{"title":"Electroconvulsive therapy consultation: an update.","authors":"M M Klapheke","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the past, a pre-electroconvulsive therapy (ECT) psychiatric evaluation focused on the question, \"Does the patient have an ECT-responsive condition?\" Technological advances, a broadening experience base with psychiatric patients with concomitant severe medical illness, and advances in ECT technique have led to the need for a more extensive pre-ECT assessment of the patient's psychiatric and medical status, including concomitant medications. A specific \"ECT consultation\" has evolved that builds on the basic components of the standard psychiatric consultation and extends to recommendations designed to maximize the safety and efficacy of ECT for each individual patient. This article briefly reviews the key components of the ECT consultation and provides an extensive update on important considerations in the use of combined ECT and psychotropic medications.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"227-41"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20364563","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}
M S Nobler, H A Sackeim, J R Moeller, J Prudic, E Petkova, C Waternaux
{"title":"Quantifying the speed of symptomatic improvement with electroconvulsive therapy: comparison of alternative statistical methods.","authors":"M S Nobler, H A Sackeim, J R Moeller, J Prudic, E Petkova, C Waternaux","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although electroconvulsive therapy (ECT) is believed to have a rapid onset of antidepressant activity, there has been limited investigation in this area. This study contrasted alternative statistical methods for testing treatment group differences in the rapidity of clinical response to ECT. Patients with major depression were randomly assigned to receive right unilateral or bilateral ECT and low or high electrical dosage relative to seizure threshold. The 24-item Hamilton Rating Scale for Depression (HRSD) was administered by blinded clinical raters twice weekly (non-treatment days). We evaluated four alternative statistical strategies. Two methods considered time to improvement as a dependent variable: (a) time (treatment number) to reach various cutoffs for percentage decrease in HRSD from baseline; and (b) survival analysis using the same cutoffs for percentage decreases as endpoints. Two methods considered time to improvement as an independent variable: (c) the slope of linear regression of HRSD scores against treatment number; and (d) a random regression model using the HRSD scores as repeated measures. The statistical methods differed in whether or not omnibus group differences were observed, the criterion level of improvement associated with group differences, and the results of pairwise comparisons establishing specific therapeutic advantages. Survival analysis generally displayed the greatest sensitivity in detecting treatment group differences.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"208-21"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20363988","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":"Prejudice against ECT: competition with psychological philosophies as a contribution to its stigma.","authors":"M Fink","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"253-65; discussion 266-8"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20364565","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":"Multiple ECT late in the course of neuroleptic malignant syndrome.","authors":"P McKinney, C Kellner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report a 19-year-old woman who received electroconvulsive therapy (ECT) late in the course of neuroleptic malignant syndrome (NMS). She received at least two sessions with multiple ECT and had a full recovery. We suggest that multiple seizures may optimize ECT treatment in NMS.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"269-73"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20364566","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":"Maintenance electroconvulsive therapy for Parkinson's disease.","authors":"D Aarsland, J P Larsen, O Waage, J H Langeveld","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In two patients with severe Parkinson's disease (PD) whose response to levodopa had decreased, the parkinsonian motor symptoms responded to acute and maintenance unilateral electroconvulsive therapy (ECT). Case 1 relapsed while taking antiparkinsonian medication 2 and 3 months after two brief courses of ECT. After another relapse, he received maintenance ECT and stayed well for 13 months. Case 2 relapsed 4 months after a course of ECT. Acute and maintenance ECT induced improvement for 14 months. Further relapses were treated with brief courses of ECT followed by maintenance ECT. Three and 4 years after their first ECT, the parkinsonian motor symptoms in these two patients are still markedly improved. Neuropsychological assessments did not suggest ECT-induced long-term cognitive impairment. We conclude that maintenance ECT should be considered in PD patients who relapse after having responded to an initial course of ECT. There is an urgent need for controlled studies.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"274-7"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20364567","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":"Quantifying utilization and practice variation of electroconvulsive therapy.","authors":"J R Westphal, R Horswell, S Kumar, J Rush","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The objective of this study was to quantify inpatient electroconvulsive therapy (ECT) utilization and its practice variation within the State of Louisiana using Medicare data for beneficiaries age 65 years and older. The Louisiana Medicare claims (MedPar) history and the Medicare beneficiary denominator files for fiscal years 1993 and 1994 were used for analysis. Statistical techniques used were: chi 2 to determine significance of the proposed null hypothesis, and the modified systemic component of variance (SCV) to determine the magnitude of variation between the individual parish utilization rates for ECT. The ECT utilization rate for the Louisiana Medicare population was found to be 2.38 per 10,000 person-years, falling well within the range of previous ECT utilization studies in the United States. The chi 2 value was 0.0003 when comparing parishes, indicating the presence of significant nonrandom variation. The SCVs of inpatient treatment for major depression and impatient ECT were 0.47 and 1.34, respectively. Inpatient ECT in this population demonstrates high geographic variability. Further research is required to determine and quantitate the factors responsible for the geographic variation in inpatient ECT utilization within the Louisiana Medicare population.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"242-52"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20364564","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":"ECT for the treatment of mood disorders in cancer patients.","authors":"M D Beale, C H Kellner, P J Parsons","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The authors review the literature and report three patients with cancer whose comorbid mood disorder was successfully treated with electroconvulsive therapy (ECT). They make recommendations for early consideration of ECT and aggressive treatment of depression in this high-risk population.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 4","pages":"222-6"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20363989","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}
S Kamath, C Andrade, S Faruqi, B V Venkataraman, M A Naga Rani, V S Candade
{"title":"Evaluation of pre-ECS antihypertensive drug administration in the attenuation of ECS-induced retrograde amnesia.","authors":"S Kamath, C Andrade, S Faruqi, B V Venkataraman, M A Naga Rani, V S Candade","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Two once-daily electroconvulsive shocks (ECS) produced retrograde amnesia in rats trained on a Hebb-Williams maze; Verapamil (12.5 mg/kg, i.p.) or felodipine (10 mg/kg, p.o.) administered half an hour before each ECS attenuated this ECS-induced amnesia. Hence, these drugs may hold promise for the containment of amnesia induced by electroconvulsive therapy (ECT). Speculatively, one or more of several mechanisms may be involved: cerebral vasodilatation, enhancement of cholinergic tone, and inhibition of calcium-mediated impairment of neuronal function. These drugs may also act by attenuating the systolic surge in blood pressure during ECT, thereby decreasing edema due to cerebral hyperperfusion, as well as decreasing the possible transfer of potentially neurotoxic macromolecules through a putative breach in the blood-brain barrier.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"185-95"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274731","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}