Childs, Allen. Cranial electrotherapy stimulation reduces aggression in a violent retarded population: a preliminary report. The Journal of Neuropsychiatry and Clinical Neurosciences, 17(4), 2005.

Abstract

Nine aggressive, retarded patients refractory to conventional care at a maximum security hospital were given a three month course of cranial electrotherapy stimulation using Alpha-Stim CES technology (Electromedical Products International, Inc. Mineral Wells, Texas, www.alpha-stim.com). Aggressive episodes declined 59% over baseline, seclusions were down 72%, restraints 58% and PRN medications decreased 53% (see Table 1). The most dramatic change was a disorganized schizophrenic patient whose aggressive episodes declined from 62 to 9, seclusion’s from 53 to 8, restraints from 9 to 1 and PRN’s dropped from 25 to 1 (see case example below). No patients discontinued CES because of side effects. This preliminary report indicates that CES appears to be an efficacious, safe and cost-effective addition to the treatment regimen in this patient population.

Case Example

The patient is a 38 year old, unmarried citizen of Mexico undergoing her second hospitalization at NTSH-V, having again been sent from another state hospital as manifestly dangerous. Prior to this admission she had committed 45 acts of aggression resulting in 14 injuries at the previous state hospital and she continued biting, hitting, exposing herself, urinating and defecating in the seclusion room and being too disorganized to participate in any programming. She has spent all but six months of the past decade in state hospitals in Texas.

The patient was the sixth of seven children born to impoverished parents in Mexico. Her mother died from complications of childbirth when the patient was two years old and her alcoholic father was cold and distant with her and her siblings. She attended school only through the third grade, could not get along with other students and learned very little. She can not read or write in English or Spanish. She has been diagnosed as being mildly retarded. The patient is said to have spent her childhood running loose in the streets and she could not keep friends because of her explosive temper. At age 15 she was hospitalized in Mexico and diagnosed as schizophrenic. The family had no money for her medications so they were not continued after her multiple hospitalizations in Mexico. At age 23 she delivered a child which was taken by the Mexican authorities because of her mental condition. She was quite traumatized by this and shortly thereafter, she kidnapped the infant of another woman. She spent 6 months in jail during which time she had no psychiatric treatment. The family brought her at age 24 to the United States and within a year she had begun a decade of hospitalization. In a prior hospitalization she had stabilized on clozapine but unfortunately her seizures increased and she also had QTC prolongation problems resulting in discontinuation of the medicine. No other medication has had much effect on her relentlessly assaultive and disorganized behavior. She was noted on this admission to be babbling incoherently, bizarre, malodorous and disheveled. Such sentences as she spoke were meaningless compilations of words, which seemed to be in a “bizarre language unknown to anyone”. In the three months prior to starting CES, the patient was assaultive 62 times, requiring seclusion on 53 occasions, was restrained 9 times and received 25 PRN injections of antipsychotic medicine. Shortly before Alpha-Stim CES was started, at the 0.5 Hz frequency, 1 hour twice daily, the 60 mgs haloperidol daily was discontinued, leaving her on lithium, valproic acid, phenytoin and aripiprazole. In the first three months of CES therapy the number of aggressive episodes dropped from 62 to 9, seclusions went down from 53 to 8, restraints declined from 9 to 1 and she required only one PRN injection, down from 25 before CES therapy. Her interactions became much more appropriate with peers and even when she required seclusion she no longer urinated and smeared feces in the seclusion room. In the second month of CES therapy there were no seclusion’s or restraints and in the third month, only three personal restraints and one seclusion. She began attending classes and therapies and was able to be housed on a dormitory for less aggressive patients. In all she seemed less demented as CES continued and she was no longer as disorganized in her thinking.

Table 1                                                  Outcomes

Discussion

In this group of violent, refractory patients it is surprising that CES made any difference in their behavior. Though some patients had modest declines in the absolute number of aggressive episodes, diminished severity lead to fewer restraints, seclusions and PRN medications. In some cases brief personal hold was enough to allow the patient to regain control without having to be secluded or medicated. In a time when hospitals are under pressure to reduce seclusion and restraint, it appears that CES is useful in diminishing the necessity of these procedures in persistently aggressive patients. In the first three months of CES use on the unit for retarded patients (housing 7 of these 9 cases) staff injuries declined 50%, patient injuries dropped by 66% and, with no change in census, the cost of medications was $14,000.00 less. Patient 1 had a better response to the second course of CES, suggesting a cumulative benefit that has also been apparent in the seven patients who continued the treatment after the initial three-month period.

Conclusion

These nine retarded, aggressive, medication resistant patients have benefited substantially from CES. Other cases at NTSH-V quite similar but slightly less severe than these nine, have also responded briskly to CES. While controlled studies should be undertaken, CES appears to be an efficacious, safe and cost-effective addition to the treatment regimen in this patient population.

Pre and Post Totals

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Aggression

Seclusions

Restraints

PRN's

Totals 3 mo Pre

Totals 3 Mo Post

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