ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Continuation and maintenance electroconvulsive therapy (ECT) are used to prevent relapse of depression after a successful course of index ECT. Such a course of treatment is typically extended for as long as a year. However, some patients seem to require longer courses of maintenance ECT. Little is known about the outcomes of long-term use (> 1 year) of maintenance ECT. We reviewed our maintenance ECT practice for the year 2000 and found that 43 patients had been receiving maintenance ECT for more than a year. This retrospective study reviews the outcomes of these patients. All patients had depression associated with either unipolar or bipolar disorder or schizoaffective disorder. These patients had multiple medication or psychotherapy trials or both and multiple hospitalizations before receiving maintenance ECT. Effects on depressive symptoms, level of functioning, health care use, frequency of hospitalizations, and cognition are discussed. We conclude that extended maintenance ECT is efficacious and well tolerated and reduces hospital use for a population of chronically depressed patients refractory to medication.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Continuation and maintenance electroconvulsive therapy (c/mECT) is a treatment alternative for the long-term management of mood and psychotic disorders, especially in chronic, recurring, medication-resistant illnesses and in patients who are medication-intolerant, are non-compliant, and have a high risk of suicide with medications. A MEDLINE search was performed withmaintenance electroconvulsive therapy(ECT),continuation ECT, andprophylactic ECTas keywords. The relevant literature was obtained and reviewed. Despite methodologic flaws, the overwhelming majority of the studies report the effectiveness of c/mECT in bipolar mood disorder. We also reviewed the charts of 13 patients with mood disorder receiving maintenance ECT in the ECT service of a Veterans Administration medical center. Despite good results, c/mECT is underused in the treatment of bipolar mood disorder. More research with better study design is needed to define the predictors of response to c/mECT and to develop c/mECT treatment protocols for treatment-resistant bipolar patients.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo assess the impact of the use of electroconvulsive therapy (ECT) on the length of hospital stay of manic patients.Materials and MethodsWe reviewed 425 consecutive admissions of 269 patients with manic or mixed affective episodes in a Brazilian private psychiatric hospital. Lengths of stay (LOSs) were compared for admissions in which ECT versus exclusive pharmacologic treatment was administered. A mixed model for repeated measures was developed to control for intraindividual correlations and potential demographic, clinical, and treatment confounder variables. The analyses were repeated using LOS minus the time until ECT was first given in each admission (LOS-tECT) as the response variable.ResultsUse of ECT was associated with longer LOS than exclusive pharmacologic treatment (18.78 versus 12.51 days; p < 0.001). This effect disappeared when using LOS-tECT as the response variable (11.57 versus 12.16 days; p = 0.530). Violent behavior and in-hospital use of antipsychotics and benzodiazepines were also associated with longer LOS, whereas being married was associated with shorter LOS.ConclusionThe use of ECT during hospitalizations for mania was associated with longer lengths of stay. This effect was caused mostly by delays in commencing ECT treatments rather than by the duration of treatment itself.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Serious adverse events associated with electroconvulsive therapy (ECT) are uncommon and consist mostly of cardiovascular complications, mainly arrhythmias. The risk of complications is increased in elderly and physically ill patients. In the current study, a 24-hour pre-ECT and 24-hour post-ECT Holter recording was performed on 26 elderly patients during their first ECT treatment. ECT caused a significant increase in bigeminy/trigeminy and supraventricular tachycardia, but did not increase other arrhythmias. Pre-ECT arrhythmias correlated with post-ECT arrhythmias. All patients in the current study completed the ECT course. Thus, the clinical significance of arrhythmias remains uncertain. The present findings support the usual practice of continuous electrocardiogram monitoring during ECT and recovery.