the history of psychiatrypsychiatry.pote.hu/pdf/eng_1_001_history_slides.pdf · the history of...
TRANSCRIPT
The history of psychiatry
Sandor Fekete M.D. PhD
klinika -Pécs
Dept.of Psychiatry and PsychotherapyUniv.of Pecs, http://psychiatry.pote.hu
The history of psychiatryI. Pre-scientific era - before the
XIX.th.centuryprehistoric data - 2000 B.C. –Scandinavian burial place findings -
trepanation shamanism - demonism Old Testament (Saul and David..)classical greek culture
Hippokrates (459 - 377 B.C.)temperaments
The oldest medical document inexistence, the Eber Papyrus (probablycomposed in 1900 B.C.), containsreferences to specific syndromes such asdepression.
Biblical writings also containdescriptions of individuals with major mental illnesses; for example, in I Samuel, Saul is portrayed as falling intoa serious depression, for which he is treated with soothing music.
Hippocrates argued that mentalillnesses, as well as all other cognitive andemotional functions, derived principallyfrom the brain. Galen and his followersbelieved that mental illnesses were due toimbalances in quantities of body fluids. Melancholia, for example, was due to anexcess of black bile.
The history of psychiatry
classical roman cultureGalen, Celsus
middle ageconnection with religion – philosophy
Salem Witchcraft Trials1692 The history of psychiatry
Pinel 1793
Esquirol
Griesinger Kraepelin E. Bleuler(1855-1926)
The history of psychiatry
Ph. Pinel 1793 - scientific era EsquirolGriesingerKraepelin (1855-1926) E. Bleuler
P. Pinel, a one of the leader of the FrenchRevolution, is usually considered to be thefounding father of modern psychiatry. In 1793, he was named director of the Bicêtre, thehospital in Paris for insane men.
Soon afterward he instituted a grand, symbolic change by removing the chains thatbound the patients to the walls at the Becêtreand instituted a new type of treatment that he referred to as „moral treatment.”
The French Revolution and Pinel's Moral Treatment of the Mentally Ill
In addition to introducing psychotherapy, inthe form of moral treatment, and stressing theimportance of empirical observation, Pinelalso applied the scientific method to the studyof psychiatry.
Mesmer 1720-1815 „animalmagnetism”
Dynamic psychiatry-psychotherapyXIX. - XX.th century
Charcot P. - Janet – hypnosis
Freud - Adler, Jung psychoanalysis
Ferenczi, Balint, Mahler, Klein, Erikson, Rogers
social psychiatry - and - biological psychiatry
social psychiatry bio - psycho - social unit
The history of psychiatryPsychotherapy XIX. - XX.th century
Charcot P. Janet
Freud Adler JungFerenczi
Balint, Mahler, Klein, Erikson, RogersEdward Munch: A sikoly, 1893.
Charcot 1825-1893 hypnotic treatment ofhysteria
Sigmund Freud
Freud
Roots of Psychoterapies I
Freud 1856-1939Stekel 1868-1940Adler 1870-1937
psychoanalysisFerenczi 1873-1933Jung 1875-1961Abraham 1877-1925
Roots of Psychoterapies II
Rogers 1902-1987 person-centered, client-centered therapy
Wolf 1926
Slater 1949 behavioural therapies
Wolpe 1958
Bandura 1963
A.Beck, Ellis cognitive therapy
PsychotherapiesPsychotherapies�� DynamicDynamic - - interpretation of unconscious interpretation of unconscious
conflicts to produce insight conflicts to produce insight (trauma, (trauma, losseslosses))
�� CognitiveCognitive - - learninglearning, , perceptionperception, , cognitivecognitive schemesschemes, , correctioncorrection
�� InterpersonalInterpersonal – – familyfamily therapytherapy., ., socsoc. . skillsskills, , communicationcommunication, , copingcoping
�� SupportiveSupportive thth: : problem solvingproblem solving, , adaptationadaptation, , strengthening patient’s defensesstrengthening patient’s defenses
�� Crisis interventionCrisis intervention�� IndividiualIndividiual vsvs groupgroup therapiestherapies
biological therapies
1887 Wagner von Jauregg – fevertherapy
1926 Klaesi sleep - therapy1933 Sakel insulin coma1935 Meduna cardiazol-convulsions1936 Moniz psycho-surgery1938 Cerletti,Bini
electroconvulsivetherapy
Delgado, unpublished.
