Somatic therapies

Discuss issues surrounding the use of Biological (somatic) therapies. The three main biological therapies are Chemotherapy, Electro convulsive therapy and Psychosurgery. Chemotherapy involves the use of drugs to treat mental problems. For example, Anxiolytics or Anti-anxiety drugs are subscribed to calm and reduce anxiety. They are known as Minor tranquillisers as large doses can cause drowsiness and act as a sedative. Examples of Anti-anxiety drugs are Librium and Valium, which are relatively cheap and widely used.

With Anti-anxiety drugs, they should only be prescribed for a short time as prolonged use can result in tolerance and dependency. Use of Anti-anxiety drugs for over six months can also cause people to experience withdrawal syndrome, which includes apprehension, anxiety tremor and muscle twitching. Otherwise, the short-term side effects Gelder adds have the properties of sedatives, hypnotics, muscle relaxant and anti-convulsing properties. They do not have as many possible side effects as Antipsychotics but are similar to the EP symptoms. EP side effects include muscle spasms, agitation, tremor, chewing and sucking movements.

Antipsychotics are another type of drug and originally developed to calm patients facing surgery. In some cases, it allowed the most disturbed schizophrenics to live outside or reduce their length of stay at a hospital. It was found to be particularly effective in treating acute symptoms of schizophrenia such as hallucinations, excitement, thought disorder and delusions. It is also referred to as ‘Positive’ symptoms and work by blocking the D2 receptor for dopamine. Unfortunately, Antipsychotics do not work for the ‘Negative’ symptoms of blunting, slowness of speech, lack of movement and social withdrawal.

As with most drugs, Antipsychotics involve side effects including all the EP ones and others, which can be dry mouth, blurred vision, low blood pressure, constipation and hypothermia. Hutton 1998 quotes that even though the side effects are rare, they can be life threatening and can occur anytime. The newer drugs e. g. clozapine however, have claimed to be able to treat ‘Negative’ symptoms and are less likely to cause EP symptoms. The effectiveness of drugs is questioned so placebos were used as ‘fake’ pills to see if improvements were still being reported.

Fishers and Greenberge found from research that placebos cause the brain to think and respond in equivalent ways to talk and drug treatments. The general idea of Chemotherapy was to reduce the likelihood of death from surgical shock. Electro convulsive Therapy (ECT) is quite different from the use of drugs where the aim is to ‘shock’ the brain with an electrical current. In doing so, it would eliminate the symptoms of schizophrenia, but it has been found more effective on depression. It is conducted by the patient lying on a bed and given an anaesthetic medication called Atropine, which dries up salivary and bronchial secretions.

Thigetone is then given as a quick acting anaesthetic along with a muscle relaxant. Electrodes are then connected to the temples and 70-150 volts lasting 0. 04-1 second is transmitted. The use of one electrode on the non-dominant hemisphere side is called Unilateral. Bilateral means the use of two electrodes on either side of the head. The procedure is usually done 2-3 times a week for 3-4 weeks. ECT has been said to be more effective than Anti-depressents. Sackeima 1989 provided an experiment where real ECT was performed as well as a fake one (SHAM).

It was found that the real condition was more effective. This shows that ECT does make a difference to a patient’s condition but it was not stated whether or not it was the better. Unilateral ECT can reduce depression by changing the biochemical balances of the nor-adrenaline and endorphins. Bilateral ECT is more effective than Unilateral but have greater memory deficits. This can be a problem, as the size of the memory problem cannot be known. With both ECT types, the patients would be confused for up to 40 minutes after treatment but memory of prior events may gradually return.

However, Breggin 1991 believes that it can cause brain damage, delirium and brain syndrome, severe and long-term cognitive and emotional functioning. Adding to this, a likelihood of amnesia and the inability to form new memories. Another immediate effect of Electro convulsive therapy is face and limb twitching which lasts for a minute. ECT can be criticised as being uncertain and not definite about the outcomes, which is all the reason against the use of it. It is also unethical too as full consent may not come from every patient.

Even if the patients did give consent, they may not be in such a psychological state to understand the dangers with ECT. The benefits are short and the side effects are long. There is also evidence for suicide risks after ECT. Also the mortality rate is 3. 6-9 per 100,000 treatments but is argued to be low compared to depression related suicides. The greatest problem, which has been mentioned from the associations MIND, PROMPT, and NAPA, is that death is a possibility. Any treatment with such a probability should be considered inappropriate. It seems also that there are more issues on the harmful effects of the treatment than there are good.

