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Electroconvulsive Treatment Compared With Lithium in the Management of Manic States

Electroconvulsive Treatment Compared With Lithium in the Management of Manic States Abstract • Thirty-four hospitalized manic patients were randomized to treatment with either lithium carbonate or an average series of nine bilateral electroconvulsive treatments (ECTs), followed by maintenance with lithium carbonate. Weekly ratings of manic, depressive, and psychotic symptoms were obtained for eight weeks, and patients were followed up monthly for up to two years. Ratings by nonblind and blind observers indicated that the patients who underwent ECT improved more during the first eight weeks than did patients who were treated with lithium carbonate. This was especially true of patients with mixed symptoms of mania and depression and/or extreme manic behavior. Clinical ratings after eight weeks showed no significant differences between the lithium carbonate— and ECT-treated patients. Likewise, the two groups had comparable rates of relapse, recurrence, and rehospitalization during the follow-up period. References 1. Gerbino L, Oleshansky M, Gershon S: Clinical use and mode of action of lithium , in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1261-1275. 2. Prien RF, Caffey EM, Klett CG: Factors associated with treatment success in lithium carbonate prophylaxis: Report of the Veterans Administration and National Institute of Mental Health Collaborative Study Group . Arch Gen Psychiatry 1974;31:189-192.Crossref 3. Swann AC, Secunda SK, Katz MM, Koslow SH, Mass JW, Chang S, Robins E: Lithium treatment of mania: Clinical characteristics, specificity of symptom change, and outcome . Psychiatry Res 1986;18:127-141.Crossref 4. Winokur G: Psychosis in bipolar and unipolar affective illness with special reference to schizo-affective disorder . Br J Psychiatry 1984;145:236-242.Crossref 5. Rosen LN, Rosenthal NE, Dunner DL, Fieve RR: Social outcome compared in psychotic and nonpsychotic bipolar I patients . J Nerv Ment Dis 1983;171:272-275.Crossref 6. Secunda SK, Katz MM, Swann A, Koslow SH, Mass JW, Chang S, Croughan J: Mania: Diagnosis, state measurement and prediction of treatment response . J Affective Disord 1985;8:113-121.Crossref 7. Keller MB, Lavori PW, Coryell W, Andreasen NC, Endicott J, Clayton PJ, Klerman GL, Hirschfeld RMA: Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness . JAMA 1986;255:3138-3142.Crossref 8. Secunda SK, Swann A, Katz MM, Koslow SH, Croughan J, Chang S: Diagnosis and treatment of mixed mania . Am J Psychiatry 1987;144:96-98. 9. Lerer B: Alternative therapies for bipolar disorder . J Clin Psychiatry 1985;46:309-316. 10. Post RM, Uhde TW, Putnam FW, Ballenger JC, Berrettini WH: Kindling and carbamazepine in affective illness . J Nerv Ment Dis 1982;170:717-731.Crossref 11. Lerer B, Moore N, Meyendorff E, Cho SR, Gershon S: Carbamazepine versus lithium in mania: A double-blind study . J Clin Psychiatry 1987;48:89-93. 12. American Psychiatric Association (eds): Electroconvulsive Therapy: Task Force Report 14 . Washington, DC, American Psychiatric Association, 1978. 13. Gralnick A: A three-year survey of electroshock therapy: Report on 276 cases: Comparative value on insulin-coma therapy . Am J Psychiatry 1946;102:583-593. 14. Schiele BC, Schneider RA: The selective use of electroconvulsive therapy in manic patients . Dis Nerv Syst 1949;10:291-297. 15. Fink M: Mania and electroseizure therapy , in Shopsin B (ed): Manic Illness . New York, Raven Press, 1979, pp 219-228. 16. Black DW, Winokur G, Nasrallah A: Treatment of mania: A naturalistic study of electroconvulsive therapy versus lithium in 438 patients . J Clin Psychiatry 1987;48:132-139. 17. Small JG, Milstein V, Klapper MH, Kellams JJ, Miller MJ, Small IF: Electroconvulsive therapy in the treatment of manic episodes , in Malitz S, Sackeim HA (eds): Electroconvulsive Therapy—Clinical and Basic Research Issues . New York, New York Academy of Sciences, 1986, pp 37-49. 18. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders . New York, New York State Psychiatric Institute, 1977. 