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.

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.

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.

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.

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.