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This article throws light upon the three important physical therapies used in treatment of behavioural disorders. The physical therapies are: 1. Chemo Therapy 2. Electro Therapy 3. Brain Wave Therapy.
Physical Therapy # 1. Chemo Therapy:
During the last three decades or so, chemicals and drugs have been used on a mass scale for the treatment of mental and behavioural disorders. After 1950’s tranquilizers and antidepressant drugs were widely applied as a means of treatment of the mentally ill persons.
Due to the wide application of the tranquilizers admission of patients to the mental hospitals and institutions showed a downward tendency.
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Drug therapies made it even much easier to treat the mental patients and to give them an “emotional lift”. The knowledge of psychiatrists about the function of biochemistry in brain pathology and the development of new tranquilizers and drugs made the chemotherapy quite popular and useful as well.
In chemotherapy many important drugs are used some of which are discussed below along with their advantages and disadvantages:
(a) The antipsychotic drugs or major tranquilizers
(b) The antianxiety drugs or minor tranquillizers
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(c) The antidepressant drugs.
The antipsychotic drugs (Major tranquilizers):
Used to treat psychotic patients these are chemicals that can reduce schizophrenic behaviour as well as alleviate severe anxiety and excitement. Reserpine, a drug prepared from rouwolfia, is a major tranquilizer effective for the treatment of affective psychoses like manic reaction, schizophrenia and other forms of psychopathology.
It was first used in India in the fifth century. The roots of this plant were used in India for the treatment of a number of physical and mental illnesses.
The Indian Medical Gazette (1943) reported the use of this drug for the treatment of psychotic disorders. Reserpine was also found to be effective specially in the reduction of tension and anxiety in neuroses and in acute schizophrenia.
But subsequently, because of its side effects such as lowered blood pressure, drowsiness, dizziness, fatigue, muscular cramps and other gastro intestinal troubles, it has been replaced by other tranquilizers like phenothiazine’s used in the form of chlorpromazine used for a severe case of schizophrenia in 5000 mg dose.
Introduced in the early 50s, the phenothiazine’s have been still popular as they have side effects like psychomotor retardation, drowsiness and jaundice. This tranquilizer was first synthesised in France in 1952. It is very effectively used for controlling the emotional tensions of psychotics, disordered thought processes and motor hyperactivity.
By the use of this drug actually excited patients are calmed down within 48 hours after the treatment starts and within two weeks normally delusions and hallucinations are eliminated or reduced. Even reports are available that chronic schizophrenics get relief from their symptoms.
These are considered relatively safe drugs. The side effects of these drugs can be cleared up with an adjustment in doses. One should further be cautious of the fact that they should be used in combination with alcohol. Among the other antipsychotic drugs, the butyrophenones, the thioranthenes and the dibenzoxazepines, molindone are important.
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The antianxiety drugs (Minor tranquilizers):
Unlike the major tranquilizers, minor tranquilizers have been applied in recent years to reduce anxiety and stress in normal people during periods of high stress and tension. Minor tranquilizers are also used in the neutric and psychophysiologic disorders. It is applied particularly to reduce mild tension and anxiety and other accompanying disturbances like sleeplessness and irritability.
Berger (1952) developed the first minor tranquilizer which was named as Mebrobanate, its trade name being Miltown. Librium and Valium are the other two trade names used for chlordiazepoxide, hydrochloride and diazepam respectively.
Minor tranquilizers act mainly on the subcortical centres and produce a state of muscular reaction. They have minimal side effects such as drowsiness and severe withdrawal symptoms like insomnia, tremors, hallucinations when the application of the drug is withdrawn.
Particular care is taken not to recommend these drugs for pregnant women, for children below 6 years of age and for depressed persons, for individuals who are engaged in dangerous and alterative jobs requiring alertness and attention such as drivers, pilots and machine operators and soldiers, military personnel’s. Like the major tranquilizers they should be used in combination with alcohol.
Stimulants and depressants have also been used in the recent times for the treatments of depressions in general. This group of medicine is said to be most widely prescribed in the U.S.A. According to the reports of Cob and Davis (1975) 80 million prescriptions were written for minor tranquilizers in one year.
In India, the demand for tranquilizers is not so heavy like her western counterparts though currently a few percentage of the student population particularly in the urban areas, use antianxiety drugs. As it seems, emotional stress and anxiety is less frequently experienced among Indian people and probably they have a greater capacity for stress tolerance.
Another explanation of less use of these drugs in the home country may be due to the fact that attitude towards the use of drugs and depressants is not that favourable in the home country as it is in the western countries.
Evaluation:
Pointing out the advantages of chemotherapy Coleman (1981) has remarked “All in all chemotherapy not only has outmoded more drastic forms of treatment but has led to a much more favourable hospital climate for patients and staff alike.”
Disadvantages:
Apart from the already discussed possible side effects, matching of the drug and dosage according to the need of the patient becomes a complicated problem. Further in the course of treatment, it may be required to change medication.
To add to this as quite a number of investigators have pointed out tranquilizers and antidepressants tend to alleviate symptoms rather than to bring the individual to grips with personal and situational factors that may be reinforcing maladaptive behaviours.
Chemotherapy may not always bring a permanent cure, though it may possibly be able to reduce anxiety, tension, disturbed thought and other effective disorders. Thus, in addition to biological therapies, it may appear necessary to include psychotherapy and socio-therapy.
