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HILLSIDE HOSPITAL
FOR PSYCHIATRIC TREATMENT. TRAINING AND RESEARCH
75-59 263RD
GLEN OAKS. N. Y.
STREET
FIELDSTONE
3-7300
JOSEPH S. A. MILLER. M. D.
MAURICE BACHRACH
MEDICAL DIRECTOR
ADMINISTRATOR
SIMON KWALWASSER. M. D.
Assoc.
June 27’ 1955
MEDICAL DIR.
Dear Dr. Fink:
This
is to
I
sure that there
acknowledge,
with thanks, the receipt of $100
for the Research Fund, from
yourself and your Associates,
Hyman Karin and Simon Kwalwasser.
no need
am
for us to
tell
you
is
of the
importance of our research program.
The Directors are appreciative of
the sentiment underlying your gift
of this $100. to Hillside Hospital.
Very
sincerely yours
Maurice Bachrach
MBzhm
cc: Dr. Kwalwasser
Dr. Miller
Mr. Korin
AN AFFILIATE OF FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK
�June 30, 1955
Somatic Therapy'fbsearch Program 1955-57
From the Research
Service of the Hillside Hospital
mode
of
action
the
to
investigate
A. AIMS: It is the purpose of this study
We
do
by
this
to
plan
mental
illness.
of somatic therapies in
and
personality
behavioral
of
physiological,
the systematic investigation
factors which
B.
may
be involved.
mechanism
conc‘eming
the
therapeutic
Although many theories
BACKGROUND:
been
have
they
advanced,
been
have
of the somatic therapies
cannot
validity
their
that
either empirically disproved, or, are so vague
be
and
hypothesis,
meaningful
more
of
a
development
the
More
recently,
tested.
new methods of study have provided the opportunity
ion. In l952,'fleinstein
and Kahn (Amer.
for a fruitful investigat-
Journal Psychiatry l923 22-26) sug-
of
milieu
a
creating
by
improvement
to
gested that the somatic therapies lead
Some
could
of
denial
operate.
anisms
mec
in.which
function
brain
altered
support for this
hypothesis has been found in the
literature. Carter
(Am.
earlier work of Janis,
unpleasant life memories after
the
of
some
confirmed
1953)
has
§5
330,
Psychologist
of
selective
forgetting
there
is
showing that
electroshock.
non—emotional
and
emotional
of
Using tachistoscopic presentation
demonstrated
1953)
hhS,
§5
(Am.
Psychologist
words, Teicher
that
of repression" to emotional stimuli occur in the post-shock
state.
For the past year and a half preliminary studies
"mechanisms
investigating this
done
been
have
hypothesis
at these laboratories at Hillside Hospital.
results to date
striking.
have been
patients were followed.with serial
taneous
tactile
Twenty—four
The
consecutive electroshock
electroencephalograms and amytal, simul-
perceptual and memory
tests.
A
marked
correlation between
�.02.
improvement and
early, persistent
alogram, and in the amytal
tests
was observed.
appear, improvement did not occur.
sistent
and severe changes on the electroenceph-
It is
If
such changes did not
our conclusion that early and per-
sufficient, prepossible to predict
changes in these indices are a necessary, though not
make
These
observations
improvement.
for
it
requisite
the short term response to therapy during the second and third
week of
treat-
ment.
A
report
on
the amytal test results was presented at the recent meet-
ing of the American Psychiatric Association (May 1955) and submitted fer public-
Electroshock
the
At
of
of
meeting
American
Journal
a
Psychiatry.
the
to
ation
Research Association on
May
8th, a report of the changes in
memory and
learn-
This
was
treatment
presented.
electroshock
of
the
course
ing occurring during
he
Award
citation
Association.
the
of
Annual
Prize
awarded
the
was
report
noted the methodology as exemplary, and offering a
fruitful
method of study-
ing electroshock.
Concomitant with these
studies,t7e
have followed
patients
on
insulin
therapy. Recent reports onthe value of prolonged coma as the basis for
improvement (Kwalwasser and Caplan: J. Hillside Hospital l; 1&5, 1952; Revitch,
coma
E.
:
Neurol.
Arch
A.M.A.
Rowsell:
and
195h;
shagass
72,
Quart.
fig;
Psychiat.
and Psychiat. 225 705, l95h; and Yeager
195h)
In one
gt 3;; J.
Nerv.
&
Ment. Dis. llgg h35,
2
the
over
studies
past
in
years.
in our patients
unusual case report the direct relationship between altered brain fun-
have been confirmed
(Delusional
demonstrated
Reduplication
been
has
and
improvement
denial
ction,
of Parts of the Body After Insulin Coma Therapy, J. Hillside Hospital, 1955,
in press).
C.
METHOD:
1.
we
plan to verify and amplify our preliminary observations on
the relation of changes in behavior to altered brain function after
somatic treatment.
�-3”
E.A. and Kahn,
sease,
Am.
electroshock will be given amytal tests (heinstein,
DiBrain
Sodium
In
Organic
Use
Amobarbital
of
Diagnostic
Patients
(a)
3.:
on
J. Psychiatlggf
Test" for Brain Disease:
889—89h, 1953;
Its
Serial Administration of the
"Amytal
Arch
A.M.A.
Value,
and
Prognostic
Diagnostic
and
before
and
electroencephalograms
l95h)
Neurol. and Psychiat. 1;; 217-226,
treatment.
make
be
a
used
to
This
will
data
preat stated intervals during
diction of the short term response to treatment.
(b)
Double simultaneous
tactile perceptual tests will
using threshold electrical stimulation.
be
carried out
Using two Grass Sh-B stimulators,
to
be
his
for
tested
ability
the
will
patient
monitored by an oscillograph,
of
his
body.
different
parts
to
simultaneously
two
stimuli
applied
perceive
shown
to
been
previously
has
stimulation
simultaneous
double
of
technique
hé-SB,
g}
Neurology,
(Fink
function
3},
be a good index of altered brain
at
The
January, 1952).
By
applying this highly refined technique
it is hoped that
elicited.
be
will
patients
tests,
changes in brain function which are not otherwise apparent
will
be
and
amytal
of
electroencephalognmn
the
case
in
tested before and at stated intervals during treatment.
As
2.
Other Physiological procedures will be carried out in con-
junction with the tests above.
(a) Each patient will be given the mecholyl-epinephrine
cribed by Funkenstein and associates
The
results will
(J. Nerv.
(b)
sulin
coma
as des-
Ment. Dis. Egg: h09, Nov. 19h8).
be compared with the work of previous
as with the results of our other physiological
test
investigators as well
tests.
and
electroshock
of
undergoing
Biochemical testing
patients
treatment have been in progress for
some time
in-
in these laboratories.
In this series of patients, estimates of urinary ketosteroid excretionxates
Simultaneously
esexcretion
rate.
be
post-treatment
to
compared
their
will
timates of steroid sulphates; phosphatase; and blood levels of steroid sulphate,
�«hphosphorus, phosphatase and
total alkaloid will
be done.
of
many
that
investigation
3. It has been evident in our preliminary
months.
within
six
treatment
somatic
relapse
the patients tm.t improve after
imp
of
duration
the
to
involved
in
regard
The critical problem of the factors
provement
is also to
be
studied.
One
hypothesis
now
under investigation
is
related to the premorbid personality.
denial"
verbal
of
the
"explicit
characteristics
the
with
patients
Specifically,
Denial
Factors
in
Personality
R.L.:
and
Kahn,
personality (Mainstein, E.A.
that sustained improvement
may be
1953)
March,
1-13,
fig:
Psychiat.
Illness, A.H.A. Arch. Neurol.
more likely to maintain improvement, than patients
&
of
who do
will
be
not have this pre-
morbid personality makeup.
(a)
two
with
interviews
by
personality
of
premorbid
the
Evaluation
close relatives will
airre will
be used to
be made
elicit
dictive value such as need to
for each patient.
A
standardized question-
characterological factors, which
be
at least
may
have
pre-
right, prestige-consciousness, sensitivity
toczfiticismand compulsive drive.
words:
and
of
pictures
(b) Tachistoscopic presentation
The
threshold
material
be
compared.with
will
illness
to
related
levels of subject matter
characterological
for
be
evaluated
data
This
will
of more indifferent nature.
assessed
be
as
quantwill
in
response
alterations
In
addition,
indications.
itative indices of denial.
(c)
and
be
Rorschach
given
will
and
the
Test
The Thematic Appereeption
evaluated for the
same
factors as the personality interviews.
to
of
response
predictions
material,
the
of
personality
(d)
the basis
of
treatment
the
to
start
Prior
made
at different periods..
treatment will be
1)
those
unthree
to
possibilities:
according
be
classified
patients will
On
and
temporarily;
moderately
or
to
improve
2)
those
likely
to
improve;
likely
3) those
improvement
and
sustained
marked
maintain
to
likely
(for at least
6
�.5.
Prediction will also be
months).
made
during the course of treatment (the
third weekfbr the electroshock patients) taking into account the physiological
At
the
of
factors.
the
premorbid
personality
well
analysis
indices as
as
conclusion of treatment patients will be evaluated for actual immediate response to the treatment. Those
who showed some improvement
ified again according to whether or not improvement will
will then
be
be
class-
sustained.
h. Evaluation of the change in behavior of patients undergoing treatment
will
Such
ratings will be
be made on the
basis of a modification of the
made
independently of
all
Malamud
the other
rating scales.
test results
by a
supervising psychiatrist.
D.
FACILITIES AVAILABLE:
l.
Hillside Hospital is a
200 bed
voluntary hospital
for psychiatric care. All patients subjected to phy—
siological therapies are available for study. Periods of hospitalization.are
2-8 months; and a h-6 week observation period is generally available prior to
the
institution
A
of physical therapy.
Research Service has been established, with a
full
time professional
staff of a Director (neuropsychiatrist); assistant in psychiatry; biochemist
EEG
and
technician
(Ph.D.)
research
and assistant chemist;
neurophysiologist
and secretary. A full time psychologist and two chemists are associated on a
project basis.
Laboratory
a Medcraft D-8,
two
S—hB
8
facilities include:
(a) Electroencephalographic unit with
channel instrument; (b) Neurophysiological laboratory with
Grass stimulators,
Du Mont
# 3&0
R
oscillograph; two synchronized tach-
Biochemical
(0)
laband
equipment;
electronic
auxiliary
projectors
istoscopic
the
followwith
and
of
equipped
1000
with
feet
laboratory
space
square
oratory
ing major items:
Beckman
spectrophotometer,'Warburg respirator, Coleman Spect-
rophotometer, and radioisotope unit following the basic specifications of the
A.E.C.
�2. Personnel:
(a) Dr.
Max
Fink, M.D., Director of Research: After undergrad-
uate studies at the University College of
his
D-A.
New
York University where he received
cunllaude with Honors in Biology in l9h2, he attended the
New
York
University College of Medicine, graduating in 19h5. After a rotating interneship he served in the
U.SL Army, where he
attended the School of Military
Neuropsychiatry.
training
Formal neurologic
York
(19h8-l9h9) and
was
received at Montefiore Hospital in
at Bellevue Hospital
(
l9h9-1951). Formal psychiatric
training received at Bellevue Psychiatric HOSpital (6
Hillside Hospital (1952).
and
During 1951,
again
in 1953,
New
at
months 1950) and then
he was a research fellow of the Nat-
ional Foundation for Infantile Paralysis,
first at
of Medicine and then at Mount Sinai Hospital in
New
New
York University College
York.
Both periods of
study were under the supervision of Dr. Iorris B. Bender.
In 1952 he was certified in Neurology by the Amer. Board of Psychiatry
and Neurology, and was granted complementary
May
certification in Psychiatry in
l95h. Simultaneously he attended and.gsunnfindfrom the William Alanson
Institute of Psychoanalysis, Psychiatry
Certificate for Physicians in January 1953.
White
and Psychology, receiving
(b) Dr. Jeseph Jeffe, M.D., Assistant in Psychiatry:
undergraduate studies
at
their
Following
Columbia College (B.A., l9hh), Dr. Jaffe attended the
New
York University College of Medicine, and was granted
was
elected to Alpha
Omega
Alpha.
He was
an interne
his
M.D.
in 19h7.
He
at the Morrisania City
Hospital, and then began three years intensive study at the Bellevue Psychiatric
Hospital. First as a resident in psychiatry, theniizneurology, and he
com»
pleted his studies as a U.S.P.H.3. post-doctoral research fellow under the
supervision of Dr. Morris B. Bender.
�~7—
From 1951
to
1953 he was
in the United States Air Force.
He
graduated from
the School of Aviation Medicine and was Chief Psychiatrist at the Mitchell
Air Force Base Hospital.
Since discharge from the military service he has been in the private
practice of psychiatry.
He
was
certified in psychiatry
by the American Board
of Psychiatry and Neurology in 1953. Since 19h? he has been a candidate in
White
Psyof
Psychoanalysis,
Alanson
Institute
William
the
at
psychoanalysis
in
Research
Assistant
two
and
the
and
for
past
years
Peychology;
chiatry
Neurology at the Mount Sinai Hospital of
(0)
New
York.
Dr. Robert L. Kahn, Fh.D.: Assistant in Neurophysiology:
After graduation from Brooklyn College
Columbia University which was
United States Army.
in l9h0, he started graduate
interrupted
by
work
at
four years of service in the
In the army he went to Clinical Psychology School and
served as psychologist in various hOSpitals within this country and overseas.
On leaving the army he became a Research Psychologist in the Department of
Neurology of the Mount Sinai Hospital in
the supervision of Dr.
time.
To
date,
M. B.
New
York, where he has worked under
Bender and Dr. E. A. Weinstein up to the present
he has been an author of more than twenty
co-author of the monograph.
"Denial of Illness:
ASpects" which was published
in
Symbolic and Physiological
May, 1955.
received his Ph. D. from the
He
publications, and is
New
York University School of Graduate
Arts and Sciences in 1953, and was an instructor of psychology
and Hunter Colleges
sultant to the
New
for
York
at
Brooklyn
For the past two years he has been a con-
years.
State Department of Mental Hygiene and has conducted
two
training programs in several of thé mental hospitals.