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Accumulation of carbon dioxide (CO2) can disturb systemic and cerebral hemodynamics in patients receiving electroconvulsive therapy (ECT). The purpose of this study was to identify the effects of end-tidal CO2monitoring on hemodynamic changes in patients who received ECT under propofol anesthesia. ECT was prescribed to 40 patients under propofol anesthesia. Ventilation was assisted using a face mask and 100% oxygen, with or without end-tidal CO2monitoring. Heart rate was significantly increased in patients without end-tidal CO2monitoring at 1 to 5 minutes after electrical stimulation (p < 0.01). Mean arterial blood pressure and middle cerebral artery blood flow velocity in the group without end-tidal CO2monitoring were significantly larger than the values in the group with the monitor at 1 to 5 minutes after electrical stimulation. Arterial CO2tension in the group without end-tidal CO2monitoring was larger than the value in the group with the monitoring at 1 minute (45 ± 5 mm Hg with the monitor and 56 ± 8 without the monitor) and 5 minutes (37 ± 4 mm Hg with the monitor and 51 ± 8 without the monitor) after electrical stimulation (p < 0.01). Application of end-tidal CO2monitoring is considered beneficial for safe and effective anesthesia management of patients undergoing ECT, especially patients with an intracranial disorder or ischemic heart disease.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe efficacy and adverse effects of electroconvulsive therapy are generally believed to depend upon the extent to which an administered stimulus is suprathreshold. The seizure threshold is therefore an important biologic marker. We sought to examine the variability of the electroconvulsive shock (ECS) seizure threshold in rats, and to identify factors influencing the threshold, to guide future research using animal models.Materials and MethodsWe administered once-daily subconvulsive stimuli to Wistar rats beginning at a charge of either 1 mC (n = 25) or 5 mC (n = 25) and titrated the dose upward in 1-mC steps until the baseline seizure threshold was identified. Two weeks later, we divided each group into two subgroups and administered stimuli that were either at or 2 mC below the baseline threshold, and titrated the dose upward, again in 1-mC steps once daily, until the final threshold was identified.ResultsThe mean baseline seizure threshold was 3.8 mC when upward titration was begun at 1 mC, and 6.7 mC when upward titration was begun at 5 mC (p < 0.001). Two weeks later, titration from baseline-subthreshold stimuli was associated with a lower final threshold in the 5-mC group, while titration from baseline-threshold stimuli was associated with a higher final threshold in the 1-mC group (p < 0.006).ConclusionsThe ECS seizure threshold ranged from 3 to 7 mC in this sample of rats; since the twofold variation is very small relative to clinical contexts, it is unlikely that ECS research needs to be threshold-based. The administration of low-dose, once-daily subconvulsive stimuli significantly lowered the seizure threshold; while this kindling effect wore off within 2 weeks, thresholds otherwise identified remained stable at the 2-week time point.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo determine whether animal-assisted therapy (AAT) is associated with reductions in fear, anxiety, and depression in psychiatric patients before electroconvulsive therapy (ECT).Materials and MethodsBefore their scheduled ECT treatment, 35 patients were assigned on alternate days to the treatment condition, consisting of a 15-minute AAT session, and the standard (comparison) condition, consisting of 15 minutes with magazines. Visual analogue scales were used to measure anxiety, fear, and depression before and after treatment and standard conditions.ResultsThe effect of AAT on fear was significant in both the mixed-model, repeated-measures analysis of covariance (ANCOVA) (p = 0.0006) and the secondary analysis (p = 0.0050), which covaried out all of the demographic conditions (gender, race, marital status, pet ownership, age), condition order, and the pretest rating. The effect of AAT on anxiety approached significance in the ANCOVA (p = 0.0982), but in the secondary analysis, the effect was not significant (p = 0.6498). The AAT effect on depression was not significant in ANCOVA (p = 0.7665) or in the secondary analysis (p = 0.9394). A least squares mean analysis showed that AAT reduced fear by 37% and anxiety by 18%. There was no demonstrated effect of AAT on depression.ConclusionsAnimal-assisted therapy may have a useful role in psychiatric and medical therapies in which the therapeutic procedure is inherently fear-inducing or has a negative societal perception.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Episodic psychoses characterized by predominant abnormalities of movement are calledmotility psychosesin Leonhard's classification of endogenous psychoses. They have been treated with a variety of methods, including ECT and lithium. Here we describe a case of motility psychosis that was successfully managed with ECT as the only modality of treatment.

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:2003

数据来源: OVID