10.1192/bjp.104.434.221 Access the most recent version at doi:
1958 104: 221-227 Journal of Mental Science
Neville Peel Lancaster, Reuben Ralph Steinert and Isaac Frost
Unilateral Electro-Convulsive Therapy
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ISAAC FROST, B.Sc.(Hons.), M.B.,B.S., M.R.C.S.,L.R.C.P., D.P.M.
and has now become the principal
be quite insidious.
be ignored, and others of major practical importance.
is at present
effects, some of which may
enjoying whilst this method
it is not without
in a change
Juba (1948), described Gerstmann syndrome,consisting
acalculia, agraphia, and disturbances
encounteredfor a short period after the shock.
Stengel (1951), drawsa parallelism
injury,and during his condemnation
methodof treatment, states that amnesia
the brain in the conventional
is the findingthat
when an electric
severe mental impairment
et al. (1942),
which may persist
of 3â€”6 cycle/sec.
to high of moderate
on the amount of
being often of right and left laterality,
as aof intensive
can be gross, extending
* Based ona papergiven at the QuarterlyMeeting ofthe RoyalMedico-Psychological
Association at Bristol in May, 1957.
Anderson (1951), states that electro-convulsive therapy should be avoided
if possible in very superior intellectuals.
creative workfollowing electro-convulsive
students who forgot large parts of their knowledge.
Hafner (1951), believes that after eight or even less shocks, early organic
syndromes may commence. These manifest themselves as apathy and con
fusion. He states that to prevent amnesia must be a major objective of therapy.
These memory disturbances may have a legal significance in that patients
may forget for a time that they â€œ¿?wantto go homeâ€•and therefore
may constitutea means of restraint,whilst the disorientation
increase significantly the observation needed of patients given treatment on
an out-patient basis.
Stengel (1951), showedpsychoneurotics
showed arterioscleroticsparticularly susceptible
One theoretical complicationwhich is little known,
stressed, is that of eye lesions.
He cites examples of poets who ceased
therapy, andprofessors and
and we feel must be
Duke Elder (1954), states that lenticular
exposure to high voltage alternating
therapy.He stresses the following
I. After injuries due to lightning,
â€”¿?cases after 3, 6, and 11 years are reported.
2. The strength of current
3. If bilateralcataract
proximal eye precede those in the contralateral
4. Other eye disturbances
include skin burns and necrosisâ€”painless
fields, and retinal and corneal
Though we personally
ing electric shock therapy,
burns have frequently been noted. The long latent period of cataract means
that it will be many years before a verdict of innocence
It was with the object of reducing the confusion
and preventingthe passage of the current through
application of E.C.T. was startedby us.
opacities have occurred
opacities develop in 1 to 7 days. After strong
an average of 2â€”4 months with extremes of days to years
seems to bear no definite relationship
from 500 to 50,000 volts, though the
to the strength
eye by several months.
and aseptic, hair singeing, spasm
have never witnessed any serious eye -lesions follow
then changes in the
associatedwith the current
contraction of visual
difficulties, and skin
can be given.
and memory disturbances
the orbits, that the unilateral
Induced Focal Fits
There are some previous references in the literature
conventional E.C.T. they are not as therapeutically
much quicker return to consciousness than when a generalized convulsion
Pacellaand Impastato (1954), used unilateral
to induced focal fits
that if focal fits occurof
but there is a
application of the electric
1958]BY N. P. LANCASTER, R. R. STEINERTAND I.FROST
lateral seizure commenced.
the other.They thought
cases who need less confusion
but used continuouscurrentgraduallyincreasing untilthe contra
focal seizures were less therapeutically
but were useful in poor
first one side of the brain and then
and paranoidrisk patients, the elderly
1. METHOD OF APPLICATION
was of the type where discharge
currentto each patient.
was the scalp at the points of application.
was chosen since it was felt that damage here would not be as important
the dominantside. The lower electrode
of the orbit and the externalauditory
upper electrode was 3 in. higher than the lower and at an angle of 70Â°to the
line. (Slight deviations from these points do not materially
150 mg. and Brevidil E 50 mg.
used had electrodes about
of a condenser gave a constant
atropine 1/75th about 45
I@ in. diameter and
were lubricatedwith Cambridge
electrodejelly as also
side of the skull
angle was midway between
meatusand 1@in. above this line. The
affect the result.)
After the passage of the current,
tion commenced again within 90 seconds, but if this was not so, positive pressure
insufllationby means of a Beaver respirator
an air way was inserted. Usually respira
2. (a) ASSESSMENT OF UNDESIRABLEEFFEcTs
This involvedthe use of three assessors,
with a clock or
procedure. to commencing
to repeat it. He then recorded:
the patient a cardon which was writtena short memory test
four items. He read the sentence to the patient and got him
Name of Patient.
Time of Injection
Time of applying
Details of method
Result, i.e. Subshock,
the electric shock.
Focal Fit, or Generalized
i.e. Unilateral or Bilateral.
Name of Patient.
Time of first attempting
Time of first attempting
Name of Patient.
Orientation in Place, i.e. Time of knowing where he was.
Orientationin Time, i.e. Time of knowing
Memorytest, i.e. If he could remember
prior to the treatment.
Due to practicalconsiderations,
15 minutesin each case and if a particular
time it was recorded as 15 minutes +.
in Ego, i.e. Time of knowing Name and Age.
Day and Date.
the sentence he was shown j ust
the maximumtime for observation
faculty had not returned
2. (b) ASSESSMENT OF DESIRABLEEn@cTS
1. Patientsfor whom
prior to commencing
Ideas of guilt, worthlessness,
The score of the individual
summatedand this total became â€œ¿?the
2. Particularcare was taken
whether unilateralor bilaterally
by means of a draw system and a series of cards in which the nursing
played a prominent role.
3. A total of four E.C.T.swere then given and the depressive
again determinedin a similar manner
E.C.T. was recommended were carefullyassessed
1==Slight,therapy and a rating on a 4 scale grade (0=Nil,
given for each of the following
Feelings of Unreality
and general worries.
items for each particular
depressive quotientâ€• for that particular
doctor was not
inducedwas given. was done
A total of 135 electric shocks were analysed.
39 cases of Bilateral E.C.T.
31 cases of Unilateral E.C.T. with generalized fit.
33 cases of Unilateral E.C.T. with focal fit.
32 cases of Unilateral subshocks.