LkC op ,vas

CONTENTS OF VOLUME 138

No. 1, JANUARY 1904

I .itiis iuldin: A Tribute 2

:uul iple I eterminants of Suicidal Efforts: Editorial. Laureae S. ICubie 3

11w Concept of Process-Reactive Seluzoplirenia: Criteria and Related Research. .Jerry higgins . 9

jsetirlaiitP vi [Ii B espec I to Scliiz phretii:t in lonozygot ic Male Twins: Some Genetic Aspects.

Linar Kringlen 20

11w itelat ionship between the Elgin and the Phillips Measures of Process-Reactive Se]iizophrenia,

Leonard Solomon aiid .liartin Zloiowski ... 32

Tue I evelopmeii t of a Self-Report Measure of the Process-Reactive Coot inuum. Leonard P.

7fnionn 1111 Jeanne 31. Giovunnoni 38

hole Perception: A Comparative Study of Good and Poor Pie-Morbid Schizophrenic Men. Joy .11.

.Vea/e Query 43

An Historical Review of the Remitting Sehizophreuias. George E. Vail/ant 48

Aln,hisli the Insanity I efeose-Why Not? Jau Katz and Joseph Goldstein 57

liii' Lay In Eerviewer in Psyehtiat ne Research. Lee .V. Ilobins and .Viels JF. Bra roe 70

The Mental Development of Es-Premature Children With Betrnlental F'il `roplasia. .lfiuaa .liurder

Genii and ll'illiun: 1. ASitrrruian - . . 79

I ;rt Ii Order and Seliii.opliren ia. S/iaradamba i/ito 87

Brief Communication. Irene AS. Forrest and Fred .11. Forrest DOW1LIUXS Co.

Book Reviews 02

No. 2, I'EnRt-ArLv 1964

The Teleological Fallacy iii I yn:uaic Pyeliilogy : Etli I ori:d . I_airrence S. Kubic 103

The Sources of Observer Variation and Bias in Clinical .1 udgnieots : I. The Item if Psychiatric ii is-

tory. Banns J. Gros: 11:4 K. lraarilte Grossman 105

1 ogroat ism and the Jedii.:tl Profession. Erir 1!. Marcus I 1-I

Field Dependence and Sophist icat ion of Body Concept in Scl:izophrcoies 1/u r Sugrroua ii

and Robert `ancro 119

Suicide Rates among Corre: it aiiil Foritien Mental lost itut ion Pat ieiits. .1 lie/art/a l'emor/ie, Y'hounas

F. Pugh niol Brian .liueilahon 124

I riteractiori of Miii ivat ii,oal a iud 1 ntig Ellee ts in An ioual Behavior ltesc:ireli . 1l. 7'. Liberson 131

l:k'ctrrjshock with and wit hoot llanluitnrae Ariest liesia: A St udv of Pat ieiut Preference. P. Ken -

net/i Huggins, Myron 7. Sandifer and William AS. Pearson 141

l-;lectro-Cl;jiical Correlates of Eiiiot iini:ul Act ivat iini of the Elect roeneephal u igrarn. Joyce 6'. Small,

.ianiee it, Stevens and I ietor Mt istu in 1-16

Ment:d Ill ness and alues iii a Ci illege Populal ii in. II 71/ian: G. Sin dli, .ioseph 7'. English and .Vorris

hansel? ionl'laittar Warts: A Case Study. 1mm 1. Valon- 163

Lnvironuneiital Stimulus Reduction as a Technique to Ehlect [lie Reactivation of Crucial Repressed

Memories. .1 nt/toni, Saran 172

fite VIP Syndrome'': A Clinical SI tidy in iluspil at Psychiatry. Wailer l1'eintraub 181

Book Reviews 194

No. 3, MAnen 1964

1iii' Bearing of Psychoanalytic Theory on Selected Issues in Research on Marginal Stimuli. Fret!

