Month: April 2019

Little history

They say that the fifties radically changed the face of psychiatry. Why? Yes, because there was aminazine. And then other neuroleptics. And — antidepressants. And off we go. If you believe the teachers, with the beginning of the era of neuroleptics mentally ill people are not left — in its classic version, which existed before many centuries. Now the psychiatrist at hand has an Arsenal of magic pills and injections: from bad mood, from surveillance of intelligence services, from cosmic rays and alien invasion — Yes from anything. Not only potions of intelligence, charisma powder, vaccinations conscience and something else on the little things. And Yes, still no one really knows what’s going on in your head and where schizophrenia comes from. But now there is an opportunity not to keep patients in isolation from society for life.

A natural question: what was the treatment of patients in psychiatric hospitals until the fifties? Let me give you a brief overview of the methods — so you have a General idea about them.

The ancient Greeks to the mentally ill were quite severe — could and stones beat. According to some reports, particularly demoniac they even chained or put on an electric Stingray (as we see, the basics of electroconvulsive therapy date back to the fifth century BC).

The Romans offered their options: to follow, to avoid constipation (it’s in melancholia), bind and keep in the dark (rage and fury), to give the emetic and the time to associate with hallucinations and delusions (if not helps, to prescribe “fasting and healing Lyuli”, recommended that Celsus). And epilepsy was proposed to treat the blood of a Gladiator. No,no, don’t spill it. That is to spill, of course, and then give it to the insane.

Quite varied were approaches to the treatment of mental illness in medieval Europe. Patients were often kept at monasteries and used exorcism. Hot iron and therapeutic auto-dafe were used infrequently. For the treatment of melancholy offered to eat pork heart stuffed with herbs. There were also rods (in order to switch the thoughts of the patient to bodily discomfort), mustard plasters for the whole person (to dilute the blood, stagnated in melancholy), bloodletting and, as an act of condescension, — warm baths. In Switzerland, in a shelter near Zurich, practiced content on the chain and the daily issuance of wine for medicinal purposes. Hellebore water was used quite widely — both from lice on the head, and from “cockroaches” inside (now it, by the way, sometimes pour alcoholics caring wife, in full accordance with the attached instructions).

In Europe, the XVIII century continue to actively use americnas water (it was used in psychiatry for a long time) and practice of the cold water. The British instead of ropes and shackles begin to use a straitjacket — a prototype of a straitjacket. However, in Bedlam still let onlookers (one-penny entrance), and on weekends it’s a full house. The French, through the efforts of Philippe Pinel, too, reject the detention of patients in chains and begin to use a straitjacket to the early nineteenth century. The style of this kind of clothing is relevant to this day.

In the nineteenth century, doctors began to show a greater interest in the mentally ill, combined with irrepressible imagination. Thanks to this, there are a straitjacket chair, a straitjacket bed, a rotational bed and a rotational machine (so that the blood flows to the head and the brain works better), a device for an unexpected immersion in a pool of cold water, as well as an ice shower on the head from a hose (the prototype of the Charcot shower — this method will appear in the same century a little later). Leeches (10-12 pieces per head) are popular in combination with wrapping with cold wet towels and laxative salt (the practice of the ancient Greeks was in use for a long time). Treatment with morphine and cannabis is in Vogue. The first sprouts of psychotherapy begin to break through. Hypnosis is increasingly practiced. There are preparations of bromine and barbituric acid: veronal, medinal. Begin to use paraldehyde and chloral hydrate.

In the XX century (first half) – box methods of treatment of mental illness updated malariotherapy (vaccination of malaria-treated paralysis), and then the injection sulfazine, and electroconvulsive and insulin shock therapy. Except for the lobotomy, of course. And finally, there are the antipsychotics, antidepressants and other psychiatric the contents of the magic briefcase. We look forward to the vaccine against Alzheimer’s disease in this new XXI century, but the creation of vaccinations of conscience and intelligence potions can not even hope.

Sleep Deprivation

Depression is almost always associated with sleep disorders. Depending on the type of disease, these disorders can be of different nature, from difficulties with falling asleep, surface sleep with frequent awakenings to opposite symptoms, expressed in increased drowsiness, heavy waking. It is characteristic that with any orientation of violations sleep does not bring relief to the patient, recovery in sleep does not occur, regardless of the amount of time spent in bed.

There have even been theories that point to sleep disorders not as a symptom, but as a cause of depression, although to date there is no scientific evidence to support this assumption.

The mechanism of the therapeutic effect of deprivation is based on the regulation of disturbed daily cycles of the body, the so-called circadian, 24-hour rhythms, in this case, the cycle “sleep – wakefulness”. In the same rhythm there are changes and other human functions, such as appetite, body temperature, heart rate, blood pressure and others. The speed of metabolic processes, the activity of the endocrine system, the metabolism of neurotransmitters – all this is subject to circadian rhythms.

In a healthy person, all these periodically occurring processes are strictly synchronized with each other, but in a depressed state their normal course becomes disturbed, while there are also characteristic daily fluctuations in the emotional background, in the morning the patients feel worse, in the evening the condition usually improves.

These biochemical studies show that during depression disturbed normal daily rhythm of hormone production, metabolism of other biologically active compounds. All this suggests that somehow such desynchronization is involved in the pathogenesis of depressive States. Sleep deprivation is a kind of reset, an attempt to restore the original synchronicity of the circadian cycles.

The positive effect of sleep deprivation on endogenous depression was first reported in 1966. Since that time, deprivation has become popular as a simple and relatively safe method. There have been many reports from various psychiatrists about the successful application of the method in practice. Subsequently, enough data have been accumulated to judge a certain commonality of mechanisms for the development of disorders and depressive States.

