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                  <text>-.
”n.5,

"mtw—WWWWW'HV“;W

May

Richard Shader,

23, 1977

M.D.

132 Homer Street
Newton Center, Massachusetts

02159

Dear Dick,

I have been using the sedation threshold as a diagnostic
1955, and have not had any complications associated with
this procedure. Recently, I have re—instituted a study program for
another assessment of this test, using the RDC as diagnostic

test since

criteria; in the belief that much of the difficulty with the original
test data was inherent in the lability of diagnosis, and not in the
specificity of the test. To do the present study, my associates

Drs. Martin Heymand Had Timothy Ts'o have prepared and filed a
protocol which has been approved by the appropriate review committees
of the VA Hospital, Northport, and the Long Island Research Institute.
In both protocols, permission has been given to carry out tests in
patients prior to definitive treatment with drugs or EST, and to
repeat the test periodically during the treatment course to assess
the changes in the test with cahnged behavior. Dosages of amobarbital
up to 1.0 gram are given at the rate of 0.5 mg/kg/HO seconds following
the descriptions of Shagass, up to nystagmus, slurred speech and
defined EEG cahnges (higher voltage 20-25 Hz spindling).
In filing for these studies we referred to the extensive
data reported by Shagass (for reference see my summary in Katz, Cole
and Barton: The Role of’Msthodblogy in Classification in Psychiatry
and Psychopathology, PHS publication 1584, 1968; to the volume by
Gordon ClaridgezPersonality and Arousal, Oxford and London, Pergamon
Press, 1967, 274 pp.; and the reports by Mario Perez-Reyes in
Williams, Katz and Shield: Recent Adbanaes in the Psychobiology of
the Depressive Illnesses, DHEW publication 70-9053, 1972. It was
our impression that these reports supported our estimates regarding
the safety of the procedure.

I trust these date are helpful.

Good luck

in your studies.

Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

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