ELECTROSHOCK THERAPY WITH THE PHENOTHIAZINES AND RESERPINE: A SURVEY AND REPORT.

Abstract

Some ten years ago reserpine and the phenothiazines, beginning with chlorpromazine, came into general use altering the structure of psychiatry; the treatment of the psychotic patients and the whole atmosphere of state hospitals undergoing perhaps the most marked changes. To many psychiatrists, particularly those in state hospitals who continue to bear the major responsibility for the treatment of severe psychotic illness, combination treatment with the phenothiazines and the older treatment method, electroshock, has seemed useful. This technique remains controversial. There are two questions at issue: 1) how effective is this combination of EST with the phenothiazines compared with the use of either alone? and 2) how safe is the use of this combination? There is at least the possibility that investigation of the former question is being hampered because of apprehension about the latter question. In 1955 Rogy( 1) reported on the combined use of thorazine and EST noting that there had been no untoward result of any kind. He also expressed the clinical impression that the combination of treatment methods was useful in shortening the duration of illness. Also in 1955 Foster and Gayle(2) in a paper on the combination of EST with reserpine noted a 10% incidence of severe reactions. One of their patients died, the others showing confusion, lethargy and a fall in blood pressure to shock levels which persisted for several hours. They reported that there was no correlation between the amount of reserpine given and the severity of the reaction. F. J. Ayd, Jr. (3) in 1956 reported on a series of 25 patients treated with combined chlorpromazine and EST. His conclusions were that chlorpromazine does not influence the intensity or