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In the years 1947–57, following a turbulent retirement, Ugo Cerletti, the father of electroconvulsive therapy (ECT) (1938), invested his energies in a new audacious project conceived as an extension of his ECT research. Forced to leave the direction of the Sapienza University Clinic, he got funds from the National Research Council of Italy to carry out his experimental activities, and founded a 'Center for the study of the physiopathology of Electro-shock' in Rome. The Center was aimed at studying liquid substances extracted from electro-shocked animals' brains that Cerletti named acroagonine and injected into human patients. Inspired by coeval literature, Cerletti believed that electroshock efficacy was due to stimulating some homeostatic processes in the brain, specifically in the meso-diencephalic area (i.e. involving neuroendocrine response in the hypothalamic–pituitary–adrenal axis). Cerletti's team wished not only to find these effects, but also to reproduce them. With this hypothesis, that proved ineffective, Cerletti anticipated intuitions on the neuroendocrine effects of ECT and the necessity for the development of psychopharmacology. In this article, I cross-combined previously unexplored archival materials stored at Sapienza University of Rome ('ES Section') with established bibliographic and archival sources. [ABSTRACT FROM AUTHOR]

Objectives: Electrochemotherapy uses electric fields to facilitate the influx of chemotherapy into cancer cells, producing a targeted effect. For head and neck cancer, it is mainly used for palliation of non-skin-origin metastases. It is used infrequently in the UK. This paper presents our experience and a UK survey to identify its frequency of use. Methods: Between 2016 and 2019, a prospective database was created and reviewed. Only patients with non-skin-origin metastatic head and neck cancer, with no other palliative options, were included. Survival length, complications and symptomatic benefit were assessed. The survey was conducted via e-mail. Results: Five patients were included: three with squamous cell carcinoma, one with esthesioneuroblastoma and one with hepatocellular carcinoma. Survival ranged from 1 month to over 20 months. Minor complications were seen. Only 15 out of 69 UK head and neck multidisciplinary teams offer electrochemotherapy. Conclusion: Electrochemotherapy is a well-tolerated adjunct to standard palliation of metastatic head and neck cancer, and is offered by a limited number of UK multidisciplinary teams. [ABSTRACT FROM AUTHOR]

ObjectivesElectroconvulsive therapy (ECT) is a non-pharmacological treatment that is effective in treating severe and treatment-resistant depression. Although the efficacy of ECT has been demonstrated to treat major depressive disorder (MDD), the brain mechanisms underlying this process remain unclear. Structural–functional changes occur with the use of ECT as a treatment for depression based on magnetic resonance imaging (MRI). For this reason, we have tried to identify the changes that were identified by MRI to try to clarify some operating mechanisms of ECT. We focus to brain changes on MRI [structural MRI (sMRI), functional MRI (fMRI) and diffusion tensor imging (DTI)] after ECT.MethodsA systematic search of the international literature was performed using the bibliographic search engines PubMed and Embase. The research focused on papers published up to 30 September 2015. The following Medical Subject Headings (MESH) terms were used: electroconvulsive therapy AND (MRI OR fMRI OR DTI). Papers published in English were included. Four authors searched the database using a predefined strategy to identify potentially eligible studies.ResultsThere were structural changes according to the sMRI performed before and after ECT treatment. These changes do not seem to be entirely due to oedema. This investigation assessed the functional network connectivity associated with the ECT response in MDD. ECT response reverses the relationship from negative to positive between the two pairs of networks.ConclusionWe found structural–functional changes in MRI post-ECT. Because of the currently limited MRI data on ECT in the literature, it is necessary to conduct further investigations using other MRI technology. [ABSTRACT FROM PUBLISHER]

BackgroundKetamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).AimsTo establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.MethodDouble-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760)ResultsNo significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.ConclusionsKetamine as an anaesthetic does not enhance the efficacy of ECT. [ABSTRACT FROM AUTHOR]

