Cuidados de enfermagem em terapia eletroconvulsiva no período pré-reforma psiquiátrica numa instituição brasileira / Nursing care in electroconvulsive therapy in a Brazilian institution before the Psychiatric Reform / Cuidados de enfermería en la terapia electroconvulsiva en el período prerreforma psiquiátrica en una institución brasileña

Resumo Enquadramento: A terapia electroconvulsiva (TEC) é parte do passado da enfermagem que precisa de ser conhecido, a fim de dar sentido às transformações nos saberes e práticas após a Reforma Psiquiátrica. Objetivo: Identificar os cuidados de enfermagem na aplicação da terapia electroconvulsiva em utentes internados num instituto psiquiátrico brasileiro entre 1980 e 1990. Metodologia: Investigação histórico-social em documentos escritos da instituição cenário e orais produzidos com profissionais de enfermagem, interpretados à luz do referencial foucaultiano. Resultados: Os cuidados de enfermagem foram definidos pela experiência quotidiana e realizados nos momentos pré, trans e pós a aplicação da terapia electroconvulsiva. A enfermagem não tinha formação profissional e agia por conta própria, aplicando a terapia para acalmar utentes agitados ou acompanhando a aplicação pelo médico, prestando cuidados para reduzir efeitos colaterais. Conclusão: Apesar do modelo manicomial, a aplicação da terapia electroconvulsiva contava com cuidados de enfermagem aos utentes para evitar efeitos indesejados. A enfermagem acompanhou o declínio da TEC na sociedade. Este estudo evidenciou características da TEC que não se adequam à prática contemporânea.

Abstract Background: Electroconvulsive therapy (ECT) is a part of Brazilian Nursing History that needs to be known to understand the evolution of knowledge and practice following the Psychiatric Reform. Objective: To identify nursing care for inpatients undergoing ECT at a Brazilian psychiatric institution between 1980 and 1990. Methodology: Social-historical study based on written documents from a Brazilian psychiatric institution and oral statements from nursing professionals, analyzed according to Foucault's framework. Results: Nursing care was defined based on everyday experiences and provided before, during, and after ECT. Nursing professionals had no professional training. They acted autonomously, administering ECT to calm agitated patients, or accompanied physicians' interventions, providing care to reduce the side effects of ECT. Conclusion: Despite being part of the asylum-style care model, ECT included nursing care to avoid unwanted effects. Nursing professionals witnessed the decline of ECT in society. The present study describes aspects of ECT that are inconsistent with today's practice.

Resumen Marco contextual: La terapia electroconvulsiva (TEC) forma parte del pasado de la enfermería que es necesario conocer para dar sentido a las transformaciones del conocimiento y la práctica tras la Reforma Psiquiátrica. Objetivo: Identificar los cuidados de enfermería en la aplicación de la terapia electroconvulsiva en pacientes ingresados en un instituto psiquiátrico brasileño entre 1980 y 1990. Metodología: Investigación histórico-social en documentos escritos de la institución y documentos orales producidos con profesionales de enfermería, interpretados según el referencial foucaultiano. Resultados: Los cuidados de enfermería se definieron por la experiencia diaria y se llevaron a cabo antes, durante y después de la terapia electroconvulsiva. El personal de enfermería no tenía formación profesional y actuaba por su cuenta, aplicando la terapia para calmar a los pacientes agitados o acompañando la aplicación del médico, proporcionando cuidados para reducir los efectos secundarios. Conclusión: A pesar del modelo de manicomio, la aplicación de la terapia electroconvulsiva contaba con cuidados de enfermería a los pacientes para evitar efectos no deseados. La enfermería ha seguido el declive de la TEC en la sociedad. Este estudio pone de manifiesto las características de la TEC que no se ajustan a la práctica contemporánea.

