Psychiatric Treatment Methods Research Articles

Main Debates on the Management of Mental Illness: 1990-2020 : A narrative review

Introduction: Since the introduction of newer psychiatric treatment methods during the 20th century, debates about the effectiveness andappropriateness of such treatment have featured. Advocates among those who promote the sociological, biological, psychological and spiritual understandings of mental illness and its treatment have created tangible tensions with those supporting each position commonly indulging in fierce attacks on the others. Aims: The aim of this paper is to explore some of the principal treatment viewpoints that characterized the late 20th century (1990 onwards) and early 21st century (up till 2020). Ultimately, these debates guided contemporary practice towards a biopsychosocial-spiritual view of mental illness in a move towards holistic person-centered care, which nowadays is the advocated model in many health systems. Methods: The authors undertook a literature search in order to locate published debates on psychiatric treatment during the late 20th century (1990 onwards) and the early 21st century (up till 2020). Results: Debates emerging from 36 articles were identified and synthesized in a narrative review. Conclusions: Exploring the various debates that have characterized mental health care serves as a crucial reflective exercise on what needs to be considered when claiming that contemporary care is based on a holistic and person-centered approach. In this view, critical evaluation is needed so as to avoid repeating the coercive and inhumane mistakes of the past.

When boys will not be boys: American eugenics and the formation of gender nonconformity as psychopathology

ABSTRACTDrawing from Michel Foucault’s theorization of disciplinary power and biopolitics, this paper advances and reconstructs earlier scholarly literature on American eugenics through an examination of nineteenth- and twentieth-century penological and psychiatric techniques that contributed to the birth of a discourse on gender nonconformity as psychopathology. In this paper, I ask: how do certain forms of embodiment, dress and expression come to be interpreted as ‘effeminate’ and ‘sissy’? Furthermore, how did various moral and penological techniques around gender nonconforming embodiment and subjectivity contribute to the development of psychiatric treatment methods for homosexuality and transsexuality? Drawing from early sexological studies on prisoners as well as psychiatric studies on institutionalized children, the paper argues that in the context of ‘boyhood effeminacy’, normalizing power operates not merely on the disciplinary level of the individual body, but also through a biopolitical governing of health, reproduction, family and citizenship. The paper concludes by addressing the contemporary European Trans sterilization legislation as a biopolitical offshoot of eugenic rationality.

An Individualized Approach to Treatment-Resistant Bipolar Disorder: A Case Series

Treatment-resistant bipolar disorder (TRBD) is an increasingly prevalent, debilitating condition with substandard treatment outcomes. Polypharmacy has become the mainstay among practitioners though long-term efficacy of this method has not been adequately tested. Determine retrospectively if individualized, integrative treatment strategies applied while withdrawing pharmaceuticals were beneficial and safe among a TRBD clinic population. A chart review was performed for six adult patients, treated in a private psychiatric practice. Data were collected regarding psychiatric diagnosis, hospitalizations, medications, side effects, substance abuse, and applied treatments. Using individualized, integrative psychiatric treatment methods, the majority of medications were eliminated. Long-term remission was attained in all cases, defined as clinical stability with no discernable symptoms of bipolar disorder for at least one year. Applying an integrative treatment approach, and eliminating most medications, provided lasting resolution of symptoms and side effects in a selected sample of TRBD outpatients. These data may provide the basis for future randomized, controlled trials.

Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease

Ulcerative colitis and Crohn's disease, commonly known as inflammatory bowel disease (IBD), draw attention from specialists of various disorders, including gastroenterology, psychiatry, and radiology. The involvement of a cortical influence in the brain-gut axis as well as the interaction of the hypothalamic-pituitary-adrenal axis and the peripheral nervous system provide an initial explanation of the psychological symptoms associated with IBD. The involvement of structures the limbic system, such as the anterior cingulate cortex, the prefrontal cortex, and the amygdala, paves the way for the discovery of the mechanisms underlying depression depression, anxiety, alexithymia, personality traits, and other psychological impairments following the onset of IBD. Psychiatric therapy in IBD patients is almost as important as the gastroenterological approach and consists of pharmacological treatment and psychotherapy. Neither of the available psychiatric treatment methods is considered the golden standard because both methods have side effects, and psychotropic medication can provoke the worsening of IBD symptoms. Thus, both approaches must be applied with awareness of the possibility of side effects. We suggest that psychiatrists and gastroenterologists work together to reach a consensus on IBD therapy to ensure success and to reduce side effects and relapse to the lowest possible rates.

Should We Expand the Toolbox of Psychiatric Treatment Methods to Include Repetitive Transcranial Magnetic Stimulation (rTMS)?

