Ugo Cerletti

Ugo Cerletti

Ugo Cerletti (26 September 1877 - 25 July 1963) was an Italian neurologist who discovered the method of electroconvulsive therapy in psychiatry. Electroconvulsive therapy is a therapy used, in which a seizure is provoked for a short amount of time by the use of electrical currents. This therapy is used to treat mental disorders by altering the chemical processes that occur in the brain. By doing so, the symptoms experienced by the patient before the procedure, will no longer be experienced by the patient after undergoing the procedure. This method is useful when other possible treatments do not cure the person of their mental disorder.

Life

He was born in Conegliano, in the region of Veneto, Italy, on 26 September 1877. He studied Medicine at Rome and Turin, later specializing in neurology and neuropsychiatry. As a student, he conducted some research under several influential people studying in the Medicinal field at that time. He studied with the most eminent neurologists of his time, first in Paris, France, with Pierre Marie and Dupré, then in Munich, Germany, with Emil Kraepelin (the "father" of modern scientific psychiatry) and Alois Alzheimer (the discoverer of the most common form of senile dementia, which today bears his name); and in Heidelberg, with Franz Nissl, a neuropathologist.

After his studies, he was appointed head of the Neurobiological Institute, at the Mental Institute of Milan. He remained the director of the Neurobiological Institute of the Psychiatric Hospital of Milan from 1919 to 1924. In 1924 he was given a lecturing post in Neuropsychiatry in Bari; then, in 1928, he took over the post of Prof. Enrico Morselli, at the University of Genoa. Finally, in 1935, he became the Chair of the Department of Mental and Neurological Diseases at the University of Rome La Sapienza, where he developed electroconvulsive therapy for the treatment of several kinds of mental disorders, a discovery which made him world-famous.

Works

Cerletti came to the first use of electroshock for therapeutic purposes in human beings by way of his experiments with animals on the neuropathological consequences of repeated epilepsy attacks. In Genoa, and later in Rome, he used an electroshock apparatus to provoke repeatable, reliable epileptic fits in dogs and other animals.

The idea to use ECT in humans came first to him by watching pigs being anesthetised with electroshock before being butchered, in Rome. The story goes on his way home, he stopped at a butcher shop. The shop didn't have the cut he wanted, and was told to walk back to the slaughter house behind the shop to have the cut made for him. At that slaughter house, the technique used for butchering cattle was to shock their heads. The cattle would go into seizures and fall down. This made it easy to slit their throats, as the cattle couldn't resist or fight back. He reasoned that ECT might be useful, particularly for schizophrenia; in his time period, people believed that seizures were essential in preventing schizophrenia, since many found that those diagnosed with epilepsy were immune to the disorder. The reasoning was incorrect, but his findings were monumental, and EST therapies continue to be used to treat depression today.

Furthermore, since 1935, metrazol, an epileptogenic drug, and insulin, a hormone, were in wide use in many countries to treat schizophrenics, with great success. This approach was based on Nobel winner Julius Wagner-Jauregg's research on the use of malaria-induced convulsions to treat some nervous and mental disorders, such as the general paresis of the insane, caused by neural syphilis, as well as on Ladislas J. Meduna's theory that schizophrenia and epilepsy were antagonistic, which eventually led, in the same period, to institute insulin-coma therapy in psychiatry, by Manfred Sakel, in 1933.

Cerletti first used ECT in a human patient, a diagnosed schizophrenic with delusions, hallucinations and confusion, in April 1938, in collaboration with Lucio Bini. A series of electroshocks were able to return the patient to a normal state of mind. Thereafter, in the succeeding years, Cerletti and his coworkers experimented with thousands of electroshocks in hundreds of animals and patients, and were able to determine its usefulness and safety in clinical practice, with several indications, such as in acute schizophrenia, manic-depressive illness, major depression episodes, etc. His work was very influential, and ECT quickly spread out as a therapeutic procedure all over the world. Despite the fact that it does evoke a grand mal seizure marked by a stereotyped succession of events. EC work done later was deemed to be a safe and highly effective treatment, particularly for mood disorders . A tetanic muscular contraction, the "electric spasm, is followed after a latency of seconds by unconsciousness, a high voltage paroxysmal spike and sharp-wave discharge, and a clonic convulsion. Upon recovery of consciousness the subject is left with a transient acute brain syndrome. Acute brain syndrome can be defined as "A sudden state of severe confusion and rapid changes in brain function, sometimes associated with hallucinations and hyperactivity, in which the patient is inaccessible to normal contact. Symptoms may include inability to concentrate and disorganized thinking evidenced by rambling, irrelevant, or incoherent speech. There may be a reduced level of consciousness, sensory misperceptions and illusions, disturbances of sleep, drowsiness, disorientation to time, place, or person, and problems with memory," which is to be expected in people who suffer head injury, and contributes to the 'need' for compulsion to treatment under law, as people are unwilling to volunteer to such barbarism .

As a result of his experiments, which took him from the psychiatric hospital to the abbatoir and the zoologic gardens, Cerletti developed a theory that ECT caused the brain to produce vitalising substances, which he called "agro-agonines" (from the Greek for extreme struggle). He put his theory into practice by injecting patients with a suspension of electroshocked pig brain, with encouraging results. Although electroshocked pig brain therapy was used by a few psychiatrists in Italy, France and Brazil it did not become as popular as ECT, which soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient. Cerletti and Bini were nominated for a Nobel Prize but didn't get one.

In his long activity as a psychiatrist and neurologist, Cerletti published 113 original papers, about the pathology of senile plaques in Alzheimer's disease, on the structure of neuroglia, the blood-brain barrier, syphilis, etc. In 1950 he received a honorary degree by the Collège de Sorbonne at the University of Paris, in addition to a long list of other awards and degrees.

Away from his medical work, Cerletti is also credited with having designed winter camouflage suits for Italian military forces during the First World War, and also for the creation of a time delay fuse for artillery shells.

Cerletti died in Rome on 25 July 1963.

See also

• Electroconvulsive therapy

References

• Cerletti, U. L'Elettroshock. Rivista Sperimentale di Frenatria. 1940, Vol I, 209- 310.
• Baruk H - Professor Hugo Cerletti. Bull Acad Natl Med 1966 Nov 8;150(28):574-579
• Medea E - Ugo Cerletti. Arch Psicol Neurol Psichiatr 1966 May;27(3):198-202
• Kalinowsky LB - History of convulsive therapy. Ann N Y Acad Sci 1986;462:1-4.
• Ugo Cerletti 1877–1963. Am J Psychiatry 156:630, April 1999.
• Passione, R. Italian Psychiatry in an International Context: Ugo Cerletti and the Case of Electroshock. History of Psychiatry11, 2004, 15(1), 83-104.

External links

• Ugo Cerletti. WhoNamedIt.
• Psichiatria Biologica e terapie da shock - Ugo Cerletti. Storia delle Neuroscienze in Italia (In Italian).