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                  <text>February

1, 1986

Michael Miller, MD.
Apt SE
515 West 110 Street
New York City 10025
Dear Michael,
The enclosed report is quite good. A larger sample, or more observations
per patient would have provided definitive data for the profession. As it is, the
report supports the continued use of atropine for ECT in the patients with clear

evidence of cardiovascular disease.

1. If you wish to have the article considered by CONVULSIVE THERAPY, then the
citation style should be that of Raven Press. A copy of the guidelines to authors is
enclosed. In general, we have found that the citation style we use is best in the
preparation of a manuscript. As you have already discovered, the numeric style is
difficult to alter by addition or subtraction of a citation; and it is difficult to find
citations, especially in articles with long citation lists.

2. Pg 4: Note the discrepancy in your use of 0.8 mg atropine and the stated
recommendation of the APA of 0.1+ mg. Explain or leave the APA guide out.
3. Pg 7: The section on the criteria for cardiac arrhythmia is a bit muddled. If your
article is intended for a psychiatric audience, this paragraph needs clarification.

Pg. 9: Tl-iis section is quite muddled. Read it to a non-physician, and if it can be
clearly understood, then you have hit the right level of complexity.
1+.

5. Pg 10: Same as 4 above.
6. Page

ll:

All of this paragraph can be safely forgotten, as can most of the next.

7. The alternate anticholinergic treatment is glycopyrrolate; there is a literature
for this use, and it should be included in your discussion. See reference list.
Since your findings seem to differ for the two medically identified groups
of patients, cardiovascular disease and none, why not present your data in this
framework? Also, if you can arrive at a recommendation for the usage of atropine,
you should do so, clearly.
Thank you for the opportunity to read this report.
Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

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