La catatonia. Diagnóstico y tratamiento a propósito de un caso / Catatonia. Diagnosis and treatment of a case report

El síndrome catatónico es un cuadro de etiología múltiple tanto médica como psiquiátrica, con una variada sintomatología que muchas veces escapa al ojo clínico, siendo por tanto un síndrome infradiagnosticado en la actualidad. Es necesario la realización de un abordaje multidisciplinar y global de estos pacientes, debido a la amplitud de factores predisponentes de tipo farmacológico, tóxico y orgánico y a la elevada morbimortalidad de este síndrome. Es por ello que presentamos un cuadro clínico de un síndrome catatónico inhibido en una paciente de 37 años con diagnóstico de esquizofrenia hebefrénica que presenta un cuadro de estupor, mutismo y negativismo.Es de vital importancia una formación en profundidad para los clínicos y la aplicación de escalas y criterios diagnósticos actualizados, para un diagnóstico, evolución y tratamiento de estos pacientes. La utilización de benzodiacepinas y la terapia electroconvulsiva de manera precoz son los tratamientos de primera línea, siempre asociados a medidas de soporte y prevención de complicaciones. (AU)

The catatonic syndrome present multiple etiologies, both medical and psychiatric, with a variety of symptoms that often escape the clinical eye; therefore, it is currently an underdiagnosed syndrome. A multidisciplinary and global approach is necessary in these patients, due to the wide range of pharmacological, toxic and organic predisposing factors and the high morbidity and mortality of this syndrome. That is why we show a clinical case of an inhibited catatonic syndrome in a 37-year-old patient diagnosed with hebephrenic schizophrenia who presents a clinical picture of stupor, mutism and negativism.In-depth training for clinicians and the application of up-to-date diagnostic scales and criteria are of vital importance for diagnosis, evolution and treatment of these patients. The use of benzodiazepines and early electroconvulsive therapy are the first-line treatments, always associated with support measures and prevention of complications. (AU)

Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression.

INTRODUCTION: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Clinical experience of electroconvulsive therapy with anaesthetic and muscle relaxant at the Clínica Universidad de La Sabana: 2009-2017.

INTRODUCTION: Electroconvulsive therapy is an effective and safe procedure, which is indicated mainly in patients with both unipolar and bipolar depressive episodes, mania and schizophrenia, when they do not respond to other treatments. OBJECTIVE: To describe the demographic, social and clinical properties of a group of patients treated with electroconvulsive therapy (ECT) with anaesthetic and muscular relaxant at the Universidad de La Sabana Clinic for a period of 8 years. METHODS: The databases and records of the procedures were reviewed from 1 January 2009 to 31 December 2017. An analysis was performed with descriptive statistics. RESULTS: In this period, 1322 procedures were performed on 143 patients (54.5% women) with an associated diagnosis of major depression in 57%. The number of treatments per person was 9.2 and complications occurred in 3.8%, without any of them requiring invasive management. CONCLUSIONS: Electroconvulsive therapy is performed safely in patients and with different parameters in terms of age, gender and diagnosis, in comparison to other countries in Latin America and the world. It is important to join efforts in research that allow a more complete overview of the characteristics of its application in the country.

Experiencia clínica de la terapia electroconvulsiva con anestesia y relajación en la Clínica Universidad de La Sabana: 2009-2017

Introducción: La terapia electroconvulsiva es un procedimiento efectivo y seguro, el cual se indica principalmente a pacientes con episodios depresivos tanto unipolares como bipolares, manía y esquizofrenia, cuando no responden a otros tratamientos. Objetivo: Describir las propiedades demográficas, sociales y clínicas de un grupo de pacientes tratados con terapia electroconvulsiva con anestesia y relajación (TECAR) en la Clínica Universidad de La Sabana por un periodo de 8 arios. Métodos: Se revisan las bases de datos y los registros de los procedimientos desde el 1 de enero de 2009 hasta el 31 de diciembre de 2017. Se realiza un análisis con estadística descriptiva. Resultados: En este periodo se realizaron 1.322 procedimientos a 143 pacientes, el 54,5% de ellos mujeres, y con diagnóstico asociado de depresión mayor en el 57% de los pacientes. El número de tratamientos por persona fue 9,2 y en el 3,8% se presentaron complicaciones, sin que se requiriese tratamiento invasivo en ninguna de ellas. Conclusiones: La terapia electroconvulsiva se aplica con seguridad a los pacientes y con parámetros diversos en cuanto a edad, sexo y diagnóstico más frecuente, en comparación con otros países de Latinoamérica y el mundo. Es importante sumar esfuerzos en investigación que permitan tener un panorama más completo de las características de su aplicación en el país.

Electroconvulsive therapy is an effective and safe procedure, which is indicated mainly in patients with both unipolar and bipolar depressive episodes, mania and schizophrenia, when they do not respond to other treatments. Objective: To describe the demographic, social and clinical properties of a group of patients treated with electroconvulsive therapy (ECT) with anaesthetic and muscular relaxant at the Universidad de La Sabana Clinic for a period of 8 years. Methods: The databases and records of the procedures were reviewed from 1 January 2009 to 31 December 2017. An analysis was performed with descriptive statistics. Results: In this period, 1,322 procedures were performed on 143 patients (54.5% women) with an associated diagnosis of major depression in 57%. The number of treatments per person was 9.2 and complications occurred in 3.8%, without any of them requiring invasive management. Conclusions: Electroconvulsive therapy is performed safely in patients and with different parameters in terms of age, gender and diagnosis, in comparison to other countries in Latin America and the world. It is important to join efforts in research that allow a more complete overview of the characteristics of its application in the country.

Impacto de la Terapia Electroconvulsiva en el Funcionamiento de la Memoria en Pacientes con Depresión

Introducción: La seguridad de la terapia electroconvulsiva ha mejorado mucho en las últimas décadas, lo que hace que los efectos potencialmente adversos en la memoria y otras funciones neurocognitivas sean el principal aspecto clínico de preocupación en el presente. En Colombia, la población general y los profesionales de la salud (incluso algunos psiquiatras) parecen tener opiniones mayoritariamente negativas sobre el tratamiento electroconvulsivo, pero quizá esto podría reconsiderarse si se brinda más información; por lo tanto, el objetivo del presente estudio es evaluar los cambios en la memoria y la gravedad de los síntomas en un grupo de pacientes con depresión grave antes y después de la terapia electroconvulsiva. Métodos: Se incluyó a 23 pacientes con edades comprendidas entre los 23 y los 70 anos del Servicio de Terapia Electroconvulsiva de la Clínica San Juan de Dios (Manizales, Colombia) para evaluar el efecto de esta terapia en la memoria de pacientes con depresión grave. Los síntomas depresivos y la memoria se evaluaron con la escala de depresión de Hamilton (HAMD) y la prueba de aprendizaje auditivo verbal de Rey (RAVLT) respectivamente. Se evaluó a los participantes antes de la sesión inicial de la serie de terapia electroconvulsiva (0-1 día) y 2 días después de su último tratamiento. Resultados: La terapia electroconvulsiva resultó en una mejora significativa en la puntuación de depresión. No hubo diferencias significativas en las puntuaciones de las 5 pruebas de aprendizaje, recuerdo retardado, aprendizaje y olvido desde antes del tratamiento hasta después de este. Se encontraron diferencias significativas antes y después del tratamiento en la prueba de reconocimiento retardado. Conclusiones: Los problemas de memoria pueden evaluarse y caracterizarse de manera práctica tras la terapia electroconvulsiva. La evaluación cognitiva antes y después de la terapia electroconvulsiva es un procedimiento viable y útil. En general, el rendimiento de la memoria no empeora después de la terapia electroconvulsiva en pacientes con depresión. Solo el reconocimiento retardado se ve afectado unos días después, particularmente en pacientes con bajo nivel educativo y colocación de electrodos bitemporales (BT).

Introduction: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

La terapia electroconvulsiva en el síndrome neuroléptico maligno / Electroconvulsive therapy in neuroleptic malignant syndrome

Resumen: Uno de los efectos adversos más importantes de los neurolépticos es la posibilidad de desencadenar el síndrome neuroléptico maligno (NMS). El diagnóstico se determina por exclusión y el manejo terapéutico inicial será retirado por neurolépticos por la administración de benzodiacepinas y, en casos extremos, el uso de la terapia electroconvulsiva (ECT). La ECT es una opción terapéutica eficaz en estos pacientes y en esos casos se obtiene una mala respuesta a la administración con fármacos antipsicóticos. Basándonos en el caso del artículo «Rocuronium-sugammadex for electroconvulsive therapy management in neuroleptic malignant síndrome. A case report¼ donde se describe el manejo exitoso del uso de relajantes no despolarizantes y su reversor específico en terapias electroconvulsivas en pacientes diagnosticados de síndrome neuroléptico maligno, comentamos la fisiopatología e implicaciones anestésicas además de similitudes con otras entidades hipertérmicas, como es la hipertermia maligna.

Abstract: One of the most important adverse effects of neuroleptics is the possibility of triggering neuroleptic malignant syndrome (NMS). The diagnosis is determined by exclusion and the initial therapeutic management will be withdrawn by neuroleptics by the administration of benzodiazepines and, in extreme cases, the use of electroconvulsive therapy (ECT). ECT is an effective therapeutic option in these patients and in these cases a poor response to administration with antipsychotic drugs is obtained. Based on the case of the article «Rocuronium-sugammadex for the management of electroconvulsive therapy in neuroleptic malignant syndrome. A case report¼ where the successful management of the use of non-depolarizing relaxants and their specific reversal in electroconvulsive therapies in patients diagnosed with of malignant neuroleptic syndrome, we comment on the pathophysiology and anesthetic images as well as similarities with other hyperthermic entities, such as malignant hyperthermia.

October Girl / Niña de octubre.

Reseña de la obra: Niña de octubre, de Linda Boström Knausgard Traducción de Rosalía Sáez, Gatopardo Ediciones, 2022.

Historia de la terapia electroconvulsiva: ¿cuándo empezó a utilizarse anestesia para este procedimiento? / History of electroconvulsive therapy: when did anesthesia begin to be used for this procedure?

Resumen: La terapia electroconvulsiva consiste en la aplicación de corriente eléctrica a través de electrodos colocados en regiones frontotemporales (bilateral) o unilateral, con el objetivo de inducir una crisis convulsiva, controlada y monitorizada, que se realiza bajo anestesia general con la presencia de un equipo multidisciplinario. En este trabajo, se hace una reseña de la historia de la aplicación de anestésicos y relajantes musculares que se han utilizado para este tratamiento y de cómo el anestesiólogo se ha posicionado como un elemento fundamental para la aplicación del mismo.

Abstract: Electroconvulsive therapy consists of the application of electric current, through electrodes placed in frontotemporal regions (bilateral) or unilateral, with the aim of inducing a seizure, controlled and monitored, and performed under general anesthesia, with the presence of a multidisciplinary team. This paper reviews the history of the application of anesthetics and muscle relaxants, which have been used for this treatment and how the anesthesiologist has positioned himself as a fundamental element for its application.

Ketamina para la depresión refractaria: una revisión exploratoria / Ketamine for resistant depression: a scoping review

Introducción. La ketamina es un anestésico de efecto rápido con propiedades hipnóticas. Además, podría mejorar potencialmente los síntomas afectivos en pacientes con trastorno depresivo refractario. Objetivo. Explorar la literatura científica disponible hasta el 10 de diciembre de 2021 sobre la eficacia y seguridad de la ketamina en pacientes con trastorno depresivo mayor refractario al tratamiento. Material y métodos. Revisión exploratoria que incluyó PubMed y Scopus. Se incluyeron registros de ensayos clínicos y publicaciones con datos empíricos en inglés y español. Resultados. Se incluyeron 31 documentos y 12 registros de ensayos clínicos: estudios clínicos aleatorizados (n = 19), estudios clínicos no aleatorizados (n = 11) y estudios de cohortes retrospectivos (n = 1). La suma de participantes en registros de ensayos clínicos fue de 1,318. Un 58,3 % (7/12) de los registros de ensayos clínicos aún no están reclutando la población de estudio, el 25 % (3/12) son estudios de fase 2 y solo un estudio se encuentra actualmente en la fase cuatro. Conclusiones. La evidencia apoya el uso de ketamina para el tratamiento de la depresión refractaria. Los efectos adversos son generalmente leves y autolimitados, aunque los efectos adversos más complejos requieren vigilancia por parte de personal experimentado. Son necesarios estudios experimentales que comparen la eficacia y seguridad de la ketamina frente a la terapia electroconvulsiva como tratamiento de primera línea de esta entidad.(AU)

