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1.
Psychiatr Danub ; 33(3): 328-333, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795174

RESUMO

BACKGROUND: Although the efficacy of electroconvulsive therapy (ECT) has been well established, the utilization rate of ECT has decreased in Poland in recent years. One of the main reasons could be the negative attitude towards ECT in the community and by mental health professionals. The aim of this study was to assess the knowledge about and attitudes toward ECT in Polish mental health professionals including psychiatrists and non-physicians: nurses, psychologists, social workers. SUBJECTS AND METHODS: Psychiatrists and other mental health professionals in two large Polish hospitals were approached to participate in the survey by completing a 28-item questionnaire. The specific hospitals have been selected due to the fact that they were located in the same province of Poland (Mazowsze), had similar catchment area and profile, provided similar mental health services with only one exception; one offered ECT while the other did not. Of the 185 questionnaires that had been distributed, 165 were completed yielding a response rate of 89.19%. The study population consists of 85 psychiatrists and trainees and 80 non-physicians. RESULTS: Psychiatrists did not differ from other mental health professionals with respect to the knowledge and attitudes toward ECT. However, there were significant differences in the attitude (9.1±3.8 vs 7.1±3.3; p<0.001) and knowledge (5.9±3.8 vs 2.8±4.1; p<0.001) scores between those professionals, who have ever worked in a psychiatric ward where they could observe ECT sessions and those who have not had such an opportunity. CONCLUSIONS: Frequent witnessing of ECT sessions seems to be the most effective educational intervention to change negative attitudes towards ECT.


Assuntos
Eletroconvulsoterapia , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Saúde Mental , Polônia , Inquéritos e Questionários
2.
Neurol India ; 69(5): 1374-1379, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747817

RESUMO

New-onset refractory status epilepticus (NORSE) describes prolonged or recurring new onset seizures which fail to respond to antiseizure medications. NORSE poses a challenge in diagnosis and treatment, and limited high-quality evidence exists to guide management. The efficacy of Electroconvulsive therapy (ECT) in aborting refractory status epilepticus has been described in case reports, but its application remains uncommon, particularly in young children. We describe a case of NORSE in a 3-year old child in which ECT played an important role in aborting status epilepticus, facilitating the diagnosis and surgical excision of an underlying focal cortical dysplasia. Although further research is needed, our case suggests that ECT can be a valuable tool in the treatment of refractory status epilepticus in children.


Assuntos
Eletroconvulsoterapia , Estado Epiléptico , Criança , Pré-Escolar , Humanos , Recidiva , Estado Epiléptico/terapia
3.
Trials ; 22(1): 786, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749782

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is well-established and effective for treatment-resistant depression (TRD), but in Canada and the USA, less than 1% of patients with TRD receive ECT mainly due to its cognitive adverse effects (i.e. amnesia). Thus, new treatment alternatives for TRD are urgently needed. One such treatment is magnetic seizure therapy (MST). ECT involves applying a train of high-frequency electrical stimuli to induce a seizure, whereas MST involves applying a train of high-frequency magnetic stimuli to induce a seizure. METHODS: In this manuscript, we introduce our international, two-site, double-blinded, randomized, non-inferiority clinical trial to develop MST as an effective and safe treatment for TRD. This trial will compare the efficacy of MST to right unilateral ultra-brief pulse width electroconvulsive therapy (RUL-UB-ECT) with a combined primary endpoint of remission of depression and superior cognitive adverse effects in 260 patients with TRD. Amelioration of suicidal ideation will be assessed as a secondary endpoint. Inpatients or outpatients, over 18 years of age with a MINI International Neuropsychiatric Interview (MINI) diagnosis of non-psychotic major depressive disorder (MDD) can be enrolled in the study provided that they meet illness severity and full eligibility criteria. Participants are randomized to receive MST or RUL-UB ECT, 2-3 days per week over seven weeks, or a maximum of 21 treatments. The study will involve before-, during-, and after-treatment assessments of depression severity, suicidal ideation, subjective side-effects, and cognitive performance consistent with an intent-to-treat study design approach. DISCUSSION: Positive results from this trial could have an immediate and tremendous impact for patients with TRD. If MST demonstrates comparable antidepressant treatment efficacy to ECT, but with greater cognitive safety, it could rapidly be adopted into clinical practice. Indeed, given that the administration of MST is nearly identical to ECT, the majority of ECT facilities in North America could readily adopt MST. Furthermore, the potential for cognitive safety could lead to improved treatment acceptability. Healthcare providers, patients and care partners, and policymakers would therefore demand this form of convulsive therapy. TRIAL STATUS: Enrollment for this study began on June 26, 2018, and is estimated to complete recruitment by July 2024. At the time of submission, we have enrolled and randomized 117 participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT03191058 , Registered on June 19, 2017. Primary sponsor: Daniel Blumberger (DMB), Principal Investigator Daniel.Blumberger@camh.ca , 416-535-8501 x 33662 Contact for public queries: DMB, Daniel.Blumberger@camh.ca Contact for scientific queries: ZJD, Zdaskalakis@health.ucsd.edu.


