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Electroconvulsive Therapy (ECT) and Race: A Report of ECT Use and Sociodemographic Trends in Texas 电痉挛治疗(ECT)和种族:德克萨斯州ECT使用和社会人口趋势报告
Pub Date : 2017-06-01 DOI: 10.1097/YCT.0000000000000379
J. Williams, L. Chiu, Robin K. Livingston
Objectives Minimal research on race and other sociodemographic disparities in patients receiving electroconvulsive therapy (ECT) exists. One previously noted national trend reveals whites receiving ECT disproportionately more than other races. The aim of this study is to determine whether a county ECT program demonstrates similar disparities observed at the state and national levels. Methods This study examined 21 years of ECT data, between 1993 and 2014, provided by the Texas Department of State Health Services, focusing on race, sex, age, and payer source and 2.5 years of the same variables from a Harris County hospital ECT program. In addition, population demographic data for Harris County and the state of Texas during the same period were obtained from the Department of State Health Services Web site. Results Despite an overall decrease in the population of whites countywide and statewide, whites continue to use more ECT than African Americans, Latinos, and Asians in both Harris County and Texas. However, the rates of ECT use in minorities increased overall. Both countywide and statewide, ECT was used more than twice as often in women than men. Statewide, elderly patients (>65 years old) saw decreases in ECT use, and there was an increase in private third-party payer source. Conclusions Electroconvulsive therapy remains underused among African Americans, Latinos, and Asians. Hypotheses and areas for future study include cultural beliefs, stigma, patient and provider knowledge of ECT, and access to care. Despite this, the general use of ECT in Texas has increased overall, and minority use is slowly on the rise.
目的:关于接受电休克治疗(ECT)患者的种族和其他社会人口差异的研究很少。一项先前被注意到的全国趋势显示,白人接受电痉挛治疗的比例高于其他种族。本研究的目的是确定一个县的ECT项目是否在州和国家层面上表现出类似的差异。方法本研究检查了1993年至2014年间21年的ECT数据,这些数据由德克萨斯州卫生服务部提供,重点关注种族、性别、年龄和付款人来源,以及哈里斯县医院ECT项目2.5年的相同变量。此外,同一时期哈里斯县和德克萨斯州的人口统计数据来自国家卫生服务部的网站。结果:尽管县和州的白人人口总体上有所减少,但在哈里斯县和德克萨斯州,白人仍然比非裔美国人、拉丁美洲人和亚洲人使用更多的电痉挛疗法。然而,少数族裔使用电痉挛疗法的比率总体上有所上升。在县和州范围内,女性使用电痉挛疗法的频率是男性的两倍多。在全州范围内,老年患者(>65岁)使用电痉挛疗法的人数有所减少,而私人第三方支付来源有所增加。结论电惊厥疗法在非裔美国人、拉丁美洲人和亚洲人中仍未得到充分应用。未来研究的假设和领域包括文化信仰、耻辱感、患者和提供者对ECT的了解以及获得护理的机会。尽管如此,德州电痉挛疗法的普遍应用总体上有所增加,少数人的应用也在缓慢上升。
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引用次数: 11
Case Report: ECT in a Patient With Primary Parkinsonian Syndrome and Schizophrenia. 病例报告:电痉挛治疗原发性帕金森综合征和精神分裂症患者1例。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000363
P. Baldinger-Melich, A. Weidenauer, C. Linder, M. Hienert, S. Kasper, M. Stamenkovic, M. Willeit
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引用次数: 1
Left Anterior-Right Temporal Electroconvulsive Therapy for Catatonia After Epilepsy Surgery: A Case Report. 左前右颞电痉挛治疗癫痫术后紧张症1例。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000372
Dyani Loo, Daniel Evans, C. Abbott, D. Quinn
Psychiatric Rating Scale (BPRS), the Montgomery and Asberg Modified Scale (MADRS) and the Montreal Cognitive Assessment Scale (MoCA), at baseline and after 6 sessions. All have been validated (BPRS and MoCA) or adapted (MADRS) for use in the Portuguese population. Pretreatment and immediate posttreatment scores were as follows: BPRS, 42 and 29 (30.95% reduction); MADRS, 3 and 1 (66.7% reduction); and MOCA, 13 and 20 (53.85% improvement). Mental state examination showed marked improvement in thought organization and delusional beliefs. There were no apparent adverse effects, and the patient tolerated all treatment procedures easily. The patient was discharged with clozapine 300 mg QD and haloperidol decanoate 100 mg monthly. Although maintenance ECTwas offered, the patient dropped out after 3 maintenance treatments. Nevertheless, after 12 weeks of being treated only with haloperidol and clozapine, at equivalent or lower doses than those previously ineffective, the benefit obtained with ECT was sustained or enhanced: BPRS, 26 (38.09% reduction); MADRS, 0 (100% reduction); and MoCA, 23 (76.92% improvement).
