Biological Approach: Therapy: Psychosurgery
- 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.
- Modern methods of psychosurgery involve stimulating areas of the brain which has an effect on these!
- 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
- Localisation of brain function
- 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.
- CINGULOTOMY: Designed surgically to interrupt this circuit.
- 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
- Surgeons thread wires through skull. These wires are connected to a battery pack implanted in chest.
- 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
- Walter Freeman 1940s-50s
- 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.
- PURPOSE: Alleviate severe symptoms of mental illness. RULE: Severity of illness more important that type.
- selective destruction of nerve fibres. Performed on frontal lobe of brain which is an area involved in mood regulation.
- Stereotactic
- 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!
- Cosgrove and Rauch (2001)
- 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!
- EEG able to tell us when activity in brain is happening, but not where
- 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!
- Early
- 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.
- Patients with severe depression are ARGUABLY not in right frame of mind!
- Used in mental asylums on patients who hadn't given valid consent
- 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.
- Valid consent
- Biological assumptions
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