ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundPropofol is an anesthetic agent commonly used for ambulatory surgery because is associated with rapid recovery and a benign side effect profile. In electroconvulsive therapy (ECT), its use is limited because of its seizure-shortening effects, and is recommended only for patients with preexisting cardiac conditions requiring attenuated hemodynamic response during treatment. We have identified two additional significant indications for propofol: to induce shorter seizures in patients with prolonged seizures and to minimize post-ictal nausea and vomiting.MethodsWe reviewed the records of 340 patients treated with ECT. We identified 28 patients who were switched from methohexital to propofol anesthesia due to adverse effects or to avoid prolonged seizures.ResultsTwenty-two patients were switched from methohexital anesthesia to propofol because they had already experienced long seizures. Nine patients had seizures longer than 180 seconds requiring termination with a benzodiazepine. The switch resulted in an average shortening of the EEG recorded seizures by 38.7%. Eight of the 22 (36.4%) patients were adolescents. These 8 comprised 53% of the total of 15 adolescents treated with ECT in our service. Five of the 15 (33%) had seizures longer than 180 seconds. Finally, 7 of the 28 patients were switched to propofol because of nausea and vomiting, which was significantly reduced. No side effects were noted, and none of these patients needed to switch back to methohexital.ConclusionPropofol may be a useful alternative to methohexital for the treatment of patients who have excessively long seizures and/or severe nausea and vomiting after ECT. Such seizures are more common among adolescents.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Stimulus parameters, such as pulse width, frequency, and stimulus train duration, affect seizure threshold in electroconvulsive therapy (ECT), although variably. This study examined the effect of low- and high-pulse frequencies of stimulus on seizure threshold and physiological responses to ECT. Twenty-four consenting inpatients prescribed ECT by the treating psychiatrist received bilateral ECT. Threshold was reassessed at second and third ECT sessions in a crossover design. In the second ECT the pulse frequency was randomly either 50 pulses per second (PPS; n = 13) or 200 PPS (n = 11). In the third ECT, the same was reversed. The seizure threshold and number of subconvulsive stimulations were significantly lower with 50 PPS compared with 200 PPS. There was no significant difference in the cardiovascular responses between the two groups. Lower stimulus frequency is more efficient in inducing a seizure (smaller threshold) without compromising the physiological responses to ECT. Clinical effects of different doses of ECT stimulus must also consider the role of charge rate (frequency of pulses).

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Despite the fact that a role for thyrotropin-releasing hormone (TRH) in seizure modulation has been consistently hypothesized, the exact nature of this role remains unclear. In this study, we investigated the effects of TRH administration on seizure threshold and seizure duration in 13 depressed inpatients undergoing electroconvulsive therapy (ECT). In a balanced order crossover design, an intravenous bolus of 0.4 mg TRH or placebo was administered immediately before anesthesia, during the first two sessions, in a series of bilateral ECT. In both of these sessions, a threshold titration procedure was applied by using gradual increments of the electrical charge delivered until seizure elicitation, a procedure that has been safely used in the past. Seizure threshold was defined as the lowest energy level required for induction of a grand mal seizure, by use of this titration procedure. Seizure duration was estimated both by simultaneous EEG recording and by the cuff method. Results showed that neither seizure threshold, nor seizure duration (either by cuff or by EEG) differed between the TRH and the placebo conditions, regardless of the order in which TRH or placebo were administered in the two ECT sessions. This was the case regardless of whether the patients had at baseline a blunted TSH response to TRH or not. Our findings do not support a role for TRH on seizure modulation, at least when TRH is administered exogenously. Such an effect, if it exists, could be obscured, however, by several factors, including pharmacokinetics.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Recently published controlled studies comparing electroconvulsive therapy (ECT) with other treatments for depression offer the opportunity to perform a meta-analysis of ECT in depression. Fifteen studies were identified which fulfilled the inclusion criteria. From these controlled trials, 20 effect sizes of ECT were calculated. The speed of action during the course and the efficacy after a full course of ECT were explored. The efficacy of sine wave and brief pulse machines were compared. The comparison between ECT and four other comparative treatments was made. Predictive variables were explored using homogeneity tests. ECT was shown to be superior after a full course. The funnel plot showed the absence of publication bias. There was no exaggeration of effect size in the lower quality trials. No evidence was found for a superior