THE EFFECT OF ELECTRIC SHOCK THERAPY UPON CEREBROSPINAL FLUID PRESSURE, PROTEIN AND CELLSJACOBS, JAMES S. L.
doi: 10.1176/appi.ajp.101.1.110pmid: N/A
JAMES S. L. JACOBS M. D. 1 1 The Wisconsin Psychiatric Institute, University of Wisconsin. The cerebrospinal fluid protein and cell content and pressure was obtained before, during and after a series of electric shock treatments performed upon a group of 21 psychotics. In only one case, a diabetic, hypertensive, arteriosclerotic woman, was a significant change noted in protein and cellular constituents. This occurred after the first shock treatment and disappeared within 10 days after 5 subsequent treatments. Occasional elevations of cerebrospinal fluid pressure were noted. These could be correlated with the patients' psychomotor status. It is concluded that the cerebrospinal fluid protein and cell contents should be ascertamed, before and after electric shock treatment, in patients who exhibit significant degrees of arteriosclerotic or hypertensive vascular disease.
CASE REPORTS: ATYPICAL POST-METRAZOL STATUS EPILEPTICUSCUMMINS, J. A.
doi: 10.1176/appi.ajp.101.1.117pmid: N/A
ATYPICAL POST-METRAZOL STATUS EPILEPTICUS J. A. CUMMINS M. D. 1 1 The Ontario Hospital, Hamilton, Ont. A case of atypical status epilepticus is reported in which convulsive spasms were slight and tended selectively to affect muscles associated with respiration with the result that cyanosis was deeper than the degree observed in ordinary status epilepticus. Status epilepticus occurs infrequently, it may be atypical and difficult to recognize. Fatal cases have been reported. On this occasion it was amenable to treatment. Its occurrence bears no relation to the size of the dose of metrazol used. In the cases reported it has followed the first administration of the convulsive agent.
CURRENT TRENDS IN MILITARY NEUROPSYCHIATRYFARRELL, MALCOLM J.; APPEL, JOHN W.
doi: 10.1176/appi.ajp.101.1.12pmid: N/A
MALCOLM J. FARRELL M. C., and JOHN W. APPEL M. C. In pursuing these policies of prevention and treatment, many difficulties remain. Perhaps the most outstanding is the widespread misconception regarding the whole subject of mental health in the mind not only of military personnel but of the civilian public, the family back home, and the public press. It is generally recognized that the concept of physical health covers a wide range of conditions ranging from a light head cold on down to terminal lobar pneumonia. Mental health, on the other hand, has been regarded as being black or white. Either a man was insane or he was completely normal. The possibility has not been considered that there might be anything in between. Actually, of course, mental health just as physical health ranges all the way from bad to good. A man may have minor temporary mental ill health just as he may have a head cold. Mental disorders may be acute or chronic, severe or mild; just as a man may have simultaneously a broken leg and the grippe he may have an acute anxiety neurosis superimposed on a psychopathic personality or an organic condition. A great deal of the confusion has arisen on the basis of terminology and semantics. Any word beginning with the letters "psy," to the average mind, suggests something mysterious and alarming: insanity, perversion, homicidal tendencies. Many laymen become frightened and resentful when a psychiatrist applies a medical term to conditions they were used to recognizing as a "case of the jitters" or "gone stale" or "nervousness." It is difficult for laymen to realize that when a case of the jitters is sufficiently serious to incapacitate a man or produce insomnia and indigestion, a psychiatrist may call it pstchoneurosis and yet not mean anything more serious than was meant by the layman who called it the jitters. Actually, of course, the problem extends further than this. The question arises whether present psychiatric terminology was designed to cover the entire range of mental health. Is it perhaps necessary to devise a new set of diagnostic terms to cover the range of acute transitory psychiatric disturbances which occur in "normal" individuals in reaction to abnormal stress? In conclusion, it may be said that the problems of mental health in this war have presented a major challenge to psychiatrists. To meet this challenge it was necessary to revise concepts and to approach problems with new viewpoints—it was necessary to shift attention from problems of the abnormal mind in normal times to problems of the normal mind in abnormal times.
AGE AND ELECTROENCEPHALOGRAPHIC ABNORMALITY IN NEUROPSYCHIATRIC PATIENTS: A Study of 1593 CasesGREENBLATT, MILTON
doi: 10.1176/appi.ajp.101.1.82pmid: N/A
A Study of 1593 Cases MILTON GREENBLATT M. D. 1 1 The Department of Psychiatry, Harvard Medical School, and the Electroencephalographic Laboratory, Boston Psychopathic Hospital, Boston, Mass. The EGGs of 1,593 neuropsychiatric cases are analyzed and the tracings are classified as "normal" or "abnormal." "Abnormality" is defined as activity with a predominant frequency outside the range of 8 to 12 per second or a tendency to change greatly with overbreathing. This criterion is applied to all records regardless of age or clinical condition. "Abnormal" records are further classified as slow, fast, and mixed slow and fast. The percentage of "abnormal" records found in the various neuropsychiatric conditions varies from 22 per cent in alcoholic psychosis to 54 per cent in senile and artericsclerotic disorders. The order is as follows: alcoholic psychosis, 22 per cent; Schizophrenia, 23 per cent; psychopathic personality and behavior disorders, 31 per cent; manic-depressive depressed, 31 per cent; psychoneurosis, 34 per cent; manic-depressive manic, 42 per cent; psychosis with mental deficiency, 50 per cent; involutional psychosis, 51 per cent; senile and arteriosclerotic psychosis, 54 per cent. A control group primarily between 20 to 30 years of age has 10 per cent abnormal EEGs. Involutional psychosis and manic-depressive depressed conditions are conspicuous because of a large amount of fast activity, whereas senile and arteriosclerotic psychosis, psychosis with mental deficiency, and psychopathic personality and behavior disorder are associated with a large amount of slow activity. The very wide range over which the various neuropsychiatric conditions are distributed makes it necessary to study the incidence of electroencephalographic abnormality as a function of age. When this is done, the relationship between percentage abnormality and age is found to be a hyperbolic curve with greatest abnormality in youth and old age, and least abnormality between 25 and 45 years. The changes of incidence of electroencephalographic abnormality with age are so great that the factor of age cannot be neglected in the evaluation of the EEG. Furthermore, marked variations of more specific types of electroencephalographic abnormality with age are also found. For example, the incidence of slow activity falls rapidly with increasing age, from 20 per cent under 15 years to 5 per cent at age 45 to 55; and beyond this the incidence of slow activity rises. On the other hand, a rapidly rising incidence of abnormal fast activity occurs with increasing age, from 4 per cent under 15 years to 20 per cent at age 45 to 55, with a probable decline beyond 55 years. The electroencephalographic findings in the various neuropsychiatric conditions are largely explained by changes associated with age. This makes it necessary to readjust our previous ideas of normality and abnormality in the classification of EEGs so as to take into full consideration the major changes and trends associated with age. In this regard, the present review of a large and diversified group of cases covering a wide age range will provide preliminary standards of comparison and may be useful as a guide to further study along the same lines.