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Electroconvulsive Therapy (electroconvulsive + therapy)

Distribution by Scientific Domains

Medical Sciences	89%
Psychology	10%

Distribution within Medical Sciences

Psychiatry	67%
Neurology	7%
Anesthesia & Pain Management	5%
3 Other Subdomains	14%

Selected Abstracts

Electroconvulsive Therapy and the Fear of Deviance

JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 1 2002
James 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]

Biological Perspectives Electroconvulsive Therapy

PERSPECTIVES IN PSYCHIATRIC CARE, Issue 1 2009
Norman L. Keltner EdD
First page of article [source]

Electroconvulsive Therapy: Issues in the Elderly

PSYCHOGERIATRICS, Issue 4 2002
Arunava 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]

Electroconvulsive therapy is equally effective in unipolar and bipolar depression

ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010
S. 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]

Epileptic Seizures Superimposed on Catatonic Stupor

EPILEPSIA, Issue 4 2006
Kazumasa Suzuki
Summary:,Purpose: Some patients with nonconvulsive status epilepticus are known to exhibit catatonic stupor. Thus it is necessary to rule out ictal catatonia by electroencephalography in patients with catatonic stupor. However, few reports are available on epileptic seizures superimposed on catatonic stupor. Methods: We report three cases of epileptic seizures superimposed on psychiatric catatonic stupor without a prominent predisposing factor, including high fever or encephalitis. None of the patients had a personal or family history of neurologic disease, including epilepsy. Results: In all three patients, catatonic stupor persisted after resolution of the epileptic seizures with administration of phenytoin. In two of the three patients, catatonic stupor resolved with electroconvulsive therapy, which caused no marked adverse effects. Conclusions: Because it is possible that catatonic stupor itself predisposes patients to the development of epileptic seizures, electroencephalographic examinations in patients with catatonic stupor are indispensable for early recognition not only of nonconvulsive status epilepticus but also of epileptic seizures superimposed on catatonic stupor. Electroconvulsive therapy deserves consideration when catatonic stupor persists after resolution of epileptic seizures. [source]

The effects of ECT on cognitive functioning in the elderly: a review

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2008
Caroline 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]

Fetal heart rate decelerations during ECT-induced seizures: is it important?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2003
C. 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]

Electroconvulsive therapy in young people and the pioneering spirit of Lauretta Bender

ACTA NEUROPSYCHIATRICA, Issue 5 2010
Garry Walter
No abstract is available for this article. [source]

Electroconvulsive therapy versus transcranial magnetic stimulation for major depression: a review with recommendations for future research

ACTA NEUROPSYCHIATRICA, Issue 6 2008
Keith 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]

Patients with a major depressive episode responding to treatment with repetitive transcranial magnetic stimulation (rTMS) are resistant to the effects of rapid tryptophan depletion

DEPRESSION AND ANXIETY, Issue 8 2007
John 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 depression

An algorithm for the pharmacological treatment of depression

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010
J. Spijker
Spijker J, Nolen WA. An algorithm for the pharmacological treatment of depression. Objective:, Non-response to treatment with antidepressants (AD) is a clinical problem. Method:, The algorithm for pharmacological treatment of the Dutch multidisciplinary guideline for depression is compared with four other algorithms. Results:, The Dutch algorithm consists of five subsequent steps. Treatment is started with one out of many optional ADs (step 1); in case of non-response after 4,10 weeks, best evidence is for switching to another AD (step 2); next step is augmentation with lithium as the best option (step 3); the next step is a monoamine oxidase inhibitor (MAOI) (step 4); and finally electroconvulsive therapy (step 5). There are major differences with other algorithms regarding timing of augmentation step, best agents for augmentation and role of MAOI. Conclusion:, Algorithms for AD treatment vary according to national and local preferences. Although the evidence for most of the treatment strategies is rather meagre, an AD algorithm appears to be an useful instrument in clinical practice. [source]

Epileptic Seizures Superimposed on Catatonic Stupor

Antidepressant efficacy and cognitive effects of repetitive transcranial magnetic stimulation in vascular depression: an open trial

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2004
I. Fabre
Abstract Background Beneficial effects of repetitive transcranial magnetic stimulation (rTMS) were demonstrated by many controlled studies in major depression. Moreover, this promising and non invasive therapeutic tool seems to be better tolerated than electroconvulsive therapy. Vascular depression is a subtype of late-life depression, associated with cerebrovascular disease and means a poorer response to antidepressant treatment. We employed rTMS over the left prefrontal cortex in 11 patients with late-onset resistant vascular depression. The primary purpose of this two-week open study was to examine antidepressant efficacy of rTMS in vascular depression. The secondary aim was to evaluate cognitive effects of rTMS in our sample. Methods Clinical status, as measured with the Hamilton Depression Rating Scale (HDRS), and cognitive effects, as evaluated by neuropsychological tests, were assessed at baseline and after two weeks of rTMS. Brain measurements to obtain an index of prefrontal atrophy were performed at both the motor cortex and prefrontal cortex. Results Five out of 11 resistant patients with late-onset vascular depression were responders. They showed a clinically meaningful improvement in HDRS scores, with a decrease of 11, 4 points (p<0.01). Antidepressant response is correlated to the relative degree of prefrontal atrophy (p = 0.05). After two weeks, verbal fluency and visuospatial memory improved. No cognitive performance deteriorated except for verbal memory, as the delayed recall decreased significantly in the responders' group. Conclusions Our preliminary observations prompt to perform a subsequent controlled study to examine if rTMS may constitute an alternative to electroconvulsive therapy. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Risk factors for falling in a psychogeriatric unit

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2001
A. 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 Deviance

Catatonia in autism: a distinct subtype?

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2005
M. 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]

Decision-making needs of patients with depression: a descriptive study

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2008
D. STACEY rn mscn phd
The study's purpose was to explore the decision-making needs of patients considering treatment options for their depression. Semi-structured interviews were guided by the Ottawa Decision Support Framework. Of 94 participants, 67 were uncertain about their decision. Common decisions identified were whether or not to take medications, attend support groups, undergo electroconvulsive therapy, and location of care. Those feeling certain were more likely to have made a decision (RR 1.37; 95% CI: 1.05, 1.78). However, 40 patients who had ,made a decision' in the recent past were uncertain about their decision. Compared with those who were certain, the uncertain group felt less informed (2.65 vs. 1.64; P < 0.001), less supported (2.63 vs. 1.88; P < 0.001) and less clear about how they valued the benefits and risks of options (2.57 vs. 1.69; P < 0.001). Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. Few patients wanted to defer decision making to their physician (n = 8) or family (n = 1). To support decision making, participants identified the need for: discussions with their psychiatrist, nurse or family doctor; access to printed information; and information provided by health professionals and health societies. [source]

Psychopharmacological and electroconvulsive treatment of anxiety and depression in the elderly

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2000
W. 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]

Arc de cercle and dysautonomia from anoxic injury

MOVEMENT DISORDERS, Issue 6 2006
T. Scott Diesing MD
Abstract Autonomic dysregulation and catatonic posturing are well described following acute cerebral injury. Others have referred to this as diencephalic seizures, sympathetic storms, midbrain dysregulatory syndrome, and, most recently, paroxysmal autonomic instability with dystonia. Some of these syndromes can evolve into malignant catatonia requiring electroconvulsive therapy. Here we report a case of hanging associated anoxic brain injury resulting in severe dysautonomia and an extreme opisthotonus (arc de cercle). © 2006 Movement Disorder Society [source]

A case of wrist fracture during modified electroconvulsive therapy

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2009
Shinji Uebaba md
No abstract is available for this article. [source]

Effects of dextromethorphan on electroconvulsive therapy

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 1 2009
Wen-Kuei Lee md
No abstract is available for this article. [source]

Benzodiazepines in catatonia associated with systemic lupus erythematosus

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2006
HUNG-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 cases

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2006
YI-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]

Catatonia in childhood and adolescence

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2003
Ken Takaoka
Abstract Child and adolescent catatonia has been poorly investigated. A literature review was undertaken to clarify phenomenology, diagnosis, etiology, and treatment as well as ethical problems of catatonia in childhood and adolescence. Although there are no accepted standardized criteria for catatonia in childhood and adolescence, catatonic features described by child psychiatrists are similar to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for catatonia. With respect to etiology, the motor and behavioral symptoms that are part of catatonia bear some similarities with those seen in autism. Several case reports suggest an association between catatonia and general medical conditions. Certain drugs abused by youngsters as well as prescribed medicine can induce catatonia. Regarding catatonic cases originally diagnosed as schizophrenia, it is unclear whether all of these cases should be identified as schizophrenia or whether some of them are pervasive developmental disorders that develop psychic features in adolescence. Environmental changes preceding the onset of catatonia in patients with mood disorder play a possibly important role. Examples that suggest stress-induced catatonia, although rare, also exist. A few patients exhibit features of malignant catatonia, some without taking neuroleptics and others having taken them. Benzodiazepines and electroconvulsive therapy are considered to be effective treatments for catatonic youngsters. [source]

