title: Rhododendron

text: The next major attempt at classification was by Sleumer who from 1934 began incorporating the Balfourian series into the older hierarchical structure of subgenera and sections, according to the International Code of Botanical Nomenclature, culminating in 1949 with his "Ein System der Gattung "Rhododendron" L.", and subsequent refinements. Most of the Balfourian series are represented by Sleumer as subsections, though some appear as sections or even subgenera. Sleumer based his system on the relationship of the flower buds to the leaf buds, habitat, flower structure, and whether the leaves were lepidote or non-lepidote. While Sleumer's work was widely accepted, many in the United States and the United Kingdom continued to use the simpler Balfourian system of the Edinburgh group.


title: Rhododendron

text: Sleumer's system underwent many revisions by others, predominantly the Edinburgh group in their continuing Royal Botanic Garden Edinburgh notes. Cullen of the Edinburgh group, placing more emphasis on the lepidote characteristics of the leaves, united all of the lepidote species into subgenus "Rhododendron", including four of Sleumer's subgenera ("Rhododendron", "Pseudoazalea", "Pseudorhodorastrum", "Rhodorastrum"). In 1986 Philipson & Philipson raised two sections of subgenus "Aleastrum" ("Mumeazalea", "Candidastrum") to subgenera, while reducing genus "Therorhodion" to a subgenus of "Rhododendron". In 1987 Spethmann, adding phytochemical features proposed a system with fifteen subgenera grouped into three 'chorus' subgenera.


title: Rhododendron

text: A number of closely related genera had been included together with "Rhododendron" in a former tribe, Rhodoreae. These have been progressively incorporated into "Rhododendron". Chamberlain and Rae moved the monotypic section "Tsusiopsis" together with the monotypic genus "Tsusiophyllum" into section "Tsutsusi", while Kron & Judd reduced genus "Ledum" to a subsection of section "Rhododendron". Then Judd & Kron moved two species ("Rhododendron schlippenbachii", "R. quinquefolium") from section "Brachybachii", subgenus "Tsutsusi" and two from section "Rhodora", subgenus "Pentanthera" ("R. albrechtii", "R. pentaphyllum") into section "Sciadorhodion", subgenus "Pentanthera". Finally Chamberlain brought the various systems together in 1996, with 1,025 species divided into eight subgenera. For a comparison of the Sleumer and Chamberlain schemata see Table 1 of Goetsch (2005).


title: Rhododendron

text: The era of molecular analysis rather than descriptive features can be dated to the work of Kurashige (1988) and Kron (1997) who used matK sequencing. Later Gao "et al." (2002) used ITS sequences to determine a cladistic analysis. They confirmed that the genus "Rhododendron" was monophyletic, with subgenus "Therorhodion" in the basal position, consistent with the matK studies. Following publication of the studies of Goetsch "et al." (2005) with RPB2, there began an ongoing realignment of species and groups within the genus, based on evolutionary relationships. Their work was more supportive of Sleumer's original system than the later modifications introduced by Chamberlain "et al.".


title: Rhododendron

text: The major finding of Goetsch and colleagues was that all species examined (except "R. camtschaticum", subgenus "Therorhodion") formed three major clades which they labelled A, B and C, with the subgenera "Rhododendron" and "Hymenanthes" nested within clades A and B as monophyletic groups respectively. By contrast subgenera "Azaleastrum" and "Pentanthera" were polyphyletic, while "R. camtschaticum" appeared as a sister to all other rhododendrons. The small polyphyletic subgenera "Pentanthera" and "Azaleastrum" were divided between two clades. The four sections of "Pentanthera" between clades B and C, with two each, while "Azaleastrum" had one section in each of A and C.


title: Rhododendron

text: Thus subgenera "Azaleastrum" and "Pentanthera" needed to be disassembled, and "Rhododendron", "Hymenanthes" and "Tsutsusi" correspondingly expanded. In addition to the two separate genera included under "Rhododendron" by Chamberlain ("Ledum", "Tsusiophyllum"), Goetsch "et al.". added "Menziesia" (Clade C). Despite a degree of paraphyly, the subgenus "Rhododendron" was otherwise untouched with regard to its three sections but four other subgenera were eliminated and one new subgenus created, leaving a total of five subgenera in all, from eight in Chamberlain's scheme. The discontinued subgenera are "Pentanthera", "Tsutsusi", "Candidastrum" and "Mumeazalea", while a new subgenus was created by elevating subgenus "Azaleastrum" section "Choniastrum" to subgenus rank.


title: Rhododendron

text: Subgenus "Pentanthera" (deciduous azaleas) with its four sections was dismembered by eliminating two sections and redistributing the other two between the existing subgenera in clades B ("Hymenanthes") and C ("Azaleastrum"), although the name was retained in section "Pentanthera" (14 species) which was moved to subgenus "Hymenanthes". Of the remaining three sections, monotypic "Viscidula" was discontinued by moving "Rhododendron nipponicum" to "Tsutsusi" (C), while "Rhodora" (2 species) was itself polyphyletic and was broken up by moving "Rhododendron canadense" to section "Pentanthera" (B) and "Rhododendron vaseyi" to section "Sciadorhodion", which then became a new section of subgenus "Azaleastrum" (C).


title: Rhododendron

text: Subgenus "Tsutsusi" (C) was reduced to section status retaining the name, and included in subgenus "Azaleastrum". Of the three minor subgenera, all in C, two were discontinued. The single species of monotypic subgenus "Candidastrum" ("Rhododendron albiflorum") was moved to subgenus "Azaleastrum", section "Sciadorhodion". Similarly the single species in monotypic subgenus "Mumeazalea" ("Rhododendron semibarbatum") was placed in the new section "Tsutsusi", subgenus "Azaleastrum". Genus "Menziesa" (9 species) was also added to section "Sciadorhodion". The remaining small subgenus "Therorhodion" with its two species was left intact. Thus two subgenera, "Hymenanthes" and "Azaleastrum" were expanded at the expense of four subgenera that were eliminated, although "Azaleastrum" lost one section ("Choniastrum") as a new subgenus, since it was a distinct subclade in A. In all, "Hymenanthes" increased from one to two sections, while "Azaleastrum", by losing one section and gaining two increased from two to three sections. (See schemata under Subgenera) (Table 1.)


title: Rhododendron

text: Subsequent research has supported the revision by Goetsch, although has largely concentrated on further defining the phylogeny within the subdivisions. In 2011 the two species of "Diplarche" were also added to "Rhododendron", "incertae sedis".


title: Rhododendron

text: This genus has been progressively subdivided into a hierarchy of subgenus, section, subsection, and species.


title: Rhododendron

text: Terminology from the Sleumer (1949) system is frequently found in older literature, with five subgenera and is as follows;


title: Rhododendron

text: In the later traditional classification, attributed to Chamberlain (1996), and as used by horticulturalists and the American Rhododendron Society, "Rhododendron" has eight subgenera based on morphology, namely the presence of scales (lepidote), deciduousness of leaves, and the floral and vegetative branching patterns, after Sleumer (1980). These consist of four large and four small subgenera. The first two subgenera ("Rhododendron" and "Hymenanthes") represent the species commonly considered as 'Rhododendrons'. The next two smaller subgenera ("Pentanthera" and "Tsutsusi") represent the 'Azaleas'. The remaining four subgenera contain very few species. The largest of these is subgenus "Rhododendron", containing nearly half of all known species and all of the lepidote species.


title: Rhododendron

text: This division was based on a number of what were thought to be key morphological characteristics. These included the position of the inflorescence buds (terminal or lateral), whether lepidote or elepidote, deciduousness of leaves, and whether new foliage was derived from axils from previous year's shoots or the lowest scaly leaves (Table 2.).


title: Rhododendron

text: Following the cladistic analysis of Goetsch "et al." (2005) this scheme was simplified, based on the discovery of three major clades (A, B, C) as follows.


title: Rhododendron

text: The larger subgenera are further subdivided into sections and subsections Some subgenera contain only a single section, and some sections only a single subsection. Shown here is the traditional classification, with species number after Chamberlain (1996), but this scheme is undergoing constant revision. Revisions by Goetsch "et al." (2005) and by Craven "et al." (2008) shown in ("parenthetical italics"). Older ranks such as Series (groups of species) are no longer used but may be found in the literature, but the American Rhododendron Society still uses a similar device, called Alliances


title: Rhododendron

text: Species of the genus "Rhododendron" are widely distributed between latitudes 80°N and 20°S and are native to areas from North America to Europe, Russia, and Asia, and from Greenland to Queensland, Australia and the Solomon Islands. The centres of diversity are in the Himalayas and Malaysia, with the greatest species diversity in the Sino-Himalayan region, Southwest China and northern Burma, from India – Himachal Pradesh, Uttarakhand, Sikkim and Nagaland to Nepal, northwestern Yunnan and western Sichuan and southeastern Tibet. Other significant areas of diversity are in the mountains of Korea, Japan and Taiwan. More than 90% of "Rhododendron" "sensu" Chamberlain belong to the Asian subgenera "Rhododendron", "Hymenanthes" and section "Tsutsusi". Of the first two of these, the species are predominantly found in the area of the Himalayas and Southwest China (Sino-Himalayan Region).


