WorldWideScience

Sample records for chronic electroconvulsive shock

  1. Chronic Tinnitus following Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    Robert L. Folmer

    2011-01-01

    Full Text Available A 43-year-old female with a 27-year history of obsessive-compulsive disorder and major depression had previously been treated with psychotherapy, antidepressant, and antipsychotic medications. Because these treatments were minimally effective and because the frequency and duration of her depressive episodes continued to increase, the patient was scheduled to undergo a series of electroconvulsive therapy (ECT procedures. The patient received four ECT treatments during one month. Stimulating current was delivered to the right frontotemporal region of the head. Electroencephalographic seizures occurred during each of the ECT procedures. After the patient recovered from anesthesia, she complained of headaches, muscle pain, amnesia, and, after the fourth ECT, she reported a ringing sound in her right ear. Audiometric testing the day after the fourth ECT revealed a slight increase in threshold for 8000 Hz tones in her right ear. It is likely that current delivered during the fourth ECT treatment triggered the perception of tinnitus for this patient. The unique organization of this patient's central nervous and auditory systems combined with her particular pharmacological history might have predisposed her to developing tinnitus.

  2. Seizure threshold to lidocaine is decreased following repeated ECS (electroconvulsive shock)

    DEFF Research Database (Denmark)

    Kragh, J; Seidelin, J; Bolwig, T G

    1993-01-01

    Seizure susceptibility to lidocaine was investigated in rats which had received repeated ECS (electroconvulsive shock). In the first experiment three groups of rats received an ECS daily for 18 days, an ECS weekly for 18 weeks, and 18 sham treatments, respectively. Twelve weeks after the last ECS...

  3. Seizure threshold to lidocaine is decreased following repeated ECS (electroconvulsive shock)

    DEFF Research Database (Denmark)

    Kragh, J; Seidelin, J; Bolwig, T G

    1993-01-01

    Seizure susceptibility to lidocaine was investigated in rats which had received repeated ECS (electroconvulsive shock). In the first experiment three groups of rats received an ECS daily for 18 days, an ECS weekly for 18 weeks, and 18 sham treatments, respectively. Twelve weeks after the last ECS...

  4. Compound 48/80, a histamine-depleting agent, blocks the protective effect of morphine against electroconvulsive shock in mice

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    Karadag C.H.

    2000-01-01

    Full Text Available We have shown that morphine has an anticonvulsive effect against maximal electroconvulsive shock (MES in mice, and this effect is antagonized by histamine H1-receptor antagonists. Brain histamine is localized both in neurons and in mast cells, and morphine is known to enhance the turnover of neuronal histamine and to release histamine from mast cells. In the present experiments, compound 48/80 was injected chronically (0.5 mg/kg on day 1, 1 mg/kg on day 2, 2 mg/kg on day 3, 3 mg/kg on day 4, and 4 mg/kg on day 5, twice daily, ip to deplete mast cell contents. Morphine (0.001-10 mg/kg, ip; N = 20 produced a dose-dependent anticonvulsive effect against MES seizure in mice with non-depleted mast cells, whereas it did not exert any anticonvulsive effect in mice with depleted mast cells. These results indicate that morphine produces its anticonvulsive effect against maximal electroconvulsive shock in mice by liberating histamine from mast cells.

  5. PBA regulates neurogenesis and cognition dysfunction after repeated electroconvulsive shock in a rat model.

    Science.gov (United States)

    Yao, Zhao-Hui; Kang, Xiang; Yang, Liu; Niu, Yi; Lu, Ye; Nie, Li

    2015-12-15

    Electroconvulsive therapy (ECT) was widely used to treat the refractory depression. But ECT led to the cognitive deficits plaguing the depression patients. The underlying mechanisms of the cognitive deficits remain elusive. Repeated electroconvulsive shock (rECS) was used to simulate ECT and explore the mechanisms of ECT during the animal studies. Previous studies showed rECS could lead to neurogenesis and cognitive impairment. But it was well known that neurogenesis could improve the cognition. So these suggested that the mechanism of the cognitive deficit after rECS was very complex. In present study, we explored the probable mechanisms of the cognitive deficit after rECS from neurogenesis aspect. We found the cognitive deficit was reversible and neurogenesis could bring a long-term beneficial effect on cognition. Astrogliosis and NR1 down-regulation probably participated in the reversible cognitive deficits after rECS. Phenylbutyric acid (PBA), generally as an agent to investigate the roles of histone acetylation, could prevent the reversible cognitive dysfunction, but PBA could diminish the long-term effect of enhanced cognition by rECS. These suggested that ECT could possibly bring the long-term beneficial cognitive effect by regulating neurogenesis.

  6. Anterograde effects of a single electroconvulsive shock on inhibitory avoidance and on cued fear conditioning

    Directory of Open Access Journals (Sweden)

    Oliveira M.G.M.

    1998-01-01

    Full Text Available A single electroconvulsive shock (ECS or a sham ECS was administered to male 3-4-month-old Wistar rats 1, 2, and 4 h before training in an inhibitory avoidance test and in cued classical fear conditioning (measured by means of freezing time in a new environment. ECS impaired inhibitory avoidance at all times and, at 1 or 2 h before training, reduced freezing time before and after re-presentation of the ECS. These results are interpreted as a transient conditioned stimulus (CS-induced anxiolytic or analgesic effect lasting about 2 h after a single treatment, in addition to the known amnesic effect of the stimulus. This suggests that the effect of anterograde learning impairment is demonstrated unequivocally only when the analgesic/anxiolytic effect is over (about 4 h after ECS administration and that this impairment of learning is selective, affecting inhibitory avoidance but not classical fear conditioning to a discrete stimulus.

  7. Propofol can Protect Against the Impairment of Learning-memory Induced by Electroconvulsive Shock via Tau Protein Hyperphosphorylation in Depressed Rats

    Institute of Scientific and Technical Information of China (English)

    Wan-fu Liu; Chao Liu

    2015-01-01

    Objective To explore the possible neurophysiologic mechanisms of propofol and N-methyl-D-aspartate (NMDA) receptor antagonist against learning-memory impairment of depressed rats without olfactory bulbs. Methods Models of depressed rats without olfactory bulbs were established. For the factorial design in analysis of variance, two intervention factors were included: electroconvulsive shock groups (with and without a course of electroconvulsive shock) and drug intervention groups [intraperotoneal (ip) injection of saline, NMDA receptor antagonist MK-801 and propofol. A total of 60 adult depressed rats without olfactory bulbs were randomly divided into 6 experimental groups (n=10 per group):ip injection of 5 ml saline;ip injection of 5 ml of 10 mg/kg MK-801;ip injection of 5 ml of 10 mg/kg MK-801 and a course of electroconvulsive shock;ip injection of 5 ml of 200 mg/kg propofol;ip injection of 5 ml of 200 mg/kg propofol and a course of electroconvulsive shock;and ip injection of 5 ml saline and a course of electroconvulsive shock. The learning-memory abilities of the rats was evaluated by the Morris water maze test. The content of glutamic acid in the hippocampus was detected by high-performance liquid chromatography. The expressions of p-AT8Ser202 in the hippocampus were determined by Western blot analysis. Results Propofol, MK-801 or electroconvulsive shock alone induced learning-memory impairment in depressed rats, as proven by extended evasive latency time and shortened space probe time. Glutamic acid content in the hippocampus of depressed rats was significantly up-regulated by electroconvulsive shock and down-regulated by propofol, but MK-801 had no significant effect on glutamic acid content. Levels of phosphorylated Tau protein p-AT8Ser202 in the hippocampus was up-regulated by electroconvulsive shock but was reduced by propofol and MK-801 alone. Propofol prevented learning-memory impairment and reduced glutamic acid content and p-AT8Ser202 levels induced by

  8. Regulation of activity-regulated cytoskeleton protein (Arc) mRNA after acute and chronic electroconvulsive stimulation in the rat

    DEFF Research Database (Denmark)

    Larsen, M H; Olesen, M; Woldbye, D P D

    2005-01-01

    up to 4 h after the stimulus, but returned to baseline at 24 h. A single ECS also increased expression of Arc mRNA in the CA1 and the parietal cortex, but the expression peaked within 1 h and returned to baseline levels within 2 h. Repeated or chronic ECS is a model of electroconvulsive therapy......, but not accumulated by long term repetitive ECS and therefore not a molecular biomarker for antidepressant properties. More likely, Arc is likely a molecular link to the decline in memory consolidation seen in depressive patients subjected to electroconvulsive therapy.......The temporal profile of Arc gene expression after acute and chronic electroconvulsive stimulations (ECS) was studied using semi-quantitative in situ hybridisation in the rat cortex. A single ECS strongly and temporarily increased Arc mRNA levels in dentate granular cells with maximal induction seen...

  9. Electroconvulsive stimulation reverses anhedonia and cognitive impairments in rats exposed to chronic mild stress

    DEFF Research Database (Denmark)

    Henningsen, K; Woldbye, D P D; Wiborg, O

    2013-01-01

    Electroconvulsive therapy remains the most effective treatment for depression including a fast onset of action. However, this therapeutic approach suffers from some potential drawbacks. In the acute phase this includes amnesia. Electroconvulsive stimulation (ECS) has previously been shown...

  10. Induction of neuroserpin expression in rat frontal cortex after chronic antidepressant treatment and electroconvulsive treatment.

    Science.gov (United States)

    Tanaka, Satoshi; Yamada, Misa; Kitahara, Sari; Higuchi, Teruhiko; Honda, Kazuo; Kamijima, Kunitoshi; Yamada, Mitsuhiko

    2006-02-01

    Using expressed sequence tag (EST) analysis, we previously identified certain molecular machinery that mediates antidepressant effects. To date, several partial cDNA fragments, termed antidepressant-related genes (ADRGs), have been isolated as ESTs from rat brain. In the present study, we identified two of the ADRGs to be rat neuroserpin. Using real-time quantitative PCR, we demonstrated increased neuroserpin mRNA expression in rat frontal cortex after chronic treatment with several classes of antidepressants, including imipramine, fluoxetine, sertraline, and venlafaxine. Electroconvulsive treatment (ECT), another therapeutic treatment for depression, also increased neuroserpin expression in rat frontal cortex. Neuroserpin is a serine protease inhibitor that is implicated in the regulation of synaptic plasticity, neuronal migration, and axogenesis in the central nervous system. In conclusion, our results support the hypothesis that neuroserpin-mediated plastic changes in frontal cortex may underlie the therapeutic action of antidepressants and ECT.

  11. Electroconvulsive therapy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007474.htm Electroconvulsive therapy To use the sharing features on this page, please enable JavaScript. Electroconvulsive therapy (ECT) uses an electric current to treat depression ...

  12. Sustained downregulation of YY1-associated protein-related protein gene expression in rat hippocampus induced by repeated electroconvulsive shock.

    Science.gov (United States)

    Ohtomo, Takayuki; Kanamatsu, Tomoyuki; Fujita, Mariko; Takagi, Mitsuhiro; Yamada, Junji

    2011-01-01

    YY1AP-related protein (YARP) is a structural homolog of YY1-associated protein (YY1AP), which has a YY1-binding domain. During perinatal development, YARP mRNA expression is increased at a late stage of embryonic neurogenesis. It is not known whether YARP expression is regulated during adult neurogenesis. Electroconvulsive shock (ECS), a model for a highly effective depression treatment, is known to induce hippocampal neurogenesis after repeated treatment, so we employed ECS to measure the expression of YARP mRNA. Northern blots revealed significantly decreased expression of the YARP gene after repeated ECS but not single ECS. In situ hybridization clearly demonstrated a reduction of YARP mRNA expression in the CA (CA1, CA2, and CA3) subfields. Although clonic-tonic seizure was induced not only by ECS but also by injection of kainic acid to the striatum, the regulation of YARP mRNA expression was different between ECS and kainic acid. YARP mRNA was decreased only by the ECS method, suggesting that YARP expression is different at embryonic and adult neurogenic stage.

  13. Regional GABA concentration and (/sup 3/H)-diazepam binding in rat brain following repeated electroconvulsive shock

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    Bowdler, J.M.; Green, A.R.; Minchin, M.C.W.; Nutt, D.J. (Radcliffe Infirmary, Oxford (UK))

    1983-01-01

    It has been confirmed that 24 hours following a series of electroconvulsive shocks (ECS) given once daily for 10 days (ECS x 10) to rats there is an increase in GABA concentration in the corpus striatum. A similar change was seen after the ECS had been given to rats anaesthetised with halothane, or when 5 ECS were given spread out over 10 days, the rats being anaesthetised during the ECS. A daily convulsion for 10 days elicited by flurothyl exposure resulted in an increased striatal GABA concentration, but also increased the GABA concentration in the hypothalamus, hippocampus and cortex. The increase in striatal GABA concentration was present 24 hours after ECS daily for 5 days or 3 days after ECS daily for 10 days. No change in (/sup 3/H)-diazepam binding was seen in hippocampus, cortex or corpus striatum 24 hours after the last of 10 once daily ECS. The increase in striatal GABA concentration was therefore seen at all times when enhanced monoaminemediated behaviours have been demonstrated following seizures.

  14. Electroconvulsive Stimulation, but not Chronic Restraint Stress, Causes Structural Alterations in Adult Rat Hippocampus

    DEFF Research Database (Denmark)

    Olesen, Mikkel V.; Wörtwein, Gitta; Pakkenberg, Bente

    2015-01-01

    The neurobiological mechanisms underlying depression are not fully understood. Only a few previous studies have used validated stereological methods to test how stress and animal paradigms of depression affect adult hippocampal neurogenesis and whether antidepressant therapy can counteract possible...... changes in an animal model. Thus, in this study we applied methods that are state of the art in regard to stereological cell counting methods. Using a validated rat model of depression in combination with a clinically relevant schedule of electroconvulsive stimulation, we estimated the total number...... induces depression-like behavior, without significantly changing neurogenesis, the total number of neurons or the volume of the hippocampus. Further, electroconvulsive stimulation prevents stress-induced depression-like behavior and increases neurogenesis. The total number of neurons and the granule cell...

