ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In patients with treatment-resistant schizophrenia (TRS), this study compared the efficacy of continuation treatment with flupenthixol alone, continuation electroconvulsive therapy (ECT) alone, and combined continuation ECT and flupenthixol. One hundred fourteen TRS patients received acute treatment (Phase I) with bilateral ECT and flupenthixol (12–24 mg/day). Fifty-eight patients met remitter criteria, including clinical stability during a 3-week stabilization period, and were eligible for the continuation treatment study (Phase II). Fifty-one patients enrolled in the single-blind Phase II continuation trial, and were randomized to the three treatment groups. The duration of the Phase II study was 6 months. Assessments of outcome included the Brief Psychiatric Rating Scale, Global Assessment of Functioning, and the Mini-Mental State Examination. Forty-five patients, either relapsed or completed the Phase II study, and six patients dropped out. Among completers, 6 of 15 (40%) patients relapsed in the combined continuation ECT and flupenthixol group. In both the group treated with continuation ECT alone and that with flupenthixol alone. 14 of 15 (93%) patients relapsed. Analyses of intent-to-treat and completer samples demonstrated a marked advantage for the combination treatment condition in relapse prevention. Furthermore, all eight patients who received maintenance ECT combined with neuroleptic medication (Phase III study) maintained therapeutic benefits during the follow-up period of 3–17 months after the continuation treatment study. Among TRS patients who respond to acute combination treatment with ECT and neuroleptic therapy, continuation of this combination treatment is more effective in relapse prevention than use of ECT or neuroleptic therapy alone.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Electroconvulsive therapy (ECT) is among the most commonly performed medical procedures requiring general anesthesia in the United States. Nevertheless, very little is known about the characteristics of depressed patients who receive ECT and how they differ from depressed patients receiving psychotropic medication. We conducted a detailed examination of demographic, clinical, and quality-of-life (QOL) measurements in a group of 90 depressed inpatients, and we then used these measurements to contrast the 31 patients who received ECT with the 59 who received alternative therapies. The ECT group did not differ from the non-ECT group in gender composition, marital status, race, education, employment status, overall severity of depression, chronicity of depression, adequacy of prehospitalization antidepressant treatment, extent of physical illness, or extent of social support. The ECT group was older. Furthermore, the ECT group had greater weight loss, worse functioning in activities of daily living (ADLs), and worse functioning in instrumental activities of daily living (IADLs). The differences in weight loss, ADL, and IADL scores disappeared after age adjustment. However, statistical adjustment for age revealed that the ECT group reported worse capacity in their daily living and role functioning than did the non-ECT group. We conclude that the decision to pursue ECT is based in part on the perceived effect of the depression on QOL, as well as the severity of specific symptoms such as weight loss. The elderly seem particularly vulnerable to depression-related functional deficits and weight loss, and this may explain why prior studies showed a differential use of ECT in the elderly.D

