Monday, May 6, 2013

"Shock Therapy Loses Some of its Shock Value"

Electroconvulsive therapy (ECT), or shock therapy, has been used to treat depression and other mental disorders since its invention in the 1930's. It's original use was to "tame" mental patients, and was used as a way to calm and sedate, in addition to relieve depression.  ECT was administered to patients while they were fully awake, with or without consent.  The shocks caused seizure-like convulsions which would often brake bones. Patients often suffered from memory loss after the treatment.  Today, ECT is used to treat severely depressed individuals as a means of treatment over antidepressants. Some other reasons for use include a rapid reversal of suicidal depression, use when the depression is "complicated by psychosis or catatonia", during pregnancy (since it is not safe to take drugs during this time period), or when mania or bipolar disorders do not respond to drugs. Shock therapy has come a long way since its first use in the 1930s. Much lower currents of electricity are used to prevent the chance of memory loss and anesthetics and muscle relaxants are given to sedate the patient to prevent them feeling the shocks and prevent the body from convulsion which is potentially very dangerous.  Although ETC has been around for almost a century, it is not known exactly how or why it works. It is thought that the shocks jog the brain and reorders the transmission of neurotransmitters which increase the uptake of serotonin, while others believe it acts as a sort of pace-maker for the brain. ETC is also a much faster solution to treat depression than drugs as its effectiveness kicks in almost immediately.
Despite this, shock therapy is not a cure for depression, only a temporary solution. Treatments must be re-administered every year or so.
The most shocking aspect of this article to me, although only briefly mentioned, was that ETC is administered to pregnant women in place of drugs that could be harmful to the developing baby. I would like to research further into this, since the first thing that comes to my mind is how do the shocks affect the fetus? and do the shocks even reach the fetus at all? Another surprising fact brought up in the article is that it is not known how ECT works to treat depression.  It seems that many things having to do with the brain and mental wellness are still unknown (including drugs for treatment), and it is interesting that treatments are so widely used without knowing how they work. There must be a strong amount of trust that scientists and doctors have, feeling comfortable to give something to the public, without knowing what it does exactly. This also means that these treatments must come about almost by chance, since scientists and doctors did not work backwards, knowing the problem and knowing how those problems are solved, therefore creating a treatment out of it.
Learning about ETC has been a huge eye-opener to me, as when prior to this past week, when I thought of shock therapy, pictures of old, run down mental hospitals and torture devices came to mind. I can blame this on movies and other representations in the media. I am glad to now know that ETC is still very commonly used and has helped to greatly improve the lives of many, who live highly functioning lives in society.

Electroconvulsive Therapy

ECT works by placing an electrode on one side of the head and a brief current is turned on. The current triggers seizures that will last about 1 minute, causing the body to convulse. In the past, ECT was not as safe; there was memory loss and broken bones, as the patents were not given muscle relaxers and anesthesia they are today. Today the World of Psychiatric Association has endorsed ECT as a safe and effective treatment especially for people with severe depression. The effects of ECT are not permanent and eventually those who were helped by ECT do need to return once of twice a year to receive treatments to keep their depression in check. Although ECT is effective with depression it is not effective with other disorders such as schizophrenia and alcoholism. 

This article states that the importance of electrical dosage and electrode placement in relation to efficacy and side effects in uncertain. In a double-blind study, the psychologist randomly assigned 96 depressed patients to receive right unilateral or bilateral electroconvulsive therapy at either a low electrical dose. Symptoms of depression and cognitive functioning were assessed before, during and immediately after and two months after therapy. The patients who responded to the treatment were followed for one year to asses the rate of relapse. They found that the response rate for low-dose unilateral electroconvulsive therapy was 17% as compared with 43% percent for high dose unilateral therapy, 65% percent for low-dose bilateral therapy, and 63% for high dose bilateral therapy. They discovered that regardless of electrode placement, high dosage resulted in a more rapid improvement.

We can conclude that increasing the electrical dosage increases the efficacy of right unilateral electroconvulsive therapy, but not of bilateral electroconvulsive therapy.

