Biomedical subjects
Publications and source records attributed to Victor Milstein.
A 40-year old man with severe psychosis and unresponsive to pharmacotherapy was treated with ECT despite the presence of Harrington Rods implanted after a suicide attempt. Complete relaxation was obtained with succinylcholine chloride 2.3 mg/kg and he received nine ECT without any musculoskeletal complications, nor did recovery from the treatments appear to be delayed.
Clinical, neuropsychological, and electroencephalogram (EEG) data from 150 ECT-treated patients with affective disorders were analyzed to bear upon current hypotheses about neurophysiological mechanisms of action of electroconvulsive therapy (ECT). Comparisons of responders and nonresponders revealed little or no evidence to support kindling, sensitization, diencephalic stimulation, or anticonvulsant theories. Neuropsychological test data supported right hemispheric dysfunctions in affective illness which resolved more in ECT responders than in nonresponders. There were more impairments in dominant and bilateral hemispheric functions after successful than after unsuccessful ECT. The amount of EEG slowing and paroxysmal activity was not related to therapeutic response. Transient left-sided EEG slowing was associated with positive ECT response whereas right-sided EEG changes were not. The data support the hypothesis that in patients with affective disorders, ECT restores hemispheric equilibrium with enhancement of right brain functions and dampening of the left.
Recent reports have challenged the assumption that unilateral and bilateral electroconvulsive therapy (ECT) are equally effective in all cases. In a prospective study, hospitalized manic patients were randomly assigned to treatment with either lithium or ECT. The first six patients received nondominant unilateral treatment but failed to respond. However, they rapidly remitted when switched to bilateral ECT. Accordingly, the next 11 manic patients to receive ECT were assigned to bilateral treatment. They were compared with the first six patients on weekly ratings of mania and other psychopathology. Both ECT groups improved but therapeutic responses were delayed until after switchover to bilateral treatment in the patients who began with unilateral ECT. We conclude that patients in the manic state should receive bilateral rather than unilateral ECT.
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To examine the issue of whether or not electroconvulsive therapy (ECT) protects against suicidal death, we followed a complete population of 1,494 adult hospitalized psychiatric patients for 5-7 years. During that time there were 76 deaths, of which 16 or 21% were by suicide. Cause of death was not significantly related to age, gender, or research diagnosis. Patients who committed suicide were more apt to have received ECT than those who died from other causes, but this difference was not significant. A control group of living patients matched for age, sex, and diagnosis had very similar exposures to ECT, which further indicates that ECT does not influence long-term survival. These findings combined with a close examination of the literature do not support the commonly held belief that ECT exerts long-range protective effects against suicide.
The authors describe an elderly depressed patient with asthma/emphysema who developed severe postictal bronchospasm immediately after one electroconvulsive treatment. Possible problems and considerations in treating such patients are discussed.
The American Psychiatric Association survey concerning electroconvulsive therapy (ECT) was repeated with Indiana psychiatrists. The results indicated that these psychiatrists currently were more accepting of ECT than the earlier, national sample. However, there was agreement between the responses of the two groups on many of the issues. There were important differences between those who used ECT and those who did not. In Indiana, responders administering ECT were significantly more likely to be board certified than those who did not employ the technique. As expected, the users were, in general, more enthusiastic and favorable in their attitude toward ECT. The present survey suggests that there may be a greater awareness of adverse side effects and that improvements suggested in the literature are being adopted by practitioners.