title: Rhododendron

text: The 300 tropical species within the "Vireya" section of subgenus "Rhododendron" occupy the Malay archipelago from their presumed Southeast Asian origin to Northern Australia, with 55 known species in Borneo and 164 in New Guinea. The species in New Guinea are native to subalpine moist grasslands at around 3,000 metres above sea level in the Central Highlands. Subgenera "Rhododendron" and "Hymenanthes", together with section "Pentanthera" of subgenus "Pentanthera" are also represented to a lesser degree in the Mountainous areas of North America and Western Eurasia. Subgenus "Tsutsusi" is found in the maritime regions of East Asia (Japan, Korea, Taiwan, East China), but not in North America or Eurasia.


title: Rhododendron

text: In the United States, native "Rhododendron" mostly occur in lowland and montane forests in the Pacific Northwest, California, the Northeast, and the Appalachian Mountains.


title: Rhododendron

text: "Rhododendron ponticum" has become invasive in Ireland and the United Kingdom. It is an introduced species, spreading in woodland areas and replacing the natural understory. "R. ponticum" is difficult to eradicate, as its roots can make new shoots.


title: Rhododendron

text: A number of insects either target rhododendrons or will opportunistically attack them. Rhododendron borers and various weevils are major pests of rhododendrons, and many caterpillars will preferentially devour them.


title: Rhododendron

text: "Rhododendron" species are used as food plants by the larvae (caterpillars) of some butterflies and moths; see List of Lepidoptera that feed on rhododendrons.


title: Rhododendron

text: Rhododendron bud blast, a fungal condition that causes buds to turn brown and dry before they can open, is caused by the fungus "Pycnostysanus azaleae", which may be brought to the plant by the rhododendron leafhopper, "Graphocephala fennahi".


title: Rhododendron

text: Both species and hybrid rhododendrons (including azaleas) are used extensively as ornamental plants in landscaping in many parts of the world, including both temperate and subtemperate regions. Many species and cultivars are grown commercially for the nursery trade.


title: Rhododendron

text: Rhododendrons can be propagated by air layering or stem cuttings. They can self-propagate by sending up shoots from the roots. Sometimes an attached branch that has drooped to the ground will root in damp mulch, and the resulting rooted plant then can be cut off the parent rhododendron.


title: Rhododendron

text: Rhododendrons are often valued in landscaping for their structure, size, flowers, and the fact that many of them are evergreen. Azaleas are frequently used around foundations and occasionally as hedges, and many larger-leafed rhododendrons lend themselves well to more informal plantings and woodland gardens, or as specimen plants. In some areas, larger rhododendrons can be pruned to encourage more tree-like form, with some species such as "Rhododendron arboreum" and "R. falconeri" eventually growing to a height of or more.


title: Rhododendron

text: Rhododendrons are grown commercially in many areas for sale, and are occasionally collected in the wild, a practice now rare in most areas. Larger commercial growers often ship long distances; in the United States, most of them are on the west coast (Oregon, Washington state and California). Large-scale commercial growing often selects for different characteristics than hobbyist growers might want, such as resistance to root rot when overwatered, ability to be forced into budding early, ease of rooting or other propagation, and saleability.


title: Rhododendron

text: Like other ericaceous plants, most rhododendrons prefer acid soils with a pH of roughly 4.5–5.5; some tropical Vireyas and a few other rhododendron species grow as epiphytes and require a planting mix similar to orchids. Rhododendrons have fibrous roots and prefer well-drained soils high in organic material. In areas with poorly drained or alkaline soils, rhododendrons are often grown in raised beds using media such as composted pine bark. Mulching and careful watering are important, especially before the plant is established.


title: Rhododendron

text: A new calcium-tolerant stock of rhododendrons (trademarked as 'Inkarho') has been exhibited at the RHS Chelsea Flower Show in London (2011). Individual hybrids of rhododendrons have been grafted on to a rootstock on a single rhododendron plant that was found growing in a chalk quarry. The rootstock is able to grow in calcium-rich soil up to a pH of 7.5.


title: Rhododendron

text: Rhododendrons are extensively hybridized in cultivation, and natural hybrids often occur in areas where species ranges overlap. There are over 28,000 cultivars of Rhododendron in the International Rhododendron Registry held by the Royal Horticultural Society. Most have been bred for their flowers, but a few are of garden interest because of ornamental leaves and some for ornamental bark or stems. Some hybrids have fragrant flowers—such as the Loderi hybrids, created by crossing "Rhododendron fortunei" and "R. griffithianum". Other examples include the PJM hybrids, formed from a cross between "Rhododendron carolinianum" and "R. dauricum", and named after Peter J. Mezitt of Weston Nurseries, Massachusetts.


title: Rhododendron

text: "Rhododendron" species have long been used in traditional medicine. Animal studies and "in vitro" research have identified possible anti-inflammatory and hepatoprotective activities which may be due to the antioxidant effects of flavonoids or other phenolic compounds and saponins the plant contains. Xiong "et al." have found that the root of the plant is able to reduce the activity of NF-κB in rats.


title: Rhododendron

text: Some species of rhododendron are poisonous to grazing animals because of a toxin called grayanotoxin in their pollen and nectar. People have been known to become ill from eating honey made by bees feeding on rhododendron and azalea flowers. Xenophon described the odd behaviour of Greek soldiers after having consumed honey in a village surrounded by "Rhododendron ponticum" during the march of the Ten Thousand in 401 BCE. Pompey's soldiers reportedly suffered lethal casualties following the consumption of honey made from "Rhododendron" deliberately left behind by Pontic forces in 67 BCE during the Third Mithridatic War. Later, it was recognized that honey resulting from these plants has a slightly hallucinogenic and laxative effect. The suspect rhododendrons are "Rhododendron ponticum" and "Rhododendron luteum" (formerly "Azalea pontica"), both found in northern Asia Minor. Eleven similar cases during the 1980s have been documented in Istanbul, Turkey. Rhododendron is extremely toxic to horses, with some animals dying within a few hours of ingesting the plant, although most horses tend to avoid it if they have access to good forage. The effects of "R. ponticum" were mentioned in the 2009 film "Sherlock Holmes" as a proposed way to arrange a fake execution. It was also mentioned in the third episode of Season 2 of BBC's "Sherlock", speculated to have been a part of Sherlock's fake death scheme.


title: Rhododendron

text: "Rhododendron arboreum" ("lali guransh") is the national flower of Nepal. "R. ponticum" is the state flower of Indian-administered Kashmir and Pakistan-controlled Kashmir. "Rhododendron niveum" is the state tree of Sikkim in India. Rhododendron arboreum is also the state tree of the state of Uttarakhand, India. Pink Rhododendron ("Rhododendron campanulatum") is the state flower of Himachal Pradesh, India. Rhododendron is also the provincial flower of Jiangxi, China and the state flower of Nagaland, the 16th state of the Indian Union.


title: Rhododendron

text: "Rhododendron maximum", the most widespread rhododendron of the Appalachian Mountains, is the state flower of the US state of West Virginia, and is in the Flag of West Virginia.


title: Rhododendron

text: "Rhododendron macrophyllum", a widespread rhododendron of the Pacific Northwest, is the state flower of the US state of Washington.


title: Rhododendron

text: The nineteenth-century American poet and essayist Ralph Waldo Emerson in 1834 wrote a poem titled "The Rhodora, On Being Asked, Whence Is the Flower",


title: Rhododendron

text: In Joyce's "Ulysses", rhododendrons play an important role in Leopold and Molly's early courtship: Molly remembers them in her soliloquy – "the sun shines for you he said the day we were lying among the rhododendrons on Howth head in the grey tweed suit and his straw hat the day I got him to propose to me". Jasper Fforde a British author, also uses rhododendron as a motif throughout many of his published books. See "Thursday Next" series, and "".


title: Rhododendron

text: Amongst the Zomi tribes in India and Myanmar, "Rhododendrons" called "Ngeisok" is used in a poetic manner to signify a lady.


title: Rhododendron

text: In Daphne Du Maurier's novel "Rebecca", the character of Rebecca is associated with "blood red" rhododendrons throughout the novel, perhaps due to the toxic roots of the plant mirroring the poisonous character of Rebecca. On the other hand, azaleas (a type of rhododendron) represent the second Mrs. De Winter.


