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ECT
Selected AbstractsPatients with a major depressive episode responding to treatment with repetitive transcranial magnetic stimulation (rTMS) are resistant to the effects of rapid tryptophan depletionDEPRESSION AND ANXIETY, Issue 8 2007John P. O'Reardon M.D. Abstract Repetitive transcranial magnetic stimulation (rTMS) appears to be efficacious in the treatment of major depression based on the results of controlled studies, but little is known about its antidepressant mechanism of action. Mood sensitivity following rapid tryptophan depletion (RTD) has been demonstrated in depressed patients responding to SSRI antidepressants and phototherapy, but not in responders to electroconvulsive therapy (ECT). We sought to study the effects of RTD in patients with major depression responding to a course of treatment with rTMS. Twelve subjects treated successfully with rTMS monotherapy underwent both RTD and sham depletion in a double-blind crossover design. Depressive symptoms were assessed using both a modified Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI). The differential change in depression scores across the procedures was compared. No significant difference in mood symptoms was noted between RTD and the sham-depletion procedure on either continuous measures of depression, or in the proportions of subjects that met predefined criteria for a significant degree of mood worsening. Responders to rTMS are resistant to the mood perturbing effects of RTD. This suggests that rTMS does not depend on the central availability of serotonin to exert antidepressant effects in major depression. Depression Anxiety 24:537,544, 2007. © 2006 Wiley-Liss, Inc. [source] Electroconvulsive therapy is equally effective in unipolar and bipolar depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010S. Bailine Bailine S, Fink M, Knapp R, Petrides G, Husain MM, Rasmussen K, Sampson S, Mueller M, McClintock SM, Tobias KG, Kellner CH. Electroconvulsive therapy is equally effective in unipolar and bipolar depression. Objective:, To determine the relative efficacy of electroconvulsive therapy (ECT) in the treatment of bipolar (BP) and unipolar (UP) depressive illness and clarify its role in BP depression. Method:, Patients referred for ECT with both UP and BP depressions. [classified by Structured Clinical Interview for DSM (SCID-I) criteria for history of mania] were included in a multi-site collaborative, double-masked, randomized controlled trial of three electrode placements , right unilateral, bifrontal or bitemporal , in a permutated block randomization scheme. Results:, Of 220 patients, 170 patients (77.3%) were classified as UP and 50 (22.7%) as BP depression in the intent-to-treat sample. The remission and response rates and numbers of ECT for both groups were equivalent. Conclusion:, Both UP and BP depressions remit with ECT. Polarity is not a factor in the response rate. In this sample ECT did not precipitate mania in depressed patients. Treatment algorithms for UP and BP depression warrant re-evaluation. [source] Outcome of late-life depression after 3 years of sequential treatmentACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2009R. M. Kok Objective:, To study the outcome of a sequential treatment protocol in elderly, severely depressed in-patients. Method:, All 81 patients from a 12-week double-blind randomized controlled trial (RCT) comparing venlafaxine with nortriptyline were asked to participate in a 3 year follow-up study. Thirty-two patients who did not achieve remission during the RCT, entered an open sequential treatment protocol and were treated with augmentation with lithium, switch to a monoamine oxidase inhibitor or ECT. Results:, Seventy-eight of the 81 patients (96.3%) achieved a response [,50% reduction in Montgomery Åsberg Depression Rating Scale score) and 68 patients (84%) a complete remission (final MADRS score , 10) within 3 years of treatment. Greater severity and longer duration of the depressive episode at baseline predicted poor recovery. Augmentation with lithium may be the best treatment option in treatment resistant depressed elderly. Only few patients dropped-out due to side-effects. Conclusion:, Our study demonstrates the importance of persisting with antidepressant treatment in elderly patients who do not respond to the first or second treatment. [source] ABSENCE OF CORRELATION BETWEEN QRS DURATION AND ECHOGRAPHIC PARAMETERS OF VENTRICULAR DESYNCHRONIZATION.ECHOCARDIOGRAPHY, Issue 2 2004CAN WE STILL TRUST THE ELECTROCARDIOGRAPHIC CRITERIA? Background: Identification of the responder candidates for multisite pacing is still difficult and severe heart failure, dilated left ventricle with reduced ejection fraction, prolonged QRS with left bundle branch block (LBBB) are still considered the principal indicators of ventricular desynchronization. The aim of the study was to assess if echographic ventricular desynchronization parameters measured in patients with dilated cardiomyopathy and severe heart failure are correlated with the duration of the QRS on surface electrocardiogram. Methods: This study included 51 patients aged 58.8 ± 7.4 years with idiopathic DCM. The following parameters were measured: QRS duration; effective contraction time (ECT) measured as the interval between QRS onset and closure of aortic valve, interventricular delay (IVD) measured as the time between onset of aortic and pulmonary flow, left ventricular mechanical delay (LVD) as the time from maximal interventricular septum contraction and posterior wall contraction, posterior (P), lateral (L), and posterolateral (PL) wall delays, as the time from QRS onset to maximal wall contraction. Regional post-systolic contraction was defined in a given wall as the difference (contraction delay , ECT)> 50 ms. Results: 29 patients presented complete LBBB, 22 patients had QRS duration < 120 ms. 39 patients had a post-systolic contraction of the PL wall (32 patients of the L wall and 26 patients of the P wall). 