[Shock therapy and psychosurgery in the early German Democratic Republic (GDR)]. / "Schocktherapien" und Psychochirurgie in der frühen DDR.

Patient files, textbooks and published articles of the time show that the wide range of psychiatric therapies of the 1950s and 1960s was also used in the early German Democratic Republic (GDR). The use of insulin coma therapy, cardiazol and electroconvulsive therapies and especially of leucotomy in the GDR must not only be seen in the context of the international development and debate concerning these therapies up to the introduction of psychopharmaceutic therapy but also, in a similar way as in the Federal Republic of Germany, in relation to the locally sometimes different availability of insulin and cardiazol in the post-war period, different schools of academic thought and scientific research interest and priorities of the clinics concerned.

["Shock" therapies in Nazi Germany. The example of Berlin psychiatry]. / "Schocktherapien" im nationalsozialistischen Deutschland. Am Beispiel der Berliner Psychiatrie.

The idea that "shock" therapies were introduced by "Nazi-Psychiatry" very early and used radically in a cruel way darkens the image of these therapies until today. A case analysis of patient files of psychiatric hospitals in Berlin is used to recapitulate the introduction of insulin coma, metrazol and electroconvulsive therapy during the National Socialism era. Contrary to the false assumption that these "shock" therapies would have been introduced and preferred by psychiatrists involved with the Nazi regime and "euthanasia", in the case of Berlin these therapies were delayed by them and seldom used.

["Even electricity cannot work wonders!". Neglected achievements by German psychiatrists around 1880 in the treatment of depressions and psychoses]. / "Auch die Electricität leistet keine Wunder!". Die vergessenen Beiträge deutscher Psychiater um 1880 zur Therapie von Depressionen und Psychosen.

Parallel to the recent reneurobiologization of psychiatry as a subject, therapies based on electricity and elektrcomagnetism are returning to mental health care. Around 1880, the application of brain stimulating treatment on patients was particularly popular among German psychiatrists. This fact has largely been ignored in historical psychiatric research as present day practices, in particular deep brain stimulation (DBS), have frequently been seen solely within the tradition of brain surgery. Against this background the present study aims to revive the first trials of non-surgical electrical brain stimulation on depressive and psychotic patients, highlighting a 2-part study published by Wilhelm Tigges. It was Tigges along with Rudolph Gottfried Arndt and Wilhelm Erb who tried to establish clear rules on the most beneficial application methods and doses. Interestingly, Tigges's therapy was successful in cases of severe depression with chronification potential, i.e. precisely the clinical picture for which brain stimulation therapies are reserved today as a last option and ascribed an easing and even curing potential. Trigges also found that electricity produced almost no positive effect whatsoever with madly insane patients and hence anticipated the current non-application of DBS on these patients. After 1890 electrotherapeutic approaches in psychiatry were marginalized, first and foremost as no clear and reliable rules could be verified for their application, nor could their mode of action be fully explained. The success of electrotherapy in psychiatry was also restricted due to limitations of the time, namely (1) electrophysiology only emerging as a discipline, (2) the electrophysical medical apparatus industry only beginning to be established and (3) the lack of generally accepted guidelines and electrotherapy restriction to individual, barely generalizable experience (eclecticism). Present day applications of electricity, mainly DBS, have overcome these problems.

A history of insulin coma therapy in Australia.

OBJECTIVE: To explore the history of insulin coma therapy (ICT) in Australia. CONCLUSIONS: The negative period between the wars came to an end with the discovery of the biological therapies, including ICT, a development of great interest to Australian psychiatrists. Melbourne psychiatrist Reg Ellery documented his use of ICT in 1937, but the evidence shows that he was beaten to it by Farran-Ridge and Reynolds at Mont Park. ICT was soon used at various centres, but phased out by the late fifties. A review follows of its use in Australia and a discussion of the issues involved. Doing ICT played a part in enhancing the professional status of Australian psychiatrists and was one of the factors that led to the establishment of the AAP in 1946.

[From shock therapies to new neuromodulation techniques]. / Des thérapies de choc aux nouvelles techniques de neuromodulation.

The first shock therapies date back to 1933 with the Sakel therapy. Electric induction experiments led to electroconvulsive therapy first used by Ugo Cerletti and Lucio Bini in 1938. Today, transcranial magnetic stimulation offers new therapeutic perspectives for the treatment of mental disorders. Similarly, deep brain stimulation techniques have been developed for the treatment of compulsive obsessive disorders and severe and treatment-resistant depression.

[Insulin shock treatment in The Hague from 1937 to the end of the 1950s]. / De insulineshocktherapie in Den Haag, 1937 tot eind jaren vijftig.