title: Rhododendron

text: In the young adult novel "Walk Two Moons" by Sharon Creech, the protagonist, Sal, and her friend, Phoebe, construct an elaborate story in which they suspect Phoebe's neighbor of murdering her husband and burying his body beneath a rhododendron in her yard. Chapter 14 of the book is entitled "The Rhododendron".


title: Rhododendron

text: The rhododendron is the national flower of Nepal, where the flower is considered edible and enjoyed for its sour taste. The pickled flower can last for months and the flower juice is also marketed. The flower, fresh or dried, is added to fish curry in the belief that it will soften the bones. The juice of rhododendron flower is used to make a squash called burans (named after the flower) in the hilly regions of Uttarakhand. It is admired for its distinctive flavor and color.


title: Rhododendron

text: The herbal tea called Labrador tea (not a true tea) is made from one of three closely related species:


title: Rhododendron

text: In the UK the forerunner of the Rhododendron, Camellia and Magnolia Group (RCMG), The Rhododendron Society was founded in 1916. while in Scotland species are being conserved by the Rhododendron Species Conservation Group.


title: Rhododendron

text: Records of the Rhododendron Society of America reside at the Albert and Shirley Small Special Collections Library at the University of Virginia.


title: Bade Achhe Lagte Hain 2

text: Bade Achhe Lagte Hain 2 ( ; English: "It all feels so good") is an Indian Hindi-language television romantic drama series that premiered on 30 August 2021 on Sony Entertainment Television. It is digitally available on Sony LIV. Produced by Ekta Kapoor under Balaji Telefilms, the show is a spiritual sequel or reboot version of the 2011 series of the same name. It stars Nakuul Mehta and Disha Parmar.


title: Bade Achhe Lagte Hain 2

text: Priya Sood hails from a middle-class family and lives with her mother, sisters Sara, Maitri, Sandy and cousin Akshay. Her father Mahendra, left them, now living with his second wife and their son. Established business tycoon, Ram Kapoor was deserted by his girlfriend Vedika and now, entirely focuses on work and family, which consists of his stepmother Nandini and half-siblings Shubham and Shivina.


title: Bade Achhe Lagte Hain 2

text: Shivina and Akshay are having an affair, but Akshay refuses to marry before Priya, thus Ram marries her, much to Nandini's displeasure. Vedika, hoping to get Ram back, reveals their past affair to Priya. Ram and Priya, however, triumph against all odds.


title: Bade Achhe Lagte Hain 2

text: Sara's son Eshan and husband Varun, shift to Mumbai to live with her. Ram decides to reopen the investigation of his father's murder with the help of Krish, a private investigator. Varun and Mahendra are implicated with this murder and are incarcerated. On Shubham's provocation, Shivina tries to leave Sood House, but dies when Eshan accidentally pushes her in the staircase. Priya takes the blame and goes to prison. She discovers being pregnant with Ram's child but is manipulated by Nandini, in keeping the child away.


title: Bade Achhe Lagte Hain 2

text: Priya serves her sentence and is blessed with a girl who she names Pihu. Ram signs a costly deal for which he reunites with Priya in the public eye. While Sara marries Vikrant, both Ram and Pihu, learn about being father-daughter. Ram corners Eshan and ends up knowing the truth behind Shivina's death. Ram, Priya and Pihu finally unite, stronger than ever. Soon enough, Vedika, Shubham and Nandini are exposed in front of Ram who subsequently has a fatal accident and loses his memory. Nandini schemes to make Ram and Vedika come closer whereas Priya disguises as Lovely Singh and becomes Ram's PA. She teaches Shubham a lesson by making him walk the path of self-dependency, much to the shock of Nandini, as Shubham no longer considers supporting her. Meanwhile Ram gains memory, but creates confusion in everyone's minds by pretending his memory loss. On the other hand, Priya learns of her pregnancy and devises a plan to help Ram regain his memory by pretending to be Krish's wife.


title: Bade Achhe Lagte Hain 2

text: In May 2021, it was confirmed that Ekta Kapoor's show, "Bade Achhe Lagte Hain" which was originally broadcast from 2011 to 2014 will return with a fresh cast and different storyline.


title: Bade Achhe Lagte Hain 2

text: Nakuul Mehta was finalized to play the male lead, Ram Kapoor. For the female lead Priya Sood, Divyanka Tripathi was approached who rejected the offer and eventually, Disha Parmar was signed by the makers. The show marks the second collaboration between Mehta and Parmar as they previously co-starred in "Pyaar Ka Dard Hai Meetha Meetha Pyaara Pyaara" (2012–2014).


title: Bade Achhe Lagte Hain 2

text: The first promo of the series was revealed and released by the show producer Ekta Kapoor on 12 August 2021 featuring Nakuul Mehta and Disha Parmar as Ram and Priya. The first look poster of the upcoming season of the series was unleashed by the show leads Disha Parmar and Nakuul Mehta, at the grand finale episode of "Indian Idol 12". The show's premier date was officially announced on 19 August 2021.


title: Bade Achhe Lagte Hain 2

text: "Bade Achhe Lagte Hain 2" and "Appnapan – Badalte Rishton Ka Bandhan" came together for an integration week, called "Mahasangam Saptah". The episodes revolved around Vikrant and Sara's wedding ceremonies, which took place in Meerut.


title: Bade Achhe Lagte Hain 2

text: Letty Mariam Abraham of Mid-Day stated "Mehta and Parmar put their best foot forward as they carry the show on their shoulders." She also noted that if the series is "relatable without indulging in melodrama ... it may well surpass its original."


title: Bade Achhe Lagte Hain 2

text: Gursimran Kaur of Times Of India stated "Nakuul Mehta steps into the shoes of Ram Kapoor beautifully. He does justice to his part. Disha Parmar takes the cake with her simplicity and genuinity."


title: Bade Achhe Lagte Hain 2

text: "Bade Achhe Lagte Hain 2"s soundtrack music is given by Lalit Sen and Nawab Arzoo. The theme song music is composed by R. D. Burman and sung by Shreya Ghoshal and Trijayh Dey.


title: Christine (1983 film)

text: Christine (titled onscreen as John Carpenter's Christine) is a 1983 American supernatural horror film directed by John Carpenter and starring Keith Gordon, John Stockwell, Alexandra Paul, Robert Prosky and Harry Dean Stanton. The film also features supporting performances from Roberts Blossom and Kelly Preston.


title: Christine (1983 film)

text: Written by Bill Phillips and based on Stephen King's 1983 novel of the same name, the movie follows the changes in the lives of Arnie Cunningham, his friends, his family, and his teenage enemies after Arnie buys a classic red and white 1958 Plymouth Fury (for 250 dollars) named Christine, license plate CQB 241, a car that seems to have a mind of its own and a jealous, possessive personality, which has a bad influence on Arnie.


title: Christine (1983 film)

text: Upon its release, the film grossed $21 million at the US box office. The film received mostly positive reviews from critics and has since become a cult classic. A remake is in development.


title: Christine (1983 film)

text: A 1958 Plymouth Fury is built on the assembly line. While a worker inspects the engine, the car injures him. During closing time, another worker is killed in the Fury when he flicks cigar ash on its upholstery. Twenty years later, Arnold Cunningham, a nerdy teen, buys the same used Fury Coupe over the objections of his friend, Dennis Guilder, who says she needs a full restoration. Arnie gets into a fight at school with Buddy Repperton, who is expelled after drawing a switchblade. Arnie begins restoring Christine in defiance of his parents at Darnell's Garage. As he spends time repairing it, he changes, shedding his glasses, dressing better, and developing a cocky arrogance.


title: Christine (1983 film)

text: When Dennis asks out new girl Leigh Cabot, he finds she has a date. As his best friend changes, Dennis returns to Christine's seller to ask about the car. He discovers the Fury's previous owner was obsessed with Christine despite his family's deaths in the car, and the previous owner killed himself in it. Leigh and Arnie attend one of Dennis' football games. Dennis not only sees them together, but that Christine is completely restored. Distracted, he is gravely injured. Arnie visits him in the hospital and learns he was almost paralyzed and can never play football again. Leigh and Arnie's relationship goes well until they attend a drive-in movie. Leigh explains she is too uncomfortable with the car to have sex in it. When Arnie coaxes her back, the car's radio spontaneously turn on and a blinding light emits from the dash. As Leigh chokes on her food, Arnie discovers the doors have locked. Leigh unlocks the doors, and another patron saves her. She and Arnie later argue about Christine and their relationship.


title: Christine (1983 film)

text: Repperton and his friends, still angry with Arnie for getting them expelled, vandalize Christine. When Leigh consoles Arnie, he lashes out at her and breaks up with her. Arnie returns to the garage later and promises Christine he will rebuild her. As he walks away, he hears creaking metal and sees the engine is fully restored. At his command, Christine restores herself to showroom quality. That evening, Christine runs over Moochie Welch. Detective Rudy Junkins questions Arnie, who says Moochie got what he deserved. Junkins lets him go when Arnie's alibi checks out.


