Capsules Ten to Thirteen

10.Definition and scope of psychopharmacology. The term “psychopharmacology” was introduced by Macht in 1920, while studying the effect of drugs on neuromuscular coordination tests. The scope of ”psychopharmacology” was gradually extended to include all experimental investigations which dealt with “psychometrics” and  “psychic” effects of drugs. By the 1940s, it embraced research with “psychotomimetics” and by the 1960s, it included research with all the different drugs used in the treatment of mental illness. Since the 1960s, “psychopharmacology” combined with neuropharmacology (“neuropsychopharmacology”) is used in the re-evaluation of concepts relevant to mental illness and in the development of “psychotropic drugs.”   

11.Pharmacological interventions and treatments in psychiatry introduced during the 1930s. (a) The sedative effect of small (sub-coma) doses of insulin was first noted by Klemperer, in 1926. It was introduced by Steck in the treatment of narcotic withdrawal, in 1932. Sub-coma (modified) insulin therapy was successfully employed in the treatment of severe anxiety refractory to other treatments until the late 1960s. (b) Catatonic inhibition was transiently removed (disinhibited) for the first time, in1929, with the inhalation of 30% carbon-dioxide and 70% oxygen mixture, and later on, but still in the 1930s, with the administration of apomorphine or with the intravenous injection of amobarbital. (c) Chemically-induced abreaction was first used in the treatment of a psychiatric patient by Lindeman, in 1932. Subsequently, for well over 30 years, chemically-induced abreactions with barbiturates (amobarbital), methamphetamine, ether, trichloroethylene, or carbon-dioxide with oxygen were used in the facilitation of psychotherapy. (d) Pharmacologically-induced convulsions in the treatment of schizophrenia with camphor, first, and pentetrazol, subsequently, were introduced by Meduna, in 1932. The numerous other substances used for inducing convulsions included acetylcholine, flurothyl, picrotoxin, cyclohexylethyltriazole and tetramethylsuccinamide. (e) Racemic amphetamine was shown to be effective in the treatment of narcolepsy by Prinzmetal and Blumberg, in 1935, and both racemic and dextroamphetamine were shown to be therapeutically effective in the treatment of hyper-excitable children by Bradley, in 1937.            

12. Introduction of causal treatments in the 1930s and ‘40s and their effect on the diagnostic distribution of psychiatric patients. Demonstration   of the therapeutic effect of nicotinic acid in pellagra by Fouts and his associates, in the 1930s, led to the introduction of the first causal treatment in psychiatry. It was followed by the demonstration of the therapeutic effect of penicillin in syphilitic general paralysis by Stokes and his associates, in 1944; and the recognition of the link between the selective memory (amnesia vs dementia) disturbance in Wernicke’s encephalopathy and thiamine deficiency by De Werdener and Lennox, in 1947. By the end of the 1940s, psychoses, due to syphilitic general paralysis, at one time occupying about 10% of all psychiatric beds, i.e., 5% of all hospital beds, and pellagra, virtually disappeared in the Western World; and the prevalence of dysmnesias markedly decreased.   

13. From the Nuremberg Code to the Helsinki Declaration. The first legal formulation of the ethics for experiments in human was drawn up by the Nuremberg Military Tribunal, in 1947. The “Nuremberg Code” was adopted by the American Medical Association with particular emphasis on voluntary participation, prior animal experiments and proper medical protection, and also by the French Academy of Sciences with particular emphasis on “true” volunteers and qualified investigators. The principles of the Nuremberg Code were reviewed by the United Nations Third Committee on Social, Humanitarian and Cultural Questions, in 1955, and were incorporated in the Helsinki Declaration (HD), in 1964. The HD is based in part on the Declaration of Geneva of the World Medical Association, which postulates that the health of the patient has to be the physician’s first consideration, and in part of the International Code of Medical Ethics, which postulates that any act or device, which could weaken physical or mental resistance of a human being, may be used only in his/her interest.