Etomidate in electroconvulsive therapy. A within-patient comparison with alphaxalone/alphadalone

In a group of 31 patients undergoing electroconvulsive therapy, there was no significant difference between the times of return of eyelash reflex, swallowing and respiration following a single induction dose of 0.2 mg/kg of etomidate as compared with an induction dose of 0.036 ml/kg of alphaxalone/alphadalone. The incidence of involuntary movements and increased muscle tone was significantly greater after etomidate than following alphaxalone/alphadalone; but the involuntary movements were never marked. The overall incidence of pain on injection was 15% after etomidate. There was a low incidence of venous sequelae following either drug.

A survey of consultant psychiatrists' attitudes to their work, with particular reference to psychotherapy

Ninety-six out of 137 consultant psychiatrists working for the majority of their time in the London area outside academic units returned questionnaires concerning attitudes to their work. Analysis of the 88 fully completed questionnaires suggested the existence of four relatively discrete but overlapping patterns of psychiatric practice in the Regions concerned, of which two largely excluded individual psychotherapy. These findings are discussed in relation to the education in psychotherapy of trainee psychiatrists working in mental hospitals.

Catatonia. Prevalence and importance in the manic phase of manic-depressive illness

Of 123 acutely ill patients with bipolar affective disease, 28% exhibited clinical signs of catatonia. We were unable to differentiate manics with catatonic signs from manics without catatonic signs with regard to demographic characteristics, psychopathology, and the prevalence and pattern of psychiatric illness in their first-degree relatives. Our sample was similar to previously studied groups of manics. Although generally held to be associated with schizophrenia and of poor prognostic import, catatonic signs did not predict a poor treatment response in our manic patients. These data support the growing body of evidence demonstrating that catatonic signs are nonspecific and may be highly prevalent among patients with bipolar affective disease.

Evaluation of the combination of tryptophan and ECT in the treatment of depression. I. Clinical analysis

A double-blind evaluation of the antidepressant efficacy of treatment with a combination of orally administered L-tryptophan (L-TP) and electroconvulsive therapy (ECT) was made in patients suffering from endogenous depression. The patients were randomly assigned to two groups, one treated with L-TP (6 g daily) and unilateral ECT, the other with placebo and unilateral ECT. L-TP treatment was initiated at least 1 day before the first ECT and terminated 4 days after the last ECT. There was a good agreement between the two groups in several measures of antidepressant efficacy: doctors' and patients' ratings of depressive symptoms, and doctors' global rating of therapeutic effect 4 days and 1 month after the last ECT. In the L-TP group, however, there was a significantly better effect on retardation symptoms in the nurses' rating scale. This difference, which is not consistent with other measures of amelioration, contributes, at most, to a marginal therapeutic addition to the antidepressant effect of ECT. It is concluded that oral administration of L-TP, in the dose of 6 g daily, is not of practical value for potentiating the antidepressant efficacy of ECT.

ECT and ethical psychiatry

The author discusses the right to receive ECT and describes voluntary and involuntary patients for whom the treatment seemed both ethical and humane. The right to refuse ECT must be respected in competent patients. However, problems arise when patients' decision-making ability is compromised by their illness. Informed consent questions include how much and what type of information patients should receive and how much those with disordered cognitive functioning can be expected to understand. The author believes that ECT should be fully voluntary whenever possible and that a court-appointed guardian should make such treatment decisions for incompetent patients.

Efficacy of ECT in affective and schizophrenic illness

The author reports on studies of the comparative efficacy of ECT, the newer psychotropic drugs, and combinations of both in the treatment of depression and schizophrenia. He concludes that ECT is indicated for acutely suicidal and other severely impaired depressive patients but not necessarily for schizophrenic patients, although ECT has been successful with some schizophrenic patients for whom drugs were ineffective.

Typhoid catatonia responsive to ECT

Twelve patients with typhoid fever presented with a catatonic syndrome that persisted after other signs of the fever had disappeared. The syndrome was distinct from the delirium seen in typhoid fever and did not have the characteristics of an affective or schizophrenic illness. Electric convulsion therapy produced rapid and lasting improvement.

Capgras' syndrome presenting as postpartum psychosis

A 25-year-old white woman was hospitalized with a postpartum psychosis presenting as an affective disorder with the delusion of Capgras. She was treated with electroconvulsive therapy with resolution of her affective and delusional states.

The efficacy of electroconvulsive therapy and antidepressants in depression

Electroconvulsive therapy (ECT), antidepressants, and neither treatment were compared by reviewing 609 hospitalizations for depression from 1959 to 1969. The groups receiving ECT had a significantly (p less than 0.001) greater percentage of patient who had marked improvement or a complete response (49%) than either adequate or inadequate antidepressant therapy groups (27%) or the group which received neither ECT nor antidepressants (25%). If antidepressant failures who require ECT are included in the evaluation, the percentage total improvement with ECT (90%) is significantly (p less than 0.001) greater than the adequate (74%) or inadequate (60%) antidepressant groups, or neither treatment (60%). At the end of 7 weeks of hospitalization, 74% of the ECT group had been discharged, significantly more (p less than 0.001) than the adequate antidepressant group, 54%. Delusional depressed patients responded much mor frequently to ECT.