title: Christine (1983 film)

text: Christine targets Repperton and his friend Richie Trelawney. After chasing them to a gas station where Repperton's friend Don Vandenberg works, Christine smashes their Camaro, killing Richie. Repperton escapes a gas tank explosion that kills Don, but Christine, still on fire, runs him down. The smoldering car returns to Darnell's garage. When Darnell investigates, the car crushes him in a seat. The police find Darnell's body in Christine, which is again in like-new condition. Junkins questions Arnie again, who becomes angry and provides an alibi.


title: Christine (1983 film)

text: Leigh requests help from Dennis to destroy Christine and save Arnie. Dennis scratches "Darnell's Tonight" into Christine's hood and leaves for the garage to hot-wire Darnell's bulldozer. They plan to lure Christine into the garage and destroy it, but Christine surprises them by emerging from a pile of scrap metal. Leigh flees while Dennis runs interference. After side-swiping another car, Arnie is revealed to be driving Christine. While trying to kill Leigh, Christine crashes into Darnell's office, and Arnie flies through Christine's windshield. As he grabs her, Leigh sees he is mortally wounded. Before he dies, Arnie reaches out to touch Christine.


title: Christine (1983 film)

text: Leigh exits the wreckage of the office to tell Dennis Arnie is dead. However, Christine continues attacking, regenerating faster than before. Dennis pulls Leigh into the bulldozer's cab, and they repeatedly smash Christine with it. They return to the junkyard the next day and see the remains of the Fury crushed into a cube. Detective Junkins joins them and attempts to console them, congratulating them for stopping Christine even though they were unable to save Arnie. They are momentarily spooked when they hear a 1950s rock and roll song, but it turns out to be a workman's boom box; however, Christine's grill slowly begins to unbend.


title: Christine (1983 film)

text: Producer Richard Kobritz had previously produced the miniseries "Salem's Lot", also based on a Stephen King novel. Through producing the miniseries, Kobritz became acquainted with King, who sent him manuscripts of two of his novels, "Cujo", and "Christine". Kobritz purchased the rights to "Christine" after finding himself attracted to the novel's "celebration of America's obsession with the motorcar."


title: Christine (1983 film)

text: Kobritz's first choice for director was John Carpenter, who was initially unavailable owing to two projects: an adaptation of another King novel, "Firestarter", and an adaptation of the 1980 Eric Van Lustbader novel "The Ninja". However, production delays on these projects allowed Carpenter to accept the director position for "Christine". Kobritz and Carpenter had previously collaborated in the 1978 television film "Someone's Watching Me!." Bill Phillips was Carpenter's choice for writer and was brought on shortly after Carpenter arrived. Carpenter was also joined by special effects supervisor Roy Arbogast, who had previously worked with Carpenter in "The Thing" (1982). According to Carpenter, "Christine" was not a film he had planned on directing, saying that he directed the film as "a job" as opposed to a "personal project." He had previously directed "The Thing", which had done poorly at the box office and led to critical backlash. In retrospect, Carpenter stated that upon reading "Christine", he felt that "It just wasn't very frightening. But it was something I needed to do at that time for my career."


title: Christine (1983 film)

text: King's novel, the source material for Carpenter's film, made it clear that the car was possessed by the evil spirit of its previous owner, Roland D. LeBay, whereas the film version of the story shows that the evil spirit of the car manifested itself on the day it was built. Other elements from the novel were altered for the film, particularly the execution of the death scenes, which the filmmakers opted for a more "cinematic approach."


title: Christine (1983 film)

text: Initially, Columbia Pictures had wanted to cast Brooke Shields in the role of Leigh because of her publicity after the release of "The Blue Lagoon" (1981), and Scott Baio as Arnie. The filmmakers declined the suggestion, opting to cast young actors who were still fairly unknown. Kevin Bacon auditioned for the role, but opted out when offered the lead in "Footloose" (1984). Carpenter cast Keith Gordon in the role of Arnie after an audition in New York City; Gordon had some experience in film, and was also working in theater at the time; John Stockwell was cast at an audition in Los Angeles.


title: Christine (1983 film)

text: Nineteen-year-old Alexandra Paul was cast in the film after an audition in New York City; according to Carpenter, Paul was an "untrained, young actress" at the time, but brought a "great quality" about the character of Leigh. According to Paul, she had not read any of King's books or seen Carpenter's films, and read the novel in preparation.


title: Christine (1983 film)

text: "Christine" was shot largely in Los Angeles, California, while the location for Darnell's garage was located in Santa Clarita. Filming began in April 1983, mere days after the King novel had been published. An abandoned furniture factory in Irwindale was used for the opening scene. The film's stunts were primarily completed by stunt coordinator Terry Leonard, who was behind the wheel of the car during the high-speed chase scenes, as well as the scene in which the car drives down a highway engulfed in flames. During that scene, Leonard wore a Nomex firefighter's suit complete with breathing apparatus.


title: Christine (1983 film)

text: Alexandra Paul's identical twin sister Caroline Paul wrote that she and her sister pulled a prank during filming, sending Caroline on set in place of Alexandra without telling Carpenter that they had made the switch until after he had shot a scene. She wrote, "My highly skilled clutch-pushing actually made it into the movie."


title: Christine (1983 film)

text: Although the car in the film is identified as a 1958 Plymouth Fury – and in 1983 radio ads promoting the film, voiceover artists announced, "she's a '57 Fury" – two other Plymouth models, the Belvedere and the Savoy, were also used to portray the malevolent automobile onscreen. John Carpenter placed ads throughout Southern California searching for models of the car, and was able to purchase twenty-four of them in various states of disrepair, which were used to build a total of seventeen copies of the film car. All cars were two door hardtops.


title: Christine (1983 film)

text: Total production for the 1958 Plymouth Fury was only 5,303, and they were difficult to find and expensive to buy at the time. In addition, the real-life Furys only came in one color, "Sandstone White" with a "Buckskin Beige" interior, seen on the other Furys on the assembly line during the initial scenes of the movie, though the car in King's novel was ordered with a red-and-white custom paint job. The original Furys had anodized gold trim on the body and Fury script on the rear fender. In order to bypass the problem of obtaining the rare trim, the cars featured the more common Belvedere "Dartline" trim. Several vehicles were destroyed during filming, but most of the cars were Savoy and Belvedere models dressed to look like the Fury. At least one '57 Savoy was used, its front end modified to look like a '58.


title: Christine (1983 film)

text: Some of King's details about the car were incorrect in the novel. The 1956-1958 Plymouth Fury was only available as a two-door coupe, while the book described it as a four-door sedan, which would have made it a Savoy or Belvedere model. During Leigh's choking scene, Christine is shown to have common vertical lock "buttons" on the inside door panels. Chrysler vehicles of this era were not equipped with such buttons. To lock the door, the door handle has to be pushed downward. King also mentions a shift lever for the automatic transmission, but in real life it had push-button controls.


title: Christine (1983 film)

text: Originally, Carpenter had not planned to film the car's regeneration scenes, but gave special effects supervisor Roy Arbogast three weeks to devise a way for the car to rebuild itself. Arbogast and his team made rubber molds from one of the cars, including a whole front end. One of the cars was stripped of its engine to accommodate internally-mounted hydraulics that pulled the framework inward, crumpling the car, with the shot then run backwards in the final film.


title: Christine (1983 film)

text: Twenty-three cars were used in the film. Initially sold as scrap metal after filming ended, one of the best known surviving vehicles was eventually rescued from the junkyard and restored. It was subsequently bought by collector Bill Gibson of Pensacola, Florida.


title: Christine (1983 film)

text: In its opening weekend "Christine" brought in $3,408,904 landing at #4. The film dropped 39.6% in its second weekend, grossing $2,058,517 slipping from fourth to eighth place. In its third weekend, it grossed $1,851,909 dropping to #9. The film remained at #9 its fourth weekend, grossing $2,736,782. In its fifth weekend, it returned to #8, grossing $2,015,922. Bringing in $1,316,835 in its sixth weekend, the film dropped out of the box office top ten to twelfth place. In its seventh and final weekend, the film brought in $819,972 landing at #14, bringing the total gross for "Christine" to $21,017,849.


title: Christine (1983 film)

text: On the review aggregator website Rotten Tomatoes, "Christine" holds a 69% approval rating based on 29 reviews, with an average rating of 5.9/10. The consensus reads: "The cracks are starting to show in John Carpenter's directorial instincts, but "Christine" is nonetheless silly, zippy fun.”