speed of action of ECT or for a difference in efficacy between sine wave and brief pulse stimulation. ECT was shown to be superior to medication and simulated ECT. Some evidence was found that psychosis predicted better response to ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveWe investigated whether the ability to learn new information, as opposed to recall information, would change significantly in depressed individuals treated by low- or high-dose right unilateral electroconvulsive therapy and tested whether change in learning explained changes in recall.MethodFifty-four depressed patients randomized to receive right unilateral electroconvulsive therapy (ECT) at approximately 2.25 times their seizure threshold (ST) or at doses greater than 2.25 times ST were evaluated for verbal and figural memory as well as verbal and figural learning both pre- and post-ECT. A subset of scores from the Rey Auditory Visual Learning Test and the Rey Figure Test were analyzed using analysis of variance and linear regression techniques.ResultsScores reflecting verbal learning decreased by a mean of approximately 50% immediately after a completed course of ECT as compared with pre-ECT verbal learning scores. Stratification of effect by dose of electrical charge revealed trends that did not achieve statistical significance. Approximately 8% of the change in delayed verbal recall was predicted by changes in verbal learning. Figural learning was not significantly changed in the aggregate (pre-versus post-treatment) or when the effect was stratified by electrical charge.ConclusionsVerbal learning scores declined immediately after ECT, but the change in learning scores explained only a minor part of the observed changes in verbal recall. These findings support the notion that the deficits in delayed recall after ECT represent a relatively specific cognitive effect that is not completely explained by changes in other aspects of cognition such as learning.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThis study examined cognitive side effects of maintenance electroconvulsive (ECT) in comparison with maintenance pharmacotherapy after index ECT.MethodClinical outcome data and neuropsychological measurements were compared in 11 maintenance ECT patients and 13 control patients treated with maintenance pharmacotherapy after index ECT. Data were gathered in a prospective naturalistic study during follow-up.ResultsThere were no significant differences in patient characteristics and effects of index ECT between groups. In control patients treated with maintenance pharmacotherapy, cognitive function as well as depression ratings remained stable. During maintenance ECT neuropsychological test performance and depression ratings improved slightly but not significantly.ConclusionsNeuropsychological functioning during the maintenance phase of treatment did not differ between the two treatment groups. Cognitive function remained stable during maintenance ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo date, right unilateral electroconvulsive therapy administered at 6× seizure threshold (6x RUL-ECT) has been described in relation to unipolar depression alone. For clinicians who have developed an experience and confidence in bilateral ECT, the effectiveness of 6× RUL-ECT in other psychiatric disorders, particularly those who are severely ill, has remained untested and therefore unknown. This article describes the results of 6× RUL-ECT in a select series of patients with a nondepressive psychotic illness.MethodSix patients with psychotic disorders of nondepressive origin were selected from a recent 2-year retrospective review of 6× RUL-ECT practice. The clinical presentation, ECT parameters, and responses were recorded.ResultsFour patients with severe psychotic disorders, two of whom met broad criteria for catatonia, responded to an index course of 6× RUL-ECT. One psychogeriatric patient who had protracted inpatient mania continues to benefit from outpatient maintenance 6× RUL-ECT over 18 months. Two elderly males, in whom seizures were difficult to elicit and maintain, responded poorly.Conclusion6× RUL-ECT was effective in 4 patients with nondepressive, psychotic disorders. While clinically viable and although memory was not assessed, it is uncertain what advantage 6× RUL-ECT confers over a bilateral electrode placement. The real focus should remain on clinical responsivity.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We describe three cases of nonconvulsive status epilepticus induced by electroconvulsive therapy (ECT). Nonconvulsive status epilepticus is an important differential diagnosis in patients who develop prolonged confusion after ECT. The present cases exemplify the difficulty in defining the diagnosis on the basis of the clinical manifestations. The application of electroencephalography is recommended in monitoring patients with prolonged confusion following ECT. Concurrent drug therapy and ECT is discussed.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A 61-year-old patient with major depression and selective serotonin reuptake inhibitor-induced bruxism was successfully treated with a course of bilateral electroconvulsive therapy. Both the depressive symptoms and bruxism completely remitted after six treatments. Possible mechanisms of this effect are discussed.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID