COMPARATIVE DIAGNOSTIC CONSIDERATIONS AND PROGNOSTIC EVALUATIONS OF ELECTROSHOCK AND INSULIN COMA TREATMENTS : A Comparison of Norwegian and American Psychiatric and Psychological Concepts

In spite of the different opinions as to the diagnosis and prognoses in the 25 cases included in this team study, the following positive conclusions are agreed upon by all members of the team:

In those cases, which in the United States are usually diagnosed as schizophrenic reactions, it is possible by the help of a careful history, psychiatric examination, psychological interview, and psychological tests, to predict with a high percentage of certainty those cases which will not profit from electroshock or insulin therapy. Although 15 of the 25 cases had a duration of less than 6 months, and 6 of the cases less than one year, only 5 cases showed a good immediate effect of the treatments. Four of these were looked upon by the Norwegian psychiatrist not as schizophrenic, but as constitutional psychoses. Eight of the cases were treated with both electroshock and insulin coma therapy. Since 12 of the cases were looked upon by one or more of the researchers as giving promise of temporary improvement from treatment, it seems it is much more difficult to evaluate a good effect than a poor one. This seems to be related to the fact that the indication of a poor effect regularly has been based on the presence of positive signs of a schizophrenic personality and actual schizophrenic symptoms.

As to the prediction of a lasting effect of treatment in cases which were assumed to have received temporary benefit, this prediction seems to have been dependent upon the decision as to whether the case in question was considered to be a real schizophrenic one or a reactive psychosis. Since great difference of opinion existed on the latter point, especially between the American as compared with the Norwegian researchers, great disagreement occurred in this type of prediction. The Norwegian psychiatrist had indicated a good lasting effect in 7 cases, which he considered as nonschizophrenic, constitutional psychoses, while the American psychologists indicated such effect in only 2 cases, and the American psychiatrist indicated a good lasting effect in 6 cases.

As to the final evaluation of results of therapy after the last follow-up investigation, the following may be stated: Although this research has produced evidence that some acute psychotic cases regularly diagnosed as schizophrenic reactions may profit temporarily from electroshock or insulin therapy, the researchers have been very reserved in their assumption of a more lasting benefit. As such lasting effect depends upon the underlying personality structure, as well as on the existence of possible precipitating factors, and on the symptomatology in the initial stages, it is of the greatest importance in the evaluation of the prognosis and in the indication of therapy to give necessary respect to the fact brought out in this study, viz., that in the group regularly diagnosed in U. S. A. as schizophrenic reactions, it is possible by coordination of psychiatric and psychological experience to distinguish between 2 groups of psychoses, characterized also by difference in immediate response to the therapies mentioned. Next it should be noted that it has been shown to be relatively easy to predict most of those cases which will not benefit from the treatments. Much clinical experiences and extensive cooperation between psychiatrists and psychologists seems necessary however to establish solid clues to the evaluation of more lasting effects in cases which prove to benefit temporarily, from the treatments. For this reason it is necessary in all statistics dealing with shock therapies to distinguish between 2 groups, viz., the one which consists of cases of psychoses which according to clinical and psychological experience are believed capable of no or only temporary effect; and the other group which is believed capable of more lasting effects. It may be merely a matter of estimation whether one wishes to include both of these groups in the comprehensive schizophrenia-group, or whether as proposed by Langfeldt (1937) and Bellak (1948) one should give them different names. But for the sake of clinical evaluation, economy, and research, such differentiation is by the authors of this paper assumed to be very important.

The small number of cases included in this teamwork can only give indication of the problems involved. It would certainly be of great value if research on a larger material could prove statistically the difference between the 2 groups of schizophrenia, and also state the lack of real effect of the different treatments in the typical schizophrenic cases.