(d)
Chemist:
A
Dr. Harry Goldenberg, Ph.D.: Director of Laboratories and Chief
Trethe
of
he
where
was
a
C.C.N.Y.
l9hh,
of
recipient
in
graduate
maine Scholarship and graduated cum laude, Dr. Goldenberg received
his Ph.D. in
�~8l9h9 from the Polytechnic Institute of Brooklyn.
(who-ll?)
Institute
the
Polytechnic
at
biochemistry
He
(1951 to date).' In l9h7-h9
National Institute
U.S.P.H.S. project
he was a Research Fellow
an
been
has
and
in
instructor in
at Brooklyn College
enzymology of the
of Health, and from 1950 to 1952 he was a chemist to a
at
Jewish Hospital of Broeklyn studying enzyme methods in
clinical chemistry.
(e)
Mr. Hyman Korin, Research
Assistant (Psychology): Following four
College of the City of
military service, he matriculated at
and received his B.S. in 19h? and his M.S. in 1950. During
years of
New
York
1951-52 he was
Ph.D.
his
for
and
matriculated
Sinai
Hospital
psychology interns at the
in
Research
Assistant
been
1953
has
he
June
Since
New
York
University.
at
thesis
doctoral
his
completed
and
has
recently
Psychology at Hillside Hospital
Mount
on "The
Effects of Electroshock on Retroactive Inhibaticn."
3. Publications:
Recent publications of the Research Service include:
The Amytal
Test in Patients with Mental Illness,
1955.
3-13,
ii:
Hospital,
Hillside
J.
Electroshock,
in
Improvement
and
to
Memory
Learning
of
in
Changes
Relation
press).
Conf. Neurologica, 1955 (In
Delusional reduplication of Parts of the Body After Insulin
J. Hillside Hospital,
1955
(
Therapy,
In press).
Relation Between Altered Brain Function and Denial
Amer.
Coma
in Electroshock Therapy,
J. Psychiatry (submitted).
Rectification of Nonlinear Beer's
Law
Plots, Anal.
Chem.
gé: 690, l9Sh.
Bioand
Biochem.
Arch
Curves,
Enzyme
Non-Linear
Activity
Rectification on
phys., fig;
288, l95h.
�July 1, 1955
BUDGET
l.
-.
RESEARCH SERVICE,
PERSOM'EL
1955-56
EFF—ES.
Director of Research
15,000
-
BD OF DIRECTORS
15,000
in Psychiatry
7,200
Research Assistant in Neurophys.
7,500
Chief Chemist
8,200
Assistant Chemist
2,800
Research Assistant in Psychology
h,000
h,000
-
Assistant Chemist
h,000
h,000
~
Assistant Chemist
1,800
1,800
-
2,520
960
150
150
3,810
2,1uo
1,670
1,000
200
800
$ 57,980
$20,750
$37,230
Research Assistant
Secretary -
EEG
Technician
2.
EQUIPMENT
3.
CONSUMABLE
)4.
TMWBL-CONFERENCES
TOTAL
SUPPLIES
7,200
7,500
-
8,200
2,800
1,560
��your grant for the biochemm and neuroplvsiologiul
approved. A mpplamuzy grunt request fer $7992.00
apprum!
by the Public Health Serum for the 24—927 pmaeem This may will amt thsalary or Dr. R. him.
6.
grants were
A.
,
3
The ascend
In sdditionk protoccla were submitted thmgh Hr.
medatim.
m
Calm ta
the Hofheimr
�Department of Biochemistry
.................................
RESEARCH PROGRESS REPORT, JULY-AUGUST
A. Major work
Dr. H. Goldenberg
1955
in Progress
1. Determination of Chlorpromazine in Blood and Urine
procedure for the colorimetric estimation of chlorpromazine and related
alkaloids, described in the June 1955 progress report, has been further refined
to permit detection of the extremely small amounts of drug circulating in blood.
The method is based on two new features: (1) The finding that drugs can be
quantitatively extracted from biological fluids with a single portion of an
ethylene dichloride-ether solvent mixture, and (2) The use of a three—phase solvent
dye partition system of analysis.
The
Clinical data are also being obtained on bound as well as free circulating
promazine, based on the use of hot acid to liberate the conjugated drug.
2. Inhibition of Cholinesterase by Hallucinogens
These studies are being continued as indicated
in the prior report.
3. Steroid Sulfate Conjugates
All but one of the major problems involved in the assay of steroid sulfate
metabolism.in mental disease have now been solved. A novel device has been
introduced for eliminating the interference with our test due to phenol sulfates
in blood and urine. A two-phase system incorporating dicyclohexylamine (DCHA) as
a complexing agent effectively separates the steroid from the phenol sulfates,
permitting their unequivocal determination. The procedure for serum is now as
follows:
is treated with alkali to release the hormone conjugates.
b. A lipid solvent is added to precipitate the proteins and simultaneously
extract the hormones.
DCHA
The
and
between
to
brought
is
dryness
supernate
partitioned
c.
lipid
a.
Serum
and chloroform.
free steroid sulfates are released by shaking the chloroform extracts
with acidic resin.
e. Final assay of the sulfate conjugates is effected by adding dye and reading
the color.
d.
The
considerable amount of clinical data have already been obtained on normal
people and on patients selected for independent studies by the Sloan-Kettering
Institute. An immediate correlation has been established in our laboratory
between urinary conjugate levels and sex, males excreting about twice as much
conjugate as females. This ties in well with what is known of steroid metabolism
A
�and tends to confirm the
validity of the method.
Attention is now being devoted to fractionation of the steroid hormones in
conjugate form. Paper electrophoresis has proven inadequate for the purpose.
Paper chromatography is more successful and is under continuing study.
B. Papers, Lectures and Conferences
following papers are in preparation: (1) "Colorimetric Determination of
Alkaloids, with Particular Reference to Chlorpromazine", and (2) "Steroid Sulfate
Conjugates. II. Colorimetric Microestimation".
The
C. Funds and Personnel Changes
1. Research Grant #A-675 from the National Institutes of Health
the fiscal period Sept. 1955 - Aug. 1956.
2. Messrs. Michael Miller and Spencer Parness terminated
in the laboratory at the end of August.
cc. to: Dr. Fink
Dr. Miller
their
was renewed
for
summer employment
�Department of Biochemistry
.................................
RESEARCH PROGRESS REPORTI SEPTEMBER
-
A. Major werk
Dr. H. Goldenberg
12§§
in Progress
1. Determination of Chlorpromazine in Biological Fluids
As a result of repeated analyses of blood drawn from patients receiving
chlorpromazine, the circulating blood level has been established as less than
1 microgram per ml. serum. The three-phase solvent dye partition scheme of
analysis mentioned in the previous report has therefore been adopted as the only
method capable of detecting the extremely minute amounts of drug in peripheral
blood. A new shaking machine has just been obtained from the A.H. Thomas 60.,
Philadelphia, to permit application of the method on a broad scale.
question naturally arises as to the metabolic fate of chlorpromazine
in humans. We have recently detected in patients! urine an ether-soluble carboxylic acid which reacts with ferric chloride and appears to be an oxidative
byhproduct of chlorpromazine metabolism.
The
2. Inhibition of Cholinesterase by Hallucinogens
three-phase system mentioned above has been found applicable to the
analysis of LSD 25 as well as chlorpromazine and serpasil. By combining this
observation with the earlier discovery of the inhibitory effect of LSD 25 on
human serum cholinesterase, it is now possible to relate the enzyme inhibitory
action to the alkaloid concentration in "unknown" samples of fluid and so deter—
mine the specific molar inhibitory action at the 0.1 microgram level. This
amounts, in effectI to the first sensitive chemical test ever reported for the
detection of LSD 25 and related hallucinogens.
The
3. Steroid Sulfate Conjugates
work progressing
cc. to: Dr.
essentially as described in JulyhAugust report.
Fink
Dr. Joe. S.A. Miller
M.
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October 20, 1955
MEMORAEDUM
TO:
Dr. Joseph S. A. Miller
mom: Max Fink, 14.1).
SUBJECT:
Six Months Report of Research Activities at Hillside Hospital
At the request of the Chairman of the Medical Affairs Committee,
I am submitting this six month report of the activities of the Research
Service and associated research activities at the hospital. During this
period, numerous projects have been under investigation, our staff has expanded, and our space requirements were met. Two projects are being completed, and one project has just been instituted.
A.
PROGRESS
l.
hmw2:
In
ONGOIfiG PROJECTS:
ELECT§9§§QQK #
Our second electroshock project was undertaken in March
project had clearly demon-
in September. Our first
strated that cerebral changes were essential to improvement and that these
1955, and completed
could be measured by the electroencephalogram and by amytal tests. 'Ue
also concluded that memory tests were a poor index of improvement and believed that there were specific psychological patterns indicative of denial
which were more prominent in the improved group than in the unimproved.
Following this study, the second project was undertaken and was designed
to demonstrate the reliability of the electroencephalogram and the amytal
tests for prognostic purposes; and to ascertain the characterological as‘fle
term
be
term
the
short
which
and
in
results.
long
factors
might
pects
have studied.twenty-seven patients to date. The data of this project is
now being processed, and will be available following our six month follow
up
period, (which is from November to January).
data from the first study was pres nted at various meetings,
including the American Psychiatric Association, the Electroshock Research
Association, and the Eastern Association of Electroencephalographers. The
memory data, presented by Mr. Korin at the Electroshocx Research Association
The
in
May, was awarded
The
their
annual prize.
electroshock project #
3
is
below), and will be instituted November 15.
now
in the planning stage (see
This project, which has been undertaken with Dr. Sidney Tarachow of
the Medical Board, has accomplished a considerable amount of its basic work.
Three approaches to the problem of measuring ambivalence have been accepted.
These include an interview evaluation; the thematic apperception test, and
tachistoscopic presentation of pictures. During this period of evaluating
methods, twenty-three patients have been studied. Dr. Tarachow has been
attending to this work, and the testing has been undertaken by dr. Korin.
2.
AMBIVALcNCE:
‘
�~2-
Serpasil evaluation study, undertaken at the end of last year, is com~
double
blind
a
by
been
have
studied
intensively
Seventeen
patients
pleted.
Blumberg
Drs.
andeachspress.
evaluated
by
The
now
data
being
is
technique.
To date, the clinical results are disappointing. Patients who were depressed,
who
were over-active
Patients
symptom.
of
this
manifested an efiag ration
disturbed/EnogIIeviation
of this activity but the psychotic ideation genand
of
secondary
induced
a
The
variety
intramuscular
dosages
erally persisted.
complaints. In the evaluation of'the mecholyl responses following serpasil,
The
blood
in
pressure response
all
subjects.
effect
consistent
was
a
there
of
this
presentation
considering
Dr.
and
Blumberg
is
lower
was significantly
data at the next meeting of the American Psychosomatic Society.
3.
SQRPASLL:
The
}
Preliminary studies by Dr. Laderman in
20 patients in a series of clinical
not
was
but
significant
this
alterations
and
behavioral
showed
symptom
studies
of
Shaw
evaluation
undertook
an
Dr.
In
mid-September,
in the doses used.
A
protocol
coma
therapy.
Thorazine as a possible substitute for insulin
French
and
Kline
submitted
Smith,
to
was
The
Research
Committee,
approved by
and approved, assuring us of adequate supplies for the duration of our proof
8,to
a
medication
for
period
receive
will
In
this
study,
patients
ject.
12 weeks, comparable to the insulin coma period. During this time, very
have
been
To
be
used.
patients
eight
date,
will
thorazine
of
doses
large
The
obser3600
1500
initial
from
to
The
daily.
mg.
dosages range
studied.
three
had
clinical
response;
a
show
significant
three
the
patients
vations
h.
THORAZINE:
and
one
symptoms,
toxic
developed
one
minimal
had
patient
changes;
patients
medthe
of
Cohen
and
Blumberg
Drs.
medication.
the
patient has just begun
our
using
to
permit
controls
the
have
contributed
necessary
ical department
such large doses of this potent drug.
Since June, Drs. Goldenberg
and Royce have been coopof
a
in
study
Sloan—Kettering
Institute
the
chemists
the
at
with
erating
the possible alteration in the keto-steroid excretion patterns in our patSince
June.
Committee
Research
in
by
our
This
was
approved
study
ients.
then five patients have been under investigation. The initial data is not
in
Dr.
Goldenberg
by
studied
Each
of
being
the
is
patients
available.
yet
his laboratory as well as by the chemists at the Institute.
5.
SLOAN KETTERIDG STUDY:
Dr. Goldenberg has been
occupied in studies measurand
acid
of
devising
the
effects
lysergic
estimating
ing chlorpromazine,
methods to measure steroid sulphate conjugates. This basic research is
to
which
to
we
apply
measurement
plan
of
methods
the
to
provide
necessary
our patients.
(a) Chlorpromazine: An ultra~sensitive technics has been
of
amounts
this drug.
microgram)
minute
(0.1
which
measure
can
developed
Golden—
Dr.
Thorazine,
of
number
By applying this to a
patients receiving
bloodstream.
the
amounts
in
small
appear
demonstrated
only
that
has
very
berg
LSD
has been
by
cholinesterase
The
LSD:
of
serum
(b)
inhibition
A
compounds.
demonstrated, and this test applied to other hallucinogenic
correlation between hallucinogenic activity and cholestestcrase inhibition
was found.
6.
BIOCHEMICAL RESEARCH:
�*3“
a
(c) Steroid Sulphate Conjugates: ‘Nith the grant support from the
USIHS, methods to estimate these compounds have been devised. By studying
hormone
demonstrated
sulphates are synthat
Dr.
Goldenberg
liver slices,
of
the
level
in
difference
and
a
there
sex
is
that
the
thesized by
liver,
steroid excretion. Both these observations are of fundamental significance,
and will be presented to various societies this winter.
In the Department of Medicine, hrs.
Cohen and Blumberg have continued
Durand
the
electroshock
of
the
patients.
serpasil
studies
their Mocholyl
and
than
more
been
have
studied
to
additional
an
patients
this
period
ing
half have had more than one such evaluation. The serpasil group demonstrated
a significant alteration in their blood pressure patterns following this
done
be
and
been
will
has
The
correlated
not
data
electroshock
yet
drug.
as soon .8 our electroshock # 2 data is available.