Psychosurgery was first established by Jacobson when apparently, outbursts were abolished in chimpanzees. Moniz pioneered it as it was also found to tranquillise monkeys when surgery was performed on the frontal lobes. The procedure involved severing the neural connections between the pre-frontal areas and the hypothalamus and thalami. It was assumed that the thought (cortex) would be disconnected from the emotion (lower brain). Moniz also used practised the leucotomy (prefrontal lobotomy) where a hole was drilled just above the ears so that a probe could be inserted and destroy brain tissue.

This alone seemed to successfully reduce aggressive behaviour, but Moniz then inserted alcohol to destroy the frontal lobe brain tissue (‘Apple Corer’ technique). This was done on schizophrenics and people with compulsive behaviour. This technique was claimed to be 70% effective. In Cinoulotomy, the cingulum bundle (small bundle of nerve fibres connecting the prefrontal cortex with parts of the limbic system) is cut in order to treat OCD and ‘evidently does so successfully’ (Lippitz et al 1999). Transorbital lobotomy involved insertions via the eye sockets to the brain and the probe is then moved up and down.

Standard prefrontal lobotomy was particularly popular where 25000-40000 operations were undergone (Freeman 1942). Modern lobotomy (capsulotomies) involves cutting two tiny holes in the forehead, which allow radioactive electrodes to be inserted into the frontal lobe to destroy tissue by beta rays. The thermocapsulatomy is where an electrode (that is heated to 68? C) is inserted in to the brain and controlled by a computer. It can be used to interrupt the neural pathways between the limbic system and hypothalamus. By doing so, it could possibly alleviate depression.

Unfortunately, the results seem very uncertain and are only hopes to the benefits that this technique would yield. With psychosurgery in general, there is no scientific support for why advantages occur in result of damaging brain tissue in surgery. David 1994 adds that there is a lack of knowledge to the prefrontal lobes so it is not suitable for use as treatment. Valenstein 1990 also criticised Moniz, saying how the reports on success were exaggerated. It is also ironic that whilst he was receiving his Nobel medicine prize, he was shot and paralysed by a former patient.

With Psychosurgery, it seems that there is a lack or evaluation with the practice as the main causes to the effects cannot be identified and it is necessary to say that psychosurgery tends to produce inconsistent outcomes where different people would have different side effects. There is a long list of possible side effects including impaired judgement, epileptic type seizures, blunting, intellectual, creativity, learning and memory impairment. It is also difficult to track the progress of patients’ behaviour or to even know whether or not improvement came because of the surgery (Gelder 1989).

The overall effectiveness of chemotherapy is that they rapidly reduce the symptoms of depression and schizophrenia. Antipsychotics may even shorten a patient’s stay at a mental hospital and help manage ‘positive’ and ‘negative’ (clozapine) symptoms of schizophrenia. Antidepressants can effectively help depression but it is suggested that ECT maybe even more effective. The use of antidepressants can be beneficial in the short-term e. g. anticonvulsive properties (Gelder) but prolonged use for over 6 months can cause tolerance and dependency.

Physical problems can include muscle twitching and psychological problems: withdrawal syndrome, which is present with antipsychotics as well. These side effects may not be as problematic as ECT and Psychosurgery where there is a chance of brain damage and other severe long-term detriments. With both of these, death is a possibility but the aim was to reduce the likelihood of death so it would not be as sensible to use them. Also the extra side effects in antipsychotics (not present of antidepressants) can be life threatening too (Hutton). This leaves antidepressants being the least risky.

Inconsistencies in Psychosurgery and uncertainties in ECT outcomes, lower their reliability. There is no scientific evidence for the results of Psychosurgery and a lack of knowledge to the prefrontal lobes. The aim of ECT is vague, only identifying that the biochemical balance of nor-adrenaline and endorphins need to change. At least with Chemotherapy it is known that the drugs block D2 receptors for dopamine. However, if placebos were found to work, it could suggest that patients have a degree of control over them-selves and perhaps do not have a mental disorder because of a chemical imbalance.

Unfortunately there is a lack of research in this area. In terms of the regularity of each therapy, anti-anxiety drugs may be prescribed for up to 6months and possibly taken throughout the day. ECT is performed 2-3 times a week for 3-4 weeks which is less often as chemotherapy by it may take up more time as after each session, the patient cannot resume back to their activities. With Psychosurgery, it is unknown how many times it needs to be performed, but as the brain tissue can only be destroyed once, it may not need to be repeated. Unless however, the mental disorders have not been cured.

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