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Relative Effectiveness of Various Components of Electroconvulsive Therapy: An Experimental Study

Relative Effectiveness of Various Components of Electroconvulsive Therapy: An Experimental Study Abstract Electroconvulsive therapy is a complex treatment which involves at least three factors: (1) introduction of a quantity of electrical current into the brain; (2) rapidly induced loss of consciousness, and (3) motor convulsion. It is the aim of this study to determine experimentally the extent to which each of these components contributes to the therapeutic effectiveness of the over-all treatment. Although ECT is extensively used in the treatment of the mentally ill, it has never been firmly established whether it is the electrical current itself, or the motor convulsion, or the resulting unconsciousness which is the major therapeutic factor of the treatment; or whether the entire treatment complex is necessary. The literature abounds in statistical and case reports comparing various forms of shock treatment, but few controlled studies have been done, especially with regard to the specific aim of this investigation (i. e., to determine the therapeutic efficacy of certain References 1. The bases for selecting patients are described more fully in an earlier publication.3 2. An Electronicraft machine, Model #107, which produces a glissando-type sinusodial current, was used with electrodes applied frontotemporally. 3. In a few instances the existence of spinal pathology necessitated assignment to either a nonshock group or ECT plus succinylcholine. 4. The following tests were administered to each patient: Individual tests: Wechsler Adult Intelligence Scale, Rorschach, Fisher Thematic Apperception Test, Bender-Gestalt, Brentwood Word-Chain Association Test, Hildreth Feelings and Attitudes Scale, Hildreth Psychological Change Scale. Group tests: Shipley-Hartford Scale, Grayson Perceptualization Test, Draw-a-Person, Saxe Sentence Completion Test, Minnesota Multiphasic Personality Inventory (MMPI). 5. A complete list of the various factors studied and times of study appear in an earlier paper.3 6. Diagnosis, Duration of Illness, Types of Illness, Age, Age at Onset, Premorbid Personality, Previous Shock Treatment, Degree of External Stress, Self-Expression, Projective Expression, Cognitive Speed, Motor Speed, Self-Esteem, Exaggerated Guilt, Fear of Shock, Expectation of Shock, Lorr Total Depression Factors, Lorr Total Schizophrenic Factors, Lorr Deviation, General Fearfulness, Degree of Fear—Verbal, Degree of Fear—Nonverbal, Attitude Toward ECT—Verbal, Attitude Toward ECT—Nonverbal, Funkenstein, Total Catecholamines, Serum Calcium. 7. A deviation score was used in preference to the morbidity score utilized in the preliminary report,3 in accordance with recommendations of the author (personal communication). 8. Further data bearing on the important question of what improvement measures are measuring will be presented in another report. 9. Statistical Treatment of Results: The relationship of the different types of treatment to improvement was analyzed by two different statistical methods, the parametric analysis of variance technique and the nonparametric X2-technique. There was no evidence that the assumptions underlying the use of analysis of variance were violated by our data (i. e., none of the tests for homogeneity of variance yielded significant results); but, in view of the nature of the data, it was considered necessary to analyze the data also by the X2-method, which involves no assumptions about the nature of the variable of improvement. This method required that some of the scores be grouped in order to have categories sufficiently large for the technique to be appropriate. In order to avoid any possibility of error through the arbitrary division into categories, the scores were broken down in a number of different ways, and the statistical test applied to each breakdown. The treatment groups were also categorized into shock vs. nonshock groups. 10. To determine correlation, diagnosis was ordered with respect to predominance of depressive component; a positive correlation, therefore, signifies that improvement increases with a greater predominance of depression over schizophrenia. The other correlations between diagnosis and improvement were 0.19 for the consensus method, 0.13 for psychological change, and 0.06 for the Lorr Scale. 11. ECT plus succinylcholine, regular ECT, nitrous oxide, thiopental, ECT plus thiopental. 12. It should be noted that a more liberal criterion for improvement would not have yielded significant differences among the groups; the analyses of variance indicate that the means did not differ. 13. Miller, D. H.; Clancy, J., and Cumming, E.: A Comparison Between Unidirectional Current Nonconvulsive Electrical Stimulation Given with Reiter's Machine, Standard Alternating Current Electroshock (Cerletti Method), and Pentothal in Chronic Schizophrenia , Am. J. Psychiat. 109:617-620, 1953. 14. Fink, M.; Kahn, R. L., and Korin, H.: Experimental Studies of the Mechanism of Electro-Shock Action , abstracts of meeting of Society of Biological Psychiatry, Atlantic City, June 15, 1957. 15. Brill, N. Q., and others: Investigation of the Therapeutic Components and Various Factors Associated with Improvement with Electroconvulsive Treatment: A Preliminary Report , Am. J. Psychiat. 113:997-1008, 1957. 16. Lorr, M.: Multidimensional Scale for Rating Psychiatric Patient , Veterans Admin. Tech. Bull. TB 10-507, 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Neurology & Psychiatry American Medical Association

Relative Effectiveness of Various Components of Electroconvulsive Therapy: An Experimental Study

