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Electroconvulsive therapy (ECT), despite its controversial history,
may well represent the only viable treatment for severe psychiatric
illness in those for whom medication is not an option. In
Electronconvulsive Therapy, Dr. Max Fink draws on over 50 years of
clinical experience to describe this safe, painless, and often
life-saving treatment.
Extensively revised and restructured since its original publication
a decade ago, the book provides readers with a detailed explanation
of the ECT procedure, helping them to better understand and prepare
for treatment. Discussions of the mechanisms of actions have been
updated and sections have been added on the use of ECT in pediatric
populations and to treat movement disorders such as Parkinsons.
Case studies of ECT patients illustrate its often dramatic success
in relieving depression, mania, catatonia, and psychosis.
Clarifying the many misconceptions surrounding the treatment, Dr.
Fink reveals how anesthesia and muscle relaxation techniques reduce
discomfort and risks to levels lower than those associated with
psychiatric drugs. He then provides a historical perspective of the
treatment, from the discovery of ECT and its widespread use
beginning in the 1930s, to the 1950s when it was replaced by
psychotropic drugs, to its revival in the last 30 years as a viable
psychiatric treatment. Dr. Fink concludes with a straightforward
discussion of the ethical issues surrounding ECT use, and on its
similarities to and differences from other modern brain stimulation
techniques.
The classic text on the subject, written by a renowned researcher
and physician, Electroconvulsive Therapy is an excellent resource
for patients, their families, and mental health professionals.
The riddle of melancholia has stumped generations of doctors. It is
a serious depressive illness that often leads to suicide and
premature death. The disease's link to biology has been intensively
studied. Unlike almost any other psychiatric disorder, melancholia
sufferers have abnormal endocrine functions. Tests capable of
separating melancholia from other mood disorders were useful
discoveries, but these tests fell into disuse as psychiatrists lost
interest in biology and medicine. In the nineteenth century,
theories about the role of endocrine organs encouraged endocrine
treatments that loomed prominently in practice. This interest faded
in the 1930s but was revived by the discovery of the adrenal
hormone cortisol and descriptions of its abnormal functioning in
melancholic and psychotic depressed patients. New endocrine tests
were devised to plumb the secrets of mood disorders. Two colorful
individuals, Bernard Carroll and Edward Sachar, led this revival
and for a time in the 1960s and 1970s intensive research interest
established connections between hormone dysfunctions and behavior.
In the 1980s, psychiatrists lost interest in hormonal approaches
largely because they did not correlate with the arbitrary
classification of mood disorders. Today the relation between
endocrines and behavior have been disregarded.
This history traces the enthusiasm of biological efforts to solve
the mystery of melancholia and their fall. Using vibrant language
accessible to family care practitioners, psychiatrists and
interested lay readers, the authors propose that a useful, a
potentially live-saving connection between medicine and psychiatry,
has been lost.
This book provides a comprehensive review of melancholia as a
severe disorder of mood, associated with suicide, psychosis, and
catatonia. The syndrome is defined with a clear diagnosis,
prognosis, and range of management strategies, differentiated from
other similar psychiatric, neurological, and general medical
conditions. It challenges accepted doctrines in the classification
and biology of the mood disorders and defines melancholia as a
treatable mental illness. Described for millennia in medical texts
and used as a term in literature and poetry, melancholia was
included within early versions of the major diagnostic
classificatory systems, but lost favour in later editions. This
book updates the arguments for the diagnosis, describes its
characteristics in detail, and promotes treatment and prevention.
The book offers great hope to those with a disorder too often
mis-diagnosed and often fatal. It should be read by all those
responsible for the management of patients with mood disorders.
Few mental illness treatments are more reviled in the public mind
than Electroconvulsive Shock Therapy. However, in reality, ECT is a
safe and effective treatment for cases of clinical depression and
catatonia that are unresponsive to drug therapy. Also, unlike
drugs, ECT has relatively few side effects. The authors argue that
it is time for this historically stigmatized procedure to be
reevaluated.
