Essay Example Dedicated to Dr. John Cade and His Discovery

Year, the Location of Birth and Relevant Family History

Dr. John Cade was an Australian psychiatrist who discovered lithium carbonate as a drug that stabilized moods and could be used in the treatment of a bipolar disorder. Cade was born on January 18, 1912, at a place called Murtoa in Victoria, Australia. His father, David Duncan Cade, was a general practitioner. Her mother was Ellen and he had two younger brothers. David was sent to serve in World War I when Cade was still young. David returned home when he suffered from war-weariness and could not continue his career in general practice. Instead, he took a position at the Mental Hygiene Department and he served as a medical superintendent at several hospitals in Victoria including Beechworth, Mont Park, and Sunbury. Cade and his brothers spent much of their time in these mental health institutions which had a bearing on his understanding of needs of mentally ill patients.

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Educational Background and Training

In 1928, Cade was enrolled at Scotch College and later joined the University of Melbourne where he graduated with Bachelor of Medicine and Bachelor of Surgery in. During his studies and further career development, he served at two different career positions. He served as a Resident Medical Officer at St Vincent's Hospital in Melbourne in 1935. In 1936, he Cade served as a Resident Medical Officer at the Royal Children's Hospital in Parkville, Victoria. Cade graduated at a young age of 21 which came him enough time to develop his career and become a prominent person in the industry of medicine.

The Scientific Institution

Cade served at various institutions that contributed to his later discovery. During the World War II, Cade was appointed as the captain to the Australian Army Medical Corps in 1940. He departed to Singapore where he was later promoted to Major in September 1941. Unfortunately, Singapore was defeated in the war and it fell under the control of Japan. The Singapore soldiers were held captives and Cade became a prisoner of war. He was locked up at the Changi Prison between 1942 and 1945. It was at the prison where he repeatedly observed his fellow inmates exhibiting strange, vacillating behaviors. He thought certainly there was a toxin affecting their brains. This toxin was eliminated through urine and they would lose the symptoms of mental illness.

As soon as Cade was released from Changi Prison, he took a position at the Bundoora Repatriation Mental Hospital, Melbourne. It was here that he decided to undertake experiments based on his observations of mania that he made during the imprisonment. An unused kitchen at Bundoora served as his laboratory. It was from here that he would become famous throughout the world.

Cade's Scientific Breakthrough

Drawing from his observations at the Changi Prison and trying to connect with Rolve Gjessing's reports that production of mescaline-like substances produced altered metabolism which was responsible for a form of catatonia, together with Albert Hofmann's discovery that an ergot alkaloid, lysergic acid diethylamide has psychomimetic effect in minute amounts, Cade began his research at Bundoora. His assumption was that manic-depressive illness is analogous to myxedema and thyrotoxicosis. Consequently, he hypothesized that mania is a state of intoxication resulting from a normal product of the body occurring in excess, and, on the other hand, melancholia resulted from the deficiency of the same product in the body (Cade, 1949, p. 12).

Cade wanted to test his hypothesis but there was neither a good laboratory nor sophisticated analytical equipment. He decided to make use of an unused kitchen as his laboratory. He took urine from mentally ill patients as well as normal subjects and injected them into the guinea pigs. He wanted to compare the effects of intraperitoneally injected manic urine with that of normal subjects. He realized that urine from mentally ill patients was more toxic as compared to that of normal subjects. He further realized that urine contained two toxic substances which were urea and uric acid, but urea in both ill and normal subjects had no difference (Cade, 1949, p. 12). He explored uric acid by making artificial solutions for the product. He wanted to make up different solutions of uric acid and that would only be possible if he converted it into a substance that would be manipulated easily. Uric acid was insoluble in water but its solubility would be enhanced by the addition of lithium. He ended up with lithium urate which upon injecting the guinea pigs, he realized that it instead of enhancing toxicity, it prevented urea's toxic effects. The protective effect was attributed to lithium (Cade, 1949, p. 13). Cade then wanted to establish the effect of lithium salts alone and injected it to guinea pigs which became lethargic and unresponsive.

To ascertain the presence of a toxic substance excreted in the urine of manic patients, Cade compared the effect of lithium in 5 depressed patients, 6 schizophrenic and 10 manic. He realized that lithium ions had a calming effect. He ingested lithium himself to ascertain its safety and proceeded with a small-scale trial on some of the patients diagnosed with mania and the calming effect was robust. Up to then, Cade had successfully discovered a drug, lithium carbonate, which would treat psychotic excitement.

