電気衝撃療法のModificationについて

抄録

1. Among barbiturates used in conjunction with the electrical shock treatment, methylhexabital is found to be the most practical in terms of deepness of the narcotic effect, degree of reducing the convulsion, affecting time, ect.
2. The strength of the convulsion can be acculately grasped by measuring the length of the convulsion time, as the strength is quite proportional to the length of its duration on the kymogram, led from the biting muscles in convulsion.
3. By making necessary changes in the amount of an injection or the injection speed, the strength of the convulsion can be adjusted at will. Therefore, a full consideration must be exercised in deciding the amount of an injection and the injection speed appropriate to a specific purpose in applying the electrical shock treatment under narcosis.
4. By using methylhexabital with the precautions mentioned above a fracture of bone and other undesirable side effects are avoided, and at the same time, this will enable a safe treatment even on a patient suffering from hypertension, thus the scope of applications of the electrical shock treatments is expanded.
5. It was found that reducing the convulsion centrally by using barbiturate would result in the lessening of various biological changes, and concureently with this the effectiveness of the treatment will also decrease.
6. To administer the narcosis using barbiturates to a patient only for the purpose of removing the fear of the electrical shock or preventing the refusal, it is advisable to apply the electrical shock treatment after a proper period of time (according to my estimate, about 5 minutes after the patient was administered methylhexabital) or when the effect to reduce the convulsion is expired.
7. In order to prevent the psychomotor excitement after the convulsion, an injection of arbiturate after unmodified electrical shock is effective.
8. when d-tubocurarine chloride is used in the electrical shock treatment, the convulsion will decrease. In this case as the central impulse in the brain will not decrease, biological changes will not be lessened in proportion to the extent of decrease in convulsion. Thus the therapeutic effect is better than that of the electrical shock under narcosis with barbiturates, however, as a full control of the convulsion using this medicament would involve a risk of causing a paralysis in respiratory muscles and is therefore practically imposible, it is considered that this treatment is after all not better than the electrical shock treatment under narcosis using methylhexabital.
9. The non-convulsive electrical stimulation therapy is not so effective as the usual electrical shock treatment, and even though there is some value in applying it for an acute poisoning from hypnotica and apnoea after the electrical shock, the treatment is not in the same category as the electrical shock treatment in respect to the mechanism.