Medical Treatments

SHOCK THERAPIES

Shock therapies were a number of treatments introduced into psychiatry in the first four decades of the twentieth century. They consisted of convulsive therapies (Electroconvulsive Therapy (ECT) and cardiazol/metrazol), Deep Sleep Therapy (DST) and Psychosurgery. This claimed good results in selected cases and promoted a speedy recovery and shortened the length of stay in hospital.

Electroconvulsive Therapy (ECT) is a procedure carried out under general anaesthetic, whereby small electric currents are passed through the brain to induce seizures.  This was mainly used to treat depression but was occasionally used to treat other conditions such as schizophrenia.  It was first used in Exminster in 1937.  

In 1935, the treatment of mental disorders by 'Insulin shock' - a form of treatment whereby patients are repeatedly injected with high doses of insulin in order to produce daily comas over a matter of weeks was introduced at Exminster. This was used for patients with schizophrenia, until it was replaced by neuroleptic drugs (also known as antipsychotics or major tranquilisers) in the 1960's.  These drugs were successful in relieving the symptoms of psychosis in the short term.

PSYCHOSURGERY

Psychosurgery is the neurosurgical treatment of mental disorder.

The operation of 'prefrontal leucotomy' - a now obsolete treatment for schizophrenia, entailed surgical interuption of the nerve tracts to and from the frontal lobe of the brain via bilateral frontal burr-holes.  This was introduced in this country in 1936.  It was mainly performed on chronic cases who had not benefitted from other treatments.  

DRUGS

Back in 1850, Morphia was used as a hypnotic but was replaced by Chloral Hydrate as this did not cause side effects such as headaches and loss of appetite like Morphia.  But from the early 1900's treatment was directed to the improvement of the physical health combined with sedatives for restless cases.  The 1930's saw the introduction of Hydrotherapeutic treatment in the form of 'continuous baths', for cases of 'extreme excitement'. The idea was that these baths reduced the dosage of hypnotic drugs as well as eliminating toxins through the skin.

Cardiazol (Pentylenetetrazol or PZT) was introduced in 1937 as a form of Convulsive Therapy which was said to be effective in the treatment of depression but in 1939 was replaced by Electroconvulsive Therapy (ECT) as it was easier to administer and the preferred method for inducing seizures.  

Lithium carbonate was used as a mood stabiliser from 1949 but was not used as often as other psychotrophic drugs. Other mood stabilisers include Carbamazepine (Tegretol), Lamotrigine (Lamictal), and Valproate (Depakote, Epilim) and these are used to treat mania and to prevent the return of manic and depressive moods associated with Bipolar disorder.  They may also help to treat the mood problems associated with schizophrenia, such as depression

The first anti-psychotic drug, Largactil (Chlorpromazine) was discovered in 1950.  It was tried on nearly all patients regardless of their diagnosis and found to bring disruptive behaviour under control making the patient 'quiet and under control'.  The use of these drugs declined in the late 1950's when other psychotropic drugs including antidepressants and antianxiety drugs were developed.  Drugs such as Librium in 1955, Valium and Ativan.  But these drugs were found to be extremely hard to 'come off'.  Although more drugs were widely available in the 1970's, Largactil remained the most popular choice by psychiatrists.   The varying amounts of drugs available on the market meant that medication could be changed to suit a particular patient.  Medications such as Moditen and Modecate injections were introduced as slow-release antipsychotics which could last for up to a month thus discarding the need for tablets or syrups.  This benefitted the patient by not having to remember to take their medication on a daily basis.

There are many antidepressant medications used in mental illness, these include Sertraline (Zoloft), snd Fluoxetine (Prozac).  Antianxiety medication includes Xanax or Nirovam (Alprazolam), Ativan (Lorazepam) and Klonopin (Clonazepam).  Other antipsychotic medication includes Risperidone, Olanzapine, Quetiapine and Ziprasidone.