ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Ethical debate and reflection have gained growing importance in medicine as well as in psychiatry. The controversy about electroconvulsive therapy (ECT) has explicit or implicit ethical significance. Recent reports of the ethics of ECT focus on the necessity to obtain informed consent from the patient: informed refusal by a rational and competent patient should be respected; irrational refusal by patients whose competency is compromised because of disordered cognitive functions should be overruled for reasons of beneficence or nonmaleficence, as defined by experts. The inherent conflict between the principle of respect for the autonomy of the patient on one side and the principle of beneficence or nonmaleficence on the other is particularly problematic in psychiatry when there is a sustained or acute impairment of autonomy of patients. The ethical implications of ECT are analyzed in the light of four prominent principles: respect for autonomy, nonmaleficence, beneficence, and justice. It is concluded that ethical options in clinical practice themselves must be evaluated empirically with respect to their consequences for the patient.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Fifteen elderly depressed psychiatric inpatients were randomly assigned to receive either standard three-times-weekly electroconvulsive therapy (ECT) or once-weekly ECT. Outcome measures included cognitive assessment and antidepressant response. Although both groups improved with treatment, the three-times-weekly group improved substantially more quickly. There was no difference in cognitive effect between the two groups. We conclude that the traditional three-times-weekly schedule of ECT may optimally balance speed of antidepressant response and cognitive impairment.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Eight subjects with acute functional psychoses receiving unmodified electroconvulsive therapy (ECT) at Ibadan were investigated for occult or subclinical internal tissue damage by serial measurements of eight acute phase reactants. Samples of venous blood were collected from each patient at pre-treatment, two within treatment, and one at posttreatment. The acute phase proteins assayed were C-reactive protein (CRP), α-2-macroglobulin, ceruloplasmin, factor B, C-4 protein, C-3 protein, transferin, and α-1-antitrypsin. Except for CRP, the values of the proteins did not change during treatment. CRP values decreased posttreatment and were not detectable in the last sample in five subjects in whom values had been present pretreatment. Our data do not support fears of occult internal tissue damage during unmodified ECT. The consistent decrease in CRP levels posttreatment when patients no longer exhibited psychotic symptoms could not be explained by type of psychosis, intramuscular injections, or changes in drugs and diet; its significance is not known.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Electroencephalographic estimates of electroconvulsive therapy (ECT)-induced seizure duration were obtained in 141 patients with major depression (n = 41) or schizophrenia (n = 100). A slight reduction in seizure duration across a course of ECT failed to reach statistical significance and was unrelated to clinical improvement.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Multiple independent investigators have reported that propofol anesthesia during electroconvulsive therapy (ECT) is associated with substantially shorter ECT seizure duration than barbiturate anesthesia, which evidences seizure obstruction by propofol. Seizure length after propofol narcosis is often below the 20–30 s range accepted as minimally adequate. Seizure-induced elevations of prolactin, adrenocorticotropic hormone, and cortisol are similarly lower after propofol. Together with a recent report that average course length with propofol exceeds 16 sessions, this report indicates that propofol is undesirable for routine ECT anesthesia, and also illustrates how aspects of ECT anesthesia that affect the psychiatric or behavioral outcome require the collaboration of a psychiatrist.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A literature review of patients with symptomatic neuroleptic malignant syndrome (NMS) treated with electroconvulsive therapy (ECT) yielded 26 cases, to which we add five cases. ECT was associated with a positive outcome in 26 of 31 cases with one unclear outcome and a poor outcome in four cases, including two deaths. ECT appeared to be effective in eight of nine patients previously treated with dantrolene and/or bromocriptine; no difference in time to apparent response was seen between those treated with medication first and those undergoing ECT first. The mean time to clinical response after the first ECT was 1.46 ± 2.38 days, with 19 of 20 having a clinical response by 72 h. The possible relationship of ECT to the two deaths is discussed. Given this experience, the suggested treatment sequence is medication (dantrolene or bromocriptine) for 48 h; if no clinical response is seen, ECT should be initiated. ECT may be used earlier in response to specific clinical situations.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 70-year old woman developed prolonged apnea during an initial administration of electroconvulsive therapy (ECT) with succinylcholine. Because of the duration of apnea, she was suspected of having a heterozygous type of atypical cholinesterase. Subsequent therapies were administered with a reduced dose of succinylcholine. Prolonged apnea did not recur.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We describe an individual with psychotic depression and bulimia who demonstrated spontaneous post-electroconvulsive therapy (ECT) myoclonic jerks after her fifth unilateral treatment. After switching to bilateral ECT, the patient developed generalized tonic-clonic seizures, beginning about 2 min after each treatment and lasting for about 4 min. These were confirmed by electroencephalographic (EEG) recording, and could be terminated and also effectively prevented by intravenous midazolam. Differential diagnosis, risk factors, and management are discussed.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Medication-resistant major depression was diagnosed in a 67-year-old man 1 1/2 years after heart transplantation. Electroconvulsive therapy was administered, resulting in remarkable improvement in depressive symptoms without complications related to the cardiac condition.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID