E. Michael Kahn

Effects of Electroconvulsive Therapy upon Brain Electrical Activitya

Electroconvulsive therapy (ECT) acts through the elicitation of a series of brief paroxysmal electrophysiologic events involving neurons throughout the brain. The mechanisms by which seizure activity produces both therapeutic and adverse effects are a major focus of this conference. The data presented here, however, will center both upon the characteristics of the seizures themselves and upon the interictal neurophysiologic changes that are produced as a result of such seizure activity. It is felt that attention to the electrophysiologic domain, particularly with respect to the effects of variations in ECT technique, may provide useful information not only clinically, but in the understanding of mechanisms as well.

Spectral and topographic analysis of EEG in schizophrenic patients

The authors performed spectral analysis of electroencephalograms (EEG), recorded awake, with eyes closed, in 13 patients with schizophrenia and 9 age-matched individuals without psychiatric diagnosis. We tested several possible parameterizations of the data, and two data-reduction strategies; these yielded similar results. Comparison of the two groups revealed a relative increase in alpha frequency activity in the frontal regions in the patient group. The authors believe that this finding is consistent with data from neuropsychologic tests, metabolic imaging studies, and evoked potential studies that suggest impaired activation of frontal brain areas in patients with schizophrenia.

Group treatment assignment for outpatients with schizophrenia: Integrating recent clinical and research findings

Many mental health clinics rely heavily on group treatment in the outpatient care of individuals with schizophrenia. Groups are used because they economize clinician time and provide social interaction for isolated patients. Empirical evidence suggests that groups, combined with medication, are at least as effective as other common treatments. Many group formats and techniques have been used. Choices are often based on pragmatism or inclination, rather than theory or experiment. The authors review recent findings from research on the neurobiology of schizophrenia, its natural history, and the impact of psychosocial factors in its course and treatment. From these findings, they elaborate research based principles for outpatient group therapy in schizophrenia. They describe three distinct formats for group treatment, and delineate the scope of use for each. Finally, they propose guidelines for assignment of patients to appropriate group treatments.

TOCRS—The therapy-oriented computer record system

A computerized system has been developed to provide treatment records for patients in the Duke Psychiatric Outpatient Clinic. Demographic, diagnostic, and therapeutic data are incorporated into a concise summary provided to the therapist for each patient visit. Variables were carefully chosen to capture essential therapeutic information while minimizing the burden of data entry on the therapist. Suggestions by the users have led to a number of modifications in the system, including the addition of special data-keeping functions for therapy groups and record generations of summary reports for clinicians and administrators. Essential information is gathered in a format well suited to analysis by standard computerized statistical techniques. Record keeping, in this fashion, provides an information base that describes the process of psychiatric treatment.

Imaging of brain electrophysiologic activity: Applications in psychiatry

Recent advances in computer technology make it relatively easy to generate color images representing the electrophysiologic activity of the brain. Because of the visual appeal of the images, and their similarity to computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans, there has been wide interest in these methods. Thorough understanding of these techniques is necessary to appreciate their strengths and limitations, and their proper application. This article explains the types of studies that are usually done, compares these methods with other imaging techniques, outlines their limitations, summarizes the literature on their use in psychiatry, and describes clinical situations in which these tests may be useful. This information will help the reader interpret clinical reports and research studies that employ these methods, evaluate representations made by commercial vendors of imaging systems, and understand the role these tests can play in his or her daily clinical practice.

Relationship of client attributes and guides’ techniques to client satisfaction at a climbing school

Our goals were to (1) conduct a preliminary investigation of the relationships of client characteristics, guides techniques, and client satisfaction with their guided experience, (2) offer guides practical information about steps they could take to increase client satisfaction, and (3) refine theories, hypotheses, and measurement techniques for further study. Climbing school clients were surveyed regarding their personal attributes, perceptions of guides actions and performance, and satisfaction with the guided experience. Eighty-seven clients and eight guides were included in the sample. Clients stated that they learned better through supervised practice than through demonstration and explanation. Clients who came with clear objectives felt a greater sense of accomplishment. Key dimensions of guide activity were Technical, Planning , and Support . Key dimensions of client satisfaction were Valuing, Pleasure, Accomplishment , and Comfort . Guides and clients may tend to focus on technical factors; however, indirect measures show the importance of providing emotional support.

Akathisia: clinical phenomenology and relationship to tardive dyskinesia

Akathisia and tardive dyskinesia (TD) are disorders of movement that are often associated with administration of antipsychotic medication. We surveyed 196 outpatients in a schizophrenia clinic, all receiving antipsychotic medication, for the presence of these disorders. Clinical global ratings of akathisia were reliable. Akathisia was found in 36% of patients, and TD in 23.5%. Akathisia was disproportionately common in patients receiving high-potency neuroleptics. The data affirmed recent revisions in the dose-equivalence formulas used with fluphenazine decanoate. Akathisia and TD did not seem to be interrelated. Because akathisia is common and often limits medication dose and contributes to noncompliance, psychiatrists must take this into account when prescribing antipsychotic medication.