WNG-TERM EFFECTh OF' ELECTROCONVULSIVE THERAPY UPQNMEMORY AND PERCEPTUAL-MOTOR PERFORMANCE

UflDflTbLUMAN,

1L4NK EJOQIJMI, AND DONALD LTZMPLU

VA lio.$a4 Jcffnon Barrw*a, Mo.

Paonzn

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" I. 1 * i". Thereappear to be only two investigations that determined the cognitive effects of EC?after a number of monthst . However, in both of these studies neither controlpatients nor an adequate number of ECT patients were employed. In the reportof Pascal and Zeaman `I a patient's Wechaler-Bellevue and Rorschacb scormbefore 10 ECT and 7 months afterward were comparable. Stone'5 reported that apatient's Henmon-Nelson Test of Mental Ability score 60 days after the last `4Z ECT was comparable to her score of 7 years earlier.

An appropriate generalization in 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 LOT have been far fewer than in the presentraarch.

MTNOD

Ba were 40 male chronic schizophrenic patients in Jefferson Barracks VeteransAdministration Hospital. Twenty patients with a history of 50 or more ECT wereassigned to the LOT group, and 20 patients with no record of LOT were matchedwith individual LOT Sn for age within 5 years, race, and level of educationwithin 2 yeam, and were assigned to the control group. Four Sn 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 theBenton Visual Retention Test Form C, Administration A were administeredsatisfactorily to 18 LOT and 18 control Ss. Table I, indicates the extent of thebetween-groups matching. The LOT Ba had received from 50 to 219 LOT with

median of 89.5, and there was a range of 10 to 15 years since the bust course of LOT

TAsla 1. LuEsir 07 l3EtWiut-GMOUP MacsaNG .`N! MIAN &NDKR-GEsTsurwp BKNTON

&oaa voa ECI' AND CONTIOL. Gitour

*., ECVGroup

Main SD

Control

Mean

Gnip

SD

Ag. 45.8 4.2 43.6 4.9

Y.usaF4ucMion 10.9 2.3 10.8 2.4

Y.enolHuspitahzstion 19.8 3.6 17.3 2.6

lleodeEnorScor. 69,9 31.6 35.9 16.9

EaitanErrorbcors 19.2 8.1 14.3 6.9

No. Corrpct 2.6 1.8 3.8 2.4

--p

-...

S..

1

t:II.

4.

`Jo

The Bender-

tests that refleci

systems. The Pa

Gestalt designs'

1 the number o

scores" that cons

-. card"'. The ii

p < .005 for I

srror scores, sod

As indicated

for the ECT grou

Benton error sco;

t - i.tm, , <

LOT group and 3

For the LOT

and Bender-Gestt

Beaten error scar'

oorrect score - .4The groups T*

juvestigators mali

important in this

years of hoapitali:

were .28 for Bent

Benton number cyere .04, .27, and

The significasBender-Gestalt at

course of treatmei

more, it seems p1*damaging effect of

between number oLOT-produced itt

observation of prVested"'.

Nevertheless,

:? permanent brain ç*r to receive LOT ar

;`it has been report

orders tend to dolutely positive thq.

LOT psycbopatj%al

11NA I

jut!

NAIC

rqINID

-ã

I d.

1. BINTON, A. L. I,hovu. NewYork: &2. Esiwni, K F. si4ttntrneat. Pr

3. Kswosu, fitreftecton

4. I_ -

6. Pacu,U.

0. PsaCsL,O.

rp______

/ LONO-T**M *PPSCTh OP *LSCT&000bVUIALVL TUUAPY 33

/r UPON The Bender-Gestalt and Benton were selected because they are well established

tests that reflect brain pathology and because they have quantitative scoringsystems. The Pascal and Suttell" method of scoring for deviations on the BenderGestalt 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 eachpJO The interscorer reliability coefficients between two scorers were .90

F p < .005 for the Bender-Gestalt error scores, .97 p < .005 for the

roeptual-motor error scores, and .94 p <.005 for the Beaten number correct scores.ive treatmentsCT noon p83'- RZSULTS

slid As indicated in Table 1, the mean error score on the Bender-Gestalt was 69.9.11. There for the ECT group and 35.9 for the control group 1 a 3.84, p <.001. The meanects of ECT Benton error score was 19.2 for the ECT group and 14.3 for the control groupsither control t - 1.90, p < .05, and the mean Benton number correct sonre was 2.4 far theIn the report LOT group and 3.8 for the control group 1 a 1.82, p <.10.mchs.ch scores For the ECT group, the product moment correlation between number of ECTsported that & and Bender-Gestalt error score was .32 p <.15, between number of LOT and

the last of Benton error score .62 p <.006, and between number of ECTsod Beaten numberWI. correct score -.43p <.05.x ECT !mIZse The groups were not matched on length of hospitalization? s,variable that some

in the investigators maintain affects test performance. However, this apparently was not* important in this study, since the correlation coefficients between test score and

kth! pieseat years of hospitalization were not significant. For the ECT group, the coefficientswere .28 for Bender-Gestalt error score, .05 for Benton error score, and .05 forBenton number correct score. For the control group, the resjsctive oorrJflions

Es Veteranswere .04, .27, au4 .12.

prc ROT were Cozicbualows - -

tere matched The significantly greater error scores obtained by the LOT Bs on both theTot education Bender-Gestalt and the Beaten after a relatively long time period since the lastç course of treatment suggest that ECT cause irreversible brain damage. Further: no scorable more, it seems plausible that the cognitive impairment results from the cumulativetalt and the . damaging effect of each treatment, particularly in view of the significant correlations

nistered between number of ECT and both Benton number correct and error scores. Suchxtent of the ECT-produced structural changes would be consistent with the common clinicalEOT with a

- observation of progressive mental deterioration of epileptia, especially if UnECT treated"1.

rULMUU.Nevertheless, it cannot be inferred with complete certainty that ECT causes

permanent brain pathology. It is possible that schizophrenic patients more likelyto receive ECT are those whose psychotic symptomatology is more severe. And,it has been reported that patients with the so-called functional psychiatric die-

P

orders tend to do poorly on tests of organicity"'1. Thereforq, one cannot be abso

______

lutely positive that the LOT awl control groups were equatad for degr of pros* LOT psychopathology.