7.
MECHOLYL:
Following the approval of this project
by the Research Committee last spring,
Drs. Navarre and Graubert had a number of meetings with members of the
Medical Board. Following these discussions, they have begun a pilot study
of one patient, and intend to evaluate those factors in the hospital environment which may be contributory to the patient's improvement. This
satisfactory
pilot study was udertaken in an effort to clarify a protocol
to the Ibsearch Conmittee and of sufficient quality to be submitted for
8.
SUBCULTURE:
To
some extent, this project
outside
to
organizations.
financial support
was hampered by the multiple duties of members of the committee and by
the resignation of Dr. Gurvitz. Since September, however, the committee has
been working very actively and it is anticipated that a satisfactory protocol will be available by the end of the year.
In June, following some
discussions concerning the
Laderman
and
Drs.
coma
of
insulin
doses
for
insulin
treatment,
correct
doses
between
the
multiple
relation
into
undertook
an
Blumberg
investigation
05 insulin and the blood glucose level. lt was anticipated that multiple
small doses of insulin might reduce blood sugar significantly earlier and
large dose. It was quickly determined,
for longer periods than a single
.)
however, that multiple small doses, even if the sum total was equal to a
This
and
of
depth.
coma
degree
a
not
did
satisfactory
produce
dose,
single
project is now being prepared for publication.
9.
B.
DIVERE'
I
SULIN
D
SE8:
PROJECTS PLANI‘IED:
November
#
the
third
Electroshock
3:
Beginning
let,
l.
electroshock project will be
undertaken. This study is designed to extend our experience with the factors
which may be relevant in both the long and short term clinical reSponses
following electroshock. Also, in this study specific emphasis is placed on
the psychiatric and language changes which follow electroshock treatment
and which we have been accustomed to calling "improvement." Dr. Joseph
Jaffe has prepared a number of specific studies, including detailed interviews with patients prior to and during treatment, in which specific aspects
of behavior and language will be assessed.
�a...
In this study, also, a basic problem in the perception of multiple
simultaneous tacti e stimuli will be undertaken. Under our original grant
from the United States Public Health Service, we were given funds to study
the problem of Satisfactorily delivering single and multiple independent
and
The
completed
was
designed
equipment
wave
impulses.
electrical square
in Septemler and for the past few weeks has been undergoing rigorous clindur«
be
and
will
applied
found
been
has
satisfactory
highly
ical tests. It
between
changes
the
of
relation
the
with
question
specific
ing this project
the
in
and
in
behavior,
changes
stimulation
tests
simultaneous
double
in
electroencephalogram and in amytal tests following electroshock.
2.
EIOC
‘thAL
APPLICATION OF
HEM
TESTS:
’
Dr. Golden—
berg has
completed.the pilot studies necessary to devise measures of Specific compounds. He believes these should be applied to our clinical population over
the next year. A specific protocol for this application is being prepared.
3.
For more
than a year,
has been interested in form-
EEQQNOSTIC IdDIGATQE§flIfl ELECTROSHOCK:
'
‘
Dr. Karliner of the attending psychiatric staff
electroshock.
would
be
in
which
helpful
factors
some
prognostic
ulating
Discussions were held in June and at the suggestion of Dr. Miller, Dr. Karlbe
This
scale
will
evaluate
scale
to
prognosis.
iner prepared a special
months.
next
the
six
and
Committee
assessed
over
Research
the
to
presented
C.
STAFF CHANGES:
Dr. Joseph daffe, a practicing peychoanalyst, was
and
in
research
psychiatry,
assistant
Service
Research
as
appointed to the
behavioral
the
in
is
Dr.
interest
Jaffe's
work
on
September
began
lst. induced altered brain function and the
by
and language changes which are
relation between such changes and premorbid personality.
were resolved effectively
Lowenstein
of
the
floor
the
on
the
of
first
extension
the
laboratory
by
The
reduced.
been
tachistoscopic
have
also
Our
problems
equipment
building.
be
able
now
to
works
and
well.
are
into
alignment
was
brought
equipment
During
this period our space problem
simultaneously.
two
or
individually
pictures
tachistoscopically
present
The electric stimulatorsale functioning satisfactoraly so that we are now
able to produce isolated simultaneous square wave stimuli with the ability
to vary any of the essential parameters.
D.
FUNDS:
In May, we submitted an application to the United
Sept—
In
of
Dr.
Jaffe's
Service
Health
program.
for
support
Public
States
an
in
the
and
staff
interviewed
the
Frank
Jerome
came
to
hospital
Dr.
ember,
USPHS
the
from
in
we
anticipate a response
evaluation of our program.
mid—December. In June, we also submitted the necessary forms for second
renewals
and
both
and
Dr.
Goldenberg
myself,
both
renewal
for
grants
year
the
these
both
renewals,
note
for
that
to
were approved. It is important
overhead allowances were increased to 15%.
At the suggestion of Mr. Coleman, specific protocols of our re»
search program were submitted to the Kaufman, hoffheimer, and lttleson
Foundations during this period.
�-5the
been
for
has
Service
writing
Research
the
which
The protocol
of
Committee
Research
the
submitted
to
was
Ford Foundation grant pr gram
was
the
protocol
that
the
consensus
was
the Medical Board in September. It
suggestions,
their
Following
be
submitted.
not
and
that it
unsatisfactory
of
Drs.
the
with
cooperation
Service
Research
made
the
by
changes are being
Lenzer and Luttrell.
another
submit
application
to
am
planning
I
present time,
re—
March
for
meetings
their
to the USth in January for consideration at
to
an
application
am
contemplating
also
I
newal of our present program.
ambivalence
study,
the
for
for
Fund
support
for
Psychiatry
Foundation
the
as soon as the basic work is completed.
At the
E.
Q?HER.ACTIJITIES:
l.
ISRAEL 5T3§p?§nF9§E§Ei9F THE JOURNLL QEWEELEEERE
HOSPITAL: Following diScussion with Dr. Tarachow,
the Research Service has undertaken the
Tarachow
issuin
Dr.
work
in
and
ssisting
editorial
necessary secretarial
Journal.
Volume
of
Hillside
the
Commemorative
the
special
ing
2. ISRAEL STRAUSS LECTURE: Consideration is being
given by members of the
at
Discussion
is
next
the
lecture.
Committee
for
Lecture
Strauss
Israel
should
decision
and
a
final
candidates
of
number
present centered about a
be available by the end of November.
Respectfully submitted,
.
i
"’ -,"
’-
4
H7
”.51
‘
‘)
{I
1
«I
g.“
,--‘or
,.
‘
j
.
If
‘f‘ \
Fink, M.D.
Director of Research
Max
.
.
�Department of Biochemistry
.................................
Research Pro ress Re
Major werk
l.
rt,
Dr. H. Goldenberg
November l9§§
in Pregress
Chlorpromazine Studies
previous work has been summarized in the report for the 6 month period
ending Oct. 1955. We have subsequently learned from two representatives of the
Smith, Kline and French Laboratories that Drs. Salzman and Brodie, working at
the National Institutes_of Health, have identified chlorpromazine sulfoxide in
the urine of dogs and men after treatment with chlorpromazine. A sample of the
sulfoxide was requested from Smith, Kline and French and arrived the end of Nov.
Our
ultraviolet absorption spectrum of the sulfoxide was determined in
aqueous solution and compared to the Spectrum obtained with extracts from
patients! urine. A remarkable similarity was noted. On the basis of this and
other data accumulated in our lab., there can be no doubt but that urine from
mental patients receiving chlorpromazine contains: (1) chlorpromazine, (2) the
sulfoxide, (3) one or two other alkaloids of related structure, and (A) at least
one break-down product which yields a violet color with sulfuric acid, as contrasted to the pink colors typical of chlorpromazine and its sulfoxide.
The
Using our dye—partition scheme, the sulfoxide yields a color which is
roughly 1/5 the value given by chlorpromazine in equimolar concentrations.
Hence our dye scheme is not applicable as such to the analysis of fluids con~
taining both derivatives, unless some additional information is available on
the relative amounts present.‘ Fortunately the relative proportions can be
estimated from the extent to which the color is depressed by the addition of
ether. Nonetheless, we are withholding a manuscript dealing with chlorpromazine
analysis until this question is completely resolved.
Ultraviolet and chromatographic studies are to be undertaken soon to
establish the various chlorpromazine derivatives in urine and their clinical
significance.
2. Role of Toxic Agents in Mental Diseas
:
An Enzyme
Test for
LSD
first draft
of a manuscript entitled "Inhibition of Serum Cholinesterase
by Lysergic Acid Derivatives. Submicro Detection of LSD 25" has been completed.
Copies are to be forwarded to the Research Committee on Dec. 8th.
The
3. Steroid
Hormone Conjugates
Little progress has been made in this area in the last 6 weeks because of
a delay in construction of our chromatography cabinet and unavailability of
electrical parts needed for the circuit. This situation should be remedied by
the middle of December.
cc. to:
Dr. M. Fink
Dr. Jos. S.A. Miller
�ELECTROSHOCK THERAPY EVALUATION PROGRAM
from the
Research Service of the Hillside Hospital
Glen Oaks,
New
York
December 20, 1955
Alvin E. Coleman, President
Joseph S.A. Miller,
M. D.
Iiedical Director
�Electroshock Therapy Evaluation Program
em
I.
Aim
II. Background
III. Previous Studies
Development
and
Progress
in
Studies
IV.
Tests of Altered Brain Function
Premorbid Personality
of
Adaptation
Patterns
NonAVerbal
Verbal,
Evaluation of Improvement
Steroid Excretion Studies
Autonomic Studies
V.
Program Summary
Method
Significance
VI. Facilities Available
Laboratories
Personnel
VII. Budget
Present Budget
Requested Support
VIII. Appendix
References
Bibliography of Personnel
Page
�I.
E:
During the past few decades there has been an
of various
new somatic
intensified development
therapies for mental illness. Jhile
some have
even-
been
an
has
established
as
electroshock
therapy
into
fallen
disrepute,
tually
important and successful method for both immediate and long term results (1).
Despite
its
empirical usefulness, the
many
theories concerning the
mechanism
of this therapy have been either disproven or are so vague that their validity
tested. In a comprehensive review, Kalinowsky and Koch (2) emphasize the lack of information in this regard stating: ".......the theoretical
cannot be
aspects of the various somatic treatments
in the case of the shock treatments,
still
.....
are poorly understood, or, as
entirely obscure in their
mode
of
action."
The aim
of this program is to study the therapeutic mechanisms in electro-
convulsive therapy by the systematic investigation of behavioral, personality,
physiological and biochemical factors. Thile the program has electroconvulsive
therapy as its focus, considerable theoretical and experimental information can
be derived
to relate the
phenomena observed
in this therapy to other somatic
treatments such as lobotomy, electronarcosis and insulin coma.
�II.
BACKGROUND:
of
abundance
has
stimulated
an
electroconvulsive
therapy
of
use
and
the
Both
kind
theories
of
the
much
and
research.
exper(3)
hypotheses
The
of
interest
the
reflect
however,
particular
undertaken,
imental investigations
the
origin
frame
reference
of
regarding
and
theoretical
his
the investigator
of mental disorders.
Thus, each has been usually limited to one aspect of the
problem. In general, these theories
may be
differentiated between those that
emphasize physiological, biochemical, or psychological constructs.
A
who
classical physiological construct is exemplified
suggests that the various
by Gellhorn (h)
forms of shock therapy "act on the centers of
the autonomic system, produce intensive and prolonged sympathetico-adrenal
mental
activity,
hypothalamic-cortical
augmented
and
alter, through
discharges
processes and behavior."
psychogalvanic reflex,
The
varying responses of blood pressure, heart rate,
and other physiological indices to chemical
stresses are
obtained
been
has
data
huch
of
sympathetic reactivity.
interpreted as indices
to
and
Show
autonomic
reactivity,
in
this
induces
change
a
electroshock
therapy
that
(5)
coaworkers
and
support this
his
Funkenstein
by
studies
recent
conclusion.
Much
illness
and
biochemical study has been devoted to the relation between mental
steroid metabolism.
between ketosteroid excretion
Numerous
rates
instances (6) in which a relation
and change
in mental state following
electroshock therapy are reported, but the clinical difficulties in the
measurement of steroids have left this issue unresolved. Kore recent studies
excretion
to
the
total
steroids
between
individual
the
relationship
exploring
rate (7) utilize elaborate chromatographic separation technics.
�In a good review of the biochemical and neurophysiological hypotheses,
mode
the
view
the
that
evidence
to
justify
Ashby (8) presents experimental
of action of electroconvulsive therapy
is
through effects on the adrenal
cortex mediated by direct stimulation of the hypothysis.
Psychologic constructs generally fall into three designs
- studies
of
the psychic significance of the loss of consciousness; the relative importance of
ities
memory
loss;
and an estimate of the
subject's re-integrating abil-
the
Numerous
unemphasize
studies
of
confusion.
following a period
conscious significance of the treatment as a “rebirth which eliminates reand
exneed
punishment
for
of
a
satisfaction
narcissism"
a
(9);
or
gressed
piation for committed sins (10).
Amnesic effects are a common concomitant of treatment but most studies
of
these
The
significance
of
impairment.
the
nature
emphasize the temporary
defects for therapeutic results is
emphasized by numerous authors.
Data
is
the
on
emotional
charge
patreduces
the
treatment
that
presented to
emotionallyfor
of
induces
familiarity
loss
a
associations
(ll),
ient's
show
toned associations (12), or a selective forgetting of unpleasant
life
memories (13).
These constructs are
further elaborated by authors
who
believe that the
as
behavioral
responses
confusionalemate
including
of
an organic
induction
im»
electroshock
the
for
basis
is
over-reacting
euphoria, impulsiveness or
provement (1h).
A
more
umerated by Weinstein
&
recent elaboration of this explanation is that enKahn
(15), described subsequently.
