http://exhibits.library.stonybrook.edu/mfp/files/original/130db8be85bd0b48cc58aa475a58b045.pdf bc509f8c91b02a75587679edc6e65f4e PDF Text Text J4» M 4‘ \ G: 3/22/57/ s ' Electroencephalogram in Electroshock: Role of Delta Change in Behavioral RBSponse Following the original x observations that electroshock induces changes in the electroencephalogram, clinical studies correlating snob changes with numerous In an exhaustive review of these improvement were undertaken. studies, Chusid and Pacella (1952) conclude their survey with "in our opinion, the slow wave formations after electric shock treatment bear no direct relation- ship to clinical improvement. favorable therapeutic response depends The primarily upon the administration of a certain number of treatments in each particular case,and since patients vary considerably in the degree of abnormality noted with the relationship between changes and EEG it of treatments, same number follows that any clinical recovery is largely coincidentalai. A}; A (. if‘kt" if: I /(/.fr ~”/ his/((9 F ,7 .6- , 221 [ff & \ ('1 F621,!” if , CWA/Ll’fii/I {‘QJ/QJ { (44.1. l '41 [L .6 o ’ f l! if; ,0 a’,,.€"5.,‘ \ 2x )4,er 1. '7 1‘ L-fi ! :13 > I" Bdké’vttfi’ , ”1’ ‘ ‘ flit)"; I , , , .. f, \ Mix/4.x. U ' R.» '4‘) ‘ 1/6, , I. 1| EEG (MA gr,“ I, , p. in 7,1,, V” ‘ 5 .9 4,, (3., "M /QM{ fl’szf/lff’ ,' {.4 L J“ \ (’2‘: / f’ :3 «m 1‘; .- in" O v’ w.» 1 ,2”, 41 ” A £146.11” kg,” (1 r14; 1 Q41 47‘4”! "4 1.0 7’ (nt/Z/fl/f 'I"l.-',v rr c F x9 if; 'A-b- :t {f I , x a ’, A; 5’, fl I”? (11"! ! /‘) "(Wk , /‘ (1.. 1 f) ,- $.44 , a ,c r ., ,7 ‘a K 1 �‘ -' J ’13]? .f‘ 5‘ V In an early report, Hoagland . §§L§;;(l9h6) noted a correlation between changes in the per cent time of more j disturbed behavior tr I /J"‘Z3’fa,t~x V than 13 cps activity and independent clinical ratings became more As -. T} ‘ manifest‘I, the fast activity increased. With treatment induced behavioral improvement, this activity diminished; only to reappear with a ,_‘ if '9‘!“ ‘AlerA ‘ 1“ A 3:419:4{F’finf reéitumu-ne of symptoms. ~35; ('1 I a! ‘ I .~ ‘ " v I f A“ delta response an activated by intravenous thiopentone, elicited characteristic in the treatment course, there EEG was random changes in every subject. Early irregular slow wave . A... "‘--"'-~—.. tre;;;;;E“‘EQE;eaee3¢%o <§¥¥§:nore a highly rhythmic, amplitude f £41 "I, clinical correlation. Roth (1951), reporting the high I . / Similar observationsfiwere reported by Kennard and Wilner (l9h8),without a V .v‘ 1/1 4 runs and bursts. These were chiefly activity whicht bilaterally 2 up to 200-350 microvolts and continuous duration of 30 to to synchronous cps, with voltages 3 80 seconds. When the resting record evinced rhythmic delta activity, thiopentone increased voltage and duration, spread its area and decreased its basic its frequency. Ebth believed that these changes were related to the process of recovery, and concluded: "the development of a typical 10 of the 36 patients two weeks. But who transient EEG change does not insure recovery and obtained such change failed to remit for longer than improvement in clinical condition seemed to be related l,‘.' , . , I �to the the EEG EEG change even in these patients. If changes with the therapeutic effect, are correct in connecting we it would seem.since most of the patients developed typical changes, that the physiological basis for improvement is acquired effective in promoting recovery." «amen-«AW... mzu/vx-W it may or may not prove by the majority of cases; ( urn ) y‘a—wnup-H‘QOMflh-MIAN-mwflmhfiia m m «WiniWW.iwm~mm , ., 7_ _, W_ni__u..aw»r Iz=tsagillunily agreed'that electroshock induces diffuse slowing and Meade,” (iég increased voltages in the electroencephalogram. There is 1iII some inW dam/a w dication that fast activity’, both in voltage and in per cent timel'aasae dice! dell-Ilia; enlistiées in nlxlxli; patients 2” are intensively treated, -CL¢€- who a slowing of the persistent alpha frequencies. degree, duration and The extent of the delta activity is directly related to the frequency and the number of grand mal convulsions. bInch activity is usually symmetric, and with anterior placed electrodes, appears maximal in anterior electroenceph- alographic leads. In patients received twelve to twenty treatments who have d‘xuet on a twice a week schedule, the electroencephalographic effects usually “WNJw‘A ; “flmwui_w-i «- -‘ disappear in h -8 weeks following the last treatment.§ Studies of the prep it»? p treatment \ EEG 7 characteristics failed to demonstrate any relat’ ship with " _ po;t\seizure the electro cephalogram or clinical \ onse. Similarily, there ,2,. tax: has been n report of \ r C/flu 1 L/{L-"Ligfla :14 SM K rum—i If /“ .\ a relation betwe K/ fat 6 Leg/2x,” flu”? K) J M. f.” ( thexpost treatment record x” A v, f a [If ‘ ’ _ .- V: t . �Both of these. reports emphasize a. W relation between the degree of electro- encpphalographic change and current behatioral response. Mfiflferent aSpects are emphasized, namely delta response to barbiturate activation and the beta response .2 m —‘ m-...-‘.......—...7...—....- Had other‘swlstematic studies been done, ha been that n correlation etween elec oencephalographic changes and M f: ”tax-:74“ 5": W” Cu X4,4! .z/f, behavioral response of electroshock exists. / Lack of such if indeed 6W .--, ‘ 5 r \‘p/‘ a relationship arm W Wei “)2” 40 /W does exist, may W # behavioral change, , -.’, ‘K" A_Iff measures of I, — 72:! r.«L.1/€ALI':" elm/7 ”r: fl-the relationship between EEG "’-/ g EEG Chafl geg “(W:tfl/f a” kg"; I?! or time or c) methods/of evaluating behavioral response, Whiéfux elucidatgun to reflect ' ' M/E‘C {if (vise/ZZ‘K; response and 44. . "M ‘ ���“NM messwnaithink' human” change was not clearly noticable or who showed only equivocal or transient improvement. Some showed fluctuations in behavior, at times appearing somewhat whom / improved. #1 But the changes were not sustained, so they appeared much that by the end of treatment, as they did before. are aware of the difficulties in evaluating improvement. Others might have differed in the estimates of change in these patients. In any case, by We MW.— using this threefold classification, the differences between the groups will be distinct.“ M‘fie ‘i first . ,, third subjects. these4“me ,w mgflfifiwgflhufigyé‘wflewww“L»?«up,she?w M. and WA“ s...,. 3...... suggestion of Dr. Hans Strauss (Clinical ; cou‘oinfltidfib three lead or (fnontal. '2’90' 0:" *NWt‘M *0-gis?¢flm av .J,v pgg‘gggja;“1%ngformléqfiesmefEMMMSMAa‘EE.3.9“‘3' '5" lW-s‘i «#33253 AIWJrrrw-sv‘am . ' ‘ _ ' "‘c~"‘"“M:= 5.»... ,V :4. , �. V .‘4 ,2 C. Minimallzfor Unimproved: In this group were placed seven patients was not cleanLy noticable or who showed only equivocal or change transient improvement. Some showed fluctuations in times appearing in whom behavior, at somewhat improved. But the change was not sustained, so of treatment, they appeared much as they did before. ,\‘\ that by the end are aware of the difficulties in.evaluating improvement Others J» might have differed in the estimates of change in these patients. In any case, by using this threefOld classification, the differences between the we 1 first and third groups will «*K‘EVALUATION OF EEG RECORDS: C ) be A distinct.” 1_”, 1.4 “MW, ”1, total of 160 records were obtained in these subjects. Fbllowing the suggestion ofillluills determined for three lead! and (frontal-parietal, anterior temporal;:vertex, parietal-ear lobe) for 180 seconds of recording for each lead. The delta index is defined as the per-cent time occupied by waves of 7 CpS /°ebdéflbb or slew-n. The average delta-index for the three leads, and the highest delta index in any lead were'éég'indices used in the final tabulation. Simultaneously, the record was scanned for the slowest frequency inn identified at least twice in any lead; the highest voltage of any delta wave; and the dhration of the longest burst. Uther aSpects recorded, but not used in the final e/aluation, were the regularity of burst act- ivity, slowing of alpha activity; and.the degree frequencies d'amplitude of fast act1v1t1es. These indices did not lend themselves to s atistical study; and were not identifiable in all the recordsp.’ Fast activit'es were �.u- 7 j. ,2; pézfzn Air. {in //e 4/4; xiv-sea administered by the staff psychiatrists, using electrostimulator. Treatment schedules were three times a 52/ As 9-to showed from number and of 33. varied the treatments week; patients a Reiter h? C greaémae’b clinical fewer tended the to give treatments, psychiatrist , spaced. There were 15 women and 9 men in the series, and and more __,_____.__ 49/ the ages ranged from 2h to 68 with a median of h7. EVALUATION 93 CLINICAL RESPONSE: All the patients were observed for at least eight weeks after termination of fiiéemé; the basis therapy. The patient's response to electroshock was of the resident psychiatrist's impression, staff opinion, the nurse's notes and the clinical evaluation of the supervi§gaidxlcharge of electroshock. The patients were<ilvided into three groups - markedly improved, moderately improved and unimprovedJflaeduaa3lfi§EEEEEEZEEEEJEEEEiBnIhs) response—tejeieetreshock:§ [3 A. Markedly Improved: The 11 cases in this group were regarded as showing recovery or marked improvement. These patients no longer showed the symptoms which brought them into the hospital; their doctors were better; felt they and the nurses' notes confirmed.such aSpects as being able to sleep without medication, better appetite, and improved capacity to get along with the other patients and participate in hOSpital activities. B. some improvement These six patients in this group showed but continued to manifest indications of mental illness. Moderately Improved: patients typically The showed symptomatic relief, 33;, acute depressive features might be gone, but the dramatic change so evident in the group was not apparent. Each patient continued to show some first noticable disturbance such as obsessional thinking, paranoid ideas, or somatic preoccupation. �medication could not be; controlled our evaluations of fast activity follow- 1", ing electroshe’cié are not satisfactory, and the results of Hoagland W’“‘"‘“W .m M ~ v 7,; ,,._,_.,.r..:.:..-.eew.u ttaal, ”Mina-x... .. On the basis of tho the records were placed in a rank order from the greatest abnormality to the lowest. The 160 records were then divided into third = 3 abnomality and lowest third high degree EEG m positive correlation groups = Low - i__e."upper degree abnormal- ity . , ,,,. Wflm.wrmnp~4ohm»wz 1..“ cheek? max .. __I . __' and improvement “Wm h. ,.wu...—.mmM ' om muc high een early ahno eA dc of tre tment. Tlie reco ds of the I :psyThese ) Mr"."W“, BydtiliZing these quanfications of slow wave abnormality in\ \ such EEG we be electroshock, abnormalitydnduc d duced conclude that { the in first 3 weeks ,r'response. 