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PubMed1989

Physical treatments in psychiatry: current and historical use in the southern United States.

Several surveys during the 1970s showed a decline in the use of electroconvulsive therapy (ECT). Psychosurgery, insulin coma, and continuous sleep treatment are widely assumed to be in total disuse. This is the first comprehensive survey on the use of physical treatments in psychiatry in the southern United States. Seventy-five percent of 315 surveys sent to psychiatric medical directors and chief residents were returned. ECT was used in 89% of training hospitals, 57% of Veterans Administration hospitals, and 44% of private hospitals, but only 19% of state hospitals within the last year. None of the 19 state hospitals begun since 1970 had started ECT services. Moreover, state hospitals abandoned ECT at a higher rate than private hospitals. The lack of this service in the public sector is a result of sociolegal pressure rather than lack of confidence or enthusiasm for ECT. The other physical treatments were reported to be in almost total disuse.

Convulsive Therapy↗

PubMed2006

Neuroethics.

Neuroimaging, psychosurgery, deep-brain stimulation, and psychopharmacology hold considerable promise for more accurate prediction and diagnosis and more effective treatment of neurological and psychiatric disorders. Some forms of psychopharmacology may even be able to enhance normal cognitive and affective capacities. But the brain remains the most complex and least understood of all the organs in the human body. Mapping the neural correlates of the mind through brain scans, and altering these correlates through surgery, stimulation, or pharmacological interventions can affect us in both positive and negative ways. We need to carefully weigh the potential benefit against the potential harm of such techniques. This paper examines some of these techniques and explores the emerging ethical issues in clinical neuroscience.

Behavior Control↗

PubMed1995

Changes in metabolism of cerebral glucose after stereotactic leukotomy for refractory obsessive-compulsive disorder: a case report.

Brain glucose metabolism was investigated with PET and [18F]fluorodeoxyglucose, before and after a bifrontal stereotactic leukotomy in a 37 year old woman with refractory obsessive-compulsive disorder. A bilateral decrease in glucose metabolism was found in the orbital frontal cortex after psychosurgery. Glucose metabolism was decreased to a lesser degree in Brodmann's area 25, in the thalamus, and in the caudate nucleus. Clinical improvement in obsessive-compulsive disorder after stereotactic tractotomy seems to be associated with metabolic changes in the brain, in particular, in the orbital part of the frontal lobe.

Adult↗

PubMed1981

Prolactin levels in cerebrospinal fluid of patients with chronic schizophrenia.

Baseline concentrations of prolactin (PRL) was determined in the CSF of 28 lobotomized and 28 non-lobotomized patients with chronic schizophrenia. The mean PRL level of the female patients was significantly higher than that of the male patients (p < 0.001). In addition, non-lobotomized patients had significantly higher concentrations of CSF PRL than patients of the lobotomized group (p < 0.05). On the other hand, patients belonging to the latter group exhibited significantly more central as well as cortical brain atrophy than the patients on whom no psychosurgery had been performed (0.05 > p < 0.001). The significance of cerebrospinal PRL as an index of central dopamine metabolism is discussed.

Adult↗

PubMed1984

The ethics of therapeutic modality choice.

Psychiatrists usually select therapeutic modalities for their patients on the basis of empirical and theoretical considerations. Only in special circumstances (e.g., psychosurgery) are ethical concerns primary. Yet every therapeutic decision involves questions of value and requires ethical justification. The author outlines four resources for ethical direction in therapy: a general systems or biopsychosocial formulation of the clinical problem, the historic ethical commitments of the medical profession, the patient's informed perspective, and the psychiatrist's own values. Finally, a method is proposed for the resolution of conflicts among these four perspectives in individual cases.

Attitude of Health Personnel↗

PubMed1997

Novel alternatives and supplements to lithium and anticonvulsants for bipolar affective disorder.

BACKGROUND: Most clinicians are familiar with the traditional anticonvulsants as alternatives to lithium in the treatment of bipolar mood disorders. METHOD: This review of the English, French, German, and Italian language literature on novel treatments, including electroconvulsive therapy, calcium channel blocking agents, antipsychotic drugs, benzodiazepines, thyroid hormone, psychosurgery, and two new antiepileptic drugs, that have not been studied as extensively as lithium, carbamazepine, and valproate but that may have promise as alternatives or supplements to traditional thymoleptics when the standard treatments are not effective or are poorly tolerated. We searched MEDLINE and PSYCHINFO data bases using the keywords bipolar, mood, and/or treatment. We then searched bibliographies of articles retrieved by the first strategy. RESULTS: The theoretical rationale for each treatment is discussed, followed by a critical discussion of the evidence supporting its efficacy. CONCLUSION: The potential risks and benefits of each treatment in actual clinical practice are placed in perspective.

