The birth of convulsive therapy revisited: a reappraisal of László Meduna's first cohort of patients.
BACKGROUND
The introduction of convulsive therapy (COT) was undoubtedly one of the milestones in the history of psychiatry. Its originator, László Meduna, has become one of the founding fathers of biological psychiatry.


METHODS
In his first major publication on COT, Meduna described the short-term treatment outcome of the first 26 schizophrenia patients who underwent camphor- or cardiazol-induced COT; 10 improved significantly, 3 appeared slightly improved, and 13 were unimproved. The original medical notes of 23 of the 26 patients were recently recovered and the patients re-diagnosed by the authors employing ICD-10 criteria.


RESULTS
The diagnosis of schizophrenia was confirmed in 15 cases (all but two of them involving prominent catatonic symptomatology), while 2 cases met diagnostic criteria for schizoaffective disorder, 3 for Bipolar Affective Disorder (BAD) with psychotic features, 1 for psychotic depression, and 1 for Acute and Transient Psychotic Disorder (ATPD). In a final case, the most probable diagnosis was schizophrenia. Scrutiny of the notes revealed that 4 schizophrenia patients evidenced slight improvement on COT and in one case the improvement was only transient. A limitation of this study is that the quality of the original files varied considerably and the re-evaluation was done retrospectively.


CONCLUSIONS
A very broad concept of schizophrenia in the 1930s explains the discrepancy between the original and the revised results. In line with the current views on the effectiveness of electroconvulsive therapy, catatonic symptoms, but not the core schizophrenic process, showed some improvement while all ATPD, BAD and depressed patients responded to COT.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, and Consultation-Liaison Psychiatric Service, Szent István and Szent László Hospitals, Budapest, Hungary.
Brigitta
B
Baran
István
I
Bitter
Gabor S
GS
Ungvari
Gábor
G
Gazdag
D000293:Adolescent; D000328:Adult; D001689:Biological Psychiatry / Q000266:history; D002164:Camphor / Q000266:history / Q000627:therapeutic use; D003292:Convulsants / Q000266:history* / Q000627:therapeutic use; D003295:Convulsive Therapy / Q000266:history*; D005260:Female; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D010433:Pentylenetetrazole / Q000266:history / Q000627:therapeutic use; D011618:Psychotic Disorders / Q000266:history* / Q000628:therapy; D012559:Schizophrenia / Q000266:history* / Q000628:therapy; D055815:Young Adult
D003292:Convulsants; D002164:Camphor; D010433:Pentylenetetrazole