  15. Intracerebral trafficking of lactate in vivo during stress, exercise, electroconvulsive shock and ischemia as studied with microdialysis

    NARCIS (Netherlands)

    Korf, J

    1996-01-01

    We developed techniques to continuously monitor lactate in the living rat ('lactography') based on microdialysis and on-line enzymatic conversion of lactate in the dialysate using either continuous flow technologies or enzyme reactors. Ln vivo lactate was monitored during a single electroconvulsive

  16. Propofol ameliorates electroconvulsive shock-induced learning and memory impairment by regulation of synaptic metaplasticity via autophosphorylation of CaMKIIa at Thr 305 in stressed rats.

    Science.gov (United States)

    Ren, Li; Zhang, Fan; Min, Su; Hao, Xuechao; Qin, Peipei; Zhu, Xianlin

    2016-06-30

    Electroconvulsive therapy (ECT) is an effective treatment for depression, but it can induce learning and memory impairment. Our previous study found propofol (γ-aminobutyric acid (GABA) receptor agonist) could ameliorate electroconvulsive shock (ECS, an analog of ECT to animals)-induced cognitive impairment, however, the underlying molecular mechanisms remain unclear. This study aimed to investigate the effects of propofol on metaplasticity and autophosphorylation of CaMKIIa in stressed rats receiving ECS. Depressive-like behavior and learning and memory function were assessed by sucrose preference test and Morris water test respectively. LTP were tested by electrophysiological experiment, the expression of CaMKIIa, p-T305-CaMKII in hippocampus and CaMKIIα in hippocampal PSD fraction were evaluated by western blot. Results suggested ECS raised the baseline fEPSP and impaired the subsequent LTP, increased the expression of p-T305-CaMKII and decreased the expression of CaMKIIα in hippocampal PSD fraction, leading to cognitive dysfunction in stressed rats. Propofol could down-regulate the baseline fEPSP and reversed the impairment of LTP partly, decreased the expression of p-T305-CaMKII and increased the expression of CaMKIIα in hippocampal PSD fraction and alleviated ECS-induced learning and memory impairment. In conclusion, propofol ameliorates ECS-induced learning and memory impairment, possibly by regulation of synaptic metaplasticity via p-T305-CaMKII.

  17. Electroconvulsive therapy (ECT) in Parkinson's disease: ECS and dopamine enhancement.

    Science.gov (United States)

    Cumper, Samantha K; Ahle, Gabriella M; Liebman, Lauren S; Kellner, Charles H

    2014-06-01

    In addition to its effects in major psychiatric illness, electroconvulsive therapy (ECT) is known to have a beneficial effect on the core motor symptoms of Parkinson's disease (PD). This effect is believed to be mediated via dopamine in the striatum. Electroconvulsive shock (ECS), the animal analogue of ECT, is the model in which investigators have sought to elucidate the specific dopaminergic mechanisms by which ECT exerts its therapeutic effect in PD. Electroconvulsive shock has been given to intact animals as well as to animals with neurotoxic lesions that create parkinsonism. In this paper, we selectively review the electroconvulsive shock literature on dopamine in the striatum. Electroconvulsive shock, and by extension, ECT, is associated with increased dopamine release and modulation of dopamine receptors. Better understanding of how ECT works to enhance dopaminergic systems in the brain could help to make it a more accepted treatment for PD.

  18. [Extracorporeal shock wave therapy in chronic prostatitis].

    Science.gov (United States)

    Kul'chavenya, E V; Shevchenko, S Yu; Brizhatyuk, E V

    2016-04-01

    Chronic prostatitis is a prevalent urologic disease, but treatment outcomes are not always satisfactory. As a rule, chronic prostatitis results in chronic pelvic pain syndrome, significantly reducing the patient's quality of life. Open pilot prospective non-comparative study was conducted to test the effectiveness of extracorporeal shock wave therapy (ESWT) using Aries (Dornier) machine in patients with chronic prostatitis (CP) of IIIb category. A total of 27 patients underwent ESWL as monotherapy, 2 times a week for a course of 6 sessions. Exposure settings: 5-6 energy level (by sensation), the frequency of 5 Hz, 2000 pulses per session; each patient received a total energy up to 12000 mJ. per procedure. Treatment results were evaluated using NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) upon completing the 3 week course of 6 treatments and at 1 month after ESWT. Immediately after the ESWT course positive trend was not significant: pain index decreased from 9.1 to 7.9, urinary symptom score remained almost unchanged (4.2 at baseline, 4.1 after treatment), quality of life index also showed a slight improvement, dropping from 7.2 points to 6.0. Total NIH-CPSI score decreased from 20.5 to 18.0. One month post-treatment pain significantly decreased to 3.2 points, the urinary symptom score fell to 2.7 points, the average quality of life score was 3.9 points. ESWT, performed on Aries (Dornier) machine, is highly effective as monotherapy in patients with category IIIb chronic prostatitis.

  19. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    DEFF Research Database (Denmark)

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann; Dam, Henrik

    2008-01-01

    Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were inves...

  20. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    Directory of Open Access Journals (Sweden)

    Klaus Damgaard Jakobsen

    2008-09-01

    Full Text Available Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted κ-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, κ = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, κ = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, κ = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, κ = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

  1. Chronic electroconvulsive stimulation but not chronic restraint stress modulates mRNA expression of voltage-dependent potassium channels Kv7.2 and Kv11.1 in the rat piriform cortex

    DEFF Research Database (Denmark)

    Hjæresen, Marie-Louise; Hageman, Ida; Plenge, Per

    2008-01-01

    The mechanisms by which stress and electroconvulsive therapy exert opposite effects on the course of major depression are not known. Potential candidates might include the voltage-dependent potassium channels. Potassium channels play an important role in maintaining the resting membrane potential...... and controlling neuronal excitability. To explore this hypothesis, we examined the effects of one or several electroconvulsive stimulations and chronic restraint stress (6 h/day for 21 days) on the expression of voltage-dependent potassium channel Kv7.2, Kv11.1, and Kv11.3 mRNA in the rat brain using in situ...... hybridization. Repeated, but not acute, electroconvulsive stimulation increased Kv7.2 and Kv11.1 mRNA levels in the piriform cortex. In contrast, restraint stress had no significant effect on mRNA expression of Kv7.2, Kv11.1, or Kv11.3 in any of the brain regions examined. Thus, it appears that the investigated...

  2. Regulation of BDNF and trkB mRNA in rat brain by chronic electroconvulsive seizure and antidepressant drug treatments.

    Science.gov (United States)

    Nibuya, M; Morinobu, S; Duman, R S

    1995-11-01

    The influence of chronic electroconvulsive seizure (ECS) or antidepressant drug treatments on expression of brain-derived neurotrophic factor (BDNF) and its receptor, trkB, was examined by in situ hybridization and Northern blot. In frontal cortex, acute ECS increased BDNF mRNA approximately twofold, an effect significantly augmented by a prior course of chronic ECS treatment (10 d). In the hippocampus, the influence of chronic ECS varied between the major subfields. In the dentate gyrus granule cell layer, chronic ECS decreased the acute induction of BDNF and trkB mRNA by approximately 50%, but prolonged their expression: levels remained elevated two- to threefold 18 hr later after the last chronic ECS treatment, but returned to control 18 hr after acute ECS. In CA3 and CA1 pyramidal cell layers, chronic ECS significantly elevated the acute induction of BDNF, and tended to prolong the expression of BDNF and trkB mRNA. A similar effect was observed in layer 2 of the piriform cortex, where chronic ECS significantly increased the acute induction and prolonged the expression of BDNF and trkB mRNA. Chronic (21 d), but not acute (1 d), administration of several different antidepressant drugs, including tranylcypromine, sertraline, desipramine, or mianserin, significantly increased BDNF mRNA and all but mianserin increased trkB mRNA in hippocampus. In contrast, chronic administration of nonantidepressant psychotropic drugs, including morphine, cocaine, or haloperidol, did not increase levels of BDNF mRNA. Furthermore, chronic administration of ECS or antidepressant drugs completely blocked the down-regulation of BDNF mRNA in the hippocampus in response to restraint stress. The enhanced induction and prolonged expression of BDNF in response to chronic ECS and antidepressant drug treatments could promote neuronal survival, and protect neurons from the damaging effects of stress.

  3. Electroconvulsive stimulations prevent chronic stress-induced increases in L-type calcium channel mRNAs in the hippocampus and basolateral amygdala

    DEFF Research Database (Denmark)

    Maigaard, Katrine; Pedersen, Ida Hageman; Jørgensen, Anders;

    2012-01-01

    Although affective disorders have high prevalence, morbidity and mortality, we do not fully understand disease etiopathology, nor have we determined the exact mechanisms by which treatment works. Recent research indicates that intracellular calcium ion dysfunction might be involved. Here we use...... the chronic restraint stress model of affective disorder (6 h restraint per day for 21 days) in combination with electroconvulsive stimulations to examine the effects of stress and an effective antidepressive treatment modality on L-type voltage gated calcium channel subunit mRNA expression patterns......, while stress only upregulated Ca(v)1.3 channel expression significantly in the dentate gyrus. ECS effects on Ca(v)1.2 channel expression were generally specific to stressed animals. Our findings are consistent with and extent previous studies on the involvement of intracellular calcium ion dysfunction...

  4. Anesthetic considerations for pediatric electroconvulsive therapy.

    Science.gov (United States)

    Franklin, Andrew D; Sobey, Jenna H; Stickles, Eric T

    2017-05-01

    Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment. Dexmedetomidine is likely the most appropriate preoperative anxiolytic as oral benzodiazepines are relatively contraindicated. Methohexital, though becoming less available at many institutions, remains the gold standard for induction of anesthesia for pediatric electroconvulsive therapy though ketamine, propofol, and sevoflurane are becoming increasingly viable options. Proper planning and communication between the multidisciplinary teams involved in the care of children presenting for electroconvulsive therapy treatments is vital to mitigating risks and achieving the greatest therapeutic benefit. © 2017 John Wiley & Sons Ltd.

  5. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...

  6. Electroconvulsive therapy, hypertensive surge, blood-brain barrier breach, and amnesia

    DEFF Research Database (Denmark)

    Andrade, Chittaranjan; Bolwig, Tom G

    2014-01-01

    Preclinical and clinical evidence show that electroconvulsive therapy (ECT)-induced intraictal surge in blood pressure may result in a small, transient breach in the blood-brain barrier, leading to mild cerebral edema and a possible leach of noxious substances from blood into brain tissues...... of blood pressure during electroconvulsive shocks attenuate electroconvulsive shock-induced amnestic changes; however, the evidence suggests that antihypertensive mechanisms may not necessarily be involved. Clinical studies involving pre-ECT administration of antihypertensive medications do not provide...

  7. Shock wave therapy for chronic proximal plantar fasciitis.

    Science.gov (United States)

    Ogden, J A; Alvarez, R; Levitt, R; Cross, G L; Marlow, M

    2001-06-01

    Three hundred two patients with chronic heel pain caused by proximal plantar fasciitis were enrolled in a study to assess the treatment effects consequent to administration of electrohydraulicall-generated extracorporeal shock waves. Symptoms had been present from 6 months to 18 years. Each treated patient satisfied numerous inclusion and exclusion criteria before he or she was accepted into this study, which was approved by the Food and Drug Administration as a randomized, double-blind evaluation of the efficacy of shock wave therapy for this disorder. Overall, at the predetermined evaluation period 3 months after one treatment, 56% more of the treated patients had a successful result by all four of the evaluation criteria when compared with the patients treated with a placebo. This difference was significant and corroborated the fact that this difference in the results was specifically attributable to the shock wave treatment, rather than any natural improvement caused by the natural history of the condition. The current study showed that the directed application of electrohydraulic-generated shock waves to the insertion of the plantar fascia onto the calcaneus is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been present for at least 6 months and has been refractory to other commonly used nonoperative therapies. This technology, when delivered using the OssaTron (High Medical Technology, Kreuz-lingen, Switzerland), has been approved by the Food and Drug Administration specifically for the treatment of chronic proximal plantar fasciitis. The results suggest that this therapeutic modality should be considered before any surgical options, and even may be preferable to cortisone injection, which has a recognized risk of rupture of the plantar fascia and recurrence of symptoms.

  8. Electroconvulsive Therapy and Suicide.

    Science.gov (United States)

    Tanney, Bryan L.

    1986-01-01

    When the effectiveness and mortality-morbidity of electroconvulsive therapy (ECT) are compared with those of drug therapies, it appears that ECT is an effective and preferred treatment strategy. It remains underutilized as a modality of suicide prevention. Addresses controversies that presently limit the use of this treatment. (Author/ABB)

  9. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...... studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment. METHODS: We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1...... November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used. RESULTS: Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months...

