Cerebral Ventricular Enlargement in Chronic Schizophrenia

The authors mention the use ofcaffeine as a poss ible measure for lowering seizure threshold.Sub sequent to the case report which they cite (Shapira et a!, 1985), we have evaluated the effect of pre-ECT administration of caffeine sodium benzoate on seiz ure parameters in a controlled study (Shapira et a!, 1987).The results supported our original obser vation and showed a significant increase in seizure duration during treatments preceded by caffeine ad ministration.Caffeine did not induce untoward hae modynamic effects, nor a greater degree of cognitive impairment than is normally associated with ECT, and was subjectively well-tolerated.These findings have been borne out by other studies (e.g.Hinkle et a!, 1987).The patient reported by Drs Sharpe & Andrew eventually remitted following lithium sup plementation of ongoing treatment with amitrypti line and chlorpromazine.We have recently reported (Shapira et a!, 1988) seven patients who were unres ponsive to ECT and eventually remitted following lithium supplementation of tricyclic antidepressant (TCA) treatment.Two had not responded to this combination prior to ECT.Four of these patients were administered ECT in our hospital; they all had seizures exceeding 25s in length during their courses of 11 or more bilateral treatments.Three reports by other authors (e.g.Nelson & Mazure, 1986) mention cases in which lithium supplementation of TCA induced remission in patients unresponsive to ECT.We therefore suggest that lithium supplementation be considered in TCA non-responders prior to re ferral for ECT.