Convulsive Shock Therapy Research Articles

Curare: the flying death.

Curare: the flying death.

Curare: a preventive of traumatic complications in convulsive shock therapy (including a preliminary report on a synthetic curare-like drug). 1941 [classical article

Curare: a preventive of traumatic complications in convulsive shock therapy (including a preliminary report on a synthetic curare-like drug). 1941 [classical article

Nursing care to patient on electroconvulsive therapy

Eletric convulsive shock therapy has become a controversial topic in psychiatric services. Patients continue to have electroconvulsive therapy. The team nursing has seen the treatment as just another task. In this paper the authors present how the nurse can help the patient who is submitted to electroconvulsive therapy.

Uses and Abuses of Electric Convulsive Shock Therapy

Uses and Abuses of Electric Convulsive Shock Therapy

Preventing traumatic complications in convulsive shock therapy by curare by A. E. Bennett.

Convulsive shock therapy has been very enthusiastically endorsed by many workers and critically condemned by others. Its exact status as a permanent therapeutic agent in neuropsychiatry is yet to be determined. The follow-up studies after convulsive shock treatment of schizophrenic reaction types are not very encouraging, since relapses are frequent. Hypoglycemic shock therapy seems preferable. However, in chronic affective disorders of both the depressive and the manic types, the favorable sustained improvements from convulsive shock are more encouraging. 1 Midlife and presenile depressive states are terminated in the large majority of cases by convulsive therapy. 2 The cases of schizophrenia that respond best to this type of treatment are likewise admixture types with affective components. For convulsive shock most workers use a convulsant dose of metrazol (pentamethylenetetrazol). Other convulsant drugs in use are triazol, 3 picrotoxin4 and coriamyrtin. 5 Preliminary reports 6 indicate that all these methods are therapeutically effective.

EFFECT OF ELECTRIC CONVULSIVE THERAPY AND INSULIN SHOCK THERAPY ON THE PITUITARY GONADOTROPIN PRODUCTION OF PSYCHOTIC PATIENTS*

Summary Physiological effect of electric convulsive therapy and insulin shock therapy was investigated in terms of pituitary gonadotropin production. The following observations were obtained by the study: (1) Both ECT and IST caused an increase in urinary gonadotropin excretion, after a brief latent or inhibitory stage. (2) Acute schizophrenic patients showed more pronounced responses (often 5–10 times as much as the initial value) than chronic cases (2–3 times increase). Possible mechanism of therapeutic action of ECT and IST was discussed in relation to the above findings.

Desoxycorticosterone therapy in certain psychotic cases; an interval report.

DESOXYCORTICOSTERONE acetate, 1 a synthetic steroid, has been used as theray, since 1948, for psychotic patients in a program of evaluation of its effect on the psychoses. A preliminary report was published in 1949. 2 The present report concerns the latest results of the study, namely, the recorded observations from August, 1949, to April, 1951. The project was undertaken on the basis of an assumption that patients with psychoses are subjected to repeated and overwhelming stress, which results in depletion. In this situation desoxycorticosterone acetate would supply a replacement therapy. This concept has been strengthened and enlarged by several publications, especially that by Hoagland and associates, 3 who have proposed that convulsive shock therapy acts theoretically by causing a release of endogenously produced corticotropin. Reiss and associates 4 have shown that certain psychotic patients who did not show an adrenocortical response to a test dose of corticotropin showed no improvement

A clinical evaluation of the use of decamethonium bromide in convulsive shock therapy.

A clinical evaluation of the use of decamethonium bromide in convulsive shock therapy.

