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The block-paradigm of the Functional Image Analysis Contest (FIAC) dataset was analysed with the Brain Activation and Morphological Mapping software. Permutation methods in the wavelet domain were used for inference on cluster-based test statistics of orthogonal contrasts relevant to the factorial design of the study, namely: the average response across all active blocks, the main effect of speaker, the main effect of sentence, and the interaction between sentence and speaker. Extensive activation was seen with all these contrasts. In particular, different vs. same-speaker blocks produced elevated activation in bilateral regions of the superior temporal lobe and repetition suppression for linguistic materials (same vs. different-sentence blocks) in left inferior frontal regions. These are regions previously reported in the literature. Additional regions were detected in this study, perhaps due to the enhanced sensitivity of the methodology. Within-block sentence suppression was tested post-hoc by regression of an exponential decay model onto the extracted time series from the left inferior frontal gyrus, but no strong evidence of such an effect was found. The significance levels set for the activation maps are P-values at which we expect <1 false-positive cluster per image. Nominal type I error control was verified by empirical testing of a test statistic corresponding to a randomly ordered design matrix. The small size of the BOLD effect necessitates sensitive methods of detection of brain activation. Permutation methods permit the necessary flexibility to develop novel test statistics to meet this challenge.

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In an acute inpatient environment, clinicians are often faced with patients experiencing mental illness to an extent that is life-threatening, whether this is through absolute loss of the will to eat and drink, through the intense impulse towards suicide, or through the sheer exhaustion of severe mania. It is essential to have the ability to bring these symptoms under control in a way that is rapid, effective, and humane, and electroconvulsive therapy (ECT) provides this. Despite enormous advances in the safe delivery, regulation, and efficacy of ECT over the last 70 years, and its ability to bring patients from stupor to recovery over (on average) just 6–12 treatments, it remains a stigmatized and stigmatizing treatment in the public eye. This chapter outlines the history of ECT, and explains how it can be safely prescribed and monitored, and who will be most likely to benefit.

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