BackgroundKetamine has emerged as a novel therapeutic agent for major depressive episodes, spurring interest in its potential to augment electroconvulsive therapy (ECT).AimsWe sought to update our preliminary systematic review and meta-analysis, focusing on randomised controlled trials (RCTs) involving an index course of ECT, and testing the hypothesis that lack of efficacy is due to barbiturate anaesthetic co-administration.MethodWe searched EMBASE, CENTRAL and Medline to identify RCTs examining the efficacy of ketamine during a course of ECT. Data were synthesised from ten trials (ketamine group n = 333, comparator group n = 269) using pooled random effects models.ResultsElectroconvulsive therapy with ketamine was not associated with greater improvements in depressive symptoms or higher rates of clinical response or remission, nor did it result in pro-cognitive effects. This held true when limiting analysis to trials without barbiturate anaesthetic co-administration. Increased rates of confusion were reported.ConclusionsOverall, our analyses do not support using ketamine over other induction agents in ECT. [ABSTRACT FROM AUTHOR]

Although historians have shown that there has been a complex and multi-layered relationship between the body, medicine and the force of electricity, many avenues remain to be explored. One of the most prominent of these is the way in which electrotherapy technologies were marketed to a wide variety of different end users and intermediaries. This paper offers the first historical analysis of one such device – the Overbeck Rejuvenator – a 1920s electrotherapy machine designed for use by the general public. Its inventor, Otto Overbeck, was not a medical man and this enabled him to use aggressive strategies of newspaper advertising, using testimonials to market his product alongside appeals to his own scientific authority. He commissioned the prestigious Ediswan Company to manufacture the Rejuvenator on a large scale, and took out patents in eleven countries to persuade users of the efficacy of the device. In response to Overbeck’s activities, the British Medical Association enlisted an electrical engineer to examine the Rejuvenator, contacted practitioners whose endorsements were being used in publicity material, and denied Overbeck permission to advertise in the British Medical Journal. Despite this, the Rejuvenator brought its inventor wealth and notoriety, and helped redefine the concept of ‘rejuvenation’, even if the professional reception of such a device was almost universally hostile. This paper shows how the marketing, patenting and publishing of Overbeck combined to persuade members of the laity to try the Rejuvenator as an alternative form of therapy, bypassing the medical profession in the process. [ABSTRACT FROM PUBLISHER]

Irregular practitioners ('quacks') specialising in male sexual problems succeeded in nineteenth-century New Zealand by taking advantage of the growing population of unattached men who were ignorant of their own sexual physiology. The irregulars also profited from the regular practitioners' acceptance of ill-defined or imaginary male sexual disorders and the side effects of conventional venereal disease treatments, the lack of a clear demarcation between quacks and the regular medical profession, and an increased availability of newspaper advertising. Improvements in the postal system enabled quacks to reach more potential customers by mail, their preferred sales method. The decline in quackery resulted from scientific advances in the understanding of disease and government legislation to privilege regular practitioners and limit quacks' access to postal services and advertising. [ABSTRACT FROM AUTHOR]

Irregular practitioners ('quacks') specialising in male sexual problems succeeded in nineteenth-century New Zealand by taking advantage of the growing population of unattached men who were ignorant of their own sexual physiology. The irregulars also profited from the regular practitioners' acceptance of ill-defined or imaginary male sexual disorders and the side effects of conventional venereal disease treatments, the lack of a clear demarcation between quacks and the regular medical profession, and an increased availability of newspaper advertising. Improvements in the postal system enabled quacks to reach more potential customers by mail, their preferred sales method. The decline in quackery resulted from scientific advances in the understanding of disease and government legislation to privilege regular practitioners and limit quacks' access to postal services and advertising. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements.Aims: To compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT.Method: This multicentre randomised, double-blind, controlled trial (NCT00069407) was carried out from 2001 to 2006. A total of 230 individuals with major depression, bipolar and unipolar, were randomly assigned to one of three electrode placements during a course of ECT: bifrontal at one and a half times seizure threshold, bitemporal at one and a half times seizure threshold and right unilateral at six times seizure threshold.Results: All three electrode placements resulted in both clinically and statistically significant antidepressant outcomes. Remission rates were 55% (95% CI 43-66%) with right unilateral, 61% with bifrontal (95% CI 50-71%) and 64% (95% CI 53-75%) with bitemporal. Bitemporal resulted in a more rapid decline in symptom ratings over the early course of treatment. Cognitive data revealed few differences between the electrode placements on a variety of neuropsychological instruments.Conclusions: Each electrode placement is a very effective antidepressant treatment when given with appropriate electrical dosing. Bitemporal leads to more rapid symptom reduction and should be considered the preferred placement for urgent clinical situations. The cognitive profile of bifrontal is not substantially different from that of bitemporal. [ABSTRACT FROM AUTHOR]

BackgroundVagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.MethodAn open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically.ResultsThe baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (50% reduction in baseline scores) reached 37% and remission rates (HAMD-28 score <10) 17%. Response rates increased to 53% after 1 year of VNS, and remission rates reached 33%. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset; 44% of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63% at 3 months of stimulation) and coughing (23%).ConclusionsVNS therapy was effective in reducing severity of depression; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study. [ABSTRACT FROM AUTHOR]

Background Studies investigating mortality secondary to electroconvulsive therapy (ECT) are few. Aims To assess the risk of mortality from natural and unnatural causes among ECT recipients compared with other psychiatric in-patients over a 25-year period. Method Register-based cohort study of all in-patients admitted to a psychiatric hospital from 1976 to 2000. Cause-specific mortality was analysed using log-linear Poisson regression. Results There were 783 deceased inpatients who had received ECT compared with 5781 who had not. Patients who had received ECT had a lower overall mortality rate from natural causes (RR=0.82,95% CI 0.74-0.90) but a slightly higher suicide rate (RR=1,20,95% CI 0.99-1.47), especially within the first 7 days after the last ECT treatment (RR=4.82,95% CI 2,12-10.95). Conclusions Further investigation of the effect of ECT on physical health and the observed increased suicide rate immediately following treatment are needed, although the last finding is likely to result from selection bias. [ABSTRACT FROM AUTHOR]

Background: Although electroconvulsive therapy (ECT) is widely used to treat psychiatric disorders such as depression, its precise neural mechanisms remain unknown.Aims: To investigate the time course of changes in cerebral blood flow during acute ECT.Method: Cerebral blood flow was quantified serially prior to, during and after acute ECT in six patients with depression under anaesthesia using [(15)O]H(2)O positron emission tomography (PET).Results: Cerebral blood flow during ECT increased particularly in the basal ganglia, brain-stem, diencephalon, amygdala, vermis and the frontal, temporal and parietal cortices compared with that before ECT. The flow increased in the thalamus and decreased in the anterior cingulate and medial frontal cortex soon after ECT compared with that before ECT.Conclusions: These results suggest a relationship between the centrencephalic system and seizure generalisation. Further, they suggest that some neural mechanisms of action of ECT are mediated via brain regions including the anterior cingulate and medial frontal cortex and thalamus. [ABSTRACT FROM AUTHOR]

Abstract: Objective. – To describe the utilization, geographical variations and adaptation of ECT in the Spanish context. Method. – A cross-sectional study, involving a questionnaire delivered to all hospitals with a Psychiatry Unit (PU) in Spain included in the National Hospitals Catalogue (N = 233). A descriptive analysis was made of the answers to the different questions, using an adequate denominator in each case: all PUs (n = 233), those units that prescribe and apply ECT (n = 174), or only those that apply the technology (n = 108). Results. – All PUs completed the questionnaire. Fifty-nine units (25.3%) neither prescribed nor applied ECT, while 108 (46.4%) prescribed and applied the technology, and 66 PUs (28.3%) only prescribed ECT. Those units with training responsibilities for psychiatry residents or pregraduate students, and those with a larger number of beds, were more inclined to apply ECT. The estimated ECT applied in the preceding 12 months totaled 2435 with an annual rate per 10,000 inhabitants of 0.61, and a range per Spanish Autonomous Community of 0.28–16.59. Conclusions. – We now know a reliable rate and characteristics of the use of ECT in Spain, and the attitudes and opinion of PUs Spanish psychiatrists about it. We found a very important variability in ECT application rates among Autonomous Communities. [Copyright &y& Elsevier]