Assuntos
Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Eletroconvulsoterapia , Adolescente , Adulto , Depressão , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Convulsões/diagnóstico , Convulsões/terapia , Resultado do Tratamento
4.
Tijdschr Psychiatr ; 63(9): 673-678, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34647306

RESUMO

BACKGROUND: Often anorexia nervosa occurs with other psychiatric comorbidities of which mood disorders are the most frequent. Depressive feelings hamper the chance of a favourable outcome of this persistent disorder. In addition, the underweight makes antidepressants work suboptimal. Electroconvulsive therapy (ECT) offers an important therapeutic value in the treatment of mood disorders. We are investigating whether ECT can be an effective treatment method for patients with anorexia nervosa and major depressive disorder. AIM: Analysis of the literature on the possible effectiveness of electroconvulsive therapy (ECT) in the treatment of major depressive disorder and anorexia nervosa supplemented with a case report. METHOD: Literature study in PubMed, Web of Science and Embase and a case report. RESULTS: 262 published articles were found between 1955 and 2020, 16 were found to be relevant. CONCLUSION: From the literature, clinical recommendations cannot be made binding. No randomized controlled trials have been published on this subject. However, we saw in our case study and in the literature found that clearing the depressive symptoms through electroconvulsive therapy led to an improvement in food and fluid intake. ECT has no effect on their deranged thought pattern.


Assuntos
Anorexia Nervosa , Transtorno Depressivo Maior , Eletroconvulsoterapia , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Resultado do Tratamento
5.
Transl Psychiatry ; 11(1): 516, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625534

RESUMO

Electroconvulsive therapy (ECT) is of the most effective treatments available for treatment-resistant depression, yet it is underutilized in part due to its reputation of causing cognitive side effects in a significant number of patients. Despite intensive neuroimaging research on ECT in the past two decades, the underlying neurobiological correlates of cognitive side effects remain elusive. Because the primary ECT-related cognitive deficit is memory impairment, it has been suggested that the hippocampus may play a crucial role. In the current study, we investigated 29 subjects with longitudinal MRI and detailed neuropsychological testing in two independent cohorts (N = 15/14) to test if volume changes were associated with cognitive side effects. The two cohorts underwent somewhat different ECT study protocols reflected in electrode placements and the number of treatments. We used longitudinal freesurfer algorithms (6.0) to obtain a bias-free estimate of volume changes in the hippocampus and tested its relationship with neurocognitive score changes. As an exploratory analysis and to evaluate how specific the effects were to the hippocampus, we also calculated this relationship in 41 other areas. In addition, we also analyzed cognitive data from a group of healthy volunteers (N = 29) to assess practice effects. Our results supported the hypothesis that hippocampus enlargement was associated with worse cognitive outcomes, and this result was generalizable across two independent cohorts with different diagnoses, different electrode placements, and a different number of ECT sessions. We found, in both cohorts, that treatment robustly increased the volume size of the hippocampus (Cohort 1: t = 5.07, Cohort 2: t = 4.82; p < 0.001), and the volume increase correlated with the neurocognitive T-score change. (Cohort 1: r = -0.68, p = 0.005; Cohort 2: r = -0.58; p = 0.04). Overall, our research indicates that novel treatment methods serving to avoid hippocampal volume increase may result in a better side effect profile.


