December 19, 2010
School of Medicine, Kochi
Dr. Howard C. Wilinsky, Chief of Electroconvulsive Services for the University of Buffalo’s Psychiatric Residency Program was recently at the Amrita School of Medicine in Kochi.
Having designed electroconvulsive training programs at two university teaching hospitals in the United States, Dr. Wilinsky trains medical practitioners in this effective psychiatric treatment.
Invited to speak to students and faculty at Amrita, Dr. Wilinsky discussed the history of electroconvulsive therapy and its significance in the field of psychiatry.
Given below are some excerpts from his lecture.
Electroconvulsive therapy (ECT) induces seizures in anesthetized patients and is generally used to treat severe depression. It is also used to treat other mental illnesses, like status epilepticus, neuroleptic malignant syndrome, agitation, bipolar disorder, and schizophrenia. In fact, ECT was originally used to treat schizophrenic patients.
In 1938, Ugo Cerletti, Professor of Psychiatry at the University of Rome, was the first to administer ECT. He used bi-temporal placement of electrodes to induce seizures in a 27-year old man with catatonic schizophrenia.
The events leading to Cerletti’s development of ECT began in 1921, when Vienna psychiatrist Manfred Sakel injected schizophrenic patients with insulin. This was the first effective treatment for schizophrenia and a dramatic breakthrough in psychiatry.
In 1934, Ladislaus J. von Meduna, from Hungary, injected camphor oil in a schizophrenic patient, who improved after only five treatments.
Cerletti applied Sakel’s and Meduna’s discoveries and experimented with both insulin and camphor injections to treat schizophrenia. However, he was not satisfied with the two risky treatments.
He worked toward devising an alternative treatment for schizophrenia. After considerable struggle, he created an electrically safe ECT machine.
Using the ECT machine, Cerletti successfully treated the 27-year-old catatonic schizophrenic man. After two treatments, he had a convulsion and emerged speaking rationally.
In the 1940’s, Lothar Kalinowsky, a member of Cerletti’s team, settled in New York City. He wrote the first textbook on ECT and became the reining authority in electroconvulsive therapy. From then onward, ECT was well accepted in Western New York (Buffalo).
The methodology of electroconvulsive therapy has evolved over time.
Originally, ECT was performed without anesthesia and while patients were awake. The treatment caused loss of consciousness and severe muscular contractions. In addition, 50% of the patients suffered a compression fracture to the spine.
Now, it’s standard to give psychiatric patients injections of rapidly acting sleep and paralyzing substances before an ECT treatment.
An additional complication of electroconvulsive therapy is memory loss. This continues to be its greatest side effect.
Many psychiatric hospitals use ECT therapy. To administer ECT, extensive training is required.