Bibliographic record
Abstract
Editor—The editorial by Young et al on the treatment of bipolar affective disorder makes no reference to the benefits of electroconvulsive therapy (ECT).1 The authors do a disservice to their patients and to the BMJ's readers by neglecting to mention ECT and by overstating the benefits of new treatments that have not been tested sufficiently. The merits of ECT in resolving both mania and depression were so well documented by 1940 that they justified its widespread, worldwide acceptance.2,3 A review of literature published over five decades found that 66% of patients went into remission or showed marked clinical improvement of bipolar affective disorders when treated with ECT.4 A retrospective review of patients who had been matched for age, sex, and severity of illness contrasted the efficacy of the therapy in patients with mania with those later treated with chlorpromazine. All of the 28 patients treated with ECT responded to treatment but only 18 of 28 treated with chlorpromazine responded. All 10 patients who had not responded to chlorpromazine were later treated with ECT and all responded, suggesting that ECT is superior. Another study comparing ECT, lithium, and chlorpromazine for treatment of chronic mania found that outcomes were equivalent. A comparison of the efficacy of ECT and lithium over eight weeks in patients with a suboptimal response to lithium alone found that ECT was superior. Patients with mania whose treatment with lithium or neuroleptics was unsuccessful were treated either with ECT or a combination of lithium and haloperidol: 59% had a complete remission with ECT but none who received the combined medication went into remission. The efficacy of ECT in patients with delirious mania is well documented in case reports, and it is often a life saving option. Anticonvulsant agents were introduced into the treatment of mania partly because of their ability to raise seizure thresholds. The efficacy of ECT in raising seizure thresholds is well established. There are no studies comparing ECT with any of the treatments for bipolar disorder recommended in the editorial (anticonvulsant drugs or anticonvulsants with antipsychotic drugs or lithium, or both). Ignoring the benefits of ECT while asserting that other unproved non-pharmacological treatments “are emerging” relies more on hope than on evidence. The efficacy of ECT in relieving bipolar affective disorders has been shown, and its use should be considered in patients with the severe forms of the illness, and those with rapid cycling, delirious mania, and mania that has been resistant to treatment (that is, two adequate trials of medication of no longer than six weeks each have failed). The authors' call for additional evidence should include studies of ECT.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.011 |
| Insufficient payload (model declined to judge) | 0.020 | 0.009 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".