EEG immediately after unilateral ECT

EEG was continuously recorded in 15 patients for a period extending from just before to 1/2 hour after unilateral ECT. Fourier analysis was performed on the EEG following 15 right-sided treatments and five left-sided treatments. During the induced seizure, epileptic slow-wave activity had significantly greater power on the treated side. Immediately after the seizure, there was significantly more delta activity and less alpha and beta activity on the treated side. This asymmetry, though becoming less marked, was usually still present at the end of the recording period. Analysis of other variables associated with the treatment showed that there was a significant correlation between the time to eye-opening after ECT and both the duration of the seizure and the amount of anaesthetic administered. The similarity between these induced unilateral seizures and unilateral seizures occurring spontaneously in some epileptics is discussed.

The dose-response ratio in electroconvulsive therapy a preliminary study

To investigate pretreatment patient variables that might correlate with dose-response characteristics of electroconvulsive therapy (ECT) and treatment outcomes, 14 patients were assessed on a daily basis, before and during treatment, using self-report affective scales, three simple paper-and-pencil tests of cognitive function,and finger-tapping speed. From these data, dose-response ratios and treatment outcome measures were derived. The dose-response ratio of ECT was found to correlate with age--the younger the patient, the more favorable the ratio. This finding is discussed in terms of the known relationships between brain monoamine oxidase levels and age, and the established relationship between seizure duration and treatment efficacy. The dose-response ratio over the first two electroconvulsive treatments as well as lesser degrees of initial congnitive and greater degrees of initial affective impairment correlated strongly with greater overall affective improvement. Some clinical and research implications of these findings are discussed.

Hazards of succinylcholine administration during electrotherapy

We describe prolonged apnea following electrotherapy in a patient who was also being treated with a topical organophosphate anticholinesterase, ecothiophate iodide (phospholine iodide), for glaucoma. The increased duration of action of succinylcholine resulted from low levels of serum cholinesterase that had been caused by the organophosphate. Attention is called to other drugs that directly or indirectly (by lowering serum cholinesterase) interact with succinylcholine chloride resulting in prolonged apnea. Other potential hazards of succinylcholine administration, such as hyperkalemia and cardiac arrhythmias, are also discussed.

[The place of psychopharmacology in the treatment of depressions (author's transl)]

The great strides science has made in the field of pharmacology, on the one hand, and the refinement of numerous psychotherapeutic techniques, on the otherhand, provides the psychiatrist with efficient means to not only fight but also cure depressive illness. In certain cases electroconvulsive shock therapy performed under anaesthesia and under cover of a myoplegic remains nevertheless a necessity. This possibility must always be considered as it is not harmful to the patient.

Common errors in the treatment of suicidal patients

As a suicidology consultant to a county coroner and to several hospitals, the author has noted 5 common errors by the mental health caretakers in the treatment and management of suicidal patients. Prototypical cases of these errors are presented and discussed along with suggestions for prevention.

Continuation therapy in endogenous depression controlled by changes in the TRH stimulation test

Thyrotropin response to thyrotropin-releasing hormone is impaired during endogenous depression and normalized between the depressive periods. Changes in the thyrotropin response to thyrotropin-releasing hormone were shown to be of predictive value and might be useful in the control of continuation therapy with antidepressants in patients with endogenous depression.

Then and now

Dr Post has been known to generations of students of psychiatry passing through The Maudsley Hospital, London, as a clinician and clinical teacher. He retired in July 1978.

Indicators of E.C.T. response and non-response in the treatment of depression

Two matched groups of depressed patients, one ECT responsive and one ECT non-responsive, were compared for clinical, historical and treatment variables. Three factors predicted good response: (1) duration of illness less than one year; (2) presence of a precipitating event; (3) presence of delusions. A trend suggested that concurrent physical debilitation was a negative indicator. Possible explanations for these findings were proposed.