Clinical Neuroscience of ECT (CNECT)

"Classics in ECT" brings you this editorial from Dr. Max Fink, 1984: ECT : for whom is its use justified? Fink M. J Clin Psychopharmacol. 1984 Dec;4(6):303-4. PMID:  6511995   The pdf is here . The editorial is here: Here is a Max Fink classic, with his perspective on clinical indications as well as the sad state of ECT practice and training in the USA in the early 1980s. I'm sure you will enjoy reading it, and reflecting on how things have changed for the better in the intervening decades, in no small part thanks to his efforts.

"Classics in ECT" brings you this Max Fink editorial from JECT in 2011: Transcranial  magnetic stimulation is not a replacement for electroconvulsive therapy in depressive mood disorders. Fink M. J ECT. 2011 Mar;27(1):3-4. doi: 10.1097/YCT.0b013e3181f18076. PMID:  21336049   The pdf is here . The editorial is here: Here's a fairly recent Max Fink classic. I agree with him completely, and wonder how many followers would also...Has the intervening decade changed anything? I particularly like his description of ECT as having "optic dissonance."

PubMed shows this as Dr. Max Fink's first first-author citation: The face-hand test as a diagnostic sign of organic mental syndrome. FINK M , GREEN M, BENDER MB. Neurology. 1952 Jan-Feb;2(1):46-58. doi: 10.1212/wnl.2.1-2.46. PMID:  14899594   The pdf is here . And from the text: So here is what I believe to be Max's first first-authored publication, 71 years ago!  It reminds us of his roots in neurology. There's even a reference to some ECT patients' results on the face-hand test.  On behalf of all of us in the field, allow me to express  gratitude to Max for his mentorship, collegiality and friendship over the decades. His body of work is monumental and his support for ECT has shaped the field as we know it today. If I could speak for all the patients saved by ECT, I know they would echo these thanks. Very happy birthday, Max!

Out on PubMed, in JECT,  from clinicians at Stony Brook, is this paper: An Examination of Electroconvulsive Therapy and Delivery of Care in Delirious Mania. Reinfeld S, Yacoub A. J ECT. 2022 Apr 14. doi: 10.1097/YCT.0000000000000844. Online ahead of print. PMID:  35462389 The abstract is copied below: Objectives: Delirious mania is a severe life-threatening syndrome, often misdiagnosed, and eminently treatable as a variant of catatonia. Our aim is to provide a comprehensive examination of electroconvulsive therapy (ECT) parameters and clinical features, as well as describe the delivery of care of the patients with delirious mania. Methods: A retrospective study was conducted of the ECT records at Stony Brook University Hospital from years 2014 to 2021. We characterized demographic and clinical variables, including psychiatric diagnoses and ECT parameters of patients identified with delirious mania. Results: We identified 8 cases (3 women) of delirious mania with 8 corresponding acute t

"Classics in ECT" brings you this remarkably insightful essay on the origins of prejudice against ECT by Dr. Max Fink in 1997. The pdf is here . And from the text: And this conclusion: In this essay, Dr. Fink carefully traces the origins of the stigma and prejudice surrounding ECT, by reviewing the history of American psychiatry since World War II. He describes the impact of the "Group for the Advancement of Psychiatry" and the competing struggles between psychodynamics, psychopharmacology and somatic treatments. This may be the best explanation ever written of all the factors that have gone into the needlessly tarnished reputation and "controversy" that follow ECT to the present day.  This is a must-read in its entirety (about 20 minutes).

This LTE from 1997 in the Australian and New Zealand Journal of Psychiatry argues for reasonable guidelines for ECT consent forms regarding number of treatments. Then and now, standard of care should be flexible enough to ensure fully adequate courses of treatment, recognizing that premature cessation of the course may result in incomplete remission and the risk of earlier relapse. I particularly like the final sentence:[limiting treatment courses] "also fosters public disappointment with the treatment itself."

The pdf is here . And from the text: This review by Dr. Fink is the leadoff article in the special section on ECT in the American Journal of Psychiatry in September, 1977. It gives the modern reader a vivid picture of the pressure that ECT was under from various sources within, and without, medicine. He systematically debunks the myths that were sullying the reputation of ECT at the time. This is a must-read (about 15 minutes) for ECT health care professionals interested in a historical perspective on ECT in the USA. (See also blog post of October 7, 2020)

Use of  ECT  in the United States. Fink M. Am J Psychiatry. 1988 Jan;145(1):133-4. PMID:  3276227 The pdf is here . This is a classic LTE from Dr. Max Fink, most definitely deserving of a careful read. His letter is responsive to an article in the American Journal in 1987 ( Thompson JW, Blaine JD, Use of ECT in the United States in 1975 and 1980, Am J Psychiatry, 1987, May;144(5):557-62 ) which reported declining use of ECT. He counters that the authors' survey was a "lagging indicator" and subject to "sampling error" and that, in fact, ECT use, and interest in ECT, was increasing. He cites the growing number of scientific articles on ECT, the birth of the journal, Convulsive Therapy , and development of the ECT device industry. To this day, we do not know exactly how much ECT is actually performed in the United States. As I have said before, we in the USA are at a great disadvantage compared to many European countries, where systems of socialized medicine allow