�-h-
adaptive
in
changes
proregard
explanations
of
psychologic
Another group
describe
(16)
and
Frosch
Impastato
mechanism.
cesses as the basic therapeutic
on
a
which
then
re-integrates
the
of
ego
electroshock as causing a dissolution
suggestopinion
similar
has
a
Alexander
of
adaptation.
previous or higher level
ing that
defensive
operations.
enhances
active
and
electroshock arouses
For
this
in'whii1
conditions
those
in
effective
such
is
therapy
that
he
asserts
reason
conp
in
ineffective
but
are
low
ebb, as in depressions,
such operations are at a
(17).
alerted
highly
already
ditions in which defensive operations are
most
two
in.which
Kahn
(15)
and
Another hypothesis was developed by weinstein
were
the
process
of
therapeutic
aspects
related.
They
asserted that the thera-
of
altered
milieu
of
a
creation
the
in
convulsions
lay
induced
of
action
peutic
is
of
problems
his
expression
symbolic
brain function in which the patient's
Their
them.
studies,
denying
of
form
the
explicitly
altered, particularly in
cerebral
with
with
patients
documented by an extensive neurologic experience
behavior.
in
adaptive
of
changes
a
function, amply demonstrate great variety
dys—
attention
(l9),
orientation
(18),
They describe altered patterns in language
manifestations
(21)
as
defect
of
and
awareness
(15b)
(20), sexual behavior
the
patient's
constitute
mechanisms
these
conclude
that
and
of adaptive behavior
attempt to deny his illness or
striking
and enduring in those
its
meanings.
patients
Such
who had
most
were
denial
at
attempts
habitually used the defenses
with
their
of
coping
means
a
as
and
rationalization
of verbal denial
of
indicative
these
patterns
that
problems (22). They also demonstrated
administraintravenous
the
following
interview
"denial" could be elicited in an
interview
the
clinical
manifest
in
not
when
were
they
tion of sodium amytal
(23)-*
followdenial
and
explicit
disorientation
of
* This appearance of patterns
with
associated
so
clearly
sodium
is
amytal
ing the administration of
authors
these
by
described
been
has
diffuse cerebral dysfunction, that it
test."
named
"amytal
the
been
has
This
(23).
as a test for such dysfunction
�-5of
denial
between
a
patient's
noted
direct
relationship
a
they
cere—
of
the
of
and
signs
the
electroshock
appearance
therapy
pain following
test)
of
mechanism
the
that
suggested
they
amytal
bral dysfunction (positive
Thus, when
electroshock therapy
may be
the facilitation of patterns of denial by altered
brain function (15).
and
psychophysiological
at
integrating
This hypothesis is an attempt
which
terms
in
View
it
of
the
and
As
operational
in
such,
factors.
logical
have
which
studies
base
our
theoretical
upon
a
has
provided
is stated, it
been elaborated.
�III
PREVIOUS STUDIES:
of
altered
manifestations
studies
investigating
For the past three years,
cerebral function in psychiatric patients, have been in progress at Hillside
Hospital.
In 1952, the application of the amytal
was asseSSed
(2h).
test to psychiatric subjects
Positive responses were found only
in patients
who had had
electroshock therapy or had other indications of organic brain disease.
in order to test the relationship between altered brain
referred
consecutive
patients
electroshock
to
therapy,
and
the
function
response
electroencephalograms,
with
serial
intervals
weekly
at
tested
treatment
were
for
During 1953-195h%
amytal
tests,
simultaneous
tactile
perception%%
tests,
and
tests of recall
function.
A
marked
correlation
was found between improvement
therapy and early, persistent
the electroencephalograms.
following electroshock
and severe changes in both the amytal
If
no such
tests
such changes did not appear, improvement
and
failed
correlations were manifest between improvement
to occur. In contrast,
and tests of recall function or changes in simultaneous tactile tests.
WM
TWenty—four subjects were
tested in this first study, and were classified
improved
markedly
as
psychiatrist
the
supervising
by
independently
ately
improved (6) and unimproved (7)
at the
(ll),
moder-
end of one month post-treatment.
Paralysis
Infantile
for
Foundation
National
from
the
Aided
Fellowship
a
by
*
(Dr. Fink, 1953) and Grant K—927, National Institute of Fental Health,
National Institutes of Health lQSh-Sé.
stimuli
two
simultaneous
tactile
of
the
of
perception
as Previous studies
one
localize
to
or
of
perceive
failure
demonstrated characteristic patterns
of the stimuli in patients with diffuse cerebral dysfunction (25).
�-7Of
the markedly improved patients, every one had at least one positive amytal
reaction during treatment.
Of
the
50
tests
given to
this group,
38 (765) were
positive. In contrast, of the unimproved patients, five of the seven never
showed a
positive result,
positive.
6 (13%) were
and of the
The
LS
tests administered to this
group, only
moderately improved group showed more positive re-
sponses than the unimproved patients, but
fell far short
of the
much improved
group.
In addition, there were consistent changes in language and non-verbal as-
pects of behavior indicating alterations in adaptive mechanisms in the
in interviews not employing amytal. These alterations
improved group, even
were
much
either minimally or only transiently manifest in the
unimproved group and
then only under the influence of sodium amytal.*
Concomitant studies of the electroencephalograms taken on a day pre-
ceding the amytal
first
measured
test indicate
for per~cent time
a similar
31 w wave
relationship.
The 160
records were
(delta) activity, the extent of
burst activity and the amplitude and frequency of the slowest waves present.
They were then placed in a rank serial order. Those falling in the upper third
were
labelled "high abnormality"
abnormality."
ality after
Of
the
and those in the lower
much improved
patients,
one week of treatment; 80%
after
25% showed
third as "low
a high degree abnormp
two weeks and over 90%
after three
In the unimproved patients, however, none had a high degree abnormality
record during the first three weeks and only one had such a record by the fourth
weeks.
week of
treatment.
The
records of the moderately improved patients
fell
between
these two groups.*%
* Presented at the Annual Meeting of the American Psychiatric Association,
Kay 10, 1955.
** Presented at the joint meeting of the Eastern and Southern Electroencephalographic Societies, Bethesda, September 30, 1955.
�Changes
in
memory and
learning were tested in these subjects by using
the principle of retroactive inhibition.
3-letter originally learned
By
the serial testing of recall of
words following the
interpolated learning of nonsense
syllables, patterns of decrement in learning and recall
were
elicited.
As
a
week
of treatthe
showed
to
third
impairment
the
increasing
up
patients
group,
ment, and a rapid improvement after the cessation of treatment. No relation-
ship, however, could be established between impairment and reSponse to treatment.*
The
responses of these subjects to simultaneous
tactile tests using touch
stimuli were also assessed. While an increasing impairment in the ability to
be
two
demonstrated with increasing
could
and
stimuli
the
localize
identify
treatment, no relation to improvement was noted.
however, and
in anticipation that
more meaningful
The
tests
were extremely gross,
correlation for this index
of altered brain function could be obtained, a study using threshold electrical
stimuli has been undertaken (pg. 10).
As
ent and
result of these studies, it was our conclusion that early, persistsevere changes in both the electroencephalogram and in the amytal tests
a
are a necessary, though not sufficient pre—requisite for improvement following
electroshock therapy. These observations make it possible to predict the short
term response to electroshock, and such a study was undertaken
earlier this
year (pg.ll).
Concomitant with these studies,
we
have made some preliminary observations
in patients undergoing insulin coma therapy. Recent reports of the value of
prolonged coma as the basis for improvement (26) have been confirmed in our
patients. In
one unusual case
report
we
noted a direct relationship between
* Presented before the Electroshock Research Association,1;ay 8, 1955 and
awarded
their
Annual Prize award
for excellence in research design.
�altered brain function, altered patterns of adaptation in language and behavior,
clinical
and
improvement (27).
Concurrent with these psychologic investigations, basic studies have been
done
in
in biochemistry.
1950* with an
The
initial
biochemical research laboratory was established
program of study of the
relationship between steroid
excretion patterns and states of mental illness.
studies, utilizing alumina column chromatography, demonstrated atypical
The
number
excretion
of
a
levels
in
psychotic
ketosteroid
patients.
urinary
The
of B—steroids (particularly dehydroisoandrosterone) was found to be elevated,
and the etiocholanolone was depressed (7a). The ll-ketoetiocholanolone
values appeared to be sex-dependent: male patients excreted the steroid
metabolite in normal amounts, while the several female patients studied had
markedly elevated values.
During the past year, a collaborative study was
chemical department of the Sloan-Lettering
initiated with the
Institute of
new York.
bio~
Similar
steroid excretion pattern studies were undertaken utilizing paper chromatographic technics.
In the
first
phase of the study recently completed, the
elevated excretion of ll-ketoetiocholanolone was confirmed, with a severe
reduction in the excretion of this
when
compound
prior to discharge, at a time
the patient had shown considerable improvement from her
* Supported by grants from the Dazian Foundation
illness.
for Hedical Research.
�.10...
IV. §EUDIES IN PROGRESS
1.
Relation 2f
AND
Tests
IN DEVEILEEENT:
Improvement:
Function
Brain
33
Altered
3;
altered
between
relationship
direct
Our earlier studies
this
that
however,
apparent,
is
treatment.
It
to
and
function
response
brain
and
not
only
function
brain
altered
of
indices
certain
holds
for
relationship
and
elabconfirm
to
undertaken
been
has
for others. Further study, therefore,
have shown a
methods of measuring
orate these findings, as well as to investigate
improvement.
clinical
to
related
function which are more reliably
a.
cerebral
Amytal Test and Electroencephalogram:
Amytal
tests
and electroencephalograms are done
and
second
the
and
during
subjects before,
third
in all
weeks of electroshock treat—
make
a
used
predicto
data
is
the
findings
ment. On the basis of our earlier
those
that
predicted
is
treatment.
It
to
term
short
response
the
of
tion
and
with
positive
abnormality
electroencephalographic
patients with a high degree
amytal
test findings will
be most
likely to
show improvement;
while those with
amytal
and
with
negative
abnormality
a low degree electroencephalographic
results are considered unlikely to improve.
b. Tactile Perceptual Tests:
perceptual
tactile
simultaneous
the
As described before,
was
planned
inconclusive.
It
were
of
test results in our first series patients
conditions
under
stimulation,
electrical
to repeat this study using threshold
terms
Under
controlled.
be
could
rigidly
wherein the various stimulus parameters
two
of
consisting
assembly
instrument
(M—927)
an
USPHS
grant
of an existing
dewhich
can
devised
was
oscillograph
monitored
by
an
Grass Sh-B stimulators
the
assembly,
this
Using
stimuli.
electrical
wave
independent
square
liver
stimuli applied simul-
to
perceive
their
ability
for
tested
patients are
technique
refined
this
By
applying
body.
taneously to different parts of the
two
�.11be
may
otherwise
not
apparent
function
brain
in
it is anticipated that changes
and
of
improvement
the
be
to
degree
compared
will
observations
These
elicited.
to our other test~results.
As
in the case of the electroencephalogram and
the
and
intervals
during
stated
before
at
tested
are
amytal tests, patients
course of treatment.
c.
Hemory
Tests:
imp
and
loss
of
memory
of
relation
the
Numerous theories
provement have been described.
Our own
data to date
shows no
significant re-
and
words
and
simple
nonsense
syllables
for
lationship
forselective
a
there
is
evidence
that
considerable
But
there
is
improvement.
For
memories.
and
situations
of
life
significant
getting, during treatment,
between the memory loss
a record
this purpose,
may be
is
made
of events during the preceding six months which
of emotional significance to the patient. During treatment, inquiries
records
verbatim
of
these
events,
recollection
patient's
are
and these compared to the pre-treatment reports.
made
of the
2. Relation gf’Premorbid Personality
to Duration 3;
made,
Response:
has also been apparent that the relationship between altered
It
brain function and clinical response is valid only for the short term response
When
six
followed
a
for
treatment.
weeks
several
after
to treatment, ite.,
return
a
had
showing
relapsed,
the
of
improved
several
patients
period,
of their former symptoms, and in some instances requiring further hospital-
month
ization.
thesis
To
account for the varying duration of
was advanced
that the difference
personality patterns. Specifically,
it
was
clinical response, the
hypo-
related to differences in premorbid
was suggested
that patients
who showed
would
(22)
denial
verbal
personality"
the
of
"explicit
the characteristics
likely to maintain improvement.
premorbid personality of each patient is assessed
be those more
The
an interview with family members, psychologic
and
psychiatric interviews.
by
four procedures
tests, tachistoscopic tests
-
�a. Family Interviews:
At least two close relatives are seen in independent
interviews. A standardized questionnaire has been devised to elicit characterological factors indicative of the "explicit verbal denial" personality. For
this study fifteen characteristics defined as typically present or absent in
conscious—
Such
include
items
prestige
selected.
were
of
this type
personality
and
and
to
sex
attitudes
temper
to
imagination,
criticism,
ness, sensitivity
illness. Each patient is rated on a scale of 0 to 2 for each item - the higher
score signifying a greater tendency to denial.
b. Psychologic Tests:
Each
patient is tested
on a
standard psychologic eval-
uation battery including the Rorschach and Thematic Apperception TEStS. These
adap—
defense
of
and
usual
or
types
structure
character
assessed
for
tests are
tation.
Such
tests are repeated at the termination of the treatment
program and
again prior to discharge, to obtain additional information as to changes in
behavior in the course of treatment.
-
c. Tachistoscopic Tests:
tachistoscopic study has been devised; in which pairs
of emotional and non-emotional words are flashed on a screen at 10, 20, 50,
100, and 250 millisecond periods. The patient's ability to identify the words,
A
the reaction time, and the distortions are ascertained. This pre-treatment
data is
now
being explored as to
defense patterns.
The
its ability
to clarify the patient's usual
tests are repeated at the
end of greatment and again
prior to discharge for the possibility that characteristic changes in perception
develop with altered modes of adaptation..
�-13..
d. Psychiatric Interviews:
In the course of estimating changes in behavior, patients
are seen prior to treatment, and at intervals during treatment. In a clinical
interview setting, an assessment is made of the patient's symptoms, and usual
of adaptation. Changes in symptoms, behavior, language and modes of adap-
modes
tation are noted.
