Iver F. Small

Effects of ACTH 4–10 on ECT-induced memory dysfunctions

Double‐blind studies of ACTH 4–10 and placebo were conducted in psychiatric patients receiving bilateral ECT to determine whether the polypeptide exerted anti‐amnesic effects. Observations after a single ECT were suggestive of some positive effects, but studies between seizures after five or six ECTs showed no significant drug‐placebo differences. Although the findings were largely negative, they do not rule out positive effects of ACTH 4–10 on memory. Possibly the designs and timing of the experiments and/or the dosages of ACTH 4–10 employed were unsuitable for demonstrating such influences.

Manic symptoms: An indication for bilateral ECT

As a follow-up to pilot observations that six manic patients who failed to respond to unilateral electroconvulsive therapy (ECT) recovered rapidly when switched to bilateral treatment, a retrospective study was conducted. Twenty-five patients who responded after switchover from unilateral to bilateral ECT, 25 age- and sex-matched controls, and 25 concurrent controls who responded to right unilateral ECT alone were evaluated. Demographic variables and DSM-III diagnosis did not discriminate between the groups, nor were they different in terms of electroencephalographic (EEG) findings, neuropsychological test results, numbers of ECT, and duration of seizure discharges. Standard assessments of psychopathology performed by independent psychiatrists showed no differences in ratings of psychosis or depressive phenomena. However, scales assessing manic symptoms showed highly significant differences with many more features of unrestrained behavior, elevated mood, hurried speech, and other typical features of mania in the patients who were switched from unilateral to bilateral ECT. Although there were no differences in prescribed drugs, the use of prn medications for sleep was greater in the experimental-switched patients than in controls. Patients who responded to unilateral ECT alone exhibited virtually no manic features, whereas those who demonstrated these characteristics failed to respond to unilateral ECT but benefited when switched to bilateral treatment.

Stereotactic Amygdalotomy for Convulsive and Behavioral Disorders

58 patients, whose convulsions and behavioral disorders did not respond to nonsurgical therapy, were treated with stereotactic amygdalotomy between 1963 and 1973. A retrospective study was carried out

Mechanisms of action of ECT: Schizophrenia and schizoaffective disorder

A variety of neurophysiological mechanisms have been suggested to explain the therapeutic action of electroconvulsive therapy (ECT). Processes of kindling, resolution of hemispheric dysfunctions, anticonvulsant effects, and diencephalic stimulation all have been proposed to account for the beneficial effects of ECT. To investigate these, we analyzed clinical, neuropsychological, and electroencephalographic (EEG) data from 110 ECT-treated patients with schizophrenia and schizoaffective disorders, comparing responders with nonresponders. Fifty-four percent of all the patients were rated as very much or much improved. Mechanisms of kindling or anticonvulsant effects were not supported by the data. Dominant hemispheric dysfunctions in schizophrenics were suggested by the neuropsychological test data. There was tenuous support for the sensitization theory and both the neuropsychological and EEG data contradicted the dominant accentuation theory. Taken together with our previous report on ECT-treated patients with affective disorders, we propose that ECT might act by restoration of equilibrium between the hemispheres.

PHARMACOLOGY-NEUROPHYSIOLOGY OF LITHIUM

Trace amounts of the cation, lithium, are normally present in the human body. As such, lithium is a very different kind of agent than most other psychoactive substances that are used therapeutically. The matter of how this simple inorganic ion can exert profound effects upon the CNS and somehow dampen the cycles of mental disturbance in patients with manic-depressive disease presents a fascinating area for neurophysiological research. Although considerable work on this subject has already been accomplished, much more remains to be performed.

Influence of sex and handedness on hemispheric functioning.

Forty normal adult volunteers comprising an equal number of right- and left-handed males and females solved simple multiplication problems presented visually to one cerebral hemisphere while various competing stimuli were simultaneously presented to the other hemisphere. The contribution of sex of subject, handedness, hemisphere of presentation and the nature of the competing stimulus in relation to task performance was examined. Each of these variables was significantly associated with correct responses and errors, with few statistically significant interactions. Females and dextrals made more correct responses than males or sinistrals. Type of error depended upon which hemisphere received the problem, with the right hemisphere yielding more errors of commission and the left more errors of omission. Simultaneously presented identical or different arithmetic problems resulted in the most errors compared to the other competing stimuli.

Effect of Electroconvulsive Therapy on Cardiac Rhythm, Conduction and Repolarization*

Because sympathetic stimulation has been implicated in the genesis of arrhythmias, we studied the effects on arrhythmias of electroconvulsive therapy (ECT). Fifteen psychiatric patients (male: 8, female: 7, age: 19‐51, mean: 29.8) without known heart disease underwent 24‐hour Holter recordings before, during, and after ECT (25 episodes). All patients were taking psychotropic drugs and received atropine (0.4‐1.2 mg, mean: 1.1 mg IV), methohexital, and succinylcholine prior to ECT. Following ECT, mean maximum heart rate increased (106 ± 3.2 to 142 ± 6.0 beats/min, p < .001), PR interval decreased (149 ± 3.3 to 131 ± 3.7 msec, p < .001) and QTC interval increased (432 ± 6.5 to 454 ± 9.7 msec, p < .001) compared to values obtained after atropine administration. Mean PVC or PAG frequency immediately after ECT or per 24 hours did not change significantly (PVC per 24 hours 6.8 ± 3.2 to 10.4 ± 6.4, NS; PAC per 24 hours 0.4 ± 0.3 to 0.3 ± 0.2, NS) and no complex arrhythmias were noted. Rate and PR changes suggest adrenergic effeqts of ECT and QTC increase may be due to imbaianced sympathetic discharge. Autonomic stimulation produced by ECT did not induce arrhythmias in these patients without heart disease. The possible antiarrhythmic role of psychotropic agents or premedication is unknown.

The Misfits: a Comparative Study of Failures of Social Adaptation

N modern society, each citizen is expected to assume responsibility for adhering Ito the requirements of the law, for conforming to acceptable limits of behavior and for providing a livelihood for himself and his family. Individuals who fail to meet these fundamental obligations of social existence sooner or later reach the attention of community agencies, such as the police, the courts or departments of welfare. In turn, these agencies may require psychiatric consultation and evaluation prior to their disposition of such cases.