Anticonvulsants↗

PubMedDate not supplied

Introduction to the organically based therapies.

The author presents his whole-life experience with biological treatment of mental disorders. He qualified 50 years ago in 1933 and has been psychiatrist for 50 years. During his practice extending over half a century he tested personally and clinical work all biological therapeutic procedures in psychiatry, starting with treatment by pharmacogenic sleep, all types of shock therapy, psychosurgery, modern psychiatric pharmacotherapy as well as possibilities of contemporary prevention of psychiatric diseases by thymoprophylaxis . In this chapter the author presents a chronological review of different types and forms of biological therapy in psychiatry and his own views on the therapeutic effectiveness on different methods of biologically oriented psychiatric therapy.

Convulsive Therapy↗

PubMed1990

Treatment of obsessive compulsive disorder: psychotherapies, drugs, and other somatic treatment.

Ninety percent of obsessive compulsive patients can be helped by treatment with behavior therapy and drug treatment, used sequentially or concurrently. The effectiveness of these treatments has been demonstrated in controlled clinical trials and is superior to electroconvulsive therapy and dynamic or cognitive psychotherapies for this disorder. Potent serotonin uptake inhibiting drugs, from the class of heterocyclic antidepressants, are the most effective antiobsessional medications currently available. Although these drugs usually do not induce complete remission, they can reduce obsessive compulsive symptoms by 30% to 42%. Behavior therapy combines exposure and response prevention, which the patient first learns with the therapist and then practices independently. With behavior therapy, patients confront the triggers for their anxiety and then delay, diminish, or discontinue their rituals. Reduction in symptoms with behavior therapy averages 50% or greater. Behavior therapy is usually not effective in patients who are substantially depressed, are delusional, fail to comply, or undermine therapy with covert rituals or avoidance techniques. The rare patient with very severe obsessive compulsive disorder who does not respond to behavior or drug therapy may be a candidate for psychosurgery. Modern psychosurgical procedures are quite safe and can improve symptoms in the majority of otherwise unresponsive patients.

Antidepressive Agents↗

PubMed1988

Obsessive-compulsive disorder: a treatment review.

Obsessive-compulsive disorder, which may affect 2% to 3% of the U.S. population, can be severely disabling, permeating an individual's personal, social, and work life. Only within the past 2 decades have effective treatments been proposed and tested. Specific behavior therapies such as exposure in vivo and response prevention have proved successful in decreasing compulsive rituals in 70% to 80% of patients who accept and comply with treatment. For those patients who do not respond to behavior therapy, medications should be used. To date the tricyclic clomipramine is the only medication that has been consistently effective in controlled studies. However, for certain patients other medications may be of benefit. For the minority of patients who do not respond to either behavior therapy or medication, psychosurgery--specifically stereotactic limbic leucotomy--should be considered a viable option.

Anti-Anxiety Agents↗

PubMedDate not supplied

The management of resistant depression.

Between 10 and 30% of depressed patients, mostly bipolar, develop a therapy-resistant illness. The known causes of such chronic evolutions are discussed: misdiagnosis (underlying schizophrenia, personality disorder or dementia), drug-induced depression (neuroleptics), systemic disease (hypothyroidism, multiple sclerosis, cardiovascular or neoplastic disease etc.), or lack of efficacy (drug compliance, insufficient dosage). Remedies are suggested: adequate dosage, drug combination (Newcastle cocktail. tricyclic antidepressant + MAOI, imipramine + T3), carbamazepine in lithium-resistant cases, alprazolam, reduction in vanadium intake, sleep deprivation, psychosurgery.

Antidepressive Agents, Tricyclic↗

PubMed1988

[Dynamic syndrome formation in patients with schizophrenia in the late period after a prefrontal leucotomy].

The authors analyze the course of the underlying process after prefrontal leucotomy in 15 patients with schizophrenia. Types of syndrome transformation are analyzed on the basis of a long-term follow-up (30 years). Three variants of the course of the underlying disease and the initial status of patients are described. Destructive postoperative morphological changes in the brain are examined by unidimensional echoencephalography. The relationship between classical leucotomy and modern methods of psychosurgery is considered.

Aged↗

PubMedDate not supplied

[Neuropsychology and psychological testing: boundaries and proximity (author's transl)].