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Speed of response to bilateral electroconvulsive therapy (ECT) was defined as the number of ECTs required to induce a 50% reduction in Hamitton Depression Scale score and was established in 48 patients who had participated in two controlled trials of twice versus three times weekly ECT and were responders to treatment. Potential clinical predictors of response were examined dichotomously by comparing early (up to and including ECT 4) and late (ECT 5–9) responders and by correlation. Younger patients manifested a more rapid response (p = 0.03), but no other clinical variables were significantly related to speed of response. Because speed of response affects choice of ECT schedule, biological predictors should be sought.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In answer to allegations by electroconvulsive therapy (ECT) detractors that psychiatrists never prescribe the treatment for themselves or their families, I sought clinicians with personal or family experience as ECT patients. A letter inviting firsthand accounts of treatment was published in a commonly read psychiatric publication (Psychiatric News) and mailed to selected American Psychiatric Association District Branches. Forty-two psychiatrists responded. Ten practicing psychiatrists had received at least one ECT series, five during their training years, and one had taken one treatment for personal educational reasons (“to see what my patients were experiencing‘’). More than 80 series and maintenance courses of ECT were described among 11 psychiatrists, nine parents, five siblings, and 18 other relatives of psychiatrists. Almost all patients had moderate to excellent improvement; no serious adverse effects were reported. Inability to get ECT for depressive relapses years after earlier, positive responses may have contributed to two suicides. Three psychiatrists published their personal or family experience with ECT in medical journals. A number of brief case reports are presented. It appears that psychiatrists and their families are consumers of ECT in much the same way as are patients from the general population.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Anticholinergic medications such as atropine or glycopyrrolate have long been used in electroconvulsive therapy (ECT) to eliminate parasympathetically mediated dysrhythmias. However, such agents increase heart rate and myocardial workload and may increase risk of cardiac adverse events. What is needed is an intervention that is parasympatholytic without substantially increasing myocardial workload. In this study, a low dose of atropine was compared with placebo in ECT with attention to heart rate, blood pressure, cardiac rhythm, myocardial workload, and parasympathetic function. The dose of atropine that was used effectively blocked vagal tone with only a small and probably not clinically significant rise in myocardial workload for only a few minutes after the ECT seizure.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The heart rate (HR) rises rapidly with ECT seizure onset and falls with seizure termination. The peak HR is a potential reflection of the intensity of the seizure. Because it varies greatly among patients, comparison with a benchmark HR for each patient should be useful. By comparing variations in the peak and baseline HRs, this study aims to determine if the peak HR should be compared with the baseline. HRs were measured on all treatments for 24 subjects receiving asymmetric bilateral ECT, excluding treatments with motoric seizure duration under 18s or no EEG postictal suppression. The resulting mean variations within subjects were significantly larger for the baseline (7.7 bpm, 8.1%, SD 4.6 bpm, p = 0.004 2-tail, p = 3.2 than the peak HR (4.6 bpm, 3.0%, SD 2.4 bpm). This indicates that comparison of the peak HR with the baseline substantially increases random variations. There was a general absence of correlation between peak and baseline HRs; this reveals no rationale for subtraction of the baseline from the peak. An expression of the peak HR that allows comparisons between patients but avoids the baseline HR is the difference between the seizure peak HR and the highest peak HR seen during that patient's ECT course.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The case of a patient with bipolar disorder is presented to illustrate that past clinical course may suggest flexible scheduling strategies for maintenance ECT (MECT), which will allow some patients to be successfully treated with the fewest number of ECT. For 7 years prior to MECT, manic episodes regularly occurred during early summer and late autumn/early winter. ECT rapidly aborted the mania in the two episodes prior to referral for MECT. Given the rhythmicity of his manic episodes, MECT was begun by giving four outpatient ECT during the two at-risk periods each year to both abort and prevent affective episodes and to stop cycling. No breakthrough hypomania occurred by the third such period, and the ECT was reduced to three ECT for the following period and two for the next. The patient had no significant affective episodes or hospitalizations during the 3 years of MECT. He continued maintenance lithium carbonate between ECT. This treatment strategy has allowed the patient to maintain stability in his employment and personal life.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 47-year-old acutely psychotic schizophrenic man was diagnosed with malignant catatonia. Because of a history of neuroleptic malignant syndrome (NMS), traditional neuroleptics were avoided, and the patient had been treated with reserpine for a period of 10 years. Symptomatically, severe agitation alternated with severe retardation. The syndrome progressed, despite early termination of any neuroleptic medications, to marked catatonic rigidity and dehydration. Worsening was associated with transfer to a medical intensive care unit, intubation, and subsequently a tracheostomy. Dantrolene and bromocriptine were unhelpful. Lorazepam produced muscular relaxation and resulting decreases in creatine phosphokinase levels but elicited no other improvement. Eleven bilateral electroconvulsive treatments, however, resolved the respiratory impairment and catatonia and improved the psychosis. This report highlights the efficacy of ECT in lethal catatonia despite respiratory impairment and tracheostomy.

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:1999

数据来源: OVID