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Psychosomatic Medicine 14:347-362 (1952)
© 1952 American Psychosomatic Society

An Autonomic Nervous System Test of Prognostic Significance in Relation to Electroshock Treatment

DANIEL H. FUNKENSTEIN M.D.1, MILTON GREENBLATT M.D.1, and HARRY C. SOLOMON M.D.1

1 Department of Psychiatry, Harvard Medical School, and the Boston Psychopathic Hospital Boston, Massachusetts

Additional studies of a test of the autonomic nervous system which we reported on previously were made. On the basis of the blood pressure reactions obtained following adrenergic stimulation (intravenous epinephrine) and cholinergic stimulation (intramuscular Mecholyl), the data were classified into six groups. An additional factor studied was whether or not the drugs precipitated anxiety in the patients. In addition, five new mathematical measures not used by us previously were studied.

All of the above data were correlated with the clinical outcome of patients treated by means of electroshock therapy with the following results:

Blood Pressure Groups:

Group I: 9.4 per cent scored as "improved."

Group II-III: 35.3 per cent scored as "improved."

Group VI: 88.8 per cent scored as "improved."

Group VII: 96.9 per cent scored as "improved."

Groups IV and V provided insufficient data for statistical analysis, but the trend was in the direction of a low rate of improvement for each group. For Groups I, II-III, VI, and VII these results show significance at better than the .01 level. Reliability studies showed that the original criteria were valid.

Mathematical Measures:

Associated with "improvement":

High basal blood pressure.

After Mecholyl: Large "area"

Large "fall"

Long "time of homeostasis."

Associated with "unimprovement":

Low basal blood pressure.

After Mecholyl: Small "area"

Small "fall"

Short "time of homeostasis."

All of these measures show significant difference between the means of the "improved" and "unimproved" at better than the .01 level. Height of blood pressure rise following epinephrine bore no statistical relationship to prognosis.

Precipitable Anxiety:

Anxiety precipitated by epinephrine alone: Over-all rate of improvement: 36.4 per cent With B.P. Groups I, II-III, IV: 11.8 percent

With B.P. Groups VI, VII: 62.5 per cent These results are significant at better than .01 level.

Anxiety precipitated by Mecholyl alone:

Insufficient cases for statistical analysis, but trend in direction of recovery.

Anxiety precipitated by both drugs:

Insufficient cases for statistical analysis or trends.

The physiological indices had a higher relationship to the clinical outcome in patients treated with electroshock therapy than did the diagnostic categories.

Previous work reported by us elucidating some of the psychology and physiology underlying the drug reactions was discussed.

Submitted on January 4, 1952






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Copyright © 1952 by the American Psychosomatic Society