Background Electroconvulsive therapy (ECT) is a procedure that attracts special safeguards under common law for voluntary patients and under both current and proposed mental health legislation, for those receiving compulsory treatment. Aims To review patients' views on issues of information, consent and perceived coercion. Method Seventeen papers and reports were identified that dealt with patients' views on information and consent in relation to ECT; 134 'testimonies' or first-hand accounts were identified. The papers and reports were subjected to a descriptive systematic review. The testimony data were analysed qualitatively. Results Approximately half the patients reported that they had received sufficient information about ECT and side-effects. Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. Clinician-led research evaluates these findings to mean that patients trust their doctors, whereas user-led work evaluates similar findings as showing inadequacies in informed consent. Conclusion Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales. [ABSTRACT FROM AUTHOR]

Background. The outcome of electroconvulsive therapy (ECT) is affected by the placement and dose of the stimulus. In general, the ECT dose can be selected either by the dose-titration method (on which the measured seizure threshold level is based), or the method of predetermined dose (e.g. the age-based dosing and the fixed high dose method). Methods. Seizure thresholds were measured in 50 patients with right unilateral (RUL) and in 30 patients with experimental bifrontal (BF) ECT stimulus. The ECT dose (mC) of the age-based dosing was calculated by multiplying the age (years) by 5·0 (age method) or 2·5 (half-age method). The fixed high dose was set to 378 mC. Results. The seizure thresholds had only a moderate correlation with the age of the patients. The methods based on the predetermined dose would have led us to give patients with the lowest seizure thresholds in the RUL ECT group very high stimulus doses, up to 12 (age method) or 15 (fixed high dose method) times the individual seizure threshold. In contrast, the RUL ECT patients with the highest seizure thresholds would have received low stimulus doses down to 1·5 times (half-age method) the initial seizure threshold. In the BF ECT group the-age based dose would have been similarly dependent on the initial seizure threshold level. Conclusion. The use of the dose-titration method is recommended, because it is the only method that allows for the individual selection of ECT stimulus dose relative to the seizure threshold. [ABSTRACT FROM AUTHOR]

Background. A relationship between the anticonvulsant and antidepressant properties of electroconvulsive therapy (ECT) has been hypothesized. The goal of this study was to see whether the anticonvulsant effects of ECT could be measured in a clinical setting and whether there was any relationship between the anticonvulsant effects of ECT and the antidepressant response to it. Methods. We examined the temporal relationship between change in seizure duration (as an index of anticonvulsant activity) and improvement in Hamilton Rating Scale for Depression scores in a retrospective sample of 114 depressed patients who received 145 courses of ECT. A linear mixed effects model was utilized for analysis so that the repeated measures nature of the data could be taken into account. Results. Both seizure duration and depression scores decreased significantly through the course of ECT. However, no evidence was found for a relationship between decrease in seizure duration and clinical improvement as measured by Hamilton ratings. Conclusions. The process underlying the reduction in seizure duration through a course of ECT may not be related to antidepressant efficacy. [ABSTRACT FROM AUTHOR]

Background: Abnormalities of catecholaminergic function have been hypothesised to cause depressive illness. Plasma noradrenaline can be used as a marker of central noradrenergic activity. It is of interest to examine the change in resting plasma noradrenaline in patients with depressive illness over a course of electroconvulsive therapy (ECT) and relate this to their clinical state.Method: Patients referred for ECT who suffered from DSM-III-R major depressive disorder or dysthymia were recruited. Blood samples were taken before and after each treatment, during a course of ECT, to measure plasma noradrenaline and cortisol. Clinical ratings were carried out weekly during the course of ECT.Results: Plasma noradrenaline fell significantly in those patients with melancholic/psychotic depressions but increased in those with non-melancholic depressive illness. There was a strong trend indicating that a fall in plasma noradrenaline was associated with improvement in depression ratings in the melancholic/psychotic patients only.Conclusions: Electroconvlusive therapy decreases plasma noradrenaline in melancholic/psychotic depressive illness and this shows a trend associated with clinical improvement. [ABSTRACT FROM AUTHOR]