Assuntos
Transtornos Cognitivos , Eletroconvulsoterapia , Cognição , Hipocampo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética
6.
Zhonghua Yi Xue Za Zhi ; 101(39): 3221-3226, 2021 Oct 26.
Artigo em Chinês | MEDLINE | ID: mdl-34689534

RESUMO

Objective: To explore the effect of modified electroconvulsive therapy (MECT) on resting-state functional connectivity (RSFC) in patients with major depressive disorder (MDD). Methods: Patients with MDD from Anhui Mental Health Center from October 2017 to May 2019 were included. Using bilateral nucleus accumbens (NAcc) as seed points, changes of RSFC were investigated before and after MECT through resting-state functional magnetic imaging (fMRI). Antidepressant effects were measured by 17 items of Hamilton Depressive Rating Scale (HDRS-17). Correlation analysis was performed between changed HRSD-17 scores and changes of functional connectivity. Results: A total of 40 MDD patients (10 males and 30 females), aged (38±11) years, who received MECT were included in the study. After MECT, patients showed increased RSFC in the right NAcc (rNAcc) and superior frontal gyrus (P<0.001), right supramarginal gyrus (P<0.001), right angular gyrus (rAG) (P= 0.017), right inferior parietal lobule (P= 0.017), left superior frontal gyrus (LSFG) (P<0.001), left middle temporal gyrus (P=0.017) and left angular gyrus (LAG) (P=0.012), respectively. The RSFC changes of rNAcc-LSFG (r=-0.454, P = 0.003), rNAcc-rAG (r=-0.437, P=0.005) and rNAcc-lAG (r=-0.383, P=0.015) were negatively correlated with the changes of HRSD-17 scores. Conclusions: MECT may alleviate major depression by regulating the functional connectivity between the rNAcc and bilateral angular gyrus and left superior frontal gyrus.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Encéfalo/diagnóstico por imagem , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Córtex Pré-Frontal , Lobo Temporal
7.
Asian J Psychiatr ; 66: 102874, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34624745

RESUMO

Available literature remains limited in the identification of risk factors for prolonged seizures in electroconvulsive therapy and much less is reported about the continuation of electroconvulsive therapy after prolonged seizures. We describe two cases with prolonged seizures early in their course of electroconvulsive therapy and the subsequent adjustment made that allowed for safe and effective continuation of electroconvulsive therapy. In both cases, right unilateral electroconvulsive therapy was continued at a suprathreshold stimulus dose of six times relative to seizure threshold. Both patients continued their course of electroconvulsive therapy with no further episodes of prolonged seizures. They did not experience significant cognitive side effects and were discharged after showing marked improvement in their clinical symptoms. Prolonged seizures do not preclude the use of electroconvulsive therapy. The selection of ultrabrief right unilateral electroconvulsive therapy allows for a higher suprathreshold dose with less cognitive side effects compared to bilateral placements. This mitigates the risk of prolonged seizures, allowing for safe and effective continuation of electroconvulsive therapy.


Assuntos
Eletroconvulsoterapia , Humanos , Convulsões , Resultado do Tratamento
8.
Acta Psychiatr Scand ; 144(6): 599-625, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34523119

RESUMO

OBJECTIVE: The primary aim was to determine whether electroconvulsive therapy (ECT) is associated with reduced risk of psychiatric readmission in major depressive disorder (MDD). METHODS: This study was based on data from multiple Swedish population-based registries. All adult patients admitted to any Swedish hospital for moderate-to-severe MDD between 2012 and 2018 were included. Participants were divided into two groups depending on whether they received ECT during inpatient care. Follow-up was set at 30 and 90 days from discharge. Data were analyzed using logistic regression, and matching was conducted. RESULTS: A total of 27,851 unique patients contributed to 41,916 admissions. ECT was used in 26.8% of admissions. In the main multivariate analysis, the risk of both 30- and 90-day readmission was lower in the ECT group than in the non-ECT group. In a matched sensitivity model, the results pointed in the same direction for readmission risk within 30 days, but statistical significance was not reached. ECT-treated subgroups with superior outcomes on readmission risk compared with non-ECT treatment were older, unemployed, married, or widowed patients, those treated with antipsychotics or benzodiazepines before admission, with psychotic features, prior psychiatric hospitalizations, or family history of suicide. However, in patients below 35 years of age, ECT was associated with increased readmission risk. CONCLUSION: This study suggests that ECT reduces the risk of psychiatric readmission in certain subgroups of patients with MDD. Since patients receiving ECT tend to be more difficult to treat, there is a risk of residual confounding.


