Insanity in historical context:
What is madness?
Behaving in an absurd manner
Thought to be caused by God etc.
How was it dealt with?
Locked them up
• How is it dealt with in 21 century?
Institutionalization (lock people up…)
Dealt with nowadays more humane?
work with them behavourally etc.
The brain and behaviour relationship
• recall the definition of behaviour
• if you want to change behaviour, yu must change the brain
• These therapies do help insanity
Insanity in current contexts
• The term insanity is no longer used in most professional fields
in law, can be used in court (plead insane)
• Specific diagnonses are preferred e.g.
All have their own characteristics, and diagnoses…
What is psychosis
• Dysregulation in information processing within the brain leading
to altered mental states
• Symptoms can span a range of mental functions:
3 different classes:
o Positive symptoms
increase in function
o Negative symptoms decrease in function
o Cognitive symptoms
either amped up or decreased…
Presents in conditions such as schizophrenia, mania,
dementia, delirium, drug influence and schizoaffective
• Drugs can also produce psychotic behaviours…what drugs can
Psychedelics (e.g. hallucinogens, Ketamine)
• DSM-IV criteria:
• Typically surfaces in early adulthood
• Increased suicide risk
Can be fatal, important to talk about and work through in
• Variable course of outcome
Some people can do quite well in therapy, others may not..
Not really known, but dysregulation of thought suggests
Don‟t memorize all of chart, idea is to look at all the
different components – there is a lot!! Predisposing factors,
thought to influence later state
o There is this level of functional disruption – neurons
aren‟t talking to each other like they should be
o One idea - too much DA in brain???
• Dopamine theory of Schizo:
Presentations are due to too much DA in brain (DA
Anti-psychotic drugs work by antagonizing DA receptors
Should know DA system by now!!!
o Synthesis etc
o DA tracts (x4)
tuberoinfundibular = hormonal tract…important
for side effects for DAergic drugs
• Dominant theory is still used and held to this day…
But there are other ideas that are emerging
o Serotonin Hyperfunction?
Evidence for this?
1) LSD + psychedelic drugs are
sometimes called “psychotomimetics”
because they can mimic psychosis
behaviour Maybe these drugs mimic this
because they work at the serotonin
o i.e. 5HT agonist = LSD
2) 5-HT receptor line of evidence that
suggests maybe there is too much
serotonin in the brain that gives patients
these psychosis features
o NMDA Hypofunction?
Evidence for this?
1) Ketamine and PCP = NMDA
Give these drugs to lab rats etc,
they develop a lot of behaviours
that look like schizophrenia
2) Create a mouse that has its NMDA
receptors taken out, it causes a
schizophrenic phenotype in the
mouse…suggests NMDA tone
• All ties in with functional deficit can fix these with drugs, but
in the chart is also says anatomical features
If anatomical problem, then none of these things are going
Have to look at other strategies, (like growth factors etc)
• Historically patients confined, isolated
• early treatments relied on psychosurgery (lobotomy)
• 1950s introduced of pharmacotherapy radically changed
People were „let out‟ into the world again – de-
o These people are used to living in an institution –
used to having this very structured life (when they
go out into the real world they have to learn how to
get a job, cook for themselves etc – very very
o Hard to deal with going out into unstructured world
o Highlights the point that you really have to have
occupational, behavioural therapy in addition to
letting them out into the world – important to give
supportive networks to go with it so people can
adjust back in
• There are pharmacotherapeutic approaches:
Atypcial anti-psychotics Traditional/classic anti-psychotics:
• 1950s – Chlorpromazine
while it calmed normal people down, try it in psychotic
patients to see if it did – it did!
• 1960s – Haloperidol
• Both drugs led to hug drops in institutionalistion
• Use these drugs in combination with behavioural therapy!!
Not what happened historically…huge fail
• Mode of action
Decrease in positive psychotic symptoms
• Mechanism of action
Antagonist for D2 receptor
Also affects a lot of other receptors - not a highly selective
• Side effects:
Parkinsoneon motor deficits
o Late onset dyskinesia
When you block these D2 receptors, you get hormonal
o Prolactin release is disinhibited – for men, breast
development, lactation when not feeding child (preg)
o Decreased gonadotropic release – sexual side effects
Also have side effects that relate to inhibition of other
o Dry mouth, blurred vision, mydriasis, hypotension,
sedation, antiemetic (drug that‟s used to help you
stop throwing up)
o Protracted elimination period – metab
Good = helps you wean off the drug…rather
than just stopping – slow release mechanism