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Muller DJ. 
Amer J Psychiat. 1972;128:1154-1155.
Dr. Muller Replies

SIR: Let me respond directly to the points raised by Dr. Liskow.

1. I totally agree that the nature and dosage of illegally used drugs are difficult, if not impossible, to determine. I believe, however, that the average user can distinguish between LSD and marijuana, for example.

2. It is clear from the literature that LSD can cause prolonged psychoses(3). Too many educated people are still skeptical about this despite clear evidence. A similar lack of objectivity has been seen in regard to the dangers of cigarette smoking. The extent to which other illegal drugs or the chemicals added to them can cause prolonged psychoses remains to be more fully explored, Talbott and Teague (4) described 12 patients with toxic psychoses associated with marijuana usage. Treated supportively, the longest case lasted only 11 days, but the exact nature of the offending agent was assumed, as with my patients, on the basis of historical data.

3) It is well known that functional psychoses responded to electroconvuisivc therapy (ECT) before LSD was available to the public. My paper refers to organic or toxic psychoses, however, and my last reference was to work done in this area (5).

Dr. Kiskow is correct in pointing out how little is actuaily known about this subject. The absolute test of the effectiveness of ECT in LSD psychoses would have to be done on experimental subjects. But in lieu of the dangers involved, such a study is not likely. Since I wrote my paper, I might add, I have treated with ECT four more patients with refractory cases of presumed LSD psychosis. These psychoses had persisted for one to three months despite the administration of various medications before the administration of and dramatic response to ECT. I have not yet had a treatment failure with ECT in patients with this type of psychosis.

The references are:

1) Cohen S: Lysergic acid diethylamide side effects and complications. J Nerv Ment Dis 130: 30-40, 1960.

2) Mallesop N: Acute adverse reactions to LSD in clinical and experimental use in the United Kingdom. Brig J Psychiat 118: 229-230. 1971.

3) Smart T, Bateman K: Unfavourable reactions to LSD: a review and analysis of the available case reports. Canad Med Ass J 97:1214-1221. 1967

4) Talbott J, Teague J: Marijuana psychosis. JAMA 210.299-302.1969

5) Roberts A: The value of ECT in delerium. Brit J Psychiat 109: 653-655, 1963.
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