BACKGROUND: Insulin shock treatment began to be applied in the 1930s to patients with a clinical diagnosis of schizophrenia. Although lacking theoretical and empirical support, the therapy was received enthusiastically and applied quite frequently. However, it quietly disappeared from the treatment repertories in the 1950s. AIM: To provide insight into experiences with insulin shock therapy in the psychiatric clinics in The Hague and into the factors that led to the therapy's rise and fall. METHOD: We searched the literature via PubMed, Medline, Embase and earlier articles using the search terms 'insulin shock treatment' and 'insulin coma therapy', and we studied medical records and other relevant documents from the former Rosenburg and Bloemendaal psychiatric clinics in The Hague. RESULTS: Insulin shock therapy made its debut in The Hague in 1937. The improvement rates, measured according to the guidelines issued by the Canadian Committee for Mental Hygiene, were good. There were relatively few reports of serious complications. The lack of insulin during World War II and subsequent staff shortages had a negative impact on the use of the therapy. CONCLUSION: Insulin shock therapy was applied in The Hague just as successfully as elsewhere. The abandonment of the therapy in The Hague seems to have been due to practical rather than to evidence-based considerations.

Convulsive therapy turns 75.

The Hungarian psychiatrist Laszlo Meduna was the first who induced epileptic fits to influence the course of mental illness. The following account, based on a review of Meduna's recently unearthed files and his writings, traces the beginnings of convulsive therapy.

Sakel versus Meduna: different strokes, different styles of scientific discovery.

It is ironic that Laszlo Meduna and Manfred Sakel made epochal discoveries in psychiatry only two years apart because in most other ways, the two men could hardly be more different. The story of their differences and similarities invites us to consider the personal preconditions for scientific discovery. What common denominators led them to develop treatments, which represent the introduction of convulsive therapy, which remains today the most powerful treatment in psychiatry? Despite the marked differences in their personalities, Sakel and Meduna shared intellectual quickness, drive, and a willingness to take risks, three qualities that, in the case of these individuals at least, came together to revolutionize the treatment of serious psychiatric illness.

The beginnings of modern psychiatric treatment in Europe. Lessons from an early account of convulsive therapy.

Convulsive therapy (COT) is a major European contribution to the psychiatric armamentarium and biological psychiatry. COT was introduced in psychiatry by László Meduna, a Hungarian neuropsychiatrist. All subsequent publications about the first patient treated with COT, Zoltán L (ZL), were based on Meduna's papers and autobiography. After 4 years of catatonic stupor, ZL received camphor-induced COT which resulted in full remission and discharge from the institution. The aim of this paper is to reconstruct ZL's case history from the original case notes--partly written by Meduna himself--which were recovered from the archives of the National Institute of Psychiatry and Neurology. The case notes show that ZL repeatedly received COT between 1934 and 1937, first with camphor and then with cardiazol induction. After the first course of COT the catatonic stupor was resolved and the psychotic symptoms subsided. However, the remission lasted for only a few months and was followed by a relapse. Despite repeated courses of COT, ZL never became symptom free again, was never discharged and died in the Institute in 1945. This historical case is discussed from both the diagnostic and therapeutic points of view, and an attempt is made to explain the possible reasons for the discrepancies found between Meduna's account and ZL's case notes.

[The birth of convulsive therapy]. / A görcskezelés születése.

The history of the first convulsive treatment is summarized here in commemoration of its 75th anniversary. The neuropathological and clinical findings underlying the theoretical basis of the method are reviewed, together with the case histories of the first batch of patients who underwent convulsive therapy. The early indications and effectiveness of convulsive therapy are also discussed. Finally, in a broader context, the role of convulsive treatment in the development of modern biological psychiatry and Laszlo Meduna's contribution to this development touched upon.

Meduna and the origins of convulsive therapy.

Convulsive therapy for dementia praecox was first used by the Hungarian neuropsychiatrist Ladislas Meduna in January 1934. On the 50th anniversary the author discusses the introduction of the treatment, the role of a theory of the biological antagonism between epilepsy and schizophrenia, and the contributions of Meduna, Sakel, Cerletti, and Bini. He also describes the changes in usage and methods and the impact of psychotropic drugs on the practice of convulsive therapy.

Introduction to the organically based therapies.

The author presents his whole-life experience with biological treatment of mental disorders. He qualified 50 years ago in 1933 and has been psychiatrist for 50 years. During his practice extending over half a century he tested personally and clinical work all biological therapeutic procedures in psychiatry, starting with treatment by pharmacogenic sleep, all types of shock therapy, psychosurgery, modern psychiatric pharmacotherapy as well as possibilities of contemporary prevention of psychiatric diseases by thymoprophylaxis . In this chapter the author presents a chronological review of different types and forms of biological therapy in psychiatry and his own views on the therapeutic effectiveness on different methods of biologically oriented psychiatric therapy.

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.