Serotonin and Serotonin and NorepinephrineNorepinephrine: : Effect on Depressive SymptomsEffect on Depressive Symptoms
NorepinephrineVigilance
AnxietyIrritability
Impulsivity
MotivationSex
AppetiteAggression
Cognitive functionMood
Emotion
Serotonin
Pain
Dual action agents may provide the broadest spectrum of therapeutic effect across the full range of emotional and physical symptoms of depression
Ventromedialis
DLPFC
Orbitofrontalis
DLPFC right•Negatíve affectsAnxiety – increased activation (afterprovocation)•Working memory
Amygdala
DLPFC left•injury – positíve affects disturbed•Depression positíve affects deficit nucleus accumbens also involved
Ventromedial PFC:
•Anticipation of positíve andnegatíve consequences•Affectíve working memory
OFC
cognitive and affectiveintegration
Amygdala•negative affectsperception•Positíve emotions
Conscious
perception
unconscious perception
Within psychiatry as a specializeddiscipline, the major sources of impact fromneuroscience have been neuro-pharmacology and neurochemistry.
Coupled with the overall developmentin neuroscience, the discovery of relativelypotent pharmacological treatments for major mental illnesses has also served toreawaken interest in clinical neurobiology
biological therapies
1949 Cade líthium (mood stabilizer)1952 Delay chlorpromazine
(antipsychotics)
1957 Kuhn imipramine(antidepressants)
1962 Carlsson, Schildkrautneurotransmitter changes inschizophrenia and depression
Other somatic/biological butnon-pharmacological therapies
• Sleep withdrawal (depression, „chronobiological model)
• Light therapy (seasonal, atypicaldepression)
• Psychosurgery (resistent OCD cases)• ECT (th resistent depressive cases,
catatonic schizophrenia)
Social psychiatry
1905 Pratt group-therapy with tbc patients1912 Durkheim suicidal behaviour1917 Simon working therapy1920 Moreno psychodrama
Social psychiatry
1953 Jones community psychiatry1958 Hollmgshead, epidemiology
1961 Moore cross-cultural psychiatry1960Szász, Laing, antipsychiatry
Sociotherapies
• Ergotherapy• Vocational rehabilitation• Social skills training• Assertive training• Non-verbal therapies• Bibliotherapy• Poetry therapy
The „antipsychiatry”
social psychiatry - antipsychiatry
Szasz Laing
•• WhatWhat is is „„normalnormal”” oror „„pathologicalpathological”” humanhuman behaviourbehaviour
•• CanCan thethe „„pathologicalpathological””, , thethe diagnosisdiagnosis be be justjust a a labellabel oror stigma? (stigma? (socialsocial deviancydeviancy modelmodel, , „„constructionconstruction””) ) -- //.... antipsychiatryantipsychiatry/ /
•• BUT:BUT:
•• symptomssymptoms, , outcomeoutcome, , familyfamily clusteringclustering areare differentdifferentinin thesethese disordersdisorders, ,
•• TheyThey alsoalso havehave thethe biologicalbiological backgroundbackground, , specificspecificresponsesresponses inin treatmenttreatment
•• The The purposepurpose ofof diagnosisdiagnosis andand classificationclassification is is totoisolateisolate a a groupgroup ofof discretediscrete diseasedisease entitiesentities,, eacheach ofofwhichwhich is is characterizedcharacterized byby a a distinctdistinct pathophysiologypathophysiologyandand//oror etiologyetiology..
bio - psycho - social approach
stress – vulnerability modell
These developments have placedpsychiatry in the 1990s squarely withinthe traditions of medicine andneuroscience.
To an interest in neuropharmacologyhave been added interests inneuroimaging and molecularbiology/genetics
Modern students of psyhiatry must simultaneously view their patients onmultiple planes:
as human beings who have particularsymptoms (psychological),
as individuals living within a socialand cultural context (social),
as products of the geneticendowments given them by their parentsand coded in their chromosomes (genetic-molecular),