  10. Electroconvulsive therapy and its different indications

    Science.gov (United States)

    Baghai, Thomas C.; Möller, Hans-Jürgen

    2008-01-01

    In spite of recent developments in the pharmacotherapy of depressive disorders, the delay until clinical improvement can be achieved, and the considerable rate of nonresponse and nonremission, are major problems which remain unresolved. Electroconvulsive therapy (ECT) is a nonpharmacoloqic bioloqical treatment which has been proven to be a highly effective treatment option, predominantly for depression, but also for schizophrenia and other indications. Though there is a lack of controlled investigations on long-term treatments, ECT can also be used for relapse prevention during maintenance therapies. The safety and tolerabitity of electroconvulsive treatment have been enhanced by the use of modified stimulation techniques and by progress in modern anesthesia. Thus, today a safe treatment can also be offered to patients with higher somatic risks, ECT still represents an important option, especially in the therapy of treatmentresistant psychiatric disorders after medication treatment failures. Earlier consideration of ECT may reduce the rate of chronic and difficult-to-treat psychiatric disorders. PMID:18472488

  11. Electrocardiographic and Blood Pressure Alterations During Electroconvulsive Therapy in Young Adults

    OpenAIRE

    Rumi Demetrio Ortega; Solimene Maria Cecília; Takada Júlio Yoshio; Grupi César José; Giorgi Dante Marcelo; Rigonatti Sérgio Paulo; Luz Protásio Lemos da; Ramires José Antonio Franchini

    2002-01-01

    OBJECTIVE - To study cardiovascular alterations in young patients with no apparent organic disease who underwent electroconvulsive therapy. METHODS - The study comprised 47 healthy patients (22 males and 25 females) with a mean age of 30.3 years, who underwent electroconvulsive therapy. Ambulatory blood pressure monitoring and continuous electrocardiographic monitoring (Holter monitor) were performed during 24 hours. Blood pressure and heart rate were assessed 4 hours prior to electric shock ...

  12. Electrocardiographic and Blood Pressure Alterations During Electroconvulsive Therapy in Young Adults

    Directory of Open Access Journals (Sweden)

    Rumi Demetrio Ortega

    2002-01-01

    Full Text Available OBJECTIVE - To study cardiovascular alterations in young patients with no apparent organic disease who underwent electroconvulsive therapy. METHODS - The study comprised 47 healthy patients (22 males and 25 females with a mean age of 30.3 years, who underwent electroconvulsive therapy. Ambulatory blood pressure monitoring and continuous electrocardiographic monitoring (Holter monitor were performed during 24 hours. Blood pressure and heart rate were assessed 4 hours prior to electric shock administration, during electric shock administration, and 3 hours after electric shock administration. Arrhythmias and alterations in the ST segment in 24 hours were recorded. RESULTS - On electroconvulsive therapy, a significant increase in blood pressure and heart rate was observed and the measurements returned to basal values after 25 minutes. Three females had tracings with depression of the ST segment suggesting myocardial ischemia prior to and after electroconvulsive therapy. Coronary angiography was normal. No severe cardiac arrhythmias were diagnosed. CONCLUSION - 1 Electroconvulsive therapy is a safe therapeutic modality in psychiatry; 2 it causes a significant increase in blood pressure and heart rate; 3 it may be associated with myocardial ischemia in the absence of coronary obstructive disease; 4 electroconvulsive therapy was not associated with the occurrence of severe cardiac arrhythmias.

  13. Electroconvulsive therapy in Parkinson's disease.

    Science.gov (United States)

    Calderón-Fajardo, Humberto; Cervantes-Arriaga, Amin; Llorens-Arenas, Rodrigo; Ramírez-Bermudez, Jesús; Ruiz-Chow, Ángel; Rodríguez-Violante, Mayela

    2015-10-01

    Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson's disease.

  14. Extracorporeal shock wave treatment for chronic lateral epicondylitis (tennis elbow).

    Science.gov (United States)

    Ho, C

    2007-01-01

    (1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic lateral epicondylitis (CLE) of the elbow (elbow tendonitis or tennis elbow). These waves may help to accelerate the healing process via an unknown mechanism. (2) Results from randomized controlled trials have been conflicting. Half of the studies showed statistically significant improvement in pain in the treatment group, and half of the studies had data showing no benefit over placebo for any measured outcomes. (3) Limited evidence shows that ESWT is cheaper than arthroscopic surgery, open surgery, and other conservative therapies, such as steroid infiltrations and physiotherapy, that continue for more than six weeks. (4) The lack of convincing evidence regarding its effectiveness does not support the use of ESWT for CLE.

  15. Electroconvulsive therapy without consent.

    Science.gov (United States)

    Moksnes, Kjell Martin

    2013-10-15

    In principle, electroconvulsive therapy (ECT) can only be administered to patients who consent to the treatment. If the patient does not consent, the treatment can be given in exceptional cases, in situations where a plea of necessity can be made. The purpose of this study was to investigate whether the issue of consent was documented in the patient records at Dikemark Hospital in the period 1960-95, and to study the outcomes for patients who were given ECT treatment without having consented. The article is based on a review of the ECT protocols and the records of patients who were given this treatment during the period 1960-95 in three psychiatric wards at Dikemark Hospital. We registered whether the issue of consent had been documented, and if so, whether consent had been provided or not. The material encompasses 241 ECT series administered to 141 patients. The issue of consent had been documented for 107 of a total of the 241 series. Seven patients were given the therapy against their wishes. The median age of these seven was 68 years (range 56-82 years). All of them had been diagnosed with depressive psychosis and were given electroconvulsive therapy on a vital indication under a plea of necessity. Insufficient intake of nourishment was described as the main reason for the vital indication in all the seven patients. According to their records, they showed signs of improvement on the day after the first treatment. Their lifespan after the treatment varied from three to 19 years. On the basis of the records in which it was documented that the patient had not provided consent, electroconvulsive therapy was administered exclusively as a life-saving intervention.

  16. How does electroconvulsive therapy work?

    DEFF Research Database (Denmark)

    Bolwig, Tom G

    2011-01-01

    This article reviews 3 current theories of electroconvulsive therapy (ECT). One theory points to generalized seizures as essential for the therapeutic efficacy of ECT. Another theory highlights the normalization of neuroendocrine dysfunction in melancholic depression as a result of ECT. A third t...... theory is based on recent findings of increased hippocampal neurogenesis and synaptogenesis in experimental animals given electroconvulsive seizures. Presently, the endocrine theory has the strongest foundation to explain the working mechanism of ECT....

  17. How does electroconvulsive therapy work?

    DEFF Research Database (Denmark)

    Bolwig, Tom G

    2011-01-01

    This article reviews 3 current theories of electroconvulsive therapy (ECT). One theory points to generalized seizures as essential for the therapeutic efficacy of ECT. Another theory highlights the normalization of neuroendocrine dysfunction in melancholic depression as a result of ECT. A third...... theory is based on recent findings of increased hippocampal neurogenesis and synaptogenesis in experimental animals given electroconvulsive seizures. Presently, the endocrine theory has the strongest foundation to explain the working mechanism of ECT....

  18. Analgesic effect of extracorporeal shock wave therapy versus ultrasound therapy in chronic tennis elbow

    OpenAIRE

    2015-01-01

    [Purpose] This study compared the analgesic effects of extracorporeal shock wave therapy with those of ultrasound therapy in patients with chronic tennis elbow. [Subjects] Fifty patients with tennis elbow were randomized to receive extracorporeal shock wave therapy or ultrasound therapy. [Methods] The extracorporeal shock wave therapy group received 5 treatments once per week. Meanwhile, the ultrasound group received 10 treatments 3 times per week. Pain was assessed using the visual analogue ...

  19. Analgesic effect of extracorporeal shock wave therapy versus ultrasound therapy in chronic tennis elbow.

    Science.gov (United States)

    Lizis, Paweł

    2015-08-01

    [Purpose] This study compared the analgesic effects of extracorporeal shock wave therapy with those of ultrasound therapy in patients with chronic tennis elbow. [Subjects] Fifty patients with tennis elbow were randomized to receive extracorporeal shock wave therapy or ultrasound therapy. [Methods] The extracorporeal shock wave therapy group received 5 treatments once per week. Meanwhile, the ultrasound group received 10 treatments 3 times per week. Pain was assessed using the visual analogue scale during grip strength evaluation, palpation of the lateral epicondyle, Thomsen test, and chair test. Resting pain was also recorded. The scores were recorded and compared within and between groups pre-treatment, immediately post-treatment, and 3 months post-treatment. [Results] Intra- and intergroup comparisons immediately and 3 months post-treatment showed extracorporeal shock wave therapy decreased pain to a significantly greater extent than ultrasound therapy. [Conclusion] Extracorporeal shock wave therapy can significantly reduce pain in patients with chronic tennis elbow.

  20. Electroconvulsive Therapy: A Current Review

    Directory of Open Access Journals (Sweden)

    Gokben Hizli Sayar

    2014-06-01

    Full Text Available Most of the electroconvulsive therapy guidelines state that severe major depression with psychotic features, manic delirium, or catatonia are conditions where there is a clear consensus favoring early electroconvulsive therapy. The decision to administer electroconvulsive therapy is based on an evaluation of the risks and benefits for the individual patient and involves a combination of factors, including psychiatric diagnosis, type and severity of symptoms, prior treatment history and response, identification of possible alternative treatment options, and consumer preference. In this review history, mechanisms of action, side effects that have been referenced in the literature and clinical experience are discussed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 107-125

  1. Electroconvulsive Therapy in Multiple Sclerosis.

    Science.gov (United States)

    Steen, Katie; Narang, Puneet; Lippmann, Steven

    2015-01-01

    We performed a literature search regarding the safety and efficacy of electroconvulsive therapy in patients with multiple sclerosis and comorbid psychiatric symptoms. Literature review was conducted via PubMed databases. Of the cases we reviewed, most subjects with multiple sclerosis reported significant psychiatric symptom relief, with only a handful reporting neurologic deterioration. There was some evidence that active white matter lesions may be predictive of neurologic deterioration when electroconvulsive therapy is used in patients with multiple sclerosis. A brief description of the pathophysiology and effects of depression in patients with multiple sclerosis is also provided. Although no clinical recommendations or meaningful conclusions can be drawn without further investigation, the literature suggests that electroconvulsive therapy for treatment of psychiatric illnesses in patients with multiple sclerosis is safe and efficacious.

  2. Electroconvulsive Therapy: A Comprehensive Assessment

    Directory of Open Access Journals (Sweden)

    Tayfun Zeren

    2003-08-01

    Full Text Available Electroconvulsive therapy (ECT is one of the most important discoveries of psychiatric treatments. This article comprehensively assesses historical progress, mechanism of actions, practical methods, indications, side effects, complications, drug interactions of ECT and attitudes towards ECT. [Archives Medical Review Journal 2003; 12(4.000: 340-377

  3. Effect of electroconvulsive therapy on hematological parameters.

    Science.gov (United States)

    Chaturvedi, S; Chadda, R K; Rusia, U; Jain, N

    2001-11-30

    Although a complete blood count is part of the evaluation before the use of electroconvulsive therapy (ECT), there are no known hematological contraindications for the procedure. A preliminary study was done on 31 randomly selected psychiatric patients (chronic schizophrenia, n=10; acute depression, n=8; acute mania, n=6; acute psychosis, n=6; delusional disorder, n=1) receiving ECT to study its hematological effects. Blood samples were drawn just before and 0, 1 and 2 h after ECT. Hemoglobin (Hb%), total and differential leukocyte count (TLC and DLC), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and platelet count were measured on a fully automated hematology analyzer (Sysmex K-1000). Significant changes were found in TLC, percentage of polymorphs and lymphocytes, and Hb%. Changes in other parameters were not statistically significant. More such studies are needed to substantiate these observations and to understand the mechanism and implication of these effects.

  4. Safety and efficacy of extracorporeal shock wave therapy for chronic lateral epicondylitis.

    Science.gov (United States)

    Furia, John P

    2005-01-01

    Efficacy and safety of extracorporeal shock wave therapy (ESWT) were investigated in 36 patients with chronic lateral epicondylitis--9 patients receiving and 27 patients not receiving worker's compensation. All patients were treated with a single application of 3200 shock waves. Twelve weeks after treatment, the mean visual analog scale score for the entire group improved from 8.0 to 2.5 (P elbows (77.8%) were rated excellent or good on the Roles and Maudsley scale. There were no significant differences in outcome measures among the subgroups. There were no significant complications. ESWT is an effective treatment for chronic lateral epicondylitis. Worker's compensation status did not affect outcomes.

  5. The depiction of electroconvulsive therapy in Hindi cinema.

    Science.gov (United States)

    Andrade, Chittaranjan; Shah, Nilesh; Venkatesh, Basappa K

    2010-03-01

    There is little literature on the depiction of electroconvulsive therapy (ECT) in movies. In India, Hindi cinema is an important source of public information and misinformation about ECT. We identified depictions of ECT in Hindi cinema through inquiries with e-communities, video libraries, and other sources. We also searched the PubMed database using search terms related to ECT and movies. Between 1967 and 2008, 13 Hindi movies contained referrals to or depictions of ECT. By and large, the depictions were inaccurate, distorted, and dramatized. Electroconvulsive therapy was administered to punish, to obliterate identity, to induce insanity, and for other rarely clinically valid indications. Electroconvulsive therapy was almost always administered by force. Premedication was rare. Genuine ECT devices were uncommonly used. Electroconvulsive therapy stimulation almost invariably appeared to cause pain. Multiple shocks were frequently delivered in the same session. The convulsions were usually bizarre. The treatment caused mental disturbance, amnesia, weakness, and even a zombielike state, thought not mortality; clinical improvement was rare. There was no pattern of increasing accuracy of depiction of ECT with recency of movie release. We examine the extent to which the identified inaccuracies are practically important and offer reasons for the inaccuracies. Although the inaccuracies are a cause for concern, we suggest that because Hindi cinema is generally hyperbolic, the public may be willing to distinguish real life from reel life when facing clinical decisions about ECT. Nevertheless, considering the potential for harm in the dissemination of misinformation, filmmakers should exhibit a greater sense of ethics when creating impressions that might adversely influence health.