2. What M fur“ of treatment is essential for t flea; "3 e short term” clinical k exist between the clinical reaponse»; and then amongeach '1 1. ach of the indices, 0 er? fi\st with ity �//' I, -w _‘ Quantitative Studies of Slow Wave Activity Follgging Electroshock Despite repeated attempts: correlations between slow wave activity induced by electroshock and subsequent therapeutic outcome have been unsuccessful. tain conclusions from previous studies are warrented,.heue¥sih All Cer- patients sub- electroencephalogra‘z;b electroshock the therapy suffer alterations in jected to pliilllfi. Three patterns are generally described as 1) the slowing of the alpha frequencies; 2) the appearance of random, symmetric SIOW'wave activity, generally activitygcigiNB) diminution of beta which of high voltage progresses to burst frequencies in rate and amplitude. There is a direct relation between the degree of these changes, and the number and frequency of treatments. saturation point of change is described, which can is not increased. ment, but which, seemingly, changes are reversible. The In many be maintained by subjects a further treat- Also, such electroencephalographic rate of return of the cerebral patterns to the pre- treatment levels is generally 1 to h weeks, depending directly again on the number, frequency and the type of treatment. Another area of agreement among the cited authors ship between degree of manifest roencephalographic abnormality. few treatments and without memory is the lack of direct relation- loss and confusion and the degree of elect- Mamba» cited-of severe Cases are memory changes significant electroencephalographic change; and also of severe changes in cerebral rhythms without manifest clinical confusion or laid memory on such impairment. O Mam! 6f 5. £257 In these reports, emphasis isfrequently organic confusion also correlating poorly with clinical results 0 ,Eufiada, with �studies, however, Two cited may be 6L0 71t7¥éodf which—noted a correlation between Electroencephalographic changes and clinical improvement. amud, Kaufman and Péagcus Hoagland, Mal- +1924)» in this 19h6 study of involutional in the electroencephalogram and in the excretion of -(changes women ketosteroids 17 accomp panying electroshock therapy of agitated depression, Psychosom. Med. 8' 2h6-251,19h6lg, reported a relation between changes in their clinical me, rating scale and the per cent timeJlB cps activity;AL the bediszirbed havior became more manifest, the 13 cps activity increasedi Sivtreatmeht W induced behavioural improvement, 13 cps activity diminished. of symptoms, there was an increase in the More recently, Roth (6hanges in the % time 13 cps EEG With recurrence activity. under Barbiturate Anesthesia Produced by Electroconvulsive Treatment and Their Significance Theory of action, ECT EEG for the and Clin. Neurophys. 2: 261-280, 1951) described ekseTies-e£.sindies_in_nhieh a relationship between thiopentone induced EEG changes and the recovery process. was—elicited. Roth noted that slow Pod“ $12.94!. wave activity as seen in a routinenrecord was irregular in appearance, and he confirmed the reports that it could not be satisfactorily related to improvement. ; By administering an intravenous solution of‘;fbarbiturate thdoperitone, Beth elicited characteristic changes in the shock in every subject. Early there was random EEG irregular slow after electro- activity, which, with more treatment, increased to a highly rhythmic, bilaterally synchronous, high amplitude delta runs and bursts. These were chiefly wave 2-3 cps, with voltages of 200-350 uv and continuous durations of 30-80 seconds. pentone th: resting record increased its voltage and its basic When W duration, spread activity, thén- its area, and decreased frequency. Roth believed that these changes were related to the process of recovery,‘§i$haagh,;the a typical evinced rhythmic delta EEG ‘4” concluded: “’Enuaner, the development of change does not ensure recovery and 10 of the 36 attained such a change failed to remit for longer than patients two weeks. But who �Similar analyses of the relation of each of the indices and clinical result showed identical curves to the group curve shown before. Slide 2 shows the the relation of the delta index to improvement. to much improved group jumps index in by the 7-9 treatment; while the mod- 52% erately improved and unimproved groups 10-20% by The mean show a gradual, slow increase to the 10-12 treatment. similar set of curves is demonstrated in slide highest percent time delta in one lead. A In the next slide the mean slowest frequency 3 for‘the is recorded, mean and this too shows the same significant relationships. While the much improved patients show delta waves down to 3 cps or less by the second week of treatment, the other two groups barely reach h cps by the fourth week of treatment. Slide the 5 shows correlations for the same The much improved group show mean higher voltages by the second the fourth week the differences are perseatent for Finally, slide 6 shows highest amplitude the mean all three duration of bursts. week and by groups. The records of the much improved patients show longer bursts, averaging more than 7_ seconds by the third week of treatment. Bursts are less frequent in the unimproved and moderately improved groups and are significantly shorter here:€E:::¢::Mthe in duration. Not noted factor ofiaregulgzgity of bursts. In the lonéfibursts, wave forms frequently were more regular in frequency and amplitude, than in the other two groupsl These studies may be measures of slow wave interpreted as demonstrating that each of these activity arise from the same physiological process, and assufle the same significance function indufied by electroshock. in relation to the disturbances in cerebral �3. Finally, can these alterations in the aSpects of cerebral function which may EEG have been be correlated