Pub Date : 2017-06-01DOI: 10.1097/YCT.0000000000000403
M. Fink
144 fter more than 80 years of clinical experience, electroconvulsive therapy A (ECT)—the induction of grand mal seizures as treatments of severely ill patients with psychiatric disorders—continues to raise strong emotions with doubts of its efficacy and fears of its adverse effects. To these criticisms, Jonathan Sadowsky, Professor of Medical History at Cleveland's Case Western Reserve University sees the treatment as a means of social control. He comes to this subject with prior writing on the history of madness treated in Nigeria in the colonial era. He begins by quoting the “whee” of Sylvia Plath and the failure of her first course of treatment. A recurrence was successfully treated. In the history of trials of electricity in medicine, the induction of seizures using electric currents was developed in fascist Rome in 1938 by Professor Ugo Cerletti as replacements for those induced by chemicals in Budapest 4 years earlier by Ladislas Meduna. The first electric inductions were remarkably facile and safe to apply, and the technique was quickly brought to America by prewar European émigrés. By 1941, 42% of American psychiatric hospitals had ECT machines. Although Sadowsky doffs his hat to the treatments' usefulness in relieving severely depressed, manic and psychotic patients, he focuses his interest on its social impacts. In his third chapter, he considers “ECT has been used as a mechanism of social control: 1) ECTas a tool for maintaining order and hierarchy on the wards of mental hospitals; 2) ECTas a tool for gender conformity, and 3) ECTas a tool for the enforcement of sexual norms.” The enthusiasm aroused by the successful and quick treatment of long-term hospitalized psychiatric ill is compared with the publicly praised limited benefits of psychoanalysis. The conflicts encouraged public anti-ECT movements in the
{"title":"Electroshock as Means for Social Control","authors":"M. Fink","doi":"10.1097/YCT.0000000000000403","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000403","url":null,"abstract":"144 fter more than 80 years of clinical experience, electroconvulsive therapy A (ECT)—the induction of grand mal seizures as treatments of severely ill patients with psychiatric disorders—continues to raise strong emotions with doubts of its efficacy and fears of its adverse effects. To these criticisms, Jonathan Sadowsky, Professor of Medical History at Cleveland's Case Western Reserve University sees the treatment as a means of social control. He comes to this subject with prior writing on the history of madness treated in Nigeria in the colonial era. He begins by quoting the “whee” of Sylvia Plath and the failure of her first course of treatment. A recurrence was successfully treated. In the history of trials of electricity in medicine, the induction of seizures using electric currents was developed in fascist Rome in 1938 by Professor Ugo Cerletti as replacements for those induced by chemicals in Budapest 4 years earlier by Ladislas Meduna. The first electric inductions were remarkably facile and safe to apply, and the technique was quickly brought to America by prewar European émigrés. By 1941, 42% of American psychiatric hospitals had ECT machines. Although Sadowsky doffs his hat to the treatments' usefulness in relieving severely depressed, manic and psychotic patients, he focuses his interest on its social impacts. In his third chapter, he considers “ECT has been used as a mechanism of social control: 1) ECTas a tool for maintaining order and hierarchy on the wards of mental hospitals; 2) ECTas a tool for gender conformity, and 3) ECTas a tool for the enforcement of sexual norms.” The enthusiasm aroused by the successful and quick treatment of long-term hospitalized psychiatric ill is compared with the publicly praised limited benefits of psychoanalysis. The conflicts encouraged public anti-ECT movements in the","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130733821","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}
Pub Date : 2017-06-01DOI: 10.1097/YCT.0000000000000386
C. Lantrip, F. Gunning, L. Flashman, R. Roth, P. Holtzheimer
Depression negatively impacts quality of life and is associated with high mortality rates. Recent research has demonstrated that improvement in depression symptoms with transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (DLPFC) may involve changes in the cognitive control network, a regulatory system modulating the function of cognitive and emotional systems, composed of the DLPFC, dorsal anterior cingulate, and posterior parietal cortices. Transcranial magnetic stimulation to the DLPFC node of the cognitive control network may have antidepressant efficacy via direct effects on cognitive control processes involved in emotion regulation. This review provides a review of the impact of TMS on cognitive control processes, especially those related to emotion regulation, and posits that these effects are critical to the mechanism of action of TMS for depression. Treatment implications and future directions for study are discussed.
{"title":"Effects of Transcranial Magnetic Stimulation on the Cognitive Control of Emotion: Potential Antidepressant Mechanisms.","authors":"C. Lantrip, F. Gunning, L. Flashman, R. Roth, P. Holtzheimer","doi":"10.1097/YCT.0000000000000386","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000386","url":null,"abstract":"Depression negatively impacts quality of life and is associated with high mortality rates. Recent research has demonstrated that improvement in depression symptoms with transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (DLPFC) may involve changes in the cognitive control network, a regulatory system modulating the function of cognitive and emotional systems, composed of the DLPFC, dorsal anterior cingulate, and posterior parietal cortices. Transcranial magnetic stimulation to the DLPFC node of the cognitive control network may have antidepressant efficacy via direct effects on cognitive control processes involved in emotion regulation. This review provides a review of the impact of TMS on cognitive control processes, especially those related to emotion regulation, and posits that these effects are critical to the mechanism of action of TMS for depression. Treatment implications and future directions for study are discussed.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125327712","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}
Pub Date : 2017-06-01DOI: 10.1097/YCT.0000000000000392
C. Kellner, M. Çiçek, Kate G. Farber, W. Reiss, Christopher R. Cowart
temperature change, studies have demonstrated the energy used in ECT to be too low to cause significant heating of metallic plates, especially titanium (the material used in most neurosurgical implants at this time), which is principally inert. In addition, given the exponential fall in total energy with increasing distance, lead placement that maximizes distance from the intracranial objects further decreases theoretical risk of heat and current shunting. We therefore suggest that in patients with intracranial objects and comorbid seizure disorders, antiepileptics should be safely minimized to limit energy delivered and intracranial objects be clearly located to optimally adjust lead placement. Although there have been previously published cases of successful ECT treatment with intracranial metallic objects and comorbid epilepsy, this is the first, to our knowledge, to document safe treatment with ECTwith titanium mesh in the posterior fossa.
{"title":"Spontaneous Seizure From Remifentanil Induction During Electroconvulsive Therapy.","authors":"C. Kellner, M. Çiçek, Kate G. Farber, W. Reiss, Christopher R. Cowart","doi":"10.1097/YCT.0000000000000392","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000392","url":null,"abstract":"temperature change, studies have demonstrated the energy used in ECT to be too low to cause significant heating of metallic plates, especially titanium (the material used in most neurosurgical implants at this time), which is principally inert. In addition, given the exponential fall in total energy with increasing distance, lead placement that maximizes distance from the intracranial objects further decreases theoretical risk of heat and current shunting. We therefore suggest that in patients with intracranial objects and comorbid seizure disorders, antiepileptics should be safely minimized to limit energy delivered and intracranial objects be clearly located to optimally adjust lead placement. Although there have been previously published cases of successful ECT treatment with intracranial metallic objects and comorbid epilepsy, this is the first, to our knowledge, to document safe treatment with ECTwith titanium mesh in the posterior fossa.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130748955","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}
Pub Date : 2017-06-01DOI: 10.1097/YCT.0000000000000385
Christoph Ziegelmayer, G. Hajak, A. Bauer, M. Held, R. Rupprecht, W. Trapp
Objectives Although electroconvulsive therapy (ECT) is considered a safe and highly effective treatment option for major depressive disorder, there are still some reservations with regard to possible adverse cognitive adverse effects. This is the case despite a large body of evidence showing that these deficits are transient and that there even seems to be a long-term improvement of cognitive functioning level. However, most data concerning cognitive adverse effects stem from studies using mixed samples of treatment-resistant and non–treatment-resistant as well as ECT-naive and non–ECT-naive subjects. Furthermore, neurocognitive measures might partly be sensitive to practice effects and improvements in depressive symptom level. Methods We examined neurocognitive performance in a sample of 20 treatment-resistant and ECT-naive subjects using repeatable neurocognitive tests, whereas changes in depressive symptom level were controlled. Cognitive functioning level was assessed before (baseline), 1 week, and 6 months (follow-up 1 and 2) after (12 to) 15 sessions of unilateral ECT treatment. Results No adverse cognitive effects were observed in any of the cognitive domains examined. Instead, a significant improvement in verbal working memory performance was found from baseline to follow-up 2. When changes in depressive symptom levels were controlled statistically, this improvement was no longer seen. Conclusions Although findings that ECT does not lead to longer lasting cognitive deficits caused by ECT were confirmed, our study adds evidence that previous results of a beneficial effect of ECT on cognition might be questioned.