16 patients with QRS duration <120 had a post-systolic contraction of the PL wall (as for the LBBB the rest of 39 patients). In 40 patients the sequence of regional ventricular contraction was: P-L-PL wall (16 patients with QRS < 120). LVD was > 100 ms in 36 patients (26 patients with LBBB and 10 with QRS < 120). 27 patients with LBBB and 6 with QRS < 120 ms presented IVD > 30 ms. There was no correlation between the QRS duration and the parameters listed above. Conclusions: In a population of patients with severe heart failure and dilated cardiomyopathy there is no correlation between the duration of the QRS and echocardiographic parameters of ventricular desynchronization. These results show that mechanical ventricular desynchronization can be observed in patients with a QRS duration < 120 ms. Further studies are needed to evaluate if this population could beneficiate of multisite pacing therapy. [source] Mice Carrying the Szt1 Mutation Exhibit Increased Seizure Susceptibility and Altered Sensitivity to Compounds Acting at the M-ChannelEPILEPSIA, Issue 9 2004James F. Otto Summary:,Purpose: Mutations in the genes that encode subunits of the M-type K+ channel (KCNQ2/KCNQ3) and nicotinic acetylcholine receptor (CHRNA4) cause epilepsy in humans. The purpose of this study was to examine the effects of the Szt1 mutation, which not only deletes most of the C-terminus of mouse Kcnq2, but also renders the Chnra4 and Arfgap-1 genes hemizygous, on seizure susceptibility and sensitivity to drugs that target the M-type K+ channel. Methods: The proconvulsant effects of the M-channel blocker linopirdine (LPD) and anticonvulsant effects of the M-channel enhancer retigabine (RGB) were assessed by electroconvulsive threshold (ECT) testing in C57BL/6J- Szt1/+ (Szt1) and littermate control C57BL/6J+/+ (B6) mice. The effects of the Szt1 mutation on minimal clonic, minimal tonic hindlimb extension, and partial psychomotor seizures were evaluated by varying stimulation intensity and frequency. Results:Szt1 mouse seizure thresholds were significantly reduced relative to B6 littermates in the minimal clonic, minimal tonic hindlimb extension, and partial psychomotor seizure models. Mice were injected with LPD and RGB and subjected to ECT testing. In the minimal clonic seizure model, Szt1 mice were significantly more sensitive to LPD than were B6 mice [median effective dose (ED50) = 3.4 ± 1.1 mg/kg and 7.6 ± 1.0 mg/kg, respectively]; in the partial psychomotor seizure model, Szt1 mice were significantly less sensitive to RGB than were B6 mice (ED50= 11.6 ± 1.4 mg/kg and 3.4 ± 1.3 mg/kg, respectively). Conclusions: These results suggest that the Szt1 mutation alters baseline seizure susceptibility and pharmacosensitivity in a naturally occurring mouse model. [source] The Energy of Charge-Transfer States in Electron Donor,Acceptor Blends: Insight into the Energy Losses in Organic Solar CellsADVANCED FUNCTIONAL MATERIALS, Issue 12 2009Dirk Veldman Abstract Here, a general experimental method to determine the energy ECT of intermolecular charge-transfer (CT) states in electron donor,acceptor (D,A) blends from ground state absorption and electrochemical measurements is proposed. This CT energy is calibrated against the photon energy of maximum CT luminescence from selected D,A blends to correct for a constant Coulombic term. It is shown that ECT correlates linearly with the open-circuit voltage (Voc) of photovoltaic devices in D,A blends via eVoc,=,ECT,,,0.5,eV. Using the CT energy, it is found that photoinduced electron transfer (PET) from the lowest singlet excited state (S1 with energy Eg) in the blend to the CT state (S1,,,CT) occurs when Eg,,,ECT,>,0.1,eV. Additionally, it is shown that subsequent charge recombination from the CT state to the lowest triplet excited state (ET) of D or A (CT,,,T1) can occur when ECT,,,ET,>,0.1,eV. From these relations, it is concluded that in D,A blends optimized for photovoltaic action: i) the maximum attainable Voc is ultimately set by the optical band gap (eVoc,=,Eg,,,0.6,eV) and ii) the singlet,triplet energy gap should be ,EST,<,0.2,eV to prevent recombination to the triplet state. These favorable conditions have not yet been met in conjugated materials and set the stage for further developments in this area. [source] The effects of ECT on cognitive functioning in the elderly: a reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2008Caroline E. M. Tielkes Abstract Background Electroconvulsive therapy (ECT) as a single course or in maintenance form (M-ECT) is an effective treatment in depressed elderly. However, ECT may have adverse effects on cognition. Objective To review all studies from 1980,2006 on ECT and cognition in the elderly with a minimum age of 55 years or a mean age of 55 years, and with valid measurements of cognition before and after ECT. Results Nine out of the 15 eligible studies were focused exclusively on the elderly. Three studies reported verbal learning- and recall problems post ECT, while three studies found positive effects of ECT on memory, speed of processing and concentration. Global cognitive functioning in patients with cognitive impairment improved in all studies. At follow up, most studies reported improvement of cognitive functions. Learning verbal information and executive functioning were impaired in M-ECT patients whereas global cognition remained stable after M-ECT over a year. Conclusions To date research of ECT on cognitive functioning in the elderly is very limited. Small sample size, lack of controls, use of a single screening instrument and a short follow up period may explain the conflicting results. Given the clinical importance, more extensive research on cognition in elderly treated with ECT is urgently needed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Response to ECT in depressed, demented patients; possible role of apolipoprotein E4 as response markerINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2001Michael Fisman No abstract is available for this article. [source] Risk factors for falling in a psychogeriatric unitINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2001A. John de Carle Abstract Objective To identify risk factors associated with falls in a psychogeriatric inpatient population. Design Retrospective cohort study. Setting A psychogeriatric inpatient unit in a Brown University affiliated psychiatric hospital. Participants A total of 1834 men and women who represented all admissions to the psychogeriatric inpatient unit between January 1992 and December 1995. Results Over the study period a total of 175 falls were recorded, giving a fall rate of 9.5%. Using a logistic regression model, six variables were found to be independently associated with an increased risk of falling: female gender, electroconvulsive therapy (ECT), mood stabilizers, cardiac arrhythmias, Parkinson's syndrome and dementias. Falls and ECT were associated with longer hospital stay, when adjusted for confounders including ECT. Conclusions These findings support previous results and identify ECT as a possible risk factor for falling in a hospital setting. Copyright © 2001 John Wiley & Sons, Ltd. [source] Electroconvulsive Therapy and the Fear of DevianceJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 1 2002James Giles After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior. [source] How resonance assists hydrogen bonding interactions: An energy decomposition analysisJOURNAL OF COMPUTATIONAL CHEMISTRY, Issue 1 2007John Frederick Beck Abstract Block-localized wave function (BLW) method, which is a variant of the ab initio valence bond (VB) theory, was employed to explore the nature of resonance-assisted hydrogen bonds (RAHBs) and to investigate the mechanism of synergistic interplay between , delocalization and hydrogen-bonding interactions. We examined the dimers of formic acid, formamide, 4-pyrimidinone, 2-pyridinone, 2-hydroxpyridine, and 2-hydroxycyclopenta-2,4-dien-1-one. In addition, we studied the interactions in ,-diketone enols with a simplified model, namely the hydrogen bonds of 3-hydroxypropenal with both ethenol and formaldehyde. The intermolecular interaction energies, either with or without the involvement of , resonance, were decomposed into the Hitler-London energy (,EHL), polarization energy (,Epol), charge transfer energy (,ECT), and electron correlation energy (,Ecor) terms. This allows for the examination of the character of hydrogen bonds and the impact of , conjugation on hydrogen bonding interactions. Although it has been proposed that resonance-assisted hydrogen bonds are accompanied with an increasing of covalency character, our analyses showed that the enhanced interactions mostly originate from the classical dipole,dipole (i.e., electrostatic) attraction, as resonance redistributes the electron density and increases the dipole moments in monomers. The covalency of hydrogen bonds, however, changes very little. This disputes the belief that RAHB is primarily covalent in nature. Accordingly, we recommend the term "resonance-assisted binding (RAB)" instead of "resonance-assisted hydrogen bonding (RHAB)" to highlight the electrostatic, which is a long-range effect, rather than the electron transfer nature of the enhanced stabilization in RAHBs. © 2006 Wiley Periodicals, Inc. J Comput Chem 28: 455,466, 2007 [source] Catatonia in autism: a distinct subtype?JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2005M. Ghaziuddin Abstract Catatonia is a life-threatening disorder characterized by motor abnormalities, mutism, and disturbances of behaviour, which is increasingly being diagnosed in persons with autism. In this report, we describe the presentation and course of catatonia in an adolescent