The therapeutic efficacy of electroconvulsive therapy (ECT). A double blind controlled trial of ECT and simulated ECT

A double-blind controlled trial of ECT versus simulated ECT is described. The results show that real ECT is significantly superior to simulated ECT in the treatment of depressive illness.

The treatment of severely depressed schizophrenic patients

The diagnosis and treatment of severe masked depression in schizophrenia is discussed, and the difficulties in management are stressed, with particular reference to drug therapy, E.C.T., and psychotherapy.

Psychotherapy in combination with antidepressant drugs in severely depressed out-patients--20-year evaluation

Eight hundred fifty-one severely depressed patients were treated on an out-patient basis over a twenty-year period with psychotherapy in combination with antidepressant drug therapy. The selection of patients and treatment technique is described. Eighty-three percent of the patients had excellent or good results within a period of three weeks. These results are compared with those obtained with electroshock treatment or psychotherapy alone.

Bipolar affective disorder--techniques and results of treatment

Differences between bipolar and unipolar patients and the natural history of bipolar illness are discussed. Reviewing recent studies, the paper then outlines the treatment of mania, the treatment of depression, and the prophylactic treatment of bipolar illness.

Long-term prognosis and followup in schizophrenia

The long-term course or natural history of schizophrenia is correlated with differing diagnostic criteria and commonly agreed upon prognostic variables. A review of 38 long-term followup studies of hospitalized schizophrenics reveals that unspecified or Kraepelinian-type schizophrenia has a much worse prognosis than atypical schizophrenia, schizoaffective psychosis, reactive psychosis, or other good premorbid types. Diagnoses based on longitudinal as well as cross-reactional data are more predictive of outcome than cross-sectionally based diagnoses. Drug and psychosocial treatment results must be evaluated in terms of prognostic variables, many of which are incorporated in some currently employed diagnostic criteria. There is no firm evidence that maintenance medication is indicated in some good prognosis patients. The paucity of long-range followups, the inadequacies of outcome assessments, and diagnostic disagreements limit our understanding of the effects of drug treatment, a treatment which is not without dangerous neurological side effects in many patients.

Depression in the aged: dynamics and treatment

Depression is one of the common threats to the mental health of the aged. The chief cause is the interiorization of the personality and the growth of inferiority feelings due to poor adjustment to retirement, widowhood, and/or chronic physical conditions. Psychotherapy for geriatric depression can be done by a primary care physician. Specific guidelines are given for the use of psychotherapy, psychotropics, and electroconvulsive therapy (ECT) with aged patients suffering from depression in conjunction with various complications (suicidal risk, chronic brain syndrome, hypochondriasis, and paranoia).

A study of predictive factors in depressive disorders of poor outcome

A retrospective comparison was made between two groups, each consisting of 30 depressed patients, one in which the outcome following discharge had been good, the other where it had been poor. A previous psychiatric history, earlier admission for psychiatric illness, particularly for affective disorders and a poorer performance on routine intelligence tests were found in the poor prognosis group. In this group the duration of the index admission was longer and the condition of the patient was less improved at the time of discharge. Several symptom variables also discriminated between the groups. These findings are discussed.

Treatment of chronic schizophrenia

The comprehensive treatment of schizophrenia requires the full resources of a clinical team that is able to offer treatment for the acute psychotic state in a hospital environment, and appropriate rehabilitation following resolution of the florid symptoms. Following a second or subsequent relapse, maintenance therapy with long-acting injections of depot antipsychotics will be required for an unknown period. Although drugs form an essential part of all treatments, it is essential to examine the environment for precipitating factors and to involve the patient's family in the rehabilitation. Recent studies have reported that some patients still have a relatively poor prognosis; although this proportion may be in the minority, the strain on the whole family of an even moderately handicapped patient can be enormous, and it is important to examine the needs of the whole family in evaluating care within the community. The effect of antipsychotic drugs is much wider that the mere control of acute symptoms and can influence the patterns of social behaviour and rehabilitation, in addition to offering protection against stress. The proper use of depot injections requires that they be kept under constant review. The current widespread practice of prescribing anti-cholinergic drugs on a prophylactic basis, or even as the inital treatment of extrapyramidal side-effects, needs revision.

Delusional depressions: natural history and response to treatment

A review of the abundant literature concerning the distinction between delusional and non-delusional depressions, especially of the work of Aubrey Lewis, reveals that before the introduction of specific therapies most in-patients with major depressive illness eventually recovered; the small percentage who did not almost all came from the delusional group. The dichotomy lost its clinical significance after the introduction of ECT, as both groups were equally responsive. However, accumulating evidence indicates that unipolar delusional depressives are significantly less responsive to tricyclic anti-depressant therapy than non-delusional depressives. The presence or absence of delusional thinking should be considered as a significant criterion in the classification of depressive disorders, and the presence or absence of delusional thinking should influence the choice of treatment for severely depressed patients.