Schizophrenia
It is concluded that convulsive or insulin treatment is justifiable in pregnant women because of the apparent harmlessness of convulsive seizures due to these drugs and to epilepsy.
Abstract
The beneficial effect of shock therapy in the treatment of the emotional mental disorders is now so firmly established that any possible contraindications should be critically examined before deciding to withhold treatment. Several conditions which were formerly considered to be a bar to shock treatment have sipce been found to involve very little risk. A consideration of the patient's age, for example, is not now regarded as important, and patients of 70 to 80 and children of 3 years have been successfully treated with induced convulsions (Hemphill and Walter, 1941). Provided they are well compensated, cardiovascular disorders are not serious obstacles, even in cases of auricular fibrillation (Good, 1940). In fact, both cardiazol and electric convulsions act as cardiac stimulants, with apparent benefit in cases of circulatory asthenia and low blood pressure. But so far as I am aware, little mention has been made in the literature regarding the use of shock therapy in the mental disorders arising during pregnancy. Although such disorders are relatively uncommon, it is possible that in some quarters the pregnant state is thought to be a contraindication to shock therapy. The result in the following case, however, suggests that in suitable patients the treatment is fully justified and entirely harmless. The stress of pregnancy may precipitate a mental breakdown in predisposed individuals, usually a state of depression, but as a rule the prognosis is good when mental disorders occur before the fourth month. If they appear later they tend to become increasingly severe until the birth of the child, when they usually disappear. In the late case shock therapy would be worth while if only to enable the child to be born at home instead of in a mental hospital, provided there are no risks to the mother or the child. The first consideration, however, is the possible risk of precipitating a miscarriage. But this appears unlikely when one thinks of the number of epileptic women who have fits during pregnancy with no untoward results. Goldstein et al. (1941) state that a review of the literature indicates that epilepsy does not influence pregnancy unfavourably other than by predisposing to injury from falls. (The spasms of epilepsy occur only in voluntary muscles.) Those workers also report the case of a schizophrenic, 34 months pregnant, who was given 13 cardiazol seizures and insulin shock treatment for 13 days with no harmful effects on the pregnancy. They conclude that convulsive or insulin treatment is justifiable in pregnant women because of the apparent harmlessness of convulsive seizures due to these drugs and to epilepsy. The following description of a similar case would seem to support the above conclusion.