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Medical Psychology

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Stephanie Hicks

on 13 March 2014

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Transcript of Medical Psychology

Psychology from the Medical Perspective
Health Psychology
Health Psychology- The study of the contribution of lifestyle variables to physical health and the application of that knowledge to the enhancement of physical health; also called behavioral medicine (Wertheimer,p.)
Surgical practices in Psychology
Electroconvulsive Therapy
Much of Electroconvulsive therapy's negative reputation comes from its own history and its portrayal in popular culture. While it is not without its risks, ECT is not the torturous procedure it once was.
Psychopharmacology
Christina
Jacob
Marissa
Stephanie
Nataly

Sigmund Freud and Conversion Hysteria
Dunbar and Alexander and Psychosomatic Medicine
Biopsychosocial Model versus Biomedical Model
Health Psychology relies on the premise from Greek philosophy of the "Mind-Body relationship", in which psychological factors were believed to contribute to biological illnesses.
the development, study, and use of drugs for the modification of behaviour and the alleviation of symptoms, particularly in the treatment of mental disorders.
Encyclopaedia Britannica
Polarization
Psychological theory vs
biology & medication
19th Century
mental illness is a "biological disturbance"
based on theories proposed by Emil Kraepelin & Jean-Martin Charcot
no physical evidence
Psychotic-Organic Brain Syndrome
&
Organic Mental Syndromes
Psychotic -Organic Brain syndrome-about 1/2 of patients in asylums effected by CNS infection causes "hysterical conversation symptoms" results from syphilis
Organic Mental Syndromes-disease result from niacin or protein difficiency
Emil Kraepelin
developed diagnostic classification method
DSM
used sedatives to treat agitation
Jean-Martin Charcot
Hysterical Conversation symptoms result from legions in the central nervous system
autopsy research did not show evidence of legions
argued lesions disappeared postmortem
Late 19th century
-
Early 20th Century
state mental hospitals
seclusion
restraint
wet sheet packs
1920's
-
1950's
American Psychiatry
development theories used to treat mental illness
no drugs
not successful for illnesses like schizophrenia or manic depression
Sigmund Freud used the rise of modern psychology to study the effects of subconscious thoughts and repressed memories on psychological and biological states.
Conversion Hysteria- unconscious conflicts can produce particular physical disturbances that symbolize repressed psychological conflicts .
The psychological conflicts manifest themselves through biological symptoms such as ulcers which were supposed to relive the person of the psychologcal conflict.
Between 1890 and 1920 Sigmund Freud developed his work on conversion therapy which eventually became very popular in Britain until challenged by Dunbar and Alexander.
Renaissance Practices
Opposed to the treatments we utilize today, in the Renaissance era they practiced treatments that we would consider strange now. Blood letting was a popular treatment. A physician would cut either at the wrist or up towards the elbow to drain the "ailment" out of the body.
Other treatments
Blood letting was not the only treatment that was practiced. Some patients were given laxatives, chained upside down, and given special herbs to induce vomiting. All very physical types of therapy. At this time there was not an association between behavior and psychological issues.
Ailments
Physicians assumed that the patients were suffering from divine retribution and demonic possession. After reviewing records from this era, most of the symptoms that were associated with demonic possession are also the same symptoms as people who suffer from OCD, anxiety, depression, dementia, etc.


Transitions in Treatments
Towards the end of the Renaissance era more philosophers and psychologists began noticing the blood letting and exorcisms were not effective.
They began to believe that you react to the experiences you live. The theories of emotion were not yet popular, but emotions were seen as "pure acts of the soul". This cultivated the new theories and forms of treatments that we have today.
1960's
Pro-medication
systematic
faster
work for everyone
cheaper
Consequences:
side effects
overuse
misuse
tranquilizers
90% prescriptions by primary physicians
over use and addiction
Rolling Stones
Ritalin
In the 1930's and 1940's Flanders Dunbar and Franz Alexander utilized the study of personality to link psychological disorders to medical illnesses.
They argued that repeated psychological disturbances would eventually lead to organic disturbances. For example; extreme anxiety due to psychological conflicts will cause physical damage such as ulcers.
Psychosomatic Medicine- Bodily disorders caused by emotional conflicts(p.5).
Biopsychosocial Model
is based on the assumption that health and illness are the result of a combination of biological, psychological, and social factors in persons life.
Biomedical Model
is based on the assumption that illness is only caused by biological factors and that psychological and social factors play little if no role at all. This has been the governing model in the medical field for the past 300 years.
References



Blood Letting: First Documented Surgical Procedure
Benjamin Rush (1746-1813)
Hypothesis:
Mental illness caused by influx of blood.
Treatment:

Removal of excess blood will ease tension.
Conclusion:

Rush advocated a broad and vigorous use of blood letting in psychiatric hospitals even though there was no evidence of successful treatment.
Conclusion Year 2014:

Bloodletting has shown to be useful in treating iron overload as in Hereditary Hemochromotosis (HH) or in decreasing red blood cells.