title: Christine (1983 film)

text: Roger Ebert gave the movie three out of four stars, saying: "by the end of the movie, Christine has developed such a formidable personality that we are actually taking sides during its duel with a bulldozer. This is the kind of movie where you walk out with a silly grin, get in your car, and lay rubber halfway down the Eisenhower." Janet Maslin of "The New York Times" gave the film a middling review, saying: "The early parts of the film are engaging and well acted, creating a believable high-school atmosphere. Unfortunately, the later part of the film is slow in developing, and it unfolds in predictable ways." "Variety" gave the film a negative review, stating: ""Christine" seems like a retread. This time it's a fire-engine red, 1958 Plymouth Fury that's possessed by the Devil, and this deja-vu premise [from the novel by Stephen King] combined with the crazed-vehicle format, makes Christine appear pretty shop worn." "Time Out" said of the film: "Carpenter and novelist Stephen King share not merely a taste for genre horror but a love of '50's teenage culture; and although set in the present, "Christine" reflects the second taste far more effectively than the first."


title: Christine (1983 film)

text: The film was released on VHS by Columbia Pictures, a DVD came out on August 4, 1998, and later as a special edition DVD in 2004. On March 12, 2013, Twilight Time video released the film on Blu-ray for the first time in a limited edition run numbered at 3,000 copies. On September 29, 2015, Sony Pictures Home Entertainment re-released the film on Blu-ray. The film was released on 4K UHD Blu-ray on September 11, 2018.


title: Christine (1983 film)

text: Two soundtracks were released, one consisting purely of the music written and composed by John Carpenter and Alan Howarth, the other consisting of the contemporary pop songs used in the film.


title: Christine (1983 film)

text: The soundtrack album containing songs used in the film was entitled Christine: Original Motion Picture Soundtrack and was released on LP and cassette on Motown Records. It contained 10 (of the 15) songs listed in the film's credits, plus one track from John Carpenter and Alan Howarth's own score. The track listing was as follows:


title: Christine (1983 film)

text: The following tracks were not included on this LP release, but were used in the film and listed in the film's credits:


title: Christine (1983 film)

text: In June 2021, Sony Pictures Entertainment and Blumhouse Productions announced the development of a remake of the film with Bryan Fuller penning the script and directing and Jason Blum, Vincenzo Natali and Steve Hoban producing.


title: Electroconvulsive therapy

text: Electroconvulsive therapy (ECT) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT). However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.


title: Electroconvulsive therapy

text: The ECT procedure was first conducted in 1938 by Italian psychiatrist Ugo Cerletti and rapidly replaced less safe and effective forms of biological treatments in use at the time. ECT is often used with informed consent as a safe and effective intervention for major depressive disorder, mania, and catatonia. ECT machines were originally placed in the Class III category by the United States Food and Drug Administration (FDA) in 1976. They were re-classified as Class II devices, for treatment of catatonia, major depressive disorder, and bipolar disorder, in 2018.


title: Electroconvulsive therapy

text: Aside from effects on the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment, the most common adverse effects are confusion and transient memory loss. Among treatments for severely depressed pregnant women, ECT is one of the least harmful to the fetus.


title: Electroconvulsive therapy

text: A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a muscle relaxant. ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient.


title: Electroconvulsive therapy

text: Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one hemisphere of the brain. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy.


title: Electroconvulsive therapy

text: ECT appears to work in the short term via an anticonvulsant effect primarily in the frontal lobes and longer term via neurotrophic effects primarily in the medial temporal lobe.


title: Electroconvulsive therapy

text: ECT is used, where possible, with informed consent in treatment-resistant major depressive disorder, treatment-resistant catatonia, prolonged or severe mania, and in conditions where "there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psychomotor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania)." It has also been used to treat autism in adults with an intellectual disability, yet findings from a systematic review found this an unestablished intervention.


title: Electroconvulsive therapy

text: For major depressive disorder, despite a Canadian guideline and some experts arguing for using ECT as a first line treatment, ECT is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide. ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson's disease, Huntington's chorea, developmental delay, brain arteriovenous malformations, and hydrocephalus.


title: Electroconvulsive therapy

text: A meta-analysis on the effectiveness of ECT in unipolar and bipolar depression was conducted in 2012. Results indicated that although patients with unipolar depression and bipolar depression responded to other medical treatments very differently, both groups responded equally well to ECT. Overall remission rate for patients given a round of ECT treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. The severity of each patient's depression was assessed at the same baseline in each group. Most severely depressed patients respond to ECT.


title: Electroconvulsive therapy

text: In 2004, a meta-analytic review paper found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus tricyclics and ECT versus monoamine oxidase inhibitors."


title: Electroconvulsive therapy

text: In 2003, The UK ECT Review Group published a systematic review and meta-analysis comparing ECT to placebo and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the standard deviation) for ECT versus placebo, and versus antidepressant drugs.


title: Electroconvulsive therapy

text: Compared with repetitive transcranial magnetic stimulation (rTMS) for people with treatment-resistant major depressive disorder, ECT relieves depression as shown by reducing the score on the Hamilton Rating Scale for Depression by about 15 points, while rTMS reduced it by 9 points.


title: Electroconvulsive therapy

text: The response rate is from 50 to 60% in treatment-resistant patients. Efficacity does not depend on depression subtype.


title: Electroconvulsive therapy

text: There is little agreement on the most appropriate follow-up to ECT for people with major depressive disorder. When ECT is followed by treatment with antidepressants, about 50% of people relapsed by 12 months following successful initial treatment with ECT, with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of the evidence for continuation therapy is with tricyclic antidepressants; evidence for relapse prevention with newer antidepressants is lacking.


title: Electroconvulsive therapy

text: ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of ECT in catatonia is generally acknowledged". For people with autism spectrum disorders who have catatonia, there is little published evidence about the efficacy of ECT; as of 2014 there were twelve case reports.


title: Electroconvulsive therapy

text: ECT is used to treat people who have severe or prolonged mania; NICE recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania.


title: Electroconvulsive therapy

text: ECT is widely used worldwide in the treatment of schizophrenia, but in North America and Western Europe it is invariably used only in treatment resistant schizophrenia when symptoms show little response to antipsychotics; there is comprehensive research evidence for such practice. It is useful in the case of severe exacerbations of catatonic schizophrenia, whether excited or stuporous. There are also case reports of ECT improving persistent psychotic symptoms associated with stimulant-induced psychosis.


title: Electroconvulsive therapy

text: Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia; the US Surgeon General's report says that there are "no absolute health contraindications" to its use. Immediately following treatment, the most common adverse effects are confusion and memory loss. Some patients experience muscle soreness after ECT. A meta-analysis from 2017 found that the death rate of ECT is around 2.1 per 100,000 procedures. There is evidence and rationale to support giving low doses of benzodiazepines or otherwise low doses of general anesthetics, which induce sedation but not anesthesia, to patients to reduce adverse effects of ECT.


title: Electroconvulsive therapy

text: While there are no absolute contraindications for ECT, there is increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms; who have recently had a stroke; who have increased intracranial pressure (for instance, due to a solid brain tumor), or who have severe pulmonary conditions, or who are generally at high risk for receiving anesthesia.


title: Electroconvulsive therapy

text: In adolescents, ECT is highly efficient for several psychiatric disorders, with few and relatively benign adverse effects.


title: Electroconvulsive therapy

text: Cognitive impairment is sometimes noticed after ECT. It has been claimed by some non-medical authors that retrograde amnesia occurs to some extent in almost all patients receiving ECT. The American Psychiatric Association (APA) report in 2001 acknowledges: "In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss". After treatment, drug therapy is usually continued and some patients will continue to receive maintenance ECT treatments. It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use. However, the methods used to measure memory loss are generally poor, and their application to people with depression, who have cognitive deficits including problems with memory, have been problematic.


title: Electroconvulsive therapy

text: The acute effects of ECT can include amnesia, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment). Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses, as opposed to a steady flow, seemed to incur less memory loss. The vast majority of modern treatment uses brief pulse currents.


title: Electroconvulsive therapy

text: Retrograde amnesia is most marked for events occurring in the weeks or months before treatment, with one study showing that although some people lose memories from years prior to treatment, recovery of such memories was "virtually complete" by seven months post-treatment, with the only enduring loss being memories in the weeks and months prior to the treatment. Anterograde memory loss is usually limited to the time of treatment itself or shortly afterwards. In the weeks and months following ECT these memory problems gradually improve, but some people have persistent losses, especially with bilateral ECT. One published review summarizing the results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes. In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to right unilateral ECT.


title: Electroconvulsive therapy

text: Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associations—including the APA—have concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the US Surgeon General states: "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals."


title: Electroconvulsive therapy

text: Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the "Journal of ECT", stated in a 2007 interview that, "There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT." Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments. Kellner stated "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness." Two meta-analyses find that ECT is associated with brain matter growth.