精神病学评定量表(BPRS),蒙哥马利和阿斯伯格修正量表(MADRS)和蒙特利尔认知评估量表(MoCA),在基线和6个疗程后。所有这些都经过了验证(BPRS和MoCA)或改编(MADRS),以便在葡萄牙人口中使用。治疗前和治疗后立即得分分别为:BPRS, 42分和29分(降低30.95%);MADRS, 3和1(降低66.7%);MOCA分别为13和20,提高53.85%。精神状态检查显示在思维组织和妄想信念方面有明显改善。没有明显的不良反应,患者很容易耐受所有治疗程序。患者出院时给予氯氮平300 mg QD和癸酸氟哌啶醇100 mg每月。虽然给予了维持治疗,但患者在3次维持治疗后退出。然而,仅用氟哌啶醇和氯氮平治疗12周后,在与先前无效的剂量相等或更低的剂量下,ECT获得的益处得以维持或增强:BPRS, 26(减少38.09%);MADRS, 0(100%还原);MoCA 23例,提高76.92%。
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引用次数: 0
An Unwanted Reduction of Seizure Duration During Electroconvulsive Therapy With Diltiazem. 地尔硫卓电惊厥治疗中癫痫发作持续时间的不必要减少。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000380
Taylor Morrisette, John Rice, P. Vickery
To the Editor: W e write to report a case of transient bilateral parotid gland swelling after bilateral electroconvulsive therapy (ECT) treatment. Our patient is a 40-year-old white man with a history of schizoaffective disorder, childhood trauma, and alcohol use disorder in sustained remission, receiving ECT to augment clozapine for treatment refractory schizoaffective disorder. The patient's inpatient medications include clozapine, benztropine, magnesium citrate, diphenhydramine, and acetaminophen. He has received a total of 23 ECT treatments, now in a maintenance stage of treatment. The patient received methohexital 100 mg, succinylcholine 50 mg, and toradol 30 mg for anesthesia, consistent with previous treatments, and emergence was uneventful. The patient was treated with a MECTA spectrum model 5000Q, with bilateral lead placement; pulse width, 0.5 ms; frequency, 40 Hz; duration, 3 seconds; current, 800 mA; energy, 16 J; convulsion duration, 42 seconds; seizure duration, 49 seconds, with adequate seizure morphology. About 30 minutes after his 23rd treatment, the patient developed slightly tender, acute-onset, bilateral nonfluctuant submandibular swelling. There was no crepitation on palpation to suggest pneumoparotitis nor changes in overlying dermis to suggest an infectious process. Vitals signs were within normal limits, he was afebrile, and had no other systemic signs of infection nor dyspnea. Warm compresses were applied to both areas of swelling with good response and full resolution after an hour. Subsequently, he reported this response had occurred one other time prior after ECT, which resolved gradually after 24 hours.