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Monday, April 29, 2013

Dissociative Identity Disorder

Dissociative Identity Disorder (DID), commonly known as Multiple Personality Disorder, is the result of a traumatic event. With Post Traumatic Stress Disorder being the least extreme on the scale of post-trauma disorders, DID is one of the most extreme.  DID is a sort of coping mechanism for the stress of the experienced event, and results from the separation of the event (and thoughts, memories, feelings, and ultimately personality) into parts rather than dealing with the overwhelming whole.  This also leads to a separation of thought/experience and emotions; so a person may feel nothing while remembering or experiencing something, or have an emotion but not know why they are feeling that way.  DID always develops in childhood after experiencing traumatic events such as sexual or physical abuse, terror, or repeated medical trauma.  Symptoms may appear later in adulthood triggered by stress.

People with DID have multiple 'alternate personalities', or 'alters' or 'parts'.  Some of these parts may be aware of the others, while some may be completely unaware that they have more than one personality and experience a sort of amnesia during an episode of that alter.  There is no specified treatment for DID, but it is dealt with by long term visits with a therapist. During therapy, the therapist and DID patient work on three major steps: "establishing safety, stabilization, and symptom reduction", "working through and integrating traumatic memories", and "integration and rehabilitation".

DID is much more wide-spread than it is often thought to be, as it is easy for sufferers to hide their symptoms out of embarrassment and often live very high functioning lives in normal society.  Therefor, it takes someone that really knows them and sees them at their most personal times to see that something is wrong; it even often goes undiagnosed or misdiagnosed in mental health facilities and Borderline-Personality Disorder of Schizophrenia.

When I learned that DID is a result of trauma, it automatically changed my opinion and understanding of the disorder.  Due to the way that DID is perceived in the media, I obliviously thought that people with multiple personalities were just crazy, however now that I have read this article, I have a much better knowledge about the disorder.  I was also reminded of the video we watched as a class earlier in the semester with the man who was convinced that loved people and things in his life were "impostors" as a result of his dissociation of emotion and memory.  However, for DID people, I don't quite understand how this dissociation between memory and emotion results in alternate personalities.  I understand the aspect of breaking things down into parts that are easier to cope with (different emotions brought on by the event are expressed in different alters?), however I am not sure of where the emotional/memory dissociation comes into play.  All of these symptoms fall under the Post-Tramatic coping spectrum, but what causes them to manifest into such different, and varying in extremeness, disorders?

Schizophrenia and ETC

      Schizophrenia is a mental disorder that makes it challenging for people to tell the difference between what is and is not real. Other symptoms include the inability to think clearly and have normal emotional responses. Doctors and researchers are still unclear as to what the cause is, but as Jason mentioned in the last blog post, there is a genetic link evident. Regardless of the cause, I was interested in understanding ways that the disorder is treated. Since the mid- 1950’s schizophrenia has been treated with antipsychotic medications. By 1990, a second generation of “atypical” antipsychotics were created. These new class of drugs are effective in treating hallucinations but they come with some serious side effects. A treatment that I was curious about was the electro-convulsive therapy, ETC often used for depression. 

     ETC is a type of electroshock therapy that utilizes electrodes on a patient’s scalp and an electric current is conducted creating a short seizure in the brain. It has been understood that ETC is a beneficial treatment for depression but I was curious as to how it would work with patient’s with schizophrenia. I was able to find a study produced by the University of Ibadan, Nigeria titled “Naturalistic comparative study of outcome and cognitive effects of unmodified electro-convulsive therapy in schizophrenia, mania and depression in Nigeria”. I was unable to gain access to the full text but the study compares the effectiveness of ETC on patients with schizophrenia, mania and depression. The study examined a body of seventy subjects with depression, schizophrenia and mania over six months. They were assessed and interviewed before and after the treatment. The lab results proved that ETC was an effective treatment for patients that were resistant to drug treatment. 

The Sleepwalker is Not Insane

This article specifically discusses the liability issues with violence associated with sleepwalking. In addition, sleepwalkers do not suffer from mania, which makes it a unique mental disorder. The article covers history of this phenomenon in relation with violence. The biggest example was the R v. Burgess trial was a very interesting case: a man murdered his friend in a sleepwalking episode. They debated if it was really an act of crime. It was labeled as insanity and a disease of mind, because they didn’t know how else to categorize it. However, scientists debated that no act is punishable if it is involuntary, like a car accident.

The involuntary act of sleepwalking (somnambulism) impairs the human mind and it’s functioning, much like how you can’t usually control your dreams. This is perfectly normal, but violence is not. It is believed that an internal cause, like a concussion, can spark this act of violence. However, scientists conclude that these people are sane.