  6. 2,6-二异丙基苯酚逆转嗅球切除抑郁模型大鼠电休克后的Tau蛋白过度磷酸化和认知障碍%2,6-Diisopropylphenol Protects Against The Impairment of Learning-memory and Reduces The Hyperphosphorylation of Protein Tau Induced by Electroconvulsive Shock in The Depression Model Rats Whose Olfactory Bulbs Were Removed

    Institute of Scientific and Technical Information of China (English)

    刘超; 闵苏; 魏柯; 刘东; 董军; 罗洁; 刘小滨

    2012-01-01

    Protein Tau is a very unequal phosphoric microtubule associated protein, which affect the transport of substances in the axons of the neurons, whose phosphorylation is one of the key methods to regulate neuronal function. The hyperphosphorylation of protein Tau can damage the learning and memory of rats. The impairment of learning-memory induced by electroconvulsive shock in depressed rats is relevant to the function failure of glutamic acid signal system. The phosphorylation of protein Tau can be up-regulated by the individual stress level through the excitatory neurotransmission system. The mechanisms of 2, 6-diisopropylphenol effect on the central nerve system relate to inhibiting the release of glutamic acid and the activity of NMDAR. And the 2, 6-diisopropylphenol can protects against the impairment of learning-memory induced by electroconvulsive shock in depressed rats though inhibiting the excitotoxicty of glutamate. The rise of glutamic acid which induced by electroconvulsive shock in depressed rats can lead to the impairment of learning-memory through up-regulating the hyperphosphorylation of protein Tau? The 2, 6-diisopropylphenol can protect against this process? This study explore the reversion of the 2, 6-diisopropylphenol against the impairment of learning-memory and the hyperphosphorylation of protein Tau induced by electroconvulsive shock in depressed rats, in order to provide experimental evidence for neuropsychological mechanisms on improving learning and memory and the clinical intervention treatment. According to the design of factorial analysis, two intervention factors were set up: the electroconvulsive shock (two levels: no disposition; a course of electroconvulsive shock) and the 2, 6-diisopropylphenol (two levels: 5 ml Saline was injected peritoneally; 5 ml 2, 6-diisopropylphenol was injected peritoneally by dosage of 100 mg/kg). Thirty-two adult depression model rats whose olfactory bulbs were removed were randomly divided into four

  7. Assessment of the cardiovascular effects of electroconvulsive therapy in individuals older than 50 years

    Directory of Open Access Journals (Sweden)

    Takada J.Y.

    2005-01-01

    Full Text Available To evaluate the impact of electroconvulsive therapy on arterial blood pressure, heart rate, heart rate variability, and the occurrence of ischemia or arrhythmias, 38 (18 men depressive patients free from systemic diseases, 50 to 83 years old (mean: 64.7 ± 8.6 underwent electroconvulsive therapy. All patients were studied with simultaneous 24-h ambulatory blood pressure and Holter monitoring, starting 18 h before and continuing for 3 h after electroconvulsive therapy. Blood pressure, heart rate, heart rate variability, arrhythmias, and ischemic episodes were recorded. Before each session of electroconvulsive therapy, blood pressure and heart rate were in the normal range; supraventricular ectopic beats occurred in all patients and ventricular ectopic beats in 27/38; 2 patients had non-sustained ventricular tachycardia. After shock, systolic, mean and diastolic blood pressure increased 29, 25, and 24% (P < 0.001, respectively, and returned to baseline values within 1 h. Maximum, mean and minimum heart rate increased 56, 52, and 49% (P < 0.001, respectively, followed by a significant decrease within 5 min; heart rate gradually increased again thereafter and remained elevated for 1 h. Analysis of heart rate variability showed increased sympathetic activity during shock with a decrease in both sympathetic and parasympathetic drive afterwards. No serious adverse effects occurred; electroconvulsive therapy did not trigger any malignant arrhythmias or ischemia. In middle-aged and elderly people free from systemic diseases, electroconvulsive therapy caused transitory increases in blood pressure and heart rate and a decrease in heart rate variability but these changes were not associated with serious adverse clinical events.

  8. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    Science.gov (United States)

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy. Copyright © 2015 IJS Publishing Group Limited. All rights reserved.

  9. Atrioventricular Dissociation after Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    Siegfried William Yu

    2011-01-01

    Full Text Available Electroconvulsive therapy (ECT is increasingly used as a treatment for psychiatric disorders. Cardiac effects are the principal cause of medical complications in these patients. We report a case of atrioventricular (AV dissociation that occurred after ECT that was treated with pacemaker implantation. The mechanisms contributing to the onset of AV dissociation in this patient, and the management and rationale for device therapy, in light of the most recent guidelines, are reviewed.

  10. A neural model for chronic pain and pain relief by extracorporeal shock wave treatment.

    Science.gov (United States)

    Wess, Othmar J

    2008-12-01

    The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reflexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an efficient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.

  11. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment. METHODS: We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1...... November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used. RESULTS: Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months...

  12. Immune and neurotrophin stimulation by electroconvulsive therapy : is some inflammation needed after all?

    NARCIS (Netherlands)

    van Buel, E. M.; Patas, K.; Peters, M.; Bosker, F. J.; Eisel, U. L. M.; Klein, H. C.

    2015-01-01

    A low-grade inflammatory response is commonly seen in the peripheral blood of major depressive disorder (MDD) patients, especially those with refractory and chronic disease courses. However, electroconvulsive therapy (ECT), the most drastic intervention reserved for these patients, is closely

  13. DARPP-32 expression in rat brain after electroconvulsive stimulation.

    Science.gov (United States)

    Rosa, Daniela V F; Souza, Renan P; Souza, Bruno R; Motta, Bernardo S; Caetano, Fernando; Jornada, Luciano K; Feier, Gustavo; Gomez, Marcus V; Quevedo, João; Romano-Silva, Marco A

    2007-11-07

    Although electroconvulsive therapy (ECT) has been used as a treatment for mental disorder since 1930s, little progress has been made in the mechanisms underlying its therapeutic or adverse effects. The aim of this work was to analyze the expression of DARPP-32 (a protein with a central role in dopaminergic signaling) in striatum, cortex, hippocampus and cerebellum of Wistar rats subjected to acute or chronic electroconvulsive stimulation (ECS). Rats were submitted to a single stimulation (acute) or to a series of eight stimulations, applied one every 48 h (chronic). Animals were killed for collection of tissue samples at time zero, 0.5, 3, 12, 24 and 48 h after stimulation in the acute model and at the same time intervals after the last stimulation in the chronic model. Our results indicated that acute ECS produces smaller changes in the expression of DARPP-32 but, interestingly, chronic ECS increased transient expression of DARPP-32 in several time frames, in striatum and hippocampus, after the last stimulation. Results on the expression of proteins involved in signaling pathways are relevant for neuropsychiatric disorders and treatment, in particular ECT, and can contribute to shed light on the mechanisms related to therapeutic and adverse effects.

  14. [Extracorporeal shock wave therapy as a treatment of a non-healing chronic leg ulcer].

    Science.gov (United States)

    Stieger, M; Schmid, J-P; Bajrami, S; Hunziker, T

    2013-06-01

    Extracorporeal shock waves are defined as a sequence of sonic pulses characterized by high peak pressure over 100 MPa, fast pressure rise, and short lifecycle. In the 1980s extracorporeal shock wave lithotripsy (ESWL) was first used for the treatment of urolithiasis. Orthopedic surgeons use extracorporeal shock wave therapy (ESWT) to treat non-union fractures, tendinopathies and osteonecrosis. The first application of ESWT in dermatology was for recalcitrant skin ulcers. Several studies in the last 10 years have shown that ESWT promotes angiogenesis, increases perfusion in ischemic tissues, decreases inflammation, enhances cell differentiation and accelerates wound healing. We successfully treated a non-healing chronic venous leg ulcer with ESWT. Furthermore we observed an improvement of the lymphatic drainage after application of ESWT. We are confident that ESWT is a non-invasive, practical, safe and efficient physical treatment modality for recalcitrant leg ulcers.

  15. [Clinical analysis of safety and effectiveness of electroconvulsive therapy].

    Science.gov (United States)

    Dabrowski, Marek; Parnowski, Tadeusz

    2012-01-01

    The aim of the study was to assess efficacy and safety of electroconvulsive therapy. 43 patients included into the study were hospitalised in The Institute of Psychiatry and Neurology and received all together over 400 bilateral electroconvulsive procedures. Most of the patients (N = 25) were qualified for electroconvulsive therapy due to treatment resistant depression (58.1%). Six patients: 2 with catatonia and 4 with depression had life saving indications for electroconvulsive therapy. Three patients (7%) were excluded from electroconvulsive therapy, following 1 or 2 electroconvulsive procedures. Forty patients continued electroconvulsive therapy. There were no complications and serious adverse events in patients who continued electroconvulsive therapy. Generally, electroconvulsive therapy was well tolerated and treatment had been cut down in only one case due to adverse events and high risk related to the procedure. Transient cardiac arrhythmias (10% of patients) were the most often occurring adverse events and patients (35%) mostly reported headaches. We observed remission in 22 patients (58%) and improvement in 14 patients (35%) following electroconvulsive treatment. Only 4 patients (10%) had no benefit after a series of electroconvulsive procedures. Electroconvulsive treatment was most effective in patients with catatonia (80% patients had full recovery) and in depressive patients with bipolar disorder (73% patients had full recovery). Electroconvulsive procedures were safe and effective. Electroconvulsive treatment was most effective in catatonic patients with schizophrenia and in depressive patients with bipolar disorder.

  16. Electroconvulsive therapy and Klinefelter syndrome.

    Science.gov (United States)

    Wei, Qiang; Xie, Xinhui; Chen, Yang; Tian, Yanghua; Wang, Honghao; Wang, Keyong; Wang, Kai

    2013-09-01

    Klinefelter syndrome is a common sex chromosome disorder characterized by the presence of 1 or more extra X chromosomes, and the most prevalent karyotype is 47,XXY. Epidemiological studies have showed that patients with Klinefelter syndrome had a significantly increased risk of psychosis. We presented a case of a patient with Klinefelter syndrome who was characterized by psychiatric symptoms. The patients had been refractory to clozapine and sodium valproate, but a remarkable improvement occurred after a cycle of 11 sessions of modified electroconvulsive therapy.

  17. Electroconvulsive Therapy and Corpus Callosum Aplasia: A 3-Year Followup

    Directory of Open Access Journals (Sweden)

    Ulrich Palm

    2011-01-01

    Full Text Available Electroconvulsive Therapy (ECT is a powerful treatment option in severe or chronic catatonic states and has been reported to be useful in oligophrenic patients. We report the followup medical history of a patient with corpus callosum aplasia (or agenesis who was continuously treated with ECT over three years. First, he improved considerably after a series of ECT, but relapses of catatonia made a continuous, weekly ECT necessary. Due to the severity of the brain malformation, an add-on medication with benzodiazepines and second generation antipsychotics was necessary to treat catatonic symptoms. This case emphasises the benefits of long-term ECT in oligophrenic patients.

  18. Shock

    Science.gov (United States)

    Shock can be caused by any condition that reduces blood flow, including: Heart problems (such as heart attack or heart failure ) Low blood volume (as with heavy bleeding or dehydration ) Changes in blood vessels (as with infection ...

  19. Electroconvulsive therapy substantially reduces symptom severity and social disability associated with multiple chemical sensitivity: a case report

    DEFF Research Database (Denmark)

    Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice

    2010-01-01

    Multiple chemical sensitivity (MCS) is a chronic nonallergic, multisymptom disorder triggered by common environmental chemicals in concentrations considered nontoxic for most individuals. The condition may lead to loss of occupation and social isolation, and no effective treatment has been reported....... Electroconvulsive therapy (ECT) is a safe and effective treatment of severe depression and medical conditions such as chronic pain disorders....

  20. Nonconvulsive status epilepticus after electroconvulsive therapy

    DEFF Research Database (Denmark)

    Povlsen, Uffe Juul; Wildschiødtz, Gordon; Høgenhaven, Hans;

    2003-01-01

    SUMMARY: We describe three cases of nonconvulsive status epilepticus induced by electroconvulsive therapy (ECT). Nonconvulsive status epilepticus is an important differential diagnosis in patients who develop prolonged confusion after ECT. The present cases exemplify the difficulty in defining...

  1. Benjamin Franklin and Shock-Induced Amnesia

    Science.gov (United States)

    Finger, Stanley; Zaromb, Franklin

    2006-01-01

    Shock-induced amnesia received considerable attention after Cerletti popularized electroconvulsive shock therapy in the late 1930s. Yet, often overlooked is the fact that Benjamin Franklin recognized that passing electricity through the head could affect memory for the traumatic event. Franklin described his findings on himself and others in…

  2. The electroconvulsive shock can aggravate the cognitive impairment of the depression model rats though up-regulate the hyperphosphorylation of protein tau%电休克通过上调tau蛋白过度磷酸化程度加重抑郁模型大鼠认知障碍

    Institute of Scientific and Technical Information of China (English)

    陈安; 刘鸿章; 刘超

    2016-01-01

    Objective To explore the change of the cognitive ability after a course of Electroconvulsive therapy (ECT) in depressed rats.Methods The depression model rats whose olfactory bulbs were removed were established.The analysis of variance of factorial design was done to set up two intervention factors:the electric current groups (three levels:25,50,and 75 mA) and the duration groups (three levels:3 times,6 times,and 9 times electroconvulsive shock).Fifty-four adult depression model rats whose olfactory bulbs were removed were randomly divided into nine experimental groups (n =6 in each group).The morris water maze test started within 1 day after the course of electroconvulsive shock finished in order to evaluate learning-memory.The hippocampus was removed from rats within 1 day after the morris water maze test finished.The content of glutamate (Glu) in the hippocampus of rats was determined by high performance liquid chromatography.The expression levels of tau protein including p-AT8Ser202 and GSK-3β1H8 in the hippocampus of rats were detected by Westem blotting.Results With the increase of ECT current,the escape latency is prolonged and space exploration time is shortened.With the extension of ECT time,the escape latency is prolonged and space exploration time is shortened.In 75 mA and the 9 ECT group,the escape latency was longest [(100.51 ± 6.64) s],and the space exploration time is the shortest [(10.02 ± 1.20) s].With the increase of ECT current,the concentration of Glu increased.With the increase of ECT,the concentration of Glu was increased.In 75 mA and the 9 ECT group,Glu concentration was the highest [(184.39 ±20.86) μmol/gprot].With the increase of ECT current,the expression of target protein was increased.With the prolongation of ECT time,the expression of target protein was increased.In 75 mA and the 9 ECT group,the expression of target protein was the highest (p-AT8Ser202:1 771.50 ± 278.26,GSK-3β1H8:1 747.13 ± 162.23).Conclusion Our results

  3. Electroconvulsive therapy-induced mania: a case report

    Directory of Open Access Journals (Sweden)

    Saatcioglu Omer

    2009-11-01

    Full Text Available Abstract Introduction Despite its controversial history, electroconvulsive therapy is generally an effective treatment with few serious side effects. One rare but troublesome side effect of electroconvulsive therapy is mania. Case presentation A 33-year-old Turkish woman developed mania on three separate occasions after receiving electroconvulsive therapy for severe depressive episodes. Conclusion Patients who experience electroconvulsive therapy-related mania should be evaluated for alternative treatments when presenting with severe depression.

  4. Medication management during electroconvulsant therapy

    Directory of Open Access Journals (Sweden)

    Zolezzi M

    2016-04-01

    Full Text Available Monica Zolezzi Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar Abstract: Electroconvulsive therapy (ECT has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords. Keywords: ECT, medications, drug interactions

  5. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used for...

  6. Chronic SIV and morphine treatment increases heat shock protein 5 expression at the synapse.

    Science.gov (United States)

    Pendyala, Gurudutt; Periyasamy, Palsamy; Callen, Shannon; Fox, Howard S; Lisco, Steven J; Buch, Shilpa J

    2015-10-01

    The abuse of opiates such as morphine in synergy with HIV infection accelerates neurocognitive impairments and neuropathology in the CNS of HIV-infected subjects, collectively referred to as HAND. To identify potential pathogenic markers associated with HIV and morphine in perturbing the synaptic architecture, we performed quantitative mass spectrometry proteomics on purified synaptosomes isolated from the caudate of two groups of rhesus macaques chronically infected with SIV differing by one regimen-morphine treatment. The upregulation of heat shock 70-kDa protein 5 in the SIV + morphine group points to increased cellular stress during SIV/morphine interaction thus leading to CNS dysfunction.

  7. Chronic SIV and Morphine treatment increases heat shock protein 5 expression at the synapse

    Science.gov (United States)

    Pendyala, Gurudutt; Periyasamy, Palsamy; Callen, Shannon; Fox, Howard S.; Lisco, Steven J.; Buch, Shilpa J.

    2015-01-01

    The abuse of opiates such as morphine in synergy with HIV infection accelerates neurocognitive impairments and neuropathology in the CNS of HIV infected subjects, collectively referred to as HAND. To identify potential pathogenic markers associated with HIV and morphine in perturbing the synaptic architecture, we performed quantitative mass spectrometry proteomics on purified synaptosomes isolated from the caudate of two groups of rhesus macaques chronically infected with SIV differing by one regimen- morphine treatment. The up regulation of heat shock 70 kDa protein 5 in the SIV+morphine group points to increased cellular stress during SIV/Morphine interaction thus leading to CNS dysfunction. PMID:26037114

  8. [Left ventricular assist devices in cardiogenic shock and chronic refractory heart failure].

    Science.gov (United States)

    Genton, Audrey; Hullin, Roger; Tozzi, Piergiorgio; Cook, Stéphane; Liaudet, Lucas

    2012-12-12

    Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.

  9. Acute and maintenance electroconvulsive therapy for treatment of severely disabling obsessive-compulsive symptoms in a patient with Asperger syndrome.

    Science.gov (United States)

    Nilsson, Björn M; Ekselius, Lisa

    2009-09-01

    We report successful treatment with electroconvulsive therapy of a comorbid condition including severe obsessive-compulsive symptoms and hypochondriacal delusions in a 38-year-old man with Asperger syndrome. His condition deteriorated into a severely disabled chronic state that was refractory to different pharmacological and psychological treatments but was completely reversed after electroconvulsive therapy. Although typical obsessive-compulsive symptoms were predominant, the case also exhibits differences compared with regular obsessive-compulsive disorder regarding onset and course that are discussed in the report.

  10. Electroconvulsive Therapy Intervention for Parkinson's Disease.

    Science.gov (United States)

    Narang, Puneet; Glowacki, Anna; Lippmann, Steven

    2015-01-01

    Electroconvulsive therapy is an established means to improve function in a variety of psychiatric and neurologic conditions, particularly for patients who remain treatment-refractory. Parkinson's disease is a neurodegenerative disorder that sometimes does not respond well to conventional pharmacotherapies. Reports have indicated that electroconvulsive therapy may be an effective and safe treatment for those patients with Parkinson's disease who are not optimally responding to first-line treatments. Despite these reports, however, electroconvulsive therapy is not often used by clinicians in patients with treatment-resistant Parkinson's disease, perhaps due to stigma, lack of knowledge regarding its safety and efficacy, and/or inability to predict the duration of therapeutic benefit. Our objective was to determine if the available literature on ECT supports it as a safe and effective treatment option in patients with treatment-refractory Parkinson's disease. Motoric improvement induced by electroconvulsive therapy has been documented for decades in persons with Parkinson's disease. Efficacy and safety are reported following electroconvulsive therapy in people with Parkinson's disease who have sub-optimal response to medicines or experience the "on/off" phenomenon to L-dopa. Electroconvulsive therapy is an effective option for acute and maintenance treatment of Parkinson's disease in select patients. Inability to predict how long the beneficial effects of ECT therapy will last in patients with Parkinson's disease may be a reason why this treatment is underutilized by clinicians. More research is warranted to clarify parameters for application and duration of therapeutic benefit in individuals with difficult-to-treat Parkinson's disease.

  11. Is electroconvulsive therapy during pregnancy safe?

    Science.gov (United States)

    Jiménez-Cornejo, Magdalena; Zamorano-Levi, Natalia; Jeria, Álvaro

    2016-12-07

    Therapeutic options for psychiatric conditions are limited during pregnancy because many drugs are restricted or contraindicated. Electroconvulsive therapy constitutes an alternative, however there is controversy over its safety. Using the Epistemonikos database, which is maintained by searching multiple databases, we found five systematic reviews, including 81 studies overall describing case series or individual cases. Data were extracted from the identified reviews and summary tables of the results were prepared using the GRADE method. We concluded it is not clear what are the risks associated with electroconvulsive therapy during pregnancy because the certainty of the existing evidence is very low. Likewise, existing systematic reviews and international clinical guidelines differ in their conclusions and recommendations.

  12. Electroconvulsive therapy and nursing care.

    LENUS (Irish Health Repository)

    Kavanagh, Adam

    2011-04-27

    Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. It is, therefore, essential that nurses possess sufficient information to help patients make rational and informed treatment decisions and be able to care for both the clinical and psychological needs of patients treated with ECT. This review outlines the nursing role in ECT and summarizes the main aspects of contemporary ECT practice relevant to general and psychiatric nursing practice.

  13. [Electroconvulsive therapy in nonconsenting patients].

    Science.gov (United States)

    Besse, M; Methfessel, I; Wiltfang, J; Zilles, D

    2017-01-01

    Electroconvulsive therapy (ECT) is a potent and successful method for the treatment of severe psychiatric disorders. Severe depressive and psychotic disorders may lead to legal incapacity and inability to consent. In Germany, administration of ECT against the patient's will is feasible under certain constellations and is regulated under the terms of the guardianship law. This article outlines the prevalence, effectiveness and tolerability of ECT when applied in nonconsenting patients. Case report and literature review. The literature on ECT as a treatment in nonconsenting patients is relatively sparse. In 2008 the prevalence in Germany was less than 0.5 % of all patients receiving ECT. Case reports and case series suggest a good and equal level of effectiveness when compared to consenting patients. In the course of treatment the majority of patients consented to receive further ECT and retrospectively judged ECT as helpful. The use of ECT is a highly effective treatment in severe psychiatric disorders even when administered as treatment in nonconsenting patients. It can be lifesaving and lead to a rapid improvement of symptoms and relief from severe suffering also from the patients' perspective. Thus, it seems unethical not to consider ECT as a treatment against the nonautonomous will of legally incompetent patients in individual cases. Nevertheless, physicians should always seek to obtain the patients' consent as soon as possible for both legal and ethical reasons.

  14. Beta-blocking agents and electroconvulsive therapy

    NARCIS (Netherlands)

    W.W. van den Broek (Walter); T.H.N. Groenland (Theo); P.G.H. Mulder (Paul); A. Kusuma (Ari); T.K. Birkenhäger (Tom); E.M. Pluijms (Esther); J.A. Bruijn (Jan)

    2007-01-01

    textabstractIn this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables. We searched for studies in the

  15. Beta-Blocking Agents and Electroconvulsive Therapy

    NARCIS (Netherlands)

    W.W. van den Broek (Walter); T.H.N. Groenland (Theo); A. Kusuma (Ari); T.K. Birkenhäger (Tom); E.M. Pluijms (Esther); J.A. Bruijn (Jan); P.G.H. Mulder (Paul)

    2007-01-01

    textabstractIn this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables. We searched for studies in the

  16. [Electroconvulsion therapy for neuroleptic malignant syndrome].

    Science.gov (United States)

    Buggenhout, S; Vandenberghe, J; Sienaert, P

    2014-01-01

    A 64-year-old man, diagnosed with recurrent depression, developed a neuroleptic malignant syndrome (nms) during treatment with olanzapine and mirtazapine. Psychotropic drugs were discontinued. Supportive therapy in an intensive care setting was initiated and electroconvulsive therapy (ect) was administered, after which the patient recovered. This case report discusses the place of ect in the treatment of nms.

  17. Beta-Blocking Agents and Electroconvulsive Therapy

    NARCIS (Netherlands)

    W.W. van den Broek (Walter); T.H.N. Groenland (Theo); A. Kusuma (Ari); T.K. Birkenhäger (Tom); E.M. Pluijms (Esther); J.A. Bruijn (Jan); P.G.H. Mulder (Paul)

    2007-01-01

    textabstractIn this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables. We searched for studies in the electron

  18. Beta-blocking agents and electroconvulsive therapy

    NARCIS (Netherlands)

    W.W. van den Broek (Walter); T.H.N. Groenland (Theo); P.G.H. Mulder (Paul); A. Kusuma (Ari); T.K. Birkenhäger (Tom); E.M. Pluijms (Esther); J.A. Bruijn (Jan)

    2007-01-01

    textabstractIn this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables. We searched for studies in the electron

  19. Protocolized hyperventilation enhances electroconvulsive therapy.

    Science.gov (United States)

    de Arriba-Arnau, Aida; Dalmau, Antonia; Soria, Virginia; Salvat-Pujol, Neus; Ribes, Carmina; Sánchez-Allueva, Ana; Menchón, José Manuel; Urretavizcaya, Mikel

    2017-08-01

    Hyperventilation is recommended in electroconvulsive therapy (ECT) to enhance seizures and to increase patients' safety. However, more evidence is needed regarding its effects and the optimum method of application. This prospective study involving 21 subjects compared two procedures, protocolized hyperventilation (PHV) and hyperventilation as usual (HVau), applied to the same patient in two consecutive sessions. Transcutaneous partial pressure of carbon dioxide (TcPCO2) was measured throughout all sessions. Ventilation parameters, hemodynamic measures, seizure characteristics, and side effects were also explored. PHV resulted in lower TcPCO2 after hyperventilation (p=.008) and over the whole session (p=.035). The lowest TcPCO2 was achieved after voluntary hyperventilation. Changes in TcPCO2 from baseline showed differences between HVau and PHV at each session time-point (all p<.05). Between- and within-subjects factors were statistically significant in a general linear model. Seizure duration was greater in PHV sessions (p=.028), without differences in other seizure quality parameters or adverse effects. Correlations were found between hypocapnia induction and seizure quality indexes. Secondary outcomes could be underpowered. PHV produces hypocapnia before the stimulus, modifies patients' TcPCO2 values throughout the ECT session and lengthens seizure duration. Voluntary hyperventilation is the most important part of the PHV procedure with respect to achieving hypocapnia. A specific ventilation approach, CO2 quantification and monitoring may be advisable in ECT. PHV is easy to apply in daily clinical practice and does not imply added costs. Ventilation management has promising effects in terms of optimizing ECT technique. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Bloqueo de las crisis audiogénicas y del choque electroconvulsivo por la 2-fenil-4,4-bis-(hidroximetil-2-oxazolina Block of the audiogenic seizures and of the electroconvulsive shock by 2-phenyl-4, 4-bis-(hydroxymethyl-2-oxazoline

    Directory of Open Access Journals (Sweden)

