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The Lobotomist | Article

Treatment Options Today

Dr. David Brendel practices psychiatry in the Boston area and received an award in 2011 from the Academy at Harvard Medical School for teaching medical ethics and professionalism. Read his comments about patients profiled in The Lobotomist and treatment options today. For information about Dr. Brendel's clinical, academic, and media work, visit his website at www.drdavidbrendel.com.

Lobotomist Dr Brendel.jpg
Dr. David Brendel

Disclaimer: Dr. Brendel's discussion of the cases profiled in Patients' Stories is based upon his viewing of the film The Lobotomist. He did not personally interview any of these patients or their family members.

Ellen Lonesco
Ellen Lonesco presented a clinical picture that contemporary psychiatrists would most likely diagnose as major depression with psychotic features. According to the documentary, she was a 29-year old mother who became aloof, withdrawn, inaccessible, and unable to function in her daily life. The film depicts the worsening of her syndrome to the point that she became suicidal, paranoid, aggressive, and violent (she tried to smother her six-year old daughter just before her hospital admission and lobotomy).

First line treatment for someone with this clinical picture today would involve use of antipsychotic and antidepressant medications that have been developed over the past couple of decades. These medications usually help to stabilize patients with psychotic depression and allow them to receive treatment as outpatients, though they can cause numerous short-term and long-term side effects such as sedation, obesity, and problems with sexual functioning.

For patients whose psychotic depression does not respond adequately to psychotropic medications, electroconvulsive therapy (ECT) is an effective and safe treatment option. ECT involves placing the patient under anesthesia and inducing a seizure by applying an electric shock. Patients usually require 6-12 such treatments over 2-4 weeks in order to achieve a favorable response. Possible adverse effects include headache and transient confusion, mental slowness, and short-term memory loss.

Beulah Jones
Beulah Jones had a syndrome that psychiatrists today would most likely diagnose as schizophrenia or schizoaffective disorder. The documentary describes her as a young wife and mother who began to hear voices that others could not hear (auditory hallucinations) and to develop delusions, such as the belief that she was the lost queen of Scotland. In addition, the film notes that her behavior became agitated, unruly, and violent at times. The chronic nature of her condition suggests that she had a deteriorating psychotic disorder, most likely schizophrenia.

Her grandiose delusions and her agitated behavior, however, suggested that she might have suffered with a severe psychotic disorder with prominent mood symptoms (schizoaffective disorder). Regardless of her actual diagnosis, contemporary treatment of this kind of disorder would involve antipsychotic and mood stabilizing medications. Medication management frequently helps to stabilize agitation and hallucinations, but sometimes at the cost of such side effects as sedation, weight gain, and cognitive problems.

In successful cases, patients may be able to lead relatively normal work and family lives if they remain on medications and in psychiatric treatment. In less successful cases, patients require a great deal of social services to function day-to-day and may never achieve satisfying social or occupational functioning.

Howard Dully
Howard Dully was a twelve-year-old boy with a clinical syndrome that 21st century child and adolescent psychiatrists would most likely diagnose as oppositional defiant disorder. He may also have suffered from co-occurring conditions such as attention-deficit hyperactivity disorder, anxiety, and depression. According to the documentary, he was disrespectful, disobedient, and at times acted out in an aggressive and violent manner. The film reports that he frequently daydreamed, was unable to focus, and displayed idiosyncratic behaviors.

His situation was probably shaped in large measure by the tragic death of his mother and his rebellion against a step-mother whom he perceived as overly controlling. Contemporary treatment of a youngster with these issues would involve individual psychotherapy and possibly the judicious use of psychotropic medications, such as mood stabilizers. The treatment approach also would necessarily include intensive family therapy and counseling for the parents or other caregivers of the child. Attention to the patient's needs at school would be an important component of a treatment plan that might help to stabilize such a complicated and troubling situation.

All aspects of the treatment should involve the youth as an active participant whose point of view and best interests are foremost in all decision making.

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