Mass killing under the guise of ECT: the darkest chapter in the history of biological psychiatry.

Following its inception, electroconvulsive therapy (ECT), rapidly spread all over the world, including Nazi Germany. Paradoxically, at the same time, the euthanasia programme was started in Germany: the extermination of people with intellectual disabilities and severe psychiatric disorders. In Lower Austria, Dr Emil Gelny, who had been granted a specialist qualification in psychiatry after three months of clinical training, took control of two psychiatric hospitals, in Gugging and Mauer-Öhling. In 1944, he began systematically killing patients with an ECT machine, something that was not practised anywhere else before or after, and remains unprecedented in the history of convulsive therapy. He modified an ECT machine, adding extra electrodes, which he fastened onto a victim's wrists and ankles to administer lethal electric shocks.

The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia.

BACKGROUND: Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). METHODS: Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. RESULTS: Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. CONCLUSION: Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.

Catatonia in an inpatient gerontopsychiatric population.

There are limited data on the prevalence of catatonia in the elderly. The aim of this study was to determine the prevalence of catatonia in elderly patients (=/> 65 years) acutely admitted to the psychiatric unit of a general hospital. All patients aged 65 years and above admitted to a general hospital psychiatric unit over a 4-month period were screened for catatonia with the 14-item Bush-Francis Catatonia Screening Instrument (BFCSI). Patients with a minimum of 2 symptoms on the BFCSI were rated with the 23-item Bush-Francis Catatonia Rating Scale (BFCRS). Catatonia was simultaneously evaluated according to DSM-5 criteria. Clinical diagnoses were established using the validated Hungarian versions of the Structured Clinical Interview for DSM-IV Disorders, the Mini Mental State Examination and the Clock Drawing Test. Ninety-eight (28.1%) of the 342 patients admitted to the psychiatric unit during the study period were above 65 years of age; 11 (11.22%) and 6 (6.12%) patients were classified as having catatonia according to the BFCRS and DSM-5 criteria, respectively. The majority of the patients had catatonia due to a medical condition. A significant minority of gerontopsychiatric inpatients present with catatonia. Dementia was not a risk factor for catatonia.

The effects of exercise and cardiovascular fitness on stereotyped bodyrocking.

A severely mentally retarded person residing in a large state institution participated in a 16-week cardiovascular conditioning program. The participant engaged in a high rate of stereotyped bodyrocking. Cardiovascular fitness was estimated by a measure of heart recovery rate obtained during the exercise periods. The amount of bodyrocking was measured prior to, during and following the implementation of the conditioning program. Increased fitness and decreased rates of bodyrocking were noted. These results are encouraging with regard to the implementation of fitness training programs for persons with severe retardation who reside in institutions.

ECT practice and psychiatrists' attitudes towards ECT in the Chuvash Republic of the Russian Federation.

The practice of electroconvulsive therapy (ECT) and the attitudes of psychiatrists towards ECT in the Chuvash Republic are described. A significant proportion of Chuvash psychiatrists had a patchy knowledge about ECT and held negative attitudes towards the treatment. Enhancing the knowledge about ECT and changing negative attitudes will require persistent educational efforts.

Rates of electroconvulsive therapy use in Hungary in 2002.

OBJECTIVE: In Hungary there has been no systematic evaluation of ECT use since 1992. Nine years ago, the legal regulation of ECT practice changed. Since 1994, the collaboration of a specialist in anesthesiology is a legal obligation. However, the introduction of the new antipsychotic and antidepressant drugs expanded the possibilities in psychopharmacological treatment. These events basically influenced ECT use. The aim of this study was to obtain an overview of ECT practice in Hungary after these changes. METHODS: A 13-item containing questionnaire was sent to all psychiatric departments. RESULTS: All departments except 1 replied by mail, by phone, or by e-mail. Forty-three departments indicated the use of ECT, but in clinical practice only 34 departments applied ECT in 2002. The average number of treated inpatients was 9 on ECT using departments. Altogether 0,6% of all hospitalized psychiatric inpatients received ECT in 2002. The indication for ECT was schizophrenia in 55.6% of the patients and affective disorder in 40% of the cases. Mostly bitemporal electrode placement was used usually thrice weekly. Most commonly used sleep induction agents were thiopental and propofol. CONCLUSION: The rate of ECT use in Hungary is significantly lower than in the United States, in the United Kingdom, or in the Scandinavian countries and similar than in Hong Kong. The indication of ECT was schizophrenia in 55.6% of the cases.

Facilitating prelinguistic communication skills in young children with developmental delay. II: Systematic replication and extension.

Four children with mental retardation were studied in the context of a multiple baseline across subjects design. Staff members used a modified version of the milieu teaching method to facilitate intentional requesting. The results replicated the finding that a modified version of milieu teaching was effective in facilitating the use of intentional requesting by children with developmental delays in an intervention context (Warren, Yoder, Gazdag, Kim, & Jones, 1993). This study also extended the Warren et al. (1993) work by (a) documenting that increased intentional requesting generalized to sessions with the children's mothers, (b) demonstrating that mothers who were naive to the purposes of the study were more likely to linguistically map their children's prelinguistic communication after the intervention than before the treatment, and (c) that mothers and teachers who were naive to the purposes of the study linguistically mapped the children's intentional communication more than the children's preintentional communication. We discuss implications of these results for early intervention, the transactional theory of development, and the importance of the distinction between intentional versus preintentional communication.

Facilitating prelinguistic communication skills in young children with developmental delay.

Very little research has focused on the development and evaluation of intervention strategies designed to facilitate the acquisition of prelinguistic communication skills. We conducted two experiments to determine the effects of a milieu teaching approach on the acquisition and generalization of specific prelinguistic communication skills. In the first experiment, we utilized this intervention approach within a multiple baseline design to teach prelinguistic requesting, commenting, and vocal imitation to a single subject with Down syndrome and language delay. The results indicated that the intervention approach was effective at facilitating the child's use of these skills within the treatment setting. Therefore, in the second experiment we conducted a more comprehensive analysis of this approach with 4 subjects with mental retardation. Three of these subjects were taught to request, and 1 subject was taught both to request and to comment. The effects were experimentally evaluated with multiple baseline across subjects design. The results indicated that the intervention was effective in eliciting the intervention targets within the training setting for all 4 subjects. All 4 subjects showed evidence of generalization across stimulus materials, setting, teachers, and interaction style. There was also evidence of reciprocal effects on how classroom teachers in the generalization setting interacted with the subjects as a result of changes in the child's communication behavior.

Changes in the generativity and use of semantic relationships concurrent with milieu language intervention.

Changes associated with a milieu language intervention implemented to teach productive semantic relationships (e.g., action-object combinations) were investigated. Subjects were 11 young children with borderline to moderate levels of mental retardation, all in the early stages of language development. Following a baseline period, each subject received three to four training sessions per week in a small group interactive play situation. Measures of generativity were analyzed via pre/post group comparisons. Concurrent with the intervention subjects showed substantial gains in their ability to generatively produce semantic relationships in the intervention context and across settings, adults, and interaction styles. Subjects also correctly responded to an increasing proportion of target probe questions in both the intervention and generalization settings. The results suggest that, for most of the subjects, milieu teaching was associated with enhanced generativity and use of semantic relationships.