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                  <text>November 26, 1995
Lizzie Sand Stromgren, MD.
Department of Biological Psychiatry
Psychiatric Hospital in aarhus
Skovagervej 2
DK-8240 Risskov, Denmark
Dear Lizzie,
I read your essay on ECT in acute delirium with much interest. I marked up
the text, and made suggestions which I believe will clarify the presentation. I also made
marginal numbered notes which are discussed in the attached memorandum.

There is little question about the efficacy of ECT in severe melancholia,
stupor, or acute manic states. The argument which I believe you wish to present is that in
acutely ill patients with histories of psychiatric or systemic disorders, the appearance of an
acute delirium, with or without fever, with or without rigidity, with or without autonomic
signs, is a possible indication for ECT; and if ECT, the use of en bloc [2-?3 ?4] treatments
may be life-saving. The discussion of unilateral and bilateral ECT and cognitive features is
beside the point. I believe we need a follow-up of the Kramp and Bolwig article as an
invitation to others to entertain the possibility of using ECT in this special type of case.
Thank you for the opportunity to read this report. My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

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