BIOLOGIC/ SOMATIC THERAPY ELECTROCONVULSIVE THERAPY Was first described by Cerletti and Bini in 1938 as a treatment for schizophrenia.

Electroconvulsive therapy is a treatment in which a grand mal seizure is artificially induced in an anesthetized patient by passing electrical current through electrodes applied to the patients head. Electrodes have been applied bilaterally. Electrode placements are now routinely used, including unilatereal and bifontal. It has been reported that patients have fewer cognitive side effects with these alternative placement, including less disorientation and fewer disturbances of verbal and nonverbal memory Current clinical wisdom notes that for ECT to be effective, a grand mal seizure most occur A usual course is 6-12 treatments given two of three times a week. A patient with schizophrenia may require more.

Indications The primary indication for ECT is major depression. ECT response rate of 80% or more for most patients is better than response associated with antidepressant medication.

Mechanism of action The precise mechanism of action of ECT is still not known. Most theories about the mode of action of ECT focus on its efficacy with depressed patients and include the following: o Neurotransmitter theory o Neuroendocrine theory o Anticonvulsant theory

Adverse effects Mortality and morbidity are believed to be lower with ECT than with the administration of antidepressant medications despite the frequent use of ECT in patients with medical complications and in the elderly o Cardiovascular effects o Systemic effects o Cognitive effects

INSULIN SHOCK THERAPY Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. I introduced in 1933 by Polish-Austrian-Americanpsychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs. It is causing an intensification of the tonus of the parasympathetic end of the autonomic nervous system, by blockading the nerve cell, and by strengthening the anabolic force which induces the restoration of the normal function of the nerve cell and the recovery of the patient.

Technique The daily insulin dose was gradually increased to 100150 units until comas were produced, at which point the dose would be leveled out. Occasionally doses of up to 450 units were used. After about 50 or 60 comas, or earlier if the psychiatrist thought that maximum benefit had been achieved, the dose of insulin was rapidly reduced before treatment was stopped. After the insulin injection patients would experience various symptoms of decreased blood glucose: flushing, pallor, perspiration, salivation, drowsiness or restlessness. Sopor and comaif the dose was high enoughwould follow. Each coma would last for up to an hour and be terminated by intravenous glucose.] Seizures sometimes occurred before or during the coma. Many would be tossing, rolling, moaning, twitching, spasming or thrashing around.

PHOTOTHERAPY A. What is Phototherapy? It is more commonly known as light therapy. It is a new form of intervention that provides artificial lighting, brighter than indoor lighting to stimulate bright summer light conditions. B. Indications Light therapy is treatment for individuals with Seasonal Affective Disorder (SAD), which is a nonpsychotic depression experienced during winter months. SAD is a cyclical illness, and in most cases, episodes begin in fall or winter and remits in spring. The

prevalence of winter-type SAD varies with latitude, age and sex. Prevalence increases with higher latitudes, younger persons are at higher risk than older adults, and women comprise 60% to 90% of person with the illness. In addition to seasonal affective disorder, light therapy is being studied as a treatment for other conditions, including types of depression that don't occur seasonally, obsessive-compulsive disorders, jet lag, sleep disorders, adjusting to a nighttime work schedule, Parkinson's disease, dementia, and attentiondeficit/hyperactivity disorder (ADHD). C. Effectiveness Light therapy probably won't cure seasonal affective disorder, depression or other conditions. But it may ease symptoms, increase energy levels and help the patient feel better about the self and life. Light therapy can start to improve symptoms within just a few days. In some cases, though, it can take two or more weeks. It relieves symptoms of about 75% of persons with SAD. It also provides positive effects on depressive symptoms within 1 week of initiating treatment. Light therapy is an important alternative to drug treatment for nearly 15 million of Americans who are experiencing SAD. SLEEP THERAPY A. What is sleep? Sleep is the regular period in every 24 hours when we are unconscious and unaware of our surroundings. There are two main types of sleep: Rapid Eye Movement (REM) sleep It comes and goes throughout the night, and makes up about one fifth of our sleep time. During REM sleep, the brain is very active, the muscles are very relaxed, the eyes move quickly from side to side and then a person dreams.

Non-REM sleep The brain is quiet, but the body may move around. Hormones are released into the bloodstream and the body repairs itself after the wear and tear of the day. There are 4 stages of non-REM sleep: The muscles relax, the heart beats slower and body temperature falls - "pre- sleep". Light sleep the person can still be woken easily without feeling confused. "Slow wave" sleep - the blood pressure falls, a person may talk in his/her sleep or sleep walk. Deep "slow wave" sleep the person becomes very hard to wake. If he/she is woken, he/she feels confused. The person moves between REM and non-REM sleep about five times throughout the night, dreaming more as one gets toward the morning. B. Sample of sleep therapy script Start by just closing your eyes down... take a deep breath... hold it... and exhale slowly... one more time... with each and every breath, you will experience a growing sense of calm and peace in your mind and body... you let go and allow yourself this time... for you... and you alone... allow your body to respond naturally... one more nice, deep breath... and relax. I want you to picture yourself right now, just as you are, right where you're laying... get a good mental image... you will notice that there is a beautiful, white light... so white, sparkling with beautiful tones of violet... radiating around your body... you feel this pure, positive energy... this is a very healing energy, and I want you to allow it to flow in and out of your body... allow it to heal Just imagine now that this energy begins to flow from the very top of your head... and immediately, you begin to relax... as this pure, relaxing energy flows into your forehead, it becomes the most beautiful shade of indigo... it flows down into your eyes... your eyes become very heavy... you couldn't open them if you tried... your cheeks relax... your lips... your chin... your jaw... completely relaxed... if your mind wanders, just allow it to happen...

This beautiful energy flows down into your throat now... becoming the most lovely shade of blue you have ever seen... you can feel it's healing power... down into your shoulders... relaxing more and more... the relaxation flows down into your chest... as it nears your heart, the light becomes a brilliant, healing green... detach yourself now from any thoughts of the outside world at all... and relax even more... The energy continues to flow through your back muscles... making them numb and warm... your arms begin to feel heavy and limp... they relax at your sides... completely relax... heavy and numb... the relaxation flows down into your ribs... right above your belly button... the light becomes yellow... it continues to flow... into your diaphragm... your breathing is so rhythmic and easy... the light becomes orange... Almost every muscle in your body completely relaxed... your mind is at ease... your body is numb... this feeling flows down into your hips... the healing light becomes a beautiful red... the energy flows down into your thighs... your knees... your calves... your feet... and right to your toes... your legs are heavy and numb... there is no feeling is discomfort whatsoever... you are completely relaxed and comfortable... Now find yourself in your most serene place in the universe that you can possibly imagine... imagine yourself lying there asleep... see yourself... completely relaxed... completely comfortable... asleep... allow yourself to be in this place... allow yourself to sleep a full 8 hours... and wake in the morning feeling fully rested... every muscle relaxed and refreshed... feeling better than you have ever felt before. (End of script)