Editing Psychosis (section)

=== Treatment ===
Written record of supernatural causes and resultant treatments can be traced back to the [[New Testament]]. [[Mark 5]]:8–13 describes a man displaying what would today be described as psychotic symptoms. [[Christ]] cured this "[[demon]]ic madness" by casting out the demons and hurling them into a herd of swine. Exorcism is still utilized in some religious circles as a treatment for psychosis presumed to be demonic possession.<ref>{{cite journal |vauthors=Vlachos IO, Beratis S, Hartocollis P |year=1997 |title=Magico-religious beliefs and psychosis |journal=Psychopathology |volume=30 |issue=2 |pages=93–99 |doi=10.1159/000285035 |pmid=9168565}}</ref> A research study of out-patients in psychiatric clinics found that 30 percent of religious patients attributed the cause of their psychotic symptoms to evil spirits. Many of these patients underwent exorcistic healing rituals that, though largely regarded as positive experiences by the patients, had no effect on symptomology. Results did, however, show a significant worsening of psychotic symptoms associated with exclusion of medical treatment for coercive forms of exorcism.<ref>{{cite journal |vauthors=Pfeifer S |date=September 1994 |title=Belief in demons and exorcism in psychiatric patients in Switzerland |journal=The British Journal of Medical Psychology |volume=67 |issue=3 |pages=247–258 |doi=10.1111/j.2044-8341.1994.tb01794.x |pmid=7803317}}</ref>
[[File:Hippocrates.jpg|thumb|Bust of Hippocrates]]
The medical teachings of the fourth-century philosopher and physician [[Hippocrates of Cos]] proposed a natural, rather than supernatural, cause of human illness. In Hippocrates' work, the [[Hippocratic corpus]], a holistic explanation for health and disease was developed to include madness and other "diseases of the mind". Hippocrates writes:

{{Blockquote|text=Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant.... It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts that are contrary to habit.<ref>[[Hippocratic corpus]]</ref>}}

Hippocrates espoused a theory of [[humoralism]] wherein disease is resultant of a shifting balance in bodily fluids including [[blood]], [[phlegm]], [[black bile]], and [[yellow bile]].<ref>{{cite book |vauthors=Bennet S |title=History of Psychiatry and Medical Psychology |chapter=Mind and Madness in Classical Antiquity |year=2008 |pages=175–197 |doi=10.1007/978-0-387-34708-0_3 |isbn=978-0-387-34707-3}}</ref> According to humoralism, each fluid or "[[humour]]" has temperamental or behavioral correlates. In the case of psychosis, symptoms are thought to be caused by an excess of both blood and yellow bile. Thus, the proposed surgical intervention for psychotic or manic behavior was [[bloodletting]].<ref>{{cite book |vauthors=Spring B, Weinstein L, Lemon M, Haskell A |title=Clinical Psychology |chapter=Schizophrenia from Hippocrates to Kraepelin |year=1991 |pages=259–277 |doi=10.1007/978-1-4757-9715-2_10 |isbn=978-1-4757-9717-6}}</ref>

18th-century physician, educator, and widely considered "founder of American psychiatry", [[Benjamin Rush]], also prescribed bloodletting as a first-line treatment for psychosis. Although not a proponent of humoralism, Rush believed that active purging and bloodletting were efficacious corrections for disruptions in the circulatory system, a complication he believed was the primary cause of "insanity".<ref>{{cite book |title=Medical Inquiries and Observations upon Diseases of the Mind |vauthors=Rush B |year=1830 |isbn=978-0-559-92167-4 |location=Philadelphia |pages=98–190}}</ref> Although Rush's treatment modalities are now considered antiquated and brutish, his contributions to psychiatry, namely the biological underpinnings of psychiatric phenomenon including psychosis, have been invaluable to the field. In honor of such contributions, Benjamin Rush's image is in the official seal of the [[American Psychiatric Association]].

