# data[].attributes.body
The first person to write on psychiatry was Aulus Cornelius Celsus, who is pictured below¹. Celsus lived from 25 BCE to 50 AD¹. He believed there were three types of insanities, which were delirium, melancholy, and delusions². Celsus was not a doctor, however, he was an encyclopedist who translated the Hippocratic Corpus to latin, as well as writing his own books on his medical knowledge, which included mental disorders³. Celsus' description of delirium was used as a symptom and a syndrome that could occur following a trauma to the head³. While a trauma seems like a reasonable conclusion at that time to cause mental disturbances, Celsus also believed that they could be caused by the gods or moon¹. Because of this belief that involved the supernatural, Celsus believed the treatment for such mental disturbances should be anything which aggravates the spirit and could include starvation, imprisonment, and beating the patient¹. Even though he had descriptions of it the word 'psychosis' was not used by Celsus and did not exist until centuries later.

Source:
(1) http://eitmentalhealth.blogspot.com/2011/11/aulus-cornelius-celsus.html
(2) https://journals.sagepub.com/doi/pdf/10.1177/003591575404700312
(3) https://www.psychologytoday.com/us/blog/tender-is-the-psyche/201707/the-lexicon-delirium

# data[].attributes.headline
The Term and Classifications of Psychosis

# data[].attributes.subject
The Term and Classifications of Psychosis

# data[].attributes.body
The first time the word "psychosis" was used was in 1841 by Karl Friedrich Canstatt, when he abbreviated "psychic neurosis."1,2  The term was used to refer to symptoms that result from diseases of the brain². The term was then popularized by Ernst von Feuchtersleben in 1845, who used it to refer to insanity and mania². It wasn't until  the late 1800s that Emil Kraepelin developed a new "clinical" approach to mental illness as opposed too treating it as merely a symptom rather than a disease itself. Kraepelin he then classified the diseases according to a pattern of symptoms rather than being based off of a major symptom and because of this he is called the "father of modern psychiatriatry," and his picture is listed below2,3. His classifications the the differences between schizophrenia and bipolar disorder are still used today⁴.

Source:
(1) https://inhn.org/home/central-office-cordoba-unit/education/thomas-a-ban-neuropsychopharmacology-in-historical-perspective-education-in-the-field-in-the-post-neuropsychopharmacology-era/bulletin-28-ernst-feuchterslebens-separation-of-psychosis-from-neurosis.html
(2)  https://www.news-medical.net/health/Psychosis-History.aspx
(3) https://en.wikipedia.org/wiki/Emil_Kraepelin
(4) https://www.britannica.com/biography/Emil-Kraepelin

# data[].attributes.body
All the way back in Celsus' time, he believed those who suffered from psychosis should be imprisoned. It is sad to say that as centuries went on that idea did not change very much. All the way until the mid-1900s patients with mental illness were looked upon as lesser humans than others and it was easier to keep them "out of sight out of mind." Asylums were the "prisons" in which those with psychotic behavior were held captive. The very first asylum recorded was founded in the Middle East in the 5th century². The time of the "Asylum era" that we think of today began in the 1700s³. Asylums really were storages to contain the mentally ill some, including the Pitié-Salpêtrière Hospital in France, which is pictured below, had chains in which the patients were chained to a wall1,2. Patients were seen no better than criminals and just needed to be kept off the streets.

Source:
(1) https://en.wikipedia.org/wiki/Pitié-Salpêtrière_Hospital
(2) https://www.seeker.com/an-illustrated-history-of-the-mental-asylum-1766218599.html
(3) https://www.talkspace.com/blog/history-inhumane-mental-health-treatments/

# data[].attributes.body
While in the asylums, there were various therapies were developed which the patients were subjected to. The majority of these therapies had a common theme in that they were considered a success if it caused the patient to stop exhibiting their symptoms of psychosis. This sounds like a good thing, to stop the symptoms, however, in reality the symptoms were not actually being treated as they were being suppressed. One therapy used was hydrotherapy, in which they were placed into a cold bath while being restrained for hours at a time¹. The next therapy to come into play was shock therapy, in which the patients were given extremely high does of insulin so that they went into a coma¹. Another popularized therapy to suppress symptoms was the lobotomy. During a lobotomy, which is pictured below, an ice pick was inserted beside the eye puncturing the skull and used to sever connections in the brain's frontal lobe¹. Lobotomies seemed to be successful because patients were no longer exhibiting symptoms of psychosis, however, in reality they were exhibiting nothing at all as the higher cognitive and personality regions of their brains had been damaged. So as we can see these therapies really just were more constraints on the patients such as the asylums were.

Source:
(1) https://www.talkspace.com/blog/history-inhumane-mental-health-treatments/

# data[].attributes.body
In the 1930s, electroconvulsive therapy or ECT was first used¹. It had been previously discovered that a medically induced seizure would reduce psychotic behaviors¹. ECT was developed to induce these seizures using electricity instead of medication¹. Pictured below is an example of what the ECT machines looked like, and in the box electricity was generated and then discharged through the electrodes which were placed on the patients skull¹. ECT in its beginnings was also used similarly as other therapies and simply suppressed the psychotic behaviors. However, as time as progressed there has been research done using ECT and in controlled amounts and targeting specific brain regions ECT has been proved an effective therapy for certain disorders, however there is still a stigma surrounding it¹.

Source:
(1) https://www.scientificamerican.com/article/electroconvulsive-therapy-a-history-of-controversy-but-also-of-help/

# data[].attributes.body
The first antipsychotic medication was Chlorpromazine and was developed in the 1950s¹. It was originally designed to be an antihistamine that affected the nervous system and when they tested it on rats they observed it had a calming effect¹. Doctors Jean Delay and Pierre Deniker, who are pictured below, were the first to use Chlorpromazine as a treatment for symptoms of schizophrenia and mania in their patients¹. They saw that Chlorpromazine was effective in decreasing agitation in their patients and so the drug became known as a tranquilizer¹. This does not help with the history of holding captive patients by suppressing their symptoms and not actually getting to the main cause of the problem. Today sedatives are still used in extreme cases, but there have been great improvements in finding medical treatments that can more specifically target at the neurotransmitter level the imbalance that is caused by mental illness.

Source:
(1) https://www.bap.org.uk/articles/chlorpromazine-the-first-antipsychotic/

# data[].attributes.body
Pictured below is Dr. Benjamin Rush, who is considered the "Father of American Psychiatry."¹ He was a man of many talents as he was a doctor, politician, and activist, as well as being one of the signers on the "Declaration of Independence."1 I think Dr. Rush would be a great docent for this exhibit; he served as the surgeon general for the Continental Army before going on to work at the the University of Pennsylvania as a professor and working as a physician at the Pennsylvania Hospital.2  Dr. Rush believed that mental illness could be diagnosed and that those who were diagnosed should be treated in a humane manner, contrary to the popular opinions of the time.³ He also worked on developing treatments to work at what he believed to be the source of the problem, brain inflammation, and did not simply try to suppress the behaviors of those suffering from mental illness.2 Had Dr. Rush been alive today, I am sure he would be thrilled to see all the improvements made to the treatment of those with psychosis, and even though there has been a dark and not always pleasant past, things have changed and progress is still being made for the good today.

Source:
(1) https://en.wikipedia.org/wiki/Benjamin_Rush
(2) https://www.uphs.upenn.edu/paharc/features/brush.html
(3) https://www.uphs.upenn.edu/paharc/timeline/1751/tline7.html

# data[].attributes.body
This article was discussing new protocols developed by Dr. Nicholas Breitborde for those  at risk for developing psychosis, and these protocols are being implemented at Ohio State. These protocols were developed after being awarded  a grant from the Substance Abuse and Mental Health Services Administration to develop a 'step-based' program for individuals who are at high risk for developing a psychotic disorder. The 'step-based' program begins starting participants at a lower level intensity of treatment and gradually increasing the intensity as needed and as the participants want. There are a couple reasons for the 'step-based' program: 1) the lower levels of treatment are not specialized for psychotic disorders, so there is not a sigma associated in receiving them 2) as the intensity increases there are more risks of adverse side-effects if the patients do not actually have a psychotic disorder since all the individuals are only shown to be at risk and not yet diagnosed with one. The image below is figure 1 from the paper and is depicting the program. There are different areas dedicated to helping with specific aspects of the disorder, and the patients could engage in all the programs offered or just pick and choose which ones they were interested in. In order to be a participant in this study to test these new protocols they had to meet certain criteria: 1) identified of being high-risk for a psychotic diagnosis 2) between the ages of 12-25 3) no evidence of developmental disabilities. In order to confirm criteria 1 & 3 the participants took several clinical and research batteries. Participants were allowed to take evaluations at different stages of the study to test the efficiency of this program. The results of this study will determine how the center is run and what protocols are implemented as standard care for its patients. They authors want to work with schools and pediatricians and local agencies to receive referrals of patients who are in need. It will also receive patients from hospitals as well as be an outpatient facility¹. I think this is very important research as there is so much stigma around psychotic disorders and reducing the sigma around treatment is something that is very much need. We can see from the history of psychotic disorders that it has not been treated very well and it is encouraging to see these patients getting access to the help that they need. The work in this study will allow for a center to be opened and help all those who want it, as well as giving education to others on how to best deal with those who have been diagnosed.

Source:
(1) Breitborde NJK, Guirgis H, Stearns W, et al. The Ohio State University Early Psychosis Intervention Center (EPICENTER) step-based care programme for individuals at clinical high risk for psychosis: study protocol for an observational study. BMJ Open. 2020 Jan;10(1):e034031. DOI: 10.1136/bmjopen-2019-034031