with autism who responded to electroconvulsive therapy (ECT). The illness started with depressive symptoms, but the predominant feature was one of extreme obsessive slowing and immobility. We propose that catatonia should be ruled out as a cause of regression sometimes seen in adolescents with autism, and that catatonia of autism may index a distinct subtype with a particularly poor outcome. [source] On the electrostatic equilibrium of granular flow in pneumatic conveying systemsAICHE JOURNAL, Issue 11 2006Jun Yao Abstract An analytical methodology involving the concept of "electrostatic equilibrium" is developed for granular flow in pneumatic conveying systems. The methodology can be used for estimation of the electrostatic field distribution at various sections of the system and explanation of the mechanisms involved for various electrostatic phenomena observed. For all cases conducted in the conveying system, there was a "charging time" required for the system to reach the state of "electrostatic equilibrium." Experiments conducted at different sections of the system showed that the time required increased in the order: horizontal pipe, vertical pipe, and pipe bend. Through a physical analysis, it is deduced that electrostatic equilibrium is related to the granules' behavior and local flow characteristics. In general, a longer time duration taken to reach equilibrium corresponds to a process with more complicated granular flow patterns. In the electrostatic equilibrium state, the field distribution shows the highest electrostatic field strength near the pipe wall, and this field strength degrades from the pipe wall to the pipe center. At various pipe sections, the highest strength occurs at the bend, in accord with observations that electric sparking first occurs at that location within the entire pneumatic conveying system. In the vertical pipe, granular distribution was measured using electrical capacitance tomography (ECT), and granular velocities were cross-referenced with those using particle image velocimetry (PIV). The electrostatic force at low air flow rates is found to be the primary cause for granules sticking to the pipe wall and results in the formation of the half-ring or ring structure. The state of electrostatic equilibrium is physically influenced by several elements in conveying systems. In a cyclic conveying system, a new pipe (or low humidity or no antistatic agent) tends to expedite the process to reach electrostatic equilibrium and attain high magnitude of electrostatic current at the state. In a non-cyclic horizontal conveying system, a thin film (pipe) is found to prolong the process duration to reach equilibrium, while the case with charged film (pipe) takes shorter duration to do so. © 2006 American Institute of Chemical Engineers AIChE J, 2006 [source] Tryptase levels after suxamethonium administration and defibrillationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2008E. STORJORD Background: A more than threefold increase in tryptase, when comparing with the control sample, strengthens the diagnosis of anaphylaxis. Trauma, coronary ischaemia and non-IgE-mediated reactions to several medications have been shown to cause more than threefold rise in tryptase levels. The aim of our study was to examine whether suxamethonium or defibrillation could lead to a more than threefold increase in tryptase in the absence of signs of anaphylaxis. Methods: S-tryptase was measured in 50 patients who had general anaesthesia with either pentothal and suxamethonium before electro convulsive therapy (ECT) to treat depression (n=31) or propofol before electro conversion to treat atrial fibrillation (n=19). Blood samples were collected minutes before and 1 h after the procedures. Results: Tryptase values did not differ significantly before and after the procedures. Conclusion: Tryptase levels do not increase in patients undergoing elective defibrillation or ECT with the administration of suxamethonium, in absence of symptoms of anaphylaxis. [source] Psychopharmacological and electroconvulsive treatment of anxiety and depression in the elderlyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2000W. A. Heffern MN The pharmacotherapeutics of antianxiety and antidepressant medication in the elderly is reviewed, and the benefits and risks of electroconvulsive therapy (ECT) are discussed. Physiological changes in normal ageing are described, and the pharmacodynamic and pharmacokinetic implications are addressed. Finally, the role of the advanced practice nurse (mental health/psychiatry) is discussed in terms of accountability, collaboration, and the development of empirical knowledge to enhance quality patient care. [source] Electrolytic ablation is as effective as radiofrequency ablation in the treatment of artificial liver metastases in a pig modelJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2008Sebastian Hinz MD Abstract Background The best treatment option for liver metastases is complete surgical resection. Unfortunately, at the time of diagnosis, not all patients are candidates for complete resection. Electrolytic therapy (ECT) is a novel non-thermal method of tissue destruction. We evaluated its safety and effectiveness in comparison with radiofrequency ablation (RFA). Methods Tumor mimics were created by injecting a gel into the pig liver. The volume of the lesions was measured by ultrasound before treatment. The tumor mimics were treated with either RFA or electrolytic ablation. 