Did some 18th and 19th century treatments for mental disorders act on the brain?

Pathologic role of nitrergic neurotransmission in mood disorders

Mood disorders are chronic, recurrent mental diseases that affect millions of individuals worldwide. Although over the past 40 years the biogenic amine models have provided meaningful links with the clinical phenomena of, and the pharmacological treatments currently employed in, mood disorders, there is still a need to examine the contribution of other systems to the neurobiology and treatment of mood disorders. This article reviews the current literature describing the potential role of nitric oxide (NO) signaling in the pathophysiology and thereby the treatment of mood disorders. The hypothesis has arisen from several observations including (i) altered NO levels in patients with mood disorders; (ii) antidepressant effects of NO signaling blockers in both clinical and pre-clinical studies; (iii) interaction between conventional antidepressants/mood stabilizers and NO signaling modulators in several biochemical and behavioral studies; (iv) biochemical and physiological evidence of interaction between monoaminergic (serotonin, noradrenaline, and dopamine) system and NO signaling; (v) interaction between neurotrophic factors and NO signaling in mood regulation and neuroprotection; and finally (vi) a crucial role for NO signaling in the inflammatory processes involved in pathophysiology of mood disorders. These accumulating lines of evidence have provided a new insight into novel approaches for the treatment of mood disorders.

Dr William Saunders Hallaran and psychiatric practice in nineteenth-century Ireland

BACKGROUND

Dr William Saunders Hallaran wrote the first Irish textbook of psychiatry in 1810.

AIMS

To explore the relevance of Dr Hallaran's textbook: An Enquiry into the Causes producing the Extraordinary Addition to the Number of Insane together with Extended Observations on the Cure of Insanity with Hints as to the Better Management of Public Asylums for Insane Persons.

METHODS

This paper uses Dr Hallaran's textbook to explore dominant themes in nineteenth-century psychiatry.

RESULTS

Dr Hallaran's approach was characterized by (a) recognition of organic factors in aetiology; (b) concern about apparent increases in mental illness; (c) systematic engagement with causes, courses, outcomes; (d) reconsideration of traditional treatments (venesection, emetics, purgatives); (e) exploration of novel approaches (Dr Cox's Circulating Swing); and (f) re-evaluation of traditional remedies (digitalis, opium, camphor, mercury) and physical treatments (shower baths, diet, exercise).

CONCLUSIONS

Many aspects of Dr Hallaran's progressive approach to psychiatric care remain relevant today.

Self-blood letting in congestive cardiac failure

A 33-year-old male with idiopathic restrictive cardiomyopathy had dilated and tortuous veins over both lower limbs and over the scrotum with multiple hyperpigmented scars. He was in the habit of puncturing the veins to let out blood during episodes of worsening of dyspnoea, thereby relieving dyspnoea by decreasing the preload.