Psychiatry throughout the History

Dr. Mohamed AbdelbadieFEB.Psych Specialist psychiatristKhorfakkan Hospital

INTRODUCTION

• Ancient history contains data about psychiatry more so than any other field of medicine !!!

• A few make a degree of scientific sense, some were genuine breakthroughs, and most were disasters.

• Sorcerers took the role of psychiatrists in ancient Egypt.• Depression and alcoholism were described. • Hallucinogenic drugs and religious dance (Zar) used in

treatment with some Bizarre methods.

M.Abdelbadie

Madness

Mental illness

M.Abdelbadie

1000 AC

Ibn Sina – Avicenna (980-1030)

A pioneer in psychosomatic medicine.He provided description and treatment for insomnia, mania, stroke, epilepsy , depression and others.

Al-Razi (865–925)Among the first in the world to write on mental illness and psychotherapy. As chief physician of Baghdad hospital, he was also the director of one of the first psychiatric wards in the world.

M.Abdelbadie

Julius Wagner- Jauregg• Noticed that residents of the asylum seemed to return to

sanity after experiencing a febrile episode.

• In 1917, he reported positive results after inoculating patients with intravenous injections of malaria, followed by quinine treatment after resolution of syphilitic like symptoms (Psychosis).

• The only Nobel prized psychiatrist (1927) for linking psychosis to a potentially natural cause.

M.Abdelbadie

Sigmund Freud (1856-1939)

• One of the most influential scientists of the 20th century.

• The father of psychoanalysis; his theory based on the unconscious mind,

and the role of sexual and destructive drive in personal psychology.

• A disastrous surgery was done by his ENT fellow Fliess by removal of the  middle turbinate of hysterical patient.

• But his work has had a large and lasting impact on medical practice by presenting a new framework for researching, understanding / treating range of psychological conditions.

M.Abdelbadie

Pathophysiology of mental disorders• The lack of knowledge about the exact pathophysiology

of psychiatric disorders continues to hinder accurate diagnosis mostly due to Epigenetic model of illnesses.

• The limited number of treatment mechanisms which were due to serendipitous findings pushed us to arrange illness according to treatments response.

Functional MRI

M.Abdelbadie

Psychiatric Nosology

International Classification of Diseases by the WHO

• 1st version, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893.

• 6th version in 1948 “no wide acceptance of the mental disorder listings ’’.

• (ICD-10) 1992.• (ICD-11) 2017? Beta draft

DSM by the American Psychiatric Association

• USA was recording of the frequency of “idiocy/insanity”

• The APA developed a variant of the ICD-6 that was published in 1952 as the 1st Ed. of DSM.

• A "turning point" in psychiatry: The DSM-III 1980

• (DSM-5) 2013.Dimensional rather than

categorical classification.

M.Abdelbadie

Psychiatric NosologyInternational Classification of Diseases by the WHO

DSM by the American Psychiatric Association

M.Abdelbadie

Odd & Outlandish Psychiatric Treatments• Trepanation to allow the "evil to escape" .• Hysteria Therapy by exposure to foul-smelling

substances intended to repel the uterus from the upper regions of the body.

• Mesmerism with the aid of strategically placed magnets.• Rotational Therapy• Wisdom Tooth extractions.• Hydrotherapy with extremely cold then hot water.

M.Abdelbadie

History of Convulsive therapy• Insulin was discovered (1922) and tested in patients suffering

from illnesses for which no treatment was known (opioid withdrawal by Sakel 1930).

• In 1934, Meduna made a false observation: Schizophrenia & epilepsy rarely co-presented in individual patients.

• Tried to induce seizures by injecting the blood of epileptic patients into those with schizophrenia, Meduna soon turned to chemical agents, beginning with Camphor oil and Cardiazol.

M.Abdelbadie

The Electroconvulsive therapy

• Cerletti 1900 noticed at the slaughter house, the technique used for butchering cattle involved an electric shock to their heads & asked his trainee to design a device.