By
interviews with the patient's therapist, judgment as to
the significance of such changes and
bral states can
ment
their relation to treatment, or altered cere-
be made.
On
the basis of the data in a-d above a prediction of response to
is
made.
treat-
Prior to the start of treatment the patients are classified as:
1) those unlikely to improve;
2)
those likely to improve moderately or temporarily;
3)
those likely to maintain marked and sustained improvement (for at least
six months).
During the
third
week of
treatment, (after the patients have had
ments), a second prediction of the short term response
change
is
made
7—9
treat-
according to the
in the physiological indices.
3. Altered Patterns g£.Adaptation Kanifested in‘Verbal and NonéVerbal
Behavior:
In the earlier study on the amytal test
it
had been noted
that
specific changes in language and behavior indicative of altered adaptive responses occurred in the improved patients to a significantly greater degree than
in the unimproved patients. Further experimental procedures were
necessary to clarify the nature and significance of these changes.
deemed
�alb-
a.
The
is
a highly structured interview
of the patterns of language.
made
ients
who show
language
will
in émytgl Tests:
amytal test procedure is recorded. This
Language Changes Induced
situation,
The
and systematic observations are
hypothesis tested
is that those pat-
consistent, increasing use of the following types of adaptive
be more
likely
improve:
1) The use of the second or
to
third
person. In such instances the patient reports his main trouble as "the Doctors
say I'm depressed", or state the wish that "my family should be well." 2) The
selective response to questions, as answering readily questions about date and
location but failing to answer,
illness.
tive
mumbling or using neologisms when asked about
3) The use of conditional or qualifying expressions, or the subjunc-
mood which has
the effect of vitiating the patientis committment to the
is
I feel kind of dBpressed", in w hich
"sometimes" qualifies the temporal degree of illness, and "feel" and "kind of"
statement.
An example
"sometimes
‘qualify the intensity of the illness. Committment would be indicated by
the direct, unconditional statement of "I
am
depressed". h)
or stereotyped expressions in discussing illness, as "to
or "well, in a manner of speaking..." or "I didn't keep
wheel". 5) Language
antic statements. 6)
problems.
tell
my
The use
of cliches
you the
shoulder to the
filled with nonpsequiturs, circumlocution, ornate
The use
or pedp
of humor when talking about their illness or other
7) The use of metonymy or paraphasia, as
Dr. as a "recorder". 8 )The various forms of
ulation about the main problem
truth..."
referring to the examining
explicit denial including confab-
and temporal displacement.
9) changing the sym-
bolic frame of reference in response to questions, as replying to the question,
feel?", by stating, "with my hands." 10) The use of hyperbole, as
"you're the best Dr. in the whole eastern Atlantic seaboard area."
"how do you
�.15-
State:
Confusional
the
PostaShock
b. Language Changes in
Each
orientation
for
tested
is
patient
and awareness of
treatment.
a
following
immediately
awakening
of
the
period
in
his main problem
such
At
intervals.
weekly
and
then
at
treatment
the
initial
done after
@his
is
most severe, and a
defects
are
cerebral
neurologic
the
times,
These
of
language
appear.
tive changes in the pattern
variety of
may be comparable
adap—
to the
records
are
and
the
situations,
interview
other
the
in
noted
changes
language
and
changes
language
the
later
to
both
as
indications
assessed for prognostic
the degree of improvement.
Study:
Sentence
Completion
0.
in
language
in
and
changes
A way of studying the patterns
technique.
completion
sentence
a
devised
using
been
has
fashion
a quantitative
accordstructured
been
have
which
complete,
to
sentences
to
given
The patient is
the
in
first
been
have
put
sentences
the
of
Ten
different
patterns.
ing to four
when....",
criticized
am
"I
Wish that......",
such
"I
as
unconditional,
person,
the
in
expressed
are
they
that
except
meaning
in
identical
Ten others are
etc.
sometimes
"people
as
aspect,
qualifying
or
conditional
third person and with a
the
In
reetc.
When.....,"
criticized
wish that.....", "people are usually
these
of
senten
In
indicated.
maining twenty items no person is specifically
or
occurrence
exact
an
to
refers
or
direct
is
sentence
the
tences, however,
event as "every
time....",
”when the
doctor
comes
in.....",
etc.
The remainp
"at
times....",
as
aspect,
indefinite
or
qualifying
conditional,
have
a
ten
ing
etc.
when.....",
better
"things usually seem a little
for
analyzed
not
in
sentences
The response of patients to the incomplete
rated
is
each
response
Instead,
manner.
psychologic
content in the traditional
�16
the
whether
include
ratings
for its grammatical or syntactical structure.
or
conditional,
direct
or
is
second
third
person,
or
response is in the first,
The
1h).
(page
above
described
of
language
manifests aspects
1)
assumptions:
following
the
on
This study is based
begins in
the
to
most
obviously
applicable
a manner
A
sentence which
patient (e.g.,
first
person,
adaptive
reto
elicit
likely
unconditional) creates
conditional
is
or
the
third
in
person
A sentence which is expressed
2)
sponses.
and
least
minimal
is
stress
creates
is less applicable to the patient. It
complete
used
to
The
3)
person
syntactical
likely to elicit adaptive responses.
maximum
stress
and
is
most
of
indicative
is
to
person
in
regard
indeterminate
is
whose
beginning
sentence
a
shows
less
of
the
person
first
the
use
the degree of stress experienced (e.g.,
third
second
or
the
of
the
use
defensiveness,
person shows
greater defensive—
ness).
d. Attitude Interviews:
In
this
part of the study an attempt
the
of
mechanisms
ego.
adaptive
the
tionally
Two
is
made
to define
opera—
structured interviews
followed. The attitude of the
questionnaire is
interone
In
next.
the
to
interview
from
one
examiner, however, is reversed
and
the
in
concerned,
view the examiner is empathetic, pessimistic,
minimize
to
and
tends
insensitive
non-empathetic,
he
brusque,
is
other interview
are held, in which the
the patient's
same
difficulties.
In general, the
first attitude
produces good
a
in
grossly
results
latter
the
while
rapport with these disturbed patients,
each
asked
in
are
non-communicative situation. Although the same questions
to be appropriate to the examiner‘s
attitude.
interview, the wording is altered
"YOu
must
today?",
poorly
"feeling
as
such
he
questions
asks
In one interview
worse?.“
been
getting
"has
and
it
consider your condition pretty serious?",
don't
"you
today?",
well
While in another interview he asks, "feeling pretty
consider your condition serious,
do you?" and "have you been improving?".
�.11.:
The two structured.interviews are performed
just prior to electroshock
interviews
All
are
treatment.
of
treatment and repeated following the course
of
the
patient's
1)
alteration
the
study:
in
recorded. There are two variables
The
four
attitude.
examiner's
the
in
behavior by treatment, and 2) alteration
recordings are studied for
and
changes.
language
vocal
changes,
content,
The
it
defensive mechanisms of the patient
both
out
be
carried
can
that
transactions
of
the
of
terms
range
in
ationally,
and any changes
in
can be defined, oper-
be
commmay
patient
depressed
For
a
example,
very
treatment.
and
after
before
he
whereas
interview,
empathetic
concerned,
the
in
treatment
before
unicative
jovial,
mood
is
the
when
latter
examiner's
the
in
will be unable to participate
of
one
is
treatment
to
his
response
However,
if
and
minimizing.
bantering
becomes
he
sustreatment
Following
reversed.
be
euphoria, the situation may
and
empathetic,
concerned
examiner
is
when
the
anxious
or
hostile,
picious,
Thus
the
interview.
the
optimistic
in
stressful
less
communication
is
whereas
terms,
objective
in
be
stated
the defensive system of the patient can
change
i.e.,
in
of
interpersonal
standardized
range
to
a
in terms of his reactions
uations.
in
sit-
M
h. Clinical Ratings 2: "Improvement":
changes
evaluating
of
methods
and
test
These various experimental
ratthe
psychiatric
in
significance
further
have
may
and
behavior
language
considerable
experienced
we
studies
revious
In
our
:
rovement."
"im
of
P
ing
Or,
be
guide?
the
to
relief
symptomatic
Is
our
patients.
difficulty in rating
to
recovery
Is
be
the
goal?.
to
improvement"
"social
recovery"
or
is a "social
relief?
Agreement by
symptomatic
well
as
as
of
insight
be judged by the degree
"unimproved"
and
improved"
"much
"recovered",
of
definition
the
in
psychiatrists
is not available,
investigations,
to
further
crucial
is
issue
and yet, this
We
�they
terms
as
these
of
assessing
task
further
the
undertaken
have therefore
apply to the electroshock population.
of
incapacity
and
type
the
degree
are
Central to this problem of evaluation
and
the
the
of
therapist,
the
goal
personality,
of the patient, his premorbid
capacity
events,
intercurrent
as
Other
aspects,
therapy.
to
attitudes
patient's
environmental
the
patient's
of
therapy,
suitability
of the therapist, temporal
present.
at
encompassed
not
but
are
assessment,
to
important
also
assets are
To
are
studies
evaluation
following
the
"improvement",
of
meaning
clarify the
in progress.
Evaluation:
Pre-treatment
a.
the
by
therapy
electroshock
Patients are referred for
and
resident therapist.
supervising psychiatrist
evaluation is made by the research psychiatrist.
An
Two
independent psychiatric
aspects are specifically
decompensation
of
signs
clinical
encompassed in this study:
of
sympdegree
for
and
rated
mental
status
descriptive
a
recorded
in
which are
of
the
patient‘s
estimate
2)
an
(28);
scale
tomatology on a Kalamrd rating
1) the symptoms and
operations.
defensive
usual
his
of
with
description
a
develOpment
of
ego
level
Relationship:
Therapist—Patient
the
in
Changes
b.
to
held
prior
therapist
resident
the
with
interviews
In
and
the
therapist
between
relationship
the
therapy,
electroshock
of
the onset
recomp
the
for
the
reason
on
emphasis
with
specific
explored
the patient are
and
the
patient's
treatment,
the
of
the
goals
mendation for this form of therapy,
mental
of
treatment
of
method
Since the primary
attitude to the treatment.
electroshock
for
recommendation
the
disorders at this hospital is psychotherapy,
the
between
patient
communication
that
assumption
the
with
carries
it
generally
deis
the
exploration
For
this
reason,
meaningful.
no
longer
was
and therapist
and
recommendation,
the
led
to
that
relationship
the
in
voted to those changes
�19
and
symptoms that it is
behavior
of
of
those
aspects
statement
a definitive
We
the
in
interested
also
therapist's
affect.
treatment
are
may
the
anticipated
attitude to this
may
form of treatment, and attempt to assess the
role this attitude
play in the eventual results.
of
the
the
results
theories
relating
numerous
there
are
Furthermore,
made
being
are
attempts
and
in
our
inquiries,
therapy to its punitive aspects,
to assess the significance of this factor in the outcome. During the interviews with the resident therapist and with the patient, the patient's attitude
behavior)
and
against
(both
language
defensive
operations
to the treatment, his
his
in
and
alterations
the
electroshock
represents,
the reality threat that
attitude
during the weeks of treatment are
studied. Further information regard—
of
our
the
in
course
be
ascertained
will
of
factor
this
ing the significance
control study (page 21).
c.
Follow—up Study:
Crucial to the evaluation of "improvement" is the
oppor—
treatment
of
the
period
following
various
periods
tunity to repeat evaluations at
from
hosthis
discharged
of
the
patients
follow—up
report
Recently, a four-year
between
customary
the
disparity
indicated
and
(1)
this
pital was made available
of
inthis
the
In
course
illness.
discharge ratings
at
out
carried
being
observers
is
same
the
vestigation, repeat evaluations by
As
check
a
treatment.
months
after
and
six
various times during hospitalization
and eventual course of the
and
the
physiological
of
the
personality
basis
the
on the predictions
two—week
the
for
recorded
factors studied, specific follow—up evaluations are
(long-term
months
period
and
the
result)
six
post-treatment period (short-term
made on
ther—
the
resident
of
the
to
ratings
result). These evaluations are compared
each
In
instance,
medical
director.
and
the
apist, supervising psychiatrist
and
the
of
terms
projected
formulated
in
the ratings made in this study are
and
interpersonal
language
of
behavior,
those
noted
aspects
in
actual changes
�Excretion
23 Improvement:
5. Relation of Steroid
and
their
reof
steroids
excretion
patterns
of
The studies of the
More
recently
continuing.
is
9,
on
described
page
mental
to
states,
lation
of
measurement
the
for
of
techniques
development
the
on
been
has
emphasis
colorimetric
and
*
new
separative
steroid conjugates. During the past year
sulfate
steroid
measure
to
(29)
devised
techniques have been
these
for
patterns
excretion
blood and urine. Daily urinary
compounds
in
compounds
are
and
prior
again
electroshock
of
the
course
assayed prior to treatment, during
resolve
to
is
of
this
program
The
object
selected
patients.
in
to discharge
individual
total
the
with
values
these
and
compare
bound
steroids,
the sulfate excretion
hormone
between
relationship
the
elucidating
Besides
hormone levels.
which
to
extent
the
indicate
of mental illness, such studies
and
rates
states
hormones.
steroid
of
metabolism
the
the liver (30) participates in
Electroshock
Therapy:
Results
Functions
of
on
6. Effect of Autonomic
behas
studies,
it
electroencephalographic
of
our
In the course
alterations
the
typical
fail
of
number
patients
that
a
apparent
come
to
also
fail
These
patients
treatment.
extensive
in cerebral rhythms despite
and
frequently
tactile
tests,
in the amytal tests, simultaneous
to
show
show changes
reactivity
the
studies,
these
with
Simultaneous
periods.
confusional
evince no
mecholyl
of
administration
the
to
rate
and
the
pulse
blood
of the
pressure
to
done
was
prior
too,
This,
out.
carried
been
have
"Funkenstein—test")
(the
Marked
ended.
had
treatment
of
the
course
after
immediately
treatment and
two
test
these
found
in
were
medication
this
to
variations in the responses
the
of
earlier
the
reports
way
general
a
in
followed
observations
These
periods.
between
relationship
the
of
exploration
the
undertaking
workers, but we are now
tests.
physiological
and
these
function
brain
altered
of
tests
in
the alteration
* Aided by a grant (A-6YSC)
Public Health Service.