CONVULSIVE SHOCK THERAPY IN PATIENTS OVER SEVENTY YEARS OF AGE WITH AFFECTIVE DISORDERS

Experience with a group of 30 patients all past 70 shows that convulsive shock therapy is well tolerated by the aged. Convulsive shock therapy in the aged can be made more safe if curare modification of the convulsion is utilized. The organic defects and diseases of old age are not necessarily contraindications for curare electroshock therapy. Follow-up studies show that half of this group of patients obtained sustained recoveries or sufficient recovery to remain functional in society. Evaluation and retreatment of relapses suggest that prompt treatment of recurrences will produce an early remission and prevent prolonged hospitalization. No conclusions can be drawn regarding the death rate in this group.

Convulsive Shock Therapy in Involutional States After Complete Failure with Previous Estrogenic Treatment

Current Literature: Symbolic Neurology: Psychology, Psychoanalysis, Neuroses, Psychoneuroses, Psychoses: PDF Only

METRAZOL AND ELECTRIC CONVULSIVE THERAPY OF THE AFFECTIVE PSYCHOSES

The longer follow-up period and the larger number of patients warrant our present attempt to deal with some of the controversial aspects of convulsive shock therapy not adequately met by earlier studies. MATERIAL AND PROCEDURE The procedure is essentially similar to that employed in our first two studies. 1 A comparison is made of the results obtained with treated and with untreated patients with affective psychoses who were seen in private practice in the five years between July 1, 1938 and July 1, 1943. Of a total of 278 such patients, 81 were excluded because of incomplete or complicating data. Follow-up observations were conducted from December 1943 to March 1944, by means of telephone, letter or personal interview. The follow-up period ranged from six to sixty-nine months, with an average of forty months. Of the 88 patients treated, the first 58 received metrazol and the other 30 were given electric

Preliminary curarization in electric convulsive shock therapy

1. The treatment of affective disorders particularly the depressions, by the induction of grand mal seizures is an established, highly-effective procedure. 2. The introduction of the electric shock method has been a material improvement over previous methods. 3. Trauma is still an important but neglected factor in convulsive shock therapy, and the traumatic hazards have not been eliminated by the adoption of electric shock. 4. The traumatic complications are not confined to the vertebrae and the long bones; and sufficient attention has not been given to visceral complications in the form of petechial hemorrhages, increased incidence of tuberculosis, etc. 5. The writers believe that a direct, safe and effective means of eliminating trauma incident to convulsive shock therapy is available in curare and that straight, unmodified electric shock is unjustified. 6. Preliminary curarization increases the scope of usefulness of convulsive therapy and makes the treatment available in cases where it might otherwise be contraindicated. 7. Results obtained in 139 cases treated by the combined curare-electric shock method are reported. The best results were seen in the depressions with an increased percentage of complete recoveries in the older age groups. 8. One death incident to electric shock therapy is reported.