Diseases That Became Treatable Upon Cade's Discovery

The breakthrough discovery of Cade became a solution to manic-depressive disorders (presently known as bipolar disorders). It also treated the schizoaffective disorder and unipolar depression (Shorter, 2009, p. 4). Cade's discovery prompted isolated studies of lithium which eventually confirmed that the drug was effective for treatment of chronic mania. Noack and Trautner (1951) used lithium to treat over 100 patients and found that the therapeutic benefits outweighed the side effects for mania patients. Similarly, Schou et al. (1954) confirmed that using lithium in manic phases was effective.

Cade's discovery was not only significant in adding a new agent to psychopharmacologic armamentarium but also exemplifying triumph of the scientific method. Cade demonstrated to the world scientists that reporting cases, clinical observations, inquiry mind, and patient-centered approach were all significant towards the expansion of treatment and would even lead to further discovery (Cade and Malhi, 2007, p. 125)

How Cade's Discovery Changed Clinical Practice

Prior to the discovery of lithium therapy by Cade, manic patients were treated through electroconvulsive therapy (ECT). ECT involves electrical inducement of patients with seizures to provide relief from mental disorders. It is also known as shock treatment. It had adverse side effects on the brain including confusion and memory loss. It was administered two to three times a week under anesthetic (Coffey et al., 1987, p 629).

However, upon Cade's discovery of lithium carbonate, mentally ill patients could no longer undergo the terrific ECT. Instead, they would be kept under normal conditions as they administered a maintenance dose (Shorter, 2009, p. 5). Adverse side effects of ECT would be averted and the patients would be released within a few days after having fully recovered (Shorter, 2009, p. 5). Also, whereas ECT and barbiturates that had dominated in the treatment of mental illnesses had had a success rate of about 50% only, lithium, in the early trials, showed a 78% response rate among the manic patients (Stokes et al., 1971, p. 1319). This was a milestone in the treatment of mental illness thanks to Cade's discovery.

Lithium is the single most effective treatment in psychiatry with manageable side effects. Also, the patients stay on low-dose lithium for decades. The benefits of lithium in terms of relief of prophylaxis of depression and mania are inculpable (Shorter, 2009, p. 9).

Subsequent Pharmaceutical Innovations That Resulted From Cade's Discovery

Cade's discovery became a turning point in the treatment of mental illness. It established the basis of mood stabilizers in the treatment of mental illnesses. On modern psychiatry, the discovery of lithium was the genesis of the launch of psychopharmacology revolution which has forced psychiatrists to be more adept at diagnosis. Besides, lithium discovery has established a window into secular changes in the bipolar illness which has produced pharmaco-economic data on the social costs as a result of psychiatric illness. It has led to the birth of patient-run advocacy movements. It has also resulted in a closely intertwined purpose of basic and clinical research and the importance of continued research in clinical settings (Goodwin and Ghaemi, 1999, p. 54).

References

Cade, J.F. and Malhi, G.S., 2007. Cade's lithium. Acta Neuropsychiatrica, 19(2), pp.125-126.

Cade, J.F., 1949. Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia.

Coffey, C.E., Hinkle, P.E., Weiner, R.D., Nemeroff, C.B., Krishnan, K.R.R., Varia, I. and Sullivan, D.C., 1987. Electroconvulsive therapy of depression in patients with white matter hyperintensity. Biological psychiatry, 22(5), pp.629-636.

Goodwin, F.K. and Ghaemi, S.N., 1999. The impact of the discovery of lithium on psychiatric thought and practice in the USA and Europe. Australian and New Zealand Journal of Psychiatry, 33, pp.S54-S64.

Noack, C.H. and Trautner, E.M., 1951. The lithium treatment of maniacal psychosis. The Medical journal of Australia, 2(7), pp.219-222.

Schou, M., Juel-Nielsen, N., Stromgren, E. and Voldby, H., 1954. The treatment of manic psychoses by the administration of lithium salts. Journal of Neurology, Neurosurgery, and Psychiatry, 17(4), p.250.

Shorter, E., 2009. The history of lithium therapy. Bipolar disorders, 11, pp.4-9.

Stokes, P., Shamoian, C., Stoll, P. and Patton, M., 1971. Efficacy of lithium as acute treatment of manic-depressive illness. The Lancet, 297(7713), pp.1319-1325.