title: Electroconvulsive therapy

text: If steps are taken to decrease potential risks, ECT is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments. Suggested preparation for ECT during pregnancy includes a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. In many instances of active mood disorder during pregnancy, the risks of untreated symptoms may outweigh the risks of ECT. Potential complications of ECT during pregnancy can be minimized by modifications in technique. The use of ECT during pregnancy requires thorough evaluation of the patient's capacity for informed consent.


title: Electroconvulsive therapy

text: ECT can cause a lack of blood flow and oxygen to the heart, heart arrhythmia, and "persistent asystole". Deaths, however, are very rare after ECT: 6 per 100,000 treatments. If they do occur, cardiovascular complications are considered as causal in about 30%.


title: Electroconvulsive therapy

text: The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis.


title: Electroconvulsive therapy

text: In unilateral ECT, both electrodes are placed on the same side of the patient's head. Unilateral ECT may be used first to minimize side effects such as memory loss.


title: Electroconvulsive therapy

text: In bilateral ECT, the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on the temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye.


title: Electroconvulsive therapy

text: Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses. Most patients in the US and almost all in the UK receive bilateral ECT.


title: Electroconvulsive therapy

text: The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT. Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains. Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex. Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold.


title: Electroconvulsive therapy

text: Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, etomidate, or thiopental, a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation. In a minority of countries such as Japan, India, and Nigeria, ECT may be used without anesthesia. The Union Health Ministry of India recommended a ban on ECT without anesthesia in India's Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013. The practice was abolished in Turkey's largest psychiatric hospital in 2008.


title: Electroconvulsive therapy

text: ECT is usually administered three times a week, on alternate days, over a course of two to four weeks.


title: Electroconvulsive therapy

text: Neuroimaging prior to ECT may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist. Nonetheless, it is not indicated due to high cost and low prevalence of these conditions in patients needing ECT.


title: Electroconvulsive therapy

text: Whether psychiatric medications are terminated prior to treatment or maintained, varies. However, drugs that are known to cause toxicity in combination with ECT, such as lithium, are discontinued, and benzodiazepines, which increase the seizure threshold, are either discontinued, a benzodiazepine antagonist is administered at each ECT session, or the ECT treatment is adjusted accordingly.


title: Electroconvulsive therapy

text: A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves ECT efficacy.


title: Electroconvulsive therapy

text: ECT is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds. It is also recommended to not do ECT more than 3 times per week.


title: Electroconvulsive therapy

text: In the US, the medical team performing the procedure typically consists of a psychiatrist, an anesthetist, an ECT treatment nurse or qualified assistant, and one or more recovery nurses. Medical trainees may assist, but only under the direct supervision of credentialed attending physicians and staff.


title: Electroconvulsive therapy

text: Most modern ECT devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in ECT. A small minority of psychiatrists in the US still use sine-wave stimuli. Sine-wave is no longer used in the UK or Ireland.


title: Electroconvulsive therapy

text: Typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and the current flows for between one and six seconds.


title: Electroconvulsive therapy

text: In the US, ECT devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta. In the UK, the market for ECT devices was long monopolized by Ectron Ltd, which was set up by psychiatrist Robert Russell.


title: Electroconvulsive therapy

text: Despite decades of research, the exact mechanism of action of ECT remains elusive. Neuroimaging studies in people who have had ECT, investigating differences between responders and nonresponders, and people who relapse, find that responders have anticonvulsant effects mostly in the frontal lobes, which corresponds to immediate responses, and neurotrophic effects primarily in the medial temporal lobe. The anticonvulsant effects are decreased blood flow and decreased metabolism, while the neurotrophic effects are oppositeincreased perfusion and metabolism, as well as increased volume of the hippocampus.


title: Electroconvulsive therapy

text: Another proposed mechanism of action is that the seizures induced by ECT cause a profound change in sleep architecture (a reversible inhibition of REM sleep); it is this change in the state of the organism that drives the therapeutic effects of ECT and not any simple change in the release of neurotransmitters, neurotrophic factors and/or hormones.


title: Electroconvulsive therapy

text: There is wide variation in ECT use between different countries, different hospitals, and different psychiatrists. International practice varies considerably from widespread use of the therapy in many Western countries to a small minority of countries that do not use ECT at all, such as Slovenia.


title: Electroconvulsive therapy

text: About 70 percent of ECT patients are women. This may be because women are more likely to be diagnosed with depression. Older and more affluent patients are also more likely to receive ECT. The use of ECT is not as common in ethnic minorities.


title: Electroconvulsive therapy

text: Sarah Hall reports, "ECT has been dogged by conflict between psychiatrists who swear by it, and some patients and families of patients who say that their lives have been ruined by it. It is controversial in some European countries such as the Netherlands and Italy, where its use is severely restricted".


title: Electroconvulsive therapy

text: ECT became popular in the US in the 1940s. At the time, psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure. Whereas lobotomies would reduce a patient to a more manageable submissive state, ECT helped to improve mood in those with severe depression. A survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas.


title: Electroconvulsive therapy

text: Accurate statistics about the frequency, context and circumstances of ECT in the US are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information. In 13 of the 50 states, the practice of ECT is regulated by law.


title: Electroconvulsive therapy

text: In the mid-1990s in Texas, ECT was used in about one third of psychiatric facilities and given to about 1,650 people annually.


title: Electroconvulsive therapy

text: Usage of ECT has since declined slightly; in 2000–01 ECT was given to about 1,500 people aged from 16 to 97 (in Texas it is illegal to give ECT to anyone under sixteen). ECT is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in the ECT statistics.


title: Electroconvulsive therapy

text: In the United States, ECT is usually given three times a week; in the United Kingdom, it is usually given twice a week. Occasionally it is given on a daily basis. A course usually consists of 6–12 treatments, but may be more or fewer. Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly, fortnightly or monthly intervals. A few psychiatrists in the US use multiple-monitored ECT (MMECT), where patients receive more than one treatment per anesthetic. Electroconvulsive therapy is not a required subject in US medical schools and not a required skill in psychiatric residency training. Privileging for ECT practice at institutions is a local option: no national certification standards are established, and no ECT-specific continuing training experiences are required of ECT practitioners.


title: Electroconvulsive therapy

text: In the UK in 1980, an estimated 50,000 people received ECT annually, with use declining steadily since then to about 12,000 per annum in 2002. It is still used in nearly all psychiatric hospitals, with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of mood disorder; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent. In 2003, the National Institute for Health and Care Excellence, a government body which was set up to standardize treatment throughout the National Health Service in England and Wales, issued guidance on the use of ECT. Its use was recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode".


title: Electroconvulsive therapy

text: The guidance received a mixed reception. It was welcomed by an editorial in the "British Medical Journal" but the Royal College of Psychiatrists launched an unsuccessful appeal. The NICE guidance, as the "British Medical Journal" editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure. A voluntary accreditation scheme, ECTAS, was set up in 2004 by the Royal College, and the vast majority of ECT clinics in England, Wales, Northern Ireland and the Republic of Ireland have signed up.


title: Electroconvulsive therapy

text: The Mental Health Act 2007 allows people to be treated against their will. This law has extra protections regarding ECT. A patient capable of making the decision can decline the treatment, and in that case treatment cannot be given unless it will save that patient's life or is immediately necessary to prevent deterioration of the patient's condition. A patient may not be capable of making the decision (they "lack capacity"), and in that situation ECT can be given if it is appropriate and also if there are no advance directives that prevent the use of ECT.


title: Electroconvulsive therapy

text: ECT was introduced in China in the early 1950s and while it was originally practiced without anesthesia, as of 2012 almost all procedures were conducted with it. As of 2012, there are approximately 400 ECT machines in China, and 150,000 ECT treatments are performed each year. Chinese national practice guidelines recommend ECT for the treatment of schizophrenia, depressive disorders, and bipolar disorder and in the Chinese literature, ECT is an effective treatment for schizophrenia and mood disorders.


title: Electroconvulsive therapy

text: Although the Chinese government stopped classifying homosexuality as an illness in 2001, electroconvulsive therapy is still used by some establishments as a form of "conversion therapy". Alleged Internet addiction (or general unruliness) in adolescents is also known to have been treated with ECT, sometimes without anestheia, most notably by Yang Yongxin. The practice was banned in 2009 after news on Yang broke out.


title: Electroconvulsive therapy

text: As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the "London Medical and Surgical Journal". As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of "Electricity and Medicine". Treatment and cure of hysterical blindness was documented eleven years later. Benjamin Franklin wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, James Lind as well as Giovanni Aldini had used galvanism to treat patients with various mental disorders. G.B.C. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice.


title: Electroconvulsive therapy

text: In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable.