Electroconvulsive Therapy: Issues in the Elderly

Vagal tone as an indicator of treatment response in major depression

PSYCHOPHYSIOLOGY, Issue 6 2002
Andrea S. Chambers
Increased vagal tone has been associated with treatment success using pharmacological agents and cognitive-behavioral treatment in major depression, but not using electroconvulsive therapy. The present study investigated whether increases in vagal tone would be associated with favorable treatment response with nonpharmacological treatment. At baseline and following treatment, 16 subjects were administered the Hamilton Rating Scale for Depression (HRSD) followed by electrocardiographic recording. Those with little change in vagal tone from before to after treatment showed minimal reduction in HRSD score (,4.8); those with larger vagal tone change showed a large decrease in HRSD score (,14.8). Changes in vagal tone are thus related to favorable treatment response in depression, and do not represent anticholinergic pharmacological effects. Future work manipulating vagal tone might prove informative in teasing apart the causal role of vagal tone and depression. [source]

Litigation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995,2007

ANAESTHESIA, Issue 6 2010
T. M. Cook
Summary Claims notified to the NHS Litigation Authority in England between 1995 and 2007 and filed under anaesthesia were analysed to explore patterns of injury and cost related to airway or respiratory events. Of 841 interpretable claims the final dataset contained 96 claims of dental damage, 67 airway-related claims and 24 respiratory claims. Claims of dental damage contributed a numerically important (11%), but financially modest (0.5%) proportion of claims. These claims predominantly described injury during tracheal intubation or extubation; a minority associated with electroconvulsive therapy led to substantial cost per claim. The total cost of (non-dental) airway claims was £4.9 million (84% closed, median cost £30 000) and that of respiratory claims was £3.3 million (81% closed, median £27 000). Airway and respiratory claims account for 12% of anaesthesia-related claims, 53% of deaths, 27% of cost and ten of the 50 most expensive claims in the dataset. Airway claims most frequently described events at induction of anaesthesia, involved airway management with a tracheal tube and typically led to hypoxia and patient death or brain injury. Airway trauma accounted for one third of airway claims and these included deaths from mediastinal injury at intubation. Pulmonary aspiration and tube misplacement, including oesophageal intubation, led to several claims. Among respiratory claims, ventilation problems, combined with hypoxia, were an important source of claims. Although limited clinical details hamper analysis, the data suggest that most airway and respiratory-related claims arise from sentinel events. The absence of clinical detail and denominators limit opportunities to learn from such events; much more could be learnt from a closed claim or sentinel event analysis scheme. [source]

Adjunctive antidepressant use and its clinical correlates in patients with schizophrenia: an East Asia multicenter comparative prescribing audit

ASIA-PACIFIC PSYCHIATRY, Issue 1 2010
FAMS, Kang Sim MBBS, MMed (Psychiatry)
Abstract Aims: Previous pharmacoepidemiological studies have highlighted considerable rates of adjunctive psychotropic medication prescriptions in patients with schizophrenia, including the use of adjunctive antidepressants, but this has not previously been studied in East Asia. This study examined the frequency of adjunctive antidepressant prescriptions in patients with schizophrenia and their clinical correlates in six East Asian countries and territories. Methods: Co-prescription of antidepressants for a sample of 2,136 patients with schizophrenia from six countries and territories (China, Hong Kong, Korea, Japan, Taiwan, Singapore) were evaluated in 2004 using a standardized protocol. Results: Adjunctive antidepressant prescriptions were found in 6.5% (n=139) of the patients with some intercountry differences. Co-prescription of antidepressants was significantly associated with younger age, shorter duration of index admission, electroconvulsive therapy in the past month, less likelihood of manifesting disorganized speech, and prescription of first generation antipsychotic drugs. Concomitant antidepressant prescription was associated with greater weight and increased number of adverse events including constipation, sedation and sexual dysfunction. On multivariate analysis, it was found that country, younger age and history of electroconvulsive therapy for the past month were significantly associated with adjunctive antidepressant use. Discussion: Adjunctive antidepressant use for schizophrenia in East Asia was associated with a number of demographic, clinical, and treatment variables. The association with greater weight and more adverse events reinforces the notion that prescription of adjunctive psychotropic medication is not without its costs. The challenge for the clinician is to constantly reevaluate the risk benefit ratio in the process of understanding the patient in a holistic context and to optimize the treatment regimes for patients with schizophrenia. [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 trial

BIPOLAR DISORDERS, Issue 2 2009
Titus 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]