Delaying initiation of electroconvulsive treatment after administration of the anaesthetic agent and muscle relaxant reduces the necessity of re-stimulation.

OBJECTIVES: To investigate the effect of delaying initiation of electroconvulsive therapy (ECT) after administration of anaesthetic agent and muscle relaxant. METHODS: A retrospective cohort study utilizing a case-based analysis comparing number of re-stimulations, length of seizures, number of ECTs per series and stimulation dosage before and after introducing a new treatment regimen. In 2013, ECT was initiated approximately 60-90 seconds after administration of thiopental and succinylcholine. This interval was increased to 120 seconds in 2014. Ninety-three patients were included (40 in 2013 and 53 in 2014). Outcome measures were length of seizure, number of re-stimulations, number of ECTs per series and stimulation dosage. Regression model analyses were conducted with entering year of treatment (2013 vs. 2014), sex and age as covariates. RESULTS: We showed that a lowered frequency of re-stimulation was independently associated with the 2014 treatment regimen. No effect of treatment regimen on duration of seizures as measured clinically or by EEG, on number of treatments per series or on stimulation dosage was observed. CONCLUSIONS: We found an association between an increased time interval from administration of thiopental and succinylcholine to ECT and a lowered risk of re-stimulations. The current study substantially strengthens the evidence on the benefits of delaying ECT after administration of anaesthetic agent and muscle relaxant.

Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia.

OBJECTIVE: Investigate the associations of long-acting injectable (LAI) second generation antipsychotic drugs with number of relapses, psychiatric admissions, days hospitalized, intentional self-harm events, and costs linked to hospitalizations in incident patients diagnosed with schizophrenia. METHOD: A nationwide, population-based, retrospective study utilizing mirror-image models before and after initiation of LAI SGA. RESULTS: 10,509 patients were included as study population, with analyses being conducted on 2223 patients in a six-month period, 1383 in a 12-month period, 713 in a 24-month period. After initiation of LAI antipsychotics, patients experienced a reduction in number of relapses with an incidence rate ratio (IRR) of 0.60 for the first six months, IRR 0.64 for the first 12 months and IRR 0.64 for the first 24 months following initiation of LAI, all P < 0.001. The number of psychiatric admissions was reduced in a similar manner with respective IRR of 0.59, 0.60 and 0.64, all P < 0.001. Psychiatric bed-days were reduced with 58, 100 and 164 days for the respective periods after LAI initiation, all P < 0.001. In a Cox regression model in patients initiated on LAI, higher age at diagnosis, hazard rate ratio (HR) 0.99, 95%CI(0.98-0.99), P < 0.001, and a later calendar year of diagnosis, HR 0.99, 95%CI(0.98-1.00), P < 0.05, were associated with a lower risk of relapse, whereas mainly psychiatric comorbidity, HR 1.07, 95% CI (1.04-1.11), P < 0.001, and cardiovascular disease, HR 1.12, 95%CI(1.01-1.26), P < 0.05, were associated with relapse. CONCLUSION: Even though the design does not allow inferences regarding causality, these population-based findings support the use of second generation LAI antipsychotics.