Introduction. Ketamine is a fast-acting anesthetic with hypnotic properties. Moreover, could potentially improve affective symptoms in patients with refractory depressive disorder. Objective. explore the scientific literature available until December 10, 2021, about the efficacy and safety of ketamine in patients with treatment-refractory major depressive disorder. Material and methods. Scoping review that included PubMed and Scopus. Records of clinical trials and publications with empirical data in English and Spanish were included. Results. 31 documents and 12 clinical trial records were included: randomized clinical trials (n = 19), non-randomized clinical trials (n = 11) and retrospective cohort studies (n = 1). The sum of participants in clinical trial registries was 1,318. Some 58.3% (7/12) of the records of clinical trials are not yet recruiting the study population, 25% (3/12) are phase 2 studies and only one study is currently in phase four. Conclusions. The evidence supports the use of ketamine for the treatment of refractory depression. Adverse effects are generally mild and self-limited, although more complex adverse effects require monitoring by experienced personnel. Experimental studies are needed to compare the efficacy and safety of ketamine versus electroconvulsive therapy as the first-line treatment for this entity.(AU)

Adaptación cultural al español de laencuesta “Patient Satisfaction Survey”para valorar la satisfacción con laterapia electroconvulsiva (TEC) / Cultural adaptation to spanish of the “patient satisfaction survey” to assess satisfaction with electroconvulsive therapy (ECT)

Introducción. El grado de satisfacción de pacientes y familiares con la terapia electroconvulsiva (TEC) es un resultado importante del tratamiento, pero no existe ningún instrumento en español que lo cuantifique. El objetivo del estudio es traducir y adaptar culturalmente al español el instrumento “Patient Satisfaction Survey” (PSS)1 para pacientes y familiares. Metodología. La traducción inicial la realizaron dos traductores y la retrotraducción un tercer traductor. Se obtuvouna encuesta de consenso adaptada por el comité investigador y revisada por los autores del instrumento original. Para la adaptación cultural se valoró la equivalencia entre el instrumento original y la retrotraducción, la legibilidad de la encuesta y se ensayó la versión española en una muestra de pacientes, de familiares y de expertos en TEC. Se realizó el mismo proceso para la encuesta de satisfacción de los familiares o cuidadores. Resultados. Las encuestas finales en español se obtuvieron de forma consensuada tras completarse el proceso de traducción e identificarse ítems problemáticos que se modificaron satisfactoriamente. La legibilidad de las encuestas fue muy accesible a la población española. La prueba piloto realizada en pacientes, familiares y expertos permitió detectar y modificar ítems confusos. Con los comentarios y los cambios realizados en esta prueba piloto se obtuvo la versión final de la traducción adaptada al español. Conclusiones. La traducción y adaptación realizada de la PSS para pacientes y familiares o cuidadores podría proporcionar unas escalas adecuadas de satisfacción con la TEC para su uso en español.(AU)

Introduction. The degree of satisfaction of patients and their relatives with electroconvulsive therapy (ECT) is considered an important treatment goal; however there is no scale in Spanish to quantify it. The aim of the study was to translate and adapt into Spanish the “Patient Satisfaction Survey” (PSS) for its use in patients and their relatives. Methodology. Two translators performed the initial translation and a third translator did the back translation. The research committee obtained a consensus survey; the authors of the original instrument reviewed and accepted this survey. The equivalence between the original instrument with the back translation and the readability of the survey were analyzed. The Spanish version was tested on a sample of patients, relatives and experts in ECT. The same process was carried out for the satisfaction survey of relatives or caregivers. Results. The Spanish surveys were obtained after completing the translation process and identifying the problematic items that were successfully modified. The readability of the surveys was very accessible to the Spanish population. The pilot test carried out on patients, relatives and experts allowed detection and changes of confusing items. The final Spanish surveys were obtained after this pilot test. Conclusions. The adaptation of the PSS for Spanish patients and relatives provide suitable satisfaction scale for its use in Spanish population.(AU)

Terapia electroconvulsiva de mantenimiento y recuperación de la disfunción cognitiva: a propósito de un caso de trastorno depresivo recurrente / Maintenance electroconvulsive therapy and cognitive disfunction recovery: A case of recurrent major depressive disorder

Objetivo: Cuestionar que la terapia electroconvulsiva (TEC) sea perjudicial a nivel cognitivo a medio y largo plazo en el trastorno depresivo recurrente.Caso clínicoSe presenta el caso de una mujer de 75 años con trastorno depresivo recurrente, resistente e intolerante a varios psicofármacos, descartada previamente para TEC por sospecha de deterioro cognitivo, pero incluida en junio de 2016 en el programa de TEC de mantenimiento (TEC-M), tras 10 sesiones de TEC aguda.ResultadosTras más de 30 sesiones de TEC-M la paciente se mantiene eutímica, recibiendo una sesión trimestral de TEC y mostrando recuperación de la disfunción cognitiva tanto en la valoración subjetiva como mediante test de screening.ConclusionesLa TEC-M es eficaz en ancianos con depresión y puede mejorar e incluso normalizar la función cognitiva. (AU)

Aim: Challenge the idea that electroconvulsive therapy (ECT) is cognitively detrimental in the medium and long term in recurrent depressive disorder.Clinical caseWe introduce the case of a 75-year-old woman with recurrent major depressive disorder, resistant and intolerant to various antidepressant drugs, previously ruled out for ECT due to suspected cognitive decline, but included in June 2016 in the maintenance-electroconvulsive therapy (M-ECT program), after 10 sessions of acute ECT.OutcomesAfter more than 30 sessions of M-ECT, the patient remains euthymic, receiving a quarterly session of ECT and showing recovery from cognitive dysfunction both in the subjective assessment and through the screening test.Main findingsM-ECT is effective in the elderly with major depression, and may improve and even normalize cognitive function. (AU)

Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression.

INTRODUCTION: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Clinical Experience of Electroconvulsive Therapy with Anaesthetic and Muscle Relaxant at the Clínica Universidad de La Sabana: 2009-2017. / Experiencia clínica de la terapia electroconvulsiva con anestesia y relajación en la Clínica Universidad de La Sabana: 2009-2017.

INTRODUCTION: Electroconvulsive therapy is an effective and safe procedure, which is indicated mainly in patients with both unipolar and bipolar depressive episodes, mania and schizophrenia, when they do not respond to other treatments. OBJECTIVE: To describe the demographic, social and clinical properties of a group of patients treated with electroconvulsive therapy (ECT) with anaesthetic and muscular relaxant at the Universidad de La Sabana Clinic for a period of 8 years. METHODS: The databases and records of the procedures were reviewed from 1 January 2009 to 31 December 2017. An analysis was performed with descriptive statistics. RESULTS: In this period, 1,322 procedures were performed on 143 patients (54.5% women) with an associated diagnosis of major depression in 57%. The number of treatments per person was 9.2 and complications occurred in 3.8%, without any of them requiring invasive management. CONCLUSIONS: Electroconvulsive therapy is performed safely in patients and with different parameters in terms of age, gender and diagnosis, in comparison to other countries in Latin America and the world. It is important to join efforts in research that allow a more complete overview of the characteristics of its application in the country.

Nota Clínica: Trastorno bipolar en xantomatosis cerebrotendinosa: a propósito de un caso / Clinical Note: Bipolar disorder in Cerebrotendinous Xanthomatosis: a case report

La xantomatosis cerebrotendinosa (XCT) es una rara enfermedad autosómica recesiva que puede cursar con manifestaciones psiquiátricas cuyo tratamiento puede resultarcomplejo. Presentamos el caso de una mujer de 29 años, diagnosticada de XCT, que desarrolló un trastorno bipolar queno respondió a tratamiento farmacológico, precisando terapia electroconvulsiva (TEC), cuyo resultado fue positivo. Alser la XCT una enfermedad rara, existe poca evidencia sobreel abordaje farmacológico de la sintomatología psiquiátricaque puede aparecer en el curso de la enfermedad. En estesentido, planteamos que la TEC pueda ser una opción de tratamiento segura y eficaz. (AU)

Cerebrotendinous X anthomatosis (CTX) is a rare autosomal recessive disorder presenting with possible psychiatricmanifestations that, once established, are difficult to control. We present the case of a 29-year-old woman diagnosedwith CTX who developed bipolar disorder. Owing to difficulties in pharmacological management, the patient underwentelectroconvulsive therapy (ECT), which lead to a favorableoutcome. Little is known about the treatment of psychiatricsymptoms of CTX, un uncommon disorder, though ECT maybe an effective and safe approach. (AU)

Panorama general de la terapia electroconvulsiva: indicaciones y funcionamiento / Electroconvulsive Therapy Overview: Indications and How it Works

Resumen La terapia electroconvulsiva (TEC) constituye una de las modalidades terapéuticas disponibles para el tratamiento de padecimientos psiquiátricos como depresión, manía, esquizofrenia y estados de catatonia. Incluso se considera la terapia con resultados más eficaces y rápidos para pacientes con padecimientos como depresión resistente, ideación suicida recurrente, psicosis aguda y padecimientos que llegan a ser mortales como el síndrome neuroléptico maligno. La TEC es una terapia de estimulación cerebral en la cual la respuesta terapéutica se logra a través de la generación de un estímulo eléctrico con una intensidad suficiente para producir una crisis convulsiva encefálica controlada, logrando una respuesta neurobiológica y neuroquímica positiva favorable. Este artículo enfoca la utilidad de la TEC en el tratamiento de distintos padecimientos neuropsiquiátricos, sus principios fisiopatológicos, la técnica utilizada, sus principales complicaciones y, sobre todo, una descripción global de su utilización, su eficacia y seguridad, así como la experiencia de su uso en nuestra institución. Constituye uno de los pocos artículos en México con este contenido que consideramos fundamental como parte del conocimiento de todos los profesionales de la salud.

Abstract The electroconvulsive therapy (ECT) constitutes one of the many treatment modalities available for management of psychiatric illnesses like depression, mania, schizophrenia, and catatonic states. It is even considered the single most effective and fastest treatment modality for patients with conditions like antidepressant-resistant depression, recurring suicidal ideations, acute psychoses, and potentially fatal conditions like malignant neuroleptic syndrome. ECT is a brain-stimulation therapy in which the therapeutic goal can be achieved through generating an electrical stimulus with enough intensity to produce a controlled seizure, achieving a positive and favorable neurobiological and neurochemical response. This article focuses on the use of ECT in treating the various neuropsychiatric conditions, its pathophysiological principles, the employed technique, its main complications and overall a description of its use, its efficiency and safety, as to the experience of its employment in our institution. This comprises one of the few articles in Mexico with this kind of content that we deem fundamental as part of the general knowledge for healthcare professionals.

Anaesthesia in electroconvulsive therapy. Special conditions.

OBJECTIVES: Electroconvulsive therapy (ECT) is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drug-resistant depression. The pre-anaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. The present review aims to propose guidelines to achieve a higher level of safety and effectiveness during ECT in the most frequent situations, in accordance with the current literature. METHODS: We conducted a search on the role of anaesthesia in ECT in the Ovid MEDLINE, PubMed, and SciELO (Scientific Electronic Library Online) databases, with special attention to the populations undergoing this type of therapy. The search was carried out between 1978 and December 2016. RESULTS: We included the 96 articles that contained the most important recommendations for the preparation of this guide. CONCLUSIONS: We propose these guidelines in order to achieve a higher level of safety and effectiveness during ECT in special conditions. We also summarize the most important attitude to be taken into account by the anaesthesiologist in these cases.

Clinical outcome after discontinuation of maintenance Electroconvulsive Therapy. A retrospective follow-up study. / Evolución clínica tras la discontinuación de la terapia electroconvulsiva de mantenimiento. Estudio de seguimiento retrospectivo.

INTRODUCTION: Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS: Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS: Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS: The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse.

Terapia Electroconvulsiva y Estimulación Magnética Transcraneal Repetitiva en pacientes con esquizofrenia: una revisión sistemática / Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in patients with schizophrenia: a systematic review

Cuando la esquizofrenia no responde satisfactoriamente a tratamiento farmacológico, alcanzar una terapia efectiva para el paciente es una tarea bastante frustrante para el médico psiquiatra. Es en este contexto que la terapia electroconvulsiva y la estimulación magnética transcraneal repetitiva han tomado fuerza en la investigación clínica, a pesar de los grandes cuestionamientos sobre su efectividad y mala reputación. Se realizó una revisión sistemática de la literatura en las principales bases de datos disponibles. Concluyendo que ambas terapias demuestran ser herramientas útiles en el tratamiento de la esquizofrenia resistente a tratamiento farmacológico, así como también complementarias a los antipsicóticos

When schizophrenia does not respond satisfactorily to pharmacological treatment, achieving effective therapy for the patient is quite a frustrating task for the psychiatrist. It is in this context that electroconvulsive therapy and repetitive transcranial magnetic stimulation have gained strength in clinical research, despite huge questions about its success and bad reputation. A systematic review of the literature was conducted in the main available databases. Concluding that both specific therapies will be useful tools in the treatment of schizophrenia resistant to pharmacological treatment, as well as complementary to antipsychotics.

Convulsoterapias na prática psiquiátrica brasileira / Convulsive therapy in Brazilian psychiatric practice / Convulsoterapia en la práctica psiquiátrica brasileña

Contexto: Nas décadas de 1920-40, a psiquiatria tradicional no Brasil apostava na prática de convulsoterapias como tratamento inovador para reduzir sintomas das doenças mentais. Objetivo: Analisar as técnicas de aplicação de convulsoterapias em dois periódicos médicos. Metodologia: Estudo documental, qualitativo, cujas fontes históricas foram os Arquivos Brasileiros de Neurologia e Psiquiatria (ABNP) e os Anais do Instituto de Psiquiatria (IPUB) de 1928 a 1947. Para análise crítica foi feita a triangulação dos dados e organização temática. Resultados: Foram encontradas 27 publicações em ambos os periódicos. As publicações encontradas foram agrupadas de acordo com as técnicas utilizadas [choque cardiazólico (14); malarioterapia (5); choque insulínico (4); choque cardiazólico associado ao choque insulínico (2); eletroconvulsoterapia (1); choque cardiazólico associado a eletroconvulsoterapia (1)]. Conclusão: Os periódicos pesquisados contribuíam para a difusão do desenvolvimento científico sobre as terapias biológicas, publicando estudos que norteavam a sua aplicação, visando estabelecer um sentido entre as doenças mentais, os seus sintomas e os efeitos de cada uma das técnicas convulsivas de tratamento, sem mencionar explicitamente a participação da enfermagem.

Context: From 1920 to 40, traditional psychiatry in Brazil focuses on convulsive practices as an innovative treatment to reduce symptoms of mental illness. Objective: To analyze the techniques of application of convulsive therapies disclosed in two major medical journals. Methodology: Documental study, with a qualitative approach. The historical sources were the Brazilian Archives of Neurology and Psychiatry (ABNP) and the Annals of the Institute of Psychiatry (IPUB) from 1928 to 1947. Critical analysis was based on data triangulation and thematic organization. Results: Twenty-seven publications were found in both journals. The publications were gathered in groups according to the techniques used [cardiazolic shock (14); malariotherapy (5); insulin shock (4); cardiazolic shock associated with insulin shock (2); electroconvulsive therapy (1); cardiazolic shock associated with electroconvulsive therapy (1)]. Conclusion: The journals had contributed to the dissemination of scientific development on the biological therapies, with the publishing of studies to guide their implementation. They aimed to establish correlations between mental illnesses, their symptoms, and the effects of each convulsive treatment technique, without any explicit reference to the participation of nursing professionals.

Marco contextual: En las décadas de 1920-40, la psiquiatría tradicional en Brasil apostaba por la práctica de la convulsoterapia como tratamiento innovador para reducir los síntomas de las enfermedades mentales. Objetivo: Analizar las técnicas de aplicación de la convulsoterapia en dos fuentes médicas. Metodología: Estudio documental, cualitativo, cuyas fuentes históricas fueron los Archivos Brasileños de Neurología y Psiquiatría (ABNP) y los Anales del Instituto de Psiquiatría (IPUB) de 1928 a 1947. Para el análisis crítico se realizó la triangulación de los datos y la organización temática. Resultados: Se encontraron 27 publicaciones en ambas fuentes. Las publicaciones encontradas se agruparon de acuerdo con las técnicas utilizadas: choque cardiazólico (14); malarioterapia (5); choque insulínico (4) [choque cardiazólico asociado al choque insulínico (2); electroconvulsoterapia (1); choque cardiazólico asociado a la electroconvulsoterapia (1)]. Conclusión: Las fuentes utilizadas contribuyeron a difundir el desarrollo científico sobre las terapias biológicas, así como a publicar estudios que orientaban su aplicación con el objetivo de establecer un sentido entre las enfermedades mentales, sus síntomas y los efectos de cada una de las técnicas convulsivas de tratamiento, sin mencionar explícitamente la participación de la enfermería.