致编者:我们在此报告一例双侧电休克治疗(ECT)后短暂性双侧腮腺肿胀的病例。我们的患者是一名40岁的白人男性,有分裂情感性障碍、童年创伤和酒精使用障碍的持续缓解史,接受ECT增加氯氮平治疗难治性分裂情感性障碍。患者的住院药物包括氯氮平、苯托品、柠檬酸镁、苯海拉明和对乙酰氨基酚。他总共接受了23次ECT治疗,目前处于维持治疗阶段。患者接受甲氧己酮100 mg、琥珀胆碱50 mg、妥拉多30 mg麻醉,与既往治疗一致,无意外出现。患者使用MECTA光谱模型5000Q进行治疗,双侧放置导联;脉冲宽度,0.5 ms;频率:40hz;持续时间,3秒;电流,800毫安;能量,16 J;抽搐持续时间,42秒;癫痫持续时间,49秒,癫痫形态正常。第23次治疗后约30分钟,患者出现轻微压痛,急性发作,双侧下颌下无波动性肿胀。触诊没有提示肺炎的震颤,也没有提示感染过程的上覆真皮变化。生命体征在正常范围内,无发热,无其他全身性感染体征和呼吸困难。在两个肿胀部位进行热敷,一小时后反应良好,完全消退。随后,他报告说,这种反应在ECT治疗前曾出现过一次,24小时后逐渐消退。
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引用次数: 0
Procedural Consolidation During Electroconvulsive Therapy for a Patient With Severe Tourette Syndrome. 重度抽动秽语综合征患者电休克治疗过程中的程序巩固。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000378
R. Katz, E. Bukanova, R. Ostroff
with stimulus energies set to 100%. Anesthetic agents used for the ECT procedures included methohexital 90 mg intravenous and succinylcoline 100 mg intravenous. The patient experienced 3 ECT episodes that lacked appropriate EEG seizure duration documentation despite blood pressure and heart rate changes typically associated with seizure activity. During each of these episodes, the patient was being treated with diltiazem extended-release 180 mg daily. Upon discontinuation of diltiazem and concurrent switch to bitemporal stimulus electrode placement, the treatment-induced seizures began to reach more predictable durations. Diltiazem seemed to interfere with achieving full ECT treatment seizures. Wajima et al compared 18 patients taking diltiazem 10 mg intravenous daily or placebo and reported a significantly shorter EEG seizure duration in the diltiazem group (P < 0.05). These patients also exhibited predictable increases in hemodynamics, which was precisely what was observed in this reported patient case. Verapamil, another nondihydropyridine calcium channel blocker, was compared with placebo in patients undergoing ECT and found no reduction of seizure duration, so this phenomenon is not necessarily class specific.
刺激能量设置为100%。用于电痉挛治疗的麻醉剂包括静脉注射甲氧己酮90毫克和静脉注射琥珀碱100毫克。患者经历了3次电痉挛发作,尽管血压和心率变化通常与癫痫发作活动相关,但缺乏适当的脑电图癫痫发作持续时间记录。在每次发作期间,患者给予地尔硫卓缓释片180mg /天治疗。在停用地尔硫卓并同时切换到双颞叶刺激电极放置后,治疗引起的癫痫发作开始达到更可预测的持续时间。地尔硫卓似乎妨碍了癫痫的全面电痉挛治疗。Wajima等比较了18例每日静脉注射地尔硫卓10mg或安慰剂组的患者,发现地尔硫卓组脑电图发作时间明显缩短(P < 0.05)。这些患者也表现出可预测的血流动力学增加,这正是在本报告的患者病例中观察到的。维拉帕米,另一种非二氢吡啶类钙通道阻滞剂,在接受ECT治疗的患者中与安慰剂比较,发现癫痫发作持续时间没有减少,所以这种现象不一定是类特异性的。
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引用次数: 1
Successful Treatment With Electroconvulsive Therapy of a Patient With Bipolar Disorder and a 7-mm Cerebral Aneurysm. 电痉挛疗法成功治疗双相情感障碍和7毫米脑动脉瘤患者。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000389
Mesut Toprak, S. Wilkinson, R. Ostroff
To the Editor: M s N is a 54-year-old woman whowas admitted to our inpatient unit for exacerbation of bipolar depression, type I. Six months before admission, she experienced a brief manic episode, after which her mood dropped precipitously. After medication adjustments failed to alleviate her depression, shewas admitted for expedited initiation of electroconvulsive therapy (ECT). At the time of admission, her medications included lamotrigine, lithium, and olanzapine. Her medical history was notable for hypertension, as well as a 7-mm cerebral aneurysm located in the left cavernous sinus. Her hypertension had been successfully managed with amlodipine/valsartan/hydrochlorothiazide 10/160/12.5 