Assuntos
Antipsicóticos , Transtorno Depressivo Maior , Eletroconvulsoterapia , Suicídio , Adulto , Antipsicóticos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/terapia , Humanos , Readmissão do Paciente
9.
Brain Behav ; 11(8): e02001, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34342142

RESUMO

OBJECTIVES: Vascular endothelial growth factor (VEGF) has been related to the etiology of major depressive disorder (MDD). The findings involving the effects of electroconvulsive therapy (ECT) on the VEGF levels have been conflicting. The aim was to examine the possible changes in the VEGF levels and their associations with clinical outcome in patients with MDD during ECT. METHODS: The study comprised 30 patients suffering from MDD. Their plasma VEGF levels were measured at baseline and 2 and 4 hr after the first, fifth, and last ECT session. The severity of depression was quantified by the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: The VEGF levels increased between the 2-hr and 4-hr measurements during the first (p = .003) and the fifth (p = .017) sessions. The baseline VEGF levels between individual ECT sessions remained unchanged during the ECT series. No correlations were found between the increased VEGF levels and the clinical outcome. CONCLUSIONS: Electroconvulsive therapy increased the VEGF levels repeatedly at the same time point in two different ECT sessions. These increases had no association with the response to ECT. Consequently, VEGF may act as a mediator in the mechanism of action of ECT.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Transtorno Depressivo Maior/terapia , Humanos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular
11.
Transl Psychiatry ; 11(1): 437, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34420033

RESUMO

Magnetic seizure therapy (MST) has established efficacy in the treatment of depression and a growing evidence base in the treatment of depression. We conducted the first systematic review and meta-analysis of the efficacy of MST in anti-depressive treatment and its impact on cognitive function (INPLASY registration number: INPLASY202170061). We searched for controlled trials published in English between 1 January 2001 to 31 December 2020 in PubMed, EMBASE, Cochrane Library, Web of Science, and PsycINFO databases. The evaluation process strictly followed the Cochrane bias risk assessment tool into the literature, and Meta-analysis was performed according to the Cochrane System Reviewer's Manual. Data from a total of 285 patients from 10 studies were retained in the quantitative synthesis. The results showed no significant difference between MST and ECT in the antidepressant effect (SDM -0.13 [-0.78;0.52]). Compared with ECT, MST showed shorter recovery time (MD -5.67 [-9.75; -1.60]) and reorientation time (MD -14.67 [-27.96; -1.41]); and MST showed less cognitive impairment on the immediate recall of words (SDM 0.80 [0.35;1.25]), delayed recall of words (SDM 0.99 [0.01;0.74]), visual-spatial immediate memory (SDM 0.51 [0.20;0.83]), visual-spatial delayed memory (SDM 0.57 [0.11;1.02]), and the verbal fluency (SDM 0.51 [0.20;0.83]). Our evidence-based study is the first meta-analysis on the efficacy of MST in anti-depressive treatment and its effect on cognitive function. It showed that the curative effect of MST in anti-depressive treatment is equivalent to that of ECT. Besides, depressive patients with MST benefit more from cognitive function compared with ECT.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Cognição , Transtorno Depressivo Maior/terapia , Humanos , Memória , Convulsões
12.
Psychiatry Res ; 304: 114149, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34384943