Early 20th-century treatments for severe and persisting psychosis were characterized by an emphasis on shocking the nervous system. Such therapies include [[insulin shock therapy]], [[cardiazol]] shock therapy, and [[electroconvulsive therapy]].<ref>{{cite book |title=A History of Psychiatry: From the Era of the Asylum to the Age of Prozac |vauthors=Shorter E |publisher=John Wiley & Sons |year=1998 |isbn=978-0-471-24531-5 |location=Hoboken, New Jersey}}</ref> Despite considerable risk, shock therapy was considered highly efficacious in the treatment of psychosis including [[schizophrenia]]. The acceptance of high-risk treatments led to more invasive medical interventions including [[psychosurgery]].<ref>{{cite journal |vauthors=Stone JL |date=March 2001 |title=Dr. Gottlieb Burckhardt—the pioneer of psychosurgery |journal=Journal of the History of the Neurosciences |volume=10 |issue=1 |pages=79–92 |doi=10.1076/jhin.10.1.79.5634 |pmid=11446267 |s2cid=29727830}}</ref>
[[File:Gottlieb Burckhardt (1836-1907).jpg|thumb|Gottlieb Burckhardt (1836–1907)]]
In 1888, Swiss psychiatrist [[Gottlieb Burckhardt]] performed the first medically sanctioned psychosurgery in which the [[cerebral cortex]] was excised. Although some patients showed improvement of symptoms and became more subdued, one patient died and several developed [[aphasia]] or seizure disorders. Burckhardt would go on to publish his clinical outcomes in a scholarly paper. This procedure was met with criticism from the medical community and his academic and surgical endeavors were largely ignored.<ref>{{cite journal |vauthors=Gross D, Schäfer G |date=February 2011 |title=Egas Moniz (1874–1955) and the "invention" of modern psychosurgery: a historical and ethical reanalysis under special consideration of Portuguese original sources |journal=Neurosurgical Focus |volume=30 |issue=2 |pages=E8 |doi=10.3171/2010.10.FOCUS10214 |pmid=21284454 |s2cid=25332947 |doi-access=free}}</ref> In the late 1930s, [[Egas Moniz]] conceived the [[leucotomy]] (AKA [[prefrontal lobotomy]]) in which the fibers connecting the [[frontal lobe]]s to the rest of the brain were severed. Moniz's primary inspiration stemmed from a demonstration by neuroscientists John Fulton and Carlyle's 1935 experiment in which two chimpanzees were given leucotomies and pre- and post-surgical behavior was compared. Prior to the leucotomy, the chimps engaged in typical behavior including throwing feces and fighting. After the procedure, both chimps were pacified and less violent. During the Q&A, Moniz asked if such a procedure could be extended to human subjects, a question that Fulton admitted was quite startling.<ref name="Pressman1998">{{cite book |title=Last Resort: Psychosurgery and the Limits of Medicine |vauthors=Pressman JD |publisher=Cambridge University Press |year=1998 |isbn=978-0-521-35371-7 |series=Cambridge Studies in the History of Medicine |location=Cambridge, UK |pages=18–40 |oclc=36729044}}</ref> Moniz would go on to extend the controversial practice to humans with various psychotic disorders, an endeavor for which he received a [[Nobel Prize]] in 1949.<ref>{{cite journal |vauthors=Berrios GE |date=March 1997 |title=The origins of psychosurgery: Shaw, Burckhardt and Moniz |journal=History of Psychiatry |volume=8 |issue=29 pt 1 |pages=61–81 |doi=10.1177/0957154X9700802905 |pmid=11619209 |s2cid=22225524}}</ref> Between the late 1930s and early 1970s, the leucotomy was a widely accepted practice, often performed in non-[[Sterilization (microbiology)|sterile]] environments such as small [[outpatient]] clinics and patient homes.<ref name="Pressman1998" /> Psychosurgery remained standard practice until the discovery of antipsychotic pharmacology in the 1950s.<ref>{{cite journal |vauthors=Mashour GA, Walker EE, Martuza RL |date=June 2005 |title=Psychosurgery: past, present, and future |journal=Brain Research. Brain Research Reviews |volume=48 |issue=3 |pages=409–419 |doi=10.1016/j.brainresrev.2004.09.002 |pmid=15914249 |s2cid=10303872}}</ref>

