Shortened REM latency PostECT is associated with rapid recurrence of depressive symptomatology.

Electroconvulsive therapy (ECT) is highly effective in the treatment of major depressive disorder (MDD). The 1-year relapse rates are reported to be high and in the 30%-60% range, however. To test whether polysomnography (PS) can identify patients with a propensity for relapse we studied 20 patients, responders to a course of ECT, with PS studies. All patients met baseline diagnostic criteria for MDD, were treated with ECT following standardized protocols, had PS studies performed after the course of ECT in a medication-free state, received maintenance antidepressants postECT, and were followed periodically with phone interviews. The recurrence of depressive symptoms was determined at 3 months and 6 months after discharge. Fifty-five percent of the patients were symptomatic when evaluated 6 months after the ECT. Sleep Onset rapid eye movement (REM) periods were identified in 55% of the patients. As a group, patients who had experienced a recurrence of depressive symptoms by 6 months after discharge, had significantly shorter REM latencies after the course of ECT. A shorter REM latency after ECT identified patients who at six months demonstrated significant depressive symptomatology. Shortened REM latency after ECT in patients with MDD appears to be a correlate of vulnerability for relapse.

Sleep-onset rapid eye movement after electroconvulsive therapy is more frequent in patients who respond less well to electroconvulsive therapy.

The response to electroconvulsive therapy (ECT) was monitored with sleep polysomnography studies (SPS) performed pre- and post-ECT, in 25 patients with major depressive disorder (MDD). Patients included in this study met research diagnostic criteria for MDD and had been free of psychotropic medication for at least 10 days before SPS were performed. We compared ECT responders and nonresponders on SPS, demographic, and clinical parameters. Many SPS parameters, regardless of the clinical response, changed significantly with ECT. The presence of delusions was significantly associated with SOREM post-ECT. The presence of sleep-onset REM periods post-ECT was associated with poor response to ECT. SPS performed during a course of ECT may help identify patients at risk of responding less well to this modality of treatment.

Factor analysis of the English version of the Kategoriensystem für Partnerschaftliche Interaktion [Interaction Coding System].

The Kategoriensystem für Partnerschaftliche Interaktion (KPI), or Interaction Coding System, is an observational coding system used to study behaviors occurring during dyadic interactions. The KPI offers several summary categories (e.g. positive, negative, neutral) to facilitate data analysis, but empirical evidence supporting these rationally derived groupings is lacking. Reported here are the results of a factor analysis of data obtained from 121 spouses or other close relatives of patients with anxiety disorders who participated in dyadic problem-solving interactions with the patients. A three-factor solution accounting for 50% of the variance emerged. The factors were Negativity, Problem-Solving Focus and Emotional Engagement. Confidence in the reliability of the first two factors is bolstered by their similarity to factors detected in prior research on a different coding system, the Marital Interaction Coding System.

Formation of antisperm antibodies in women treated with fallopian tube sperm perfusion.

Fallopian tube sperm perfusion (FSP) is a combination of ovarian stimulation and intra-uterine insemination using a large volume (4 ml) of inseminate containing 10(7)-10(8) spermatozoa. The inseminate will flush the Fallopian tubes and some of it will end up in the pouch of Douglas. In the present study, we have investigated whether the FSP method will result in the formation of serum antisperm antibodies in the female. A total of 184 treatment cycles were given to 128 women. The indications for treatment were: unexplained infertility (n = 35), various infertility diagnoses (n = 28) and donor insemination (n = 65). Prior to treatment, 11 (8.6%) women had a positive tray-agglutination test (Friberg) and/or a positive immunobead test. After completing one to four treatment cycles, another six (4.7%) women had developed serum antisperm antibodies. The antibodies induced by the treatment were of isotype IgM and directed against the tail-tip of the spermatozoa. Two of the women, who prior to the treatment had antisperm antibodies, showed an increase in antibody titre during treatment. There was no statistically significant difference in the pregnancy rate between the women with antisperm antibodies and the women without. In our opinion, the small risk of developing antisperm antibodies is no contra-indication for treating infertile couples with FSP.

Sleep Electroencephalographic Studies After ECT.

Forty-one patients with major depressive disorder were treated with electroconvulsive therapy (ECT). Sleep polysomnography studies (SPSs) were performed after the course of ECT. The hypotheses tested were that age is a significant factor in post-ECT SPS results and that some SPS parameters are correlates of outcome of ECT. An interaction between age and response to ECT could not be identified; however, older patients demon strated significantly disrupted sleep post-ECT. Response to ECT was associated with lower REM activity and lower REM density. Sleep-onset REM periods post-ECT were observed in almost 50% of the patients regardless of age. The SPS monitoring of recovery after a course of ECT may identify sleep correlates of response to ECT and variables associated with poorer longitudinal outcome.

[Freezing, thawing and transfer of human embryos]. / Nedfrysing, tining og tilbakesetting av humane embryoer.

We present our experience of cryopreservation of human embryos from 1 July 1987 to 1 July 1989. During this period, 667 in vitro fertilizing cycles were completed. In 173 (26%) of these cycles, a total of 805 surplus embryos were cryopreserved. 516 embryos were thawed and 247 of these were transferred to the uterine cavity in a total of 110 replacement cycles. This resulted in 22 (20%) pregnancies in which a total of 28 gestational sacs could be verified by ultrasound. Seven of the pregnancies aborted spontaneously in the first trimester and one pregnancy was ectopic. By 1 July 1989, five singleton pregnancies were in progress and 13 babies had been born from nine deliveries (one set of triplets and two sets of twins). 25% of the patients whose embryos were cryopreserved became pregnant in the in vitro fertilizing cycle after replacement of fresh embryos.

Polysomnographic studies in patients referred for ECT: pre-ECT studies.

Forty-one patients referred for electroconvulsive therapy (ECT) were evaluated with a standardized clinical protocol and had polysomnographic studies performed pre-ECT after 10 or more days drug free. Clinical evaluations were performed by blind investigators and included the Research Diagnostic Criteria and the Hamilton Rating Scale for Depression (HRSD). Patients were categorized according to the clinical response. Thirty patients (73%) reached a post-ECT HRSD < or = 10, whereas 21 of them (51.2%) reached a post-ECT HRSD score < or = 6. Sleep-onset rapid eye movement (SOREM) periods were present in 27 (66%) of the patients. Few polysomnographic variables differentiated between excellent responders and patients with residual symptoms. Older patients had significantly more disrupted polysomnographic study parameters. Although present in a significant proportion of patients, baseline SOREM was not a factor in outcome.