Duke and Nowicki (1979) have remarked “However it must be remembered that in general, drugs do not cure but rather control symptoms of disordered behaviour, in much the same manner, that antihistamines merely control symptoms of colds.”
Physical Therapy # 2. Electrotherapy:
The effect of electric current on the functioning of central nervous system refers to electrotherapy.
There are mainly 3 forms of electrotherapy:
1. Electro convulsive therapy:
Otherwise known as shock therapy ECT was developed for the first time by a Budapest psychiatrist named Vonneduna. Later in 1938, two Italians named Cerletti and Bini used the ECT for the artificial production of convulsive seizures in mental patients and made it a much more refined technique than the earlier one.
Care has been taken since then to have minimum convulsions after the shock is applied and thus the ECT has been considered as a relatively safe method of treatment.
Though ECT has not proved to be very effective in the treatment of schizophrenics, it is found to be highly effective in the treatment of depressives, in spite of a few complications. It can be used also in patients with heart disease.
In-spite of certain advantages some behaviour therapists hold that ECT acts as a negative reinforce to ‘crazy’ or depressed behaviour, so that the individual changes his behaviour to avoid more punishment. However, it is observed that with the wide use of chemotherapy in the recent years, the use of ECT has been reduced. Currently it is mainly used for the quick alleviation of depression in suicidal individuals.
2. Electro sleep therapy:
Apart from drugs like bromides to induce sleep, sleep can also be induced by electro shock therapy. Currently, it is the topic of most extensive research in U.S.S.R. In EST a soft mask containing electrodes, is placed on the upper half of the individual’s face and mild electric current is administered.
The duration of treatment is half an hour daily for one or two weeks depending upon the nature of symptoms. During this treatment, the patient does not experience convulsions or lose consciousness, he only experiences a mild tingling sensation. Further he may or may not fall asleep during the treatment.
Rosenthal and Wulfsohn (1970) found favourable effects on 40 outpatients suffering from chronic anxiety, depressive states and associated insomnia. But subsequent studies by Astrup (1974), Brown (1975), Hearst et al (1974), have not strongly confirmed the above results and hence further research is needed to ascertain the effectiveness of EST, in mental disorder.
3. Implantation of micro circuitry:
The electrical stimulation of the brain known as ESB aims at knowing how the various areas of brain function. It has thus been found that electrical stimulation of the hypothalamus in human beings can produce plenty of emotional responses.
In order to control certain forms of maladaptive behaviour associated with pathological brain functioning such as homicidal impulses or chronic suicidal behaviour the chances of surgical implantation of micro circuitry has been examined by such findings.
In as much as, some researchers even hope that the possibility of controlling the extreme mood swinging of the manic depressive psychodc patients with the help of ESB cannot be ruled out.
Physical Therapy # 3. Brain Wave Therapy:
E.E.G. records show that the dominance of a given wave pattern appears to be related to specific functions of the brain. For instance, Alpha waves having a frequency of 8 to 12 cycles per second and an amplitude up to 40 microvolts are associated with an alert state that is free from concrete visual imagery and is accompanied by feelings of tranquillity and lack of tension and anxiety.
On the contrary, Beta waves which fall into a fast placed 14-28 cycles per second, usually occur when the individual is passing through a period of deep stress. Thirdly, delta waves occur when the individual is asleep or unconscious.
Various therapists and psychiatrists in recent years have shown sufficient interest in the therapeutic use of brain wave control. It has also been demonstrated that by means of yoga, brain waves can be controlled. The use of bio-feed-back training, popularly known as Electric Yoga, for the control of brain waves and muscle tension could be specifically helpful in reducing chronic anxiety and tension.
Townsend, House and Addario (1973) observed that biofeed back mediated relaxation therapy proved much effective than group therapy in the treatment of chronic anxiety.
Psycho surgery:
Psycho surgery, as the term indicates refers to a group of surgical treatments in which various parts of the patient’s brain may be destroyed to change behavioural or emotional disorders. Swiss psychiatrist Burckhardt in 1888 reported his classic discovery on the intentional destruction of a part of the cerebral cortex of the mental patients.
In 1936, Moniz, a Portuguese Physician suggested frontal lobe surgery for the treatment of schizophrenia. This operation involved surgical opening of the skull and destroying various tissues connecting the frontal lobes with the rest of the brain.
Gradually, the trend, of psychosurgery shifted to relatively smaller brain operations, like the trans orbital Lobotomy. In such an operation, no surgical incision or skull opening is necessary. Only the central nerve tracts are severed by introducing an instrument through the eye sockets above the eyes.
Modern psychosurgery differs from the lobotomies. Instead of drastically scrambling brain areas electrodes are carefully implanted into specific sites through which electrical impulses are passed selectively, destroying predetermined areas like the limbic system, which is said to be related to the integration and control of emotional behaviour.
Another modern form of psychosurgery is known as amygdalectomy in which the anygdala is destroyed electrically while trying to control violent behaviour. Mark and Ervin have further reported that amygdalectomy may be used effectively in treating children and adults who show violent antisocial behaviour due to some defect in the central nervous system.
In thalamotomy, the thalamus is destroyed in order to modify aggressiveness in adults and hyperactivity in children. However, with the increasing use of the psychoactive drugs, the use of psychosurgery has highly decreased.
In the words of Duke and Nowicki (1979), psychosurgery is rarely performed to-day except in cases of what are called completely intractable emotional illness. In other words, for patients who are very dangerous to themselves and others for whom nothing else- works, surgery may be considered. Psychosurgery is a drastic step, because its effects are inversible.