The first clinical trial of [[antipsychotic]]s (also commonly known as neuroleptics) for the treatment of psychosis took place in 1952. [[Chlorpromazine]] (brand name: Thorazine) passed clinical trials and became the first antipsychotic medication approved for the treatment of both acute and chronic psychosis. Although the mechanism of action was not discovered until 1963, the administration of chlorpromazine marked the advent of the [[dopamine antagonist]], or first generation antipsychotic.<ref>{{cite journal |vauthors=Stip E |date=May 2002 |title=Happy birthday neuroleptics! 50 years later: la folie du doute |journal=European Psychiatry |volume=17 |issue=3 |pages=115–119 |doi=10.1016/S0924-9338(02)00639-9 |pmid=12052571 |s2cid=29883863|doi-access=free }}</ref> While clinical trials showed a high response rate for both acute psychosis and disorders with psychotic features, the [[side effect]]s were particularly harsh, which included high rates of often irreversible Parkinsonian symptoms such as [[tardive dyskinesia]]. With the advent of [[atypical antipsychotic]]s (also known as second generation antipsychotics) came a dopamine antagonist with a comparable response rate but a far different, though still extensive, side-effect profile that included a lower risk of Parkinsonian symptoms but a higher risk of cardiovascular disease.<ref>{{cite journal |vauthors=Crossley NA, Constante M, McGuire P, Power P |date=June 2010 |title=Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis |journal=The British Journal of Psychiatry |volume=196 |issue=6 |pages=434–439 |doi=10.1192/bjp.bp.109.066217 |pmc=2878818 |pmid=20513851}}</ref>  Atypical antipsychotics remain the first-line treatment for psychosis associated with various psychiatric and [[neurological disorder]]s including schizophrenia, [[bipolar disorder]], [[major depressive disorder]], [[anxiety disorder]]s, [[dementia]], and some [[autism spectrum]] disorders.<ref>{{cite journal |display-authors=6 |vauthors=Maher AR, Maglione M, Bagley S, Suttorp M, Hu JH, Ewing B, Wang Z, Timmer M, Sultzer D, Shekelle PG |date=September 2011 |title=Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis |journal=JAMA |volume=306 |issue=12 |pages=1359–1369 |doi=10.1001/jama.2011.1360 |pmid=21954480 |doi-access=free}}</ref>

Dopamine is now one of the primary neurotransmitters implicated in psychotic symptomology. Blocking dopamine receptors (namely, the dopamine D2 receptors) and decreasing dopaminergic activity continues to be an effective but highly unrefined effect of antipsychotics, which are commonly used to treat psychosis. Recent pharmacological research suggests that the decrease in dopaminergic activity does not eradicate psychotic [[delusion]]s or [[hallucination]]s, but rather attenuates the reward mechanisms involved in the development of delusional thinking; that is, connecting or finding meaningful relationships between unrelated stimuli or ideas.<ref name="Kapur" /> The author of this research paper acknowledges the importance of future investigation:

{{Blockquote|text=The model presented here is based on incomplete knowledge related to dopamine, schizophrenia, and antipsychotics—and as such will need to evolve as more is known about these.|sign=Shitij Kapur|source=From dopamine to salience to psychosis—linking biology, pharmacology and phenomenology of psychosis}}

[[Freud]]'s former student Wilhelm Reich explored independent insights into the physical effects of neurotic and traumatic upbringing, and published his holistic psychoanalytic treatment with a schizophrenic. With his incorporation of breathwork and insight with the patient, a young woman, she achieved sufficient self-management skills to end the therapy.<ref>{{cite book |title=Character Analysis |vauthors=Reich W |date=1980 |publisher=Macmillan |isbn=9781466846876 |veditors=Higgins M, Raphael CM |page=437 |translator=Carfango VR |chapter=The Schizophrenic Split |access-date=2022-04-29 |chapter-url=https://books.google.com/books?id=ez7nNDjECOQC&pg=PA437 |archive-url=https://web.archive.org/web/20220429013530/https://books.google.com/books?id=ez7nNDjECOQC&pg=PA437 |archive-date=2022-04-29 |url-status=live |name-list-style=vanc}}</ref>

[[Lacan]] extended Freud's ideas to create a psychoanalytic model of psychosis based upon the concept of "[[foreclosure (psychoanalysis)|foreclosure]]", the rejection of the symbolic concept of the father.

Psychiatrist [[David Healy (psychiatrist)|David Healy]] has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors that are known important influences in the etiology of psychosis.<ref>{{cite book |title=The Creation of Psychopharmacology |vauthors=Healy D |publisher=Harvard University Press |year=2002 |isbn=978-0-674-00619-5 |location=Cambridge |author-link=David Healy (psychiatrist)}}</ref>