States
United
Health,
of
from the National Institutes
�v.
THE PROJECTED PROGRAM: SUMMARY
1.
3
21 -
Method:
the
along
and
development
continuation
The projected program is a
Our
ultimate
of
this
two
report.
sections
lines indicated in the preceding
the
systematic
by
therapy
electroshock
of
mechanism
goal is to clarify the
of
behavioral,
inter-relationship
the
of
and integrated investigation
biochemical
factors.
and
physiological
sonality,
This program
is
per—
rev
interdisciplinary
full-time
a
by
undertaken
being
neurophysiolpgist,
psychoanalyst,
of
psychiatrists,
search staff consisting
help.
technical
and
allied
biochemist
physiologist, experimental psychologist,
Some
in
scope
clear
already
are
the
in
program
of the specific studies
and
new
continues
the
program
as
become
apparent
Others
will
and outline.
Two new basic
develop.
leads
promising
further
or
problems
appear
critical
decided
been
upon.
already
have
methodological aspects
date
work
to
our
in
1. Control group:0ne of the major deficiencies
starting
Accordingly,
control
group.
has been the absence of an adequate
two
into
divided
be
will
electroshock
for
referred
January 1, 1956, patients
of
conusual
course
the
receive
will
One
group
fashion.
random
a
in
groups
treatments.
sub-convulsive
be
given
vulsive therapy; the other group will
Ulett
of
study
instructive
recommendation follows the recently reported
This
et a1. (31).
In other respects the two groups will
be
treated in the
same
will
each
group
in
are
patients
who
will
The
only
person
fashion.
of
The
purpose
treatments.
the
administering
be the supervising psychiatrist
in—
of
the
effects
physiological
the
differentiate
to
is
such a control group
know which
outcome.
therapeutic
the
affecting
Some
duced convulsions from other factors
disease
process,
the
of
particular
1)
nature
the
of these factors might include
2) the
attitude
and symbolic
etc.;
depression,
involutional
or
as schizophrenia
of
a
large
attention
3)
the
special
the
patient;
to
treatment
of
the
meaning
�~22:
numbers of observers
h) the
incident to being placed
on
the treatment program;
attitude of the patient's therapist toward the patient
and toward
electroshock therapy, including the expected goals in each case; and S) the
relative effectiveness of other forms of therapy provided for these patients
in the hospital milieu. The use of a control group will also clarify the
nature of "Spontaneous recovery" and
may
aid in the understanding of
"atypical" results in the patients actually receiving convulsive therapy.
2. Insulin
Coma:
It is
planned to extend the present methods of study
to an investigation of those patients receiving insulin
coma
therapy.
�~23.-
2. Significance
This program of study has both applied and theoretical significance.
there
since
electroshock
of
therapy
use
clinical
It can lead to the improved
be
mechanism.
will
It
the
of
therapeutic
will be a greater understanding
to
who
better
improve,
will
those
patients
more
skillfully
select
to
possible
and
to
predict
the
involved
therapeutic
in
process,
factors
other
manipulate
more
accurately future management problems.
of
the
psychounderstanding
to
a
greater
however,
also
This study
leads,
pathology of mental
picture
which
illness.
Through the various methods of study a
clearer
will be obtained
meaningful criteria for
of the mechanism of defense and modes of communication
may
contribute
more
operationally accurate and
"improvement".
of
determination
the
for
diagnostic classification
techtherapeutic
other
on
throw
light
may
Finally, the investigation
and
and
obserthe
function
cerebral
in
niques. The studies of the alteration
have
signifi—
damage
and
cerebral
behavior
between
vations on the relationship
also
is
It
electrocoagulation.
and
cerebral
cance for the studies in Ibbotomy
modes
of
and
in
language
the
changes
into
here
gained
the
insights
that
likely
of
psychotherapy.
study
eventual
significant
make
an
possible
adaptation may
�VI. FACILITIES
AVAILABLE:
1. Hillside Hespital is a
200 bed
non-profit psychiatric hospital.
All admissions are voluntary, with periods of hospitalization varying from
h-lZ months. All patients are available for study.
The
hospital
was
established in 1927, for the purpose of treating
ulatory psychiatric patients.
A
amb-
residency training program.was instituted
earxy, under the supervision of an active staff of psychoanalytic psychiatrists.
In 1950 the research biochemical laboratory was established, to be followed
in
1953 by
the neurophysiological research laboratory.
In 19Sh these laboratories were combined and expanded, and a Research
Service established as a:full-time operation of the hospital.
Research Director was appointed to integrate
program.
At this time, the
staff consists
all
A
full-time
the studies into a basic
of the Director, research assis—
tants in psychiatry and psychology, biochemist and assistant biochemist,
siologist,
and
EEG
technician. In addition, a psychologist and
phyb
two chemists
are associated on a project basis.
Laboratory
Medcraft D-8,
two S-hB Grass
8
facilities include:
(a) Electroencephalographic unit with a
channel instrument; (b) Neurophysiological laboratory with
stimulators,
tachistoscopic projectors
ical laboratory with
Du Mont # 3&0 R
and
feet of laboratory space
Beckman
Coleman Spectrophotometer, and
ifications of the A.E.C.
two synchronized
auxiliary electronic equipment; (c)
1000 square
the following major items:
oscillograph;
Biochemp
and equipped with
Spectrophotometer,'Warburg respirator,
radioisotope unit following the basic spec-
�£2 5..
fl
2. Personnel:*
studies
Undergraduate
Research:
of
(a) Dr. Max Fink, H.D., Director
the
and
degree
New
Yorn
College
University,
of
Universitv
were undertaken at the
{e
the
attended
l9h2.
in
was
granted
of B.A. cum laude with Honors in Biology
New
l9h5.
in
graduating
of
Hedicine,
York University College
interneship he served in
School
of
the
from
he
where
graduated
U.S.
Army,
the
Military Heuropsychiatry in
Knox
After a rotating
19h7, and was Chief of the
Psychiatric Section, Fort
Station Hospital during 1947.
Formal neurologic
training
was
received at hontefiore Hospital in
York
New
Formal
psychiatric
(l9h9«1951).
Hosoital
Bellevue
Dsychiatric
and
at
(l9h8-l9h9)
and
than
(1950)
at
Hospital
Bellevue
?svchiatric
undertaken
at
training was
Hillside Hoscital (1952).
During 1951, and again
in
1953, he
and then
at
Mount
In 1952, he was
American Board of
first at
Sinai Hospital in
a research fellow of the Hational
Both periods of study were under the
Foundation for Infantile Paralysis.
ection of Ur. horris 3. Bender,
Was
flew York
dir-
University College of fledicine
flew York.
the
by
in
l95h,
and
Psychiatry,
in
Feurology,
in
certified
‘sychiatry and Neurology.
Simultaneously he attended and gradof Psychoanalysis, Psychiatry and
Institute
1953.
In
January,
in
Physicians
for
Psychology, receiving their Certificate
Mental
of
Institute
National
the
of
June, l9Sh, he was granted a research grant
uated from the ”illiam
Alanson Fhite
Health for a 2-vear study of electroshock processes.
In September, l95h, he was
Fink
Dr.
Hillside
Hospital.
Service
at
Research
appointed Director of the
is
33, married and has one son.
_____._.__.___.___________.___.____________.._._____._______._____________.______.
38.
apaended,
page
of
is
personnel
* Bibliography
�7-20Collowing
Psvcuiatry:
in
Assistant
(b) Dr. Joseph Jaffe, h.D.,
the
attended
Jaffe
Dr.
l9hh),
(B.A.,
Columbia
College
at
studies
undergraduate
Then
19b7.
M.D.
in
his
and.was
granted
of
hedicine,
College
New vorlr. University
he
began
interneship,
rotating
a
he was elected to Alpha Omega Alpha. Followinr
resident
a
as
First
Hospital.
DelleVue
Psychiatric
the
at
of
study
three years
U.S.P.H.S.
posta
as
studies
his
he
completed
in psychiatry, then in neurology,
lender.
3.
Morris
Dr.
of
doctoral research fellow under the supervision
from
graduating
Air
Force,
States
United
the
in
he
was
1953,
From 1951, to
Air
Eitchell
the
at
Psychiatrist
Chief
He
was
fiedicine.
Aviation
the School of
Force Base Hospital.
prac—
the
private
been
in
has
he
service
Since discharge from the military
of
Board
American
the
by
psychiatry
in
He
certified
was
tice of psychiatry.
psychoin
candidate
been
he
a
has
Since
l9h9,
1953.
in
and
Neurology
Psychiatry
Psychiatry
Psychoanalysis,
of
Institute
'hite
Alanson
analysis at the William
the
at
Assistant
Research
been
has
a
two
years
the
and
past
for
and Psychology
in
position
present
to
his
He
was appointed
Mount Sinai Hospital of New York.
September, 1955.
Chemist:
Chief
Ph.D.,
Goldenberg,
(0) Dr. Harry
A
graduate of the
Tremaine
of
a
recipient
York
New
in
of
the
City
of
College
D.
in
”h.
his
received
Goldenberg
Dr.
Scholarship and graduated cum laude.
in
instructor
He
been
has
an
Brooklyn.
of
Institute
from
‘olytechnic
the
l9h9
l9hh, he was the
College
Brooklyn
and
at
(l9h6-h7)
biochemistry at the Dolytechnic Institute
Natthe
of
enzymology
Fellow
in
Research
he
l9h7~h9
was
a
In
(1951 to date).
ional Institute
of Health, and from 1950
the
to
chemist
he
was
a
1952,
to
methods
enzyme
studying
of
Brooklyn
Hospital
Jewish
the
at
U.S.D.H.S. project
in clinical chemistry.
�...27..
Dr. Robert L. Iahn, Ph.D., Assistant in Psychology:
(d)
After
graduation from Brooklyn College in l9h0, he undertook graduate studies at
Columbia University. These studies were interrupted by four years of service
and
School
Dsyc‘hology
went
he
Clinical
to
where
United
Army,
States
in the
On
and
overseas.
country
in
this
various
hospitals
served as psychologist in
of
Neurology
the
Department
in
Research
T’syc‘iologist
became
he
the
army
leaving
of the
Mount
of Dr.
horris
Sinai Hospital in
New
York, where he wormed under the supervision
B. Bender and Dr. E. A.
"einstein until January, 1955.
is
He
of
monograph,
the
and
co-author
is
studies,
experimental
of
numerous
the author
"Denial of Illness:
He
Symbolic and Physiological Aspects" published
received his Ph.D. from the
New
in
May, 1955.
York University School of Graduate Arts
instructor of psychology at Brooklyn and Huntto
been
he
a.consultant
has
two
two
For
the
past
fbr
years
years.
er Colleges
conducted
and
has
training proMental
of
Hygiene
New
York
Department
State
the
and Sciences in 1953, and
was an
he
been
has
1955,
a
Since
January,
mental
the
of
several
hospitals.
in
grams
member
of this
staff.
(e) Dr.
Hyman
years of military service,
received his 3.8. in
ogy
interns at
York
four
Following
Psychology:
in
Assistant
Ph.D.,
Korin,
he matriculated
l9h9, and
at College of the City of
his H.S. in 1950. During 1951-52 he
the Hount Sinai Hospital and
University.
New
was
York and
psychol-
matriculated for his Ph.D. at
New
Since June, 1953, he has been Research Assistant in Psychology
at Hillside Hospital.
He
recently completed his doctoral thesis on
"The
Effects
of filectroshock on Retroactive Inhibition," and received his Ph.D. in October,
1955.
his'L.
F.
(f) Dr. Arnold Blumberg, H.D., Internist: Dr. Blumberg received
from the University of Pennsylvania in l9h2, for studies in physiology,
and in l9h5, received his E.D. from
the
Mew
York
University College of Medicine.
continued
he
two
of
and
service,
military
years
interneship
Following a rotating
1952.
l9h8
First
from
to
Memorial
Goldwater
Hospital
at
his residency training
�-28he
completed
Fellow
Medicine,
in
then
a
as
as a resident in neuropsychiatry,
He
has
1950-1952.
Division
Research
the
his studies as a Research Fellow in
been a Fellow in
Medicine
at the
New York
University College of Medicine,
1951-Sh.
He was
is
an
certified
Internal Medicine in l95h and
of Physicians. He is the associate
by the American Board of
associate of the American
Attending Internist at Hillside
Academy
Hospital and has'been
directly responsible fa'
of
coordinator
well
as
as
Research
Service,
the physiological studies of the
the biochemical programs.
3. Function of Research Service:
the
Research
Service,
the
of
research
programs
In addition to the
with
actively
They
cooperate
functions.
staff is active in two additional
research
who
on
part-time
carrying
are
those members of the hospital staff
In such instances, aid
nature.
of
clinical
a
chiefly
projects,
the
planning
of
goals,
project
clarification
the
is given in
and design of programs, and
is needed.
and
during
in
is
progress,
program
Secondly, an active resident training
independon
an
to
opportunity
carry
an
given
is
the third year, each resident
been
have
two
service
projects
of
this
ent project. Since the development
such technical assistance as
the
include
projects
completed, and three are
testosterone
of
and
the
use
states
anxiety
in
of
reserpine
clinical evaluation
include
resident
At
projects
present,
coma
therapy.
insulin
to
adjuvant
an
as
now
active.
The completed
a
factor,
therapeutic
milieu
a
as
the
of
hospital
a study
clinical evaluation
and
clinical,
coma
therapy
insulin
for
substitute
a
of chlorpromazine as
aMbivalence.
of
measures
and
tachistoscopic
psychologic
�-29In
May, 1955,
the Research Service established
a.
liason with the Sloan-
York
of
steroid
New
out
study
to
cooperative
a
of
Institute
carry
Kettering
excretion rates in psychotic patients, with emphasis on the patterns altered
during and following electroshock thefapy.
�-30..