Fun Filled Fact
Barbers Sign to signify the craft of blood letting used to cure such diseases as fever.
-Red line: Blood
-White: Tourniquet
-Pole Stick: Patient
would squeeze
in hand to dilate
veins.
Lobotomy Evolved: The Moniz and Freeman Competition
Antonio Agas Moniz (1874-1955) (Portuguese Neurologist)
Hypothesis: By severing the frontal lobes from the rest of brain the result would be successful treatment of Schizophrenia
Treatment: 1935 First surgical treatment conducted: Leucotomy
injected alcohol into frontal lobes
Influenced by: Manfred Joshua Sakel
Lowered blood sugar with insulin injections causing short term comas
Treatment for substance abusers and schizophrenia
Career Goal: Nobel Prize, received.
Conclusion: No symptom relief of psychosis and obsessive compulsive disorder symptoms BUT patients became calm.
Walter Freeman (1895-1972) (American)
Hypothesis: Severe the frontal lobes in order to break up thinking and keep thinking from being restored.
Treatment: Transorbital lobotomy AKA Ice Pick Surgery:
Progressed quickly in performing first lobotomy in 1936 (previously labeled as leucotomy) due to Moniz's progression in the field.
Used ECT as anesthesia
Reach frontal lobes from under eyelid using an instrument named a leucotome.
Conclusion:
Variance in responsiveness in patients
Hallucinations and delusions persistent
Mood disorders, anxiety, and violent behavior in remission.
Loss of interest in life or as Freeman agreed to a lack of creativity.
Mary Frances Robinson concluded direct result of lobotomy.
Patients became calm.
Public Perception and Risks
ECT Legality
Electroconvulsive therapy differs from pharmacological anti-depressants most significantly in speed. Because of this, it is most often used in situations where a patient is suicidal or catatonic. It is also used by patients who cannot take anti-depressants.
Due to its potential for abuse and the stigma surrounding it, electroconvulsive therapy is completely voluntary. However, in the US, for extreme cases of obvious suicidal intent, treatment can be ordered by a judge once a formal hearing has taken place, during which the patient has legal representation.
ECT Process
- Patients are put under a general anesthetic, then while unconscious are given a muscle relaxant to control siezures.
- In Bilateral ECT, electrodes are placed on both sides of the head and current is passed through them.
- In Unilateral ECT, two electrodes are placed on the right side of the head and current is passed through them.
ECT vs Anti-Depressants
Electroconvulsive therapy usually takes two to three weeks of sessions to take effect, compared to anti-depressants, most of which take six to eight weeks. Also, during those weeks, anti-depressants can cause an increase in depressive symptoms, which does not occur with ECT. After these three weeks, the patient and psychiatrist decide how to procede.
1970's Mother's Little Helper
1980's
side effects addressed
new medications to treat anxiety
PET scans, SPECT scans, Lab testing
Public awareness on Ritalin and psychopharmacology
1990's Prozac Nation
Prozac and other antidepressants begin to be developed and used

Today
debate continues
integration
Cherry, K. (no date). What is Abnormal psychology? Psychology. Retrieved from
http://psychology.about.com/od/abnormalpsychology/f/abnormal-psychology.htm

Preston, J.D., O’Neal, J.H., Talaga, M.C. (2013). Handbook of Clinical Psychopharmacology for Therapist (7th Ed). Oakland, CA: Mew HaHarbinger Publications, Inc.




Wertheimer, M. (2012).
A Brief History of Psychology
. Psychology Press: New York, NY.
Taylor, S.E.(2011).
Health Psychology
. McGraw-Hill:New York, NY
The most common side effect of electroconvulsive therapy is short-term memory loss. This occurs in 10% of patients who undergo bilateral ECT and usually effects memory of the weeks leading up to the treatment. Because of this, more psychiatrists are choosing to perform unilateral ECT, which has a significantly decreased risk of memory loss.
Reti, I. (no date). Electroconvulsive therapy today. Retrieved from http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/images/DepBulletin407_ECT_extract.pdf
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