RESUMO

Patients receiving mood stabilizers such as valproate (VAL) and carbamazepine (CMZP)/Oxcarbazepine (OX) may be referred for electroconvulsive therapy (ECT). The relative effects of these anticonvulsants on seizure threshold and seizure duration are unknown. We extracted data for a 20-month period from the medical records of patients who received bilateral ECT while on treatment with VAL (n=102) or CMZP/OX (n=31; 20 on CMZP, 11 on oxcarbazepine). Age-matched ECT-treated anticonvulsant-free patients (n=133) formed the control group. Seizure threshold in these patients had been determined by stimulus dose titration. The effect of VAL vs CMZP/OX on seizure threshold was examined using multivariable regression with adjustment for confounders. The mean (standard deviation) seizure threshold at the first ECT was highest in the CMZP/OX group (243.9 [106.1] mC), intermediate in the VAL group (177.7 [97.0] mC), and lowest in the control group (138.7 [86.0 Mc]). The regression model explained 37.5% of the variance in seizure threshold at the first ECT. Age, use of CMZP/OX, and anticonvulsant dose were each significantly associated with higher seizure threshold. CMZP/OX was associated with a higher initial ECT seizure threshold than VAL. ECT practitioners may prefer to start with a higher initial stimulus dose in patients receiving CMZP/OX or VAL, and more so for CMZP/OX than VAL, to avoid repeated sub-convulsive stimuli being administered.


Assuntos
Eletroconvulsoterapia , Ácido Valproico , Carbamazepina , Humanos , Oxcarbazepina , Convulsões
13.
Psychiatry Res ; 304: 114169, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34425459

RESUMO

Episode chronicity and medication failure are considered robust predictors of poor response to electroconvulsive therapy (ECT). In this study we explored the associations between indexes of drug exposure during current episode and outcomes of ECT in 168 bipolar depressive patients. The association between response or remission and number of previous pharmacological trials, failure of treatment with antidepressants, antipsychotics or combinations, and sum of maximum Antidepressant Treatment History Form (ATHF) scores obtained in each pharmacological class were tested. 98 patients (58%) were considered responders and 21 remitters (13%). Number of trials, number of adequate trials, ATHF sum, antidepressant-antipsychotic combination therapy failure and failure of two adequate trials were significantly negatively associated with remission. The association with ATHF sum stayed significant when controlling for episode duration and manic symptoms and survived stepwise model selection. No significant associations with response were identified. In conclusion, a history of multiple drug treatments may be linked to a greater resistance to all types of therapies, including ECT. However, we could not exclude that, at least in some patients, a prolonged exposure to pharmacological treatments may be responsible for a greater chronicity and for the presence of residual symptoms, which would explain reduced remission after ECT.


Assuntos
Antipsicóticos , Transtorno Bipolar , Eletroconvulsoterapia , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Terapia Combinada , Humanos , Resultado do Tratamento
14.
Biomolecules ; 11(7)2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34356654

RESUMO

Clozapine is superior to other antipsychotics as a therapy for treatment-resistant schizophrenia and schizoaffective disorder with increased risk of suicidal behavior. This drug has also been used in the off-label treatment of bipolar disorder, major depressive disorder (MDD), and Parkinson's disease (PD). Although usually reserved for severe and treatment-refractory cases, it is interesting that electroconvulsive therapy (ECT) has also been used in the treatment of these psychiatric disorders, suggesting some common or related mechanisms. A literature review on the applications of clozapine and electroconvulsive therapy (ECT) to the disorders mentioned above was undertaken, and this narrative review was prepared. Although both treatments have multiple actions, evidence to date suggests that the ability to elicit epileptiform activity and alter EEG activity, to increase neuroplasticity and elevate brain levels of neurotrophic factors, to affect imbalances in the relationship between glutamate and γ-aminobutyric acid (GABA), and to reduce inflammation through effects on neuron-glia interactions are common underlying mechanisms of these two treatments. This evidence may explain why clozapine is effective in a range of neuropsychiatric disorders. Future increased investigations into epigenetic and connectomic changes produced by clozapine and ECT should provide valuable information about these two treatments and the disorders they are used to treat.