Pine 205A Sieiuad Look at Sensory Deprivation. Eugene Ziskind 223

l'syeliologieaj Eliects of Lateral ized Bas:d Gangl ia Lesions: A Factorial Stud3. JIan nd b?iklan

and Erie LenIn 233i.!Ieeu of Brain Damage ott Adaptability. Robert 1. .lleDonald 241

.1', 1 `sturhnnce in TAT Stories as a Function of Aggression-Arousing Stimulus Properties. Lloyd

II. ASituru-uzan 2-ISI Ulhilicit Personalit Iisordcr in Patients with Toxic and Non-Toxic Goiter. .Joseph .11. Lnhart,. 255

In

--

1

If

S. .tXt' LIIJNItSON, V. `

serpine DII liehavior fixati.,:.

rop. Physiol. Psycitol., 53:

Tue investigatoin of the Pit.;psychological processes:

;o' etuisiderations front tin' p

mica1 psl° 1aII:LI3Si5. in 1 `,...

1s31,'hophonnaro1oyy: Ph,,

eels on Behavior, pp. :1o2

rper, New York, 1958.?f

Analysis of the effect.

Ic drugs ott rigid behavj,,r

tsented at V Aotoiai Coop.

atherapy studies in Psyeli:1Research .4pptottiiies to Mi;

r'i!liiOII, hio, 1901.

"I'. Prolonged hypnotic si:

signs' induced iii guinea p,.

1: 40-11, 19IS.

`1'., Ei.LEN, P. AND Fxi.ioi

if soritat Ic vs. `guidance' ti.

avior rigidity iii rats. J. ii::

17-19, 1959.

- T., El.i.EN, P., Srinvairrz.

KAFKA, A. ANt GAIINON, .

dies of the effects of psyrliot r

lie iCIELVRII of gui itea pigs

,ropsvehiat., 3: 29S -303, 1902.

1'., FELDMAN, IL S. AXI Ei.ii

1VIOPLI analysis of the efferk

e as conipa red Wi Ii other i

i ad eke t it nimuisi vu

It' qdmarioacol ., 1: 351-357, 1K

T., KAFKA, A. ANO Scinv.tini,

hiordiaxejioxide tLiimriooo

hopharinacid'igicai ageit

avior in rats.' I3iucliero. P1.

3-it;, 1901.

T., KAFKA, A., Snnvawrz.

, Effect S of ilili rd ian`

0 fixated lieliavii,i iii rats. I:

riuacol., 2 : 07-75, 1913.

T., Ssiii-a, it. W. AND STERN.

1 st oWes of t lie pr d onged `h

:nval in guinea pigs.' .1. Nec.

28-34, iuoi.TM Study of Jkluz'ior 171

raw-li ill, New ork, 1949.

p iciiNNmii HLGOINS, M.D.,' MYRON U. SANIJFEB, M.D.2 AND

WILLIAM S. PEARSON, M.D.'

ii i:c'l'l0S1i0C1 WITH ANI V1TIIOUT BAIIBII'UIIATE ANESThESIA:

A STUDY OF PATIENt' PREFERENCE

j,urjxise. of this paper is to report ait

-tig:itiOfl of one controversial aspect of

;mslit,t'k therapy, namely the qutstioii if

;. or not patients prefer barbiturate

li'snt prior to the electrical shuck.

literature reports divergent points of

.V. AlVJCCtte of presliock anesthesia

`Seoline suecinylehiohine adininistra-

must always he preceded I' ItilcOIl-

:cIIt'Ss produced by pentothial, as the

:iIg of progressiv' paralysis which wouhd

tvise he felt is terilfying'' 8. Again:

anesthesia Brevital eluninates time

,e,'n'ss of the unpleasant side-effects of

.uivlcholnie chloride, such as muscular

t'ulat.ions and feel itigs of sifh teation''

