ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Empirical titration procedures increasingly are being used to estimate initial seizure threshold. These procedures involve the administration of subconvulsive electrical stimulation. There has yet to be evaluation of the impact of such stimulation on the acute cognitive consequences of electroconvulsive therapy. In two studies we randomized depressed patients to right unilateral or bilateral ECT, with stimulus intensity maintained just above seizure threshold throughout the treatment course. These low dosage treatment groups received one or more subconvulsive stimuli in ∼40% of treatment sessions, with a grand mal seizure also elicited at each session. Extensive neuro-psychological evaluation was conducted at each session. We contrasted treatment sessions in which generalized seizures were preceded by subconvulsive stimulation with treatment sessions in which a single convulsive stimulation was applied. Across a variety of neuropsychological measures, there were no adverse cognitive consequences of subconvulsive stimulation.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The American Psychiatric Association Task Force on ECT has recommended that electroconvulsive therapy (ECT) stimuli be dosed at “moderately suprathreshold” intensities. Empiric estimation of the convulsive threshold by stimulus dose titration may expose the patient to subconvulsive stimuli, and subconvulsive stimuli have been reported by some to carry serious cardiovascular risk. This study examines the electrocardiographic (ECG) and cardiovascular effects of subconvulsive stimuli. Forty consecutive inpatients (29 women, 11 men; mean age 68 years) with major depression received subconvulsive stimuli during titrated, right unilateral (RUL) ECT. Successively larger stimuli were administered until a convulsion began. The effects of subconvulsive stimuli on the ECG, heart rate (HR), and blood pressure (BP) were assessed with multivariate repeated measures analysis. Subconvulsive stimuli prolonged the R-R interval and decreased HR compared with baseline values immediately before the subconvulsive stimulus, but the changes were of questionable clinical significance. BP was not changed. In conclusion, subconvulsive stimuli are well tolerated in the context of titrated RUL ECT. If stimulus dose titration proves to be useful in optimizing efficacy with fewer cognitive side effects, then cardiovascular considerations should not be an obstacle in the application of stimulus dose titration in most patients.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors review their experience with electroconvulsive therapy (ECT) in 32 patients meetingDSM-IIIRcriteria for obsessive compulsive disorder. All patients had received extensive behavioral and cognitive therapy and pharmacotherapy prior to the initiation of ECT without apparent benefit. Following ECT, most subjects showed considerable improvement in obsessive compulsive symptoms and remained improved up to 1 year after therapy. Some patients also showed short-term improvements on several measures of depression. The change in obsessive compulsive symptoms, however, appeared to be independent of changes in measures of depression.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

While unilateral electroconvulsive therapy (U-ECT) is generally considered to induce negligible disturbances of memory as compared with bilateral bitemporal ECT, its relative antidepressant efficacy has been questioned. The aim of the present study was to compare, in a double-blind design, clinicians' ratings of global clinical impression of the antidepressant efficacy of the two treatment modalities. The treatment technique included avoidance of benzodiazepines, prolonged hyperventilation with oxygen, intermittent unidirectional pulses distributed in a long pulse train, permitting individualized and relatively high doses of electrical charge at each treatment occasion, and non-dominant long-distance (12–13 cm) parietotemporal (d'Elia) electrode placement in the U-ECT group. The results indicated no therapeutic advantage for either treatment modality, which was also in accordance with the symptom ratings by an independent nonblinded rater. The findings encourage the continued use of nondominant long-distance parietotemporal ECT with a treatment technique that induces fully generalized seizures as the modality of choice in the convulsive treatment of depression.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The presence of movement disorders was ascertained blind to treatment status in 35 schizophrenic patients. All were on neuroleptics and receiving, or had received earlier during the index episode, adjunctive bilateral electroconvulsive therapy (ECT). None manifested signs of neuroleptic-induced parkinsonism (rigidity, bradykinesia, or abnormal gait). Fine tremor of the hands was noted in two patients, and only one met criteria for probable mild tardive dyskinesia. The implications of these findings for understanding neurological complications associated with schizophrenia and its treatment with ECT are discussed. The hypothesis is proposed that ECT protects against neuroleptic-induced parkinsonism and thereby may reduce the risk for the subsequent development of tardive dyskinesia.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To date, no pharmacological agent has been confirmed to lessen eleetroconvulsive therapy (ECT)-induced memory deficits. BR-16A is an herbal preparation, containing various organic extracts, used in India for the enhancement of cognition (among other applications). In the present study, adult male Sprague-Dawley rats received six once-daily electroconvulsive shocks (ECSs). Half the animals were treated with BR-16A (200 mg/kg/day) for 1 week before ECS, during the ECS course, and during the post-ECS learning assessment phase; the remaining animals received vehicle alone. In experiment 1, rats (n = 16/treatment group) were preassessed for learning on days 3 and 5 of exposure to the Hebb—Williams complex maze and were reassessed after comparable exposure to the maze starting from the second day post-ECS. In experiment 2, rats (n = 9/treatment group) were preassessed for number of trials to satisfactory learning and number of wrong arm entries in a T-maze and were reassessed on the second day post-ECS. The learning preassessments were conducted just prior to the commencement of the BR-16A/vehicle treatments. In both experiments, rats receiving BR-16A performed significantly better than controls. It is concluded that BR-16A protects against ECS-induced anterograde amnesia. BR-16A may therefore have scope in minimizing ECT-induced learning deficits.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We describe various measures to reduce severe anxiety that interfered with much-needed maintenance electroconvulsive therapy in a 32-year-old man. Treatment with ketamine met with moderate success, and then large doses of lorazepam and midazalam were used. The potential anticonvulsant effect of these drugs was successfully reversed by the administration of intravenous flumazenil just prior to the treatments.

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1994

数据来源: OVID