Repetitive transcranial magnetic stimulation (rTMS) is a safe treatment method with few side effects. However, efficacy for various psychiatric disorders is currently not clear. A literature search was performed from 1966 through October 2008 using PubMed, Ovid Medline, Embase Psychiatry, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and PsycINFO. The following search terms were used: transcranial magnetic stimulation, TMS, repetitive TMS, psychiatry, mental disorder, psychiatric disorder, anxiety disorder, attention-deficit hyperactivity disorder, bipolar disorder, catatonia, mania, depression, obsessive-compulsive disorder, psychosis, posttraumatic stress disorder, schizophrenia, Tourette's syndrome, bulimia nervosa, and addiction. Data were obtained from randomized, sham-controlled studies of rTMS treatment for depression (34 studies), auditory verbal hallucinations (AVH, 7 studies), negative symptoms in schizophrenia (7 studies), and obsessive-compulsive disorder (OCD, 3 studies). Studies of rTMS versus electroconvulsive treatment (ECT, 6 studies) for depression were meta-analyzed. Standardized mean effect sizes of rTMS versus sham were computed based on pretreatment-posttreatment comparisons. The mean weighted effect size of rTMS versus sham for depression was 0.55 (P < .001). Monotherapy with rTMS was more effective than rTMS as adjunctive to antidepressant medication. ECT was superior to rTMS in the treatment of depression (mean weighted effect size -0.47, P = .004). In the treatment of AVH, rTMS was superior to sham treatment, with a mean weighted effect size of 0.54 (P < .001). The mean weighted effect size for rTMS versus sham in the treatment of negative symptoms in schizophrenia was 0.39 (P = .11) and for OCD, 0.15 (P = .52). Side effects were mild, yet more prevalent with high-frequency rTMS at frontal locations. It is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms. We do not recommend rTMS for the treatment of OCD.

Early Color Illustrations of Psychiatric Treatment Methods, as Drawn by Physician Serefeddin Sabuncuoglu (1385–1470)

Serefeddin Sabuncuoglu lived and practiced medicine in Amasya in northern Anatolia in what is now Turkey during the 15th century. He is the author of the first known illustrated surgery textbook, Cerrahiyetu’l Haniyye (Imperial Surgery) (1, 2), which survives as only three copies. Besides several original contributions noted by several authors, Sabuncuoglu’s book is unique for the revolutionary illustrations used to show details of the surgical procedures described. During the previous prevailing period of Islamic medicine, all medical texts were written without any illustrations of the human body because the depiction of such figures was prohibited by contemporary thinking. An unknown aspect of Sabuncuoglu’s book is that it contains a few sections related to psychiatry with the earliest known color illustrations of the field, drawn by the physician himself. One section is on the cauterization of “mâl-i hulyâ,” which refers to a variety of neurotic disorders, and the other is about “unutsaguluk,” which means forgetfulness. Sabuncuoglu recommended a stepwise approach in treating both disorders: the use of herbal medicine, then the application of warm oil derived from sheep’s tail fat to the vertex area, and finally, if all efforts failed, cauterization with heat at certain points, with caution against the risk of harming the skin. It is apparent that Sabuncuoglu did not practice as a surgeon but as a general physician capable of treating all kinds of medicalsurgical conditions, including psychiatric ones. In the following centuries, Amasya Hospital evolved from a general hospital into one providing services only to mentally ill people and remained so for a long time. Along with his pioneering work, Sabuncuoglu deserves attention and recognition for his professional qualities as a modest researcher, a fine clinician, and a devoted medical educator with high ethical standards. No doubt his advice to colleagues is still valid today, regardless of their specialty: “Keep your compassion separate from your fame and ambition” (2, vol. 1, p. 66).

Early Color Illustrations of Psychiatric Treatment Methods, as Drawn by Physician Serefeddin Sabuncuoglu (1385–1470)

Back to table of contents Previous article Next article Images in PsychiatryFull AccessEarly Color Illustrations of Psychiatric Treatment Methods, as Drawn by Physician Serefeddin Sabuncuoglu (1385–1470)Osman Sabuncuoglu M.D.Osman Sabuncuoglu M.D.Search for more papers by this authorPublished Online:1 Dec 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Serefeddin Sabuncuoglu lived and practiced medicine in Amasya in northern Anatolia in what is now Turkey during the 15th century. He is the author of the first known illustrated surgery textbook, Cerrahiyetü’l Haniyye (Imperial Surgery) (1 , 2) , which survives as only three copies. Besides several original contributions noted by several authors, Sabuncuoglu’s book is unique for the revolutionary illustrations used to show details of the surgical procedures described. During the previous prevailing period of Islamic medicine, all medical texts were written without any illustrations of the human body because the depiction of such figures was prohibited by contemporary thinking. An unknown aspect of Sabuncuoglu’s book is that it contains a few sections related to psychiatry with the earliest known color illustrations of the field, drawn by the physician himself. One section is on the cauterization of “ mâl-i hulyâ ,” which refers to a variety of neurotic disorders, and the other is about “unutsaguluk,” which means forgetfulness. Sabuncuoglu recommended a stepwise approach in treating both disorders: the use of herbal medicine, then the application of warm oil derived from sheep’s tail fat to the vertex area, and finally, if all efforts failed, cauterization with heat at certain points, with caution against the risk of harming the skin. Figure 1. Illustration of treatment for “Mâl-i Hulyâ” or cauterization for certain neurotic disorders.It is apparent that Sabuncuoglu did not practice as a surgeon but as a general physician capable of treating all kinds of medical-surgical conditions, including psychiatric ones. In the following centuries, Amasya Hospital evolved from a general hospital into one providing services only to mentally ill people and remained so for a long time. Along with his pioneering work, Sabuncuoglu deserves attention and recognition for his professional qualities as a modest researcher, a fine clinician, and a devoted medical educator with high ethical standards. No doubt his advice to colleagues is still valid today, regardless of their specialty: “Keep your compassion separate from your fame and ambition” ( 2 , vol. 1, p. 66). From the Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey. Dr. Sabuncuoglu reports no competing interests. Address correspondence and reprint requests to Dr. Sabuncuoglu, Halk Cad., Emin Ongan Sok., 11/ 7, 80300 Üsküdar, Istanbul, Turkey; [email protected] (e-mail). Drawing reprinted with permission of Fatih Millet Library.

