Electronarcosis in the treatment of schizophrenia

• Main Author: Monro, A. B.
• Published: University of Edinburgh 1949
• Subjects: 616.89
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.657934

1. An account is given of the administration of 2443 treatments by electro-narcosis to 152 patients, with special reference to the treatment of 105 vases of schizophrenia. 2. The history of the development of the method known as electro-narcosis is described. The description refers to the pioneer efforts of Leduc to introduce eiectrical anaesthesia, and deals with the experimental work on animals, in which Van Harreveld was the principal investigator. Work done on the types of current which may be used, and on the effects of electro-narcosis on cerebral metabolism and blood pressure, is summarised. An account is also given of investigations into the ineidenee and possible causation of cerebral damage following the passage of an electrical current through the brain. 3. The claims of other workers in the clinical field are set out; the lack or controls is commented on and the divergent developments in technique noted. 4. An account is given of the technique used to induce electro-narcosis, with special reference to refinements such as thiopentone premedication and movement of the electrodes. 5. The difficulties and dangers encountered are described, together with the methods of overcoming them. 6. A description of the survey of 557 cases of schizophrenia admitted to hospital during 10 years prior to the introduction of shock therapy is given, for purposes of control. 7. The results achieved after the use of electro-narcosis are set out and compared with the control group in a manner which contrasts groups of cases of similar duration of illness before treatment. 8. The value of advances in technique which diminish convulsive phenomena is discussed, and the importance of using thiopentone is stressed in this connection. The use of thiopentone is shown to have no adverse effect on therapeutic results. 9. It is argued that a doctor can treat at least twice as many patients by electro-narcosis as by insulin shock, in a given time. It is shown that the organisation of the treatment unit can be very flexible. 10. The difficulties involved in comparing two groups of schizophrenics are discussed, and the reasons for the method chosen are given. While the main emphasis is placed on clinical appraisal, the use of statistics in regard to measurable factors is defended, especially in regard to the duration of illness before treatment. 11. The electro-narcosis group is shown to be of intrinsically worse prognosis than the control group, as regards duration of illness before treatment. Yet the percentage of discharges after electro-narcosis is 41% as opposed to 35.2% in the control group. 12. Comparison of groups of similar duration of illness shows that the ratio of discharges after electro-narcosis to discharges in the, control group is approximately 5 : 3. 13. The Report of the New York State Hospitals' Commission (1944) is cited to show that the ratio of discharges in cases treated by insulin shook to discharges in a control series is 4 : 3. 14. Caution is suggested in comparing these results, especially as the former are short-term, while the latter are long-term. Emphasis is placed on the unwisdom of regarding electro-narcosis as a rival or possible successor to insulin shock treatment, but it is submitted that it has a useful place in the treatment of schizophrenia, especially where there is a shortage of medical staff. 15. The case histories of the 105 patients treated by electro-narcosis are appended in a reasonably abbreviated form.