Background: The mechanism of the antidepressant action of electroconvulsive therapy (ECT) remains unknown. Based on previous work with antidepressant drugs and their effects on the noradrenergic system, we undertook this study to further determine the effects of ECT on selected indices of peripheral adrenoceptor function in depressed patients.Methods: Binding parameters (Bmax and Kd) of platelet alpha 2- and leukocyte beta 2-adrenoceptors, plasma noradrenaline (NA), 3-methoxy-4-hydroxy-phenylglycol (MHPG) and cortisol levels were determined in 18 patients, prior to treatment and 14 days after the last of a series of ECTs, and compared with samples obtained from 18 matched control subjects.Results: Platelet alpha 2-adrenoceptor sites were significantly elevated in untreated patients compared with controls (P < 0.03), but leukocyte beta 2-adrenoceptor numbers did not differ. Treatment with ECT led to a significant reduction in platelet alpha 2-adrenoceptor numbers, whereas leukocyte beta 2-adrenoceptor densities increased. Pre-ECT plasma NA, MHPG, and cortisol levels were elevated in patients, compared with controls, and decreased following ECT, but these differences were not statistically significant. Post-ECT plasma NA and beta 2-adrenoceptor numbers were significantly, negatively correlated (P < 0.05).Conclusions: These results suggest that platelet alpha 2-adrenoceptors are supersensitive in depressed patients and treatment with ECT results in down-regulation of these receptors, which may be interpreted as a primary therapeutic, "normalising' effect. The post-ECT changes in leukocyte beta 2-adrenoceptors are probably only secondary to the lower circulating plasma NA levels. [ABSTRACT FROM AUTHOR]

Background: The induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.Method: In a prospective, randomised, double-blind study 20 subjects with major depressive disorder (DSM-III-R criteria) received propofol or methohexitone anaesthesia. The Hamilton Depression Rating Scale and Beck Depression Inventory were used to assess depression before therapy, at every third treatment, and at the end of therapy. Seizure duration was measured using the cuff technique.Results: Mean seizure durations (P < 0.01) and mean total seizure duration (P < 0.01) were shorter in the propofol group. There was no difference in outcome.Conclusions: Use of propofol may not adversely affect outcome from depression and it is not necessarily contraindicated as an induction agent for ECT. Our results should be interpreted cautiously, and larger studies are needed. [ABSTRACT FROM AUTHOR]

The severity of depression in 11 drug-free unipolar patients diagnosed with definite major depressive disorder was assessed using the Hamilton Rating Scale for Depression during a course (5-10 treatments) of bilateral electroconvulsive therapy (ECT). The degree of improvement after three treatments of ECT was six times greater than the improvement that occurred over the remainder of the course. Although depressed patients who recover with ECT require repeated treatments, the treatments early in a course of ECT can have marked antidepressant effect. [ABSTRACT FROM AUTHOR]

The article discusses the lack of research about the onset and rate of the antidepressant effect of electroconvulsive therapy (ECT) in Great Britain. The selection of depressed patients who will receive ECT and the recommended ECT practice have significantly changed. All depressed patients who recover with ECT require at least several treatments to have complete remission. However, this does not necessarily mean that treatments early in an ECT course are without antidepressant effect. Little research is being conducted in Great Britain. The last study of the effectiveness of ECT in the country was completed in 1983.

The effects of ECT on plasma insulin and glucose were assessed in 20 depressed patients, during the first, third and fifth session of ECT. After each administration of ECT there was a significant rise in blood glucose and plasma insulin levels, both of which peaked at 15 minutes. Insulin responses tended to attenuate over the course of ECT, whereas the glucose responses were similar for all three treatments. ECT was effective in all patients, although two months after the last treatment nine patients had partially relapsed (Hamilton score greater than 15). Those who relapsed had a more attenuated insulin response at the fifth treatment than those who had remained well, which suggests that insulin response to ECT may be predictive of clinical outcome. [ABSTRACT FROM AUTHOR]