with other altered by electroshock? In these studies, three other indices of cerebral function were assayed! the amytal test of Weinstein and Kahn) tests of double simultaneous tactile g?) Si) stimulation/and tests of memory and recall. of these three indices, only “gigpfifit' V/ the amytal test showed a positive correlation withimprovement and with A); stoma; WW may.4, 41:2th Julia“ We 0’ is this test, the subject is interViewedm uestions o Ahbbld atdkhuus nae: alas/d autbaeaawae cafhfla ation of int venou sodium amytal, the stions are repeated errors in thQ/I-vm . e orientation, coniabulation, denial as "POSitive" amytal t:‘t, and illness and reduplicatioh are scored are indicative of cerebral dysfunction. “Ms”r Ab tal test. 9"” ,, .1, #flwwf yyyfir” \ In the next,slide, #7, the pe centage positive amytalthSts are if“ if“? compared for edéh of the three groups, «hf weeks of treat- ‘3 - , jge’difference between the much impror -i the other two groups is strfiing. While every patient in the mu_;‘; oved group had a positive gonna al by the third week of treatment, the abno \ity persistedgF ment. M was it W#7 ation with improvement. In this that there are various types of cerebralflgyefi function and that”g;:flcannot speak in gross terms of a ”Absfgeefl'thew 0“,.“ n .rvn w..,,«wm.~~m—we rm«Antw-12mm gflMéorrelat1on lath and cerebral dysfunction or organighpsychoses. muv maxim» we. \\I ‘\ \ 111; {ZENWWf’IflWW showed no can be concl EEG ‘\ ‘15 um! recall? These indices respect, \ \f transient despite continue. treatment. ‘ WW“ Rh “met”. WWW”, ‘ "New“ ewes V4799» “new“.y‘d ”fI M 51““? flag“ ”Why �* Semen, these ethe:ee pemttethe �5M5? Vt m WWM in mamm: Relating at Induced Mu nativity to WMum, Roam Dunno midonblo study and shock mom Wind ahcck 1: menu. the man at Recent tho m enema (9.6mm, at wow-1cm «that. In Mm own... chanson u a, the basin no have: obnexwd n mum at chasm of am. And) hm tor tho 01mm- rolnucn comm chum inmaumdhmmncMmaadthamquRw. hmmmm hum batman clinical Wt 1'ch emanation taunting orientation and olcctmahock nit-h changes in Mam whnrbi’cal ( mummmhngmgcf ).ondmxyandmu1( “My in 1mm: an mluaticn of ”mm mums change: function, and behavioral M, '11: our no mama 1::th mm. 0mm nan and Panama (1952) minim, up direct an an incur W. the observation b y various observers that clontrcmm change: in the olentmencoptulogm, with clinical syn-- ). Thoprcmt in thc thmnnoophalnsx-nm, a» ), slow alumni}: ta Imma- «mung In an exhaustive amm their may W mm c: than nth-tho sum nan fez-mum arm clam-la shod: mm Wmt. such a! Watt tmmt but the favorable therapeutic mmmmmmmommwnmmrfi �tmm in tha dame of tone» Wt Maul” each m can, we we abnormality noted with the hem my rahtionuhip patient: vary comidenbly in am number of hmmts, it Em mango: and is War anneal largely wincidental or maul-11y mini-ad to othrrr factors.” Yet, the alwtmcephalognphie chmgu mmnt. and Most new Wen wltagt 611:8.an that fast. tin; and in tho who activity is dimuy mum mnflsm ( Bach L» law. fluent: wha have intensively In View electromock, or the it dam, ), The to than {W appears than is a duration and mummy m W ind» in percent slowing at tho meat of delta Mar afar-and m1 and tho and with mtarlor mind in anterior aleetmmefimomphic received twelve to wimpy ramming my be 1:: voltage and W. ( of wires treatments per wok, the diuppear in us new uWhock are con:- The” in considerable nativity in mud]: ”metric, plum mutant. «hatred», In dootrowophflm. no Imam. by mart that elactmshock Mm mm» ) ( accrual» ), bath wtivity in paint“ persistent alpha ( Maud mutants dammiognphic a» last mama; ctr tho ( mum: am mu bum max-meme and humeral a. schedub effects usually ). olcotmmephalumphic to an weapons. to that a mktionahip dam changes. Tia swan �.3... do ”human. indicate we}: a Mod a relation human flung» in than :3 spa) and WW MW MW“, behavioral Wm: pentam, elicited characteristic of tmfiwmt tandem thin xeuuiy EEG Vchanges ungular to m 209—350 m! mum, ”than and. continua-nu m banana that thaw eluded: want-d by 113sz men bufienlly m mum its mm changes were (39th of and to 3 which in» Mm, high cps. with voltages up 30 $9 60 seem. when the its thiopsntono increased «creased mum ta typical a. 2 at activity, mu We spread “fly in the ”sunny appomd, slam warm harm. than. mm unravel“ resting more! mm and tmta only to ran in every subject. continued treatment. with to Winnie, cmsgd «puma. Whoa; an. ‘ mapma del‘hn' Wang... A: fem. nativity inerumdu with W” of (3.91:6) w ”want #130 tut activity (mu 9mm, aw; (1951), reporting the cm apart. Renal-ad 33 9; Momdont clinical mung; atbomionl behavior beam man: with 3 m Ifi an m its bum tummy... the games: at Waxy, and cam m change does not insure mmzy mmflmfipmtnmoewmmfailadtaréxd‘bfwlongw h * i’mfi and 1mm G (1'9 H u ”I ) won-m “a “mm the behaviaml comfitim. ‘ ‘ " :51, 9" L‘lig Yr ' II": .,,i‘3l’ ‘ V �4‘. he than tmiunf. wants; fiat ulaudtothcmmnge 1:33 the EEG mm militia“ patient» clung“ with flat therapeutic effect, tin patianta dueloped typical dung”, pmt in 0.1mm audition sound is W by tho lager-1w cf 1.9 b- «mammotof «on, we Ifmara it most» 10111:! that. the physiological hula far in. W311: any or my not pm affective in mixing waver-y." Bow thee» mmmogmphie are Mixed, ”pom «pm-m 1 solution batman the dams of elect“? change Ind cement-mt behavioral suspense. Different aspect: namely delta mm to barbiturate activation and beta. not. ivity. In tho present impetigation, quantitative aerial studio! of the dart: anyone. were undertaken to timer the following quuuonls (1.) What. in tho "lama! of the elomcophalqmphie mama to be- havioral responu 1n electroshock? (2) I: a "hummus: «mm, :1an aubgocta 931; what signification my W’ at prior ta a) In the tmtmt, 8 chums). finder-It. bipolar, hm tor an under. of tho process of electromoek therapy? 