http://exhibits.library.stonybrook.edu/mfp/files/original/77b0a9b3dc98f45e3cf5a46362214c3d.pdf 228c0d2302b9d263cf3e7a60fe9df5b7 PDF Text Text ~¢ w Julian an «mmyvflww? rsavrm» ,-——-‘—'7- - K «ww— «rm-«paws-»-mwv-n.-rmwrnwrwwwmnr vw4 v w Eof: ""1me Dear Jack, w: n—u- ”win-VW'.‘ W.Vv—¢A . WW Wu... .— om, y'w -- ww-V ,r ~ "W, , . EXHER M323152~01 AM lo the proposal, ”Malamute of Schizophrenia by E .3" has imartmt and interesting goals, the methods ".7,me wuw— - March 23, 1972 E. Laoky, Phi). Hational Institute of’Mhntal Hoalth Bookv’llle, daryland . . wvw-va, Regressive are inadequate to tho task. Should film Committee wish to encourage such a program, it would lo advisable for the investigators to diamos two isouao with otz‘zoro: tho lrztomlatimzo of modifications of the 363‘ prooeoa to therapeutic outcome, and the; isouaa in quantification of the EEG. In Million, since the min «Issues in regrosoivo EC'T from a public hoalth point of view are the long Mm affects of multiple seen as an aaeault on the central nervouo amt-om, particularly “lama, on masuree of brain Motion and on such oapaoitloa as concentration, mmry, and thought prooooaoa, the evaluation of nouroZOgloal deficits and poyoizologéoal taste focusoad on what is usually called ’organioity’ must be considered. “.I-vv‘wrrnr—y investigators have done an interns ting clinical study in oohiaophranio patients. There is a need for such a ra-evaluatt‘on of regressive 3‘02”, for this modification has a chequered history. Older atudiee fomd it rarely useful. Recent studies of multiple of mgroealve ‘ , am mzwwnmvvvmwmw «A; A-"fiz'sv 362’, The EC?“ under oxygenation control,- kave indt'oatod safe, pmduaing no that multiple ECT are mmry lose, nomlogioal deficits, or EEG changes than slnglo E63". Unfortunately, multiple E02” only occasionally produces better results than Mingle ECT in depressed patients. Tho data for schizophrenic patients is unclear, hmwr; and than now are some reports of better results: with multiple E’CT. Thaw data mantra verthe proposal 2):; Row:- warrmta some ification, and in this assistcmann its present form, it is inadequate to the make outlined by the investigators, and suggostod by my view of the public health issues. more erk, favorable features of the proposal: is adequate, and the setting is probably a good one for such studios. (In our investigations of ECT at Gracie Square and Hillside, was in those small hospitals that the staff were favorably diaposed tp it EST, allowing the investigations to proceed.) The 1) the population 2) The investigators have an interest and some experience in rograsaiva EC’T. �EXNE’HOOIOIIOOIOCOOOOODCOIOOIOOQII 2.0.00.00090000. We}: 33’ 1972 3} 2%3 PI ochibits statistical and doeign sophistication, and his rocord as pcychomotrist is good. Ifio negative fhaturoc of'tho proposal: 1) The aeaign is ECT vs. drug treatmont. This £8 not the most important locus, but were it the doslgn to be followed, there are specific problemc. 2) change Wfiile the evaluation mothodc may be adoquato lndicoc in porconallty and behavior, the issue in gogroacivo ECT of is the impact on lntorporoonal behavior, neurological dcflcltc, thought processes, momory, and cmontraoion. In their first study, they emphasize a porcictonce of’somo of’tho thought disordcr~u but is it difforont and how is changed ? The clinical aspects seem inadbquatcly covered, and the omphaois on a psychiatric interview no less than 30 mdnuteo and no more than 45 minutoo is mochaniotic and loos than helpful. it ovaluction is at thoworong time for any important ghoulfi be evaluated coriatlm (weekly) to assess tho rate and dogroo of’chango in brain function. But wool critical is the likolikood that the patiouts will all rooeivc drugs aflor the treaomont oourso. Yfio druggcontrolc of'nocoocity; the EC? patients most probably. Slfioo no statcmont is modo about the specific drugs, dosages, and relation of EEG measuroa to drug intako, I have to asaumo the investigators are not acutely awaro of'thc impact of'drugs on the EEG. To unravol EEG effocts of ECT from drugs without attention to the controls necessary, is exceedingly dlfflcult. Ifio EEG issue. Porhaps the EEG ffie samo problem in the evaluation and followmup will what {a the impaco of’drugc given after EU? tho EC? on rogroacivo prococc, and on the compariaoo of'ECT and drugo 7 (For thio reason, I would favor rogrosolvo ECT vs single ECT). occur for other indicoc~~ Patient selection is 3) XII-Mr. , an issue. The statement of’procoas doccribad are too nan~spcciflc schizophrenia is inadoquato. tests to help othera define tho population. It were better for the investigators to specify which criteria of’prococc schizophrenia thoy use (3.9. Fish, Eoylor, others ?). Paychological tests are supplementary~~ they cannot be used as the diagnostic critcria. Too criteria on while I'am not ordlnarily prone to question selection ethical groundb, in this instance, the authors should be asked to make clear aomo of'thcir minimum criteria of’prior treatments and failure, recent treatmont and failure, etc. bcfbro rogrcssivo ECT. Should not all pationtc have had a course of”rcgu&ar' ECT and failed ? Poychological teats arc given heavy emphasis, but the more selected in not indicated. Why the MMPI and the SRSC ? Noithcr is aulecicntly speciflc in its interpretation to be very helpful. 4) theoretlc bass from which these touts �EXNEktiiofiioIOODOOOOOCDIOOIOOOCO 3 OUOIOQCOOOOOCO‘IOIOOWh I) There are many problcma with the the ctudy could be done without EEC moaaurcc, EEG 33’ 1972 measures, but cincc I will not go into full datail of’thcinadbquaciac. It to not clcar why the invcctigatorc are measuring E33 affccte, for the only specific suggestion comoc from the dhscriptéon of’lack of’abncrmallty bcfbro and after troatmont, as evaluated by tho neurologists on visual lncpcction. Etc issues that could be investigated are the difycrancca in EEG offhctc of rogroscivc EU? to other EZflk the rate at which the induced changes disappear; the relation of‘changa to improvement, to memory cffhctc, or to other neurological indlccc. They cuggcat quantiftcation cf'thc Efiflg suggesting rocording and analysis for chart epochs. Tfic equipmont they request, rcprccenttng a large part of'thc budget, to adoquatc only for the analog to digital conversion, and some simplc ctcpc of'data reduction. But EEG data it voluminous, coon when reduced, and the interrelations among many chancclc a horrcndouc tack. (Ihdocd, vary for investigators have challenged more than one or 2 channel data, and tf’morc, only for 1 0r 2 minute cpochc). 8 channel Their interest in sleep EEG to unjustified in the protocol. cbcn suggest sleep EEG recording (8 hours), for 8 channels (I), to so voluminous a tack, tkat I cucocct tlcy do not moan this. suggestion about doing visual analytic of'tha sloop records to interacting, but this too to a big task) and will not in thctr for cares, answer any of’tka quattcac. The same problem of'drug control must be considorcd hero. Eb thir I 10 l 4 1h rcwrcadfing thic proposal, I believe the investigator bringo to the questions, posed by his clinical colleagues, and cxpcrlcncc at a clinical psychologist and psychometrtctan. Those aopcctc scam well handled. For ’ccicntlfic' reasons and interacts, they are suggesting EEG analyses, sleep recording, and some fblloa~up studies. It these aspects, they team to lack experience, but alco cuffictcnt judgmont to visualize the tasks and to obtain advice. Earhapt, more they encouraged to visit and work with one of'thc untoercity based centers studying EC? and on: focuccad on quantification of’thc EZEQ these issues might become clearer to them. ware they then still interacted in the studies auggoatcd here, a better propoaal might (?) to fbrtkcomtng. to a clinical better atatamcnt of the population, assessment of'ncurologtcal chhcto, control of'ECT paramctarc and drugc, ctc.~« and a contribution madc to the EC? literature. In the Alternatively, the dcctgn could replication of their pilot study, with some be reduced latter case, the budget could to subjected to rcqorktng; dblcting sleep and statistical consultants ($8300), equipment ($30,300), and E36 chart paper ($600); with additions for neurological evaluation. I trust those comments are helpful. you already know the laboratories interacted in those iccuac, and I am confldont principal that any would be interested in this study. Stnccroly yours, Max Fink, MI D. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence to: Lasky, Julian J. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-05-00-026-1-040 Date A point or period of time associated with an event in the lifecycle of the resource 1971 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource Correspondence -- Correspondence Relation A related resource The Max Fink Collection Description An account of the resource Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. 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