Baran Brigitta, Bitter István, Ungvari Gabor S, Nagy Zoltán, Gazdag Gábor
Dept. of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Eur Arch Psychiatry Clin Neurosci. 2008 Oct;258(7):434-40. doi: 10.1007/s00406-008-0816-9. Epub 2008 May 26.
Convulsive therapy (COT) is a major European contribution to the psychiatric armamentarium and biological psychiatry. COT was introduced in psychiatry by László Meduna, a Hungarian neuropsychiatrist. All subsequent publications about the first patient treated with COT, Zoltán L (ZL), were based on Meduna's papers and autobiography. After 4 years of catatonic stupor, ZL received camphor-induced COT which resulted in full remission and discharge from the institution. The aim of this paper is to reconstruct ZL's case history from the original case notes--partly written by Meduna himself--which were recovered from the archives of the National Institute of Psychiatry and Neurology. The case notes show that ZL repeatedly received COT between 1934 and 1937, first with camphor and then with cardiazol induction. After the first course of COT the catatonic stupor was resolved and the psychotic symptoms subsided. However, the remission lasted for only a few months and was followed by a relapse. Despite repeated courses of COT, ZL never became symptom free again, was never discharged and died in the Institute in 1945. This historical case is discussed from both the diagnostic and therapeutic points of view, and an attempt is made to explain the possible reasons for the discrepancies found between Meduna's account and ZL's case notes.
惊厥疗法（COT）是欧洲对精神医学和生物精神病学的一项重大贡献。惊厥疗法由匈牙利神经精神病学家拉斯洛·梅杜纳引入精神病学领域。所有后续关于首例接受惊厥疗法治疗的患者佐尔坦·L（ZL）的出版物，均基于梅杜纳的论文和自传。在经历了4年的紧张性木僵后，ZL接受了樟脑诱发的惊厥疗法，结果完全缓解并出院。本文的目的是根据从国家精神病学和神经病学研究所档案馆找到的原始病历——部分由梅杜纳本人所写——来重构ZL的病史。病历显示，ZL在1934年至1937年间多次接受惊厥疗法，最初用樟脑，之后用戊四氮诱发。在首个惊厥疗法疗程后，紧张性木僵得到缓解，精神症状消退。然而，缓解仅持续了几个月，随后复发。尽管多次接受惊厥疗法疗程，ZL再也没有完全摆脱症状，从未出院，并于1945年在该研究所去世。本文从诊断和治疗的角度对这一历史病例进行了讨论，并试图解释梅杜纳的记述与ZL的病历之间存在差异的可能原因。
