The oral examination in psychiatry for final-year medical students at Wellington and Dunedin School of Medicine, University of Otago, was studied. Between December 1989 and April 1990, 40 medical students were videorecorded during such an examination. The transcripts of the recording of each oral, and at a later date the videorecordings, were individually scored by a panel of six research psychiatrists who were experienced examiners. In addition verbal and non-verbal behaviour was rated using visual analogue scales and the students completed personality and anxiety questionnaires. There was a low level of agreement between research psychiatrists in the allocation of oral marks. The oral score was positively associated with the level of confidence of the student and negatively with anxiety in men.
Changes in psychiatric symptoms following electroconvulsive therapy (ECT) were related to alterations in global EEG and cerebral blood flow (CBF) in 21 in-patients suffering from depression. They were examined by clinical ratings, EEG, and CBF immediately before and 1 to 3 h after treatments during an ECT series and at follow-up. Four symptom clusters from a factor analysis of symptoms in depression, representing different dimensions of emotion, cognition, and psychomotor retardation, were used for clinical description. The changes in the separate symptom clusters showed different patterns and also different correlations with neurophysiological (EEG and CBF) changes during the course of serial ECT. Furthermore, acute clinical and neurophysiological effects following single ECT's were found to be different from non-acute changes, building up during the treatment course. Acute relief in symptoms of anxiety, depressed mood, and psychomotor retardation correlated with an acute slowing of the EEG. Regarding non-acute effects a reversed relationship was found, i.e. improvement in symptoms of depressed mood and psychomotor retardation was related to less EEG slowing. As opposed to the acute clinical changes, the non-acute changes, found following the first two or three treatments of a series, contained predictive information about the individual clinical outcome of the patients.
Frequency analysis of EEG was made during electroconvulsive therapy (ECT) in patients with depression. Acute effects were quantified by calculating differences of EEG power from before to after the induced seizure, and were found to correlate with the duration of the seizure but not with the time lapse following the seizure. Increases in delta power were much more pronounced at the end of the treatment series than at the beginning. Non-acute effects were quantified as the differences from before the first treatment to the pre-ECT EEG later in the series. Increases in delta power correlated with the accumulated seizure duration and positively with the time lapse from the previous seizure, suggesting that it takes considerable time for this effect to develop. The concept of two different sources of EEG slowing during the ECT series is supported by different correlations between acute and non-acute EEG slowing on the one hand and on the other symptoms of depression, anxiety, cognitive disturbances, and cerebral blood flow as presented elsewhere.
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