Lelon A. Weaver

Neuropsychological effects of electroconvulsive therapy.

Although ECT as the treatment of choice for psychotic depression has been in use for many years, little is known about the neocortical residual of such treatments inferred from behavioral measures. The major portion of the literature has been concerned with inferred or observed changes in affective state. The present study compared pre- and posttreatment performances on the Halstead-Reitan neuropsychological battery of 20 patients who were receiving ECT from two different machines. Most Ss gave indicators of cerebral impairment prior to treatment when performance of one side of the body was contrasted with performance of the other side. After treatment, there was an increased number of Ss who evidenced signs consistent with damage to the right cerebral hemisphere. Some concern was raised that a large number of patients who eventually are subject ot ECT because of depression behave in this way because of an undiagnosed neocortical dysfunction. There is some suggestion that the effect of the procedure is to either create or intensify a right hemisphere focus as inferred from behavioral measures.

Failure to Normalize the Dexamethasone Suppression Test: Association with Length of Illness

It is well-documented that a subgroup of patients with major depressive disorder (MDD) have a state-dependent alteration of their hypothalamopituitary-adrenocortical (HPA) axis, most consistently demonstrated by nonsuppression of plasma cortisol following the Dexamethasone Suppression Test (DST) (Carroll et al. 1981). Although the sensitivity and specificity of this test vary considerably, recent studies of the nonsuppressor subgroup indicate that the test might have prognostic importance. Some investigators (Greden et al. 1980, 1983; Albala et al. 1981; Holsboer et al. 1982, 1983) have shown that conversion to a normal DST (suppression) in this subgroup of patients is associated with a favorable clinical response. As part of a longitudinal investigation of monoamine receptor and neuroendocrine regulation in patients with MDD, we examined the DST results pre and post treatment. We report our results in an attempt to characterize those patients who manifest nonsuppression prior to treatment and either

Some relations between psychiatric and psychomotor behavior changes associated with tranquilizing medications

Summary Twenty-six severely and chronically disturbed schizophrenic women were placed successively under conditions of regular medication, placebo, an experimental tranquilizer, trifluoperazine, and trifluoperazine-plus-benztropine methanesulfonate medication. Psychomotor performance was obtained on a battery of four tests (reaction time, steadiness, pegboard, and pursuit rotor) twice weekly for 15 weeks. Concurrent observations were made of the psychiatric status of the patients and of their muscular dysfunction. A comparison group of 10 chronic schizophrenic women were tested under conditions of regular medication. Psychiatric status steadily deteriorated under the placebo and SU-3822 regimens but began to improve following the introduction of trifluoperazine and benztropine methanesulfonate. The trifluoperazine caused muscular dysfunction which was partially alleviated by the anti-Parkinsonism agents. The reaction time and steadiness tests were found to be sensitive to the change in psychiatric status, but did not reflect the effects of muscular dysfunction. On the other hand, the pursuit rotor, pegboard, and horizontal alternation tests were not sensitive to change in psychiatric status but did indicate effects due to muscular dysfunction.