Assuntos
Antipsicóticos/farmacologia , Transtorno Bipolar/tratamento farmacológico , Clozapina/farmacologia , Transtorno Depressivo Maior/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/terapia , Clozapina/uso terapêutico , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/terapia , Esquizofrenia/terapia
15.
J Clin Psychiatry ; 82(4)2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34383392

RESUMO

Patients with major mental illness are at high risk of relapse if they discontinue acute or continuation phase pharmacotherapy. This may explain the high rates of relapse after the termination of an effective course of electroconvulsive therapy (ECT) or after the discontinuation of effective maintenance ECT (M-ECT). Two moderately large studies prospectively examined predictors of relapse in the context of ECT. The first study, conducted in 61 depressed patients who had remitted with ECT and who were maintained on individualized pharmacotherapy, found that 39% of the patients relapsed within a year, with most of the relapses occurring during the first 6 months. Older age and the presence of psychotic symptoms before ECT predicted a lower risk of relapse, and a bipolar II diagnosis and a larger number of previous depressive episodes predicted a higher risk of relapse. Lithium appeared to protect against relapse. The second study, conducted in 81 patients with different diagnoses, found that 44% of patients relapsed within 6 months of the abrupt, unplanned discontinuation of M-ECT; the median time to relapse was 8 weeks. Predictors of relapse were psychosis, receipt of a larger number of previous courses of ECT, and need for more frequent M-ECT. The methods and results of these studies are critically examined. Special mention is made of overfitting and confounding in data analysis in follow-up studies such as these. Overfitting happens when investigators use more predictor variables in their statistical model than the sample size allows for; overfitting results in overly optimistic models. Confounding happens when the statistical model excludes important explanatory variables, including variables such as the appropriateness and adequacy of maintenance pharmacotherapy, adherence to maintenance pharmacotherapy, the stress-support dimension, and interactions between important explanatory variables.


Assuntos
Eletroconvulsoterapia , Idoso , Seguimentos , Humanos , Recidiva
16.
J Clin Psychiatry ; 82(4)2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34352164

RESUMO

Anesthesia for electroconvulsive therapy (ECT) usually involves the intravenous (IV) administration of drugs such as methohexital, thiopental, propofol, etomidate, or ketamine. Sevoflurane is an inhalational anesthetic agent that has been available for the past 3 decades. Although many studies have examined sevoflurane in the context of ECT, treatment guidelines make either no mention or only passing mention of its potential use in the ECT procedure. A recent systematic review and meta-analysis identified 12 randomized clinical trials (pooled N = 377) of sevoflurane vs IV anesthetics in patients receiving ECT. The meta-analysis found that sevoflurane was associated with shorter EEG seizure duration than barbiturate, ketamine, or propofol anesthesia; that the postictal suppression index did not differ significantly between sevoflurane and propofol; that sevoflurane increased heart rate more than did the IV anesthetics; that sevoflurane increased mean arterial pressure more than did barbiturates and propofol but less than did ketamine; and that, overall, adverse events did not differ significantly between sevoflurane and IV anesthetics. Other known disadvantages of sevoflurane include the need for additional anesthesia instrumentation, the potentiation of action of nondepolarizing muscle relaxants, and the increased complexity of the ECT procedure. These findings and considerations do not encourage the use of sevoflurane for ECT anesthesia. However, there may be a niche role for sevoflurane in patients who are afraid of needlesticks or who are too agitated for an IV line to be set up while they are conscious and in patients who characteristically experience prolonged ECT seizures. Sevoflurane could also be useful in the final trimester of pregnancy because it may inhibit ECT-induced uterine contractions. Importantly, undesired effects of sevoflurane on seizure duration and the hemodynamic response to ECT can be attenuated by discontinuing its administration after induction.


Assuntos
Anestesia , Eletroconvulsoterapia , Humanos , Sevoflurano
17.
Curr Opin Anaesthesiol ; 34(5): 556-562, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34435599

RESUMO

PURPOSE OF REVIEW: The antidepressant effect of subanesthetic doses of ketamine was recognized 20 years ago. This review briefly summarizes the current understanding of the antidepressant mechanisms and the available clinical research on the use of racemic ketamine and enantiomer esketamine for depression. RECENT FINDINGS: The antidepressant effect of subanesthetic doses of ketamine is currently considered to be predominantly mediated by improved neuroplasticity in cortico-limbic areas in the brain. Single dose of 0.5 mg/kg of ketamine infused intravenously over 40 min, or single intranasal dose of esketamine cause rapid antidepressant and antisuicidal effects within hours of administration, and the antidepressant effect may last up to a week. Repeated administration of nasal spray esketamine is considered to prevent relapse of depression. Longitudinal studies are currently insufficient. When used in various doses for anesthetic induction for electroconvulsive therapy, ketamine improves seizure quality and may possibly diminish posttherapy cognitive impairment. SUMMARY: A rapid onset antidepressive effect of ketamine and esketamine has been proven conclusively. The results of extensive basic science research of the mechanism of action of low-dose ketamine doses has led to an alternative hypothesis of the pathophysiology of depression and the development of a novel neurotrophic concept of depression. Further longitudinal studies are warranted to determine the safety and efficacy of repeated administration of ketamine and its analogs to prevent relapse and recurrence of depression.


