Neuroimaging Prior to ECT: Commentary in JECT
Out on PubMed, in JECT, from authors at Mount Sinai, is this commentary:
Neuroimaging Prior to ECT: Time to Reconsider?
J ECT. 2023 Apr 14. doi: 10.1097/YCT.0000000000000915. Online ahead of print.PMID: 37053461
And here:
Here is an interesting and thoughtful commentary by my colleagues at Mount Sinai.
Here is an interesting and thoughtful commentary by my colleagues at Mount Sinai.
My opinion about this issue is somewhat different from theirs, and a letter-to-the-editor that I wrote in response will be the subject of another blog post in the near future.
Please read this carefully and consider what your position is in your practice, thanks.
The below comment is from Dr. Max Fink:
ReplyDeleteNeurology and Psychiatry
The call by the Mount Sinai psychiatrists for greater attention to neurological signs and tests for ECT candidates is timely. In 1940s and 1950s, when ECT and ICT were introduced, psychiatry was a "medical" discipline. The practitioners were neurology trained, until the APA split from neurology. As a Medical Officer during WWII I was assigned to the Ft Sam Houston School of Military Neuropsychiatry that was organized with Freudian psychoanaltyic concepts at its core by General William Menninger, a Freudian believer. The APA in 1946 and thereafter was led by Freudians. Interest in ECT was discarded while the principal teachers -- the Kalinowskys and Karliners -- were neurology trained.
The DSM-III commission was headed in 1980 by Robert Spitzer, a psychoanalytic trainee. For decades "psychiatry" has been dominated by clinical psychology and social work disciplines. The Mt Sinai physicians' call for neurology as central to ECT is a commendable understanding that warrants attention. Many of us have called for a recall of the Medical Model of Diagnosis. The Mt Sinai essayists are properly focused on Neurology training rather than psychology/social work that dominate Psychiatry training and application today.
Max Fink, MD
Ref: The medical evidence-based model to identify psychiatric syndromes: Return to a classical paradigm. Acta Psychiatr Scand 2008; 87: 81-84 ( Fink M, Taylor MA).