The authors make a strong case for greater professional and public
attention to the procedure's benefits, offering historical coverage
of ECT-related movements, legislation, public and practitioner
sentiment and the introduction of competing treatments. This volume
will not only garner the interest of mental health professionals,
but will call on policy makers and ethicists to examine its
arguments.
This book provides a comprehensive review of melancholia as a
severe disorder of mood, associated with suicide, psychosis, and
catatonia. The syndrome is defined with a clear diagnosis,
prognosis, and range of management strategies, differentiated from
other similar psychiatric, neurological, and general medical
conditions. It challenges accepted doctrines in the classification
and biology of the mood disorders and defines melancholia as a
treatable mental illness. Described for millennia in medical texts
and used as a term in literature and poetry, melancholia was
included within early versions of the major diagnostic
classificatory systems, but lost favour in later editions. This
book updates the arguments for the diagnosis, describes its
characteristics in detail, and promotes treatment and prevention.
The book offers great hope to those with a disorder too often
mis-diagnosed and often fatal. It should be read by all those
responsible for the management of patients with mood disorders.
What are the real disease entities in psychiatry? This is a
question that has bedeviled the study of the mind for more than a
century yet it is low on the research agenda of psychiatry. Basic
science issues such as neuroimaging, neurochemistry, and genetics
carry the day instead. There is nothing wrong with basic science
research, but before studying the role of brain circuits or
cerebral chemistry, shouldn't we be able to specify how the various
diseases present clinically? Catatonia is a human behavioral
syndrome that for almost a century was buried in the poorly
designated psychiatric concept of schizophrenia. Its symptoms are
well-know, and some of them are serious. Catatonic patients may die
as their temperatures accelerate; they become dehydrated because
they refuse to drink; they risk inanition because they refuse to
eat or move. Autistic children with catatonia may hit themselves
repeatedly in the head. We don't really know what catatonia is, in
the sense that we know what pneumonia is. But we can identify it,
and it is eminently treatable. Clinicians can make these patients
better on a reliable basis. There are few other disease entities in
psychiatry of which this is true. So why has there been so little
psychiatric interest in catatonia? Why is it simply not on the
radar of most clinicians? Catatonia actually occurs in a number of
other medical illnesses as well, but it is certainly not on the
radar of most internists or emergency physicians. In The Madness of
Fear, Drs. Shorter and Fink seek to understand why this "vast field
of ignorance" exists. In the history of catatonia, they see a
remarkable story about how medicine flounders, and then seems to
find its way. And it may help doctors, and the public, to recognize
catatonia as one of the core illnesses in psychiatry.
Catatonia is a syndrome of motor dysregulation (mutism, peculiar
postures, repetitive speech, negativism and imitative movements),
and is found in as many as ten per cent of acutely ill psychiatric
inpatients. Although its classification has been controversial, the
identification of catatonia is not difficult, but it is often
missed, leading to the false notion that the syndrome is rare.
Catatonia has various presentations, and may be caused by many
neurologic and general medical conditions, most commonly mood
disorder. Treatments are well defined, and when used, catatonia has
an excellent prognosis. This book, by two leading
neuropsychiatrists, describes the features of catatonia, teaches
the reader how to identify and treat the syndrome successfully, and
describes its neurobiology. Patient vignettes from the authors'
practices, and many from the classical literature, illustrate the
principles of diagnosing and treating patients with catatonia. It
is an essential clinical reference for psychiatrists and
neurologists.
Electroshock therapy (ECT) has long suffered from a controversial and bizarre public image, a reputation that has effectively removed it as a treatment option for many patients. In Electroshock, Max Fink draws on 45 years of clinical and research experience to argue that ECT is now a safe, effective, painless, and sometimes life-saving treatment for emotional and mental disorders. Dr Fink discusses the development of ECT from its discovery in 1934, its acceptance and widespread use for two decades until it was largely replaced by the introduction of psychotropic drugs in the 1950s, and its revival in the past twenty years as a viable treatment now that undesirable side-effects have been largely removed. He provides case studies of actual patients and the testimonies of their family members to illuminate successful responses. Many disorders, such as depression, mania, catatonia, and schizophrenia, respond well to ECT. We learn what the patient experiences, as the author explains the whole procedure from preparation to recovery. He also shows how anaesthesia and muscle relaxation have refined ECT, minimizing discomfort and reducing its risks to a level far lower than many of the psychotropic drugs routinely prescribed for the same problems. An excellent sourcebook for patients, their families, caretakers, and mental health professionals, Electroshock clarifies misconceptions about ECT. For those who suffer from mental and emotional disorders, it offers a safe and highly effective treatment.
Electroshock therapy (ECT) has long suffered from a controversial and bizarre public image, a reputation that has effectively removed it as a treatment option for many patients. In Electroshock, Max Fink, M.D., draws on 45 years of clinical and research experience to argue that ECT is now a safe, effective, painless, and sometimes life-saving treatment for emotional and mental disorders. Dr. Fink discusses the development of ECT from its discovery in 1934, its acceptance and widespread use for two decades until it was largely replaced by the introduction of psychotropic drugs in the 1950s, and its revival in the past twenty years as a viable treatment now that undesirable side-effects have been largely removed. He provides case studies of actual patients and the testimonies of their family members to illuminate successful responses. Many disorders, such as depression, mania, catatonia, and schizophrenia, respond well to ECT. We learn what the patient experiences, as the authoer explains the whole procedure from preparation to recovery. He also shows how anesthesia and muscle relaxation have refined ECT, minimizing discomfort and reducing its risks to a level far lower than many of the psychotropic drugs routinely prescribed for the same problems. An excellent sourcebook for patients, their families, caretakers, and mental health professionals, Electroshock clarifies misconceptions about ECT. For those who suffer from mental and emotional disorders, it offers a safe and highly effective alternative to medication or psychotherapy.
Die Abnutzungsfestigkeit von Kugelgraph- guss lasst eich durch eine
geeignete Ioni trierbehandlung in einem unerwarteten A- mass
verbessern. Dieses Ergebnis gilt sowohl fUr eine trockene
Reibungsbeanspruchung unter Notlaufbedingungen als auch fUr
FlUeeigkeits reibung. In allen untersuchten Fallen Uber trifft die
Abnutzungsfestigkeit von ioni trierten Kugelgraphitguss-Reibflachen
diejeni ge von geharteten bzw. eineatzgeharteten Reib flachen bei
weitem. Das von BERGHAUS entwickelte Ionitrierverfahren be wirkt in
einer Glimmentladung eine Nitrierung metallischer Oberflachen. Die
auf diese Weise gebildeten Schichten zeich nen eich unter anderem
durch einen gleichmassigen Aufbau, eine verhaltniemassig hohe
Duktilitat und eine nur geringe Zu nahme der Oberflachenrauhigkeit
aus. Eine Ionitrierung von Kugelgraphitguss ergab bei der Sorte GGG
60 die besten Ergebnisse bezUglieh Nitrierechicht bildung und den
daraus folgenden technologischen Eigen schaften. Durch die
gleichmassige und duktile Hartung der in den Randschichten
liegenden Ferrithofe brechen die Spha rolithen auch bei hoher
Reibungsbeanspruchung nicht aus. Sie werden mit fortschreitender
Abnutzung abgetragen und bilden dann auf der Reibflache partiell
einen dUnnen Graphit Schmierfilm. Ahnlich ionitrierfreudig verhalt
eich GGG 42, wahrend bei GGG 70 und dem vergleichsweise
untersuchten Grauguss GG 25 die Ionitrierung weniger wirksam ist.
Untersuchungen Uber das Notlaufverhalten bei trok kener Reibung auf
AMSLER-Abnutzungsmaschinen zeigten fUr ionitrierten GGG 60 die
hochste Abnutzungefeetigkeit. - 7 - Ee folgen die ionitrierten
Sorten GGG 42 und GGG 70. Dabei bewahrt der ferritieche GGG 42
weitgehend den Vorteil hoher Elastizitat. Die Abnutzungsfestigkeit
von ionitriertem Grauguss GG 25 ist etwas geringer, Ubertrifft
jedoch immer noch wesentlich diejenige von geharteten Gussproben."