Assuntos
Eletroconvulsoterapia , Ketamina , Administração Intranasal , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Humanos
18.
J Med Case Rep ; 15(1): 406, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34389061

RESUMO

BACKGROUND: Catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in old age are poorly understood. We present a report of an older person whose catatonia was refractory to extensive treatment, and we identify important implications for the management of catatonia in old age. CASE PRESENTATION: We describe a 73-year-old white man with longstanding autistic spectrum disorder who presented with symptoms of depression. Following a period of diagnostic uncertainty and failure to improve with antidepressant medication, a lorazepam challenge yielded an abrupt improvement in presentation. The patient was treated extensively with lorazepam, zolpidem, and electroconvulsive therapy during his 16-month hospital admission, but his catatonia ultimately proved refractory to treatment. CONCLUSIONS: Catatonia should be considered promptly as a differential diagnosis in older people presenting with atypical features of functional mental illness. Although partial improvement of catatonic features was achieved using benzodiazepines and electroconvulsive therapy, these were not sustained in our patient. We identified comorbid autistic spectrum disorder, prolonged duration of catatonia, and sensitivity to benzodiazepines as important factors in prognostication in old age.


Assuntos
Catatonia , Eletroconvulsoterapia , Esquizofrenia , Idoso , Benzodiazepinas/uso terapêutico , Catatonia/diagnóstico , Catatonia/terapia , Humanos , Lorazepam/uso terapêutico , Masculino
19.
BMC Psychiatry ; 21(1): 408, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404384

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders, but is associated with acute hyperdynamic responses including transient hypertension and tachycardia. This study aimed to assess the effectiveness of premedication with dexmedetomidine for hemodynamic attenuation after ECT and to evaluate its effects on seizure duration, postictal asystole duration, post ECT agitation and recovery time. METHODS: Twenty-four psychiatric patients who underwent a total of 72 ECT sessions (three sessions per patient) were randomly allocated to receive either dexmedetomidine 0.5 mcg/kg intravenous, dexmedetomidine 1 mcg/kg intravenous, or saline (control group) 15 min before the first ECT session. The patients subsequently received the other two premedication options for their next two ECT sessions. Blood pressure and heart rate were recorded at 5, 10, and 15 min after drug infusion and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after ECT. Asystole duration, seizure duration, post ECT agitation and recovery times were also recorded. RESULTS: The baseline characteristics were similar between the groups. Systolic blood pressure in both dexmedetomidine groups was significantly lower than that in the control group after ECT (p = 0.002). Diastolic blood pressure and heart rate were significantly lower in the dexmedetomidine 1 mcg/kg group (p = 0.002 and p = 0.013, respectively) compared with the control group. Asystole duration, seizure durations, post ECT agitation and recovery times were similar between the groups. CONCLUSIONS: Dexmedetomidine 1 mcg/kg administered 15 min before ECT attenuated the hemodynamic response, including suppressing the systolic, diastolic and heart rate increases, during ECT without affecting recovery time. It also did not prolong the post-stimulus asystole duration. TRIAL REGISTRATION: TCTR20170715003 , registered at Thai Clinical Trials Registry (TCTR), principal investigator: Pattika Subsoontorn, date of registration: 15/07/2017.


Assuntos
Dexmedetomidina , Eletroconvulsoterapia , Pressão Sanguínea , Estudos Cross-Over , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Método Duplo-Cego , Humanos , Hipnóticos e Sedativos/uso terapêutico , Pré-Medicação
20.
Acta Psychiatr Scand ; 144(3): 215-217, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34397107
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