| |allowed schizophrenics to live outside of mental institutions. They have been |a long-term cure, when the person |expects them to improve and this can | |

| |called pharmacological straitjackets as they control people. They do not cure |stops taking the drugs, the symptoms |affect their health. | |

| |the person but alleviate the symptoms. They include chlorpromazine, used to |may recur. They treat the symptoms but| | |

| |treat schizophrenia. They block dopamine receptor sites. Possible side effects|do not treat the problem. But people | | |

| |include blurred vision and a decrease in white blood cells (which can be |may prefer to take them because taking| | |

| |fatal). |tablets are a familiar activity, | | |

| | |unlike other therapies. | | |

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