title: Electroconvulsive therapy

text: Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol). Meduna is thought to be the father of convulsive therapy. In 1937, the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by the Swiss psychiatrist Max Müller. The proceedings were published in the "American Journal of Psychiatry" and, within three years, cardiazol convulsive therapy was being used worldwide. Italian professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant Lucio Bini at Sapienza University of Rome developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1938, experimented for the first time on a person affected by delusions. It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state. Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10-20 treatments the results were significant. Patients had much improved. A positive side effect to the treatment was retrograde amnesia. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it. ECT 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 did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship. In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was hotly contended by scientific museums between Italy and the USA. The ECT apparatus prototype is now owned and displayed by the Sapienza in Rome.


title: Electroconvulsive therapy

text: In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted. In the 1940s and early 1950s ECT, was usually given in "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s, psychiatrists began to experiment with curare, the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants.


title: Electroconvulsive therapy

text: The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media." "The New York Times" described the public's negative perception of ECT as being caused mainly by one movie: "For Big Nurse in "One Flew Over the Cuckoo's Nest," it was a tool of terror, and, in the public mind, "shock therapy" has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused".


title: Electroconvulsive therapy

text: In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices. The 1970s saw the publication of the first American Psychiatric Association (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT. Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression". In 1985, the National Institute of Mental Health and National Institutes of Health convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders.


title: Electroconvulsive therapy

text: Because of the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, the American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally, in 2001 the American Psychiatric Association released its latest task force report. This report emphasizes the importance of informed consent, and the expanded role that the procedure has in modern medicine. By 2017, ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe mental illness, was receiving favorable media coverage, and was being provided in regional medical centers.


title: Electroconvulsive therapy

text: Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies and techniques. Modern shock voltage is given for a shorter duration of 0.5 milliseconds where conventional brief pulse is 1.5 milliseconds.


title: Electroconvulsive therapy

text: Surveys of public opinion, the testimony of former patients, legal restrictions on the use of ECT and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial. This is reflected in the January 2011 vote by the FDA's Neurological Devices Advisory Panel to recommend that FDA maintain ECT devices in the Class III device category for high risk devices, except for patients with catatonia, major depressive disorder, and bipolar disorder. This may result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time. In justifying their position, panelists referred to the memory loss associated with ECT and the lack of long-term data.


title: Electroconvulsive therapy

text: The World Health Organization (2005) advises that ECT should be used only with the informed consent of the patient (or their guardian if their incapacity to consent has been established).


title: Electroconvulsive therapy

text: In the US, this doctrine places a legal obligation on a doctor to make a patient aware of the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment. The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that consent may be revoked and treatment discontinued at any time during a course of ECT. The US Surgeon General's Report on Mental Health states that patients should be warned that the benefits of ECT are short-lived without active continuation treatment in the form of drugs or further ECT, and that there may be some risk of permanent, severe memory loss after ECT. The report advises psychiatrists to involve patients in discussion, possibly with the aid of leaflets or videos, both before and during a course of ECT.


title: Electroconvulsive therapy

text: According to the US Surgeon General, involuntary treatment is uncommon in the US and is typically used only in cases of great extremity, and only when all other treatment options have been exhausted. The use of ECT is believed to be a potentially life-saving treatment.


title: Electroconvulsive therapy

text: In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent.


title: Electroconvulsive therapy

text: In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects. One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects and another survey found that about fifty percent of psychiatrists and nurses agreed with them.


title: Electroconvulsive therapy

text: A 2005 study published in the "British Journal of Psychiatry" described patients' perspectives on the adequacy of informed consent before ECT. The study found that "About half (45–55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not." The authors also stated:


title: Electroconvulsive therapy

text: In most states in the US, a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT. However, ECT can also be involuntarily administered in situations with less immediate danger. Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective.


title: Electroconvulsive therapy

text: Until 2007 in England and Wales, the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it. However, following amendments which took effect in 2007, ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act. In fact, even if a patient is deemed to lack capacity, if they made a valid advance decision refusing ECT then they should not be given it; and even if they do not have an advance decision, the psychiatrist must obtain an independent second opinion (which is also the case if the patient is under age of consent). However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization. From 2003 to 2005, about 2,000 people a year in England and Wales were treated without their consent under the Mental Health Act. Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent advocacy. In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT.


title: Electroconvulsive therapy

text: In the US, ECT devices came into existence prior to medical devices being regulated by the Food and Drug Administration. In 1976, the Medical Device Regulation Act required the FDA to retrospectively review already existing devices, classify them, and determine whether clinical trials were needed to prove efficacy and safety. The FDA initially classified the devices used to administer ECT as . In 2014, the American Psychiatric Association petitioned the FDA to reclassify ECT devices from Class III (high-risk) to Class II (medium-risk), which would significantly improve access to an effective and potentially lifesaving treatment. A similar reclassification proposal in 2010 met significant resistance from anti-psychiatry groups and did not pass. In 2018, the FDA re-classified ECT devices as Class II devices when used to treat catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder.


title: Electroconvulsive therapy

text: A questionnaire survey of 379 members of the general public in Australia indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues, on children, and on involuntary patients. Public perceptions of ECT were found to be mainly negative. A sample of the general public, medical students, and psychiatry trainees in the United Kingdom found that the psychiatry trainees were more knowledgeable and had more favorable opinions of ECT than did the other groups. More members of the general public believed that ECT was used for control or punishment purposes than medical students or psychiatry trainees.


title: Electroconvulsive therapy

text: Ernest Hemingway, an American author, died by suicide shortly after ECT at the Mayo Clinic in 1961. He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient."


title: Electroconvulsive therapy

text: Robert Pirsig had a nervous breakdown and spent time in and out of psychiatric hospitals between 1961 and 1963. He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation conducted by psychoanalysts, and was treated with electroconvulsive therapy on numerous occasions, a treatment he discusses in his novel, "Zen and the Art of Motorcycle Maintenance".


title: Electroconvulsive therapy

text: Thomas Eagleton, United States Senator from Missouri, was dropped from the Democratic ticket in the 1972 United States Presidential Election as the party's vice presidential candidate after it was revealed that he had received electroshock treatment in the past for depression. Presidential nominee George McGovern replaced him with Sargent Shriver, and later went on to lose by a landslide to Richard Nixon.


title: Electroconvulsive therapy

text: American surgeon and award-winning author Sherwin B. Nuland is another notable person who has undergone ECT. In his 40s, this successful surgeon's depression became so severe that he had to be institutionalized. After exhausting all treatment options, a young resident assigned to his case suggested ECT, which ended up being successful.


title: Electroconvulsive therapy

text: Author David Foster Wallace also received ECT for many years, beginning as a teenager, before his suicide at age 46.


title: Electroconvulsive therapy

text: New Zealand author Janet Frame experienced both insulin coma therapy and ECT (but without the use of anesthesia or muscle relaxants). She wrote about this in her autobiography, "An Angel at My Table" (1984), which was later adapted into a film (1990).


title: Electroconvulsive therapy

text: American actor Carrie Fisher wrote about her experience with memory loss after ECT treatments in her memoir "Wishful Drinking."


title: Electroconvulsive therapy

text: Electroconvulsive therapy has been depicted in fiction, including fictional works partly based on true experiences. These include Sylvia Plath's autobiographical novel, "The Bell Jar", Ken Loach's film "Family Life", and Ken Kesey's novel "One Flew Over the Cuckoo's Nest"; Kesey's novel is a direct product of his time working the graveyard shift as an orderly at a mental health facility in Menlo Park, California.


title: Electroconvulsive therapy

text: Throughout the history of ECT, women have received it two to three times as often as men. Currently, about 70 percent of ECT patients are women. This may be because women are more likely to be diagnosed with depression. A 1974 study of ECT in Massachusetts reported that women made up 69 percent of those given ECT. The Ministry of Health in Canada reported that from 1999 until 2000 in the province of Ontario, women were 71 percent of those given ECT in provincial psychiatric institutions, and 75 percent of the total ECT given was given to women.


title: Lesbian sexual practices

text: Lesbian sexual practices are sexual activities involving women who have sex with women, regardless of their sexual orientation. A woman who has sex with another woman may identify as a lesbian if she is sexually attracted to women, or bisexual if she is not exclusively sexually attracted to women, or dispense with sexual identification altogether. The term may also be applied to a heterosexual or asexual woman who is unsure of or is exploring her sexuality.


title: Lesbian sexual practices

text: Romantic or sexual interpersonal relationships are often subject to sexual desire and arousal, which then leads to sexual activity for sexual release. A physical expression of intimacy between women depends on the context of the relationship along with social, cultural and other influences. In some countries lesbian sexual practices are criminalized alongside gay sexual practices.


