http://exhibits.library.stonybrook.edu/mfp/files/original/a21022c21d8a9291a99f9393891bb859.pdf a57be03c04d724ed5f7030458850d573 PDF Text Text ~“K‘ “-‘mw‘vflrw-‘m'"' mm run: n“ "Km 7 ‘ »- '_—zvs.uv§"""xJorv-«mtl‘H-m-rq rm. haw-v! 7‘ «awn - 1:.er wry-w x:-— v—lwa-rh «no-.W‘ -‘ur',—).In ”p"... , \ ,_, Ht... “Hrs," w”, _ . . 1... __,.,‘V .Y, ‘_ March 33, 1972 Julian It. Laoky, fiational Institute of'obntal Boalth PEAK}. flockville, 234m land Eef: mom M23158~01 Dear Jack, While the propocal, "Treatment of'Schiaophrenia by important and interesting goals, the methods are EU?" has Regressive inadequate to it tile? wish. to encourage such tho invoctigatom to discuss task. Shoula tho Comrlttoo for a program, 'tao loouoo with others: tho lntorrolationo of’modiflcations of‘tfie EC? process to thorapoutlc outcome, and the ioauos in quantifloatlon of the EEG. In addition, since the twin leouoo in rogrosoivo 3326‘? from a publéo health point of'olow are the long torn offocto of‘multlple ooizuroe, coon as an assault on the oontral nervous syctong particularly on matures of brain function and on ouch capacities as concorztmt’lon, momory, and thought processes, the evaluation of‘nourological doflcéts and paychologicol tosto fbouoaod ow what to usually called 'organiolty’ must be conoldored. would be adviecdalo The investigators have done an of'rcgrocoioe EC? in schizophrenic patients. interesting clinical study There to a mood for such a ro~ovaluatlon of’rogroaaivo fill; for thin modification has a chequered rarely useful. Recent otudloa of’multlple history. Oldor studies found Elf; undor omygonatlon control, have indicatod that multiple ECT ans it dofloito, or EEG soft, producing no moro momory loss, neurological ECT only occasionally changes than single ECT. Unfortunately, multiple produces bettor results than single EST in doproeood patients. The data for schizophrenic patients is unclear, holevor; and thorn now are some roports of'bottar results with multiple ECT. Those data require vorifloation, and in this framowork, the proposal by Ewnar warrants some aselstanoo.1h its prooont form, it is inodbquate to the tasks outlined by the investigators, and suggested by my view of the public health ioauoa. 5%: favorable foaturos of the proposal: 1) the population is adequate, and the setting to probably a good one for such studies. (1h our investigations of ECT at Gracia Square and Hillside, was in those small hospitals that tho staff’wore favorably diaposod tp it Elf; allowing tho inventigationa to proceed.) 2) Tfio investigatora have an interact and coma experience in regressive ECT. �.-< . .w-r— "J‘znmp ‘wr w-n-nru-vg-m7r34W.v'ur.vu_I-4—-'m5"|0rat-,JTW ”g:- "mrflR'w-fl -r--vn-:VI' \‘N'I~’>A'Wlmm’w W\Jr‘v4r-'wv-n.wl Jaw. EXNERO'IIOOOOOUOIOOOOOIOIOOOOOOI. EICOIOOIOOOOOODO 3) The PI .. . .n, . ‘n'mgrflwrr :IWBst"-v~l*’!‘-vm March 23’ 1972 sahibits statistical and design sophistication, and his rocord as psychometrist ../.,._~ ~....-_».-r.~n. is good. "7”, The negative features of the proposal: 1) The design is EDT vs. drug treatment. Ihie the design to be followed, issue, but were it is not the most important there are specific problems. While the evaluation methods may be adequate indices of 2) change in personality and behavior, the issue in gegressive ECT is the impact on interpersonal behavior, neurological deficits, thought processes, memory, and concentration. In their first study, they emphasise a persistence of’some of the thought disorder—- but is and how is changed ? The clinical aspects seem inadsquately it different covered, and the emphasis on a psychiatric interview no less than 30 minutes and no more than 45 minutes is mechanistic and less than helpful. it , ihe EEG evaluation is at thewwrong time for any important issue. Perhaps the EEG should be evaluated soriatim (weekly) to assess the rate and degree of change in brain function. But most critical is the likelihood that the patients will all receive drugs after the treatment course. The druggcontrols of‘neeeseity; the EC? patients most probably. Since no statement is Mada about the specific drugs, dosages, and relation of.EEG measures to drug intake, I have to assume the investigators are not acutely aware of the impact of drugs on the 536. To unravel EEG effects of BCT from drugs without attention to the controls necessary, is exceedingly dijyicult. Zhe same problem in the evaluation and followvup will occur for other indicss»~ what is the impact of'drugs given after regressive EC? on the EC? process, and on the comparison of ECT and drugs ? (For this reason, I would favor regressive ECT vs single ECT). 3) Patient selection is an issue. The statement of'proceee schizophrenia is inadequate. The tests described are too non~specific to help others define the population. It were better for the investigators to specify which criteria of'process schizophrenia they use (3.9. Fish, fluylor, others ?). Psychological tests are supplementary~~ they cannot be used as the diagnostic criteria. criteria While I am not ordinarity prone to question selection ethical grounds, in this instance, the authors should be asked to make clear some of their minimum criteria of'prior treatmonts and failure, recent treatmont and failure, etc. before regressive ECT. Should not all patients have had a course of 'regular' ECT and failed ? 4) Psychological tests are given heavy emphasis, but the theoretic base from which these tests more selected is not indicated. Why the MMPI and the SPEC ? Neither is sufficiently specific in its interpretation to be very helpful. on . .wtqwurw,.m—~....nw 7.. �M. ,yv.—..-r-.m.~-«.:. w-vv— "1“sz -qumwa. ‘f‘~w-"'~' ,—)-wl*'..rxw‘ufl-v‘r't‘m‘mw'fran raw-m EXNEROIOOOOIOOOOUDI0.00.00.03.00 3 wuvvmuw-mgw..~-mw '3.“ “y“ we .-4"p~)'I-‘l .47” 'WF‘J"‘V§‘I’\“‘.w,—,‘-.;.~.-.7r nah”. OIOOOOOOOOODOCIIOOOOWI! .» —.- . ~ emu-- PM ....~ 23’ 1972 There are many problems with the EEG measures, but since I) the study could be done without EEG measures, I will not go into full detail of’theinadequacies. It is not clear why the investigators are measuring EEG effects, for the only specific suggestion comes from the description of lack of’abnormality before and after treatment, as evaluated by the neurologists on visual inspection. Ihe issues that could be investigated are the differences in EEG effects of regressive ECT vs other Elflk the rate at which the induced changes disappear; the relation of change to improvement, to memory ef?ects, or to other neurological indicee. They suggest quantification of'the EEG; suggesting recording and analysis for short epochs. The equipment they request, representing a large part of'the budget, is adequate only for the analog to digital convereion, and some simple steps of'data reduction. But EEG data ie voluminous, even when reduced, and the interrelations among many channels a horrendous task. (Indeed, very few investigators have challenged more than one or 2 channel data, and if'more, only for 1 0r 2 minute epoche). 3 channel To is Their interest in sleep EEG is unjustified in the protocol. eben suggest cloep EEG recording (3 hours), for 8 channels (1), so voluminous a tack, tiat I suspect they do not mean this. gheir suggestion about.doing visual analysis of the sleep records is interesting, but thie too it a big tack, and will not in their few cases, answer any of the auctions. She came problem of drug control must be considered here. #- 10 d J! .Ez.reureading this proposal, I believe the investigator brings to the questions, posed by his clinical colleagues, and experience as a clinical psychologist and psychometrician. fhese aspects seem well handled. For 'eeientific' reasons and interests, they are suggesting EEG analyses, sleep recording, and some follow~up studies. In these aspects, they seem to lack experience, but also sufficient judgment to visualize the taske and to obtain advice. Perhaps, were they encouraged to visit and'worh ith one of the university based centers studying ECT and one focussed on quantification of the EEG, these issues might become clearer to them. were they then still interested in the studies suggested here, a better proposal might (?) be forthcoming. Alternatively, the design could be reduced to a clinical replication of their pilot study, with some better statement of'the population, assessment of’neurologioal effects, control of EC? parameters and drugs, etc.—- and a contribution made to the EC? literature. In the latter case, the budget could be subjected to reworking, deleting sleep and statistical consultants ($3800), equipment ($20,500), and EEG chart paper ($600); with additions for neurological evaluation. helpful. Iou already know the I trust those comments are these laboratories in interested issues, and I am confident principal that any would be interested in this study. ’ISincerely yours, Mam Fink, M.D. . u--- . .7 .,.r ,. . _. � 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-05-00-026-1-064 Date A point or period of time associated with an event in the lifecycle of the resource 1972 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. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Correspondence