{"title":"Cognitive Performance Under Electroconvulsive Therapy (ECT) in ECT-Naive Treatment-Resistant Patients With Major Depressive Disorder","authors":"Christoph Ziegelmayer, G. Hajak, A. Bauer, M. Held, R. Rupprecht, W. Trapp","doi":"10.1097/YCT.0000000000000385","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000385","url":null,"abstract":"Objectives Although electroconvulsive therapy (ECT) is considered a safe and highly effective treatment option for major depressive disorder, there are still some reservations with regard to possible adverse cognitive adverse effects. This is the case despite a large body of evidence showing that these deficits are transient and that there even seems to be a long-term improvement of cognitive functioning level. However, most data concerning cognitive adverse effects stem from studies using mixed samples of treatment-resistant and non–treatment-resistant as well as ECT-naive and non–ECT-naive subjects. Furthermore, neurocognitive measures might partly be sensitive to practice effects and improvements in depressive symptom level. Methods We examined neurocognitive performance in a sample of 20 treatment-resistant and ECT-naive subjects using repeatable neurocognitive tests, whereas changes in depressive symptom level were controlled. Cognitive functioning level was assessed before (baseline), 1 week, and 6 months (follow-up 1 and 2) after (12 to) 15 sessions of unilateral ECT treatment. Results No adverse cognitive effects were observed in any of the cognitive domains examined. Instead, a significant improvement in verbal working memory performance was found from baseline to follow-up 2. When changes in depressive symptom levels were controlled statistically, this improvement was no longer seen. Conclusions Although findings that ECT does not lead to longer lasting cognitive deficits caused by ECT were confirmed, our study adds evidence that previous results of a beneficial effect of ECT on cognition might be questioned.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132960021","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}
Pub Date : 2017-06-01DOI: 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.
{"title":"Electroconvulsive Therapy (ECT) and Race: A Report of ECT Use and Sociodemographic Trends in Texas","authors":"J. Williams, L. Chiu, Robin K. Livingston","doi":"10.1097/YCT.0000000000000379","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000379","url":null,"abstract":"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.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129109431","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}
Pub Date : 2017-03-01DOI: 10.1097/YCT.0000000000000363
P. Baldinger-Melich, A. Weidenauer, C. Linder, M. Hienert, S. Kasper, M. Stamenkovic, M. Willeit
{"title":"Case Report: ECT in a Patient With Primary Parkinsonian Syndrome and Schizophrenia.","authors":"P. Baldinger-Melich, A. Weidenauer, C. Linder, M. Hienert, S. Kasper, M. Stamenkovic, M. Willeit","doi":"10.1097/YCT.0000000000000363","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000363","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"66 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":"129224895","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}
Pub Date : 2017-03-01DOI: 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).
{"title":"Left Anterior-Right Temporal Electroconvulsive Therapy for Catatonia After Epilepsy Surgery: A Case Report.","authors":"Dyani Loo, Daniel Evans, C. Abbott, D. Quinn","doi":"10.1097/YCT.0000000000000372","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000372","url":null,"abstract":"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).","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"61 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":"114199319","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}
Pub Date : 2017-03-01DOI: 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.
{"title":"An Unwanted Reduction of Seizure Duration During Electroconvulsive Therapy With Diltiazem.","authors":"Taylor Morrisette, John Rice, P. Vickery","doi":"10.1097/YCT.0000000000000380","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000380","url":null,"abstract":"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.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"36 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":"122077905","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}
Pub Date : 2017-03-01DOI: 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.
{"title":"Procedural Consolidation During Electroconvulsive Therapy for a Patient With Severe Tourette Syndrome.","authors":"R. Katz, E. Bukanova, R. Ostroff","doi":"10.1097/YCT.0000000000000378","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000378","url":null,"abstract":"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.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"15 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":"128225924","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}
Pub Date : 2017-03-01DOI: 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:
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