Victor Milstein

Multiple personality disorder. A clinical investigation of 50 cases.

To study the clinical phenomenology of multiple personality, 50 consecutive patients with DSM-III multiple personality disorder were assessed using clinical history, psychiatric interview, neurological examination, electroencephalogram, MMPI, intelligence testing, and a variety of psychiatric rating scales. Results revealed that patients with multiple personality are usually women who present with depression, suicide attempts, repeated amnesic episodes, and a history of childhood trauma, particularly sexual abuse. Also common were headaches, hysterical conversion, and sexual dysfunction. Intellectual level varied from borderline to superior. The MMPI reflected underlying character pathology in addition to depression and dissociation. Significant neurological or electroencephalographical abnormalities were infrequent. These data suggest that the etiology of multiple personality is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.

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

Clinical EEG Findings in Mania

Clinical EEG findings from 202 hospitalized manic patients repeated during 131 recurrences of mania were described. Results were considered in the light of current issues in the literature including the incidence of EEG abnormalities and minor variations, relationships between EEG and family history, EEG lateralization and longitudinal course of illness. The majority of patients had normal EEGs or mild nonspecific deviations compatible with effects of psychoactive medications. More definitive EEG abnormalities were observed in 16-percent. Microsleep occurred in 19 percent and small sharp spikes were found in 17 percent of those who drowsed, with lower incidences of 14 and 6 positive bursts and 6 Hz spike-and-slow-waves. Significant relationships between moderate or severe EEG abnormalities and negative familial loading were identified. Lateralized EEG abnormalities appeared in 9 percent of cases, involving the left side significantly more often than the right. With one exception EEG recordings during subsequent episodes did not suggest structural brain changes. Clinical EEG studies are useful in discriminating between primary and secondary affective disorders. They are also sensitive to effects of lithium and other psychoactive medications. The significance of EEG variations including microsleep and other atypical features continues to be elusive. Issues relating to heritability, hemispheric dysfunction and longitudinal course of illness merit further investigation.

Topographic EEG studies of mania

QEEG findings from 39 hospitalized manic patients were accomplished after a drug free period and following pharmacotherapy with lithium or carbamazepine alone or lithium combined with carbamazepine, haloperidol or risperidone. A subsample of 10 drug-free manic patients was compared with normal controls, which revealed lower qEEG amplitudes in the left anterior and midtemporal regions in the patients. Comparisons of drug therapies showed increased delta amplitudes and total power with lithium compared with carbamazepine. Increased fast frequencies were observed in the lithium and carbamazepine plus lithium groups compared with carbamazepine alone. Comparisons of the three drug combination groups revealed increased alpha and beta 1 amplitudes, most with risperidone and least with carbamazepine. Anterior delta and beta 2 amplitudes and interhemispheric coherence were increased directly proportional to plasma lithium levels. Nonresponders to treatment were identified at baseline by increased generalized theta amplitudes. After treatment, the nonresponders had higher amplitudes in the left temporal areas. Numerous qEEG associations with individual ratings of manic symptoms were found, more at baseline than after treatment. In general levels of psychopathology were negatively correlated with qEEG amplitudes. The qEEG findings appear to implicate dominant temporal lobe dysfunctions in mania.

Rape and post-traumatic stress in multiple personality

An increased incidence of childhood physical and sexual abuse has previously been demonstrated in patients with multiple personalities. This disorder in women is also associated with an increased incidence of forcible rape during adolescence and adulthood by strangers or acquaintances. In a series of 17 women with multiple personality, 6 had been raped. A control group of non-dissociative disorder patients matched for age and sex yielded no instances of forcible rape. This high incidence of rape is thought to be related to the masochistic character traits which are common in multiple personality. The relationship of multiple personality and rape to post-traumatic stress disorder is explored. Treatment in group and individual therapy in which education and prevention were emphasized is described.

Comparative Onset of Improvement in Depressive Symptomatology with Drug Treatment, Electroconvulsive Therapy, and Placebo

Depressive symptomatology responds very similarly to treatment with trazodone, imipramine, placebo, and electroconvulsive therapy. In one study positive therapeutic response was evident within the 1st week of therapy in most patients. If this did not occur, an unfavorable response to treatment was likely to follow. The close resemblance of the electroconvulsive therapy response profiles to those of antidepressant drugs and placebo suggests that it exerts similar effects and that all of the treatments examined probably operate through a final common pathway in those patients who respond. Among the nonresponders, there were few features that distinguished the therapeutic groups.

EEG Topography in Psychiatric Diagnosis and Drug Treatment

AbstractBrain surface activity monitoring (BSAM) of drug-free adult patients with mania, depression, and obsessive-compulsive disorder revealed no significant differences between them and age-sex-matched normal controls. Distinctive EEG changes were observed during treatment with carbamazepine and lithium in patients with affective disorders. Drug-free schizophrenics had more anterior slowing than did normals. Increased delta and theta activity was associated with neuroleptic therapy—most with clozapine and chlorpromazine and least with naloperidol. Higher left frontal alpha amplitudes were correlated with fewer negative symptoms of schizophrenia and better therapeutic response. Computerized tomographic ventricle-to-brain ratios exhibited robust positive correlations with beta-1 amplitudes that occurred exclusively during treatment with chlorpromazine. Alpha and beta-1 amplitudes were positively correlated with the BPRS anxiety depression factor in schizophrenic patients under all treatment conditions. En...

CONTINGENT ALPHA BLOCKING: CONDITIONING OR SENSITIZATION?

Abstract 1. 1. To determine whether pairing of two signals was necessary to produce a “conditioned” alpha blocking response, the EEG responses in fourteen subjects were first habituated to tone. Following repeated, independent exposure to a flickered light stimulus, 57% of the subjects showed 79% alpha blocking responses to three test tones. This blocking was shown not to be a matter of spontaneous recovery as a function of lapsed time. 2. 2. Forty paired tone-light trials were presented randomly while the subjects eyes were open and there was no alpha rhythm visible in the EEG. When three test tones were presented while eyes were closed and alpha rhythm appeared in the EEG, 57% of the subjects showed 88% blocking responses. 3. 3. The results indicate that the level of “conditioning” of alpha blocking achieved in previous studies does not necessarily require paired stimuli or the presence of obvious alpha rhythm in the EEG. Experiments involving the conditioning of cerebral electrical activity should be interpreted in light of these findings.