When to switch from bilateral to unilateral electroconvulsive therapy: A simple way to elicit seizures in high seizure threshold cases.

AIMS: Although electroconvulsive therapy (ECT) is effective for various psychiatric disorders, its therapeutic effect depends on the occurrence of adequate seizures. Thus, the management of inadequate seizures remains a clinical problem. Here, we aimed to develop a simple method to elicit adequate seizures in high seizure threshold patients during ECT sessions. METHODS: Right unilateral ECT was performed in 87 sessions (22 inpatients) in which 504 millicoulombs bilateral (bitemporal or bifrontal) electrical stimulation had failed to induce adequate seizures. A Thymatron® System IV (Somatics LLC, Lake Bluff, IL, USA) and the LOW 0.5 program were used in accordance with the manufacturer's instructions. The electrode placement was bitemporal, bifrontal, or right unilateral (d'Elia placement). The minimum duration for an adequate seizure was 15 seconds in the electroencephalogram record of the Thymatron® stimulator. The efficacy of treatment was estimated by the Global Assessment of Functioning at the time of admission and discharge. Cognitive assessment was not performed. RESULTS: By switching to right unilateral stimulation immediately after failure of bilateral stimulation, adequate seizures were achieved in 71 of 87 (81.6%) sessions. Improvement in the Global Assessment of Functioning was observed in 23 of 28 (82.1%) treatment courses. CONCLUSION: Switching from bilateral to unilateral electrode placement may be a simple clinical option for eliciting adequate seizures in high seizure threshold cases.

Measurement of circular birefringence and circular dichroism of the single crystals of lambda-(+)589- and delta-(-)589-tris(ethylenediamine)cobalt(III) triiodide monohydrate by the extended HAUP method.

We have achieved measuring four optical parameters simultaneously, namely, linear birefringence (LB), circular birefringence (CB), linear dichroism (LD), and circular dichroism (CD), of single crystals of Lambda-(+)(589)- and Delta-(-)(589)-tris(ethylenediamine) cobalt(III) triiodide monohydrate (1) along the <001> plane at the fixed wavelength (514.5 nm). Such measurements are possible only when the High Accuracy Universal Polarimeter (HAUP) is employed; it is called the extended HAUP method. Our experimental results showed that both LB and LD of the Lambda-(+)(589)-(1) crystal have the same magnitude as those of the Delta-(-)(589)-(1) crystal. It was also revealed for the first time that the CB data of crystals of Lambda-(+)(589)-(1) and Delta-(-)(589)-(1) are almost of the same magnitude, but are of opposite sign, reflecting their opposite absolute configurations. On the other hand, although the CD data obtained for Lambda-(+)(589)-(1) is almost three times larger than that for Delta-(-)(589)-(1,) these CD data are also opposite in sign, as expected from the opposite chirality of crystals. .