1mm semi, tmnty-four Maw wa- ianta referred for chetmhoek were studied. do!» 11-. mammalogrm an tad at. weekly intervals during and after treatment. wing destromcwphnlognph and noodle and hyperventilation chem. bonding in mmum m mum emu each molding. �' mm Commuting, the at least .6. was scanned for the slowest frequency identified twice in any land; the highest voltage of any delta wave; and. , the dur- atian of the longest period or delta bum activity. mm basis or these five indicate! eleven” nativiwma racom were phoeduinnnkordar,tmthomtmmto£dauwmfltytotho lowest. recordanudividod into The 160 3 mu m- m thirdm classified as “high degree deli: a records"; the middle third, as fmdemto dag-no Fignm delta a records”; I, II, and and than lowest min! as now degree delta III portray pin-mm mama.- and treatment records taken am- inguwlwtmatmntpomodtoemlitythethm rangeaofdel’aamtiuty indwed‘hy electmahock. b) In a second shock some at raw-tour mun, patients, ehctmncopmlogmpluc moon!- lent. ,Mflng tin treatment. second and third 531133 records, the wore obtained mks of try-stunt, initial observations were tested in weeks x after «comm W m: mum on A11 of max-aw. after first eerie: of 160 I predictive haw ofthemu patients were The prior to treat-- and two ween the named of analysis developed in the pantie response. mmmxg unselected electro- W m- at 1am «at. patient“ mupomo to the bani: at the resident “psychiatrist’u 15leth m mm, the nut: > �.7... opinion, the man's not» apex-visa in and the 61111130. evaluation of tho charge of elwbroahock. The pntients were dived-d into three groups a mob academia]: uprated and mama, A. WM! mama which «an aim: themaa‘lmtu «coming to the following criteria; :3,an These punts no longer shmd the mm Th. 11 or Inn-had immanent. hmgIt than into mm .. group were mended the 116mm; their doctors folt they warn mum and fileepuithoutmdscant-ad mkupactaasbomgamn to nation, better appetite, an! capmw to gut along with others improved and ‘ participate in B. mm Mimi pmmnt but cmtimed to try'picany shared gm, Each activities. but the The units” mm mun amt!» 01111130 K. idea, or We: m when than; a , m less 111. The a» haunt! teatum night he evident in tho first. group val not apparent . no m noticablo disturbance such an obsession). somatic pmccupauon. raved: mum not clearly noticablo, mo or who beam worse. may showed tons é! loam illness. mane 1.1191, 3&2.” mute dopresiive patinnt conflwd to thaw thinking, paranoid lb: patients in thisgmp showed change: were not mmn placed showed equivocal new patient-in or transient changes, fluctuations in bshnvior, at sum, treatment, they appeared Inch as before; however, no that times- appearing by the and of �Mesa the analyses of the mlatian batman the delta activity and clinical ratings, denominated between the proved" early appunnce of high @3290 delta nativity and the classified 861 were in the third week in patients and 88$ who were or third in m who ”lunch won rated 13. u nah high degree 691%! in the second week; 91% mutant. 0: the raced: fourth week of rated as migrated, none wan high degree delta in the weeks at tmtmnt, aim ‘1: The and 20% tare high degree delta 21 the mnsudin mu 1, ma graphical; in flgun h. can fourth week. a induced significant relationship clinical rating» 0! the meow in mucus. mmved, second 1 acme or m a i m 99am Delta mom m Indian W (7) Wed Imam-d 85:113.:- measured Mam: k} (u) 6. ( analyses mm indies: 91‘ of bursts, highest Men M 25 an 91 as o 3.6 50 M o o a an for the rolation hem-n each of mm (avenge S-Mm delta, mm, M. 133 and slowest highest 5mm an... they duration frequmy.) me the clinical rating!- In each instance, the relationship or degree or induced delta index and the clinical rating was sustained. This data will be pramud in detail in a �submmt ”port. taunIndaxotnu- 2. Em mmflmtafim, contubulation art! dmial ion: 1' B of. 11111033 in a ”matured latex-via after the: administration or intravenous mobsrbital in patients firm brain lacuna have ham sum-mm as signs of 13mm arm noted such patterns to ba illness, unless than. was evidence «and probable, themfora, that persistently tum mum or new” cerebral 11' mot subjects, ). ( We had m- m putientl hospitaliud with mm. mum elsutmahock indmed patina nmbarbim tam Wild «fibril be produced. mmmmmu ( ). It dysfunction, This was indeed mp0M< ). 1n ma, mm (58%) and 10-42 fourteen an 7-9 the m period, an am mum that um; report, nu mm cerebral dysfunction (671') at the 2h subjects, had positive period. In than Maw—four subjeotl, than new ninety-one to". sessions during the mac ital tests of therapy for which smear-rem; chumphalogrm and ambush- are availnble. Pro and poet mutant. records are not. mcludod. mmmmnmuummummamdmmmumuw sham a high relationship, both ratings of immt delta wfiviw a for the tests to each other, during therapy. In Tabla W II, as. and to clinical degree of induced with the results a: the concurrent mbarbihl mu. �W TABLE KEG II 22m .. An___%mm W rat. at Hicidle 313x Low Positive (25) 29 a 8 Negative (us) 10 15 20 Watan relation between the test data and clinical ntings of am also simifimt. In Tabla II, the ma and uobubital tout. results The me'dingtothoevomnl mmmmedgmp 27%,(5 m had n umber of with. gamma test mctm; sad” that tho cluster at with. nomad, high Em delta activity and mummy in» clinical rating. W Vi M proved rating 3.: 3 negative mm Wits). mung a: om. Email: alluifieant in the cluster at test, 19' 1nd Mo me an: activity and clued. Wand. Rat /m m\ rod ma Hunk High Dam and roman Amebazbital (29) Either Positive 33' Dam or obaz‘bital (26) hither High Dalta not Positive Amobarbital (35) Iv Immed r. M W Result! an Moderately Impmvcd 25 3 10 11 s S 1.0 21 3. Thedatain'kbluEmmnhumtommorotabmmtimdum n Simiicant by elm-aqua :t hotter than 2! 