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References (4)

Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0096-6886
DOI
10.1001/archneurpsyc.1959.02340170093010
Publisher site
See Article on Publisher Site

Abstract

Abstract Electroconvulsive therapy is a complex treatment which involves at least three factors: (1) introduction of a quantity of electrical current into the brain; (2) rapidly induced loss of consciousness, and (3) motor convulsion. It is the aim of this study to determine experimentally the extent to which each of these components contributes to the therapeutic effectiveness of the over-all treatment. Although ECT is extensively used in the treatment of the mentally ill, it has never been firmly established whether it is the electrical current itself, or the motor convulsion, or the resulting unconsciousness which is the major therapeutic factor of the treatment; or whether the entire treatment complex is necessary. The literature abounds in statistical and case reports comparing various forms of shock treatment, but few controlled studies have been done, especially with regard to the specific aim of this investigation (i. e., to determine the therapeutic efficacy of certain References 1. The bases for selecting patients are described more fully in an earlier publication.3 2. An Electronicraft machine, Model #107, which produces a glissando-type sinusodial current, was used with electrodes applied frontotemporally. 3. In a few instances the existence of spinal pathology necessitated assignment to either a nonshock group or ECT plus succinylcholine. 4. The following tests were administered to each patient: Individual tests: Wechsler Adult Intelligence Scale, Rorschach, Fisher Thematic Apperception Test, Bender-Gestalt, Brentwood Word-Chain Association Test, Hildreth Feelings and Attitudes Scale, Hildreth Psychological Change Scale. Group tests: Shipley-Hartford Scale, Grayson Perceptualization Test, Draw-a-Person, Saxe Sentence Completion Test, Minnesota Multiphasic Personality Inventory (MMPI). 5. A complete list of the various factors studied and times of study appear in an earlier paper.3 6. Diagnosis, Duration of Illness, Types of Illness, Age, Age at Onset, Premorbid Personality, Previous Shock Treatment, Degree of External Stress, Self-Expression, Projective Expression, Cognitive Speed, Motor Speed, Self-Esteem, Exaggerated Guilt, Fear of Shock, Expectation of Shock, Lorr Total Depression Factors, Lorr Total Schizophrenic Factors, Lorr Deviation, General Fearfulness, Degree of Fear—Verbal, Degree of Fear—Nonverbal, Attitude Toward ECT—Verbal, Attitude Toward ECT—Nonverbal, Funkenstein, Total Catecholamines, Serum Calcium. 7. A deviation score was used in preference to the morbidity score utilized in the preliminary report,3 in accordance with recommendations of the author (personal communication). 8. Further data bearing on the important question of what improvement measures are measuring will be presented in another report. 9. Statistical Treatment of Results: The relationship of the different types of treatment to improvement was analyzed by two different statistical methods, the parametric analysis of variance technique and the nonparametric X2-technique. There was no evidence that the assumptions underlying the use of analysis of variance were violated by our data (i. e., none of the tests for homogeneity of variance yielded significant results); but, in view of the nature of the data, it was considered necessary to analyze the data also by the X2-method, which involves no assumptions about the nature of the variable of improvement. This method required that some of the scores be grouped in order to have categories sufficiently large for the technique to be appropriate. In order to avoid any possibility of error through the arbitrary division into categories, the scores were broken down in a number of different ways, and the statistical test applied to each breakdown. The treatment groups were also categorized into shock vs. nonshock groups. 10. To determine correlation, diagnosis was ordered with respect to predominance of depressive component; a positive correlation, therefore, signifies that improvement increases with a greater predominance of depression over schizophrenia. The other correlations between diagnosis and improvement were 0.19 for the consensus method, 0.13 for psychological change, and 0.06 for the Lorr Scale. 11. ECT plus succinylcholine, regular ECT, nitrous oxide, thiopental, ECT plus thiopental. 12. It should be noted that a more liberal criterion for improvement would not have yielded significant differences among the groups; the analyses of variance indicate that the means did not differ. 13. Miller, D. H.; Clancy, J., and Cumming, E.: A Comparison Between Unidirectional Current Nonconvulsive Electrical Stimulation Given with Reiter's Machine, Standard Alternating Current Electroshock (Cerletti Method), and Pentothal in Chronic Schizophrenia , Am. J. Psychiat. 109:617-620, 1953. 14. Fink, M.; Kahn, R. L., and Korin, H.: Experimental Studies of the Mechanism of Electro-Shock Action , abstracts of meeting of Society of Biological Psychiatry, Atlantic City, June 15, 1957. 15. Brill, N. Q., and others: Investigation of the Therapeutic Components and Various Factors Associated with Improvement with Electroconvulsive Treatment: A Preliminary Report , Am. J. Psychiat. 113:997-1008, 1957. 16. Lorr, M.: Multidimensional Scale for Rating Psychiatric Patient , Veterans Admin. Tech. Bull. TB 10-507, 1953.

Journal

A.M.A. Archives of Neurology & PsychiatryAmerican Medical Association

Published: May 1, 1959

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