ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There are no published data on the effects of seizures on indices of γ-aminobutyric acid (GABA) function in human subjects. In study 1, the effects of electroconvulsive therapy (ECT) on free plasma GABA were studied in 39 inpatients with major depressive disorder. Acutely after ECT, free plasma GABA was significantly reduced for up to 1 h after seizure termination, and this finding replicated strongly in a subgroup of six patients who received a second course of ECT. In a second study at a different site that compared sham ECT and real ECT in seven patients, some doubt was raised about the replicability of the acute effect of ECT on GABA levels. Nonetheless, the strength of the findings in the larger study 1 sample suggests that, unlike virtually all other biochemical indices, free plasma GABA may be reduced acutely after HCT. This acute decrease could reflect decreased levels of GABA in brain extracellular space or decreased brain turnover. In study 1, compared with ECT nonresponders, ECT responders had higher GABA levels at both baseline and after a course of ECT. Because plasma GABA levels arc known to be low in a subset of patients with major depression, the higher GABA levels observed in clinical responders before and after the ECT course indirectly suggest that patients least abnormal in GABA levels may show superior clinical response. This also suggests that low plasma GABA is not a state marker for depression.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Maintenance electroconvulsive therapy (M-ECT) is used to prevent recurrence of depression. Indications regarding patient selection criteria and efficacy are uncertain, in part because data are lacking. Comparison of M-ECT patients (N = 21) with controls demonstrates that M-ECT is chosen for patients whose course is characterized by multiple hospitalizations and failure to adequately respond to other therapies. M-ECT patients were exposed, on average, to 10 different psychotropic medications, including five trials of tricyclic antidepressants. Greater than half of their cumulative hospitalizations were for ECT. Their rate of rehospitalization decreased by 67% after institution of prophylactic M-ECT, demonstrating treatment efficacy. A tendency toward relapse and rehospitalization remains when M-ECT patients are compared to controls.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Fifteen inpatients (nine women, six men) aged 50–86 years withDSM-IIIRmajor depression were treated with electroconvulsive therapy (ECT). Electrode placement (unilateral versus bilateral) and total number of treatments were determined by the patients' own psychiatrists according to clinical indications. Prolactin (PRL) was determined after the 1st, 6th, 7th, 9th, 11th, and final ECT treatments. Subjects were rated with the Hamilton Depression Rating Scale (HDRS) at baseline, after the sixth ECT treatment, and upon completion of ECT. PRL response to unilateral ECT was consistent across treatment for each subject. Percentage PRL increase was significantly higher for bilateral than unilateral ECT (α = 0.05). Subjects with final HDRS of <12 tended to have greater peak, increase, and percentage increase PRL at the first unilateral treatment than subjects with final HDRS of at least 12; these trends approached statistical significance (Kruskal-Wallis one-way analysis of variance; peak: p = 0.059, χ= 3.556,df= 1) increase: p = 0.099, χ = 2.722,df=1; percentage increase: p = 0.099, χ = 2.722,df= 1). Decrease in HDRS after the sixth treatment failed to show a statistically significant relationship to any PRL parameter at the initial unilateral treatment. Further studies are needed to characterize the relationship between PRL response, seizure activity, and stimulus dosing.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We wished to ascertain whether the addition of an informational video to the informed consent procedure for electroconvulsive therapy (ECT) results in improved patient knowledge about ECT. Eighteen ECT patients were randomized to consent using the usual written document or using the written document and an informational video. The two groups were similar when compared on demographic variables and scores on the Brief Psychiatric Rating Scale (BPRS) and Mini-Mental State Examination (MMSE). Each subject, just after signing the informed consent document, was administered an 8-question ECT knowledge questionnaire. The addition of an informational video to the consent process for ECT did not result in improved knowledge about ECT. Poor knowledge about ECT might be accounted for by unsuccessful communication from the doctors or cognitive impairment and apathy on the part of the patients. One benefit of the video was increased interest from family members in ECT and the consent process.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Members of the Association for Convulsive Therapy were surveyed by mail about use of muscle relaxants and radiologic studies for ECT. One hundred eleven completed responses were received (69%), indicating that 40% routinely acquire pre-ECT spine and skull radiographs taking from 1 to 10 films. From patients receiving more than one course of ECT, 57 pre- and post-ECT pairs of films taken within 1 month of the start and end of a course, respectively, were selected. The films were identified only by age and sex of the patient and were evaluated by a radiologist. A senior psychiatrist reviewed the pre-ECT radiographic reports to determine whether a change in routine ECT procedure was required. Few clinically significant radiologic findings in the pre- or post-ECT films were noted.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Electroconvulsive therapy (ECT) is a safe, highly effective, and rapidly acting treatment for certain major psychiatric illnesses, most notably severe mood disorders. Disturbances in mood and behavior as symptoms of delirium may complicate recovery from traumatic brain injury, but virtually no data exist on the role of ECT as a treatment modality in such clinical situations. We describe a patient with severe, unremitting, agitated behavior following a severe closed head injury from a motor vehicle accident. The initial Glasgow Coma Scale score was 3, with computed tomographic evidence of bilateral frontal and left thalamic contusions. After awakening from a 21-day coma, the patient failed to improve beyond a Ranchos Los Amigos level 4 recovery stage. He exhibited persistent severe agitation with vocal outbursts and failed to assist in performing activities of daily living. His difficulties proved unresponsive to combined behavioral therapy and multiple trials of various psychopharmacologic agents. As an intervention of “last resort,” he then received six brief-pulse, bilateral ECT treatments that resulted in marked lessening of his agitation and improvement in his ability to express his needs and participate in his self-care. Also, following the ECT, he showed a markedly enhanced response to psychopharmacologic agents. These findings may have important clinical implications for treatment of prolonged delirium after traumatic brain injury.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Status epilepticus is a rare complication of conventional single-stimulus electroconvulsive therapy (ECT). We report a case of ECT-induced nonconvulsive generalized status epilepticus (NGS) that lasted 3.5 days. The patient showed regressed psychotic behavior coupled with waxing and waning mutism and unresponsiveness as well as subtle unilateral motor signs. The diagnosis of NGS requires electroencephalographic confirmation.

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1995

数据来源: OVID