ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryIn 12 depressed inpatients referred for bilateral electroconvulsive therapy (ECT), each patient was titrated at the first treatment session by using an ascending method-of-limits procedure with a step-wise increase in pulse frequency (frequency titration) or train duration (duration titration). At the second treatment session, seizure threshold was redetermined by using the method (frequency or duration titration) not used at the first treatment. Frequency or duration was maintained at the lowest level when the other parameter was titrated. Seizure threshold was significantly lower with duration titration (mean, 90 mC; SD, 27.3) than frequency titration (mean, 114 mC; SD, 35.6; p = 0.03). On average, patients in the duration-titration group required 1.2 (SD, 0.6) subconvulsive stimulations before a seizure was elicited, and patients in the frequency-titration group required 1.7 (SD, 0.9) subconvulsive stimulations before a seizure was elicited, a nonsignificant difference. These findings suggest that to elicit a seizure during ECT, increasing train duration may be slightly more efficient than increasing frequency. Basic and other clinical research findings indicate that increasing pulse width may be an inefficient way to elicit a seizure. Therefore the following sequence in the determination of seizure threshold is worth considering when using dose-titration or related techniques: the train duration should be increased first before increasing pulse frequency, and the decision to increase pulse width should be reserved for patients who do not seize at the maximal duration and frequency settings. Further empiric research is needed to establish the utility of this approach.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryWe investigated the effect of thyrotropin-releasing hormone (TRH) on orientation time and recall, in nine depressed female inpatients undergoing electroconvulsive therapy (ECT). In a balanced order crossover design, an intravenous bolus of 0.4 mg TRH or placebo was administered 20 min before ECT in the first two sessions. Orientation time and retrograde and anterograde components of the memory dysfunction, immediately and 24 h later, were assessed. Administration of TRH did not influence orientation time, word recall, or immediate short story recall compared with placebo. We did find, however, an improvement in the number of short story items recalled after 24 h when patients were given TRH compared with placebo. This indicates that TRH may have a protective role against the specific negative effect of ECT on delayed recall.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryThis clinical report describes the successful use of a combination of lithium carbonate and maintenance electroconvulsive therapy (ECT) in the treatment of severe bipolar depression. The patient was initially taken off the lithium and given a course of ECT with remarkable improvement in symptoms. He subsequently underwent maintenance ECT, during which lithium was restarted without any side effects. Rating scales were used to assess memory, depression, and mental status. This case suggests that the overlap of the two treatments may be especially beneficial when the plan is to taper maintenance ECT while continuing pharmacotherapy.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryLabetalol, a combined α- and β-adrenergic blocker is often used to attenuate the transient increases in heart rate and blood pressure that accompany electroconvulsive therapy (ECT). It has been suggested that labetalol should not be administered during ECT without the protection provided by anticholinergic medications, because of its potential severe bradycardic effects. We present our experience with 32 patients from all age groups who received labetalol without anticholinergic treatment during ECT. None of the patients demonstrated adverse bradycardic effects. We conclude that administration of labetalol during ECT does not routinely require premedication with anticholinergic drugs and does not lengthen asystole.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryWe present the case of a young woman, 8 weeks pregnant, who had a spontaneous abortion after her third electroconvulsive therapy (ECT) session. We review the literature on ECT in the first trimester of pregnancy.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryIn this era of decreased health resources and the strong influence of third-party payers, the financial advantages of ambulatory electroconvulsive therapy (ECT) should be well recognized by all concerned parties. However, to a large degree, third-party payers are only minimally aware of the availability and potential cost savings associated with this treatment modality. Also, documentation has been problematic, because reviewers unfamiliar with ECT have not been able to find the necessary data even when they are present in the chart. This article illustrates some of these problems and how they have affected our ambulatory ECT program.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummarySeizure thresholds were determined by titration in consecutive electroconvulsive therapy (ECT) patients at the first (n = 146) and sixth (N = 83) ECT sessions. Equations to predict the threshold at the first and sixth ECT were computed from these data using a stepwise linear regression model. These equations were tested prospectively at the first ECT (n = 48) and sixth ECT (n = 26) sessions. Stimulus dose derived from the corresponding equations yielded adequate seizure (successful) in 82% and 84% of patients, respectively. Predictions based on age alone (disregarding two other significant variables—illness severity and inion-nasion distance) were estimated at these two ECT sessions. This would not appreciably compromise the success rate. The “formula” method using age alone may therefore be used in routine clinical practice.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryTwo patients with known intracranial aneurysms (ICA) received electroconvulsive therapy (ECT). The first patient received ECT 4 years after the clipping of a right middle cerebral artery aneurysm. Treatment with esmolol failed to completely prevent an increase in blood pressure, but she did well nonetheless. The second patient underwent clipping of a basilar artery aneurysm 11 years before ECT. At the time of ECT, angiography showed a right paraophthalmic artery aneurysm. He received esmolol before each ECT, and, like the first patient, still had significant peri-ictal increases in his blood pressure, but otherwise tolerated the procedure well. Our experience and previously published literature indicate that even with pretreatment, patients often sustain significant increases in their blood pressure. However, this has not been accompanied by any morbidity. Possible guidelines for the management of ICA in association with ECT are discussed.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryA 27-year-old woman receiving electroconvulsive therapy (ECT) for the treatment of depression developed post-ECT headaches refractory to treatment with acetaminophen and various nonsteroidal antiinflammatory drugs. The patient was then treated successfully with oral sumatriptan. This case suggests that sumatriptan may be a useful treatment of post-ECT headaches that are unresponsive to conventional analgesics.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID