摘要:

Six patients who failed to respond to what would ordinarily be considered therapeutically effective courses of sequential unilateral nondominant (mean number 10) and bilateral brief-pulse electroconvulsive therapy (ECT) (mean number 10) with electroencephalographic (EEG) monitoring of seizure duration (all seizures >30 s) subsequently received courses of bilateral sinusoidal ECT (mean number 6) and responded well. Some theoretical implications and clinical considerations raised by these cases are discussed.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We compared the efficacy of electroconvulsive therapy (ECT) and numbers of ECTs received by unipolar depressive (n = 368), bipolar depressive (n = 55), and manic patients (n = 37) in a review of records of patients treated in a 12-year period in a university hospital medical center. Both unipolar and bipolar depressive patients received nine treatments, one half more on average than the number of treatments received by manic patients, but the difference was not significant. ECT was equally effective in unipolar and bipolar depression (69.8 and 69.1%, respectively, rated as “markedly improved”), whereas 78.4% of patients with mania had “marked improvement.” Both unilateral and bilateral ECTs were equally effective for the three groups. Bipolar depressive and manic patients receiving mixed courses (some unilateral, some bilateral) received more treatments than did those receiving unilateral or bilateral treatments exclusively and tended not to respond as well. We conclude that ECT is an effective treatment for mania, unipolar, and bipolar depression, that unilateral and bilateral treatments are equally effective, and that no significant difference exists in the number of ECTs used to treat these disorders.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The sixty-five California hospitals administering electroconvulsive therapy (ECT) during 1984 were surveyed regarding ECT practices to develop data on the community standard of care. Usable data were obtained from 58 hospitals. In each facility two psychiatrists usually administered ECT, including one psychiatrist who received credentials in or after 1977. Thirty-four brief-pulse and 43 sine-wave machines were in use. Treatment was performed on the psychiatric unit in 41.4% of the hospitals, in the operating room or the recovery room in 50% of the hospitals, and in other locations in 8.6% of the hospitals. The psychiatrist administered the anesthesia in 12 (21%) of the hospitals. Unilateral electrode placement was used in 42% of patients. The use of anesthetic agents, ancillary equipment, and staffing patterns is reviewed.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Ten studies comparing the efficacy of unilateral versus bilateral electroconvulsive therapy (ECT) were reexamined. Three different methods of meta-analysis applied to the combined results revealed statistical significance in favor of bilateral ECT for the relief of depression. The recognition that bilateral ECT has some advantage over unilateral is in sharp contrast to an overly strong conclusion to the contrary previously reached by Janicak et al. (1985), in reviewing the same studies. Alternative statistical methods for evaluating the significance of combined results from several independent studies are illustrated with reference to previously published ECT research.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This article explains divergent reports on the relative efficacy of unilateral and bilateral electroconvulsive therapy (ECT) by hypothesizing a therapeutic effect of both seizure and electrical stimulus, with the seizure's effect based on its intensity and generalization. The effect of the stimulus is normally obscured by the seizure but emerges with reduced electrical dosage or elevated threshold. These circumstances favor a therapeutic advantage for bilateral ECT, which introduces more electrical charge into a larger and differently distributed volume of brain and induces greater seizure generalization, more diencephalic stimulation, and a relative decrease in left relative to right hemisphere electroencephalographic (EEG) frequencies.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Conflicting results continue to be reported for studies contrasting the therapeutic efficacy of bilateral and unilateral nondominant electroconvulsive therapy (ECT). At least in part, the therapeutic advantage for bilateral ECT observed by some investigators may be related to the use of nonoptimum unilateral ECT technique. Consideration of technique-related factors, such as stimulus electrode location, contact at the electrode-scalp interface, stimulus dosing, and seizure monitoring, will allow unilateral ECT to be carried out with maximal therapeutic potency.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

There is evidence that, in addition to seizure elicitation, critical factors in therapeutic response to ECT may include aspects of stimulus parameters and electrode placement. Dr. Abrams suggests that these factors contribute to efficacy by influencing the degree of seizure generalization, diencephalic stimulation, and relative asymmetry in the slowing of EEG frequencies. An alternative view is presented here, which hypothesizes that these factors converge in influencing the regional distribution and strength of the endogenous inhibitory process that terminates the seizure.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

An elderly patient at high risk for fractures due to severe osteoporosis and other spinal pathology was treated with electroconvulsive therapy (ECT). Suppression of twitch response to peripheral nerve stimulation over the ulnar nerve was a more accurate monitor of degree of paralysis than other clinical indices. Complete paralysis was consistently achieved using this method. Successive doses of succinylcholine were not required with multiple treatments per session when the nerve stimulator was used to verify continued paralysis.

ISSN:0749-8055    

出版商:OVID    

年代:1986

数据来源: OVID