RESUMO
BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements. AIMS: To compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT. METHOD: This multicentre randomised, double-blind, controlled trial (NCT00069407) was carried out from 2001 to 2006. A total of 230 individuals with major depression, bipolar and unipolar, were randomly assigned to one of three electrode placements during a course of ECT: bifrontal at one and a half times seizure threshold, bitemporal at one and a half times seizure threshold and right unilateral at six times seizure threshold. RESULTS: All three electrode placements resulted in both clinically and statistically significant antidepressant outcomes. Remission rates were 55% (95% CI 43-66%) with right unilateral, 61% with bifrontal (95% CI 50-71%) and 64% (95% CI 53-75%) with bitemporal. Bitemporal resulted in a more rapid decline in symptom ratings over the early course of treatment. Cognitive data revealed few differences between the electrode placements on a variety of neuropsychological instruments. CONCLUSIONS: Each electrode placement is a very effective antidepressant treatment when given with appropriate electrical dosing. Bitemporal leads to more rapid symptom reduction and should be considered the preferred placement for urgent clinical situations. The cognitive profile of bifrontal is not substantially different from that of bitemporal.
Assuntos
Cognição/fisiologia , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Método Duplo-Cego , Eletroconvulsoterapia/efeitos adversos , Eletrodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Indução de Remissão/métodos , Convulsões , Índice de Gravidade de Doença , Adulto JovemRESUMO
We present the case of a 28-year-old male with a history of a severe closed head injury who successfully underwent electroconvulsive therapy for treatment of his depression. A detailed neuropsychological evaluation demonstrated the cognitive tolerability of the treatment. We review the literature on electroconvulsive therapy and brain injury.
Assuntos
Lesões Encefálicas/complicações , Depressão/terapia , Eletroconvulsoterapia , Adulto , Depressão/complicações , Humanos , Masculino , Testes NeuropsicológicosRESUMO
In this paper, the common psychological consequences of terrorism are reviewed with implications for treatment and community intervention. The role of the mass media is discussed as is the need for early intervention is emphasized.