48 h after treatment the liver was fixed in formalin and subjected to histological examination. Results Histological investigation confirmed that all lesions were completely surrounded by necrosis after treatment with either ECT or RFA. Two different types of necrosis were identified. After RFA the cell membranes disappeared but the nuclei were still intact, whereas after ECT these structures were completely disrupted. After ECT the necrosis was often surrounded by infiltrating lymphocytes. This inflammatory reaction was not apparent after RFA. Conclusion ECT produced predictable and reproducible necrosis in pig livers and was as effective as RFA at destroying a defined target lesion. A local inflammatory reaction after ECT may favour the development of a systemic immune response. Our results indicate that ECT is an alternative treatment option for irresectable liver metastases. J. Surg. Oncol. 2008;98:135,138. © 2008 Wiley-Liss, Inc. [source] Fetal heart rate decelerations during ECT-induced seizures: is it important?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2003C. DeBattista Electroconvulsive therapy (ECT) is sometimes indicated during pregnancy and may offer advantages over pharmacotherapy for the patient and the fetus (1,2). However, very little data is available on the impact of epileptic or ECT-induced seizures on the fetus. We report a case of brief fetal heart rate decelerations in a fetus associated with maternal ECT-induced convulsions. [source] Advanced Statistical Analysis as a Novel Tool to Pneumatic Conveying Monitoring and Control Strategy DevelopmentPARTICLE & PARTICLE SYSTEMS CHARACTERIZATION, Issue 3-4 2006Andrzej Romanowski Abstract Behaviour of powder flow in pneumatic conveying has been investigated for many years, though it still remains a challenging task both practically and theoretically, especially when considering monitoring and control issues. Better understanding of the gas-solids flow structures can be beneficial for the design and operation of pneumatic transport installations. This paper covers a novel approach for providing the quantitative description in terms of parameter values useful for monitoring and control of this process with the use of Electrical Capacitance Tomography (ECT). The use of Bayesian statistics for analysis of ECT data allows the direct estimation of control parameters. This paper presents how this characteristic parameters estimation can be accomplished without the need for reconstruction and image post processing, which was a classical endeavour whenever tomography was applied. It is achieved using a ,high-level' statistical Bayesian modelling combined with a Markov chain Monte Carlo (MCMC) sampling algorithm. Advanced statistics is applied to data analysis for measurements coming from the part of phenomena present in the horizontal section of pneumatic conveyor during slug formation. [source] Application of a Bayesian Approach to the Tomographic Analysis of Hopper FlowPARTICLE & PARTICLE SYSTEMS CHARACTERIZATION, Issue 4 2005Krzysztof Grudzien Abstract This paper presents a new approach to the analysis of data on powder flow from electrical capacitance tomography (ECT) using probability modelling and Bayesian statistics. The methodology is illustrated for powder flow in a hopper. The purpose, and special features, of this approach is that ,high-level' statistical Bayesian modelling combined with a Markov chain Monte Carlo (MCMC) sampling algorithm allows direct estimation of control parameters of industrial processes in contrast to usually applied ,low-level', pixel-based methods of data analysis. This enables reliable recognition of key process features in a quantitative manner. The main difficulty when investigating hopper flow with ECT is due to the need to measure small differences in particle packing density. The MCMC protocol enables more robust identification of the responses of such complex systems. This paper demonstrates the feasibility of the approach for a simple case of particulate material flow during discharging of a hopper. It is concluded that these approaches can offer significant advantages for the analysis and control of some industrial powder and other multi-phase flow processes. [source] Benzodiazepines in catatonia associated with systemic lupus erythematosusPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2006HUNG-YU WANG md Abstract, Neuropsychiatric disturbances are found in 50,70% of systemic lupus erythematosus (SLE) patients. However, there are rare cases of catatonia being described in SLE. Some studies have shown the effectiveness of high-dose steroid, plasma exchange and electroconvulsive therapy (ECT) in lupus catatonia. Herein are described two SLE patients with catatonia who had good response to i.v. diazepam (i.e. relief of catatonia symptoms). Patient 1, with mild cortical atrophy, had great improvement in catatonia symptoms on i.v. diazepam 150 mg during a period of 5 days. Patient 2, without cortical atrophy, had quick response to