Somatic therapies

Forrer GR, Miller JJ Atropine coma a somatic therapy in psychiatry. Am J Psychiat 115 455-458, 1958. 

Our approach to each of these drug groups and related somatic therapies begins with a consideration of the possible mechanisms of action, followed by a comprehensive literature review on efficacy and adverse effects. These discussions then serve as the basis for the development of a clinical therapeutic strategy. Knowing that many patients fail standard treatment recommendations, because of either insufficient efficacy or intolerance to adverse effects, led us to emphasize the latter s importance. 

Although criteria-based syndromes have certain limitations, we emphasize their usefulness as a first step in developing an empirical approach to psychopharmacological and somatic therapies. Systematic studies of the effects of psychotropics on such syndromes permit investigators to ... 

Interest in the neurobiological substrates of psychiatric disorders has paralleled the increase in effective somatic therapies, which, in turn, have extended the laboratory s role in evaluating patients. Although the laboratory can never replace clinical acumen in psychiatry, or in any other medical specialty, it can play a significant role in ... 

Response rates to specific types of drug or somatic therapies... 

Depression is common, is frequently unrecognized or underestimated, and may be deadly. For example, 50% of completed suicides are associated with a major depressive episode. Furthermore, depression can adversely affect life activities in a variety of ways. Medical disorders such as cardiovascular disease are also affected by depression, often predicting future cardiac events and hastening death, which is unfortunate, given that there is a very specific set of diagnostic criteria and that there is a variety of effective pharmacologic and somatic therapies (see Chapter 7.) (8). 

Indeed, hypotheses regarding the biological mechanisms subserving mood disorders have developed from observations on the clinical effects of drug and somatic therapies in humans, as well as drug-induced behavioral changes in animals ( 26). For the purpose of discussion, current theories can be divided into several categories ... 

Other promising, investigational, nondrug forms of somatic therapy for affective disorders include transcranial stimulation and vagus nerve stimulation. These treatments are also discussed in Chapter 8. 

Beedle D, Krasuski J, Janicak PG. Advances in somatic therapies electroconvulsive therapy, repetitive transcranial magnetic stimulation, and bright light therapy. In Janicak PG, Davis JM, Preskorn SH, et al., eds. Principies and practice of psychopharmacotherapy update. 2nd ed. Vol 2. Baltimore Williams Wilkins, 1998. 

Greenblatt M, Grosser GH, Wechsler H. Differential response of hospitalized depressed patients to somatic therapy. Am J Psychiatry 1964 120 935-943. 

Preskorn SH, Burke M. Somatic therapy for major depressive disorder selection of an antidepressant. J Clin Psychiatry 1992 53[Suppl 9] 5-18. 

Treatment with Electroconvulsive Therapy and Other Somatic Therapies... 

Other Somatic Therapies Briqht Liqht Phototherapy... 

Somatic therapies have had a long and at times dubious history in the treatment of mental disorders. Clearly, electroconvulsive therapy (ECT) has stood the test of time but has also been plagued by problems in terms of misuse, underuse, a complicated administration process, cognitive adverse effects, and a negative public image. Even so, ECT remains the most effective treatment for some of the most severely ill, medication-refractory, or medication-intolerant patients, often proving to be lifesaving (1). 

The use of electrical stimulation to induce therapeutic seizures is the safest and most efficient form of convulsive therapy (e.g., as compared with pharmacoconvulsive therapy). In 1938, Cerletti and Bini ( 3) were the first to attempt this approach, and until the introduction of effective pharmacotherapy, ECT remained the primary treatment for more severe mood and psychotic episodes. Since then, however, this somatic therapy has been relegated to a secondary role, usually attempted after trials with standard psychotropics (e.g., antidepressants, antipsychotics, lithium, and other mood stabilizers, often in multiple combinations) have proved inadequate. 

FIG. 8-1. The role of electroconvulsive therapy (ECT) and possibly of other somatic therapies in the treatment of psychiatric disorders. Adapted from Martis and Janicak, 2000. 

Keller et al. (46) were also surprised to find that 75% of the nonrecovered patients had been treated with sustained, high levels of drug and/or somatic therapies and concluded that mixed or cycling patients have a more pernicious course and require more effective therapies. In addition, to achieve earlier remission, clinicians should begin aggressive treatment in the initial symptomatic stages, because the purely manic and depressed groups also had severe episodes despite adequate... 

As with any drug or somatic therapy, each of these approaches carries the risk of adverse effects, some potentially quite serious. Examples include the following ... 

Other somatic therapies were developed in the first half of the twentieth century, with variable results. Malaria therapy was conceived in 1917, insulin shock in 1927, psychosutgery in 1936, and electroconvulsive treatment (ECT) in 1938. All of these methods, as originally conceived, carried serious risks, and most demonstrated marginal effectiveness. Psychosurgeries were carried out by the thousands in the 1940s, resulting in rather effective behavioral control over agitated psychotic patients... 

Forrer, G. R. and Miller, J. J. (1958) Atropine coma somatic therapy in psychiatry. Amer. J. 

Albrecht, J. et al. (1985). A controlled study of cellular immune function in affective disorders before and during somatic therapy. Psychiatry Research 15 185-93. 

---