    Milena Díaz Molina

    2004-12-01

    Full Text Available Algunas aril-oxazolinas han sido descritas como sustancias activas sobre el sistema nervioso central, con efectos y aplicaciones diversas como depresoras, anestésicos, anticonvulsivos, etc. El presente trabajo se trazó como objetivo fundamental estudiar el posible efecto de la 2-fenil-4,4-bis (hidroximetil-2-oxazolina (OX obtenida por síntesis química bajo microondas, en 2 modelos experimentales de epilepsia: el choque electroconvulsivo por estimulación repetitiva en ratones y el de inducción de crisis convulsiva por estímulo audiogénico en el gerbo mongol. La dosis de 150 mg/kg de OX redujo el número de pulsos eléctricos necesarios para inducir la crisis tónica producida por el choque eléctrico, así como su duración. Esta misma dosis bloqueó las crisis inducidas por el estímulo audiogénico en el gerbo, y disminuyó significativamente su severidad (grados de crisis y ocurrencia. Estos resultados permiten afirmar que OX presenta un efecto antiepiléptico relacionado posiblemente con una inhibición de la sinapsis glutamatérgica en el hipocampo.Some aryl-oxazolines have been described as active substances on the central nervous system, with diverse effects and applications as depressants, anesthetics, anticonvulsants, etc. The purpose of the present paper is to study the possible effect of 2-phenyl-4,4-bis (hydroxymethyl-2-oxazoline (OX obtained by chemical synthesis under microwaves in 2 experimental models of epilepsy: the electroconvulsive shock by repetitive stimulation in mice and that of induction of convulsive seizures by audiogenic stimulus in gerbo mongol. The dose of 150 mg/kg of OX reduced the number of electric pulses, as well as its duration. This same dose blocked the seizures induced by audiogenic stimulus in gerbo and significantly reduced its severity (seizure degrees and occurrence. These reults allow to assert that OX present an antiepilectic effect possibly related to an inhibition of glutamatergic synapse in

  1. Defocused Shock Wave Therapy for Chronic Soft Tissue Wounds in the Lower Limbs: A Pilot Study.

    Science.gov (United States)

    Porso, Manuela; Loreti, Simona; Nusca, Sveva Maria; Luziatelli, Sara; Caccia, Donatella; Taborri, Giulia; Trischitta, Donatella; Taurino, Maurizio; Padua, Luca; Saraceni, Vincenzo Maria; Vulpiani, Maria Chiara; Vetrano, Mario

    2017-01-01

    Chronic soft tissue wounds of the lower limbs are debilitating, painful and often unresponsive to advanced dressing treatments. Extracorporeal shock wave therapy (ESWT) could represent an alternative treatment. Ten patients with chronic soft tissue wounds of the legs, unresponsive to advanced dressing treatments for more than 3 mo, underwent three defocused ESWT sessions at 72-h intervals. In every session, the sum of 300 standard pulses + 100 pulses per square centimeter was applied at 0.15 mJ/mm(2) and 4 Hz over the edge of the wound. The wound size in square centimeters, Bates-Jensen Wound Assessment Tool and visual analogue scale were used as outcome measures. A significant reduction in wound size and Bates-Jensen Wound Assessment Tool and visual analogue scale values from pre-treatment to 90 d was observed. Seven of ten ulcers healed completely and nine of ten patients reported complete pain relief. Defocused ESWT represents a non-invasive, feasible strategy for difficult-to-treat soft tissue wounds of the lower limbs. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  2. The effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients.

    Science.gov (United States)

    Han, Hyeonjee; Lee, Daehee; Lee, Sangyong; Jeon, Chunbae; Kim, Taehoon

    2015-02-01

    [Purpose] The purpose of this study was to examine the effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. [Subjects] In this study, 30 chronic low back pain patients were divided into an extracorporeal shock wave therapy group (ESWTG, n=15) and a conservative physical therapy group (CPTG, n=15). [Methods] The ESWTG received extracorporeal shock wave therapy and the CPTG received general conservative physical therapy two times per week for six weeks. Pain was measured using a visual analog scale (VAS), the degree of disability of the patients was assessed using the Oswestry Disability Index (ODI), and their degree of depression was measured using the Beck depression index (BDI). [Results] In intra-group comparisons, ESWTG and CPTG showed significant decreases in VAS, ODI, and BDI scores. Intergroup comparisons revealed that these decreases in VAS, ODI, and BDI scores were significantly larger in ESWTG than in CPTG. [Conclusion] Extracorporeal shock wave therapy is an effective intervention for the treatment of pain, disability, and depression in chronic low back pain patients.

  3. The practice of electroconvulsive therapy in Greece.

    Science.gov (United States)

    Kaliora, Styliani C; Braga, Raphael J; Petrides, Georgios; Chatzimanolis, John; Papadimitriou, George N; Zervas, Iannis M

    2013-09-01

    To describe the practice of electroconvulsive therapy (ECT) in Greece. A survey was conducted during the academic year 2008-2009. Electroconvulsive therapy use was investigated for 2007. All civilian institutions providing inpatient care were included. Centers that provided ECT completed a 57-item questionnaire. Centers that did not offer ECT completed a 13-item questionnaire. Fifty-five (82.1%) of 67 institutions responded. Electroconvulsive therapy was offered in 18 hospitals. Only 2 of 10 university hospitals offered ECT. Overall, 137 patients were treated with 1271 sessions in 2007. Only 1.47% discontinued treatment owing to adverse events. There were no deaths. Schizophrenia was the most common diagnosis (41.3%) among those receiving ECT, followed by major depression (28.9%), bipolar depression (9.1%), catatonia (4.1%), suicidal ideation (3.3%), and schizoaffective disorder (2.5%). Physicians considered major depression (93.8%), catatonia (86.5%), schizophrenia (56.3%), and mania (50%) the most appropriate indications. Written informed consent was required in 77.8% of the institutions, whereas the rest required verbal consent. Bilateral ECT was the preferred electrode placement (88.9%). Modified ECT was used exclusively. Propofol was the preferred anesthetic (44.4%), followed by thiopental (38.9%). Seven (38.9%) of 18 hospitals used a fixed stimulus dose at first treatment. Five (27.8%) of 18 hospitals used the half-age method. Continuation/maintenance ECT was used in 33.3% of the hospitals. Outpatient ECT was seldom used. Lack of training, difficult access to anesthesiology, billing issues, and stigma were cited as the main impediments to the practice of ECT. Electroconvulsive therapy is practiced in moderate numbers in Greece and almost exclusively on an inpatient basis. Lack of training and lack of availability of anesthesiologists were cited as the most common obstacles to providing ECT.

  4. Attitudes toward electroconvulsive therapy in Romanian psychiatrists.

    Science.gov (United States)

    Gazdag, Gábor; Zsargó, Eszter; Kerti, Katalin Margit; Grecu, Iosif Gábos

    2011-09-01

    Use of electroconvulsive therapy (ECT) is influenced by the attitudes of the psychiatrists. The aim of this pilot survey was to assess the knowledge about and attitudes toward ECT in Romanian psychiatrists. Participants of a scientific meeting were requested to fill a 29-item questionnaire. Answers reflecting false concepts or negative attitudes toward ECT were more than 20% in 15 of 21 items, which highlights the urgent need to improve psychiatrists' education and training about ECT in Romania.

  5. Electroconvulsive therapy and determination of cerebral dominance

    OpenAIRE

    Dragovic, Milan; Allet, Lindsay; Janca, Aleksandar

    2004-01-01

    Electroconvulsive therapy (ECT) often results in a number of short- and long-time side effects including memory impairment for past and current events, which can last for several months after ECT treatment. It has been suggested that unilateral ECT (uECT) with electrodes placed over the non-dominant (typically right) hemisphere significantly reduces side effects, especially memory disturbances. It is important to note that cerebral dominance equates to speech dominance and avoiding this area ...

  6. Differential expression of heat shock transcription factors and heat shock proteins after acute and chronic heat stress in laying chickens (Gallus gallus.

    Directory of Open Access Journals (Sweden)

    Jingjing Xie

    Full Text Available Heat stress due to high environmental temperature negatively influences animal performances. To better understand the biological impact of heat stress, laying broiler breeder chickens were subjected either to acute (step-wisely increasing temperature from 21 to 35°C within 24 hours or chronic (32°C for 8 weeks high temperature exposure. High temperature challenges significantly elevated body temperature of experimental birds (P<0.05. However, oxidation status of lipid and protein and expression of heat shock transcription factors (HSFs and heat shock proteins (HSPs 70 and 90 were differently affected by acute and chronic treatment. Tissue-specific responses to thermal challenge were also found among heart, liver and muscle. In the heart, acute heat challenge affected lipid oxidation (P = 0.05 and gene expression of all 4 HSF gene expression was upregulated (P<0.05. During chronic heat treatment, the HSP 70 mRNA level was increased (P<0.05 and HSP 90 mRNA (P<0.05 was decreased. In the liver, oxidation of protein was alleviated during acute heat challenge (P<0.05, however, gene expression HSF2, 3 and 4 and HSP 70 were highly induced (P<0.05. HSP90 expression was increased by chronic thermal treatment (P<0.05. In the muscle, both types of heat stress increased protein oxidation, but HSFs and HSPs gene expression remained unaltered. Only tendencies to increase were observed in HSP 70 (P = 0.052 and 90 (P = 0.054 gene expression after acute heat stress. The differential expressions of HSF and HSP genes in different tissues of laying broiler breeder chickens suggested that anti-heat stress mechanisms might be provoked more profoundly in the heart, by which the muscle was least protected during heat stress. In addition to HSP, HSFs gene expression could be used as a marker during acute heat stress.

  7. Extracorporeal Shock Wave Lithotripsy in the Management of Chronic Calcific Pancreatitis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Freeman ML

    2005-01-01

    Full Text Available CONTEXT: Main pancreatic duct stones may contribute to pain in chronic pancreatitis. Extracorporeal shock wave lithotripsy (ESWL has been used alone or in combination with endoscopic therapy for fragmentation of stones. Published studies have shown mixed efficacy due to small sample size. OBJECTIVE: Systematic analysis of all published data evaluating ESWL with or without endoscopic therapy in pancreatic duct clearance and symptom relief. METHODS: Two investigators independently reviewed the computer databases. 31 potential studies were identified. Only studies using ESWL with or without endoscopic therapy were included. Completeness of the search was confirmed by an expert. Studies were independently coded by two investigators and differences rectified by mutual consent. MAIN OUTCOME MEASURES: Pain at follow-up and duct clearance. RESULTS: Seventeen studies published between 1989 and 2002 were included. Sixteen had a measure of pain at follow-up and duct clearance. All studies were case series with a total of 588 subjects, and included varying number of subjects undergoing endoscopic pancreatic sphincterotomy and stone extraction. The mean effect size (weighted correlation coefficient for pain was 0.6215 and for duct clearance was 0.7432; thus indicating a large effect. All studies showed homogeneity suggesting similar effect size irrespective of the combinations of therapy. CONCLUSIONS: ESWL is effective in clearance of stones from the pancreatic duct and in relief of pain. Published studies showed homogeneity of the effect size of ESWL both in pancreatic duct clearance and relief of pain.

  8. Differential expression of heat shock transcription factors and heat shock proteins after acute and chronic heat stress in laying chickens (Gallus gallus).

    Science.gov (United States)

    Xie, Jingjing; Tang, Li; Lu, Lin; Zhang, Liyang; Xi, Lin; Liu, Hsiao-Ching; Odle, Jack; Luo, Xugang

    2014-01-01

    Heat stress due to high environmental temperature negatively influences animal performances. To better understand the biological impact of heat stress, laying broiler breeder chickens were subjected either to acute (step-wisely increasing temperature from 21 to 35°C within 24 hours) or chronic (32°C for 8 weeks) high temperature exposure. High temperature challenges significantly elevated body temperature of experimental birds (Pheat shock transcription factors (HSFs) and heat shock proteins (HSPs) 70 and 90 were differently affected by acute and chronic treatment. Tissue-specific responses to thermal challenge were also found among heart, liver and muscle. In the heart, acute heat challenge affected lipid oxidation (P = 0.05) and gene expression of all 4 HSF gene expression was upregulated (Pheat treatment, the HSP 70 mRNA level was increased (Pheat challenge (Pheat stress increased protein oxidation, but HSFs and HSPs gene expression remained unaltered. Only tendencies to increase were observed in HSP 70 (P = 0.052) and 90 (P = 0.054) gene expression after acute heat stress. The differential expressions of HSF and HSP genes in different tissues of laying broiler breeder chickens suggested that anti-heat stress mechanisms might be provoked more profoundly in the heart, by which the muscle was least protected during heat stress. In addition to HSP, HSFs gene expression could be used as a marker during acute heat stress.

  9. Increased expression of heat shock protein 70 and heat shock factor 1 in chronic dermal ulcer tissues treated with laser-aided therapy

    Institute of Scientific and Technical Information of China (English)

    ZHOU Jian-da; LUO Cheng-qun; XIE Hui-qing; NIE Xin-min; ZHAO Yan-zhong; WANG Shao-hua; XU Yi; Pashupati Babu Pokharel; XU Dan

    2008-01-01

    Background Chronic dermal ulcers are also referred to as refractory ulcers, This study was conducted to elucidate the therapeutic effect of laser on chronic dermal ulcers and the induced expression of heat shock factor 1 (HSF1) and heat shock protein 70 (HSP70) in wound tissues.Methods Sixty patients with 84 chronic dermal ulcers were randomly divided into traditional therapy and laser therapy groups. Laser treatment was performed in addition to traditional therapy in the laser therapy group. The treatment efficacy was evaluated after three weeks. Five tissue sections of healing wounds were randomly collected along with five normal skin sections as controls. HSP70-positive cells from HSP70 immunohistochemical staining were counted and the gray scale of positive cells was measured for statistical analysis. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were performed to determine the mRNA and protein expressions of HSF1 and HSP70.Results The cure rate of the wounds and the total efficacy in the laser therapy group were significantly higher than those in the traditional therapy group (P<0.05, P<0.01, respectively). Immunohistochemical staining revealed that the HSP70-positive cell count was significantly higher in laser therapy group than those in the traditional therapy group and controls (P<0.01), and the gray scale of the cell signal was obviously lower than traditional therapy group and controls (P <0.05). By contrast, the traditional therapy group and the control group were not significantly different. The RNA levels of HSF1 and HSP70 were higher in the laser therapy group by RT-PCR, but very low in normal skin and the traditional therapy group. The analysis on the gray scale of the Western blot bands indicated that the expression of HSF1 and HSP70 in the laser therapy group was significantly higher than in the traditional therapy group and the control group (P <0.01), and the expression in the traditional therapy group was also

  10. Troponin elevations after electroconvulsive therapy: the need for caution.

    Science.gov (United States)

    Martinez, Matthew W; Rasmussen, Keith G; Mueller, Paul S; Jaffe, Allan S

    2011-03-01

    Electroconvulsive therapy is used to treat patients with severe or resistant depression. Troponin elevations are associated with an adverse prognosis, and it is well known that central nervous system insults can cause biochemical evidence of cardiac injury. No study previously has studied this with electroconvulsive therapy. Patients scheduled for electroconvulsive therapy were enrolled. Clinical information, an electrocardiogram, and a baseline sample for cardiac troponin I and T (cTnI and cTnT) were obtained. Electroconvulsive therapy was done with standard techniques. Subsequently, electrocardiograms and additional samples were obtained. cTnT was measured with the Roche assay and cTnI with the Dade Stratus equipment. Values above the 99th percentile were considered abnormal. Seventy patients completed the study. Four patients had elevated levels of cTn before treatment. In 3 patients, the elevations persisted. Four additional patients developed elevated cTn levels during electroconvulsive therapy. Two of the patients with cTn elevations died. No other events occurred during follow-up. Elevations of cTn occurred in 11.5% of patients treated with electroconvulsive therapy. Some of the elevations preceded therapy and some occurred during treatment. Given the adverse prognostic importance of cTn elevations in general, in addition to additional studies, an increased degree of medical scrutiny may be appropriate for this group of patients and for those receiving electroconvulsive therapy. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Unmodified electroconvulsive therapy: a false dilemma.

    Science.gov (United States)

    Rajkumar, Ravi Philip

    2014-04-01

    A recent statement commissioned by the Indian Association of Private Psychiatry recommends that unmodified electroconvulsive therapy (ECT) should still be used in some settings in India, invoking the principle of beneficence. This paper critically analyses the IAPP statement in terms of both scientific accuracy and ethical principles. It is found that the statement falls short of the ethical principles of beneficence, non-maleficence and justice. It is the duty of psychiatrists and psychiatric associations to offer the best available care to their patients, both on scientific and ethical grounds.

  12. [Information about electroconvulsive therapy on the internet].

    Science.gov (United States)

    Degraeve, G; Van Heeringen, C; Audenaert, K

    2006-01-01

    This article aims to provide a quantitative and qualitative assessment of the information about electroconvulsive therapy that is currently available on the internet. We carried out a quantitative assessment by entering five search terms into eight (meta)search engines. We achieved our qualitative assessment by visiting the first twenty websites generated by each search on one of the search engines, in particular Google (www.google.com), and by scoring these websites with an adapted Sandvik-score. We conclude that the scored websites are technically sound but are incomplete as far as content is concerned.

  13. [Myotonic dystrophy as a contraindication for electroconvulsive therapy?].

    Science.gov (United States)

    Wynhoven, L M L; Scherders, M J W T; van Suijlekom, J A

    2009-01-01

    A 57-year-old woman with medication-resistant major depression was referred to our clinic for electroconvulsive therapy. After an extensive evaluation of our patient's condition we concluded that in this case the comorbid myotonic dystrophy was a contraindication for the performance of electroconvulsive therapy. However, in the current Dutch Psychiatric Association guidelines this illness is not mentioned as a possible contraindication for electroconvulsive therapy. This raises the question of whether myotonic dystrophy should now be incorporated in these guidelines and makes us wonder to what extent our conclusion could have consequences for the treatment of other neuromuscular illnesses.

  14. Electroconvulsive in a Schizophrenic Patient With Neuroleptic Malignant Syndrome and Rhabdomyolysis.

    Science.gov (United States)

    San Gabriel, Maria Chona P; Eddula-Changala, Bharathi; Tan, Yonghong; Longshore, Carrol T

    2015-09-01

    We present the case of a middle-aged man with a chronic history of schizoaffective disorder, depressed type, stable on a second-generation antipsychotic. Psychotic symptoms recurred contingent to medication noncompliance necessitating hospitalization. Treatment was complicated by the development of neuroleptic malignant syndrome (NMS). In addition, subsequent medication rechallenges failed because of recurrent rhabdomyolysis and atypical NMS. Electroconvulsive therapy (ECT) treatment was initiated, affording remission of psychotic symptoms and nonrecurrence of NMS and rhabdomyolysis. Our experience confirmed the efficacy of ECT treatment in providing symptom relief of psychosis complicated by recurrent episodes of NMS and atypical NMS. Likewise, it illustrated the efficacy of ECT treatment for rhabdomyolysis.

  15. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression.

    Science.gov (United States)

    Riva-Posse, Patricio; Hermida, Adriana P; McDonald, William M

    2013-12-01

    Geriatric depression is associated with increased mortality because of suicide and decreases in functional and physical health. Many elders' depression is resistant to psychotherapy and medication and can become chronic. Electroconvulsive therapy (ECT) is increasingly used in the treatment of medication-resistant or life-threatening geriatric depression. Neuromodulation therapies (subconvulsive, focal, or subconvulsive and focal) are alternatives for the management of treatment-resistant depression in the elderly. Therapies that combine both strategies could be safer but may not be as effective as ECT. This review covers the evidence on the safety and efficacy of ECT and the neuromodulation therapies in geriatric depression. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial

    NARCIS (Netherlands)

    Kolk, A. van der; Yang, K.G.; Tamminga, R.; Hoeven, H. van der

    2013-01-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were

  17. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial

    NARCIS (Netherlands)

    Kolk, A. van der; Yang, K.G.; Tamminga, R.; Hoeven, H. van der

    2013-01-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were

  18. Electroconvulsive Therapy Malpractice: Verdict for the Defense.

    Science.gov (United States)

    Goodman, Theodore; McCall, W Vaughn

    2015-09-01

    Malpractice cases involving electroconvulsive therapy (ECT) are rare. Even rarer are those malpractice cases alleging ECT-related brain damage. The few cases of ECT malpractice lawsuits are not described in the medical literature in detail. We provide a detailed account of a case of a patient and subsequent alleged ECT-related malpractice. The details of the case were collated using the handwritten notes of one of the authors who was present at the trial and the pretrial documents of discovery that were entered into evidence. The plaintiff alleged complete autobiographical amnesia after ECT, supposedly as a result of ECT-related brain damage. The defense was aided by the presence of extensive neurological examination and brain imaging both before and after ECT. The defense team also offered to the jury the concept of "dissociative amnesia" as an alternative explanation for the plaintiff's memory complaints. The case went to trial and was successfully defended. Electroconvulsive therapy malpractice cases alleging brain damage can be successfully defended, and the successful defense is aided by adequate documentation before, during, and after ECT. Malpractice cases, especially if they are baseless, can occur unpredictably, but they can be defended if the medical documentation is thorough.

  19. Electroconvulsive therapy in single manic episodes: a case series

    African Journals Online (AJOL)

    electroconvulsive therapy is an effective treatment strategy in ... 2Department of Epidemiology, Reproductive Medicine Research Center, Royan Institute, Isfahan, Iran. Abstract ... The proportion of patients administered chemical and physical.

  20. A Systematic Review and Meta-Analysis of Brief Versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression.

    Science.gov (United States)

    Tor, Phern-Chern; Bautovich, Alison; Wang, Min-Jung; Martin, Donel; Harvey, Samuel B; Loo, Colleen

    2015-09-01

    Electroconvulsive therapy (ECT) is an effective depression treatment, but it has potential cognitive side effects. Ultrabrief pulse (UBP) right unilateral (RUL) ECT is an increasingly used treatment option that can potentially combine efficacy with lesser cognitive side effects. However, current trials are underpowered or have conflicting results. A systematic review and meta-analysis was conducted to evaluate the relative efficacy and cognitive effects of brief pulse (BP) and UBP RUL ECT. MEDLINE, EMBASE, PsycINFO, CENTRAL, DARE, and the International Clinical Trials Registry Platform were searched with the search terms ECT, electroconvulsive therapy, electroconvulsive shock, electroconvulsive shock therapy, electrical stimulation, electroconvulsive combined with brief, ultra*, pulse, and trial in English, all fields including title, abstract, subject heading, and full text up to June 20, 2013, for studies comparing BP and UBP RUL ECT in depressed patients that reported formalized mood ratings for depression. Six studies met the inclusion criteria, comprising a total of 689 patients. Efficacy, cognitive, response, and remission outcomes were extracted from each publication or obtained directly from authors. BP RUL ECT was significantly more efficacious in treating depression than UBP RUL ECT (standardized mean difference = 0.25; 95% CI, 0.08–0.41; P = .004) but showed significantly more cognitive side effects in all cognitive domains examined (global cognition, anterograde learning and recall, retrograde memory) (P < .01). The mean number of treatment sessions given was 8.7 for BP ECT and 9.6 for UBP ECT (P < .001). UBP had a lower remission rate (OR = 0.71; 95% CI, 0.51–0.99; P = .045), with a number needed to treat of 12.1. BP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an

  1. Strategies of experiment standardization and response optimization in a rat model of hemorrhagic shock and chronic hypertension.

    Science.gov (United States)

    Reynolds, Penny S; Tamariz, Francisco J; Barbee, Robert Wayne

    2010-04-01

    Exploratory pilot studies are crucial to best practice in research but are frequently conducted without a systematic method for maximizing the amount and quality of information obtained. We describe the use of response surface regression models and simultaneous optimization methods to develop a rat model of hemorrhagic shock in the context of chronic hypertension, a clinically relevant comorbidity. Response surface regression model was applied to determine optimal levels of two inputs--dietary NaCl concentration (0.49%, 4%, and 8%) and time on the diet (4, 6, 8 weeks)--to achieve clinically realistic and stable target measures of systolic blood pressure while simultaneously maximizing critical oxygen delivery (a measure of vulnerability to hemorrhagic shock) and body mass M. Simultaneous optimization of the three response variables was performed though a dimensionality reduction strategy involving calculation of a single aggregate measure, the "desirability" function. Optimal conditions for inducing systolic blood pressure of 208 mmHg, critical oxygen delivery of 4.03 mL/min, and M of 290 g were determined to be 4% [NaCl] for 5 weeks. Rats on the 8% diet did not survive past 7 weeks. Response surface regression model and simultaneous optimization method techniques are commonly used in process engineering but have found little application to date in animal pilot studies. These methods will ensure both the scientific and ethical integrity of experimental trials involving animals and provide powerful tools for the development of novel models of clinically interacting comorbidities with shock.

  2. Transient Serotonin Toxicity Evoked by Combination of Electroconvulsive Therapy and Fluoxetine

    Directory of Open Access Journals (Sweden)

    René Klysner

    2014-01-01

    Full Text Available The serotonin syndrome has been described only in rare instances for electroconvulsive therapy combined with an antidepressant medication. We describe a case of serotonin toxicity induced by electroconvulsive therapy in combination with fluoxetine.

  3. Immune and neurotrophin stimulation by electroconvulsive therapy: is some inflammation needed after all?

    Science.gov (United States)

    van Buel, E M; Patas, K; Peters, M; Bosker, F J; Eisel, U L M; Klein, H C

    2015-01-01

    A low-grade inflammatory response is commonly seen in the peripheral blood of major depressive disorder (MDD) patients, especially those with refractory and chronic disease courses. However, electroconvulsive therapy (ECT), the most drastic intervention reserved for these patients, is closely associated with an enhanced haematogenous as well as neuroinflammatory immune response, as evidenced by both human and animal studies. A related line of experimental evidence further shows that inflammatory stimulation reinforces neurotrophin expression and may even mediate dramatic neurogenic and antidepressant-like effects following exposure to chronic stress. The current review therefore attempts a synthesis of our knowledge on the neurotrophic and immunological aspects of ECT and other electrically based treatments in psychiatry. Perhaps contrary to contemporary views, we conclude that targeted potentiation, rather than suppression, of inflammatory responses may be of therapeutic relevance to chronically depressed patients or a subgroup thereof. PMID:26218851

  4. Transient Serotonin Toxicity Evoked by Combination of Electroconvulsive Therapy and Fluoxetine

    DEFF Research Database (Denmark)

    Klysner, René; Bjerg Bendsen, Birgitte; Hansen, Maja Soon

    2014-01-01

    The serotonin syndrome has been described only in rare instances for electroconvulsive therapy combined with an antidepressant medication. We describe a case of serotonin toxicity induced by electroconvulsive therapy in combination with fluoxetine.......The serotonin syndrome has been described only in rare instances for electroconvulsive therapy combined with an antidepressant medication. We describe a case of serotonin toxicity induced by electroconvulsive therapy in combination with fluoxetine....

