WNG-TERM EFFECTS OF ELECTROCONYULSJVE THERAPY UPQ

MEMORY AND PERCEPTUAL-MOTOR PERFORMANCE

HUBZRTbLDILANI

PRANK £JOOMER, AND DONALD LflMPL*R

VA Hapisal, Jçfsraon Barracks, Mo.

PROBLEM

This study investigated whether there are memory and perceptual-motordeficits in patients who have had in excess of 50 electroconvulsive treatmentsECT. A number of investigators have explored the effects of ECT upon psychological teats sensitive to organicity. These researchers usually found decreasedperformance during and shortly after a course of ECT'2 1, S. 7.5. 10. 11, 11 Thereappear to be only two investigations that determined the cognitive effects of ECTafter a number of months" ". However, in both of these studies neither controlpatients nor an adequate number of ECT patients were employed. In the reportof Pascal and Zeaman°, a patient's Wechaler-Bellevue and Rorsohach scorbefore 10 ECT and 7 months afterward were comparable. Stone" reported that &

patient's Henmon-Nelson Test of Mental Ability score 60 days alter the last o20 ECT was comparable to her score of 7 years earlier.

An appropriate generalization is that the evidence as to whether ECT causespermanent cognitive impairment is inconclusive. The studies reported in theliterature have not been controlled adequately for the assessment of such impairment. Furthermore, the number of ECT have been far fewer than in the presentrearch.

METHOD

85 were 40 male chronic schizophrenic patients in Jefferson Barracks VeteransAdministration Hospital. Twenty patients with a history of 50 or more ECT wereassigned to the ECT group, and 20 patients with no record of ECT were matchedwith individual ECT Ba for age within 5 years, race, and level of educationwithin 2 years, and were assigned to the control group. Four Ba were eliminatedfrom the ECT group two refused to participate and two produced no scorabletest responses, and their controls also were dropped. The Bender-Gestalt and theBentan Visual Retention Teat Form C, Administration A were administeredsatisfactorily to 16 ECT and 16 control Ba. Table 1 indicates the extent of thebetween-groups matching. The ECT Bs had received from 50 to 219 ECT withmedian of 69.5, and there was a range of 10 to 15 years since the last course of EC7

flats 1. IiIZTENT OP BETW&EN-GROUP MswnzNo AND Miran Bi;NDEa-GaTAiIr asp &NTONScosu lOS ECT AND CONTMUL Gaou

IECFJ3roup Control Grtp

Mean SD Mean 81

*41' 45.8 4.2 43.6 4.9

YearsoEducaiLiun 10.9 2.3 10.8 2.4

YasseHospitaliaation 19.8 3.6 17.3 2.6

Bend&Ermr&ore 69.9 31.6 35.9 15.9

BaitcnError8core 19.2 8.1 14.3 6.9

.ptaaNo.Cormct 2.6 1.8 3.8 2.4

I ,t

LO

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tests that re.flec;

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Gestalt designs'

1 the number o

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p < .005 for i

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oorrect score -.4The groupn

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important in this

years of hospitali:were .28 for Son

Benton number a

were .04, .27, and

The signlfieai

Bender-Gestalt atcourse of treatmoimore, it seems pladamaging effect of

between number oECT-produced atrobservation of prtreated `s.

Nevertheless,permanent brain çto receive ECT arat has been reportorders tend to do Ilutely positive thECT psychopatJqJ

1. BIGNTON, A. L. I.Uona. NewYork: B2. Eawis, E. F.treaunent. t...

3. KXNDALL, Btheir effect on

4. Ninsos J.

* 5. Pawn, b.

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rceptual-motorlye treatmentstOT upon pay

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! such impair

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öka Veterans

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ECT.

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The Bender-Gestalt and Benton were selected because they are well establishedtests that reflect brain pathology and because they have quantitative scoringsystems. The Pascal and Suttell' method of scoring for deviations on the Bender-Gestalt designs was employed. Two scoring systems were used for the Benton:1 the number of correct reproductions or "number correct scores", and 2 "errorscores" that consisted of a detailed analysis of specific errors in each figure of each

card°. The interscorer reliability coefficients between two scorers were .90p < .005 for the Bender-Gestalt error scores, .97 p < .005 for the etoa

error scores, and .94 p <.006 for the Benton number correct scores.

Rz5ULm

As indicated in Table 1, the mean error score on the Bender-Gestalt was 69.9for the ECT group and 35.9 for the control group 1 - 3.84, p < .001. The meanBenton error score was 19.2 for the ECT group and 14.3 for the control groupL - 1.90, p < .05, and the mean Benton number correct scoe was 2.4 fur theECT group and 3.8 for the control group I - 1.62, p <.10.

For the ECT group, the product moment correlation between number of ECTand Bender-Gestalt error score was .32 p <.15, between number of ECT andBenton error score .62 p < .005, and between number of ECT awl Benton numbercorrect score -.43 p < .05.

The groups were not matched on length of hospitalization, a variable that someinvestigators maintain affects test performance. However, this apparently was notimportant in this study, since the correlation coefficients between test score andyears of hospitalization were not significant. For the LOT group, the coefficientswere .28 for Bender-Gestalt error score, .05 for Bcnton error score, and .05 forBenton number correct spore. For the control group, the respective cop4atiooswere .04, .27, and .12.

