HO for Biology of Mental Disorders (BCS 246)

Lecture 7 (9/26)

Issues from last class:

Today's Handout:

• Rene Descartes (1600s philosopher)
• Allowed for progress in psychiatric description by proposing a very well defined differentiation between mind and body (so was introduced "Cartesian Dualism")
• This allowed the brain, as part of the body to be explored and the ailments of the brain to be bodily problems without jeopardy of making spiritual statements that would upset the church
• 20th century early:
• Ian Pavlov (1849-1936) studied reflexes of digestion (Nobel Prize in 1904) and went on to propose how reflex learning may influence thought and result in different personality forms
• Behaviorism
• Sigmund Freud (1856-1939) "no individual in the history of psychiatry has had more influence"
• Psychoanalysis, emphasis on meaning of symptoms in terms of underlying unconscious conflict. This conflict, if brought to the surface, resulted in insight and cure. Emphasis on meaning (subjective, idiosyncratic to given patient) and not empirical observation.
• Freud never stopped thinking that most mental illness would be found to have biological underpinning, but followers did not feel this way
• Freud always felt that psychotic patients were not appropriate for psychoanalysis, though again his followers did not feel this way and used it in all psychiatric syndromes
• Studies examining the effects of different methods of psychotherapy, with a few exceptions, showed (1) therapy is effective (2) the particular "school" or "method" of therapy is not the critical aspect, but rather a number of "generic" factors that cross all forms of therapy
• Jaspers: content vs. form of psychiatric symptoms, with interest by mental health professionals focused on form (not what was happening above), developed the mental status exam much more!!
• Kurt Schneider took this further in regard to psychosis with specific descriptions of psychotic symptoms he considered diagnostic (First Rank Symptoms, see page 32 Trimble)
• Early development of biological treatments
• Three illnesses greatly affected progress in biological psychiatry
• Syphilis (10-20% of all psych admissions)
• Encephalitis (viral at the time)
• Epilepsy
• Spirochete of syphilis noted in CNS in 1913 by Noguchi (1905 found in genital lesions)
• von Economo wrote extensively (1931 publication especially) on encephalitis lethargica with numerous symptoms due to this influenza
• Numerous psychiatric syndromes resulted as sequelae
• Viral hypothesis of mental illness born (again, presently a rebirth of this theory in new form)
• von Meduna examined brought to light the antagonism between epilepsy and schizophrenia (probably many with severe and untreated mood disorders)
• Explored ways to induce seizures
• Led to convulsive therapy, first with use of camphor and other substances, then insulin shock (hypoglycemic state with seizure) and later electrically induced seizures; all of which showed marked improvement in some patients
• Wagner-Jauregg, observed that the symptoms of some mental patients improved after a fever
• Used "pyrexics", fever inducing agents", even malaria
• Nobel prize in 1927 for "fever therapy"
• Hans Berger, though writing generally ignored showed that brain electrical activity could be recorded from the scalp!! (first EEG)
• Frontal lobotomy
• Neurologist Moniz, following observations in primates that frontal lobe lesions resulted in " marked emotional changes" without intellectual impairment (Jacobsen's work, not own)
• Moniz tried on psychiatric patients with some success
• Became very popular, with 30,000 done in U.S. alone, mostly due to enthusiasm of Freeman & Watts
• Neuroanatomy and neurochemistry advances in latter 1900s helped with movement
• Ramon Y Cajal, neuron theory (1890s)
• Synapse described by Sherrington
• Hoffman, a chemist, took LSD and found it to have very potent hallucinogenic effects (1930s I believe)
• Acetyl choline and adrenaline discovered as neurotransmitters again around this time
• Papez, in 1937 proposed a neuroanatomical substrate for emotion referred to as the "Papez circuit" that is very similar to what we now call the limbic system

Case vignettes:

• Bipolar disorder continued
  
  
• Schizophrenia (variety of patients and symptomatology)