RESUMO
Electroconvulsive therapy is used for the management of severe and refractory depression across the age spectrum. Treatment is guided by clinical response. However, there may be differences between the time course of improvement in clinical observations and patients' self-report of improvements. We report 4 cases of depression in late life that illustrate this issue. We discuss the potential significance of such differences and the need for research.
Assuntos
Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia/psicologia , Afeto/fisiologia , Idoso , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/psicologia , Eletroconvulsoterapia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/psicologia , Ideação Suicida , Resultado do TratamentoRESUMO
OBJECTIVE: This study tested the hypothesis that frontal error negative wave amplitude on EEG during Stroop test activation predict change in depressive symptoms in depressed elders. METHOD: Twenty-two older patients with major depression received controlled treatment with citalopram at a target dose of 40 mg/day for 6 weeks. Paramedian error negative waves were recorded during Stroop activation before treatment. RESULTS: Nine subjects who remained symptomatic had larger left frontal error negative waves than the subjects who achieved remission. Left frontal error negative waves were correlated with percent change of depressive symptoms from baseline. Other paramedian error negative waves did not distinguish remitted from unremitted subjects. Left frontal error negative waves were negatively correlated with Mattis Dementia Rating Scale scores for initiation/perseveration; these scores were lower in unremitted than remitted patients. CONCLUSIONS: Increased left frontal error negative waves are associated with limited or slow change in depressive symptoms in elders receiving citalopram.
Assuntos
Citalopram/uso terapêutico , Transtorno Depressivo/diagnóstico , Eletroencefalografia/estatística & dados numéricos , Lobo Frontal/fisiopatologia , Lateralidade Funcional/fisiologia , Testes Neuropsicológicos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Idoso , Atenção/fisiologia , Citalopram/farmacologia , Conflito Psicológico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/fisiopatologia , Lobo Frontal/efeitos dos fármacos , Avaliação Geriátrica , Giro do Cíngulo/efeitos dos fármacos , Giro do Cíngulo/fisiopatologia , Humanos , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Resultado do TratamentoRESUMO
Extreme rise of blood pressure may increase the risk associated with electroconvulsive therapy (ECT) in patients with cardiovascular disease, cerebrovascular disease, and aortic and intracranial aneurysms. A case is presented in which sublingual nifedipene was used in the treatment of a high-risk patient with severe rise of blood pressure. The therapeutic alternatives of managing severe ECT-related blood pressure increases are presented.