http://exhibits.library.stonybrook.edu/mfp/files/original/7ed860259ecdb1b113f44df5fc9807f0.pdf cecfd3218660f32c88675d65129f330c PDF Text Text December 23, 1971 Julian J. Lasky, Ph.D. Executive Secretary Department of Health, Education, & Welfare Health Services & Mental Health Administration National Institute of Mental Health Mr. Fishers Lane Rochville, Maryland 20852 5600 RE: MH18490—03 - Kurland Dear Jack: It was kind of you to give me an Opportunity to see the menswand thus get a follow—up of the progress on this study. There has been much effort eXpended in planning and equipping the EEG analytic al request portions of the study; the promised participation of an electroencephalographer. (Dr. Bohm) is no longer listed in the renewal or the progress report; and 16 patients have had records analyzed on 3 or 4 occasions during the ECT process. The principal focus seems to be on the EEG chang— es induced by ECT and this is reflected in the large supplementary request of $36,000 for specialized EEG equipment. A. Two observations have stimulated these workers. One is the increase in podt—seizure alpha activity is related to a better clin— ical evaluation, and increased theta/delta activity with lesser degrees of improvement. This observation is reported as “contrary“ to that of others. But, the study is not a replication, and many factors that influence the EEG expression are disregarded. l. The EEG is recorded in the ten minutes before the ECT treat— is given, presumably in the treatment room. This is a time when anxiety may be intense and which may alter the EEG. Prior workers did not use this method, probably because of its lack of stability. (Is it ment — �ht. Julian J. Lasky, Ph.D. December 23, 1971 not also likely that many of the patients will have received some anxiolytic therapy before the treatment perhaps not for the psychotic depressives, but surely for those rated as depressive neurotics?) —— 2. any measure of ing the amount In the EEG evaluation, a difference score is used, without The sample size is 10 minutes, and considerbe artefact filled, it would be a surprise if variability. that must the pre~sample, on which the results are highly dependent, is a reliable estimate. (One should expect an awareness of the variablility of the EEG and estimates of variance to be included in the analyses). 3. The post—ECT assessment is at 43 hours. Rflilizing that there is a decay in the amount of slow waves, and that this is most rapid in the early treatments, the authors now suggest estimates continuously during and after the seizure for one hour; and again at 24 hours. Are they implying that this pilot work was wasted? Would it not have been useful to examine a few patients at various times and present this data for a new study? 4. The records were evaluated for normality. By whom? With what standards? One of the main reasons for the emphasis in the 1950's on quantitative measures for EEG evaluation was a difficulty to achieve agreement as to normality and abnormality among sophisticated EEG'ers. The authors have more than adequate equipment to provide preetreatmeut estimates of the amount of various frequencies, the amount of variability in amplitudes, egg, « and to use statistical techniques to allow for the relationship between these measures and change with ECT or with clinical evaluations. But they eschew these techniques for an earlier technique, which I would consider less reliable. B. The second focus is the isoelectric period after the sei— zure. This important observation follows the reports of Paul Blachly. The observation here is contrary to those reported by Blachly, and inde— pendently observed by my associates. Could it be that some of the isoelectricity that is measured is an artefact of the blockade of the amplifiers? This possibility is not mentioned. If the observation is valid, what possible explanations do they have, and how do they propose to ex- amine it further? Perhaps the biggest disappointment is in the behavioral In any correlation, the highly sophisticated analyses of one variable (EEG) ought to be matched by equally detailed and time~re~ lated behavioral measures. C. observations. 1. There is one clinical psychiatrist assigned to the project, so his observations must stand alone. He uses standard, gross measures of behavior and the results are couched in the grossest estimate of 'im~ provement'. Improvement in what? Mood? Affect? Sleep? What of the contamination of memory loss to the overall assessment? �Hr. Julian J. Lasky, condition, few. December 23, 1971 Ph.D. The authors use a fixed number of treatments. Under this some patients may receive too many treatments and some too 2, It is probable that psychotic depressives, the older patients, will reapond to the extra treatments with memory loss. Hence, they hay be evaluated poorly if memory is an integral part of the improvement evaluation. These patients may also show more slowing, for this correlation increased EEG slowing and decay in memory function is well established. ~ 3. Using their ratings for behavior, and assigning a value of 2—3 eps from the graphs, we find the following: amount to the Rating LE; 1 7 23 l2 4 5 2 3 Mean "delta" 5.7 2.0 3.0 7.5 7.4 I do not find their tentative conclusion, that delta increase is associated with lack of improvement to be well grounded. of the Also, the behavioral measures are presented without making use today. statistical techniques available is disappointing. xot uecause the authors have presented little data, for they have made a good effort to get started on an interesting problem. They have fulfilled some of the goals prom~ ised. But, the report shows a lacs of involvement by clinical psychie This review trists with sophistication and hnowledge of the issue involved. The rem newal focuses on gadgets ~ $36,000 of equipment for engineers, and no funds for the researcners. Replacing some of the clinical funds and reducing the equipment would do little to improve the project, for it is clear that the important investigators are beipcl and brown. If one had much money, perhaps the $16,000 for each of 2 years may serve to keep the project going at its present level. The electroencephalographic portions are also weak, and this may reflect the lace of someone with per~ sonal experience or involvement with this instrument (the promised ap~ pointment of a neurologistnelectroencephagrapher did not materialize). I regret that I cation. In my am less than enthusiastic about this appli~ was optimistic that the problem may ex- earlier review, I cite the staff to a productive involvement ~ but this has not occurred, and I am not sanguine that another two years would add much. Sincerely yours, Max Fink, M.D. Professor of Psychiatry MF:ig � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. 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