The birth of convulsive therapy revisited: a reappraisal of László Meduna's first cohort of patients.

BACKGROUND: The introduction of convulsive therapy (COT) was undoubtedly one of the milestones in the history of psychiatry. Its originator, László Meduna, has become one of the founding fathers of biological psychiatry. METHODS: In his first major publication on COT, Meduna described the short-term treatment outcome of the first 26 schizophrenia patients who underwent camphor- or cardiazol-induced COT; 10 improved significantly, 3 appeared slightly improved, and 13 were unimproved. The original medical notes of 23 of the 26 patients were recently recovered and the patients re-diagnosed by the authors employing ICD-10 criteria. RESULTS: The diagnosis of schizophrenia was confirmed in 15 cases (all but two of them involving prominent catatonic symptomatology), while 2 cases met diagnostic criteria for schizoaffective disorder, 3 for Bipolar Affective Disorder (BAD) with psychotic features, 1 for psychotic depression, and 1 for Acute and Transient Psychotic Disorder (ATPD). In a final case, the most probable diagnosis was schizophrenia. Scrutiny of the notes revealed that 4 schizophrenia patients evidenced slight improvement on COT and in one case the improvement was only transient. A limitation of this study is that the quality of the original files varied considerably and the re-evaluation was done retrospectively. CONCLUSIONS: A very broad concept of schizophrenia in the 1930s explains the discrepancy between the original and the revised results. In line with the current views on the effectiveness of electroconvulsive therapy, catatonic symptoms, but not the core schizophrenic process, showed some improvement while all ATPD, BAD and depressed patients responded to COT.

[The birth of convulsive therapy]. / A görcskezelés születése.

The history of the first convulsive treatment is summarized here in commemoration of its 75th anniversary. The neuropathological and clinical findings underlying the theoretical basis of the method are reviewed, together with the case histories of the first batch of patients who underwent convulsive therapy. The early indications and effectiveness of convulsive therapy are also discussed. Finally, in a broader context, the role of convulsive treatment in the development of modern biological psychiatry and Laszlo Meduna's contribution to this development touched upon.

[The birth of biological therapy in Hungary: the story of László Meduna's first patient receiving convulsive therapy]. / Biológiai terápia születése Magyarországon: Meduna László "elsô" görcskezelt betegének története.

Convulsive treatment was introduced to psychiatry by László Meduna, a Hungarian neuropsychiatrist. In his autobiography, Meduna gave a detailed description of his first patient who underwent convulsive therapy. According to Meduna's recollections, this patient was L. Zoltán, who after 4 years of fluctuating catatonic stupor received several sessions of camphor-induced convulsive therapy resulting in full remission and discharge from the institution. In this communication, the authors reconstruct L Zoltán's case history from the original case notes, which were recovered from the Archives of the National Institute of Psychiatry and Neurology, Budapest. The case notes show that L. Zoltán received courses of convulsive treatment between 1934 and 1937, first induced with camphor and then with cardiazol. After the first course of treatment the catatonic stupor was resolved and the psychotic symptoms subsided. However, this incomplete remission lasted only for a few months and was followed by a relapse. Despite further courses of convulsive therapy, L. Zoltán never became symptom free again, could never be discharged and died in the institute in 1945. The authors attempt to explain possible reasons for the discrepancies found between Meduna's account and L. Zoltán's case notes.

'A violent thunderstorm': Cardiazol treatment in British mental hospitals.

In the annals of psychiatric treatment, the advent of Cardiazol therapy has been afforded merely passing mention as a stepping-stone to the development of electroconvulsive therapy. Yet in the 1930s it was the most widely used of the major somatic treatment innovations in Britain's public mental hospitals, where its relative simplicity and safety gave it preference over the elaborate and hazardous insulin coma procedure. Devised on a dubious hypothesis of biological antagonism, Cardiazol armed psychiatry with an immediately effective weapon in the battle against schizophrenia, an enduring and debilitating condition responsible for over half of the mental hospital population. What made Cardiazol work - or appear to work? This account shows how evaluation of convulsive therapy was skewed by naive outcome measurement and diagnostic discrepancies, and how its therapeutic indication evolved from schizophrenia to affective disorders. Psychological mechanisms are considered, with the suggestion that the intense fear experienced during treatment--the major reason for abandoning Cardiazol in favour of electroshock--was therapeutically advantageous.

Notas para la historia del Manicomio General de México, década de los 40's / Notes for the history of The General Insan asylum of Mexico in the 40's

Con motivo de la inauguración del Pabellón Central del Manicomio General, en la década de los cuarenta, se inició una nueva etapa en la vida de esta institución, ya que éste contaba con una unidad de neurocirugía, un departamento de oftalmología, electroencefalografía, rayos X y otros servicios. Es la época de los tratamientos de choque, que se describen ampliamente. Exitos y fracasos son señalados por el autor, que vivió esta importante época de la psiquiatría en México

The early history of convulsive therapies in Australia.

The early experience of convulsive therapies in Australia was reported in the Medical Journal of Australia from 1935 to 1950. Cardiazol convulsive therapy, first used in Australia in 1937, appears to have been widely employed. Electroconvulsive therapy, first used here in 1941, rapidly became accepted as a mainstream treatment. Early response rates are discussed, as well as Australian adaptations of European techniques. Clinicians of the day considered the use of these procedures carefully and were circumspect about their future role.