A REVIEW OF THE DRASTIC SHOCK THERAPIES IN THE TREATMENT OF THE PSYCHOSES

Article1 March 1943A REVIEW OF THE DRASTIC SHOCK THERAPIES IN THE TREATMENT OF THE PSYCHOSESFRANKLIN G. EBAUGH, M.D., F.A.C.P.FRANKLIN G. EBAUGH, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-18-3-279 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDuring the past decade we have seen progressive changes in medical education and practice which have led to closer relationships between psychiatry and general medicine. We now accept psychiatry as that part of medicine which deals with the pathology and therapy of the person, instead of thinking of it as an isolated specialty dealing with advanced psychopathological disorders usually already admitted to institutions for treatment in the later stages of development when therapy is most difficult, more prolonged and less effective. Through this breakdown of the isolation of psychiatric medicine from basic general medicine we are now beginning to see...Bibliography1. JESSNERRYAN LVG: Shock treatment in psychiatry, 1941, Grune and Stratton, New York. Google Scholar2. U. S. Public Health Service Shock Survey, 1941. Google Scholar3. FROSTIG JP: Clinical observations in insulin treatment in schizophrenia: preliminary report, Am. Jr. Psychiat., 1940, xcvi, 1167-1190. CrossrefGoogle Scholar4. BRILLBINZILEY HRF: Involuntary eye movements—a criterion of depth of stages of insulin coma, Am. Jr. Psychiat., 1941, xcvi, 177-181. Google Scholar5. KATZENELBOGEN S: Pharmacological shock therapy, Chapter LI, Blumer's System for Practice of Medicine. Google Scholar6. ROSSMALZBERG JRB: A review of the results of the pharmacological shock therapy and the metrazol convulsive therapy in New York state, Am. Jr. Psychiat., 1939, xcvi, 297-316. CrossrefGoogle Scholar7. ROSSROSSMANCLINESCHWOERNMALZBERG JRJMWBCJB: A two year follow up study from the New York state hospitals with some recommendations for the future, Am. Jr. Psychiat., 1941, xcvii, 1007-1023. CrossrefGoogle Scholar8. CHENEYCLOW COHE: Prognostic factors in insulin shock therapy, Am. Jr. Psychiat., 1941, xcvii, 1029-1039. CrossrefGoogle Scholar9. RYMERBENJAMINEBAUGH CAJDFG: The hypoglycemic treatment of schizophrenia. A preliminary report, with particular reference to the qualitative study of remissions, Jr. Am. Med. Assoc., 1937, cix, 1249-1251. CrossrefGoogle Scholar10. PIOTROWSKI Z: A simple experimental device for prediction of the outcome of insulin treatment in schizophrenia, Psychiat. Quart., 1940, xiv, 267-273. CrossrefGoogle Scholar11. BENNETT AE: Curare: A preventive of traumatic complications in convulsive shock therapy, Am. Jr. Psychiat., 1941, xcvii, 1040-1060. CrossrefGoogle Scholar12. WHITEHEADNEUBUERGERRUTLEDGESILCOTT RWKTEKWL: Pharmacologic and pathologic effects of repeated convulsant doses of metrazol, Am. Jr. Med. Sci., 1940, cxcix, 352-359. CrossrefGoogle Scholar13. CERLETTIBINI VL: L'elettroshock, Arch. gen. di neurol. e. psichiat., 1938, xix, 266-268. Google Scholar14. WHITEHEADNEUBUERGERRUTLEDGEEBAUGH RWKTEKFG: Pathologic changes in brains of dogs given repeated electric shocks, to be published in Am. Jr. Med. Sci. Google Scholar15. U. S. Public Health Service Shock Therapy. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Denver, Colorado*Morning lecture before the American College of Physicians meeting, St. Paul, Minnesota, April 24, 1942.From the University of Colorado School of Medicine and Colorado Psychopathic Hospital. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUndoing Descartes: integrating diabetes care for those with mental illnessBibliographyEmprêgo do curare em convulsoterapiaChapter VII: Methods, Technics, and Instruments of Mental Hygiene Diagnosis and Therapy 1 March 1943Volume 18, Issue 3Page: 279-296KeywordsHospital medicineMedical educationPsychosesShock Issue Published: 1 March 1943 PDF downloadLoading ...

CONVULSIVE SHOCK THERAPY IN ELDERLY PATIENTS—RISKS AND RESULTS

Fifty patients over 50 years of age who had severe mental illness were treated with convulsive shock therapy. Of these 50 patients, 40 were either recovered or improved enough to be discharged to their homes. Ten remained unimproved. Although the risks taken seemed to be great, the complications and untoward results were remarkably few. Most of the cases had failed to respond to several months of conservative treatment, and in many cases it seemed almost certain that recovery would not occur unless drastic treatment was instituted. Even though some of the cases might have recovered eventually with prolonged conservative treatment, the time and economic saving was well worth the risks taken.