hi the other hand, Hose 7 states that

:tr,'itensions about causing anxiety to the

aiit with suecitiviehohine alone are

`imndless'' provided a proper technique is

ii. Rose's technique will he d'scriied

Two studies I in `c been repi ml ed which i

`:pted to study patients' attitudes

.`.:ril different teelniitjmtes. Barker aimd

``rpe 1 studied patient preferences to

different techniques and fount! ``. . . tltat

:.uiiIicantly larger proportion of our pa-

s favoured ECT irieji with au aii's

* lj.'' While this conclusion cannot be

-:`zarded, a few criticisms may he di-

id against the method. Patients were

..vd to compare each treatment with the

before. If they could not remember

l10'Vious treatment, they werd remindedii such words as a treatment "which

You to sleep" or ``without an injection."

I `orotiu., 1ix 1-lospitul, Raleigh, NorthN.Iiua

- .:rtlt Carolina Hospitals Board of Contnd,

No tabulation was made of "no preference."

Also, the patients who received muscular

relaxant without prior anesthesia received

suxetlionium as the relaxant. It is now

believed that succinvlchoiine is superior to

suxethioinum 0.

1-lavens 3 studied "fear of treaunent"

and ``tension'' in completely unmodifiedJ*tf

compared with ECT modified with

I hiopc'mitene and succutlehohine. He con

cluded I hat there were no differences.

However, the measu n's mif ``tension'' and

"fear'' are difficult to talulate. In iieithiei'

of the two aforemeni ioued studies were the

tiatients unaware of the teclmmu1ues cut-

ployed.

From the literature it is apparent thu t

the techniques of using succiuylchiohine Vary

widely iii at least two major respects:

ioNize of snccinylchohine and the wailing

pei'iori bet weeti the suecinvlcitohine injeetunt

and the adntimiistm-ati'iit of lie electric shock.

Those who desire complete relaxation appear

to favor large doses of suceinyleliohitic itp to

50 ing. and wait about 60 seconds between

the injection and the shock. Others advoeal e

smaller doses 15-30 itig. and wait 20-30

sec ii ids.rI-vc articles on tech iii iqi ue a ic of particu

lar importance. Buckman ci a?. 2 conducted

a study in which the timing of the electrical

current was spaced at intervals after the

succinvlcholnie injection. laxiutffln relaxa-

tuin occurred about 40 seconds after the

suceinyic-holnie injection. hi this study,

also, a system of grading the degree of

muscular relaxation was developed. Because

of its practical descriptive value this system

Vns adopted for tIte present study and will

be described subsequently unci er met hod oh-

141

-_ L

itose 7 has reported a teeluintue used

in 3000 treatments with 25 mg. females

and 30 mg. males of suecinvlelioline with

out barbiturates. Tie emphasized the timing

of the electroshock treatment. lie asked the

patient to raise his ann at a right angle and

keel it there as long as possible. When the

arm began to fall, the electroshock was

given. Tins was "usually between 5-IS

seconds'' after the injection, occasionally

prolonged to 30 seconds. Hose states that

the disagreeable clinking sensa tim i appears

of/ri t lie relaxu tiori of the ann, and is there-

fore riot a prolileiii With his technique.

Tue present hypothesis was that patients

would prefer ECT with barbiturate anes-

thiesia to E'T vitlnnit barbiturate anes-

theshi. Tim rationale for using an iritra-

-elioiis barbiturate before ECT is that tIre

patient s apprcln'nsioin at the time if treat-

merit arid his suhseqiieii t painful memories

can he red treed. haunt iwsl;v and i-loch tS

clearly state that the addition of an aries-

thetic increases the iiiuoediate risk. Some

clinicians are riot impressed by the differ-

ences in the patienrt's lear tion to E'l wit hi

and wit limit 1 irhniturates and prefer to use

sueeirtvlcliohine alone. Others feel that an

anest lietic is indicated for all ECT, and its

use should he "standardized'' as part of

the ECT much the same as succinvlcholirne

has Iwein accepted as a routine part of the

ECT. Tue literature reviewed indicates that

the problems of technique arid patient coin-

fort are controversial, and a documented

studs' of the type proposed has riot heeu

repri i'ied.

