P. Pinel, a one of the leader of the French. Revolution ... The French Revolution
and Pinel's Moral Treatment of the ... social psychiatry bio - psycho - social unit.
klinika -Pécs
The history of psychiatry Sandor Fekete M.D. PhD
Dept.of Psychiatry and Psychotherapy Univ.of Pecs, http://psychiatry.pote.hu
The history of psychiatry I. Pre-scientific era - before the XIX.th.century prehistoric 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 in existence, the Eber Papyrus (probably composed in 1900 B.C.), contains references to specific syndromes such as depression. Biblical writings also contain descriptions of individuals with major mental illnesses; for example, in I Samuel, Saul is portrayed as falling into a serious depression, for which he is treated with soothing music.
The history of psychiatry Hippocrates argued that mental illnesses, as well as all other cognitive and emotional functions, derived principally from the brain. Galen and his followers believed that mental illnesses were due to imbalances in quantities of body fluids. Melancholia, for example, was due to an excess of black bile.
classical roman culture Galen, Celsus
middle age connection with religion – philosophy
Salem Witchcraft Trials 1692
The history of psychiatry Pinel 1793
Esquirol
Griesinger
Kraepelin (1855-1926)
E. Bleuler
The history of psychiatry Ph. Pinel 1793 - scientific era Esquirol Griesinger Kraepelin (1855-1926) E. Bleuler
P. Pinel, a one of the leader of the French Revolution, is usually considered to be the founding father of modern psychiatry. In 1793, he was named director of the Bicêtre, the hospital in Paris for insane men. Soon afterward he instituted a grand, symbolic change by removing the chains that bound the patients to the walls at the Becêtre and 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, in the form of moral treatment, and stressing the importance of empirical observation, Pinel also applied the scientific method to the study of psychiatry.
Mesmer
1720-1815 „animal magnetism”
Dynamic psychiatry-psychotherapy XIX. - 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 psychiatry Psychotherapy
XIX. - XX.th century
Charcot
Freud
Adler
P. Janet
Jung Ferenczi Edward Munch: A sikoly, 1893.
Balint,
Mahler,
Klein, Erikson, Rogers
Charcot 1825-1893 hypnotic treatment of hysteria
Sigmund Freud
Roots of Psychoterapies I Freud Stekel Adler
1856-1939 1868-1940 1870-1937 psychoanalysis
Freud
Ferenczi 1873-1933 Jung 1875-1961 Abraham 1877-1925
Roots of Psychoterapies II
Psychotherapies Dynamic - interpretation of unconscious
Rogers
1902-1987
Wolf 1926 Slater 1949 Wolpe 1958 Bandura 1963 A.Beck, Ellis
person-centered, clientcentered therapy
behavioural therapies
cognitive therapy
conflicts to produce insight (trauma, losses losses)) Cognitive - learning learning,, perception perception,, cognitive
schemes, correction schemes, Interpersonal – family therapy therapy., ., soc soc.. skills skills,, communication,, coping communication Supportive th th:: problem solving, solving, adaptation adaptation,, strengthening patient’s defenses Crisis intervention Individiual vs group therapies
biological therapies 1887 1926 1933 1935 1936 1938
Wagner von Jauregg – fever therapy Klaesi sleep - therapy Sakel insulin coma Meduna cardiazol-convulsions Moniz psycho-surgery Cerletti,Bini electroconvulsive therapy
Serotonin and Norepinephrine: Norepinephrine: Effect on Depressive Symptoms tonin Sero
No rep ine phr
Anxiety Irritability
DLPFC right •Negatíve affects Anxiety – increased activation (after provocation) •Working memory
Ventromedialis
ine
Vigilance
Impulsivity
Pain Sex Cognitive function Appetite Mood Aggression Emotion
Ventromedial PFC:
Motivation
DLPFC left •injury – positíve affects disturbed •Depression positíve affects deficit DLPFC nucleus accumbens also involved
•Anticipation of positíve and negatíve consequences Orbitofrontalis •Affectíve working memory
OFC cognitive and affective integration Amygdala
Dual action agents may provide the broadest spectrum of therapeutic effect across the full range of emotional and physical symptoms of depression Delgado, unpublished.
Amygdala •negative affects perception •Positíve emotions
Conscious perception
unconscious perception
biological therapies Within psychiatry as a specialized discipline, the major sources of impact from neuroscience have been neuropharmacology and neurochemistry. Coupled with the overall development in neuroscience, the discovery of relatively potent pharmacological treatments for major mental illnesses has also served to reawaken interest in clinical neurobiology
1949 1952
Cade líthium (mood stabilizer) Delay chlorpromazine (antipsychotics)
1957
Kuhn
1962
Other somatic/biological but non-pharmacological therapies • Sleep withdrawal (depression, „chronobiological model) • Light therapy (seasonal, atypical depression) • Psychosurgery (resistent OCD cases) • ECT (th resistent depressive cases, catatonic schizophrenia)
1961 Moore cross-cultural psychiatry 1960Szász, Laing, antipsychiatry
Carlsson, Schildkraut neurotransmitter changes in schizophrenia and depression
Social psychiatry 1905 1912 1917 1920
Social psychiatry 1953 Jones community psychiatry 1958 Hollmgshead, epidemiology
imipramine (antidepressants)
Pratt group-therapy with tbc patients Durkheim suicidal behaviour Simon working therapy Moreno psychodrama
Sociotherapies • • • • • • •
Ergotherapy Vocational rehabilitation Social skills training Assertive training Non-verbal therapies Bibliotherapy Poetry therapy
The „antipsychiatry” social psychiatry
Szasz
- antipsychiatry
Laing
bio - psycho - social approach
stress – vulnerability modell
• What is „normal” normal” or „pathological” pathological” human behaviour • Can the „pathological” pathological”, the diagnosis be just a label or stigma? (social (social deviancy model, model, „construction” construction”) - /.. antipsychiatry/ antipsychiatry/ • BUT: • symptoms, symptoms, outcome, outcome, family clustering are different in these disorders, disorders, • They also have the biological background, background, specific responses in treatment • The purpose of diagnosis and classification is to isolate a group of discrete disease entities, entities, each of which is characterized by a distinct pathophysiology and/ and/or etiology. etiology.
These developments have placed psychiatry in the 1990s squarely within the traditions of medicine and neuroscience. To an interest in neuropharmacology have been added interests in neuroimaging and molecular biology/genetics
Modern students of psyhiatry must simultaneously view their patients on multiple planes: as human beings who have particular symptoms (psychological), as individuals living within a social and cultural context (social), as products of the genetic endowments given them by their parents and coded in their chromosomes (geneticmolecular),