FOLLOW-UP STUDY OF A SERIES OF PATIENTS TREATED BY ELECTRICALLY INDUCED CONVULSIONS AND BY METRAZOL CONVULSIONS

We have presented briefly a preliminary report on the results of a follow-up study of psychiatric patients treated by means of electrically induced convulsions and by means of metrazol convulsions. Of the former, 144 cases were studied and of the latter, 126 patients were studied, all cases being followed for periods exceeding six months subsequent to treatment. By evaluating the two fairly comparable groups treated by these two different means, it appears that the therapeutic effects of both methods are essentially the same, particularly in the psychotic patients. However, the statistics suggest that possibly the electric shock method may be slightly more efficacious, at least in so far as the immediate results are concerned. Therefore, and in consideration of certain undesirable effects and reactions of metrazol therapy, particularly in the psychoneurotic patients, it would seem warranted at the present time to discontinue metrazol treatments in favor of electric shock convulsive therapy, providing convulsive therapy is to be given. The convulsive treatments are undoubtedly of great value in the affective psychoses, seemingly producing a slightly more favorable response in the manic-depressive group than in the involutional psychosis group. It appeared that, regardless of the diagnostic category, if the clinical picture is characterized by depressive features, consciously expressed guilt feelings, feelings of worthlessness and self depreciation, and especially suicidal tendencies, convulsive shock therapy is of value and in fact seems to be highly specific for this type of symptomatology, often resulting in dramatic and prolonged remission of symptoms. Patients with prominent aggressive, belligerent and homicidal tendencies were not favorable subjects for convulsive therapy. Follow-up studies, including the complications or sequelae with respect to memory loss, incidence of vertebral fractures, neurological complications, electroencephalographic disturbances, and other changes will be included in a separate report.