19. Raskin A, Schulterbrandt J, Reatig N, McKeon J: Replication of factors of pathology in interview, ward behavior, and self-report ratings of hospitalized depressives . J Nerv Ment Dis 1969;148:87-98.Crossref 20. Endicott J, Spitzer RL, Fleiss JL, Cohen J: Global Assessment Scale (GAS) . Arch Gen Psychiatry 1976;33:766-771.Crossref 21. Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia—Lifetime Version (SADS-L) . New York, New York State Psychiatric Institute, 1977. 22. Bech P, Bolwig TG, Kramp P, Rafaelsen OJ: The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale . Acta Psychiatr Scand 1979;59:420-430.Crossref 23. Hamilton MA: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 24. Overall JE, Gorham DR: The Brief Psychiatric Rating Scale . Psychol Rep 1962;10:798-812. 25. Guy W: ECDEU Assessment Manual for Psychopharmacology, revision 2, US Dept of Health, Education, and Welfare publication (ADM) 76-338. US Dept of Health, Education, and Welfare, 1976. 26. Shopsin B (ed): Manic Illness . New York, Raven Press, 1979. 27. Honigfeld G, Klett C: The Nurses' Observation Scale for Inpatient Evaluation (NOSIE): A new scale for measuring improvement in chronic schizophrenia . J Clin Psychol 1965;21:65-71.Crossref 28. Renfordt E, Busch H: Time-blind analysis of TV-stored interviews: An objective method to study antidepressive drug-effects . Int Pharmacopsychiatry 1976;11:129-134. 29. Milstein V, Small JG, Klapper MH, Small IF, Miller MJ, Kellams JJ: Unilateral versus bilateral ECT in the treatment of mania . Conv Ther 1987;3:1-9. 30. Lancaster NP, Steinert RR, Frost I: Unilateral electroconvulsive therapy . J Ment Sci 1958;104:221-227. 31. Goodwin FK, Roy-Byrne P: Treatment of bipolar disorders . Am Psych Annu Rev 1987;6:81-107. 32. Quitkin FM, Rabkin JG, Prien RF: Bipolar disorder: Are there manic-prone and depressive-prone forms? J Clin Psychopharmacol 1986;6:167-172.Crossref 33. Rhoades HM, Overall JE: The Hamilton Depression Scale: Factor scoring and profile classification . Psychopharmacol Bull 1983;19:91-96. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Electroconvulsive Treatment Compared With Lithium in the Management of Manic States

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1988.01800320037004
Publisher site
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Abstract

Abstract • Thirty-four hospitalized manic patients were randomized to treatment with either lithium carbonate or an average series of nine bilateral electroconvulsive treatments (ECTs), followed by maintenance with lithium carbonate. Weekly ratings of manic, depressive, and psychotic symptoms were obtained for eight weeks, and patients were followed up monthly for up to two years. Ratings by nonblind and blind observers indicated that the patients who underwent ECT improved more during the first eight weeks than did patients who were treated with lithium carbonate. This was especially true of patients with mixed symptoms of mania and depression and/or extreme manic behavior. Clinical ratings after eight weeks showed no significant differences between the lithium carbonate— and ECT-treated patients. Likewise, the two groups had comparable rates of relapse, recurrence, and rehospitalization during the follow-up period. References 1. Gerbino L, Oleshansky M, Gershon S: Clinical use and mode of action of lithium , in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1261-1275. 2. Prien RF, Caffey EM, Klett CG: Factors associated with treatment success in lithium carbonate prophylaxis: Report of the Veterans Administration and National Institute of Mental Health Collaborative Study Group . Arch Gen Psychiatry 1974;31:189-192.Crossref 3. Swann AC, Secunda SK, Katz MM, Koslow SH, Mass JW, Chang S, Robins E: Lithium treatment of mania: Clinical characteristics, specificity of symptom change, and outcome . Psychiatry Res 1986;18:127-141.Crossref 4. Winokur G: Psychosis in bipolar and unipolar affective illness with special reference to schizo-affective disorder . Br J Psychiatry 1984;145:236-242.Crossref 5. Rosen LN, Rosenthal NE, Dunner DL, Fieve RR: Social outcome compared in psychotic and nonpsychotic bipolar I patients . J Nerv Ment Dis 1983;171:272-275.Crossref 6. Secunda SK, Katz MM, Swann A, Koslow SH, Mass JW, Chang S, Croughan J: Mania: Diagnosis, state measurement and prediction of treatment response . J Affective Disord 1985;8:113-121.Crossref 7. Keller MB, Lavori PW, Coryell W, Andreasen NC, Endicott J, Clayton PJ, Klerman GL, Hirschfeld RMA: Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness . JAMA 1986;255:3138-3142.Crossref 8. Secunda SK, Swann A, Katz MM, Koslow SH, Croughan J, Chang S: Diagnosis and treatment of mixed mania . Am J Psychiatry 1987;144:96-98. 9. Lerer B: Alternative therapies for bipolar disorder . J Clin Psychiatry 1985;46:309-316. 10. Post RM, Uhde TW, Putnam FW, Ballenger JC, Berrettini WH: Kindling and carbamazepine in affective illness . J Nerv Ment Dis 1982;170:717-731.Crossref 11. Lerer B, Moore N, Meyendorff E, Cho SR, Gershon S: Carbamazepine versus lithium in mania: A double-blind study . J Clin Psychiatry 1987;48:89-93. 12. American Psychiatric Association (eds): Electroconvulsive Therapy: Task Force Report 14 . Washington, DC, American Psychiatric Association, 1978. 13. Gralnick A: A three-year survey of electroshock therapy: Report on 276 cases: Comparative value on insulin-coma therapy . Am J Psychiatry 1946;102:583-593. 14. Schiele BC, Schneider RA: The selective use of electroconvulsive therapy in manic patients . Dis Nerv Syst 1949;10:291-297. 15. Fink M: Mania and electroseizure therapy , in Shopsin B (ed): Manic Illness . New York, Raven Press, 1979, pp 219-228. 16. Black DW, Winokur G, Nasrallah A: Treatment of mania: A naturalistic study of electroconvulsive therapy versus lithium in 438 patients . J Clin Psychiatry 1987;48:132-139. 17. Small JG, Milstein V, Klapper MH, Kellams JJ, Miller MJ, Small IF: Electroconvulsive therapy in the treatment of manic episodes , in Malitz S, Sackeim HA (eds): Electroconvulsive Therapy—Clinical and Basic Research Issues . New York, New York Academy of Sciences, 1986, pp 37-49. 18. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders . New York, New York State Psychiatric Institute, 1977. 19. Raskin A, Schulterbrandt J, Reatig N, McKeon J: Replication of factors of pathology in interview, ward behavior, and self-report ratings of hospitalized depressives . J Nerv Ment Dis 1969;148:87-98.Crossref 20. Endicott J, Spitzer RL, Fleiss JL, Cohen J: Global Assessment Scale (GAS) . Arch Gen Psychiatry 1976;33:766-771.Crossref 21. Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia—Lifetime Version (SADS-L) . New York, New York State Psychiatric Institute, 1977. 22. Bech P, Bolwig TG, Kramp P, Rafaelsen OJ: The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale . Acta Psychiatr Scand 1979;59:420-430.Crossref 23. Hamilton MA: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 24. Overall JE, Gorham DR: The Brief Psychiatric Rating Scale . Psychol Rep 1962;10:798-812. 25. Guy W: ECDEU Assessment Manual for Psychopharmacology, revision 2, US Dept of Health, Education, and Welfare publication (ADM) 76-338. US Dept of Health, Education, and Welfare, 1976. 26. Shopsin B (ed): Manic Illness . New York, Raven Press, 1979. 27. Honigfeld G, Klett C: The Nurses' Observation Scale for Inpatient Evaluation (NOSIE): A new scale for measuring improvement in chronic schizophrenia . J Clin Psychol 1965;21:65-71.Crossref 28. Renfordt E, Busch H: Time-blind analysis of TV-stored interviews: An objective method to study antidepressive drug-effects . Int Pharmacopsychiatry 1976;11:129-134. 29. Milstein V, Small JG, Klapper MH, Small IF, Miller MJ, Kellams JJ: Unilateral versus bilateral ECT in the treatment of mania . Conv Ther 1987;3:1-9. 30. Lancaster NP, Steinert RR, Frost I: Unilateral electroconvulsive therapy . J Ment Sci 1958;104:221-227. 31. Goodwin FK, Roy-Byrne P: Treatment of bipolar disorders . Am Psych Annu Rev 1987;6:81-107. 32. Quitkin FM, Rabkin JG, Prien RF: Bipolar disorder: Are there manic-prone and depressive-prone forms? J Clin Psychopharmacol 1986;6:167-172.Crossref 33. Rhoades HM, Overall JE: The Hamilton Depression Scale: Factor scoring and profile classification . Psychopharmacol Bull 1983;19:91-96.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Aug 1, 1988

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