ANIMAL BRAINS

There are a number of articles concerning the application of ECT and subsequent brain examination in animals. In the 15 study review of Hartelius (1952), 13 of the 15 reported pathological findings that were vascular, glial or neurocytological, or (as was generally the case) in two or three of these domains. However, as Hartelius pointed out, inferences of these studies tended to be conflicting because of different methods used and because of deficient controls. The research that Hartelius himself carried out was unquestionably the outstanding study in the area with respect to methodological sophistication and rigor. Hartelius employed 47 cats; 31 receiving ECT, and 16 being control animals. To prevent artifacts associated with the sacrificing of the animals, the cerebrums were removed under anesthesia while the animals were still alive. Brain examinations were conducted blindly with respect to ECT vs. control of subject. On a number of different vascular, glial, and neuronal variables, the ECT animals were significantly differentiated from the controls. The animals that had 11-16 ECTs had significantly greater pathology than the animals that had received four ECTs. Most of the significant differences with respect to reversible type changes. However, some of the significant differences pertained to clearly irreversible changes such as shadow cells and neuronophagia.

PSYCHOLOGICAL TEST FINDINGS WITH HISTORY OF MANY ECTS

There have been several studies regarding the administration of psychological tests to patients with a history of many ECTs. Unfortunately, all were not well controlled. Rabin (1948) administered the Rorschach to six chronic schizophrenics with a history of from 110 to 234 ECTs. Three patients had 6, two had 4, and one had 2 Piotrowski signs. (Piotrowski regards five or more as indicating organicity.) However, control subjects were not employed. Perlson (1945) reported the case of a 27-year-old schizophrenic with a history of 152 ECTs and 94 Metrozol convulsions. At age 12 he received an IQ of 130 on the Stanford Achievement Test; at age 14 an IQ of 110 on an unspecified general intelligence test. At the time of the case study, he scored at the 71st percentile on the Otis, at the 65th percentile on the American Council on Educational Psychological Examination, at the 77th percentile on the Ohio State Psychological Examination, at the 95th percentile for engineering freshman on the Bennett Test of Mechanical Comprehension, at the 20th percentile on engineering senior norms and at the 55th percentile on liberal arts students' norm on a special perception test. These facts led Perlson to conclude that convulsive therapy does not lead to intellectual deterioration. A more appropriate inference would be that, because of the different tests of different types and levels and norms given at different ages in one patient, no inference whatsoever is justified.

There are two studies that provide more methodological sophistication than the above described articles. Goldman, Gomer, and Templer (1972) administered the Bender-Gestalt and the Benton Visual Retention Test to schizophrenics in a VA hospital. Twenty had a past history of from 50 to 219 ECTs and 20 had no history of ECT. The ECT patients did significantly worse on both instruments. Furthermore, within the ECT groups there were significant inverse correlations between performance on these tests and number of ECTs received. However, the authors acknowledged that ECT-caused brain damage could not be conclusively inferred because of the possibility that the ECT patients were more psychiatrically disturbed and for this reason received the treatment. (Schizophrenics tend to do poorly on tests of organicity.) In a subsequent study aimed at ruling out this possibility, Templer, Ruff, and Armstrong (1973) administered the Bender-Gestalt, the Benton, and the Wechsler Adult Intelligence Scale to 22 state hospital schizophrenics who had a past history of from 40 to 263 ECTs and to 22 control schizophrenics. The ECT patients were significantly inferior on all three tests. However, the ECT patients were found to be more psychotic. Nevertheless, with degree of psychosis controlled for, the performance of the ECT patients was still significantly inferior on the Bender-Gestalt, although not significantly so on the other two tests.