ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine whether electroconvulsive therapy (ECT) patients' self-reported functional status is similar to that reported by a proxy.BackgroundIncreasing levels of depression are associated with deteriorating functional status as reflected in the Instrumental Activities of Daily Living (IADL) scale. Depressed patients referred for ECT have poorer IADL status compared with depressed patients receiving medications, suggesting that IADL status may shape physicians' decision to recommend ECT (1). Further, IADL status improves with treatment of depression, both in ECT-and medication-treated patients. Given the potential importance of IADL status for ECT patients, we examined whether IADL status as reported by patients prior to ECT was comparable to IADL status as described by a proxy.Design/MethodsForty depressed patients (23 men and 17 women, mean age 58.1 ± 17.5) were each interviewed alone with the 21-item Hamilton Depression Rating Scale (HDRS), Mini-Mental State Exam (MMSE), an Activities of Daily Living (ADL) scale, and an IADL scale. We then privately interviewed a first-degree relative who lived with each patient and recorded their impression of the patient's ADL and IADL function before ECT, and at 2 and 4 weeks after ECT.ResultsBaseline scores for HDRS and MMSE were consistent with a severe level of depressive symptoms and intact global cognitive function. Patients' and proxies' IADL scores were highly correlated before ECT, 2 weeks after ECT, and 4 weeks after ECT. Significant, but slightly weaker correlations were seen for ADL scores.ConclusionsIdeally, ADL and IADL function would be measured by direct observation rather than either patient or proxy report. At this time it is unknown whether the patient or the proxy report should be considered the “gold standard.” In this study, the patients' self-reported functional scores were highly correlated with the proxies' scores. We conclude that patients' reports of their function are roughly comparable to proxies' impressions before and after ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundClinical research shows that the antidepressant and cognitive adverse effects of electroconvulsive therapy are both dependent on the administered electrical stimulus intensity (dose); however, dose-dependent neurotransmitter system changes in the brain, which might underlie the therapeutic or adverse effects, remain to be demonstrated.ObjectiveWe used a behavioral model to examine dose-related effects of electroconvulsive shock (ECS) on dopamine postsynaptic receptor functioning in the rat brain.MethodsIn a factorially designed study, rats (n = 100) were treated with five once-daily ECSs at three levels (sham ECS, 30 mC ECS, and 120 mC ECS), and with drug at two levels (saline, and 1 mg/kg s.c. apomorphine). Motility was assessed in the small open field.ResultsApomorphine-elicited, dopamine postsynaptic receptor-mediated hypermotility was significantly increased by 120 mC ECS but not by 30 mC ECS. An additional but unrelated finding was that, while the ECS seizure duration expectedly decreased across time, no dose-dependent effects were observed.ConclusionECS-induced dopamine postsynaptic receptor up-regulation may depend on the intensity of the administered electrical stimulus.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This article describes the results of an evaluation of a system to use trained junior psychiatric doctors to perform the pre-ECT oral assessment. All junior doctors were given a 1-hour training session in making oral assessments, and their ability to diagnose was tested by dental follow-up visits to patients they had assessed. Seventy-one patients were seen by both doctor and dentist, and the sensitivity for doctors ranged between 92% for the presence of dentures or removable bridges to 8% for the presence of teeth vulnerable to fracture. Where the doctors made a positive diagnosis, these were not always correct; the positive predictive value ranging from 92% for dentures or removable bridges to 25% for teeth vulnerable to fracture. It is concluded that the use of trained doctors is better than no assessment but falls short of that provided by a dentist with experience of psychiatric patients undergoing ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study examined the short-term efficacy of electroconvulsive therapy (ECT) combined with antipsychotic medication in treatment-resistant schizophrenia (TRS). Fifteen patients with TRS from an in-patient psychiatric rehabilitation unit participated. Patients completed a course of ECT consisting of 8 to 20 sessions, while their antipsychotic medications were continued throughout the study. Patients were assessed at baseline, 1 week, 1 month, and 2 months after their last ECT session. Assessment instruments included the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale, Scale for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), Clinical Global Impression (CGI), Nurses' Observation Scale for In-Patient Evaluation, and occupational therapists' rating of the patients' functioning with respect to work, social, and leisure activities. Compared with the baseline assessment, at each posttreatment evaluation, patients showed statistically significant improvement in the GAS and CGI. In addition, they were significantly better in terms of BPRS and SANS scores, as well as work performance and social functioning at the 2-month post-ECT evaluation.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 17-year-old adolescent female presented to a psychiatric emergency room with excitement, confusion, and psychotic symptoms. After brief exposure to haloperidol and olanzapine, she developed fever, rigidity, waxy flexibility, autonomic instability, and elevated creatinine phosphokinase enzyme. Approximately 6 weeks after the onset of the illness, multiple laboratory tests, and evaluation at three different hospitals, the condition was effectively treated with electroconvulsive therapy (ECT). This case is a lesson in delayed recognition and the delayed use of ECT for the malignant catatonia/neuroleptic malignant syndrome.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The 1990 American Psychiatric Association (APA) Task Force report on electroconvulsive therapy (ECT) suggests that there is an increased risk of complications in patients with intracranial vascular masses. There have been only a few published reports on the use of ECT in these patients. In this case report, an additional case is described that used ECT in the treatment of major depression in a 72-year-old patient with a venous angioma involving the left cerebellum. Brain imaging studies, neurosurgery, cardiology, and orthopedic consultations were obtained prior to ECT. Blood pressure was monitored closely throughout the course of ECT. Prior to each ECT, antihypertensive medication was given in addition to other pretreatment medications. Consistent with previously published reports, the patient did not experience any neurological deterioration or adverse effects. A brief review of the literature on the use of ECT in patients with venous angioma and other intracranial vascular masses is presented.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundAsystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Several risks for poststimulus asystole have been described, but risks for asystole at other times have not.MethodTwo instances of ECT postictal asystole in healthy adult males are reported. Features in common are identified.ResultsFeatures shared differ from risk factors for poststimulus asystole. In common were adult but not geriatric age, male sex, good physical and cardiac health, mesomorphic habitus, anticholinergic pretreatment, vigorous ECT seizure, and low resting heart rate. Both patients showed postictal bradyarrhythmia at the previous ECT.ConclusionsPostictal asystole has apparent similarities to postexertional asystole in athletes. The combination of higher pretreatment doses of an atropinic agent, a sympatholytic agent, and close monitoring of postictal cardiac rhythm should be considered with patients similar to ours, especially after occurrence of postictal bradyarrhythmia.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID