ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryWe review the process for obtaining valid consent to psychiatric treatment, including electroconvulsive therapy (ECT). Central to controversy and clinical difficulty is the concept of mental capacity or competence to consent, its place within the common-law doctrine of consent, the lack of an operational definition, its idiosyncratic assessment in clinical practice, and the consequences to a person of being shown to lack that capacity. The ECT caseload is representative of patients for whom the issues of consent and competence are relevant. Previously identified standards of competence to consent are used as the basis for defining this legal concept in clinical terms. We propose specific questions to standardize assessment and describe criteria for competent and incompetent responses.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryWe performed a retrospective review of 5 years of experience with electroconvulsive therapy (ECT) in patients with organic brain lesions. On 26 of 27 occasions, patients with organic brain disease and a concurrent depressive disorder obtained a good affective response to a course of ECT. Patients with diffuse or multifocal brain disease were vulnerable to ECT-induced delirium; however, this was severe enough to compel discontinuation of ECT on only one occasion. We conclude that ECT is an effective treatment for depression in patients with concurrent neurological disease, although patients with degenerative brain disease or diffuse encephalopathy may be especially prone to ECT-induced delirium.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryWe surveyed medical students doing the required psychiatry clerkship at our hospital and first-year psychiatry residents in our residency training program for their attitudes, knowledge, and opinions about electroconvulsive therapy (ECT) before and after their inpatient rotations. The students' knowledge was lower and their attitudes more negative toward ECT than those of residents at baseline. Upon completion of the rotation, students and residents had more knowledge and highly positive attitudes about ECT and stated that they would undergo ECT if it were recommended. Willingness to undergo ECT if it were recommended correlated with the knowledge measures of ECT.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryTwenty patients were enrolled in a prospective, randomized, open vial, within-patient, crossover design study of methohexital and etomidate anesthesia for electroconvulsive therapy (ECT). Methohexital (1.0 mg/kg) and etomidate (0.3 mg/kg) were each given for two ECTs. While there were no differences in hemodynamics between the etomidate and methohexital groups, etomidate had a 24% longer mean wakeup time than methohexital. There was no difference between etomidate and methohexital in recovery room stay, induction time, or seizure duration. There was no difference in cardiac rhythms. More patients had pain on injection with etomidate than with methohexital. Increased incidence of pain on injection and a longer initial wakeup time are drawbacks to etomidate, but etomidate compared favorably to methohexital in hemodynamics. Etomidate is an acceptable alternative to methohexital, especially when barbiturates may be contraindicated.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryProlactin (PRL) plasma levels rise severalfold following spontaneous or electrically induced seizures. To assess the role of dopamine in this neuroendocrine response, we studied the effect of electroconvulsive therapy (ECT) on plasma PRL after maximal dopamine receptor blockade induced by intravenous metoclopramide. Six patients undergoing ECT received metoclopramide or placebo, in counterbalanced order, 30 min prior to application of the electrical stimulus. Blood samples were obtained at – 15 min, immediately before, and at 15 min intervals for 1 h after the treatment. Under placebo conditions, PRL plasma levels increased nearly sevenfold in response to ECT. The administration of metoclopramide produced a large increase in PRL plasma levels, with no further increase in PRL concentrations after ECT. The data suggest that the PRL plasma rise after ECT involves dopamine as it is not seen when the dopaminergic inhibitory tone, exerted by the hypothalamus on the pituitary lactotroph, has been removed.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryThe combination of pregnancy and affective psychosis produces a complex treatment problem. The mother and fetus can experience significant risks from the disorganized behavior associated with mental illness as well as from the medical treatments for the illness. ECT has been recommended as a safe alternative. This article reports on ECT used for a patient pregnant with twins. Multiple gestation compounds the problems encountered with single pregnancies. The report details techniques to monitor fetal well-being. The case illustrates the safe use of ECT when the fetuses and the pregnancy itself are at high risk.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryA 40-year old man with severe psychosis and unresponsive to pharmacotherapy was treated with ECT despite the presence of Harrington Rods implanted after a suicide attempt. Complete relaxation was obtained with succinylcholine chloride 2.3 mg/kg and he received nine ECT without any musculoskeletal complications, nor did recovery from the treatments appear to be delayed.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryWe describe the safe and effective use of the combination of clozapine and ECT in a patient with schizophrenia who had lost responsiveness to clozapine alone. We suggest further investigation to define the role of combined clozapine-ECT treatment in the management of treatment-resistant schizophrenia.

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1992

数据来源: OVID