ME'fliOD

Sekclwn 1/ patients: Patients selec ted for

the project were hospitalized mental pa-

tients who 1 clinically required ECT, 2

were felt to he able to communicate ade-

quately their reactions to treatment, 3 had

iro physical contrdindicatiuns for ECT or

barhitnrute anesthesia. This group included

ten males and eight females whose ages

ranged from 19 to a4 years, with varied

diagnoses but all having depression a

part of the clinical picture.

A ``i ion-project'' group of twelve patier

which met the above criteria was at.

selected, but these patients had poor veir

or entered the hospital after the project w,.

under way. i'atierits for the entire stri

were taken consecutively and no seleeti.

was made except for the above criteria.

Procedure: All patients were given E

by their own ward phvsieians. Some i

cci ved treatment t wice weekly with or.

day between treat merits, others reeem.

treatment three times weekly with one d

between each treat inert! . TI "project'' p

ieiits received treat merits in pairs. U.

treatment iii the pair was given with

hail ii Ut rate, met a rliexi ta I sod in in B revital

unit the other treatment without a barbitu

rate. "lIne two types of treatment were i.

tcited rarichinihy iii succeeding pairs. K

patieni ts received atrupiric gr. ! ion

minutes prior to either type of treatment

Admiriist ration was as follows:

1 ECT with barbiturate: A syringe Ii

cc. containing lOt ing. of inethioliexital V:

fitted with a three-way stopcock. The neetE

was introduced into tine ante-cnhital vei:

and the barbiturate injected slowly until ii

patient was unconscious, as judged by h

unresponsiveness to cnestioininig. This stat'

was produced ivi th 60-I 00 rug. averagr

75 rug. of Brevi tah. A syringe containing 2'

ing. of suceinylehohine chloride Sucnistrilt

was then attached to the stopcock and ti

cut ire 20 rug, was rapidly injected. After P'

seconds an electroshock was applied Ini

temporally using a Medcraft uiaeliiiue will

Ohissando technique and a voltage of I-f'

at 0.5 seconds. This voltage arid time svec'

selected as standard since they were felt t'

lie above the seizure threshold of airy pm

tient. it was not necessary to alter ti

voltage or time for any patient during tint

stuchy. During the course of each seizor

the degree of rehaxation was evaluated by

method pr'cnposed by Buekman ci a?. 7.

o - No ret;

- iorear

consul'

to uril

++ - i'orear

little

bend

+++ - Forcan

soft c'

- Cony''

ble.

:..spuratiohi was give

hell required.

2 ECT without

,ve except that the

1 cc. of normal saliru

`t'he ``punject'' pat

oui these t

n1r patient receive'

ethods in any given

--arily receive the 1

the saiiie sequelic

The "non-proj eel''

- :,tieats also received

l,e same techrnqu'

hey received ncr liii]

rily saecinylehohiud,

-"ut.

TIre project pat i

`t aware that dif

"ing used for altet

h;ts not directly repo

.`nunt the project did

The data were cc nil'

ar for males and or

"rviewels had no

wept for brief inte

``uit paw to aseertct

-1 nice. They were

``mw ;vhi icli pat ic r

- inn tin-project'' pa tii'i

* `lge if vluieh tech iii

`nntinerrt. Vithr c;

Itver intrechicedt

l;,t tue was c,ndltimt

ttieiit's preference

hi, further stated

142 HUGGJN5, SANIIFEIt AND PEARSON i-:r

PEMISON

ises but all having depression athe clinical picture.

cion-project 1 group of t svclve pat u1met the above criteria WLLS at

ci, but these patients had poor vc4red the hospital after the project wway Patients for the entire sUb,aken conseeutivel3- and no selectide except for the above criteria.xlure: All patients were given Etir own ivard physicians. Somet rca tmei it t ivice weekly VI t Iiftweeii treatments, others receivnt three tunes sveeklv with one 4.i each treatineiit. The "project'' preceived treatineti Is iii pails. Uitt in the pair Wits given wIt Iiit e, inetlioliexital sOliuni flrevituother treatnieii t. will tout a barbitte two types of treatment were uandtnnlv in succeed itig jmiis. .

reeei s-ed at ri J iii ie gr.

pflO I to cit lie r type of t teat ion.

titittoti was as lollows:

T with harluttirate: A syringe IaiIiiitg lOt lug. of iuelhohiexital u

III a three-way sU ijx'oelc. tfle lice':

oduce iii to the ante-cuiji tal u

aiiitliiate injected slowly until I

vas unconscious as judged by I

siveziess to utstiiiniiig. This

ineed wit Ii 00--I Of ing. aver:i:if Brevital. A s3.-riiige entaii iiiig -

uceiiiyleholine cli bride Sueust

attached to the stopcock and 1'

ing. was rapidly injected. After

an electroshock is-v applied

y Using a Mede raft machine W'r

teeltniqne and a voltage if I

tiids. This voltage and tinie w''

s standard 5111cc flies- is-crc felt -

the seizure tltresliold of any Iwas not necessary to altei r

* time for any patient during 1

tiritig the course of each sei:"

of relaxatioii is-as evalnatetl 1

°nosecl liv Buekiaa;i et a!. 7

o - No relaxation

+ - Forearms flexed on arms,

consideral de force required

to unbend the forearms

+ + - Forearms flexed on anus,

little force required to un-

bend the forearms

- Forearms not flexed; a very

soft convulsion present

+ - Convulsion barely noticea

ble.

-piration was given I positive-pressure

eli required.

2 ET is'ithoiit barbiturate: Same as

- ye except that the fit's! syringe contained

ii i-c. of normal salute.

The "project" patients is-em started al-

riiately on these two methods. Although

``li patient received t teal mcii t 1 y both

`ihiods iii any given pair, lie did not lice-

--;Lti13' receive the I at ii dt u rate and sa Ii tie

flit' same set 1ueiice f* `111 successive

The ``non-project'' or ci tnt i'ol group of

d aids also received t rca ti nen ts itt ``pa irs.''

`` same techiiiiquie was utitized except

y received 111 ha rhit urate or saline, I tnt

`tv sueeiaylel iohiiie, 20 ing., for each treat-

itt.

El te proj cc t patients were apparently

aware that dillereiit tt-chiiiques is-etc

ag used for alternate treatments. This

not directly reported, aiict ``svarcl gossip"

-it the project did not develop.

hlte data were collected Lv two clinicians,

for males and on'e for females. The iii-

tiiesvers had no contact with patients

* `lit for brief interviews after each treat-

* 1 pair to ascertain each patient's pref-

- :u-e. They were "blind," i.e., did not* `iv svliieh patients si-crc "project" or

``il-project" patients, and had no knowl-

of is-Iticli technique was used in a given

imi1eiit. `With each patient the interIi' introduced himself and indicated

lie was conducting a survey concerning-Thu!'5 preference and reactions to ECT.

Ilirtiler stated that lie knew that the

143

patient had had two treatments within

the past several days which had been ad

ministered liv his ward physic ia it; the

patiei it's preference for either treatment,

if any, was assessed. No patient indicated

that lie felt that different tech niques itt

terms of medication received accounted

for his preference. All patients were inter-

vicis-cd on time day following the last treat

ment of the pair since it was felt that

memory impairment was minimal at this

tune.

lIEst'J;rs

Of time 47 treatment pamrs a Iniinist ei'c-d

to the 18 "project" patients I tic-re was "no

preference'' in 2-1 pairs -51 pcr cciii, pref-

erenee ft ir barbiturate iii 10 pairs -10 per

ccitt and pref cit-i ice for snecittyhehiohine

alone iii four pairs 8.5 per ccitt. Of Ihie

24 paii' ad in iiiistered to 12 ``nm.ni-projeet

pal ic-mi ts, mi prelem'e mice ssas iep i rt cci iii 11

07 per ccitt. In eight pairs t: peI m'ent,

however, there was a sta ted preferm'i tee for

one treatment over II ic itlu'i- `i-eli thmirughi

tire treatments wet-c- idea! ieal. See Figmi re I .