In-patients suffering from major depressive disorder (endogenous subtype) were randomly allocated to treatment by either traditional ECT with constant-voltage modified sine-wave stimuli (n = 17) or modern, constant-current brief-pulse ECT (n = 14). All treatments were bilateral and monitored by simultaneous recording by EEG. The severity of depressive illness was assessed the day before treatment, after three treatments, and seven days after the last treatment. The improvement and final depression rating scores, the likelihood of recovery, and the average number of treatments received were virtually identical in the two groups. We concluded that the policy of bilateral suprathreshold modern ECT monitored by EEG is as efficacious as traditional ECT. [ABSTRACT FROM AUTHOR]

This paper describes the results obtained by combining data from the Northwick Park and Leicester randomised controlled trials of ECT. Patients who suffered from depression in which retardation and delusions were features and who received real ECT had a significantly improved outcome at the end of four weeks of treatment (as measured by improvement in the HRSD) in comparison with those who received simulated ECT. However, this treatment effect was not detectable at six-month follow-up. Patients who were neither retarded nor deluded did not benefit significantly from real as opposed to simulated ECT. [ABSTRACT FROM AUTHOR]

Despite renewed interest in ECT as a continuation treatment after an episode of depressive illness, few guidelines for its use are available. Meaningful research findings are few, although the potential benefits and risks of modern continuation ECT merit study. We suggest preliminary guidelines and provide an illustrative clinical example. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy is an important treatment in the depressive states of late life, and there is general agreement about the indications for its use in old age psychiatry. Indeed, old age may be associated with a better response to ECT than that in younger age groups. The additional risk involved through physical problems in the elderly is not great when compared with that of continuing depression and of the side-effects of alternative treatments. Temporary memory disorders and confusion may occur, but are minimised if unilateral electrode placement is used. Some patients treated with unilateral ECT do not respond, but will respond to bilateral treatment. Anxiety over unwanted treatment effects, which can lead to ineffective treatment of depressive illness, must be outweighed by knowledge of the dangers of leaving depression untreated in old age. [ABSTRACT FROM AUTHOR]

Seventeen patients with schizophrenic symptoms were assessed before and after ECT to elicit possible factors predictive of outcome. The strongest associations with good outcome were shown by short duration of illness and paucity of pre-morbid schizoid personality traits; significant associations were also shown by short duration of current episode, paucity of paranoid pre-morbid personality traits, and the presence of perplexity. The diagnosis of schizoaffective disorder was not related to outcome. Questionnaires completed by 16 patients after ECT showed their attitudes to be generally favourable to the procedure. [ABSTRACT FROM AUTHOR]

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery. [ABSTRACT FROM AUTHOR]

The concurrent appearance of the koro syndrome and pathology of the central nervous system is quite rare. A case of a patient with a diagnosed tumour in the genu of the corpus callosum, who displayed typical koro symptoms, is presented. A short series of electroconvulsive shock treatments brought about resolution of the koro symptoms. Neurological investigation of all sporadic cases of koro is deemed necessary, to exclude cerebral involvement. [ABSTRACT FROM AUTHOR]

The use of electricity in British psychiatry during the second half of the 19th century is examined. An account is given of the clinical and theoretical aspects of electrical therapy. Factors leading to its use and eventual decline are considered. [ABSTRACT FROM AUTHOR]

A Republic of Ireland national survey of electroconvulsive therapy (ECT) showed wide inter-hospital variation in ECT rates. Psychiatric admission rates, professional attitudes, and patient turnover were found to predict these rates. No significant association was found between ECT rates and public/private care or other socio-economic factors. A limited examination of British admission data revealed a similar set of correlations, suggesting that the findings may apply in non-profit health-care systems outside the Republic of Ireland. [ABSTRACT FROM AUTHOR]

Electrical measurements were made during treatment of two groups of patients, one group receiving treatment from a constant current ECT machine and the other from a constant voltage machine. The electrical impedance and energy were calculated and compared for the two groups. More energy was delivered by the constant voltage than by the constant current machine, but the spread of energy delivered was comparable. With a consistent technique for applying the electrodes there is little to choose between these machines, but the constant current machine may be preferred where consistency cannot be achieved. [ABSTRACT FROM AUTHOR]

