This method is used in surgeries that target specific parts of the brain, such as amygdalotomies and cingulotomies. In an amygdalotomy the amygdale, which is the part of the brain involved in anger, is destroyed by directing fine wire electrodes at it through a small hole drilled in the skull. Strong currents are then passed through the electrode, destroying the tissue around its tip. Cosgrove et al (1996) described their recent work using cingulotomies to relived emotional distress and reduce abnormal behaviour. They target the cingulated gyrus, which is a thin ribbon of grey matter believed to play a role in human emotional states.
Amygdalotomies were carried out on violent criminals during the 1950’s and 1960’s. After the operation the patients became less aggressive but there were very serious side effects. Patients became confused, lacking in motivation and unable to work. One third of the cingulotomies resulted in an improvement; this shows that psychosurgery can be affective if it is performed on the right patients.
Electroconvulsive shock treatment (ECT) is where a strong electric current is passed for about half a second between two electrodes attached to each side of the depressed patients’ forehead. The current gets passed through the non-dominant brain hemisphere. Anaesthetic and muscle relaxants are given before the treatment. This means that the patient is unconscious during ECT and there are fewer muscular spasms. Typically a patient will received between six and nine treatments over a period of a month. ECT has been successful for cases of severe depression it is effective in over 60% of psychotic-depressive patients. Sackheim found that there was a high relapse rate within a year which suggests that relief was tempary and not a cure. ECT reduces depression more rapidly than anti-depressant drugs. It is unsure why ECT is so effective so it may not be appropriate. ECT may be seen as a punishment. If maladaptive behaviours have been learned then the punishment will extinguish the S-R bond. It has also suggested that convulsions lead to memory loss and allow some restructuring of disordered thinking. Another explanation is that ECT lowers the level of noradrenalin and reduces serotonin re-uptake, which will reduce depression.
Drug therapy is used to treat patients suffering from major depression and bipolar disorder. Depression has been said to be caused by a shortage of monoamine, a type of neurotransmitter, they include dopamine, serotonin and noradrenalin. Drugs used in this therapy increase the supply of the chemicals. Monoamine oxidase inhibitors (MAOI’s) work by increasing the levels of neurotransmitters such as noradrenalin and serotonin.
Tricyclics slow down the reabsorption of catecholamine or serotonin by the presynaptic vesicle, allowing them to continue stimulating the postsynaptic neuron. Selective serotonin re-uptake inhibitors (SSRI’s) are specific to serotonin, e.g. fluoxetine (Prozac) prevents the re-uptake of serotonin by the presynaptic neuron, so it has an enhanced effect on the postsynaptic neuron.
Tricyclics are generally more effective than the MAOI’s, they produce fewer side effects but they can also cause dizziness, blurred vision, and dryness of the mouth.
Lithium carbonate produces rapid improvement in most manic patients it can delay the onset of depression in patients suffering from bipolar disorder. Lithium carbonate reduces the occurrence of manic and depressed episodes in about 80% of patients with bipolar disorder. It can have very serious side effects on the central nervous system, the cardiovascular system, and the digestive system and an overdose can be fatal. Discontinuation of lithium carbonate increases the chances of bipolar disorder recurring so it is taken continuously.
Some drugs can be very effective in reducing depression but they reduce the symptoms rather than the underlying cause of the depression.
Patients that suffer from an anxiety disorder are often give minor tranquillisers such as benzodiazepines. Benzodiazepines are more precise in their functioning and they have fewer side affects. They have sedative effects and can also impair long term memory. There are also withdrawal symptoms when patients stop taking them and they are also addictive.
Drug therapy can be useful in rapidly reducing anxiety in patients who are very distressed. These drugs are only designed to reduce the symptoms of anxiety and they do not treat the cause of the problem.
Neuroleptic drugs are used to treat schizophrenia they reduce the patients delusions and hallucinations. They have little effect on the lack of emotion, motivation and social withdrawal that schizophrenics suffer from. They can also cause seditation, problems with concentrating, dry mouth and blurred vision. Another drug that is commonly used to treat schizophrenia is clozapine it has the same effect as neuroleptics but it has fewer side effects. Clozapine are expensive and 1-2% of patients taking the drug suffer from a blood disease which is fatal.
There are many problems with chemotherapy. It tends to take the responsibility away from the patient and give it directly to the therapist or psychiatrist. Some people feel that they are used to keep people quiet and they benefit the society more than the patient. There is also a problem with compliance. Patients dislike taking the drugs because of their side effects and the therapists can not make sure that the drugs have been taken. Chemotherapy treats the symptoms rather than the cause so it does not eliminate the problem and the symptoms may reoccur when the drugs are stopped being taken. However chemotherapy has allowed lots of people to lead relatively normal lives, they may prevent suicide and it may also make the world a safer for other people.