ELECTRO-COMA THERAPY OF PSYCHOSES

Article1 November 1942ELECTRO-COMA THERAPY OF PSYCHOSESJOSEPH L. FETTERMAN, M.A., M.D.JOSEPH L. FETTERMAN, M.A., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-17-5-775 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONThe therapy of psychoses has advanced rapidly during the past decade. Observation and analysis, hydrotherapy and occupational measures, and symptomatic medication all have their fields of usefulness. However, there have been introduced more specific therapies which depend upon direct chemical and electrical influence upon brain function. In 1932 Sakel1developed the insulin shock treatment for schizophrenia, a method which opened a new era in the therapy of psychoses. Shortly thereafter, the use of the metrazol convulsion treatment was the product of the research of von Meduna.2Metrazol, at first recommended for schizophrenia, proved more effective in depressed states. The...Bibliography1. SAKEL M: Neue Behandlungsmethode der Schizophrenia, 1935, Moritz Press, Wien. Google Scholar2. VON MEDUNA L: New methods of medical treatment of schizophrenia, Arch. Neurol. and Psychiat., 1936, xxxv, 361. CrossrefGoogle Scholar3. BINI L: Elektroshockbehandlung, III Congrès Neurologique International Comptes rendus, Copenhagen, 1939. Google Scholar4. FREEMANWATTS WJW: Prefrontal lobotomy in the treatment of mental disorders, South. Med. Jr., 1937, xxx, 23. CrossrefGoogle Scholar5. FREEMAN W: The surgical treatment of mental disorders, Med. Ann. District of Columbia, 1939, viii, 345. Google Scholar6. KALINOWSKYBARRERA LSE: Electric convulsion therapy in mental disorders, Psychiat. Quart., 1940, xiv, 719. CrossrefGoogle Scholar7. KALINOWSKYBIGELOWBRIKATES LNP: Electric shock therapy in state hospital practice, Psychiat. Quart., 1941, xv, 450. CrossrefGoogle Scholar8. GONDA VE: Treatment of mental disorders with electrically induced convulsions, Diseases of the Nervous System, 1941, iii, 3. Google Scholar9. IMPASTATOALMANSI DJR: Electrically induced convulsions in the treatment of functional mental disease, Med. Ann. District of Columbia, 1941, x, 163. Google Scholar10. SINGER HD: Psychosis and the central autonomic nervous system, Jr. Am. Med. Assoc., 1938, cx, 2048. CrossrefGoogle Scholar11. ROBINSON GW: Psychiatric geriatrics, the possibilities in the treatment of mental states of old age, Jr. Am. Med. Assoc., 1941, cxvi, 2139. CrossrefGoogle Scholar12. ZISKIND E: Memory defects during metrazol therapy, Arch. Neurol. and Psychiat., 1941, xlv, 223. CrossrefGoogle Scholar13. MYERSON A: Experience with electric-shock therapy in mental disease, New England Jr. Med., 1941, ccxxiv, 1081. CrossrefGoogle Scholar14. HUGHESWIGTONJARDON JRF: Electroencephalographic studies on patients receiving electric shock treatment, Arch. Neurol. and Psychiat., 1941, xlvi, 748. Google Scholar15. SMITHHUGHESHASTINGS LHJDW: First impressions of electroshock treatment, Pennsylvania Med. Jr., 1941, xliv, 452. Google Scholar16. FURSTSTOUFFER WJF: The electrical shock treatment of psychoses, Arch. Neurol. and Psychiat., 1941, xlvi, 743. Google Scholar17. BENNETT AE: Curare: a preventive of traumatic complications in convulsive shock therapy, Am. Jr. Psychiat., 1941, xcvii, 1040. CrossrefGoogle Scholar18. KLINEFETTERMANWILLIAMS EMJLGH: Electrocardiographic changes following metrazol-induced convulsions, Am. Heart Jr., 1940, xx, 702. CrossrefGoogle Scholar19. BECK CS: The development of a new blood supply to the heart by operation, Ann. Surg., 1935, cii, 801. CrossrefGoogle Scholar20. FETTERMAN JL: The nature and modern treatment of depressions, Ohio State Med. Jr., 1941, xxxvii, 855. Google Scholar21. ELVIDGEREED ARGE: Biopsy studies of cerebral pathologic changes in schizophrenia and manic-depressive psychoses, Arch. Neurol. and Psychiat., 1938, xl, 227. CrossrefGoogle Scholar22. KATZENELBOGEN S: Studies in schizophrenia, Arch. Neurol. and Psychiat., 1937, xxxvii, 881. CrossrefGoogle Scholar23. HOSKINS RG: Oxygen metabolism in schizophrenia, Arch. Neurol. and Psychiat., 1937, xxxviii, 1261. CrossrefGoogle Scholar24. ANGYALFREEMANHOSKINS AHRG: Physiologic aspects of schizophrenia withdrawal, Arch. Neurol. and Psychiat., 1940, xliv, 621. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, Ohio*Received for publication January 26, 1942.From the Department of Medicine (Neuropsychiatry), Lakeside Hospital, the School of Medicine, Western Reserve University, Cleveland, Ohio, and the Windsor Hospital, Chagrin Falls, Ohio.Thanks are due to Drs. A. T. Steegmann, M.,D. Friedman, and S. Baumoel, some of whose patients are incorporated in this case study. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byKognitive Störungen und ElektrokrampftherapieThe Influence of Electric Shock Treatment (Ect) on the Acuity of Hearing 1 November 1942Volume 17, Issue 5Page: 775-789KeywordsBrainEpileptic seizuresFallsHospital medicineInsulinPsychosesSchizophreniaShock ePublished: 1 December 2008 Issue Published: 1 November 1942 Copyright & PermissionsCopyright, 1942, by The American College of PhysiciansPDF downloadLoading ...

