Cranial Electrotherapy Stimulation Reduces Aggression in a Violent Retarded Population: A Preliminary Report

A 24-year-old, mildly retarded Caucasian female was thought to be experiencing personality changes due to Huntington’s disease, from which her father had died in his mid 40s. The patient had been assaulting others since childhood, with her symptoms worsening at age 13. She was arrested at age 18 for driving a car at a high speed into another vehicle. Highly promiscuous, she had six children, all of whom were in the care of others. The patient was transferred to NTSH-V maximum-security unit after a 6-week period, during which she was assaultive 14 times, with one of these attacks resulting in a staff member suffering a dislocated jaw. Though she was not psychotic, efforts to diminish her violence with medications (e.g., valproic acid, lithium, quetiapine, and olanzapine) were unsuccessful and were discontinued. She never showed remorse after her assaults, and she responded to our inquires with, “I do not know” or “I just wanted to.” But she did admit a thrill at carrying out her attacks. In the 2 months prior to starting CES, she carried out 19 episodes of unprovoked and unpredictable assaults, including two attacks on her physician. In that period, she was restrained and secluded 19 times, and she received 12 haloperidol injections. One hundred Hz CES was initially provided an hour a day, then twice a day for 45 minutes to 1 hour per treatment. She was not taking psychoactive medications during the 2 months of 100 Hz CES treatment. Her aggressive episodes dropped to six, requiring restraint and seclusion four times. And she received only two haloperidol injections during the 2-month period. Her dyskinetic movements disappeared during the period of active treatment. At the end of the 2-month period, she began refusing CES. Shortly thereafter, she reported erotomanic and other delusions as well as auditory hallucinations. After CES was discontinued, she resumed her assaultive behavior at its pretreatment frequency.

The patient is a 38-year-old, unmarried citizen of Mexico undergoing her second hospitalization at NTSH-V. This was not the first time she had been sent from a state hospital as manifestly dangerous. Prior to this admission she had committed 45 acts of aggression, resulting in 14 injuries at the previous state hospital. She also continued biting, hitting, exposing herself, urinating, and defecating in the seclusion room, and she was too disorganized to participate in any programming. She has spent all but 6 months of the past decade in Texas state hospitals.

Born to impoverished parents in Mexico, the patient was the sixth of seven children. When she was 2 years old, her mother died from complications of childbirth. Her alcoholic father was cold and distant with her and her siblings. She attended school only through the third grade. While attending school, she could not get along with other students and learned very little. She cannot read or write in English or Spanish. She has been diagnosed as mildly retarded. The patient is said to have spent her childhood running loose in the streets and she could not keep friends because of her explosive temper. At age 15, she was hospitalized in Mexico and diagnosed as schizophrenic. The family had no money for her medications, which were discontinued after her multiple hospitalizations in Mexico. At age 23, she delivered a child who was taken from her by the Mexican authorities because of her mental condition. Traumatized by this experience, it wasn’t long before she kidnapped the infant of another woman. She spent 6 months in jail, during which time she had no psychiatric treatment. Her family brought her to the U.S. when she was 24 years of age, and she began a decade of hospitalization within 1 year of being in the country. In a prior hospitalization, she had stabilized on clozapine, but unfortunately her seizures increased. Additionally, she had adverse electrocardiogram (EKG) changes (QTc prolongation problems), resulting in discontinuation of the medicine. No other medication has had much effect on her relentlessly assaultive and disorganized behavior. On this admission, she was noted to be babbling incoherently, bizarre, malodorous, and disheveled. Such sentences as she spoke were meaningless compilations of words, which seemed to be in a “bizarre language unknown to anyone.” In the 3 months prior to starting CES, the patient was assaultive 62 times, requiring seclusion on 53 occasions, was restrained 9 times, and received 25 injections of antipsychotic medicine. Shortly before CES was started (at the 0.5 Hz frequency, 1 hour twice daily) the 60 mg/day of haloperidol was discontinued, leaving her on lithium, valproic acid, phenytoin and aripiprazole. In the first 3 months of CES therapy the number of aggressive episodes dropped from 62 to 9, seclusions went down from 53 to 8, restraints declined from 9 to 1, and she required only one sedative injection, down from 25 before CES therapy. Her interactions became much more appropriate with peers, and she no longer urinated and smeared feces in the seclusion room even when she required seclusion. In the second month of CES therapy, there were no seclusions or restraints. In the third month, only three personal restraints and one seclusion were implemented. She began attending classes and therapies and was able to be housed in a dormitory for less aggressive patients. Overall, the patient seemed less demented as CES continued, and she was no longer as disorganized in her thinking.