Biological Approach: Therapy: Psychosurgery

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  • Created by: jemjem
  • Created on: 25-04-16 16:55
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  • Psychosurgery
    • Biological assumptions
      • Localisation of brain function
        • treating psychological disorders in physical way involves destroying/removing certain areas of the brain that are thought to contribute to psychological problems
      • Neurotransmitters
        • Modern methods of psychosurgery involve stimulating areas of the brain which has an effect on these!
          • Low levels of SEROTONIN are linked with depression.
      • Medical model
        • Mental illnesses and similar to physical illnesses so can therefore be treated in physical way. as they have a physical cause.
        • Patient should be treated for their mental illness through direct manipulation of their physical bodily processes
    • Main components
      • Stereotactic
        • Far more precise way of surgically treating mental disorders that fail to respond to other forms of treatment
        • MRI scans to locate exact points within the brain and sever connections very precisely!
        • OCD: Circuit linking the orbital frontal lobe to deeper structures in the brain: more active than normal
          • CINGULOTOMY: Designed surgically to interrupt this circuit.
            • Surgeons: use a gamma knife to focus beams of radiation at target site.
            • CAPSULOTOMY: Surgeons insert probes through top of skull and down into CAPSULE. They then heat up tips of probes, burning away tiny portions of tissue.
      • DBS
        • Surgeons thread wires through skull. These wires are connected to a battery pack implanted in chest.
          • Batteries produce an adjustable high-frequency current that interrupts the brain circuity involved in OCD.
        • No tissue destruction and is thus only temporary
      • Transorbital lobotomy
        • Walter Freeman 1940s-50s
          • Howard Dully was Freeman's youngest victim.
        • Inserting sharp instrument into brain through eye socket
          • Prefrontal cortex is damaged and this was thought to reduce aggressive behaviour
      • Prefrontal lobotomy
        • selective destruction of nerve fibres.  Performed on frontal lobe of brain which is an area involved in mood regulation.
          • PURPOSE: Alleviate severe symptoms of mental illness. RULE: Severity of illness more important that type.
            • MONIZ (1930) developed PREFRONTAL LEUCOTOMY. Drilling hole in each side of skull and inserting a 'leucotome' to destroy nerve fibres underneath.  By doing this it was hoped to relieve patients of their distressing thoughts and behaviors.
    • EFFECTIVENESS
      • Early
        • inappropriate and ineffective. 6% fatality rate and range of severe side effects (Comer, 2002)
      • Modern
        • Cosgrove and Rauch (2001)
          • CINGULOTOMY: Effective in 56% OCD and 65% M.A.D
          • CAPSULOTOMY: 67% OCD and 55% M.A.D
        • DBS effective in patients suffering depression.
          • Mayberg et al (2005) 4/6 patents with this disorder, striking improvements were noted following treatment involving stimulation of a small area of the frontal cortex!
      • Appropriateness
        • Szasz (1978) criticised psychosurgery because a person's psychological self is not physical and therefore it's illogical to suggest it can be operated on!
      • Future directions
        • DBS evolving as a research tool as well as a form of treatment as it can give us precise information on both WHERE and WHEN!
          • EEG  able to tell us when activity in brain is happening, but not where
            • fMRI does the opposite!
    • Ethical issues
      • Valid consent
        • Used in mental asylums on patients who hadn't given valid consent
          • Patients with severe depression are ARGUABLY not in right frame of mind!
            • Mental Health Act (1983) incorporated more stringent  provisions regarding consent to this type of treatment.
      • Irreversible damage
        • Changes in brain are irreversible. Once tissue is severed/destroyed, it will not grow back!  This is why psychosurgery is now LAST RESORT.
        • Many people who underwent early  lobotomies would have lived entire lives with severe side effects such as memory loss, leaving them like zombies!
          • Side effects worse than their actual mental illness they got treatment for in first place!
      • However, modern psychosurgery is much more precise, carries a much lower risk of severe side effects but remains a CONTROVERSIAL TREATMENT!  I.e. cases of severe injury such as Mary Lou Zimmerman.

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