Milstein V, Small J G, Miller M J, Sharpley P H, Small I F
Larue D. Carter Memorial Hospital, Indianapolis, IN 46202.
Biol Psychiatry. 1990 Jun 15;27(12):1282-92. doi: 10.1016/0006-3223(90)90499-r.
A variety of neurophysiological mechanisms have been suggested to explain the therapeutic action of electroconvulsive therapy (ECT). Processes of kindling, resolution of hemispheric dysfunctions, anticonvulsant effects, and diencephalic stimulation all have been proposed to account for the beneficial effects of ECT. To investigate these, we analyzed clinical, neuropsychological, and electroencephalographic (EEG) data from 110 ECT-treated patients with schizophrenia and schizoaffective disorders, comparing responders with nonresponders. Fifty-four percent of all the patients were rated as very much or much improved. Mechanisms of kindling or anticonvulsant effects were not supported by the data. Dominant hemispheric dysfunctions in schizophrenics were suggested by the neuropsychological test data. There was tenuous support for the sensitization theory and both the neuropsychological and EEG data contradicted the dominant accentuation theory. Taken together with our previous report on ECT-treated patients with affective disorders, we propose that ECT might act by restoration of equilibrium between the hemispheres.
人们提出了多种神经生理机制来解释电休克疗法（ECT）的治疗作用。点燃过程、半球功能障碍的解决、抗惊厥作用以及间脑刺激都被认为可以解释ECT的有益效果。为了对此进行研究，我们分析了110例接受ECT治疗的精神分裂症和分裂情感性障碍患者的临床、神经心理学和脑电图（EEG）数据，比较了反应者和无反应者。所有患者中有54%被评为有很大改善或有较大改善。数据不支持点燃或抗惊厥作用机制。神经心理学测试数据表明精神分裂症患者存在优势半球功能障碍。对敏化理论的支持很微弱，神经心理学和EEG数据均与优势半球强化理论相矛盾。结合我们之前关于ECT治疗情感障碍患者的报告，我们提出ECT可能通过恢复半球间的平衡而起作用。
