The Journal of ECT最新文献

{"title":"Additional Procedures Performed During Electroconvulsive Therapy Anesthesia.","authors":"E. Li, C. Stork, Shelbi C. Jim On, E. Bryson, Amy Aloysi, C. Kellner","doi":"10.1097/YCT.0000000000000288","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000288","url":null,"abstract":"To the Editor: W e wish to report 2 cases in which we were able to perform procedures unrelated to ECT during the period these patients were under the anesthesia administered for ECT. The procedures otherwise would have been challenging to accomplish because of the patients’ psychosis and agitation. In both cases, general anesthesia was administered, ECTwas performed, and the additional procedures were carried out immediately after the termination of the ECT seizure while the patients remained anesthetized. Consent for the additional procedures was obtained in the same manner as consent for ECT before induction of general anesthesia.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122228354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortisol Levels in a Catatonic Patient Treated Daily With Electroconvulsive Therapy Using Etomidate Narcosis.","authors":"Olga Kogan-Goloborodko, M. Grözinger","doi":"10.1097/YCT.0000000000000294","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000294","url":null,"abstract":"To the Editor: F or almost a decade since 1972, etomidate has been a very popular anesthetic especially in emergency medicine and in the treatment of critically ill patients. The substance owed its initial popularity to a good safety profile. Because of its rapid metabolism, it hardly affects the characteristics of the circulatory system, causing neither any respiratory depression nor increase in intracranial pressure. Its hypnotic effect results from an agonistic interaction with the γ-aminobutyric acid receptor. In 1983, etomidate was found to cause adrenal depression, especially a temporary suppression of cortisol levels. Because of an inhibition of the 11-β-hydroxylase, the conversion of 11-desoxycortisol to cortisol is reduced. After several studies, however, there is still a debate as to the clinical relevance of this interaction. Nevertheless, the use of etomidate in critically ill patients was banned. Given that the somatic condition of electroconvulsive therapy (ECT) patients is generally quite good, the concerns raised may not be pertinent here. And because of its aforementioned advantages and only moderate suppression of seizure intensity as compared with propofol or thiopental, etomidate still remains one of the most popular narcotics for ECT treatment. A recent study by Wang et al found a decrease","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126638997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Refractory Dyskinesia Secondary to Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Electroconvulsive Therapy.","authors":"J. Sunwoo, D. Jung, J. Choi, U. Kang, Soon-Tae Lee, Sang Kun Lee, K. Chu","doi":"10.1097/YCT.0000000000000313","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000313","url":null,"abstract":"To the Editor: A nti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoantibodymediated neurological disease characterized by psychiatric symptoms, altered consciousness, cognitive dysfunction, autonomic instability, and seizures. It is well known that most patients with anti-NMDA receptor encephalitis respond to immunotherapy. However, a small proportion of patients did not respond to immunotherapy and resulted in severe neurological deficit or death. Furthermore, the treatment for patients with immunotherapy-resistant encephalitis has not been established. To the best of our knowledge, we report the first case of antiNMDA receptor encephalitis with prolonged and refractory dyskinesia, which was not improved by intensive immunotherapy and tumor removal but remarkably responded to electroconvulsive therapy (ECT). A 27-year-old woman, who was previously healthy with no history of psychiatric illnesses, complained of headache and insomnia. For a few days, confusion, visual and auditory hallucination, and disorganized speech developed. Then, she was referred to our institute 10 days after the symptom onset because of the aggravation of psychotic symptoms followed by decreased consciousness. At the time of the emergency room visit, she was observed to be semicomatosewithout focal or lateralized signs in neurologic examination. Laboratory tests showed leukocytosis (white blood cell counts, 16,120/μL)with increased segmented neutrophils (83.5%). Electrolyte panel demonstrated mild hyponatremia (130 mmol/L) with a low serum osmolality (278 mOsm/kg). Other blood test results including liver function tests and serum creatinine level were normal. Cerebrospinal fluid (CSF) study revealed pleocytosis (59/mm) with lymphocytic predominance (89.8%),whereas protein and glucose levels were within reference limits. We tested for an extensive list of infectious pathogens including herpes simplex virus, but results were all negative. Brain magnetic resonance imaging with contrast enhancement was unremarkable. At the day of the admission, we tested neuronal autoantibodies from CSF and blood samples. A computed tomography scan of the abdomen and pelvis demonstrated 2-cm-sized, low-attenuated lesion suggesting ovarian","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123977984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a Ten-Day Prefrontal Transcranial Direct Current Stimulation Protocol for Crack Craving: A Proof-of-Concept Trial.","authors":"Rodrigo de Almeida Ramos, I. Taiar, A. Trevizol, P. Shiozawa, Q. Cordeiro","doi":"10.1097/YCT.0000000000000302","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000302","url":null,"abstract":"Ms. Li reports grants from the Autism Science Foundation outside the submitted work. Dr. Kellner has received grant funding from the NIMH. He has received honoraria from UpToDate, Psychiatric Times, and the Northshore-LIJ Health System and receives honoraria fromCambridge University Press. Dr. Aloysi reports funds from Brainsway outside the submittedwork.All otherauthorshavenoconflicts of interest or financial disclosures to report.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115147942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Representations of ECT in English-Language Film and Television in the New Millennium","authors":"A. Matthews, P. Rosenquist, W. McCall","doi":"10.1097/YCT.0000000000000312","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000312","url":null,"abstract":"Objective The aim of the study was to survey the media landscape to determine whether visual depictions of electroconvulsive therapy (ECT) are becoming more or less medically accurate in the new millennium. Method English-language film and television shows depicting ECT were analyzed for patient demographics, administrator roles, indication, consent, anesthesia, paralytics, bite block, lead placement, electroencephalogram, and outcome. Results Thirty-nine ECT scenes were viewed, and just 3 included all 5 essential tools of modern ECT: anesthesia, paralytic, electrodes, electroencephalogram, and a bite block. Conclusions Media depictions of ECT do not reflect current practice. Too often, ECT is portrayed as a torture technique rather than an evidenced-based therapy, and even in a therapeutic setting, it is too often shown with outdated techniques.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134534712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Woman With Catatonia, What To Do After ECT Fails: A Case Report.","authors":"Afra van der Markt, H. Heller, E. van Exel","doi":"10.1097/YCT.0000000000000290","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000290","url":null,"abstract":"To the Editor: W e present a 46-year-old woman, with a history of bipolar I disorder, who developed catatonia during a depressive episode. Initial treatment with 8 mg lorazepam per day proved to be ineffective, as was ECT. Therefore, the lorazepam dosage was increased up to 28 mg/d, which finally led to a remission of catatonia. Before admission, our patient had been treated with lithium as a mood stabilizer for 7 years. In this period, she had 1 manic episode, during which olanzapine was added to the lithium. Twomonths before presentation, our patient experienced stress due to several life events. This led to a hypomanic episode, directly followed by a depressive episode, resulting in admission to a psychiatric hospital. On day 1, the first day of admission, the patient developed a motor rigidity, characteristic of catatonia. She presented with rigidity of the legs and confused speech. Lorazepam was started orally in a dose of 8 mg/d, as is advised in the treatment protocol described by Tuerlings et al and endorsed by several other studies. Lithium and olanzapine were discontinued; plasma medication levels were checked for lithium andwere found to be below toxic.Malignant neuroleptic syndrome and malignant catatonia were strongly suspected but were ruled out because there was no increase of serum creatine kinase and no autonomic instability. On day 8, the catatonia had fully developed, with negativism, mutism, posturing, rigidity of the legs, and confused speech. Treatment with electroconvulsive therapy (ECT) was started, which was administered bilaterally. An electroencephalography (EEG) that was performed during ECT showed these seizures were of adequate quality (either a motor seizure of 20 seconds or more or a seizure detected with the EEG of 25 seconds or more). Lorazepam was discontinued because it is known to lower the quality of seizures during ECT. Unfortunately, no clinical improvement was observed after subsequent ECT sessions. It was decided to continue ECT because several sessions may be required before the effect can be measured. Because no clinical improvement had been observed after 5 ECT sessions by day","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131264978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Genital Arousal Disorder-Case Report of Symptomatic Relief of Symptoms With Transcranial Magnetic Stimulation.","authors":"R. McMullen, S. Agarwal","doi":"10.1097/YCT.0000000000000299","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000299","url":null,"abstract":"To the Editor: P ersistent genital arousal disorder (PGAD) is a rare syndrome of excessive and unremitting sexual arousal in the absence of conscious feelings of sexual desire. It was first described in 2001 by Leiblum and Nathan. Typically, the arousal does not resolve with ordinary orgasmic experience. It is usually experienced as very distressing, intrusive, uncomfortable, and even as a form of pain. When severe, it can lead to significant suicidal ideation. To date, no obvious hormonal, vascular, neurological, or psychological causes have been identified. In 2003, PGAD was recognized as a clinical condition by the International Definitions Committee. Limited available literature suggests that PGAD may be related to an unspecified nervous system dysfunction, and therefore benzodiazepines, anesthetics, and anticonvulsants have been experimentally used to treat the symptoms. Various treatment modalities including local anesthetics, birth control pills, dietary modifications, α-adrenergic agonists, anticonvulsants, and anxiolytic and selective serotonin reuptake inhibitor medications have been tried without notable success. Regional nerve blocks with transcutaneous electrical nerve stimulation and electroconvulsive therapy have shown varying degrees of success in some cases.