Electric Convulsive Therapy Research Articles

Indications for electric convulsion therapy and its use by senior psychiatrists.

A survey by questionnaire of all senior psychiatrists in the Wessex Region showed that they considered depressive psychosis to be the major indication for electric convulsion therapy (ECT). A good clinical response was thought to be predicted by the presence of psychomotor retardation, depressive delusions, depressed mood, early morning wakening, diurnal variation, loss of appetite, and agitation. ECT was judged to be extremely useful for treating mania and acute undifferentiated, catatonic, and paranoid schizophrenia; of some use in hypochondriasis; but of little value or contraindicated when there was severe, depersonalisation, or hysterical symptoms. Only 40% of the psychiatrists favoured unilateral ECT, and the variation in electrode placements used by different psychiatrists was surprising. Eighty per cent of the respondents used courses averaging six to eight treatments given over two or three weeks. Results obtained in this study, based on clinical judgment, differed from research findings, which emphasises the need for further study of this important treatment.

Uses and Abuses of Electric Convulsive Shock Therapy

Uses and Abuses of Electric Convulsive Shock Therapy

Typhoid catatonia responsive to ECT.

Twelve patients with typhoid fever presented with a catatonic syndrome that persisted after other signs of the fever had disappeared. The syndrome was distinct from the delirium seen in typhoid fever and did not have the characteristics of an affective or schizophrenic illness. Electric convulsion therapy produced rapid and lasting improvement.

Acute Mania

We examined the relationships among family history of psychiatric illness, demographic and historical variables, clinical course and presentation, and treatment response for 58 patients satisfying research criteria for mania. Nearly two thirds of the group had excellent responses to somatic treatment, particularly lithium ion, while one third had poor responses to lithium carbonate, neuroleptics, or electric convulsive therapy. Responders frequently exhibited euphoric moods, grandiose delusions, and tended to have cyclothymic premorbid personalities. Nonresponders were rarely euphoric, frequently exhibited incomplete auditory hallucinations, and tended to hve formal thought disorder and depressive-withdrawn premorbid personalities. Responders tended (nonsignificant) to have greater genetic loading for affective illness and alcoholism. We could not distinguish the two groups by their age at illness onset, duration of illness, or number of illness episodes per ill patient year.

Blood catecholamine levels, factor VIII and fibrinolysis after therapeutic electroshock.

Summary.Two groups of patients were submitted to electric convulsive therapy, one without pre‐treatment (ECT) and the other after administration of thiopentone and succinylcholine (modified ECT). After ECT, there was a large increase in the blood level of catecholamines (noradrenaline+adrenaline), of factor VIII and of plasminogen activator. After modified ECT, the release of catecholamines and of factor VIII was significantly reduced, but hyperfibrinolysis took place as in ECT. These results suggest that while catecholamines are probably not responsible for plasminogen activator release during stress, adrenergic mediation of the concomitant increase in factor VIII is highly probable.

Diazepam Phlebitis

<h3>To the Editor.—</h3> The dearth of information available on the phlebitis caused by intravenously administered diazepam is well highlighted by the paper of Langdon et al inThe Journal(223:184, 1973). I would like to confirm their findings that phlebitis is a universal and absolute sequela of repeated intravenous injections of diazepam. I have used intravenously given diazepam in an area not described in the literature, namely as a premedicating and amnesic agent for electroconvulsive treatments. Psychiatrists have not taken full advantage of intravenously given diazepam as other specialists have in performing their diagnostic and treatment procedures. In replacing the traditional methohexital with intravenously given diazepam, the psychiatrist avoids much of the morbidity (respiratory depression, postictal agitation associated with methohexital, and electric convulsive therapy (ECT). I have found, however, that the daily use of an antecubital vein leads to a palpable venous induration with tenderness within three or four days.

Effect of electric convulsion therapy on urinary excretion of 3', 5' cyclic adenosine monophosphate.

Electric convulsion therapy (E.C.T.) was used in the treatment of 13 women inpatients suffering from depressive symptoms. Twelve of the patients showed a significant increase in urinary excretion of 3', 5' cyclic adenosine monophosphate (cAMP) on the day of treatment, whereas four controls who received all or part of the preliminary treatment but no electric shock showed a reduction. The results of this study are consistent with the hypothesis that the antidepressant action of E.C.T. is mediated through an increased production of cAMP in brain tissue.

STUDIES OF MINERAL METABOLISM IN MENTAL DEPRESSION

Calcium metabolic studies in 9 emotionally depressed patients before and after electric convulsive therapy or administration of a course of imipramine showed that treatment was associated with marked decrease in serum calcium concentration in most patients. The possible relationship of this finding to the phenomenon of depression has been discussed. Treatment with ECT in all patients and with imipramine in most was associated with improved calcium retention manifested by a shift toward positive balance. In most of these cases this resulted from increase in net absorption from the gut and decreased urinary calcium excretion. Calcium kinetic studies indicated that the increased retention due to electric convulsive therapy was caused by decreased bone resorption. In 3 out of 4 patients treated with imipramine, the increased calcium retention was associated with increased bone formation, which was marked in 2 patients and less marked in 1. The possible use of imipramine for treating osteopenia of unknown origin where bone formation is low has been suggested.

Iatrogenic epilepsy due to antidepressant drugs.

AN ANALYSIS OF THE CASE HISTORIES OF NINE PATIENTS WHO DEVELOPED EPILEPTIC FITS SHORTLY AFTER STARTING TRICYCLIC ANTIDEPRESSANT DRUGS SHOWED THAT ALL OF THEM HAD ONE OR MORE OF THE FOLLOWING FACTORS: previous or family history of epilepsy, pre-existing brain damage, cerebral arteriosclerosis, alcoholism, withdrawal of barbiturates, and history of previous electric convulsive therapy. Before prescribing antidepressant drugs these factors should be sought for in the history, and if any are present prophylactic anticonvulsant medication is indicated. From a limited experience we do not think that chlordiazepoxide is adequate to counteract the convulsant effect of antidepressant drugs.