DiscussioN

The most striking finding is that in half

the pairs svlten elect roshirim'k was adniimiis-

tered with aiict witl ioi it hiarh,itiirates "ito

preference'' was expressed. nIle fiiidings iii

the control group suggest that, in thu-se

circumstances, patic-n ts ti-itch to express some

preference alont one-third of the time even

when there is ito difference. When prefer-

emices at-c expressed., they are in favor of

-barbiturates over succiiiycholine alone,

although these preferences are mild.

Them-c appear to lie at least flu-ce exphana-

finns of the present fluiching that the pa

tients' prcferc-nc-e for barbiturate-anesthesia

ECT is a mild one.

First, the dose of succiiiyiclioline might

not be sufficient to induce respiratory paraly

sis. This diose of sueeiimyiehohine, hnwes-er,

was sufficient to produce a satisfactory the-

gree of gr-neral muscular relaxation. lJti-

/

Et,EcTitOsnocx lilTi-i ANI `55iTi-1Ot'I' BATtlifl'VIIATES

144

CC

F

I-

C

C,

wo

PROJECT TREATMENT PAIRS

47118 PATIENTS

55%

`ElNo Barbiiurale SCC Atone

Preference Preferred Preferred

Ma/cs

LJ Ferna/as

j

NOW-PROJECT PAIRS

2412 PATIENTS

"Ve/ ti

No SomePreference Preference

Fit;. L Preferences of proj ec-t treat iiien I a nil non-project 18; is of sulijec Es.

liziiig the set wit ig i net In aI of lhiekman ci cii.,

the modal rclaxatuiii tot. unties was found

to I ` + + tiiirl for leniales ± + +

Second, there is alwtty the possibility

of interviewer bitis iii assessil ig t lie pat iei it

prefercrle4. Sonic protect toil against this

SOU ice of em ir was a To tiled .1 iv ha vi tig the

interviewers ``blind'' am I by their knowing

tha.t all pat tents interviewed were in it pu `ject

patients. The results obtained Iy the two

interviewers are sufficient ly sintilar to lend

confidetice to results.

A third possibility comes from the fact

that the electroshock itself usually causes

sufficient retrograde amnesia to obliterate

Ineinoiy of the brief unpleasant sensations

of the itspiratory paralysis. When the pa

tients were interviewed the day Lifter elec

troshock they displayed tin gross memory

defects, but it is here pioposed that it is the

amnesia for events immediately surrounding

the electroshock which minimizes the stated

preference for the barbitut rate method.

rfhe data have been examined to see if

such coiniiioii variables as age, sex and

diagnosis might he related to preference for

barbiturate anesthesia. These findings were

negative, as was the supposition that a

patient's choice in the first pair would

iiifhiieiiee cluirce oil subsequent lairs. "1

dividirality'' hiow-en'r does play a role.

of the patients aennuirt for 15 of the

stated preferences for barbiturate at

tltesia. The other twelve pat ieiits had

equal opportunity to cotifribiitc to "I.,

Eitii in te jiii'1i' reiiee'' hot cliii SCI only 1

ti nies. Tt vtnild lie iii t riguii rig a ml import::

to determine what dist iiigiiisl ies these -

pat iet its, Intl tl tat aspect is tint discerni!

in this study. The lresent fiiidiiigs have li

iiiterpretetl to mean that physicians slw':

not feel under obl igat 1111 to use presli

barbiturates as a routine procedure, 1

rather on art iiiclividual hasis. Further tL

on this question are now being gathered I;

ing another niethiocl, naiiiely the assessilU

of preshock anxiety in a series of trcatnui

with and without harhiitura Ic anesthesia

SUIMAIfl

Eighteen patients on eIeetro_convuili

treatment t whici received treatment with

without harli tu rates were evaluated

regard to their ``preference'' using a douib!