The psychological testing is briefly described and we present the fields of proximity between neuropsychology and psychometry (psychosurgery and aphasiology. Yet it appears that usefulness of psychometry in neuropsychology is only limited to practical aspects. The main limitation arises from two problems: non-neuropsychological goal of psychometry and non-functional and quantitative studies of behavior. A specific "neuropsychometry" is presented and examples are suggested from studies of italian, soviet (Luria's school) and swiss (Piaget's method) researchers; applications in clinical neuropsychology are discussed. In conclusion, neuropsychology must produce a functional analysis of behavior and conceive this behavior as a reorganisation rather than a deficit or a loss.

Factor Analysis, Statistical↗

PubMed1978

Psychiatric treatment. General implications and lessons from recent court decisions in California.

The California legislature enacted tight constraints on the use of psychosurgery and electroconvulsive therapy in 1974. In April 1976 a State Court of Appeals declared part of the law to be unconstitutional. In doing so, the court enunciated several principles for regulating medical procedures. It affirmed the inherent police powers which permit the state to safeguard the public, especially incompetent, involuntary or confined persons, with respect to intrusive and hazardous medical procedures and to procedures which affect thought or feeling. Although limited to legislation concerning two psychiatric procedures, the court's decision, and subsequently enacted legislation governing these procedures, has implications for other medical procedures and for other parts of the nation.

Adolescent↗

PubMed1981

Leucotomized and nonleucotomized schizophrenics: comparison on tests of attention.

Deficits in attention have been strongly linked with both schizophrenia and pathology in the prefrontal cortex. This observation was tested by administering a battery of commonly used tests of attention, sustained mental activity, and tracking to 16 patients who had undergone prefrontal leucotomy approximately 25 years earlier. Presurgical diagnosis in each patient was schizophrenia. The 16 were divided into three groups based on their recovery after surgery. A control group of nonleucotomized schizophrenics was established to control for psychiatric symptomatology. A second control group consisted of subjects without history of psychiatric or CNS disorder. In general, there was no statistically significant impairment of performance in attention tests between the patients with prefrontal psychosurgery and the normal control subjects. The nonoperated schizophrenic control group performed most poorly. Lesion chronicity, interaction of leucotomy and presurgical psychiatric state, and conditions of test administration are suggested as possible explanations for the unexpected results.

Attention↗

PubMed1980

[Medical ethics problems in psychiatry].

A humanitarian attitude and ethical convictions have contributed much to the development of psychiatry. In the present time these convictions have been codified, for instance in the declaration of the World Federation of Psychiatry in Hawaii 1977. In more detail the author discusses 3 areas where ethical considerations have special significance: the scope of psychotherapy, psychosurgery, and the use of psychiatric means to suppress and discipline politically dissident persons.

Ethics, Medical↗

PubMed1995

Management of obsessive compulsive disorder.

The treatment of obsessive compulsive disorder was characterised by therapeutic pessimism until 25 years ago when effective treatments using behaviour therapy and the serotonin reuptake inhibitors were developed. At present the best available treatment is a combination of behaviour therapy and pharmacotherapy with a serotonin reuptake inhibitor. Psychosurgery is only indicated for patients who fail to respond to pharmacologic and behavioural treatments and who suffer from disabling symptoms.

Behavior Therapy↗

PubMedDate not supplied

Practical management of treatment-resistant affective disorders.

The Geoffrey Knight National Unit was set up in 1970 exclusively for psychosurgery. In recent years it has become increasingly concerned with the development of medication regimens that might avoid the need for surgery. This has offered a unique pharmacotherapeutic opportunity because all the referrals have severe, persistent and treatment-resistant disorders. The scheme of high-dose and combined medication devised is presented and discussed.

Algorithms↗

PubMed1976

A prospective evaluation of open prefrontal leucotomy.

Forty-three patients received an open prefrontal leucotomy for severe and intractable psychiatric illnesses. As a result of the operation three patients died, three developed personality changes and one had repeated grand-mal seizures. Of the 40 patients followed up for six months, 57-5% showed marked improvement in their clinical state and 30-0% mild to moderate degrees of improvement whilst no patient's condition was considered to be worse. Significant improvement was obtained after operation in the mean scores on the Hamilton Anxiety Scale, the Hamilton Depression Scale, the Beck Depression Scale and the Neuroticism Scale of the Eysenck Personality Inventory. Extroversion, as measured by the Eysenck Personality Inventory, was significantly increased after operation. It is recommended that open prefrontal leucotomy procedures be replaced by the safer stereotactic or electrode implantation techniques and that all psychosurgery be confined to specialist units.

Adult↗