CoNcLusioNs

The significantly greater error scores obtained by the LOT Ss on both theBender-Gestalt and the Beaten after a relatively long time period since the lastcourse of treatment suggest that LOT causes irreversible brain damage. Furthermore, it seems plausible that the cognitive impairment results from the cumulativedamaging effect of each treatment, particularly in view of the significant correlationsbetween number of ECT and both Benton number correct and error scores. SuchECT-produced structural changes would be consistent with the common clinicalobservation of progressive mental deterioration of epileptics, especially if untreated

Nevertheless, it cannot be inferred with complete certainty that LOT causes

permanent brain pathology. It is possible that schizophrenic patients more likely

to receive LOT are those whose psychotic symptomatology is more severe. And,* it has been reported that patients with the so-called functional psychiatric d*'

Orders tend to do poorly on tests of organicity°'. Thereforç, one cannot be abso

* lutely positive that the ECT a.çd control groups were equstsd for degr of proLOT psychopathology.

1. Bzrnos, A. L. TM Revised Benwn Visual Retentias Test: Cliaicai ü Exp.rinsps4aJ Applies-Lion.. New York: Psychological Corporation, 1963.

2. Eawis, E. F. and lthen E. Asseisment of p.ri*ptusl-motor rlisngw following shctresbocktreatment. Percept, snot. Skills, 1966, 31 1970.

3. ICZNDALL, B. 8., Mius, W. B. and ¶11B*LE, `F. Comparison of two m.thods of .l.$isbock intheir effect on cognitive functions. J. consult. PsychoS. 1966 W, 423-429.

4. Niziaos, J. M. A Tezlbook of Clinical Neurology. i4ew tork: Paul B. Mother, 1951.5. PASCAL, G. ft. and Su!rrzu, B. J. The BenderAJsstaJS Test. New York: Orune & Stratton, 1951.

* 6. PsscaL, 0. ft. and Zwwi, J. B. Musurerneat of some effscta of e$Vocosvulsn* bsrspy 00$4a individual pathos. .1. ala, see. PsychoS., 1961,0, 104-116.

a,

7. BroN; C. P. Characteristic losses and gains on the Wechsler Memory Scales as applied onpsychotic patients before, during, and alter & series at slectroconvulsive shocks. Ame. PspcAo!oqu4 1946 1, 245.

8. S'ron C. j. Louses and gains on the Alpha group examination as related to electroconynlalysshocks. f. cowp. physio!. Psycho!., 1947 40, 183-189.

. 9. STONE, C. P. Pre-iuusa toiL records compared with performances duripg sad after elect.roconvulsive shocks. J. aba. soc. Psycho!., 1950, 45, 154-159.

10. SUMMUISXJLL, .J., Suuua, W. and MEAUz, 0. W. An evaluation ol post electroshock coatuatouwith the Baiter apparatus. Amer. J. PsycMct , 1952, 1W, 835-838.

11. Woacan, P. and Nsaczso, I. C. Electroshock convulsions and memory: The interval betweenlearning and shock. I. aba. soc. Psycho!., 1950, 45, 85-98.

12. Yatns#A. J. The validity at some psychological tests of brain damage. Psycho!. Dull., 1954,

it `Zsuoits,E. N. and Kssiauso, It. Memory and electro-convulsive therapy. 4mc.J. Psy4iS,`49*6, lii, 646.654.

MALVARIA, THE HOFFERr.QSMOND DIAGNOSTIC TEST, AND TIL

BJwAiIOR OF PATLENTS°

w.

Qssm's Usiesity ad Kingston Ontario Psychiatric Ifcapita!

Malvaria is a psychiatric disease proposed by Hoffer and Osmond 7, thecriterion for which is simply a mauve chromatograph stain extracted froni the urine.Mauve producers were either schizophrenic or displayed features of this diagnosis.Other studies51 were less conclusive, but found these patients to be more disturbed,particularly in their thinking. A considerable relationship has been found betweenthe mauve and ingestion of certain tranquillisers"1, but anotherinvestigatort51 reported that kryptopyrrol produced the mauve. This substance is unlikely to resultfrom tranquillisers. The Hoffer-Osmond'1 Diagnostic test HOD, a sell-rating setof true-false statements, differentiated between mauve and nonmauve producingpatients in the same way that it differentiated between schizophrenS and aeu

If malvaria is truly a valid classification or a consequence of medicationsreliably and validly given for specific psychiatric disorders, then mauve-producingpatients should differ from non-mauve producers in terms of objeqtjve ratiup atauptoms and behavior such as HOD scores.

MSTZIOD

` From the psychiatric ward of a teaching general hospital, 82 patients were

obtained, all of whom were examined 4uring the first few days after admission. Only14 were on any tranquilizer, age ranged from 18 to 55, none was an alcoholic, drugaddict, psychopath, brain damaged as far as was known, or below dull-normalintelligence. Their symptoms were rated on the Wittenborn Psychiatric RatingScales°, and their ward behavior rated on the Nursing Observation of BehaviorScales". These measures were filed for scoring at a later date. The mauve andROD data were excluded from clinical use, and the results were not even known tothis investigator until long after the project was completed. Thus, all sets of datewere separated to prevent experimental bias as the project proceeded.

`The data were gathered from the psychiatric wards of the University Hospital Saskatoon,with aujmm Canadian Miitsl Health Grants. Analysi, was asitsd by the Medical Be.

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The námb

as follows: pars

psychotic depn

14 2 mauve, a

the mauve is n

the psychoneuiwould different

invalid becau&

The schizophreactivity, and pi

p < .01. The

In a coup

the HOD again

born scates, ma

in the NODS'chance. The re

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claimed power

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have been irnpi

1. Casio,W.J.1968, 14, 327-3

2. Casio, W. 3-, 91-97.

3. Eu.asn, 0.Psychiat., 1968,

4. IRvINE, 1. Chuman unne an

5. ICRLM, H. T6. Horrua, A.7. Rornii,A.i30, 335-66.

8. 0'IIaILLT P

1965, LU, `141.

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UZRBSET GOLDMAN, PlANt S. GOMER, AND DONALD 1. TZMPLSR MALvAR1A, nor

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