Sleepwalking, like Autism, is complex and hard to understand in many rights: especially in regards to violence. For Burgess, he acted violent in his sleep on numerous occasions. This is an extreme case study, as most sleepwalkers don’t even touch others. I find it interesting that it can happen, and it has. However, I feel like there can be some amount of prevention.

The comedian Mike Burbiglia suffers from Somnambulism  (Sleepwalking), and in his hilarious movie, Sleepwalk with me based off of real events, covers his misadventures with sleepwalking. One particularly serious instance, he leapt out of a second-story hotel window, where he got shards of glass stuck in his legs. Even though this isn’t an act of violence, he does He’s perfectly sane!

So, if there is prevention, then can sleepwalking be tracked back to where something may have sparked the violence? Is it possible for a sleepwalker with violent tendencies to be triggered by something in their waken life, not just by a concussion?

So, what if violent outbursts in sleep can now be controlled by preventatives? This could be avoiding aggressive video games and movies, avoiding situations involving high stress, and eating differently (sometimes food is the cause of sleepwalking) and if necessary, being secured in a separate room. By taking these precautions, the person can avoid injuring someone else.

But not all sleepwalkers are violent. What about situations where the sleepwalker doesn’t harm others but harms themselves? Mike Burbiglia leapt out of a second story hotel window and nearly died of blood loss. What he’s done to prevent further injuries is strap himself in a sleeping bag with mittens.

Irene Mackay, a lecturer in Law at the University of Manchester, wrote this article. 

--Betsy Peterschmidt

Personality Disorders and Parents Accused of Physical Abuse or Neglect

Parents who are accused or believed of abusing their children have been a major focus in fields of psychology for many years. Both the child and the parents are typically studied in various ways and for various reasons. The goal of this specific study was to demonstrate a psychological profile of parents who have been accused of mistreating their children. A clinical group of 16 parents accused of physical abuse and 22 parents accused of neglect were compared with 18 parents from a control group. The test, "MCMI-III" was given to each parent individually. Both groups of abuse or mistreatment showed significant differences on different scales and no difference was seen within both groups of abuse when compared to one another. The article states, "many parents of both child maltreatment groups reported at least one form of abuse during their childhood, which suggests that a childhood marked by abuse or neglect on the part of a parent could result in personality disorders and that these disorders may have something to do with the intergenerational transmission of abuse."

The purpose of this particular study was to describe an overall and well-defined profile of the personality traits of parents who had been accused of physical abuse or neglect in comparison to a control group of parents. The outcome and findings of this study allows for the following hypotheses to be determined: "(a) Parents from the maltreatment groups (physical abuse or neglect) will have significantly higher scores than the control group on the personality disorders and clinical syndromes scales; (b) Parents from the maltreatment groups will have significantly higher scores than the control group on the scales for anxiety, dysthymia, major
depression, alcohol abuse and drug abuse; (c) The physical abuse group will have significantly higher scores than the neglectful group for the antisocial and borderline scales, given the propensity of these two personality disorders to move into action; and (d) There should not be any significant difference between the abusive group and the neglectful group regarding the tendencies to present personality traits or disorders for clusters A (odd or eccentric) or C (anxious or fearful)."

In my opinion this article makes a lot of sense, although I also think that neglect and abuse to children can be formed from other underlying problems of a parent. The majority of parents who do such actions to their children have been victims of abuse or neglect, but I also think that most parents who have been through such, would want to break the cycle and not continue this pattern of abuse. So in my opinion, this article would only apply to a specific type of person or parent, which in this study, the majority showed previous victims of abuse.

Five Diseases Are linked By One Genetic Issue

    In this study, scientists studied the genetics of five disorder: schizophrenia  severe depression, bipolar disorder, autism and ADHD.  They took 33,332 subjects with all five disorders and 27,888 controls and tested the illnesses in the exact same way.  They found that there were 2 suspect chromosomes that affected several genes, which all related to the diseases in the patients.  One of the disrupted genes blocked calcium regulation in neurons.  This led to a common symptom of all five illnesses.

     This discover will help open up different options to treating these diseases.  I wonder if people will try to look for this genetic flaw when they check the baby's chromosomes.  Can doctors prevent the corrupt genes from affecting a child before the disorder happens?  Can people delete major depression from the genetic code.  It becomes a question of Eugenics, but I think that people would want to treat the chromosomes as fast as possible.  A question I have is, if the 5 diseases all share a similar malfunction  what determines which disease will appear.  The non control subjects they used had all five diseases.