Die vorliegende Arbeit befasst sich mit dem Abnutzungsverhalten von
haupt- sachlich ionitrierten Reibflachen, die auf gleitende und
rollende Reibung mit Schlupf beansprucht werden, wobei sich
folgendes Hauptergebnis herausstellt: Sowohl bei
Laufflachenschichten mit einem hohen Stickstoffgehalt (1-8% N), wie
auch bei solchen mit einem geringen Stickstoffgehalt (0,1-1% N) ist
die Reibox, ydation wirksam. Dieses Ergebnis wurde hauptsachlich
durch die chemische Analyse des Ab- nutzungsstaubes auf den Gehalt
an Eisenoxyd, sowie des Anteils an zwei- und dreiwertigem Eisen im
Oxydgemisch erhalten und wird auch teilweise durch die
metallographische Untersuchung erganzt. Durch den Vergleich des
Stickstoff- gehaltes in der Schicht und im Abnutzungsstaub muss
angenommen werden, dass ein Teil des Stickstoffes gegen Sauerstoff
ausgetauscht wird. Der erste Teil der Untersuchungen behandelt die
Gegenuberstellung des Ver- haltens von ionitrierten und nicht
nitrierten auf Abnutzung beanspruchten Lauf- flachen verschiedener
Werkstoffe (Armco-Eisen und Kohlenstoffstahle), wobei die
letztgenannten nebst im gegluhten auch im verguteten Zustand
verglichen werden. Die oxydationshemmende Wirkung des Stickstoffes
kommt bei den ionitrierten Proben erst nach langerer Versuchsdauer
zum Ausdruck, also bei Schichten von relativ kleinem
Stickstoffgehalt (0,1-1% N). Unerwartet grosse Oxydanteile im
Abnutzungsstaub weisen die stickstoffreichen Schichten (bis 8% N)
auf, was durch die zeitlich langere Einwirkung der Oxydation, sowie
auch durch die grosse Sauerstoffloeslichkeit der e-Phase bedingt
sein durfte. Eine Aus- bildung von Oxyden unter der Oberflache in
diesem ersten Teil konnte bei nicht nitrierten verguteten Proben
festgestellt werden.
THE SERIES The 10 volumes in this series record a fifty year
history of neuropsychopharmacology related by 213 pioneer clinical,
academic, industrial and basic scientists in videotaped interviews,
conducted by 66 colleagues between 1994 and 2008. These volumes
include a preface by the series editor placing its contents in an
historical context and linking each volume to the next. Each volume
is dedicated to a former President of the ACNP and edited by a
distinguished historian or Fellow of the College who provides an
introduction to its themes and a biography of each scientist's
career. The series provides insights into a half century of
discovery and innovation with its rewards and disappointments,
progress and setbacks, including future expectations and hopes for
the field as a whole and the ACNP as an organization. IN THIS
VOLUME In Volume 1, 22 pioneers reflect on their contributions to
the "Starting Up" of neuropsychopharmacology in the 1950s, using
behavioral methodology to detect differences in the pharmacological
profile of newly introduced psychotropic drugs. In Volume 2,
"Neurophysiology," the emphasis shifts to the detection of the
action of drugs on the functional activity of the brain. Volume 2
is divided into two parts. In Part One (Electrophysiology), 15
interviewees reflect on their contributions to the detection of the
effect of drugs on the electrical activity of the brain and in Part
Two (Brain Imaging), 5 interviewees talk about their contributions
to the study of cerebral blood flow and brain metabolism Dedicated
to the memory of Jonathan O. Cole, President, 1966, Volume 2 is
edited by Max Fink, a leading American psychiatrist who was
instrumental in the introduction of "pharmaco-EEG," using digital
computer analysis of the electroencephalogram to identify active
psychotherapeutic drugs following the model of the association of
EEG and behavior in man.
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