Rsnatucas2.4

1. Basms, A. L The Raiusi Benson Vinsoi Retention Tsar: Clinics ssd £zpeima4si4ppiia-2.6 lions. New York; Psychological Corporation, 1963.

2. Eawis, K F. and Htun K Aaaewiment of paraptual motor .4angm followwj ctrtsho*

I . tmatznent. Percept. met. Skills, 1966, U 1970 -

____ ____

6 9 3. KENDALL., B. &, Muaa, W. B. sad ¶14aau,T. Comparison of two methods of t4abm Ia* thur effect on cognitive functions. J. consult. Paydwt. 1956 W, 423-429.

* 2.4 *4. Nisisow, .1. M. A Tsxtbookof Clinical Neurology. kew tork: Paul B. Hoeber, 1961.

_______

6. Pac*t, 0. It. and Stnnu, k i The Bendsr4uslali Test. New York: Grune& Stratton, 1961.

* Pacsi.. 0. K. .ini Ztnini, J. B. Musuremsal of sow. usda of .ks%roavwsin$srspyotls4ivWual psànt. é.â..a P.ySL, tast, a, io-tio.

4'

I'.

:1

`aqrn.

34 USMBflT GOLDMAN, YSANK S. OOMtIL, AND DONALD 1. TZMPLSM

7. Sroti; C. P. CharacteSüo losses and gains on the Wechader Memory Scales an applied onpsyohoUcentsbdors, during, and alter a series at slsotrocoavulsive slwát use. Pap

8. Brows 0.1'. `Lasses and gains on the Mpha group e,aaminatãon as rained to aleotroconvulsiveshocks. .1. p. physiol. PspcAoL, 1947 40, 183-ISU.

* 9. Szon, C. P. Pre-dlnses tat records cxnnptred with psdormanos dunpg and after elocroconvulsive shocks. J. ohm. soc. PascAot, 1950, 46, l&4-159.

10. SUMunsstiu., .1., thMsW, W. sad MKsLSS, 0. W. An evaluation of post electroshock confuSewith the Baiter apparatus. 4mw. 1. Psycisiat, 1952, 1%, 835.838.

11. Woscuui, P. and Naciso, J. C. Electroshock convulsions and nwmory: Tb. interval beiwesalearning and shock. I. ohm. sac. Paychot, 1950,46,85-98.

12 Y*ne A. 3. The validity of so gaythologicsl tests of brain damage. PsychoS. Bull., 1964,

4$. `ZadKasiauso, it. Memory and cloctzo.eonvulsive therapy. Amer. J. PasS.,

Malvaria is a psychiatric disease proposed by Hoffer and Osmond7 thecriterion for which is simply a mauve chromatograph stain extracted Iron the urine.Mauve producers were either schizophrenic or displayed features of this diagnosis.Other studies' 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 i', but another investigator1 reported that kryptopyrrolproduced the mauve. This substance is unlikely to resultfrom tranquilizers. The Hoffer-Osmondt51 Diagnostic test HOD, a sell-rating setof true-false statements, differentiated between mauve and nonmauve producingpataenta in tke same way that it differentiated between schisophnoia and u

If malvaria is truly a valid classification or a consequence of medications

reliably and validly given for specific psychiatric disorders, then mauve-producingpatients should differ from non-mauve producers in terms of objec4ve ratiup of

and behavior such as HOD scores.

MSTUOD

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

obtai.dedj 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 s.looholic, drugaddict, psychopath, brain damaged as far as was known, or below dull-normalintelligence. Their symptoms were rated on the Wittenborn Psychiatric Rating

Scales°, and their ward behavior rated on the Nursing Observation of BehaviorScalest11. These measures were filed for scoring at a later date. The mauve andHOD 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 dalewere separated to prevent experimental bias as the project proceeded.

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4.

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The numbaslollows: par;psychotic deprt

14 2 mauve, athe mauve is n

the psychoneui

would different

invalid becaustThe schisophreactivitY, and pt

p < .01. TheIn a comp

the ROD again

born sc4es, ma

in the NODS'

chance. There

between the t%One perha

from those witi

patients were ra

pearcd in 6 of

scales different;

and belligerenc

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HOD depressic

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and if it is a 1

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hospital, so thclaimed power

groups of huntbetween smalldifferentiate an

have been impi

I. Cjwo,W.J.1968, *4, 3214

2. Ca.uo, W. 3*1, 01-97.

3. Euas,G.PsijcAiat., IS

4. IRvinE, D. Chuman urine an

6. Kai.u, 0. T

* 8. I-bryn, A.

7. Rorriat, A. a

39, 335-60.8. O'Rrnua P1966, In, hi

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inil.

$9C MALVADJA, TUE HOFFER-OSMOND DIAGNOSTIC TEST, AND TILE

BEHAVIOR OF FATLENTh'

w.

Qua's Usieeê ad XiapAuu Ossario Pqáiatric iloe$aS

P*oBLIIM

`The data were gathered front the psychiatric wards of the University Hospital Saskaloon,with eutfmna Canadian Mantal Health Crania. Analysis was salted by Las Medical M.