The efficacy of ECT was investigated in a double-blind trial. Twenty-two patients with schizophrenia received trifluoperazine and were randomly allocated to receive eight real or eight simulated ECTs. In the first eight weeks, the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale. However, the groups showed no significant differences from the twelfth week onwards. The superiority of real ECT was not confirmed at the end of six months. [ABSTRACT FROM AUTHOR]

Patients were treated with three different types of electroconvulsive therapy in random order in the first three sessions of their courses. Anaesthetic and muscle relaxants were administered in standard doses, and treatment applied a set time after bolus injection. Electroencephalographic recordings were undertaken before, during, and after treatment, and hormonal measures before and after. The responses to treatment differed between the three types of current in both EEG and prolactin measures. It is suggested that the quality of the convulsive response varies with different currents. [ABSTRACT FROM AUTHOR]

Sixty nine patients took part in a double-blind study to investigate the efficacy of bilateral, unilateral, and simulated ECT in the treatment of depressive illness. The findings suggest that both bilateral and unilateral ECT are highly effective treatments for depression and are significantly superior to simulated ECT. There was also evidence that patients receiving bilateral ECT recovered more rapidly than those receiving unilateral ECT and required significantly fewer treatments. The relevance of these findings to clinical practice is discussed. [ABSTRACT FROM AUTHOR]

As part of the Leicester electroconvulsive therapy (ECT) study, the role of ECT in schizophrenia was investigated in a double-blind trial. The Present State Examination criteria for schizophrenia were fulfilled by 22 patients, of whom 19 gave consent and entered the trial. Neuroleptic medication was restricted during the trial period. Patients were randomly allocated to eight real ECT or eight simulated ECT. At the end of the four-week trial period, patients receiving real ECT showed a significantly greater improvement when measured on the Montgomery-Asberg Schizophrenia Scale (MASS), the visual analogue global psychopathology scale, and the depression scale. The differences on the MASS and visual analogue global psychopathology scale were not due to improvement in depressive symptoms. The superiority of real ECT was not demonstrated at the 12- and 28-week follow-up, when treatment was not controlled. [ABSTRACT FROM AUTHOR]

Perceptual learning was examined with respect to variations in ECT electrode placement (bilateral versus right unilateral) and ECT stimulus waveform (sinusoidal versus brief-pulse). While patients receiving right unilateral ECT demonstrated more perceptual learning than did those receiving bilateral ECT, no difference in perceptual learning resulted from the variation in electrical stimulus waveform. Furthermore, the amount of perceptual learning was unaffected by EEG seizure duration and by the total amount of electrical stimulus energy delivered. The theoretical issue of whether an electrical or a seizure difference between bilateral and right unilateral ECT is responsible for inter-group learning or memory differences is discussed, as well as practical issues related to the choice of electrode placement. [ABSTRACT FROM AUTHOR]

Thirty-eight patients suffering from severe depression were given a course of ECT (Electroconvulsive therapy) in one of three waveforms. These were high-energy sine wave (HS), high-energy pulse (HP), and low-energy pulse (LP). Patients were assigned to one of these treatments on a double-blind basis. The patients were given a battery of memory tests before ECT commenced, after three treatments, at the termination of treatment, and two weeks after the last treatment. The marked improvement in both verbal and nonverbal memory scores was attributed to the lifting of depression. No significant differences were found between the memory scores of the three treatment groups at any point during the treatment period. [ABSTRACT FROM AUTHOR]

First rank symptoms (FRS) in association with affective features predict improvement on ECT. When affectivity was disregarded in 142 schizophrenic probands given ECT and the relationship between FRS alone and ECT response examined, those without FRS had a significantly better ECT outcome score than those with FRS. In various schizophrenic sub-samples, defined in terms of hypothesized predictive abilities of different sets of FRS, no differences came to light. [ABSTRACT FROM AUTHOR]

A range of memory and perceptual tests not previously used in the assessment of the effects of ECT has shown no impairment in 38 depressed patients after six unilateral (one dominant and five non-dominant) Ed. [ABSTRACT FROM AUTHOR]