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115626967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Course of Depression Improvement With Ketamine Adjunction in Electroconvulsive Therapy.","authors":"B. Romeo, W. Choucha, P. Fossati, J. Rotge","doi":"10.1097/YCT.0000000000000293","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000293","url":null,"abstract":"In a recent and elegant meta-analysis, McGirr et al 1 assessed ketamine adjunction in electroconvulsive therapy (ECT), which is frequently used in pharmacoresistant major depressive disorder. Because ketamine demonstrated good efficacy in depression, some studies assessed the potentiation of ECT by using ketamine as the anesthetic agent. In their meta-analysis, the authors included 5 randomized controlled trials comparing the antidepressive effects of ketamine + ECT (K + ECT) versus another anesthetic agent + ECT (AAA + ECT). No significant difference in remission or response rates, or in depressive symptoms was observed with or without ketamine adjunction in ECT. However, results from many studies argued for a possible ketamineinduced improvement of depressive symptoms during the very first week of treatment. Thus, a time-course of ketamine effects in ECT may provide relevant information in addition to the data supplied in the meta-analysis. To investigate the time-course of ketamine’s action, we searched the MEDLINE and PsycINFO databases through January 2015. Details concerning the data sources, study selection process (Figure S1), data extraction, and the data analyses were given in Supplemental Digital Content 1 (http://links.lww.com/JECT/A41). With one exception, original means and SDs for the depression scores were kindly provided by the authors of the original publications. Standardized mean differences (SMD) between the depression scores in K + ECT and AAA + ECT groups were calculated at different time points, as follows: (1) baseline, (2) 1 or 2 ECTs, (3) 3 or 4 ECTs, (4) 5 or 6 ECTs, and (5) post-ECT (see Supplemental Digital Content 1, http://links.lww.com/JECT/A41). Six trials, including a total of 185 patients, were included in our meta-analysis. The main demographic and clinical characteristics of the included studies were described in Table S1. Three trials showed no difference between the ketamine and control groups, 1 trial reported improvement in the depression score on the first day after ECT, and 2 other trials described","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125921519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Transcranial Direct Current Stimulation in a Case of Episodic Obsessive Compulsive Disorder.","authors":"N. Hazari, J. Narayanaswamy, H. Chhabra, A. Bose, G. Venkatasubramanian, Y. Reddy","doi":"10.1097/YCT.0000000000000309","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000309","url":null,"abstract":"To the Editor: R e. “500-mA ECT—A Proof of Concept Report” by Prashanth Mayur, Anthony Harris, and Bangalore Gangadhar, published as Letter to the Editor on Journal of ECT: June 2015, Volume 31, Issue 2: p e23–e26, I would like to question the methodology involved. In the text, the authors claim that 500 mA pulses are less effective than 800 mA and question that “other ECT parameters may have to be increased to maintain the total energy delivered to the patient to obtain a well-formed seizure on electroencephalogram”; they also claim that “it is not clear if the amplitude reduction resulted in a stimulus dose that was significantly suprathreshold.” My problem with this approach and conclusions is that brief pulse machines, like the MECTA spECTrum 5000Q (MECTA Corporation, Lake Oswego, Ore) they used, allow for a complete control of the electrical stimulus being used. Total electrical charge ismeasured inmillicoulombs (mC), calculated by multiplying the 4 parameters of the brief pulse and then by 2 in biphasic machines (like the one they use, as can be easily verified by the reported parameters). Not only “other ECT parameters may have to be increased” but “other ECT parameters should have been increased” to compensate for lower amperage. To reduce amperage without this compensation created 2 variables influencing the result: lower dosage and different amperage. The authors themselves state that the patients had titrated seizure thresholds (ST) of 19.2 and 72 mC and were being treated with a dosage of 115.2 and 432 mC (6 times above ST), respectively. This means that the stimulus given by the 500 mA pulses of 72 and 270 mC were as follows: a) lower dosages and b) 3.75 times above ST.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114665611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Medical Assessment of Patients Before Electroconvulsive Therapy: An Audit Across Two Sites","authors":"Hannah R Driver","doi":"10.1097/YCT.0000000000000304","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000304","url":null,"abstract":"Objective It is essential that a medical assessment is completed before commencing electroconvulsive therapy (ECT) to identify possible risk factors that may complicate anesthesia. This audit aimed to improve the physical examination and documented medical history of this assessment usually performed by referring psychiatrists. Methods Patients from 2 sites (A and B) were retrospectively audited against standards from the Scottish ECT Accreditation Network. The timing and systems examined for the physical examination were noted. Site A used an examination sheet; at site B there was no standard way of recording examination. Documented medical histories were compared with comprehensive histories obtained using multiple sources. Discrepancies were noted. Site A was reaudited after amending the examination sheet and adding prompts to use multiple sources when gathering histories. Results There were repeat examinations for ECT in 30 patients (100%) at site A and 6 (23%) of 26 at site B. Physical examinations were incomplete in 47% of patients at A and 100% at B. Oral examination was frequently missed at both sites. Medical histories were accurate in 20% at A and 38% at B. In the reaudit of site A, all 12 patients had a complete repeat examination; histories were accurate in 8 (67%), with multiple sources used in 11 (92%). Conclusions Incomplete or inaccurate assessments put patients at risk. Oral examinations should be part of initial medical assessments. This audit shows the benefits of using a physical examination sheet to ensure a repeat complete examination. Using multiple sources to gather medical histories is encouraged.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"216 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127509790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}