1m). of confidence. �the course of therapy in the any are rater} uriy m the It and at We initial twenty-atom petimte. ra’cdsrxzvttl who me): improved tend to develop high degree a: treatmnt, Table 1) similar and sustain ohnmtionl, it throughout mde for the are gnphically portrayed in figure 5. A EEG delta. activity the period. (figure murbitel test result” Waite of figures it and 5 presented in figme 6, which chm e mmrkable eongmm of the two 3. am to 0n» ‘ » Following the observation: event? is test date. 2 in this group, that the mch :1de patients had developed a high degree delta neurity earl: end had untamed such activity, electroememalogrm were obtained during the week: of treat-ant in undertaken Sh second and lelectmdxock consecutive patients. This study to detenine whether or net the demo «at-delta response in third in pro— dictive of the wort-eta“ thermontic outcome The recent: were sound hand during both, one a to whether h1g1 degree delte activity was who or neither of the h~6 and 7-9 treatment periods, and the data was related to the clinical «elation TABLE I? (Table IV). �Ono "W, um (16) 20 um High (1:) h (25$) a (50%) h (25$) 6 (30%) 7 (35$) 7 (35$) . Total (9‘) "' ' m 31mm 22 at the 2% 19 level of confidence; 13 �«42:» or the 131518!” the Mint 111$ delta ”tawny during tho ”00nd and third mksoftmtnant, éflmmuduuwhimmd,mhmly3motp:mu diluent high delta are so mud. The sum inflation and dome delta activity in rebut! to the Short ton The arbitrary solution of ma second based upon an 12.15 6100ka trauma. mtotmm Further sax-ion and in which the W delta beauty, persistence of 6113100. mlmtim. third week: of tmmnt was mags tmtaont of this data Wul 1&1“th m course m that the div-lop» 1211le fort. at mm:- of weeks, in round to mum: at of immanent regardlesa of tho tine in the course of thump: II continua: treatment in after 15-20 am trauma, m delta mhngea no first. manifest. subjects resulting in high is associated with 9. MM this later period. Patients given many m dolta activity Won]. msponm at mama n the at. per weak, without the mention of high dogma delta activity, a United behavioral responu an - one that is M mwm mt 5.10 placebo responu ( Difiuaaig g of three tines Wm“ significantly different than ). Intansiw uranium. at a. fmqmoy of relultant induction or high dogma dam act- was: per ivity, will damn-cu not. Thu, :1 aignifimnt behavioral name. mesa studies duonstmte a consistent missionship batman the degree and duration or induced uhctrooneephalognphie delta utivity and clinical �‘13- enlmtim at behavioral change. 3ymetr1o 1m been and automated» We at tho evidence of dysfunction (mama; centers and dyerhythuo delta system) mam (own nativity WW Strata»)... and Such indioative of an alteration in the state of consciousness, also activity is new alteration bang unouy related to the aunt-10h, mum with more and frequency and (Strauss slow Bid] wane June, et the :1, of aotivity Brit). and behavioral between Muted one. rolationohip county We m the further electroshock permit: after aspen” on. mmepmm mm no: attendmt pluliologio basis of tho electroshock shock process thus physiologic “mat We conclusion that ohangee in aunties: prom. in consciousness an 1L o No upset: of the electro- elaboration: the mention of the to the behavioral response mm neuro- .. and the eignifloanoe of these observations for a theory of the node, of action of electroshock tangy. (a) Role Won]. cerebral 2mm. change Changes and perception, prone”, whatever cause, ore In this dependent 9%. \mieteot 1: a moo-pennant in mm, Mt extmively mm, I of alteratim in ltti‘budl, judgent,thooght attending changes in cerebral Motion, documented rm liter-store. in the noumlogic electmahook has hem mum to consistently teat emanation, in a {whim Mob we alter two in- have con- to associate with �431). i has biochmm substrate or this mu- away. mm mm has hem placed an tho noctylchonm—ohonmstomso changes a (finest-in, KeEwhun), tho “Iteration 1n blood-brain burner (Aird), chug» Tower and in ionic prance” has and promnqunbm [9’99 “/fsrué /'(fl’ I‘M? 7 ,r‘ L. j 44“! [Z (3916301 and 31113391 x w A“? 5 1:34: ; I; ' ‘ 3 g a f ff V M v 1 .-‘ - mm), L; z r g» figgéfiten/ �orient-p with extensive In impatience an function. cerebral of altered states am after wherbitel, tests” mama ( Wemauin and his ) ( J ( o be” dmnetmted the pmdictiw mm of this test for arsenic cerebral Winn. Davie workers by ee extensive met-cue experience likewise, Oawendom( )and-ng ).( ), Oatmmdstnnae( ). mum“ ()huefflmdthe altered in e hm Matias. W ‘smu significancecfdiffuee other tests of unbral mm been applied seriel reunion, it. is anticipated that than, too, mule! dum- mum sponse, within the in cerebral 30.6 delhectivityueninduet chengee W tmtmt salmon to vacuum re- and e units a! the sensitivity of the test. to reflect change! mum. lame mam, elmmwbeuidtcbeenthcdormmge muctflundMiantoerMMOmrwachime behevicral respcnae. «diam The mac of belmvioral patterns induced under these is wide. 'Inprcvemnt' being a subjective evaluation On 1e 3 special one at behavionl the part. cf the name, charter that the patient 1: ‘bottor.’ Electrcehcck due not induce “immanent“; diffemt than it indwcs a mum of cmbml activity in men behavicr To the extent that. the induced behavior in deprecaed permeate is perceived as lose whining, depressed, mane 18 or move, before electroshock. or in achnophrenic patients, �.1;- 1m maximal, proved". behavior, Wham complaining, or typo 9! “an. evaluated to. as is patient mm, wmmry or harm, am, 1+. 1.. in pamuivod a: mom, mum, «ammo a; 'milprovld.‘ The paranoid, woman- Warm. pattern induced by electroshock, is «pendent on a m mm, «mammumauyam-mmtt )ummotpmm. lumbar cramp]: o! the relation be to is laflw dolt( ) ( Meow m on the of. electroencephalographic mural mom me: to be- of epileptic patients. ban» )deaeribuoymgapflspucmm ordinarilypleaant, and cooperative for his clinic visits. consistently dyarhytmc. drnm, and his 1336 0:: on. occasion he 12. than. no: cum}, an ‘1th delta activity. on the that, records m unable and 31th- mbaoqmt visit, tho m was again dynamo-ac and o a behavioral 'zhtpromnt' nu ma. 51:11::- obumtionawm roporwdbyflntt( )mdnnnndor( ). (b) Theo Our , of Electron a . 7 _ studies of the electroshock procesn have demonstrated tho ing. ntemtion in brain function in induced only in whom the greatest degrees of behavioral change max deem delta. activity in the taste as indiceu or altered indioea and sustained as noted. Wannalogm and follow— in patimtl is have mailed positive mobarbitll «:0an function, with the knowledge that other at altered brain Motion, applied in the m sex-1&1 fashion, my �‘16-'- alee show We 3mm alteration and a relation to behavioral change. have been mmeeed that the rating: pf impmvemt are value Judg- ment- of the behavioral response. L11 patient-e induced by electroshock in when cerebral wrest changes in behavior. changes are My certain patterns ere evaluated ee immved, believer. while other! are regerded u "unmoved” Immutiaeeenuespeemeeeeefthebehaviorfl. mammoftheeuba of the conditions brain altered function. We Jest recent etudiee have netted a relation of the indueed botanical Our Home was to epeeific peremlity aspecteC ).. Patten“ the neat close]: apprm-mte the “explicit verbal denial" personality greater degrees of denial, dieplem, mu ), ( euphoria and Indie beim'ior (tuning electrosheck therapy. and: edeptetime are frequently rated alarmed", and no clinical my mum at! ”m that the reletieaehip between nationality, behavioral response mm is met clear. to the behavioral reepenee The mutton of other upeete of an new finder investigation. bother new in the nun: of taproment to the induced W103. 1a the environmental w new endeegativill ledificetim Tb of infill, withdmel to excitement, overactivitw and irritebility my be considered e positive movement by may. The the met-cps.“ but a disorganization by the and maiden or goals of the therapist and the family, and their meantime �4.7 bSnoh phyeiologic milieu for an ultomtion the altered cerebral tmotion provides of the organin‘e edeptive interpersmol behavior. Changes are induced in percep- tion, language, mod. recall, and Judaism mick ponit adaptive intonation: new with the omirmmont to unfold. the type of adaptive behavior induced under these conditions which the is dependent upon the pereondity of the subject; the environment in intonation occurs; and the duration or the state or altered cerebral Man. i similar view of the electroshock process m initially expressed by Weinstun, Kuhn ( Linn and chungoe and behavioral ). who mailed the interrelationship or neurOphyeiologic room”. These etudies amplify clude anothar index or oltered broil: function and «e their obeorvotione to in- the eiootrooneuphlograme delte also broaden their initiol empheeie on the denial pmcoeo fol edeptative response, to include no the only cameo. 0. wide variety of indtcod behavioro under the conditions of altered brain faction. The description of the electroshock procese is also comietent with the observations of more 335;( ), Roth ( .) and Lire 59,5 ). This neurophysiologc-edeptive interpretation of electroshock pronides on operational definilan o! the process which has procaine or further elaboration and obeemtiono. Such an hypothesis also hoe application to an understanding of therapeutic process in insulin com. therapy ( ), lobotav and tronquillieing agents ( )e �.3transient in clinical condition improvement seemed to be related to the in these patients. If we are correct in connecting the EEG changes with the therapeutic effect it would seem, since most of the patients develop typical changes, that the physiological basis for imp EEG change even provement is acquired by the it may or majority of cases; may not prove I effective in promotingxrecovery." In the course of studies of‘g§:ered function brain induced by electro- at the Hillside Hospital\in New York, further data on the relationships between EEG changes and clinical effects of electroshock were collected. The general results of previous investigations on the alterations in the shock EEG with electroshock were confirmed, but between EEu effects and the ailgs‘ca,~ clinical result a demonstrated. was \ I are presented today: (l) The definite relationship . Three foci \\ Engpatterns following electroshock and thein\re1ation to K improvement. (2) yThe intercorrelations of different quantifications of delta activity. (3) The relation of these observations to /////X ”WM SUBJECTS aficijLQn.1 "fi-"MW‘ _ i.-..mwm_w~w T /{1 Ionic fl _ merm”wwww‘wmmm,._V.-c.-»...«——v—~~-"'” aim,” Twenty-four consecutive patients U” §§2_MEEHOD:Z§ _ -m “film“-..— a theory of electroshock shock were studi d. "“‘m'w-"MW referred for electro- m4 Electroencephalo rams were done "511* few} 1/4?! Lot/W a“: channel Medcraft instrument , needle electrodes, prior to_treatment? “Ki 8 and bipolar recording was used. Hyperventilation wea-the-ealy-activation 6034’ (L. WLALF Q44. a, ‘ technic g treatment, records were taken earths day'aitasrar?;ézfié'"v*fi‘ gurum fitter treatment. generally 25 to 31 hours MLWe 0%, 3» 1'9 CL �this point I should like to summarize our findings and express some thoughts as to their significance for a theory of electroshock action. There is little doubt that electroshock induces delta abnormality in the EEG. It is symmetric, chiefly frontal, but with increasingrtreatment, the'gequencies With became treatment leads. to spreads increasing all At slower, the amplitudes higher, the burst activity longer and more regular. While delta abnormality is present in every repord after electroshock, its degree is variable. Roth's experiment's inducing increasing delta abnormality with barbiturate are significant in predfiting the later changes induced by further electroshock. In mality some subjects however, a high degree delta abnor- is not induced despite extensive treatment. Our correlations of degree of delta abnonuality with improvement are fgggziéam:ch ism of electroshock.therapy. significant An alterationm cerebral“function and also by the ' as measured by the magma as, amytal test,* ,t'necessary pre-requisite for improvement. EEG, zaflkfl early, sustained Where such 232:::: (and in the amytal test), chan es fail to occur in the a significant clinical improvement will fail to occur in the patient's behavior. not4fighent The fact that the correlations were with memory loss, points to the possibility that this is not a significant factor in improvement. EEG In conclusion, these studies lend lapport tp a theory of EST enumerated action recently by Weinstein and one of us (Kahn). These authors postulated that improvement following electroshock is the result of the creation in the patient of a milieu of altered brain function in patterns of adaptation, particularly those of denial, may be maintained. Theib EEG studies demonstrate that an altered milieu of cerebral which new function as measured by delta abnormality is a pre-requisite for improvement. To supported. this extent the first part of the Heinstein-Kahn hypothesis is 4M.-. .1 �~5During the tram generally 25 be 31 11611113131381an ( the ) was period. words not. noun lam. Emu-mm, We... may“! Wu on a» fly, following a trauma, all Wit”. test 101' at many intervals, berm, during ”mat “him the Wmtnont WI. manly been mported pntieats organic brain and study mm hi" ). ( thaw-ml electromook tharapy m manicured w the mt: manhunt“, tins using a Bauer 0 h? eleabmatdnulator. Treatment schedules. war. three a week; and the number of ,, Won arm- thorapy, refill“ at this The all!!! wore studied by matmnu varied from to 33. 9 As patients show-d a clinical response, the psychiatrist tended to give fiver and more widely spaced treatments. Thorn are 15 women and 9 man in the can“, and the ages authaudiuoth'h mezhto EVALUATIOE 93‘. ject... 33 3'0nt for three lead “natal-ear W: total at 3.60 records were obtained in muse sub- Stmfiss ( ) the delta index was the suggestion of minnow 10210) A 69%:de (frontal-parietal, anteriar “moral .. vertex, for 180 seconds of recording for each lead. 1: defined as the per-cont tine occupied by waves at 7 0:16 The delta or SWCI'. and 1W The <36;th and load the highsat kit: for, three the combinations, average 1mm in any om lead combination mm the indim used in ma fin-1 inasmuch. �«17end tolermm', are significant factors in the behavioral nepense of the petieet to therapy, am also, in the rating! a! mane effect. sue teeters an significant in the The induced changes improvement. duration of the electroshock in cerebral function persist for 24: weeks only following even intensive courses of ti‘xerepy. In respenee ‘ W eases, the behavioral tenatedtemepeflodotalmmmmniologyo patterns of behavior we not adaptive in the mum Thackunged of the patient, and the behavior 'regreeees' to pun-treatise“ patterns. In other instance, the induced behavior in adaptive to the envirement. end, we assume, sustained therett‘ter not by the initial change in brain Noam, developedintencfienof subjectuithenflmmt. is seen by the milieu is may embd. linen in which 13 cheereetm have doctor, have, and peanut. stem a 1:1in or many. led to the conclusion that electroshock a non-specific induction or pernietent discharge mptive (pemnlihy) utilize devices not otherwise available ta - the mm when Altered cerebral fmetion the subaeeb’e different interaction with the envimmenfi These matmiswm only to have a mazrrence of disgusted or discharge in prelude: the pbyeiologic preceesea the newly fmeent mememl adaptation of the patient to the hospital after electroshock, planning but. b y of altered cerebral than” mm. � 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 A name given to the resource Relation of Electroencephalographic Changes and Improvement in Electroshock Therapy (research) Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-03-01-002-7-007 Date A point or period of time associated with an event in the lifecycle of the resource 1957 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>; Kahn, Robert L. Subject The topic of the resource <a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965 Relation A related resource The Max Fink Collection Description An account of the resource Research papers, files, and related correspondence: research with Robert L. Kahn Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Research