blind technique arid a cant rol gropp.

half the time the patients had no prefereit'

for one technique over the other. It

i: i

iirt Wii5 `X]},

of

,t 1iitI'1t' vouI

ir;tl' t reatnlei

IIEPE

* ,,hi:it, .1. `. ANi'

* n ot cleeti' plc

- Sri., 106: 112

r., 1Cm-

1-iAfl, A. S. A

e rd ,iX:

-jr,1n.1cli' ilimie U

,-k I licra1iy. Ai

,:,. j'.itai.

i:s, L. 1. A ifl

nucc;ixs, StNIJFETI AN] PEAJISON

2451%

S

4

33%

WL1S expressed, it was mildly jfl

,f barbiturates. The original hypotlie-

* *..iI patients wonld Universally prefer the

* 111j'ate treatments was not snbstan-

REFERENCES

:aan, J. C. AN! ThORPE, J. C. Au evaiua-

,.o of elect roplexy ECT techniques. .1.

l*ut. Sci., 116: 1347-1360, 1160.

I E%IAN, C., ICnnu., A., PINSLEY, 1., In-

rtSTATO, A. S. AND JMI'ASTATO, 1. .1. The

* `aderl nate relaxation i at en in'' loll owing

.,irciOyIclltlline adininist rat ion in rIce io-

-liuck therapy. Amer. 3. Psyciriat., 117: :342-

.:i5, 111130.

9 VENS, L. L. A eoinjiarat ftc study of modified

antI unmodified electric shock treatoient. 1is.

Nerv. Syst., 19: 29-34, 1958.

4. 1C.&uxowsi, L. 13. AND horn, P. H. Somatic

7'rcalmcn is in Psych retry, PP. 147-148. Crune

& St rat ton, New York, 1931.

o. TIARLINER, SI. AND PADLLA, L. *J. The use of a.

new ultra-short -acting intravenous anesthetic

in shock therapy. Artier. ,1. Psychiat., 117:

355-356, 1160.

6. Ki:u.iarnrr, 3. ANO `iir'rt.ar, It. IV. Modified

elcetroconvulsive therapy without anesthesia.

Lancet, 2: 589, 1955.

7. RosE, II. 11. A standardized technique for

inodi tied ci ect roshock t herapv rising sniceinyl-

choline chloride. Amer. J. Psychint., 116:

330-333, 1959.

S. Strwsxr, `SY. ANO SL&TER, 11. Vii ysieul l1ethm1s

of i'rcotnrcn in Psychiatry, p. 112. Living-

stone, Edinburgh, 1936.

choice oii stibsequenit jiains. `1

ly'' llflVever dries play a role.

atients acernurt for 15 of the

references for harlot oral e ar

he oilier twelve p:.ittents had

prirtruritv fri eoiiti'iliiitc III ``It

preferenee'' Im t did so ontly 1

woold lie intriguing arid iiiipurt:

-tine what IistinngiUsIies these

hut that aspect is riot discernii

dv. `ike present findings have I

ci to mean that physicians shri

nider obligation lii use presli'

es as a ]iUtiiie procedure, I

air md ivirlual basis. In rther ii:

est ion are nurnv being gatherer!

tr method, namely tire assessin

c anxiety in a series of treatnin

,vitliont barbiturate anesthesia

SFMiIAWY

patients on eleetro-convul

who received treatment with a'

a rb it u rates were evahma t ccl

ieir "preference'' Using it dou1'

ique and a control group. ft

te the patidots had no prefere

clinique over the other. If

/

`r:.cuSoN ELECTROSHOCK WITH AN WITIIOUT BAIIIJITURATES

M-PROJECT PAIRS

412 PATIENTS

C74F! iV

1

33t

1-15

No Seineference Preference

i-prriject I of sulijects.