History of Psychiatric Treatments
Malaria as a Mental Treatment
From the late 19th century, doctors in psychiatric asylums began to report that some patients got better after they had had a bout of pneumonia, typhoid, or other febrile illness. One of these doctors Wagner-Jaureggs's decision that a malarial infection was the best remedy was only reached after a great deal of trial and error and his patients were in no position to refuse. He proselytised his new treatment in papers and conferences before and after World War I, and it was taken up in many countries, despite frequent reports that "cures" were temporary and relapses common. Insulin Coma Therapy (ICT) Insulin Coma Therapy was introduced in 1927 and was used extensively in the 1940s and 1950s. Coma was induced by the injection of varied doses of insulin, but the methods of administering the treatment varied and there was no agreed way of doing it. Patients were usually given not just one treatment, but a series of treatments that could last for weeks. Epileptic seizures occurred during the early stages of the treatment, about 45 - 100 minutes after injection, before the onset of coma. Insulin treatment was gradually replaced by drug therapy and finally abandoned in the mid 1960s. Prefrontal Lobotomies On November 12th, 1935, Moniz and Lima performed for the first time what they called a prefrontal leucotomy ("white matter cutting") in which two of the bundles of nerve fibres connecting the frontal cortex and the thalamus were severed. They later developed a special wire knife called a leucotome, which had an open steel loop at the end; when closed, the loop severed the nerve tracts within it. Electroconvulsive Therapy (ECT) ECT was first used in the UK in 1939. Electrodes were placed on both sides of the patient's head (or on one side only) and a dose of 70 - 150 volts was usually given for 0.1 - 0.5 seconds. In the early treatments patients were held down by a team of four nurses as convulsions happened, to prevent broken long bones or joint dislocation due to muscle pull. Later, from the 1950s, a muscle relaxant and intravenous anaesthesia were given beforehand. This was known as modified ECT and this treatment is still used today. Drug Treatments and Therapies The introduction of Largactil in 1955, which was the first of the phenothiazine drugs, some psychiatrists called "a real revolution". Psychotropic or psychoactive drugs affect the central nervous system and change behaviour or mood. They are used to treat the symptoms of "mental illness". The use of these drugs has been the subject of much debate; for example benefits, side effects and over prescribing. The acute services are now moving to a more home based approach where therapies and treatments are done on a outreach principle. People should be assured that good inpatient care will always be available for those who are in need of that service. |