i.v. diazepam 10,20 mg. Both patients had no recurrence during 6-month follow up. In conclusion, benzodiazepines may play an important role in the treatment of catatonia associated with SLE if patients refuse ECT treatment. [source] Clozapine in schizophrenia patients with recurrent catatonia: Report of two casesPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2006YI-YUNG HUNG md Abstract, Prolonged catatonia can be a source of extremely serious morbidity and mortality. Lorazepam is effective in rapidly relieving most cases of catatonia. Reports have also shown that second-generation antipsychotic drugs are also efficacious in relieving catatonia. This report describes two schizophrenia patients who demonstrated recurrent catatonic features mutism and stupor. Both patients were treated with lorazepam, diazepam or electroconvulsive therapy (ECT). Patient 1 responded well and rapidly to lorazepam each time catatonia happened; but catatonia recurred once a year under treatment with many antipsychotic drugs. Patient 2 had catatonia features associated with discontinuing or decreasing clozapine. With each recurrent episode, the duration of catatonia increased, requiring an increased dosage of benzodiazepine. The patient's response to lorazepam and ECT gradually decreased, until the patient had almost no response to lorazepam, diazepam or ECT. Both patients had no recurrence during a period of 2-year follow up with continuous clozapine therapy. [source] Electroconvulsive Therapy: Issues in the ElderlyPSYCHOGERIATRICS, Issue 4 2002Arunava Das Abstract: The elderly psychiatrically ill constitute a high proportion of the patients who receive electroconvulsive therapy (ECT). There is evidence to say that the efficacy of ECT may be enhanced in the elderly. Clinical and biological markers are increasingly being recognised as predictors of outcome to ECT. The doses of anticholinergic, anaesthetic and relaxant agents may need to be modified in accordance with physiological changes associated with aging. ECT stimulus and ECT technique should be selected against the background of increased seizure threshold and possibility of greater ECT-induced cognitive dysfunction in the elderly, particularly those with pre-existing cognitive or neurologic impairment. New brain-imaging techniques and biochemical measures of brain damage have proved that ECT does not cause brain damage. The physical risk with ECT is considered to be low. There is some evidence to say that cardiovascular complications reported with ECT are related to the nature of pre-existing cardiac disease. Although the short-term response to ECT in the elderly is quite good, post-ECT relapse rates are quite high. Continuation-maintenance ECT has a definite role in minimising relapses and recurrences in the elderly, taking care not to enhance physical and cognitive risks. With increasing administration of outpatient ECT, it is important to refine methods for monitoring patients for adverse effects of treatment. The roles of repetitive trans-cranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS) in geriatric psychiatry are yet to be established. [source] Effects of stimulus intensity on the efficacy and safety of twice-weekly, bilateral electroconvulsive therapy (ECT) combined with antipsychotics in acute mania: a randomised controlled trialBIPOLAR DISORDERS, Issue 2 2009Titus SP Mohan Objectives:, To examine differences in speed of improvement and remission in people with mania undergoing bilateral, brief-pulse, twice-weekly electroconvulsive therapy (ECT) at stimulus intensities administered just above and 2.5 times their individually titrated seizure threshold. Methods:, Consecutive, eligible subjects with mania, prescribed ECT, were randomised to receive treatments at stimulus doses either just above or 2.5 times their individually titrated seizure thresholds. Main outcomes were the speed of improvement and remission as measured by the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions,Improvement scale (CGI-I) and cognitive side effects assessed by the Mini-Mental State Exam, the Wechsler Memory Scale, and a scale for autobiographical memory. Results:, A total of 24/26 subjects (92.3%) given threshold ECT and 22/24 subjects (91.7%) given suprathreshold ECT were significantly improved [CGI = 2; odds ratio (OR) = 1.1, 95% confidence interval (CI): 0.1,8.4; p = 1.0] at the end of ECT. A total of 88% of the sample had remitted [YMRS < 10; threshold 23/26 (88.5%) versus suprathreshold 21/24 (87.5%)], with no significant differences between interventions (OR = 1.1, 95% CI: 0.2, 6.0; p = 1.0). The interventions did not differ significantly in the time or number of ECT treatments required for improvement or remission. Both interventions were equally safe. Conclusions:, Bilateral, twice-weekly ECT delivered at stimulus intensities just above individually titrated seizure threshold was as effective and safe as ECT administered at stimulus intensities 2.5 times seizure threshold in rapidly resolving the symptoms of acute mania. [source] The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjectsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2007Joachim Stangier Aims The novel direct thrombin inhibitor (DTI), dabigatran etexilate (Boehringer Ingelheim Pharma GmbH & Co. KG), shows potential as an oral antithrombotic agent. Two double-blind, randomized trials were undertaken to investigate the pharmacokinetics (PK), pharmacodynamics (PD) and tolerability of orally administered dabigatran etexilate in healthy male subjects. Methods Dabigatran etexilate or placebo was administered orally at single doses of 10,400 mg (n = 40) or at multiple doses of 50,400 mg three times daily for 6 days (n = 40). Plasma and urine samples were collected over time to determine the PK profile of dabigatran. PD activity was assessed by its effects on blood coagulation parameters: activated partial thromboplastin time (aPTT), prothrombin time (PT), reported as international normalized ratio (INR), thrombin time (TT), and ecarin clotting time (ECT). All adverse events were recorded. Results Dabigatran etexilate was rapidly absorbed with peak plasma concentrations of dabigatran reached within 2 h of administration. This was followed by a rapid distribution/elimination phase and a terminal phase, with associated estimated half-lives of 8,10 h and 14,17 h with single and multiple dose administrations, respectively. Dabigatran exhibited linear PK characteristics with dose-proportional increases observed in maximum plasma concentration and area under the curve. Steady-state conditions were reached within 3 days with multiple dosing. The mean apparent volume of distribution during the terminal phase (Vz/F) of 1860 l (range 1430,2400 l) and the apparent total clearance after oral administration (CLtot/F) of 2031 ml min,1 (range 1480,2430), were dose independent. Time curves for aPTT, INR, TT and ECT paralleled plasma concentration,time curves with values increasing rapidly and in a dose-dependent manner. At the highest dose of 400 mg administered three times daily, maximum prolongations over baseline of 3.1 (aPTT), 3.5 (INR), 29 (TT) and 9.5-fold (ECT) were observed. Dabigatran underwent conjugation with glucuronic acid to form pharmacologically active conjugates that accounted for approximately 20% of total dabigatran in plasma. Overall, variability in PK parameters was low to moderate, with an average interindividual coefficient of variation (CV) of approximately 30% and variability in PD parameters was low, with CV < 10%. Of the four assays, TT and ECT exhibited the greatest sensitivity and precision within the anticipated therapeutic dose range. Bleeding events were few and were mild-to-moderate in intensity, occurring only in the higher, multiple dose groups. Conclusions These data suggest that dabigatran etexilate is a promising novel oral DTI with predictable PK and PD characteristics and good tolerability. Further investigation of dabigatran etexilate for the treatment and prophylaxis of patients with arterial and venous thromboembolic disorders, acute coronary syndromes and other medical conditions is warranted. [source] Melancholic symptoms as assessed by the Hamilton Depression Rating Scale and outcomes with and without electroconvulsive therapy on an in-patient mood disorders unitACTA NEUROPSYCHIATRICA, Issue 1 2010Keith G. Rasmussen Rasmussen KG, Stevens SR, Kung S, Mohan A. Melancholic symptoms as assessed by the Hamilton Depression Rating Scale and outcomes with and without electroconvulsive therapy on an in-patient mood disorders unit. Background: We investigated whether 24-item Hamilton Rating Scale for Depression (HamD24)-based melancholia ratings correlated with treatment outcome, with special focus on whether electroconvulsive therapy (ECT) was used in depressed patients treated on an in-patient mood disorders unit. Methods: We analysed the data on ECT- versus non-ECT-treated patients' outcomes relative to melancholia subscale scores. Two HamD24 -based melancholia rating scale scores were computed for 201 depressed in-patients at admission and discharge. Baseline melancholia ratings were analysed to see if they correlated with improvement in total HamD24 scores. We also tested to see if the melancholia subscales followed unimodal or bimodal distributions. Results: Melancholic symptoms as assessed by one of the HamD24 -based subscales directly correlated with overall improvement. Although ECT treatment was associated with greater improvement than was noted in non-ECT-treated patients, severity of melancholia ratings did not affect this relationship. Finally, both melancholia subscale scores followed approximately unimodal distributions. Conclusions: HamD24 -based methods to assess severity of melancholic symptoms have limited clinical utility on an in-patient mood disorders unit in general, and for predicting ECT response in particular. Furthermore, these methods do not seem to identify bimodal populations of depressed patients (i.e. melancholic vs. non-melancholic). [source] Electroconvulsive therapy versus transcranial magnetic stimulation for major depression: a review with recommendations for future researchACTA NEUROPSYCHIATRICA, Issue 6 2008Keith G. Rasmussen Objective:, To review the literature comparing electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) for major depression. Methods:, Data from the six randomised, prospective studies were agglutinated into one data set. Special attention was given to the