Predictors of response to ultrabrief right unilateral electroconvulsive therapy.

BACKGROUND: Recent trials have demonstrated clinically meaningful efficacy and minimal cognitive side effects with ultrabrief pulsewidth right unilateral (RUL) ECT. In many countries it is gradually being adopted into clinical practice and further information on predictors of response is needed. METHODS: Data collected from 75 depressed patients who received ultrabrief RUL ECT in a prospective research trial were analysed for predictors of response. Mood improvement was assessed with the Montgomery-Asberg Depression Rating Scale. Improvement in unipolar versus bipolar depression was analysed. RESULTS: Sixty-one percent of patients met the criteria for response and 36% met the criteria for remission. Logistic regression identified index episode duration ≥one year (OR=10.50, p=.006), fewer failed antidepressant treatments (OR=0.46, p=.003), previous ECT course (OR=7.33, p=.01), and absence of concurrent antidepressant (OR=0.09, p=.005) as predictors of response. Psychotic features (OR=7.18, p=.032) and baseline depression severity (OR=0.90, p=.017) were predictors of remission. There was a trend towards greater improvement in bipolar than unipolar depression in the first week of treatment (p=0.077). LIMITATIONS: Data were obtained from a prospective but non-randomised clinical trial which was designed to evaluate efficacy rather than to examine predictors of response. Treatment decisions (concurrent medication, switching to other types of ECT) were made on clinical grounds. CONCLUSIONS: This preliminary study suggests that predictors of response for ultrabrief RUL ECT are similar to those identified for other types of ECT previously studied.

Learned avoidance of flavors signaling reduction in a nutrient.

Food-deprived rats learned to avoid a flavor negatively correlated with access to a rich nutrient, 20% maltodextrin (20M) solution. This avoidance in two-bottle choice tests was produced by training consisting of either an unpaired condition where sessions of unflavored 20M were intermixed with sessions of 2 or 3% maltodextrin (2M or 3M) flavored with salt (Experiment 1) or almond (Experiments 3 and 4) or a differential conditioning procedure where one flavor was mixed with 20M and another with 2M (Experiment 2). Avoidance was counter-conditioned by mixing the target flavor with 20M (Experiment 1), generalized to a neutral context (Experiment 3), and displayed strong resistance to extinction (Experiment 4). The results demonstrated that food avoidance learning can occur in the absence of an aversive unconditioned stimulus and indicated that unpaired control groups and differential conditioning procedures may be misleading in flavor preference learning research when further control conditions are absent.

Low dose lignocaine added to propofol does not attenuate the response to electroconvulsive therapy.

BACKGROUND: The addition of small amounts of lignocaine (50 mg) to propofol (200 mg) has been previously shown to reduce pain in injection, a common problem with this particular anaesthetic agent. The aim of this study was to investigate whether using the mixture of propofol plus lignocaine had any adverse effects on ECT seizure expression (duration, and ictal quality). METHOD: Ictal EEG records were retrospectively examined in 29 patients who underwent 80 pairs of ECT treatments, one given with propofol alone and one with propofol plus lignocaine. Ictal quality was manually rated for the transition from the polyspike phase to the slow wave phase, amplitude of the mid-ictal spike-and-wave phase, regularity of morphology of the predominant pattern of the slow wave phase, stereotypy, variability of the morphology and amplitude of the slow wave phase and post-ictal suppression. RESULTS: There was no significant difference in seizure duration between the two groups (33.4+/-13.0 s (propofol) vs. 33.6+/-11.2 s (propofol plus lignocaine). Furthermore although the addition of lignocaine delayed the onset of the slow wave phase by about 1s, it resulted in an improvement in three of four of the other measures of ictal quality. CONCLUSION: The addition of a small dose of lignocaine to propofol during ECT treatment enhanced rather than reduced the quality of the seizures produced.