Psychomotor Performance of Clinically Differentiated Chronic Schizophrenics

King (1954) has reported that performance on a battery of psychomotor tests distinguished between normal controls, persons with less acute behavior disorders, and long-term chronic schizophrenics. The normal controls had the best performance, while the long-term patients were the poorest. Usually, there were marked differences between the chronic and the other two groups with less differentiation between the normal and the less acute behavioral disorder group. H e interpreted these findings as indicating that defective psychomotor response may be thought of as a faulty condition of adaptation to the environment, i.e., the registration of inefficiencies in a basic adaptational mechanism. A number of investigators have disagreed to some extent with Kings findings and interpretations. Rosenbaum, et al. (1957a) found that the use of electric shock as a motivator decreased the difference in R T between schizophrenics and normals. Their data tend to support Kings findings but not his interpretation. Cohen (1956), studying the effects of shock motivation on learning motor responses to visual stimuli, found some evidence that shock increased the level of performance of the schizophrenics. The findings were interpreted in terms of an inferred process of motivational dissipation in schizophrenics during performance. King and Lovinger (1957) found a curvilinear relationship between rate of operant response and severity of mental illness. They disagree with King by regarding psychomotor defect as a peripheral variable since they view functional psychopathology as fundamentally representing disturbances in interpersonal relationships. Jentsch (1959) investigated schizophrenic reaction time as a function of method of presentation and length of preparatory interval. One finding was that the normal control Ss had faster and less variable reaction rimes, thus generally agreeing with Kings results. Wienckowski (1959) studied stimulus factors influencing the disjunctive reaction time of schizophrenic and normal Ss. H e found the usual gradation, with the normals exceeding the acute schizophrenes who exceeded the chronic schizophrenes. The poorest normal performance was significantly faster than the best chronic schizophrenic performance. Again, these findings tend to

Tardive dyskinesia: clinical and neuroendocrine response to low dose bromocriptine

Twelve patients with a long-standing history of moderate to severe symptoms of tardive dyskinesia, which had remained stable for several months, participated in a 6-week trial with bromocriptine. All patients were receiving a concomitant neuroleptic medication and were treated with a low dose of bromocriptine (0.75 to 7.5 mg). Patients showed a modest overall improvement of 16.6%, with a trend for greater improvement in male patients (23.6%). Baseline prolactin levels in the female patients showed a positive correlation with age and duration of tardive dyskinesia symptomatology. Plasma prolactin levels 4 hours following administration of bromocriptine were negatively correlated with the dose of bromocriptine. There appears to be a differential sensitivity for prolactin and growth hormone response to bromocriptine at these low doses in the presence of chronic neuroleptic treatment. (J Clin Psychopharmacol 1985;5:286–292)

The effect of visiting on psychiatric patients in a general hospital

A study of the visiting patterns of a general hospital psychiatric unit was undertaken to determine what difference could be detected between visited and unvisited patients. The physical rehabilitation floor at the same hospital was used as a “control”. The results indicate that no significant differences could be found between the two groups of psychiatric patients but that a surprisingly large number, 40%, were not visited at all. A comparison of the visiting rates to both services favors rehabilitation 2∶1 with visitors coming from a much greater distance than to psychiatry. A discussion of the data raises questions about the social isolation of psychiatric patients. The dynamics of visiting are assessed in light of their treatment implications for patients in both the hospital and the community.

Psychomotor test scores and rated functional impairment of mental retardates.

A battery of five psychomotor tests was administered to a group of 258 retardates. Test results were used to assign Ss to mildly or moderately retarded categories. Comparison with the “functional” classification used by the training school showed agreement in three-fourths of the cases. Implications for clinical use and for mental dysfunction are discussed.

Reliability of a standardized brief-pulse stimulus in ECT.

The reliability of a standardized brief-pulse stimulus in eliciting a satisfactory convulsive response was evaluated under normal clinical conditions. A total of 89 patients were given 961 initial treatments. Of these, 757 were at the standardized level with a success rate of 89%. A total of 204 trials were given at higher-than-standardized levels. Treating these as standardized level failures, the overall success rate was 70%. The probability that a standardized stimulus given to any patient at any point in the treatment series would be successful was about 7 chances in 10. Implications for the selection of ECT stimuli were discussed.

Application of a Muscle-Potential Monitor to Electroconvulsive Therapy

A battery-operated IC amplifier converts muscle potentials to audio signals. It has been successfully used clinically to monitor patients undergoing electroconvulsive therapy for evidence of muscle relaxation, duration, and bilaterality of response.

RANGE AND CORRELATION

The correlation between the mean and SD of reaction time data for 270 mental retardates was estimated by computing the coefficient for thirds and fifths of the groups and combining those with the r to z technique. The estimates obtained varied from .45 to .88. The effect was demonstrated to be due to restriction of the range of values which occurred when the distribution was ordered in terms of either the mean or SD values.