• Bini 1938 adjusted the equipment to 110 V and 2/10 of a second, and Felici clicked the switch.

• Spectrum 5000Q Mecta can produce 0.3 milli-second pulse width

M.Abdelbadie

Chlorpromazine 1950• One of the phenothiazines developed at the end of the

19th century.• They were employed as antiseptics, antihelminthics and

antimalarials.

• Between 1954 and 1975, >40 antipsychotic drugs introduced throughout the world.

(Thereafter, there was a hiatus in the development of antipsychotics)

M.Abdelbadie

Antidepressants and Mood stabilizers• The era of antidepressants started with isoniazid, an

antitubercular agent, which was accidentally found to have euphoric effects in patients with tuberculosis who were receiving this drug in 1950.

• The end of drug patency of many antidepressants (SSRI & SNRI) resulted in a large financial hit to the pharmaceutical companies.

• Lithium, discovered in 1817, was noticed to have mood stabilizing properties in the late 1800s when doctors were using it to treat gout.

M.Abdelbadie

Recent advances in psychiatry• Virtual Reality:- Used in treatment of anxiety disorders - can be advantageous over standard CBT 

• Nano-psychiatry:- add new properties to existing molecules, making them

more competitive; pass the BBB ...- CNS in-vitro Modeling before eventually a clinical trial is

designed and implemented.- Theoretically; Nanobots could repair damages

M.Abdelbadie

Human Genome and Stem cells• Gene analysis influence how effective some drugs will

be and whether they are prone to major side effects.• A Hippocampal Neural stem cell–derived small molecule

(NSI-1890) taken orally, has demonstrated efficacy in a small number of patients with major depressive disorder (phase-2 trials)

• Pig embryo hosts human cells January 27, 2017

M.Abdelbadie

Human Microbiomes • Its all of our microbes’ genes, which

outnumber the genes in our genome by about 100 to 1.

• Fecal Transplant of laboratory purified samples to remove nearly all waste material, leaving a "super probiotic" Shows Early Promise Against Autism:

After the procedure, the children experienced a 25% reduction in symptoms related to language, social interaction and repetitive behaviors.

M.Abdelbadie Khorfakkan Hospital

References• WHO; http://www.who.int/classifications/icd/en/HistoryOfICD.pdf• Medscape; odd-psychiatric-treatments Apr 2016.• Simmons, D. 2008; Epigenetic influence and disease. Nature Education 1(1):6• Okasha 2001; Egyptian Contribution to the concept of mental health, Eastern Mediterranean

Health Journal. Vol 7, NO. 3, P 377-383.• Brian Miller 2016; Novel Insights Into the Causes of Schizophrenia.• M. Fava et al 2016; A Phase 1B, study of NSI-189 phosphate, a neurogenic compound, in

depressed patients.• Chen et al 2014; Translational Psychiatry 4, e375; doi:10.1038/tp.2014.12. pluripotent stem cells

from bipolar disorder patients• Ivan Dimitrijevic and Igor Pantic 2014; Application of nanoparticles in psychophysiology and

psychiatry research.• Fond et al 2013; the potential role of nanotechnologies in the future of psychiatry.• Norman et al 1989; The Origins of ECT• Bouchard et al 2016; Virtual reality compared with in vivo exposure in the treatment of social

anxiety disorder.• Ruzzo EK , Geschwind DH 2016; Schizophrenia genetics complements its mechanistic

understanding.• Ke Xu et al 2011; Targeting HDACs: A Promising Therapy for Alzheimer's Disease• Dae-Wook Kang 2017; Microbiota Transfer Therapy • Chaitra T et al 2011; Antidepressants: From MAOIs to SSRIs and more•  Masson, Jeffrey M 1984; The Assault on Truth: Freud's Suppression of the Seduction Theory.• http://www.sciencemag.org/news/2017/01/human-organs-grown-pigs-not-so-fast