E.E.G., memory and confusion in dominant, non-dominant and bi-temporal E.C.T.

Bi-temporal electrical convulsive therapy has been used extensively in psychiatric practice since its introduction by Cerletti and Bini in 1938. There are undesirable side effects, principally memory disturbance and confusion. The organic changes in the brain following E.C.T. are not yet understood, although some E.E.G. work has been carried out on this aspect (Martin et al., 1965).

Low serum pseudocholinesterase levels complicating treatment with phenelzine.

Four patients undergoing treatment with phenelzine developed low serum pseudocholinesterase levels. In one of the patients an apnoea of one hour followed modified electric convulsion therapy. In three cases investigations showed that the serum pseudocholinesterase levels returned to normal after withdrawal of phenelzine.

Hypothalamic--pituitary function in depressive illness: insensitivity to hylycaemia.

The insulin tolerance test was performed in 16 severely depressed patients on admission to hospital and after treatment with electric convulsion therapy. The mean plasma cortisol response to hypoglycaemia was significantly impaired before treatment, particularly in the patients who also showed resistance to dexamethasone suppression. The results are consistent with hypothalamic-pituitary insensitivity to hypoglycaemia in these subjects.

Suicide Prevention and Niacin

To the Editor:— I would like to clarify an allusion about a relationship between suicide and patients with schizophrenia given niacin therapy, which Dr. Hoffer made his reply to Drs. Henninger and Bowers ( 207 : 1355, 1969). Dr. Hoffer says that none of 450 patients receiving niacin against 12 out of 450 receiving tranquilizers, electric convulsive therapy, etc, over a ten-year period [committed suicide], and he again states that, we, however, reported a large number of indices of improvement including freedom from suicide, and in my opinion, niacin therapy is generally less harmful than psychotherapy if one can judge by suicide rate, the divorce rate, and home breakdown rate. My familiarity with the literature on suicide including that among schizophrenics leads me to state that there are no controlled studies showing that schizophrenics treated with niacin are less likely to commit suicide than those receiving other methods of treatment.

Electric convulsion therapy.

Electric convulsion therapy.

Partial REM phase deprivation and schizophrenia.

DURING a recent polygraphic study of sleep patterns in patients receiving electric convulsive therapy (ECT),1we found a statistically significant reduction in both total amount and percent of rapid eye movement (REM) sleep on nights recorded immediately after the final ECT in the series. On the other hand, nights recorded early in the treatment series showed either no change or minor elevations in the REM fraction. These findings were more or less uniform among all members of the group with the exception of a dramatically aberrant response in one patient, the consideration of which led to the formulation of the present study. The exceptional patient was a paranoid schizophrenic whose sleep patterns were polygraphically monitored over four consecutive baseline nights and showed a total sleep time averaging seven hours, 11 minutes, of which 17.9%, or 77 minutes, were spent in the REM phase. After the eighth ECT in her

Norepinephrine in depressive reactions. A review.

<h3>Introduction</h3> LITTLE IS known about the possible etiological biochemical factors relating to depressive reactions. Clinical evidence suggests that many depressions respond to the following somatic treatment: electric convulsive therapy (ECT), the imipramine type of drugs, and the monoamine oxidase inhibitor group of drugs.^2,3Do these two classes of drugs have common factors in their mechanism of action and can this be related to the fact that one antihypertensive agent, namely, reserpine, produces severe depression in a small but consistent number of hypertensive patients?^4-8 Rosenblatt et al,⁹in 1959, were among the first to specifically suggest that changes in brain norepinephrine (NEP) may be involved in depression. Based in part on the knowledge of the effect of reserpine and monoamine oxidase inhibitors on depressed mood and norepinephrine (NEP), they hypothesized that the depressive state might be associated with a relative decrease of norepinephrine

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.

LITHIUM TREATMENT OF MANIC STATES.

Lithium therapy is effective in manic phases of manic-depressive psychosis and offers special advantages over other therapy in protracted or frequently recurring mania as well as in hypomanic states. It may also prevent recurring depression. The drug is administered orally, most often as the carbonate in the form of tablets or as a mixture. It may be given alone or in combination with electric convulsive therapy. The drug is potentially toxic. Overdosage may lead to intoxication. During treatment, close clinical and biochemical supervision of the patient is necessary. Contraindications are renal or cardiac failure and a low sodium intake.

An Introduction to Physical Methods of Treatment in Psychiatry

This book, according to the authors, was written primarily for the student, the young psychiatric clinician, the general practitioner and the psychiatric nurse. The central aim is to present certain of the physical therapeutic methods used in psychiatry with regard to indications, technics, advantages, disadvantages and results. Under discussion are the various insulin technics, metrazol and electric convulsion therapy, the drugs used in treatment of epilepsy, the various sedative and stimulant drugs, the role of diet, vitamins and endocrine preparations, the malarial treatment of dementia paralytica, and, finally, prefrontal leukotomy. All this material is handled objectively, and, while the tone in general is perhaps slightly optimistic, no glowing claims are made for any one procedure. The chief discussion and criticism of the book will probably come in relation to the emphasis on the so-called constitutional approach. This is expounded in the "Introduction," which is preceded by the following quotation from

STRESS ULCERS AND RENAL DISEASE FOLLOWING ELECTRIC CONVULSIVE THERAPY.

STRESS ULCERS AND RENAL DISEASE FOLLOWING ELECTRIC CONVULSIVE THERAPY.