Association between oestradiol and puerperal psychosis

Objective: Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. Method: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. Results: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. Conclusion: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.

Association between oestradiol and puerperal psychosis

Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.

The natural history of a psychotherapy group for battered women.

This paper presents the authors' experience with evaluation and treatment of battered women and assesses the implications of the work. Assuming that battered women have special problems requiring modifications of psychiatric treatment methods currently available, we chose to work with them in a consciousness-raising, problem-oriented group designed to address those special problems. Assessment includes a description of changes in the women and modifications in the treatment during the course of therapy, an indication of persistent problems in the treatment of battered women, particularly the high drop-out rate, and suggestions for further treatment modifications that might help therapists to avoid the common pitfalls of work with these patients.

The Therapist's Handbook: Treatment Methods of Mental Disorders

A book intended to cover a broad field and written by multiple authors requires careful editing to ensure a coherent presentation of its theme. If editorial control is weak, the book can easily become nothing more than a series of review articles of varying quality. This volume, which attempts to cover current psychiatric treatment methods, unfortunately is the victim of such weak editorial control. The book is divided into two sections, the first covering various specific psychiatric therapies and their indications and the second devoted to specific psychiatric illnesses and their treatments. Although such a division might be expected to create much duplication, this book avoids that problem quite well because the editor apparently informed the multiple authors that the main purpose of the book was to present practical psychiatric therapeutic treatment methods. However, there is no evidence of editorial direction beyond these instructions. The result of this lack of

Group discussions with nurses in a hospital for alcoholics: Some problems confronting nurses working in a therapeutic community

IN RECENT years considerable attention has been focussed on the problems of psychiatric nursing and on the changing role of the nurse in a psychiatric unit (1. 2.3,). As interest has shifted from the patient’s intrapersonal conflicts to include his interpersonal relationships, there has been a change of emphasis from individual psychiatric treatment in a custodial setting to treatment within a therapeutic community. The modifications in social organization of a hospital unit accompanying such changes in therapeutic approach have recently been summarised by Maxwell Jones c4 ), who emphasises that “ . . . . patient-patient interaction or nurse-patient interaction has now to be analysed in much greater detail than formerly when little attention was paid to what went on at this relatively untrained level.” He indicates that special training is needed to equip the student nurse for her therapeutic role. An early approach to provide further training for the nurse on the ward was described by Ackner et al. in 1955 (5). The value of group methods for teaching nurses and for helping them to overcome their high initial emotional barriers against learning psychiatric techniques was stressed by the World Health Organization Expert Committee on Psychiatric Nursing (l). Main c6) reported in detail on a rather specialized group of nurses which was formed to consider the problems aroused by a special type of neurotic patient. He described the strains imposed on nurses by the care of certain types of patients and the increase in skill acquired by the nurses as they retrospectively discussed and analysed the difficulties that had occurred. Other instances of the use of group methods for providing training for nurses in a clinical setting have been reported but only in very general terms(‘* *I. The aim of the present paper is to describe in some detail the nursing problems in a psychiatric hospital for the treatment of alcoholism as they became manifest in regular group discussions of the nurses with a psychiatrist. Some of the problems were related to the impact on psychiatrically untrained nurses of their first contact with emotionally disturbed patients and psychiatric treatment methods, others

Clinical aspects of combined psychiatric treatments.

Clinical observations led the author to the following conclusions: 1. Present-day psychiatric treatment methods have no specific, but have, to a certain degree, selective actions. 2. Electroconvulsive treatment relieves all forms of depressions and is able to alleviate emotional pressure. 3. Nonconvulsive electric treatment relieves anxiety and thus makes the patient amenable to productive psychotherapy. 4. Insulin coma treatment acts on an ideational level, thus enabling the patient to correct paranoid ideas. 5. Double electric shock treatment is necessary in highly emotionally disturbed states. 6. Combined treatments are indicated when different mechanisms are at work in creating psychotic symptoms. The author believes that these and similar clinical observations open many avenues to fruitful research, and that proper indications for treatment methods, together with satisfactory management of the hospital environment, would greatly improve our therapeutic results.