http://exhibits.library.stonybrook.edu/mfp/files/original/0a87bb99a2aa7b6c79a4bb2371383959.pdf 83d1427ac320e290a7950a3f9d950eb2 PDF Text Text , - n :er-tl’wvo—r‘v—y w..77¢ "w u. way v—rxuru-e 'wwwc ,r. Im January 30, 1979 Dr. L.C. Kiloh School of Psychiatry University of New South Wales Little Bay, Australia Dear Dr. Kiloh, Thank you for sending me the review, "ECT:Its Place and Value in Present Day Psychiatry". I found thorough and detailed, and congratulate you on the effort. While I agree with most of what it is included, including the conclusions, there is our understanding of the mode of action. . 7mm, mpg“! , . a, some question about It seems to me that one can deduce much about the efficacy of convulsive therapy from the information in your review—~ notably the importance of the bilateral central seizure, the equivalence of inductions, the need for multiple seizures, the predictors of outcome, the diagnostic classes which respond, and the neurophysiological evidence of the importance of bilateral EEG changes in the adsessment of efficacy. From these -observations, it seems to me that there must be an influence on some centrencephalic structure, an influence which is expressed after a number of seizures, and therefore in the persistent biochemical changes. It has been the influence of the neuroendocrinologists that suggests the next step in the process. The neuroendocrine changes which mark endogenous depression have been defined in part; and in your excellent review of the predictors of ECT, you noted that the vegetative symptoms are the best predictors of ECT outcome. These observations, plus the notes on changes in calcium metabolism and the btood brain barrier have led me (and others, as Jan Otto Ottosson) to define the present view of the mode of action of convulsive therapy in terms of the hypothalamic effects. Surely, in relation to our knowledge of the mode of action of other psychiatric therapies, we are farther along in convulsive therapy, and a ummary of your views is the only omission in your report which I missed. other question of persistent concern is the role of It is not clear from the literature whether such treatments are effective, for whom, and at what rates. Their role should be clarified One maintenance ECT. �”an?” -2in the review. I am acquainted with most of the citations but that of Osselton which you cite as personal communication, 1978. I would be grateful if this report is published, if you will let me know the citation. work on the Task Force and the reviews which you volume which will be published by Raven Press next month. In "Convulsive Therapy: Theory and Practice", I expanded on the theoretic background of the process and (hopefully) cite led My me to expand the reports into a present a cogent theory of mode of action which is quite testable. to Graham Burrows in Vienna, I had hoped it to Australia this year, and I had hoped to visit with you. That seems unfeasible at this time. Should you be coming to the States, let me know and I will be pleased to arrange for you to visit us, to discuss this and other similar issues. Thank you again for sending the preprint. I look forward to its publication. would be When-I spoke possible to come Sincerely yours, Fink, M.D. Professor of Psychiatry Max � 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: Kiloh, L. C. 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