methods of both TMS and ECT as well as data pertaining to differential outcomes in subgroups such as psychotic depressives and the elderly. Results:, There is a highly significant advantage for ECT in the prospective, randomised trials. The two non-randomised, retrospective comparative trials found the treatments to be equal in one study and superior for ECT in another. However, sample sizes are small in these studies, and both TMS and ECT may have been used suboptimally. Furthermore, the possibilities of differential efficacy of ECT or TMS for psychotic depressives or as a function of age have yet to be fully explored. Conclusions:, The data to date do not support the contention that TMS is equivalent in efficacy to ECT. It is recommended that a large-scale trial be undertaken using aggressive forms of both TMS and ECT with sample sizes sufficiently large to detect effects of moderating variables such as age and psychosis status. [source] Effects of desmopressin (DDAVP) on memory impairment following electroconvulsive therapy (ECT)ACTA NEUROPSYCHIATRICA, Issue 3 2004Ebrahim Abdollahian Background:, Memory impairment is a common adverse effect of electroconvulsive therapy (ECT). Studies on animals and humans suggest that vasopressin improves the cognitive function, and positive effects of desmopressin on memory and learning have been reported. This research was performed for evaluation of the effects of desmopressin in the prevention of memory impairment following ECT. Methods:, This randomized, double-blind controlled clinical trial with placebo administration was performed on 50 patients with psychiatric disorders who were candidates for ECT. Subjects in the case group received 60 µm of intranasal desmopressin daily (in three doses of 20 µm). For the control group 0.9% saline solution was administered in the same way. Memory function was evaluated using Wechsler's Memory Scale three times a week (the first time before the start of ECT and the second and third times after the third and sixth sessions, respectively). Results were analyzed by t -test and Paired t -test. Results:, The mean age of patients was 29 years (range 20,40). During the course of ECT, patients in the control group demonstrated a meaningful decrease in memory scores (from a base score of 80.15,75.45 in the second test and 72.60 in the third test). Despite this, a meaningful increase in memory scores was observed during the treatment with desmopressin in the case group (from a base score of 73.27,75.70 and 79.13 in the second and the third tests, respectively). There was a meaningful difference between the two groups (P < 0.0001). Conclusion:, This study confirms the protective effect of desmopressin against memory impairment. The results confirm that memory impairment is a common side-effect of ECT and suggest that desmopressin may prevent ECT-induced memory impairment by its effects on memory and the learning process. [source] Component Analysis and Free Radical-Scavenging Potential of Panax notoginseng and Carthamus tinctorius ExtractsCHEMISTRY & BIODIVERSITY, Issue 2 2010Shu-Yan Han Abstract Panax notoginseng and Carthamus tinctorius are known as traditional medicinal plants, and they also have edible values. To better understand their pharmacological mechanism, the present study assessed the in vitro antioxidant activities of extracts of P. notoginseng (EPN) and C. tinctorius (ECT). In addition, the main components of EPN and ECT were determined by HPLC. The results show that EPN mainly contained saponins, which were effective in scavenging . OH and O, while showing a low activity in the DPPH. assay. Flavonoids were the main components of ECT and were active in scavenging all three radicals in a dose-dependent manner. In brief, the antioxidant properties of EPN and ECT are distinct and might be complementary, their combined use tending to be more effective in scavenging . OH (P<0.05 vs. EPN or ECT). [source] Late-Life Depression: Detection, Risk Reduction, and Somatic Intervention: Commentary on Delano-Wood and AbelesCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2005Morgan T. SammonsArticle first published online: 11 MAY 200 Somatic interventions such as antidepressant medication and electroconvulsive therapy (ECT) have the potential to produce dramatic, potentially life-saving, responses in elderly patients suffering from depression. At the same time, the body of systematically collected evidence supporting the use of such interventions in geriatric populations is not robust and may not be sufficient to adequately guide clinicians regarding their use. In light of the greater risks associated with somatic treatments in the elderly vis-à-vis younger populations, clinicians suggesting the application of somatic interventions for late-life depression should be aware of the limitations to the data and should recommend these interventions with caution. To maximize effectiveness, somatic interventions should be incorporated into a comprehensive psychosocial treatment plan. [source] Electroconvulsive Therapy and the Fear of DevianceJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 1 2002James Giles After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior. [source] | ||||||||||||||||||||||||||||