title: Lesbian sexual practices

text: Commonly, women engage in displays of affection, such as kissing on the cheek or hugging. A kiss on the lips, a prolonged kiss or hug, or other forms of touching, may or may not be regarded as sexual. Sex educator and feminist Shere Hite stated that one of her female research subjects had written, "Sex with a woman includes: touching, kissing, smiling, looking serious, embracing, talking, digital intercourse, caressing, looking, cunnilingus, undressing, remembering later, making sounds, sometimes gently biting, sometimes crying, and breathing and sighing together."<ref name="Hite/lesbianism"></ref>


title: Lesbian sexual practices

text: Disrobing before a partner, removing the clothing of a partner or performing acts of physical intimacy, such as the touching of a partner's erogenous zones by the use of hands, tongue or rest of the mouth, may be regarded as indicators of the partner's desire for sexual activity and an erotic stimulus or turn-on (sexual arousal), which may generate erotic sensations in both partners. Allowing such acts of physical intimacy, especially the stimulation of a partner's breasts and nipples, is an indication of reciprocal interest in sexual activity.


title: Lesbian sexual practices

text: A woman's mouth, lips and tongue may be sensitive erogenous zones; they are commonly used by partners during the preliminary stages and throughout a sexual activity, whether for kissing, sucking, licking or specifically for oral sex. The stimulation of a partner's breasts, including oral or manual stimulation of the nipples, is a form of foreplay. Breast and nipple stimulation of women is a common aspect of sexual activity. The stimulation of a woman's nipples promotes the production and release of oxytocin and prolactin. During the stimulation of the nipples, large amounts of oxytocin are released, which would normally prepare the breast for breastfeeding. Besides creating maternal feelings in a woman, it also decreases her anxiety and increases bonding and trust.


title: Lesbian sexual practices

text: An orgasm includes involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation and, frequently, body movements and vocalizations. The period after orgasm, known as a refractory period, is often a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin. Although it is generally reported that women do not experience a refractory period and can thus experience an additional orgasm (or multiple orgasms) soon after the first one, some sources state that women are capable of experiencing a refractory period because they may experience a moment after orgasm in which further sexual stimulation does not produce excitement.


title: Lesbian sexual practices

text: Oral stimulation of the clitoris or other parts of vulva or the vagina is commonly practiced between women and, like oral stimulation of the nipples, can include the use of teeth in addition to use of the lips or tongue. Oral sex that involves the stimulation of the woman's clitoris or other parts of the vulva or the vagina is called cunnilingus. The oral stimulation of the anus, called anilingus, is less often practiced.


title: Lesbian sexual practices

text: Fingering (manual stimulation) involves the use of the fingers to massage a woman's clitoris or other parts of the vulva, the vagina, or anus. Oral or manual stimulation of the vulva, and in particular the clitoris, is the most common way for a woman to reach and achieve an orgasm. Fingering may be self-fingering, one-sided, mutual, penetrative or non-penetrative. Massaging inside of the vagina may stimulate a very sensitive area, sometimes termed "the G-spot area." For some women, stimulating the G-spot area creates a more intense orgasm than direct clitoral stimulation. For deeper vaginal, anal or oral penetration, a dildo, strap-on dildo or other sex toys may be used.


title: Lesbian sexual practices

text: Tribadism is a common non-penetrative sexual act between women. It is often known by its "scissoring" position, and is also referred to as frottage or in popular slang as dry humping. It involves a woman rubbing her vulva against her partner's vulva, thigh, stomach, buttocks, arm, or another body part. This may be achieved in a number of sex positions, including a missionary, a woman on top, doggy style, scissoring or other position. It may be accompanied by fingering or penetration with a dildo.


title: Lesbian sexual practices

text: On occasion, for variety, or on a more regular or routine basis, a woman may assume a passive role during sexual activity and leave it to her partner to provide their sexual satisfaction, which can also be an aspect of dominance and submission. For example, a person in a doggy style position may be passive and open to a variety of sex acts, generally at the choice of the active partner, such as fingering from behind, massage or stimulation of erogenous zones, including the genitals, nipples, or buttocks, and receiving a playful spank to the buttocks. The active partner can also introduce a sex toy, such as a dildo or vibrator, into the vagina or anus.


title: Lesbian sexual practices

text: To ensure passivity and to enhance the feeling of or actual female submission, a partner may also take part in bondage (such as wearing handcuffs) or in other BDSM activities. During sexual bondage, the restrained partner is generally open to a variety of sex acts and cannot interfere in the ensuing sexual activity. She is dependent for her sexual satisfaction on the actions of her partner, who can choose the type and pace of the sexual activity and can introduce sex toys. For example, a pecker gag can be used to gag the restrained partner as well as to require her to suck during sexual activity in a similar manner to an adult pacifier. The active partner has the role of treating the restrained partner as a sex object to be used for her own sexual satisfaction. The active partner may herself derive sexual satisfaction from providing her sex partner with sexual satisfaction and bringing her to orgasm.


title: Lesbian sexual practices

text: In 1953, Alfred Kinsey's "Sexual Behavior in the Human Female" documented that, over the previous five years of sexual activity, 78% of women had orgasms in 60% to 100% of sexual encounters with other women, compared with 55% for heterosexual sex. Kinsey attributed this difference to female partners knowing more about women's sexuality and how to optimize women's sexual satisfaction than male partners do. Similarly, studies by several scholars, including Masters and Johnson, concluded that lesbian sexual behaviors more often have qualities associated with sexual satisfaction than their heterosexual counterparts, or that female partners are more likely to emphasize the emotional aspects of lovemaking. Masters and Johnson's 1979 study on lesbian sexual practices concluded that lesbian sexual encounters include more full-body sexual contact, rather than genital-focused contact, less preoccupation or anxiety about achieving orgasm, more sexual assertiveness and communication about sexual needs, longer lasting sexual encounters and greater satisfaction with the overall quality of one's sexual life.


title: Lesbian sexual practices

text: Studies by Pepper Schwartz and Philip Blumstein (1983) and Diane Holmberg and Karen L. Blair (2009) contradict research indicating that women in same-sex relationships are more sexually satisfied than their heterosexual counterparts. Schwartz concluded that lesbian couples in committed relationships have less sex than any other type of couple, and that they generally experience less sexual intimacy the longer the relationship lasts, though this study has been subject to debate (see Lesbian bed death). Holmberg and Blair's study, on the other hand, published in "The Journal of Sex Research", found that women in same-sex relationships enjoyed identical sexual desire, sexual communication, sexual satisfaction, and satisfaction with orgasm as their heterosexual counterparts. Additional research by Blair & Pukall (2014) reported similar findings, such that women in same-sex relationships reported similar levels of overall sexual satisfaction and lower levels of sexual frequency. However, this recent study also reported that women in same-sex relationships spent significantly longer amounts of time on individual sexual encounters - often spending upwards of two hours on an individual encounter. Consequently, what lesbians may lack in frequency, they may make up for with longer durations.


title: Lesbian sexual practices

text: With regard to the ease or difficulty of achieving orgasm, Hite's research (while subject to methodological limitations) showed that most women need clitoral (exterior) stimulation for orgasm, which can be "easy and strong, given the right stimulation" and that the need for clitoral stimulation in addition to knowing one's own body is the reason that most women reach orgasm more easily by masturbation. Replicating Kinsey's findings, studies by scholars such as Peplau, Fingerhut and Beals (2004) and Diamond (2006) indicate that lesbians have orgasms more often and more easily in sexual interactions than heterosexual women do.


title: Lesbian sexual practices

text: Preferences for specific sexual practices among female same-sex relationships have also been studied. Masters and Johnson concluded that vaginal penetration with dildos is rare and lesbians tend to do more overall genital stimulation than direct clitoral stimulation, which is also often the case for heterosexual relationships. Concerning oral sex, the common belief that all women who have sex with women engage in cunnilingus contrasts research on the subject. Some lesbian or bisexual women dislike oral sex because they do not like the experience or due to psychological or social factors, such as finding it unclean. Other lesbian or bisexual women believe it is a necessity or largely defines lesbian sexual activity. Lesbian couples are more likely to consider a woman's dislike of cunnilingus as a problem than heterosexual couples are, and it is common for them to seek therapy to overcome inhibitions regarding it.


title: Lesbian sexual practices

text: Some lesbians practice anal sex. In 1987, a non-scientific study (Munson) was conducted of more than 100 members of a lesbian social organization in Colorado. When asked what techniques they used in their last 10 sexual encounters, 100% reported kissing, sucking on breasts, and manual stimulation of the clitoris; more than 90% reported French kissing, oral sex, and fingers inserted into the vagina; and 80% reported tribadism. Lesbians in their 30s were twice as likely as other age groups to engage in anal stimulation (with a finger or dildo). A 2014 study of partnered lesbian women in Canada and the U.S. found that 7% engaged in anal stimulation or penetration at least once a week; about 10% did so monthly and 70% did not at all.