The structure of sleep is cyclical, that is, in its course there is a change of several phases. These encephalograms show that in depressed patients there is a violation of these phases, the process of falling asleep and waking, the overall quality of sleep deteriorates. The distribution of sleep stages changes dominated by superficial sleep and reduced during the phase of deep sleep. There is a sharper than in healthy, the transition from one phase of sleep to another. Accordingly, the improvement of the clinical condition of patients is accompanied by its normalization.

The indication for the use of sleep deprivation as a therapeutic method is not only the presence of depression itself, but also a depressive state in other diseases, including some forms of schizophrenia. The best results are achieved with classical melancholic depression, with a marked decrease in mood, psychomotor inhibition, a feeling of sadness, guilt, combined with low self-esteem, and a sense of lack of prospects in life.

Sleep deprivation is considered to be effective both in recent depressions and in prolonged, drug-resistant therapy. Moreover, in some cases of severe prolonged depression, depression was effective in overcoming such resistance and increasing the patient’s sensitivity to antidepressants.

There are no absolute contraindications to its use, you should take the usual precautions for hypertension, recently suffered a stroke. The natural limitation of its wide application is a violation of the rhythm of life of the patient, the discomfort experienced by him, the difficulty of resisting the desire to fall asleep. The advantage is the availability and possibility of independent practice.

As for the practical application, there are several methods of deprivation, the most common of which is total sleep deprivation. The essence of the method is that the patient misses one night, that is, he does not sleep a day, a night and another day, the total is about 36 hours of continuous wakefulness. A single procedure, as a rule, causes a short-term effect, so it is repeated 8-10 times, twice, and then once a week.

On the day of the beginning of the procedure, you should exclude daytime sleep and make a program of classes at night to successfully combat drowsiness. You can prepare in advance the materials for reading, playing, music, stock up discs with movies. Load yourself with work is not necessary, because it leads to fatigue and increased need for sleep. You can alternate these classes with light exercise, push-UPS, abdominal muscles load.

During the night, you can eat light food, reception of stimulating drinks (tea, coffee) is best avoided. The next morning it is better not to sit at home, take a walk, do something in the fresh air. Having held out thus 36 hours, it is possible to go to bed at usual time for itself.

A more gentle method is a partial deprivation of sleep, in which the patient sleeps at night for about three hours, then wakes up, and then everything happens as in total deprivation. Partial deprivation is easier to tolerate than total, but it should not be used for patients with disturbed sleep, in this case, from attempts to sleep and a short sleep, a person feels only more broken.

There is an even more technically complex version of partial deprivation, in which the patient is woken up at the onset of his REM phase and then allowed to fall asleep again, before the next such phase. This procedure is repeated throughout the night. This so-called REM (rapid eyes movement) deprivation, no special efficiency it does not have, requires technical equipment and therefore is currently rarely used.

In deprivation, there are several stages, during the day the fluctuations of the emotional sphere occur in the usual scenario, in the morning the state of health is worsened, in the evening it is leveled and remains so for the first few hours of the night. Closer to the morning, the state of health improves, usually imperceptibly for the patient, and remains so until the end of the procedure.

The main difficulty is the struggle with sleep, with good preparation, the first night hours usually pass without problems, the probability of falling asleep increases sharply closer to the morning, if it is overcome, then during the next day it will be easier to sleep, periods of drowsiness will be observed at times, but not as pronounced as the morning.

In the first half of the second day, a paradoxical feeling of vivacity, a surge of energy, even talkativeness can be felt. Sometimes they write about the appearance of headaches, weakness for this period, but this phenomenon is individual and occurs not at all.

The maximum improvement occurs at 9-12 o’clock in the morning, at this time, usually in depressed patients there is the most severe period during the day. Subjectively perceived mood elevation, disappears retardation, the person becomes active, communicative, critically ill patients may disappear suicidal thoughts, ideas of self-malacense.

During the rest of the day, the mood gradually decreases, but never falls below the level usual at this time of day. Sleep, after deprivation is very good, deep, comes very quickly and lasts all night, even in patients with obvious disorders. After awakening, the symptoms of depression are again felt, albeit to a lesser extent than before the procedure. Unfortunately, the effect of deprivation is short-term and requires repeated repetition of the process.

As the procedure is repeated (first two, then once a week), there is a gradual improvement in the patient’s condition, the duration of periods of good mood increases, respectively, the periods of bad are reduced, with time, the reduction of symptoms can take large values. There is interest in what is happening, improves appetite, is inhibited. Later, other symptoms are a receding concern. This is a typical pattern, from which, of course, there may be deviations, both in relation to the reaction to the deprivation itself, and the speed and sequence of reducing symptoms.

Some patients during the night procedure may increase symptoms, more often it is observed in patients with anxiety and depressive disorder. But in the morning, almost everyone gets better.

I have repeatedly tried this method, and it really has a short-term effect, but I can not attribute it to physiological. Yet there is a rough intervention in the functioning of the body, and although the literature does not describe the serious side effects of its use, it seems to me that long-term use for the benefit of health it does not go. It should be understood that the state of consciousness in deprivation refers to the changed, it is not normal, although it brings relief. The use of deprivation is poorly combined with social life and work, although in severe depression it is not so significant.

Is it worth trying this method? I think he’s definitely better than electrical stimulation, whose effectiveness it is often compared, side effects are certainly less. Deprivation is a good immediate effect, even a short-term improvement can be a great gift for a serious patient, to open the long-closed door to another world, to give hope and give strength to continue the struggle. But I still have not seen the information about the patients, get rid of depression, just practicing deprivation.

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