FATALITY FOLLOWING INTRAVENOUS ADMINISTRATION OF MAGNESIUM SULFATE

Since the introduction of convulsive shock therapy, various methods have been used to prevent the traumatic complications. Recently Yaskin¹described favorable results in preventing these complications by the use of magnesium sulfate as a curare-like agent. He injected intravenously 25 to 30 cc. of a 25 per cent sterile aqueous solution of magnesium sulfate as rapidly as possible. The injection was followed immediately by cutaneous flushing, with a concomitant subjective complaint of a marked sensation of "heat," heaviness of the eyelids, bilateral ptosis, weakness of the neck muscles, slurred speech and weakness of the extremities. This syndrome was produced in one to three minutes, and at the height of the reaction metrazol was injected, with a resulting "softened" convulsion. The peripheral muscular paresis usually disappeared within three to six minutes after the effect was reached. Yaskin reported on 256 magnesium sulfate-metrazol treatments administered to 23 patients, ranging in age

SOME ADMINISTRATIVE ASPECTS OF SUICIDE IN THE MENTAL HOSPITAL

Suicide in mental hospitals has been studied by tabulation of various factors as well as by analysis of individual case histories in 18 patients who committed suicide at the Eloise Hospital from 1929 through 1941. The statistical approach, although of limited value because of the small number of cases, indicates the need for considering schizophrenics, particularly catatonics and paranoids, as potential suicides, as well as the more generally recognized manic-depressive and involutional patients. Suicide in a mental hospital is found to maintain the same age distribution and seasonal incidence as suicide in the general population. The suicidal attempt is more likely to be successful when it occurs in the early morning hours. Far more fruitful is a study of the individual case histories. A large majority of these patients revealed definite warning signals of the suicidal act, either by a previous attempt or through their overt behavior or verbal productions in the form of irritability, combativeness, death wishes, hypochondriacal trends or feelings of guilt. It is felt that these could have been recognized as such if full awareness of their significance had existed. Sudden, unexplained improvement in agitated patients is also to be looked upon with suspicion. Apparently trivial frustrations may also precipitate the suicidal attempt. The physical setting of the suicidal act was reviewed and several factors of importance from the point of view of hospital planning, management and routine were considered. These included the questions of window guards, surface projections, locking of mop rooms, toilet rooms and other utility rooms, as well as the prevention of plunging from heights. Specific problems in the management of suicidal patients were discussed in the light of clinical experience. The importance of ward and occupational activities designed to meet the psychological needs of the patient was emphasized. The value of convulsive shock therapy as one means of meeting the sense of need for punishment was mentioned as a possible explanation for the improvement it produces in depressed patients.

DISTURBANCES IN BRAIN FUNCTION FOLLOWING CONVULSIVE SHOCK THERAPY

As a result of the recent widespread use of convulsive shock therapy for psychiatric disorders, the effect of this treatment on the structure and function of the brain has become a matter of considerable concern to clinicians. This has been augmented since convulsive shock therapy has been successfully employed to shorten attacks of affective disorders in which intellectual functions are maintained and emerge undisturbed with spontaneous recovery. MATERIAL AND METHODS Patients under the regimen of convulsive therapy were studied neurologically and psychiatrically before and after treatment. Electroencephalograms were recorded before the first shock and at varying times after cessation of the treatment; some patients were completely rechecked at intervals several months after discharge from the hospital. Such studies were carried out on 23 patients, all but 4 of whom were suffering from primary or secondary affective disorders (see table 1 for significant data). Of the 4 other patients, 2 were

PREVENTION OF TRAUMATIC COMPLICATIONS IN CONVULSIVE SHOCK THERAPY BY MAGNESIUM SULFATE

Traumatic complications in the form of fractures of the spinal vertebrae and extremities represent a serious drawback to convulsive shock therapy. To date, none of the measures suggested to prevent complications have been accepted as entirely prophylactic or entirely practical. The essential problem in convulsive therapy is to eliminate or soften the severity of the tonic muscular contractions which cause skeletal fractures by direct muscle pull. Various chemical agents have been used to nullify the severity of the convulsion. These agents act by blocking the peripheral neuromuscular mechanism and thus produce peripheral motor paralysis of all striated musculature. Bennett,1who was the first to apply the principle of curarization in shock therapy, demonstrated that an aqueous extract of crude curare could be standardized and given safely prior to metrazol convulsive therapy. He has reported and demonstrated that he can produce with the intravenous administration of curare a flaccid motor