VII,
M
PRESENT BUDGET AND REQUESTED SUPYOR :
Budget and Present Support:
1. Present anus—“u
The following is the full budget of the Research Service
for the fiscal year l9SSmS6. The major Share of the program is supported
by the Board of Directors, supplemented by grants of the United States Public Health Service. Under Grant M—927 of the National Institute of Mental
Health, $1h,807 of direct costs and $2221 of overhead costs was granted
for the year September 1, 1955 to August 31, 1956. This grant is the second
year of a 2-year grant for neurophysiological studies including the present
Electroshock Evaluation Study.
awarded $6500
The
National Institute of Arthritis has
for the second year of a twoayear grant for biochemical studies.
�~31-
1.
w.-
'
Board of Directors
U.S.P.H.S.
15,000‘
15,000
-——-
Psychiatry*
7,200
7,200
--—
Research Assistant in
Psychology
8,000
-——-—
8,000
Research Assistant in
Psychology
5,000
-—-—-
5,000
2,520
2,520
-————
Chief Chemist
8,600
8,600
-—-—-
Assistant
Chemist
h,000
__—-
h,000
Assistant Chemist
2,800
2,800
-——-
Assistant in Chemistry
1,800
-——-
1,800
h50
-—-—
h50
3,810
2,253
1,557
1,200
1,000
200
Personnel
Director of Research
Psychiatgz:
Research Assistant in
7E0 Technician
-
Secretary
Biochemistgz:
2.
Equipment
3. Consumable supplies
h. Travel - Conferences
Total
Overhead
TOTAL
* 3/5 time to September 1956.
60,380
39,373
21,007
2,521
______
2,521
62,901
39,373
23,528
�.32..
2. Requestegjg‘udgetagr Support:
A.
include
requirements of the Electroshock Therapy Evaluation Project
The
two
two
of
other
modification
the
to
professional staff,
additions
specific allocations of equipment funds.
(1) Psychiatrist: The cooperation of an additional full time psycoma
insulin
include
of
to
the
study
the
needed
to enlarge
scope
chiatrist is
positions,
and
of
evaluations
the
in
to
assist
control
the
study;
therapy; to supervise
diange in patients
and carry out follow-up
studies.
For
this position, an-
alytic experience is essential.
(2)
Physiologist or Heurophysiologist:
Present physiological studies
of
Further
physiostudy
and
the
Internist.
Director
the
out
by
carried
are
by
full-time
a
of
studies
these
coordination
the
changes
requires
logical
physiologist,
(3)
M.D.
or Ph.D.
Equipment:
and physiology.
For
Present needs are focused in two areas
-
biochemistry
further refined studies of the steroid sulfate patterns
mechanical
and
a
Beckman.Spectrophotometer
the
attachment
for
a recording
carry out the anticipated physiological
studies modifications and attachments to the electroencephalograph are
shaker (Dubnoff) are requested.
To
suggested.
following budget is one suggested to continue the present proneeded
completo
the
of
1956
personnel
addition
the
with
July
1,
gnmn after
ment the present staff. The budget is divided into three categories, followB.
The
Research
Serthe
coordinated
in
which
divisions
are
the
three
laboratory
ing
and
five
period,
a
for
the
for
year
Estimates
listed
first
year,
are
vice.
including projected salary increments.
�M
First
1. Psvchiatqz:
a. Director
Secretary
Conferences
13
Year
Five Year Total
(20,-25,000)
20,000
112,500
(2,6-3,100)
2,600
1,200
11,220
(15,-18,000)
(15,-18,000)
15,000
15,000
9,000
5,500
82,500
82,500
52,500
35,000
1,200
3,600
. Personnel
1. Psychiatrist
2. Psychiatrist
3. Eeychologist
13.. Psychologist
c. Supplies
Subtotal
-
&
(
9"12:OOO)
(5’5' 8,500)
Equipment
388,820
69,500
Psychiatry
2. Neurophysiologx:
a. Personnel
9,000
3,600
52,500
12,000
b. Equipment
1,000
1,000
c. Supplies
1,200
6,000
1. Physiologist
2. Technician
(9,-12,000)
(3 : 641-31400)
71,500
10,800
Subtotal - Neurophysiology
3. Biochemistry:
a. Personnel
Chief Chemist (9,-11,000)
9,000
6,000
0,000
1,800
36,000
25,000
11,200
b . Equipment
7,000
7,000
0. Supplies
1,500
7,500
1.
2.
3.
h.
Chemist
Chemist
issistant
Subtotal - Biochemistry
(6,-8,h00)
(bu-6,000)
(1,8—2,600)
29,300
137,700
�Total
First
-
All Programs
..
All Programs
113,600
598,020
17,0h0
89,700
130,6h0
687,720
Overhead Allowance\(15%)
TOTAL
Five Year Total
Year
C. Budget Reconciliation:
1. Salaries:
The
salary range for each item is consistent with pre-
sent positions established at the hospital, or for
new
positions, with neighbor-
for supervising psychiatrists is
$12,-15,000, with a projected revision to the stated scale in 1956.
ing
institutions. Present salary
2. Equipment:
ment expenditure
ance
range
For psychiatry, the
initial year
includes the equip-
for tape recording system (#600) and an annual
for expenses.
The
$600 allow—
physiological equipment expense (51000) is to allow
modification of present electroencephalographic equipment to
record other physiological indices.
The
expenditure for supplies includes
allowances for consumable items and the provision for the building of specialIized equipment.
In biochemistry, the
a recording attachment for the
Beckman
intiial
expenditure includes $7,200 for
spectrophotometer and 9800 for a Dubnoff
shaker.
3. Conferences:
Present budgetary items include this
of the Director or members of the
sum
for the use
staff to attend appropriate scientific
meet-
ings.
h. Overhead: Consistent with hospital policy and recent administrative
changes in other
grants, a
15%
allowance
is requested.
This amount includes
hospital allocations for Social Security coverage; and for such contingencies
in the expenses of the program as not reg iring a significant alteration in the
budget.
5. Subtotals and Total: The budget is presented in three sections,
representing natural subdivisions of the program, thereby allowing for modifications in support.
�VII.
APPENDIX
A. REFERENCES:
from
Discharged
317
Patients
of
Study
Follow-up
H.L.
RACHLIN,
2E.§i:
1.
in
Hosp.,
Hillside
press.
l?50,
J.
in
Hillside Hospital
and
other
Psychosurgery
Shock
Treatment,
2. KALINOWSKY, L.B. and HOCH, P.H.:
New
York,
Grune
Stratton,
(2nd
a
ed.),
Somatic Treatment in Psychiatry
1952.
19h8.
397,
Mil.
Surg.
$92:
Theories,
Shock
Therapy
Fifth
GORDON,
H.L.:
3.
and
Dsvchiatry,
Neurology
of
Foundations
h. GELLHORN, E.' Physiological
1953.
Minneopblis,
Hinnesota
Press,
University of
Nervous
Autonomic
H.C.:
S.a FNNKENSTEIN, D.H.,
Ment.
3
Nerv.
J.
Shock
Treatment,
System Changes Following Electric
GREENBLATT, M.
Dis.
329%.: 2109,
and
SOLOMON,
19,480
Which
PreA
Test
H.C.:
5.b FUNKENSTEIN, D.H., GREENBLATT, M.,
Schizophrenic
on
Treatment
Shock
Electric
of
dicts the Clinical Effects
1950.
889,
Am.
199:
Psychiat.
J.
Patients,
AND SOLOMON,
5.0.
Autonomic
Changes
H.C.:
SOLOMON,
and
M.,
FUNKENSTEIN, D.H.,
&
Nerv.
J.
Patients,
in
Mentally
Changes
Psychologic
Paralleling
GREENBLATT,
Ment. Dis.
6.a.
11;: 1, 1951.
Ill
Exthe
and
in
HOAGLAND, H. et al: Changes in the Electroencephalogram
of
AgitTherapy
Electro-shock
Accompanying
cretion of T7-Ketosteroids
19h6.
Med.
§32h6,
Psychosom.
ated Depression,
Excretion
on
Treatment
of
Effect
B.H.:
6.b. ALTSCHULE, N.D. and
&
Neurol.
Arch.
Mental
Disease,
with
Patients
in
of l7-Ketosteroids
1950.
516,
éfi:
Psychiat.
Cortins
of
Excretion
the
on
Convulsive
Therapy
6.c. ASHBY,‘W. 1.: Effects of
19h9.
275,
Ment.
Sci.
23:
and Ketosteroids, J.
PARKHURST,
Excretl7-Ketosteroid
the
of
Studies
Chromatographic
H.
WERBIN,
7.a.
gt El:
Hosp.,
Hillside
Normal
J.
Individuals,
and
ion Datterns of Psychotic
195,40
2011,
2:
l7~
Neutral
of
Urinary
The
Fractionation
S.
R.:
M.
STITCH,
and
REISS,
7.b.
Ment.
$99:
Sci.,
J.
Male
Schizophrenics,
Chronic
from
Ketosteroids
7011, 195,40
8.
ASHBY, W.
R.:
Mode
22: 202, 1952.
of Action of Electro-Convulsive Therapy,
J.
Ment. Sci.
�.36...
9.
Shock
Therapy,
Hypoglycemic
and
JELLIFFE, S. E.: Discussion on Insulin
1937.
200,
&
2Q:
Psychiat.
Arch. Neurol.
of
Aspects
Psychologic
Certain
0n
E.
MOSSE,
9.:
and
J.A.B.
10. MILLETT,
l9hh.
226,
Med.
6:
Electroshock Therapy, Psychosom.
Shock
Electric
with
Treated
Patients
in
Functioning
Memory
ZUBIN,
J.:
lla.
l9h8.
33,
Dersonality
Therapy, J.
ll:
on
Therapy
Convulsive
Electric
of
Effect
S.E.:
BARRERA,
and
ZUBIN,
11b.
J.,
596,
l9hl.
fig:
Biol.
Soc.
Exper.
Hemory, Proc.
Assoword
the
on
Performance
on
Shock
Therapy
of
:
Effects
ZEAEAN,
J.
12,
19h7.
Association,
Psychological
Eastern
the
at
Presented
ciation Test.
J.
Treatments,
Convulsive
Electric
Following
Loss
Memory
JANIS,
I.L.:
13.
191.18.
Personality
1.1: 29,
der
mit
Erfabrungen
Psychopathologische
GROBE,’W.:
and
W.
BAEYER,
von,
lha.
l9h7.
163,
Psychiat.
$12:
Elektrokrampfmethode, Arch. f.
after
Patients
Mental
on
Observations
E.
STAINBROOK,
J.:
H.
and
LOWENBACH,
lhbg
l9h2.
828,
Am.
2g:
Psychiat.
J.
Electroshock,
Post—Convulsive
of
Immediate
Description
Rorschach
STAINBROOK,
E.J.:
Ibo.
19AM.
302,
&
Personality'lg:
Mental Function, Char.
Electroshock
During
Psychosis
KAHN,
and
R.L.:
LIEN,
L.,
WEIWSTFIN,
E.A.,
15a.
Am.
Psychiat.
J.
Shock
Therapy,
of
the
Theory
to
Relation
Its
Therapy:
1952.
22,
$92:
and
PhysioSymbolic
of
Illness:
Denial
KAI-1H,
R.L.:
15b. mnrsmm, F..A and
1955.
Illinois,
C.
Springfield,
Thomas,
Charles
Aspects,
logical
Ego,
the
on
Treatment
Shock
of
Effects
D.:
IMPASTATO,
and
FROSCH,
J.
16.
Psychoan. Quart. I]; 226, l9h8.
l7.
18.
19.
20.
Recent
Under
"Normal"
Person
of Electroshock on a
L.: Effect
1953.
696,
Am.
J. Psychiat. $92:
Stress,
in
(Paraphasia)
Misnaming
Non—aphasic
UEINSTEIN, E.A. and KAHN, R.L.:
1959.
72,
61:
a
Psychiat.
Neurol.
Arch.
A.M.A.
Brain
Disease,
Organic
Organic
in
Disorientation
of
Patterns
KAHN,
R.L.:
WEINSTEIN, E. A. and
1951.
21h,
&
Neurol.
I:
Brain Disease, J. Neuropath. Clin.
"47.1%.: 7-iithdrawal, Inattention,
310133,
and
mms'mm, E.A., ram-I, R.L.,
1955.
235,
&
IA:
Psychiat.
and Pain Asymbolia, A.M.A. Arch. Neurol.
ALEXANDER,
�-3721.
T‘JEII‘YST‘EIN,
&
E.
nsychiat.
A.
_6_L_l:
and mm,
772, 1950.
D.
Neurol.
Arch.
Anosognosia,
of
L.: Syndrome
"
of
Denial
Illness,
in
Factors
Personality
R.L.:
MEN,
and
22. IEINSTEIN, E.A.
1953.
§_9_:
355,
&
T.‘Ieurol.
Psychiat.
11.14.11. Arch.
23.
L.A. and LINN,
R.L., SUGABI'JIAN,
Brain
Disease,
Sodium
Organic
in
Amobarbital
of
“IEINS'I'Em, 33.11., MEN,
Am.
Use
Diagnostic
1.:
J. Psychiat.
112:
889, 1953.
21;.
Test"
"Amytal
E.A.:
H.
and
vmmsmm,
KAI-1N, R.L., PINK,
1955.
3,
Hosp.
3:
Hillside
Mental Illness, J.
in Patients with
Differential
the
in
Tests
Perceptual
NJ: Tactile
25a. DEF-HER, MB. and
1952.
21,
Hosp.,
Hillside
1:
J.
Disorders,
Psvchiatric
of
Diagnosis
Sign
8.
Diagnostic
Test
as
Face-Hand
1.1.3.:
25b. PINK, M. GREEN, M. and BINDER,
1952.
h6,
2:
Neurology,
of Organic Mental Syndrome,
ImproveClinical
and
Damage
Brain
26a. REVITCE-I, 13.: Observations on Organic
195h.
§_8_:
72,
Quart.
ment Following Protracted Insulin Coma, Psychiat.
Coma:
TreatInsulin
A
Prolonged
Case
of
M.:
26b. IC-“IALEJASSER, S. and CAPLAN,
1952.
