PHAR1101 Lecture Notes - Lecture 17: Tardive Dyskinesia, Pentylenetetrazol, American Psychiatric Association

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Lecture 17 - Impact of antipsychotics

What is mental illness?

Lunacy/madness in 19th/20th century different to what we consider mental illness

Associated with physical illnesses in the patients body

Not seen as a separate illness based in brain

Major admissions pre 1950s

oOld age/dementia

oEpilepsy, syphilis

oDown syndrome, autism

oPost natal depression, menopause

oAlcoholism

Lunacy

Mania: wild, uncontrolled behaviour/obsessions

Melancholia: sadness, inertia

Confusion insanity: person appears very confused by normal events, cannot understand what

is going on

Delusional insanity person experiencing hallucinations/delusions

Epilepsy: fitting, collapses, unconsciousness, choking

Senile dementia: elderly

Idiocy/imbecilic:: developmental disabilities - children

How can you tell if a persons mad?

No international standardised diagnostic criteria for major mental illnesses until 1950s

1952: the American Psychiatric Association developed Diagnostic and Statistical manage of

mental disorders

First edition - 106 different disorder

DSM 5 editions

DSM V

Frances MD - task force of DSM 4

Frances questions process by which 5 was developed

Cautions will turn current diagnostic inflation into hyperinflation

Potential to convert millions of normal people into mental patients

Diverts much needed resources from the much smaller number of people who need intensive

help

Dementia Praecox

Dementia: any form of progressive mental illness

First discussed in 19th century Europe

Popularised by Emil Kraepelin

Disrupted a patients ability to process info, reasoning, thinking, attention, remembering

Several forms

oDementia paranoids

oHebephrenic

oCatatonia

1908: Swiss Eugen noticed that not all patients continued to deteriorate

oSome recovered - rexamine the splitting up of their minds ability to process info

oBleuer coined term schizophrenia

Schizophrenia

Cause? Unknown

Dopamine hypothesis - late 1960s

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Genetic factor

Environment - stress, violence, migration, urbanity

Drug use - weed/meth

Inflammatory physical illness, squealed of viruses

Prenatal environmental - maternal stress

Cures

Pre 1880s - anything

Care was custodial

19th - moral treatment = being kind, sympathetic

Role of attendants, Nurses - increasingly important for recovery

Proper classification - incurables etc.

Psychiatry dark ages

No advances equivalent to antibiotics

Nobel prize 1927 - Austrian Jauregg

oDiscovered that inducing a high fever (malaria) in a person infected with tertiary

syphilis

oNot a cure for madness

o25% success in cases

oDrove experimentation to find other cures

oBarbaric/bizarre

Narcosis

1901-1936

Scottish Macleod

Coma 21-24 days

Woke up once a day

Insulin coma therapy

Huge dose of insulin and put them in a coma

Sakel from Vienna

Performed in Britain, WA

Convulsive treatment

1930s Hungarian Meduna explored epilepsy/ schizophrenia

Deliberate seizures in patients using heart drug, penta-methylene-tetrazol (cardiazol)

Quickly outstripped insulin coma popularity

Administered several times a week

Short time to perform

Cardiazol treatment

ECT - electo-convulsive treatment

Refractory depression

1938: Italian Bini - electric current

Electroshock - 1939

Promoted as cheaper, easier, less traumatic

Patients did not remember

Until late 1960s - ECT was given unmodified

Without muscle relaxants

Given in open ward settings - in front of other patients

Traumatic for staff/patients

Today; muscle relaxants/anaesthetic

oStandard treatment for severe depression

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Psychosurgery

Leucotomy: prefrontal lobotomy

Never connecting to frontal lobe were cut

Lithium

First effective drug therapy

John Cade- Victoria 1940s

Tested himself/10 other patients (one died)

Bipolar - calming affect

1949 results

Chlorpromazine

1950s accidental discovery

Slowing response, calming, control agitation

Synthesised in France

Allow them to so basic tasks

Optimum doses were unknown

No testing for LTE

oTardive dyskinesia - uncontrolled twitching

Side effects

oDry mouth

oMuscle stiffness, cramping

oWeight gain

Rapidly changing research

International research constantly testing new drugs

Optimum doses still debated

Role of drug companies

Driving/funding - legit research

Failure to be reported

Off-label prescription

Prescribed something for what it is not designed for

Seroquel - sleeping pill (psychiatric drug)

Product info does not include side effects for other usage

Lacks empirical scientific data

Huge profitable = market base increases

Patients should know that the prescription is off-label

Impacts of antipsychotic therapy

Increased use of outpatient facilities

Step-down programs - help ex patients

Increased discharges from large hospitals

A different world

Community outside hospital have changed dramatically in early 60s/70s

Articulate and educated consumer movement made up of ex-patients

Science behind psychiatry

Criticism

Thomas Szasz

Mental illness - no sense

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Document Summary

Lunacy/madness in 19th/20th century different to what we consider mental illness. Associated with physical illnesses in the patients body. Not seen as a separate illness based in brain. Major admissions pre 1950s: old age/dementia, epilepsy, syphilis, down syndrome, autism, post natal depression, menopause, alcoholism. Confusion insanity: person appears very confused by normal events, cannot understand what is going on. No international standardised diagnostic criteria for major mental illnesses until 1950s. 1952: the american psychiatric association developed diagnostic and statistical manage of mental disorders. Frances md - task force of dsm 4. Frances questions process by which 5 was developed. Cautions will turn current diagnostic inflation into hyperinflation. Potential to convert millions of normal people into mental patients. Diverts much needed resources from the much smaller number of people who need intensive help. Dementia: any form of progressive mental illness. Disrupted a patients ability to process info, reasoning, thinking, attention, remembering. Several forms: dementia paranoids, hebephrenic, catatonia.

PHAR1101 Lecture Notes - Lecture 17: Tardive Dyskinesia, Pentylenetetrazol, American Psychiatric Association

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