SynopsisFifty-nine patients suffering from a major depressive episode, for whom electroconvulsive therapy (ECT) was clinically indicated, were randomly assigned to one of three electrode placement groups for treatment with brief pulse, threshold-level ECT: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparison of these groups in terms of number of treatments, duration of treatment, or incidence of treatment failure, showed that the bilateral placements were superior to the unilateral; comparison of Hamilton, Montgomery–Åsberg, and visual analogue scale scores showed that the bifrontal placement was superior to both bitemporal and unilateral treatment. Bitemporal treatment showed therapeutic results intermediate between BF and RU. Because BF ECT causes fewer cognitive side effects than either RU or BT, and is independently more effective, it should be considered as the first choice of electrode position in ECT.

SYNOPSIS Forty patients suffering from a major depressive disorder, for whom electroconvulsive therapy (ECT) was clinically indicated, were assigned to one of three electrode placement groups: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparisons of these groups in terms of cognitive status showed that the BF placement, which avoided both temporal regions, spared both verbal and nonverbal functions. These differential effects, which were independent of the degree of clinical depression, were not, however, evident three months after the last ECT.

Although it is common practice to try to assess the risk of suicide in depressed patients the possibility of homicidal tendencies is often overlooked. Homicidal acts are frequently directed towards children by either parents or strangers and there is also a risk that children may be killed by parents suffering from severe depressive illness. It is proposed that early recognition might lead to the prevention of this type of crime. The terms infanticide, filicide, and neonaticide are used idiosyncratically by the different authors and may therefore be confusing. Infanticide in Canada is a medicolegal term; it indicates a relationship between child murder and child birth. All other cases of child killings are designated as murder. In Canada there were 1,276 incidents of homicide over a period of five years, (19641968). Of these 141 (11 per cent) were incidents of child murder - child murder being defined as the killing of a person 16 years and under. Seventy-six (54 per cent) of these were caused by parents, 41 were mothers and 35 were fathers. The mothers killed their children only, but 40 per cent of the fathers also murdered their wives. Suicide or attempted suicide following the crime was more likely to occur in those cases where the father was the assailant. Most children killed by their parents are between one and five years of age. Sixty-five (46 per cent) of child murders were caused by non-relatives and 32 per cent of these assaulted their victims sexually, the crime occurring most frequently in the evening. The dynamics of child murder by depressed parents has been reviewed. It is proposed that a child is particularly vulnerable when a depressive illness is superimposed upon a constellation of parental factors which can be recognized and specified.