Self-reports of memory problems have been evaluated prospectively in depressed patients receiving bilateral ECT or unilateral ECT, and in depressed patients receiving treatments other than ECT. Depressed patients did not complain of poor memory at seven months after hospitalization. Compared to bilateral ECT, right unilateral ECT was associated with only mild memory complaints. At three years after treatment approximately one-half of the persons who had received bilateral ECT reported poor memory. These reports seemed to be influenced by three factors: (1) recurrence or persistence of conditions that were present before ECT; (2) the experience of amnesia initially associated with ECT and a subsequent tendency to question if memory had ever recovered; and (3) impaired memory for events that had occurred up to six months before treatment and up to about two months afterwards. [ABSTRACT FROM AUTHOR]

Review of studies from the past 16 years employing quantitative measurement of memory functions before and after ECT revealed the following trends: impairment of non-verbal memory functions after less than five unilateral non-dominant ECTs; improvement of non-verbal memory functions after five or more unilateral non-dominant ECTs; no change or improvement of verbal memory functions with unilateral non-dominant ECT; consistent impairment of verbal functions with unilateral dominant ECT, and impairment of both verbal and non-verbal functions with bilateral ECT. The relative lack of impairment in memory functions with unilateral non-dominant ECT is consistent with the theory of asymmetrical hemispheric disorganization in affective disorders, and supports the choice of unilateral non-dominant ECT over bilateral or unilateral dominant ECT in the treatment of depression. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy was compared with imipramine in the treatment of endogenous depression in a double blind randomized controlled trial. Both treatments produced equally significant improvement which was equally maintained till the end of six months. However ECT produced its effects quicker with lesser subjective side effects to the patient. ECT did not cause any organic brain dysfunction as assessed at the end of three and six months. [ABSTRACT FROM AUTHOR]

Patients were randomly allocated to treatment with either low energy pulses, high energy pulses, or high energy sinusoidal wave ECT and, despite the induction of convulsions of similar duration, were found to respond at different rates and to a different degree, depending on whether low or high energy currents were used. It is suggested that the quantity of current, as well as the induction of a convulsion, is relevant to therapeutic outcome with ECT. A re-examination of previous work shows that this is not necessarily inconsistent with these findings, which also explain the contradictory results in recent controlled trials of ECT. [ABSTRACT FROM AUTHOR]

Patients diagnosed as reactively or endogenously depressed were given electroconvulsive therapy (ECT). The endogenously depressed patients tended to respond to the treatment more quickly and favourably. Measures of age and severity of depression were as predictive as the classification into endogenous or reactive depression using the Newcastle rating scale. The degree of psychological stress ascertained and presumed to be operating did not contribute to the prediction of outcome. [ABSTRACT FROM AUTHOR]

A randomized controlled study of 38 catchment unit psychiatric in-patients in a discussion group showed no significant additional benefit compared with 36 in-patients in an activity group. Symptom change scored by three rating groups agreed closely, average r = +0.64. Patients treated with ECT showed 2.6 times as much reduction in morbidity as those not so treated, but there was still no appreciable difference between discussion and activity groups when this was allowed for. Other treatment factors and the Hawthorne effect appeared to obscure any effect due to group therapy. [ABSTRACT FROM AUTHOR]

EEG monitored ECT was administrated to 20 patients, 12 females and 8 males. One hundred and fifty-six treatments were given (mean 7.8 treatments/patient), and the relation between clinically observed seizures (COS) and the cerebral patterns of convulsions (EPC) was compared. If clinical observation alone had been used, restimulation would have been necessary in 43 per cent of the treatments, whereas restimulation actually was done in 9 per cent. Similarly, too violent convulsion patterns would have been ignored in 5 per cent of the treatments. [ABSTRACT FROM AUTHOR]

The inter-electrode resistance during ECT is shown to be very variable, a finding which invalidates the measurement of shocks in joules. With square wave pulses of selected current value the threshold for convulsion may be below 100 milliamperes or above 2,000 milliamperes. It is advisable to measure the current value during millisecond pulses with relatively long intervals between. [ABSTRACT FROM AUTHOR]