mg daily. The aneurysm had been discovered incidentally from magnetic resonance imaging 4 years ago that she had for a work-up of diplopia (since resolved). Given the relatively low risk of spontaneous rupture associated with an aneurysm of this size, the patient had annual follow-up with neurosurgery for expectant management without intervention. The aneurysm had remained stable in size for the following 4 years. After consultation with neurosurgery and anesthesiology, as well as informed consent including a thorough discussion of the risks and benefits of the treatment, right unilateral ECT was initiated, administered 3 times a week using a MECTA Spectrum 5000Q machine. Methohexital was used as the anesthetic agent (dose range, 80–150 mg), succinylcholine was used as the paralytic agent (dose range,
致编辑:M s N是一名54岁的女性,因双相抑郁症i型加重而入住我们的住院部。入院前6个月,她经历了短暂的躁狂发作,之后她的情绪急剧下降。在药物调整未能缓解她的抑郁后,她被允许加速启动电休克治疗(ECT)。入院时,她的药物包括拉莫三嗪、锂和奥氮平。她的病史是高血压,以及位于左侧海绵窦的7毫米脑动脉瘤。她的高血压已成功地控制在氨氯地平/缬沙坦/氢氯噻嗪10/160/12.5 mg /天。动脉瘤是4年前在复视检查中偶然发现的(现已痊愈)。鉴于这种大小的动脉瘤自发性破裂的风险相对较低,患者每年接受神经外科随访,无需干预。在接下来的4年里,动脉瘤的大小一直保持稳定。在咨询了神经外科和麻醉学,以及知情同意,包括对治疗的风险和益处进行了彻底的讨论后,开始使用MECTA Spectrum 5000Q机器进行右单侧ECT,每周3次。以甲氧己酮为麻醉剂(剂量范围80 ~ 150mg),以琥珀胆碱为麻痹剂(剂量范围:
{"title":"Successful Treatment With Electroconvulsive Therapy of a Patient With Bipolar Disorder and a 7-mm Cerebral Aneurysm.","authors":"Mesut Toprak, S. Wilkinson, R. Ostroff","doi":"10.1097/YCT.0000000000000389","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000389","url":null,"abstract":"To the Editor: M s N is a 54-year-old woman whowas admitted to our inpatient unit for exacerbation of bipolar depression, type I. Six months before admission, she experienced a brief manic episode, after which her mood dropped precipitously. After medication adjustments failed to alleviate her depression, shewas admitted for expedited initiation of electroconvulsive therapy (ECT). At the time of admission, her medications included lamotrigine, lithium, and olanzapine. Her medical history was notable for hypertension, as well as a 7-mm cerebral aneurysm located in the left cavernous sinus. Her hypertension had been successfully managed with amlodipine/valsartan/hydrochlorothiazide 10/160/12.5 mg daily. The aneurysm had been discovered incidentally from magnetic resonance imaging 4 years ago that she had for a work-up of diplopia (since resolved). Given the relatively low risk of spontaneous rupture associated with an aneurysm of this size, the patient had annual follow-up with neurosurgery for expectant management without intervention. The aneurysm had remained stable in size for the following 4 years. After consultation with neurosurgery and anesthesiology, as well as informed consent including a thorough discussion of the risks and benefits of the treatment, right unilateral ECT was initiated, administered 3 times a week using a MECTA Spectrum 5000Q machine. Methohexital was used as the anesthetic agent (dose range, 80–150 mg), succinylcholine was used as the paralytic agent (dose range,","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116886153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Commentary on Bennett and Colleagues: Differences in Cognitive Outcomes After Electroconvulsive Therapy Depending on BDNF and COMT Polymorphisms. Bennett及其同事评论:电休克治疗后认知结果的差异取决于BDNF和COMT多态性。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000390
