Medical and general reports and accounts for the year ended 31st December, 1944 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1945?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1944 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    The Medical Director's Report ANNUAL MEDICAL REVIEW The Results of Electric Shock Therapy By Berta Andratschke and C. H. Rogerson. INTRODUCTION IN the Annual Report for 1943 a review of modern methods of treatment in psychiatry was under¬ taken. The value of electric shock therapy was briefly discussed and the indications for its employment were mentioned. In view of the widespread use of this treatment, together with the controversial opinions which have been expressed concerning its safety and advisability, it seems appropriate to present in detail the results of 3| years experience at the Cassel Hospital. We are aware that others have had more extensive experience than ourselves ; on the other hand we believe that in our case material is particularly suited for such a presentation. Admissions to the hospital are limited to non-certifiable and on the whole, to recoverable disorders, in which a dangerous and uncertain method of physical treatment would find no place and in which subsequent mental deterioration or other objectionable sequelae would show very clearly. In this report we propose to discuss first the treatment by electric shock therapy of a group of cases which we have termed mild depressive psychosis, since this is the group in which the most effective results have been obtained. We then propose to discuss the use of the treatment in psychoneurotic conditions. Afterwards we shall consider the com¬ plications and difficulties which have occurred during the treatment, including in our series for this purpose a group of cases which we have treated as out¬ patients, but which have not otherwise been as fully studied as our inpatients. Finally, we shall present a summary of the con¬ clusions which we have reached concerning the indications and contra-indications for the treatment and the results which may be expected. MILD DEPRESSIVE PSYCHOSIS TREATED BY ELECTRIC SHOCK TREATMENT In a recent communication (Brit. Med. J 1st April, 1943, p. 406), we drew attention to a group of cases which we have termed mild depressive psychosis. We pointed out that these cases, in¬ cluding so called endogenous or manic depressive disorders at one end of the scale and exogenous or reactive depression at the other, accounted each year for a great total of sickness and disability. We noted that, since the depression was often masked by physical complaints, anxiety, fatigue, etc., they were often undiagnosed. We described the natural history of the illness in a group of 100 cases. The essential features were as follows. There was no significant preponderance of one sex ; age distribution covered the whole range from 16 to 70 with a peak in the 50’s. The duration of illness before admission ranged from a few weeks to several years. The commonest presenting sym- toms were, physical complaints (78 per cent.), depression (58 per cent.), fear, anxiety, agitation (47 per cent.), feeling of inadequacy (45 per cent.). The personality of many had been of the over- conscientious, perfectionistic type. A majority had been subjected to some kind of psychological stress, usually for a considerable period before the onset of the illness. In addition 51 per cent, had had one or more previous attacks at some time in their fives, and many showed a family history of mental disorder of a similar type. It would not be appropriate, in this place, to enter into a discussion of the differential diagnosis of this illness. Mild depressive psychosis differs only in degree from the more severe depression or melancholia usually requiring mental hospital care. But it is precisely because in its milder form the illness is so common in general practice and so often unrecognised that it is so important. An under¬ standing of its essential character depends upon the understanding of the nature of psychotic depression and how this differs from simple neurotic depression and from the depression of everyday fife. Briefly a condition of psychotic depression may be said to have arisen when the individual is depressed without a logical cause based upon his relationship with external reality, or when his state of depression is grossly disproportionate to the cause or persists unduly after the removal of the cause. In ungraceful but expressive terms he has become “ stuck ” in a state of depression and his mood governs his view of external reality. In “ normal ” situational depression on the other hand such as that which occurs after bereavement or bad news his view of external reality governs his mood. l