1115,
Hosp.
1:
ment, J. Hillside
and
ClinicElectroencephalographic
26c. SHAGASS, C. and ROFSML, P."T.: Serial
&
Neurol.
A.Z"T.A.
Arch.
Coma,
Insulin
Prolonged
of
Case
al Studies in a
195b,.
705,
Psychiat. 12.:
Posthypoglycemic
in
Studies
26d. TRACER, C.L. at £1: Electroencephalographic
19530
1135,
1.32%:
Dis.
l‘ient.
Coma, Jo NerV.
Parts
of
1-5.:
Reduplication
Delusional
and
N.
FINE,
27. KAHN, R. L., GRAUBTE’ET, D.
1955.
13h,
Hosp.
g:
Hillside
Coma
Therapy, J.
Insulin
After
1Jody
the
of
Scale,
Rating
the
A
Psychiatric
of
Revision
28. MALAI‘EUD, 'T. and SANDS, S.L.:
Am. J. Psychiat. _l_9_l_l: 231, ram.
Colorimetric
Quantitative
the
for
Dyes
Basic
Use
of
29. GOLDENBERG, H.:
Chemical
Society
American
Conjugates,
Sulfate
Estimation of Steroid
1955.
'Iarch
31,
200,
Abstract,
Highspeed
by
Synthesis
Sulfate
Steriod
:
T4..
REIL’IANN,
J.
and
30. GOLDEHBERG,
Chem.
Soc.
in
Am.
press.
J.
,
Liver Supernates,
Convulof
Evaluation
the
in
Matched
Groups
Use
The
of
G.
A.
313
31.:
31. ULE'IT,
195h.
128.:
138,
July,
Menn.
Clin.
Bull.
Photoshock,
Subconvulsive
and
sive
F11 K,
(31‘.
�B.
Publications of Personnel:
Dr.
N
l.
x Fink:
Subdural Hematoma Developing during Hospitalization, Amer. J.
Psychiat., 191: 381-383, 1950 (with Dr. M. Green).
2. Patterns in Perception of Simultaneous Tests of Face and Hand,
Trans. Amer. Neurol. Assoc., 22; 250, 1950 (with Drs. M.B. Bender
and
M.
...,
Green).
ibid,
Arch. Neurol.
&
Psychiat., éé: 355-362, 1951.
Test as a Diagnostic Sign of Organic Mental Syndrome,
Neurology, 2: hé-58, 1952 (with Drs. M. B. Bender and M. Green).
The Face-Hand
Tactile Perceptual Tests in the Differential IJiagnosis of Psychiatric Disorders, J. Hillside Hosp., 1; 21—31, 1952 (with Dr. M. B.
Bender).
A
Clinical Evaluation of Carotid Angiography, Conf. Neurol., 13:
Exosomesthesia, or Displacement of Cutaneous Sensation into Extrapersonal Space, Trans. Amer. Neurol. Assoc., lg; 1952 (with Drs.
M. F. Shapiro and M. B. Bender).
....
ibid, Arch. Neurol.
&
Psychiat., éfi: h8l-h90 1952.
9. Order of Dominance in Cutaneous Perception, Trans. Amer. Neurol.
Assoc. 2E3 238~h0, 1952 (with Drs. M.B. Bender and M. Green).
10. Development of Perception of Simultaneous Tactile Stimuli in
Normal Uhildren, Neurology, 2; 27-3h, 1953 (with Dr. M. B. Bender).
11.
Perception of Simultaneous Tactile Stimuli by Mentally Retarded
Adults, J. Nerv. Ment. Dis. 111; h3-h9, 1953 (with Drs. M. B.
Bender and M. Green).
l2. Spinal Fluid Findings
2: 137, 1953 (I-rit‘n Dr.
13.
Following Cerebral Angiography, Neurology,
M.
Stein).
Statistical
Study of a Psychoanalytic Hypothesis; Absence of a
Parent as a Specific Factor Determining Choice of Neurosis, J.
Hillside Hospital, a; 67-71, 1953 (with Dr. S. Tarachow).
A
Effects of Barbiturates
15: 1953 (with Drs.
on Perception, Trans. Amer.
M. B. Bender, P. Bergman and M.
Neurol. Assoc.,
Nathanson).
Homosexuality with Panic and Paranoid States (Case Report)
Hillside Hosp., _2_: 16h-9o, 1953.
J.
16. Standardization of the Face-Hand Test, Neurology a; 211-217, 195h
(with Dr. M. Green).
�.3917.
Patterns of Perceptual Organization with Simultaneous Stimuli, Arch.
Neurol. & Psychiat., 12: 233-255, 195A (with Drs. M. B. Bender and
H. Green).
18. The Amytal Test in Patients with Mental Illness, J. Hillside Hospital,
g; 3-13, 1955 (with R. L. Kahn and E. A. Heinstein).
l9. Delusional Reduplication of Parts of
Body
After Insulin
Coma
Therapy,
Dr. Joseeh Jafiig:
1.
Perceptual Patterns During Recovery From General Anesthesia, Jour. of
Neurol. Neurosurg. & Psychiat., 1%; 316-321, 195l (with M. B. Bender).
2.
Factor of Symmetry in Tests of Double Simultaneous Stimulation, Brain,
15: 167-176, 1952 (with M.B. Bender).
Dr. Rdbert Kahn:
1. Toxicity of Quinacrine (atabrine) for Central Nervous System: Experimental
&
Human
Neurol.
Arch.
on
Psychiat., 5g: 28h—299, l9h6
Study
Subjects,
(with Dr. T. Lidz).
2. After-Imagery in Defective Fields of Vision, J. Neurol., Neurosurg. and
Psychiat., lg: 196-20h, l9h9 (with Dr. M. B. Bender).
3. A Hereditary Syndrome Characterized by Mirror Movements, Left Handedness and Organic Mental Defect, Trans. Am. Neurol. A., ZS? 22h—226,
1919 (with Drs. I. Freiman and L. Michaels).
Tumors and Vascular
15: 277-278, 1950 (with
h. Correlation of Clinical and EEG-Abnormalities in
Disease of the Brain, Trans. Am. Neurol. A.,
Drs. E. A. ieinstein and H. Strauss).
5.
Syndrome of Anosognosia, Arch. Neurol.
(with Dr. E. A. Heinstein).
&
Psychiat., ég: 772-791, 1950
6. Patterns of Disorientation in Organic Brain Bisease, J. Neuropath.
Clin. Neurol. 1; 21h-226, 1951 (with Dr. E. A. heinstein)
&
7. Nonaphasic Misnaming (Paraphasia) in Organic Brain Disease, A.M.A. Arch.
Neurol. & Psychiat., él: 72-79, 1952 (with Dr. E. A. Neinstein).
8. Preoperative and Postoperative Personality Changes Accompanying Frontal
Lobe Heningioma,
B. Schlesinger).
9.
J. Nerv.
&
Hent. Bis.,
llh;
h92-510, 1952 (with Dr.
Phenomena of Reduplication, A.M.A. Arch. Neurol. & Psychiat.,
81h, 1952 (with Drs. E. A.'Heinstein and L. A. Sugarman).
él:
808-
�uhO-
Shock Therapy, Am. J. Psychiat.,
heinstein and L. Linn).
Its Relation to the
Theory of
222; 22-26, 1952 (with Drs. E. A.
10. IBychosis During Electroshock Therhpy:
'
Brain
Sodium")
Sodium
("Amytal
Organic
in
Amobarbital
of
Diagnostic
Disease, Am. J. Psychiat., 109: 12, 889-89h, 1953 (with Drs. E. A.
Ueinstein, L. A. Sugarman and L. Linn).
Use
Neurol.
Arch.
of
Denial
Factors
in
Illness,
Personality
Q2: 355—367, 1953 (with E. A. Heinstein, M.D.).
&
Psychiat.,
Behavior Disturbances Following Cataract Extraction, Am. J. Psychiat.,
and
L.
Linn).
E.
1953
A.‘
einstein
(with
Drs.
281—289,
219}
Delusional Reduplication of Parts of the Body, Brain, 7?: h5-60, l95h
(with Drs. s. A. deinstein, s. Halitz, and J. hozanshiT:
Serial Administration of the "Amytal Test" for Brain Disease: Its Diag195h
&
217-226,
Neurol.
Arch.
and
Psychiat.,
Value,
Prognostic
nostic
ll:
(with Drs. E. A. Heinstein and S. Malitz).
16. Ludic Behavior in Patients with :rain Disease, J. Hillside Hospital,
A.
Sugarman).
and
L.
B.
A.'Heinstein
l95h
(with
Drs.
98-106,
2:
17.
Test in Mental Illness, J. Hillsifie Hospital.,
(with Drs. M. Fink and E. A. fleinstein).
The Amytal
Q;
3-13, 1955
Amer.
"Irritative"
Lesions,
in
of
Functioning
Intellectual
Patterns
18.
PSychologist, 25 h02, l95h (with Dr. E. A. Meinstein).
19.
"Spatial inattention" in Patients with Localized Lesions of the CereN.
S.
l95h
(with
327-328,
Drs.
Psychologist, 2:
Pollack and M. B. Bender).
brum, Amer.
M.
Batteery,
20. The Adaptive Role of Behavior Accompanying Brain Disease as Exemplified
by the Phenomena of Reduplication, Amer. Peychologist, 2; h90, l95h (with
Dr. E. A. ieinstein).
21.
Denial of Illness: Symbolic and Physiological ASpects, Springfield, I11.,
Charles C. Thomas, 1955 (with Dr. E. A. ;einstein).
22.
Coma
Therapy,
Insulin
Body
After
of
of
Parts
the
Jelusional [@dnplication
M.
and
Fink).
D.
Graubert
1955
(with
lBh—lh7,
Drs.
J. Hillside Hosp., g:
and Pain Asymbolia, A.M.A. Arch. Neurol.
23. ’kithdrawal, Inattention,
Psychiat., 1h: 235—2h8, 1955 (with Drs.
s.
A.
neinstein ana'h.
H.
&
Slote).
Spatial Inattention in Focal Cerebral Lesions, Brain, in press (with
Drs. C. S. Battersby,
M. B.
Bender and.M. Pollack).
�25. Autokinetic Movement in Patients with Sensory and.Motor Disturbances, J.
M.
M.
and
B.
Pollack
S.
(with
Drs.
H.
Battersby,
Exp. Psychol., in press
Bender).
26. Relation Between Altered Brain thction and Denial in Electroshock Ther& Peychiat., in press (with Drs. M. Fink and
A.M.A.
Meurol.
Arch.
apy,
E. A. heinstein).
27.
Mount
Sinai
of
J.
With
Picture
Schizophrenia,
Clinical
a
Encephalitis
Hosp., a1; 1955 (with Drs. E. A. Heinstein and L. Linn).
Korin:
Dr.
.1.
The
New
Effects of Electroshock
York University, 1955.
on
Retroactive Inhibition, Ph.D. Thesis,
Dr. Hargz Goldenberg:
and
of
Amino
Acid
Esterase
Trypsin
Activities
of
the
1.
Chymotrypsin, Arch. Biochem., 22; 15h, 1950 (with V. Goldenberg).
pH Depenfience
2.
Several Derivatives of Acetyl-dl-phenylalanine, J.
5317, 1950 (with V. Goldenberg and A. McLaren).
Am. Chem.
Soc., lg:
3. Effect of Ultraviolet Light on the Specific Activity of Chymotrypsin
and Trypsin, J. Am. Chem. Soc., 72: 1131, 1951 (with A. D. McLaren).
h.
An
Ester
Leucine
of
Ethyl
Hydrolysis
the
Enzyme-Catalyzed
Into
Inquiry
Gold1951
V.
(with
Biochem.
110,
Acta,
Biophys.
1;
et
Chymotrypsin,
by
enberg and A. D. McLaren).
5. Report D-12, April 1, l9h6; cf. pp. 117-119, concerning 8-Hydroxyquinoline Method (Alcohol Extraction), in C.J. Rodden's "Analytical Chemistry
of the Manhattan Project", (with J. Greenspan, M. J. Sohuler, D. Taub,
and A. S. Carlson).
6. Calcification. V. Influence of Fluoride and Cyanide Ions in the Presence
and Absence of Magnesium, Proc. Soc. Exp.
A. L. Sobel).
Biol., 19:
719, 1951 (with
kaline Earths on Survival of the Calcify1952
(with A. E. Sobel).
695,
Exp.
Soc.
Proc.
g1:
Mechanism,
Biol.,
ing
7. Calcification. IX.Inf1uence of
A
8. Calcification. IV. Influence of Strontium and Magnesium Ions on Calcification in vitro, Proc. Soc. Exp. Biol., IQ: 716, 1951 (with A. E.
Sobel and A. Hanok5.
9. Calcification. XI. Studies of the Incorporation of Citrate in Calcification in vitro J. Dent. Res., 3;: L97, 19Sh (with A. E. Sobel
and E. Schmeriler).
�~h2§
Ions
and
Cyanide
Fluride
by
Inhibition
10. Calcification. XII. Cation-Linked
& Hed., éé: 27S,
Biol.
Soc.
Exp.
Proc.
in B-GlycerophOSphate Medium,
l9Sh (with A. E. Sobel).
19Sh.
26:
690,
Chem.,
Anal.
Plots,
ll.
Rectification of Nonlinear Beer's
12.
Curves.
Nonlinear
Activity
of
Rectification
Biochem. & Biophys., ég; 288, 195h.
Enzyme
Law
I.
Preliminary, Arch.
�Studs.“
'1
tho room.
L
01‘
91‘
the
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Width.
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tn:
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Win
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man}:
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khanm tar claatraoncophflampw
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with
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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
Research Files and Unpublished Works
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
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Progress and annual reports; research activities (folder title 2/2).
Type
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Text
Identifier
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mfp-03-01-001-0-003
Date
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1955
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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<a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965
Relation
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The Max Fink Collection
Description
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Letter to Fink; Somatic Therapy Research Program; Monthly report; Research Progress reports - Department of Biochemistry; Letters to Dr. Miller; Electroshock Therapy Evaluation Program; Annual Report - Department of Neurology;
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Research