D. Martin
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引用次数: 0
Clinical Applicability of Monitoring the Time Interval Between Anesthesia and Electroconvulsive Therapy. 麻醉与电休克治疗间隔时间监测的临床适用性。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000384
V. Galvez, C. Loo
The anesthetic-electroconvulsive therapy (ECT) time interval (time interval elapsed from the beginning of anesthesia injection to the beginning of ECT stimulus) has been reported to have an important impact on seizure quality outcomes, because it is an indirect measure of the anesthetic plasma concentration when the ECT electrical stimulus is administered. We report the importance of the routine monitoring of this time interval in clinical settings, as an additional measure to interpret seizure quality outcomes at each ECT session, to further assist on ECT dosing decisions during the treatment course.
据报道,麻醉电痉挛治疗(ECT)的时间间隔(从麻醉注射开始到ECT刺激开始的时间间隔)对癫痫发作质量结果有重要影响,因为它是施加ECT电刺激时麻醉剂血浆浓度的间接测量。我们报告了常规监测这段时间间隔在临床设置中的重要性,作为解释每次ECT治疗中癫痫发作质量结果的额外措施,以进一步协助治疗过程中ECT剂量的决定。
{"title":"Clinical Applicability of Monitoring the Time Interval Between Anesthesia and Electroconvulsive Therapy.","authors":"V. Galvez, C. Loo","doi":"10.1097/YCT.0000000000000384","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000384","url":null,"abstract":"The anesthetic-electroconvulsive therapy (ECT) time interval (time interval elapsed from the beginning of anesthesia injection to the beginning of ECT stimulus) has been reported to have an important impact on seizure quality outcomes, because it is an indirect measure of the anesthetic plasma concentration when the ECT electrical stimulus is administered. We report the importance of the routine monitoring of this time interval in clinical settings, as an additional measure to interpret seizure quality outcomes at each ECT session, to further assist on ECT dosing decisions during the treatment course.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114567434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Catatonic Pupil in the Setting of Electroconvulsive Therapy. 电休克治疗下的紧张性瞳孔。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000375
L. Arias, P. Gligorovic, Erica Ann Bohan, James J OʼBrien
{"title":"Catatonic Pupil in the Setting of Electroconvulsive Therapy.","authors":"L. Arias, P. Gligorovic, Erica Ann Bohan, James J OʼBrien","doi":"10.1097/YCT.0000000000000375","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000375","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"119 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132995360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Clozapine-Resistant Schizophrenia Treated With Ultra-brief Pulse, Unilateral Electroconvulsive Therapy. 超短脉冲单侧电休克治疗氯氮平抵抗性精神分裂症。
Pub Date : 2017-03-01 DOI: 10.1097/YCT.0000000000000356
G. Cotovio, A. Velosa, A. Oliveira-Maia, B. Barahona-Corrêa
{"title":"Clozapine-Resistant Schizophrenia Treated With Ultra-brief Pulse, Unilateral Electroconvulsive Therapy.","authors":"G. Cotovio, A. Velosa, A. Oliveira-Maia, B. Barahona-Corrêa","doi":"10.1097/YCT.0000000000000356","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000356","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121349082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
期刊
The Journal of ECT
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