PHAR1101 Lecture Notes - Lecture 14: Dementia Praecox, Manfred Sakel, Deep Sleep Therapy
Antipsychotics:
Hospital vs asylum:
- Place where sick people are cured, vs safety for those in danger
- Limited time vs. somewhere to live
- Temporary burden want to be cured vs. sent there and cant live in own community
- Community willing to welcome back after vs. not.
What is mental illness:
Differet o to hat as osidered lua i earlier ears
Major auses of etal hospital adissio pre ’s
- Old age/dementia
- Physical illness like tertiary syphilis and epilepsy
- Developmental disorders and disabilities
- Post-natal depression, menopause
- Alcoholism
Early classifications of lunacy:
Mania – wild, uncontrollable behaviour
Melancholia – sadness, inertia
Confusional insanity - person appears confused by normal events, cant understand what goes on
Delusional insanity – person experiencing hallucinations or delisions
Epilepsy – fitting, collapses, choking
Senile dementia
Idiocy/imbecile – children with developmental disabilities.
Ho to tell if a perso’s ad?
19th century – doctor used personal experience, opinion of other doctors and relatives, carers, etc.
- WA pre 1871 – jury of 12 men could determine madness.
- After this, doctor given power to certify someone insane
No international diagnostic criteria
- 1952 first manual developed (DSM) – listed 106 disorders
- DSM V – Allen Frances MD – cautions that will turn current diagnostic inflation to hyperinflation
- has potential to convert millions of normal people to mental
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patients
- diverts needed resources from small no, of people who need
intensive help.
Dementia praecox
Dementia – any form of progressive mental illness
Dementia praecox (early dementia) disrupted a patients ability to process information, to reason, think
clearly, remember and pay attention.
- Dementia paranoids
- Hebephrenia (adolescents and young adults)
- Catatonia (immobile and trance-like-status)
The problem:
Not all patients with dementia praecox continued to deteriorate: (Eugen Bleuler)
- Some recovered – which led him to re-eaie the splittig up of the id’s ailit to proess
info.
- Coied the ter to desrie splittig of the id - schizophrenia
What causes schizophrenia and other mental illnesses:
Possible genetic factor (not proven conclusively or linked to any one gene)
Environment important – stress, violence, migration, urbanicity
Correlation with drug use – cannabis and methamphetamine
Prenatal environment – maternal stress, problems in childbirth
Theories of Inflammatory physical illness, sequelae of viruses
Cures for mental illness:
Pre-’s – anything
- Most are was custodial
19th etur oral treatet = being kind and sympathetic, providing patients with work to do,
treatig as oral ad reoerale.
Role of attendants/nurses seen as increasingly important in recovery
Proper classification also important – incurables housed together away from curables
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Psychiatry dark ages:
No advances equivalent to antibiotics etc.
- First nobel prize to Julius Wagner-Jauregg in 1927
- Discovered that inducing a high fever in person with syphilis could kill syphilis spirochetes.
- only an occasionally successful treatment for symptoms of infectious disease, not cure.
- drove experimentation to find cures
Narcosis treatment (1901-1936).
1901 – Neil Macleod advocated a coma of bromide sleep for 21-24 days
1920s – Jakob Klaesi put mental patients into prolonged narcotic coma, apparently with good results
- Narosis – deep sleep therapy
- Trialled in Wales in 1934 and England in 1936
The Chelmsford Scandal – 1990
Narcosis gradually superseded by other treatments
1960s-90s – used controversially by Dr Harry Bailey at Chelmsford hospital in Sydney
Led to a NSW Royal commission
- Over 1000 patients treated
- 27 died as result
- 24 committed suicide within a year
Insulin coma therapy:
Manfred Sakel found that injecting large doses of insulin (to induce coma) made patients feel tranquil
after.
- Published results in 1934 to unconvinced psychiatric audience
- Swiss researchers embraced the concept and developed the therapy
- Approved in Britain for trial in 1935
- Trialled in WA in 1937
Convulsive treatment:
’s – Ladislas von Meduna explored relationship between epilepsy and schizophrenia
- Deliberate seizures in patients using heart drug, penta-methylene-tetrazol (cardiazol)
- Became focus of intense research in Europe
find more resources at oneclass.com
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Document Summary
Place where sick people are cured, vs safety for those in danger. Temporary burden want to be cured vs. sent there and cant live in own community. Community willing to welcome back after vs. not. Differe(cid:374)t (cid:374)o(cid:449) to (cid:449)hat (cid:449)as (cid:272)o(cid:374)sidered (cid:862)lu(cid:374)a(cid:272)(cid:455)(cid:863) i(cid:374) earlier (cid:455)ears. Major (cid:272)auses of (cid:373)e(cid:374)tal hospital ad(cid:373)issio(cid:374) pre (cid:1005)(cid:1013)(cid:1009)(cid:1004)"s. Confusional insanity - person appears confused by normal events, cant understand what goes on. Delusional insanity person experiencing hallucinations or delisions. 19th century doctor used personal experience, opinion of other doctors and relatives, carers, etc. Wa pre 1871 jury of 12 men could determine madness. After this, doctor given power to certify someone insane. 1952 first manual developed (dsm) listed 106 disorders. Dsm v allen frances md cautions that will turn current diagnostic inflation to hyperinflation. Has potential to convert millions of normal people to mental patients. Diverts needed resources from small no, of people who need intensive help. Dementia any form of progressive mental illness.