  5. Pharmacogenetics in electroconvulsive therapy and adjunctive medications.

    Science.gov (United States)

    Mirzakhani, Hooman; van Noorden, Martijn S; Swen, Jesse; Nozari, Ala; Guchelaar, Henk-Jan

    2015-01-01

    Electroconvulsive therapy (ECT) has shown apparent efficacy in treatment of patients with depression and other mental illnesses who do not respond to psychotropic medications or need urgent control of their symptoms. Pharmacogenetics contributes to an individual's sensitivity and response to a variety of drugs. Clinical insights into pharmacogenetics of ECT and adjunctive medications not only improves its safety and efficacy in the indicated patients, but can also lead to the identification of novel treatments in psychiatric disorders through understanding of potential molecular and biological mechanisms involved. In this review, we explore the indications of pharmacogenetics role in safety and efficacy of ECT and present the evidence for its role in patients with psychiatric disorders undergoing ECT.

  6. Propofol-Remifentanil Combination for Management of Electroconvulsive Therapy in a Patient with Neuroleptic Malignant Syndrome

    Directory of Open Access Journals (Sweden)

    Modabber Arasteh

    2012-01-01

    Full Text Available Electroconvulsive therapy can be effective in severe or treatment resistant neuroleptic malignant syndrome patients. Anesthesia and use of muscle relaxant agents for electroconvulsive therapy in such patients may encounter anesthesiologists with specific challenges. This case report describes successful management of anesthesia in 28-year-old male patient undergoing eight electroconvulsive therapy sessions for treatment of neuroleptic malignant syndrome.

  7. Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow.

    Science.gov (United States)

    Rompe, J D; Hope, C; Küllmer, K; Heine, J; Bürger, R

    1996-03-01

    We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in tennis elbow. We assigned at random 100 patients who had had symptoms for more than 12 months to two groups to receive low-energy shock-wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm2 and group II, the control group, 30 impulses. The patients were reviewed after 3, 6 and 24 weeks. There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.

  8. Extracorporeal shock wave therapy for painful chronic neurogenic heterotopic ossification after traumatic brain injury: a case report.

    Science.gov (United States)

    Choi, Yong Min; Hong, Seok Hyun; Lee, Chang Hyun; Kang, Jin Ho; Oh, Ju Sun

    2015-04-01

    Neurogenic heterotopic ossification (NHO) is a process of benign bone formation and growth in soft tissues surrounding major synovial joints and is associated with central nervous system (CNS) injuries. It is a common complication in major CNS injuries, such as traumatic brain injury, spinal cord injury, and stroke. Here, we report the case of a 72-year-old male, who experienced a traumatic brain injury and painful chronic NHO around the left hip joint. Three applications of extracorporeal shock wave therapy (ESWT) were administered to the area of NHO, which resulted in pain relief and an improvement in the loss of motion in the left hip joint. Improvements were also noted in walking performance and activities of daily living, although the size of NHO remained unchanged. Therapeutic effects of ESWT lasted for 12 weeks.

  9. Erythrocyte heat shock protein responses to chronic (in vivo) and acute (in vitro) temperature challenge in diploid and triploid salmonids.

    Science.gov (United States)

    Saranyan, Pillai V; Ross, Neil W; Benfey, Tillmann J

    2017-04-01

    This research investigated how ploidy level (diploid versus triploid) affects the heat shock protein (HSP) response in erythrocytes under different thermal stress regimes, both in vivo and in vitro, in Atlantic salmon (Salmo salar) and brook charr (Salvelinus fontinalis) in order to address the question of why triploids typically have reduced thermal tolerance. A preliminary study confirmed that identical volumes of diploid and triploid erythrocytes (which equates to a smaller number of larger cells for triploids compared to diploids) did not differ in total protein synthesis rates. After chronic (100d) acclimation of fish to 5, 15 and 25°C, triploid erythrocytes had lower HSP70, HSP90, heat shock factor 1 (HSF1) and ubiquitin (free and total) levels than diploids in both species. Furthermore, Atlantic salmon erythrocytes showed significantly higher protein breakdown (based on conjugated ubiquitin levels) in triploids than diploids after acute heat stress in vitro, but no significant difference was detected between ploidies after acute cold stress. These results indicate that: 1) triploid erythrocytes synthesize more total protein per cell than diploids as a result of increased cell size; 2) triploids have sufficient total HSP levels for survival under low stress conditions; and 3) the lower basal titres of HSPs in triploids may be a handicap when combating acute stress. Taken together, this suggests that triploids are limited in their ability to withstand thermal stress because of a reduced ability to maintain proteostasis under stressful conditions.

  10. Temporal gene expression profile after acute electroconvulsive stimulation in the rat.

    Science.gov (United States)

    Dyrvig, Mads; Christiansen, Søren H; Woldbye, David P D; Lichota, Jacek

    2014-04-10

    Electroconvulsive therapy (ECT) remains one of the most effective treatments of major depression. It has been suggested that the mechanisms of action involve gene expression. In recent decades there have been several investigations of gene expression following both acute and chronic electroconvulsive stimulation (ECS). These studies have focused on several distinct gene targets but have generally included only few time points after ECS for measuring gene expression. Here we measured gene expression of three types of genes: Immediate early genes, synaptic proteins, and neuropeptides at six time points following an acute ECS. We find significant increases for c-Fos, Egr1, Neuritin 1 (Nrn 1), Bdnf, Snap29, Synaptotagmin III (Syt 3), Synapsin I (Syn 1), and Psd95 at differing time points after ECS. For some genes these changes are prolonged whereas for others they are transient. Npy expression significantly increases whereas the gene expression of its receptors Npy1r, Npy2r, and Npy5r initially decreases. These decreases are followed by a significant increase for Npy2r, suggesting anticonvulsive adaptations following seizures. In summary, we find distinct changes in mRNA quantities that are characteristic for each gene. Considering the observed transitory and inverse changes in expression patterns, these data underline the importance of conducting measurements at several time points post-ECS.

  11. Effect of thermal manipulation during embryogenesis on liver heat shock protein expression in chronic heat stressed colored broiler chickens.

    Science.gov (United States)

    Vinoth, A; Thirunalasundari, T; Tharian, Jenny Anne; Shanmugam, M; Rajkumar, U

    2015-10-01

    Thermal manipulation during embryogenesis has been shown to improve thermo tolerance in broilers. Heat shock proteins are a family of proteins produced in response to variety of stress and protect cells from damage. The aim of this study was to evaluate the effect of thermal manipulation (TM) during embryogenesis on HSP gene and protein expression in the embryos and in chronic heat stressed 42nd day old chicks. On 15th day of incubation, fertile eggs from two breeds-Naked neck (NN) and Punjab Broiler-2 (PB-2) were randomly divided in to two groups, namely Control (C) eggs were incubated under standard incubation conditions and Thermal Conditioning (TC) eggs were exposed to higher incubation temperature (40.5°C) for 3h on 15th, 16th and 17th day of incubation. The chicks so obtained from each group were further subdivided and reared from 15th-42nd day as normal (N; 25±1°C, 70% RH) and heat exposed (HE; 35±1°C, 50% RH) resulting in four treatment groups (CN, CHE, TCN and TCHE). Embryos of two groups (C and TC) on 17th day and birds from four treatment groups on 42nd day were sacrificed. Liver was collected for analysis of gene expression by real-time PCR and protein expression by Western blot of Heat Shock Proteins (HSP 90 alpha, HSP 90 beta, HSP 70, HSP 60, HSP 27 and ubiquitin). The plasma collected on 42nd day was analyzed for biochemical parameters. Thermal challenging of embryos of both the breeds caused significant (P≤0.05) increase in all the HSPs gene and protein expression. The TCHE chicks had significantly (P≤0.05) lower HSPs gene and protein expressions and oxidative stress compared to CHE groups in both NN and PB-2. Based on these findings it can be concluded that TM during incubation provides adaptation to broiler chicks during chronic heat stress.

  12. Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.

    Science.gov (United States)

    Geduldig, Emma T; Kellner, Charles H

    2016-04-01

    This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.

  13. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.

    Science.gov (United States)

    Luchini, Federica; Medda, Pierpaolo; Mariani, Michela Giorgi; Mauri, Mauro; Toni, Cristina; Perugi, Giulio

    2015-06-22

    Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelopmental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy (ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other

  14. EFFECT OF LOW ENERGY VERSUS MEDIUM ENERGY RADIAL SHOCK WAVE THERAPY IN THE TREATMENT OF CHRONIC PLANTER FASCIITIS

    Directory of Open Access Journals (Sweden)

    Khaled Z. Fouda

    2016-02-01

    Full Text Available Background: Plantar fasciitis (PF is the most common cause of heel pain and it can often be a challenge for clinicians to treat successfully. Radial shock wave therapy (RSWT has been introduced recently for treatment of musculoskeletal disorders. Different energy levels of shock wave therapy have been used in the literatures for treatment of PF with no clear settled parameters. Therefore, the purpose of this study was intended to investigate and compare the efficacy of two different energy levels of RSWT on PF patients. Methods: Forty patients having unilateral chronic PF were recruited for the study from orthopedic outpatient clinics of Cairo University hospitals and National Institute of Neuromotor System Cairo Egypt, with a mean age of (47.15±4.57 years. Patients were randomly assigned into two equal groups. Group (A treated with low intensity level of 1.6 bars (0.16 mJ/mm2 RSWT and group (B treated with medium intensity level of 4 bars (0.38 mJ/mm2 RSWT. Functional assessment of the foot based on Foot Function Index (FFI and Present pain intensity was measured during rest by Visual Analogue Scale (VAS. Results: There was as significant decreased in the total FFI scores from (118.42 ±6.51 to (81.37 ±3.46 for group (A and from (118.93 ±6.85 to (58.50 ±3.22 for group (B. Also regarding VAS Scores there was as significant decreased in the pain intensity from (5.11 ±0.41 to (2.85 ±0.31 for group (A and from (4.95 ±0.39 to (2.05 ±0.22 for group (B. Conclusion: Radial shock wave therapy is an effective modality that should be considered in the treatment of chronic PF, while the medium energy level RSWT is better than the low energy level RSWT in regarding to the measured treatment outcomes.

  15. Regional variation in electroconvulsive therapy use.

    LENUS (Irish Health Repository)

    Dunne, R

    2011-03-01

    Although electroconvulsive therapy (ECT) is the most powerful treatment for depression, substantial variability in use has been described in Ireland. The Mental Health Commission collects usage data from approved centres but does not include home addresses or independent sector patients. Therefore, estimates of regional variation cannot be accurate, e.g. 145 (35% of total) independent sector patients were omitted from their 2008 analysis. When public and independent sector patients are combined inter-regional variation for 2008 is more than halved (chi-squared decreased from 83 to 30), with Western region contributing most to variation (chi-squared = 43). Ratio of ECT programmes to depressed admissions correlated negatively with rate for depressed admissions (r = -0.53, p = 0.01), while depressed admission numbers correlated with acute beds per area (r = 0.68, p = 0.001). Regional variation in ECT is less than previously reported; service factors probably account for much of this with smaller centres admitting severely ill patients more likely to require ECT.

  16. Electroconvulsive therapy and determination of cerebral dominance.

    Science.gov (United States)

    Dragovic, Milan; Allet, Lindsay; Janca, Aleksandar

    2004-08-12

    Electroconvulsive therapy (ECT) often results in a number of short- and long-time side effects including memory impairment for past and current events, which can last for several months after ECT treatment. It has been suggested that unilateral ECT (uECT) with electrodes placed over the non-dominant (typically right) hemisphere significantly reduces side effects, especially memory disturbances. It is important to note that cerebral dominance equates to speech dominance and avoiding this area of the brain also reduces speech dysfunction after ECT. Traditionally, the routine clinical determination of cerebral dominance has been through the assessment of hand, foot and eye dominance, which is an easy and inexpensive approach that, however, does not ensure accuracy. This review of literature on different methods and techniques for determination of cerebral dominance and provides evidence that functional transcranial Doppler sonography (fTCD) represents a valid and safe alternative to invasive techniques for identifying speech lateralisation. It can be concluded that fTCD, notwithstanding its costs, could be used as a standard procedure prior to uECT treatment to determine cerebral dominance, thereby further reducing cognitive side-effects of ECT and possibly making it more acceptable to both patients and clinicians.

  17. [Experience of the use of extracorporeal shock wave therapy in the treatment of category III B chronic prostatitis].

    Science.gov (United States)

    Kernesiuk, M N; Prouza, Onrej

    2013-01-01

    The randomized controlled study was aimed to the evaluation of the efficacy of extracorporeal shock wave therapy (ESWT) compared with drug treatment in patients with chronic prostatitis category IIIB. The study included 30 patients with category IIIB chronic prostatitis (CP IIIB), divided into two groups of 15 subjects. In group 1, prostate ESWT was used as monotherapy, in the group 2--only drug treatment. The impact was carried on the perineal region using standard radial ESWT device. The procedure was performed 1 time per week for 4 weeks according to the accepted protocol. All patients completed the treatment at outpatient settings. Control examinations of 30 patients were performed at 1, 2, 4 and 12 weeks after treatment. Efficacy was evaluated using the NIH-CPSI score. All patients in group 1 had a statistically significant reduction in pain intensity and improvement of quality of life compared with group 2. The study showed that prostate ESWT is a simple and effective method of treatment of CP IIIB not accompanied by the development of side effects.

  18. Radial shock wave therapy in the treatment of chronic constriction injury model in rats: a preliminary study

    Institute of Scientific and Technical Information of China (English)

    Fu Miao; Cheng Hao; Li Duoyi; Yu Xiaotong; Ji Nan; Luo Fang

    2014-01-01

    Background Pain physicians pay close attention to neuropathic pain (NP),since there is currently no ideal treatment.Radial shock wave therapy (RSWT) is a noninvasive treatment to chronic pain of soft tissue disorders.So far,there is no information on the use of RSWT for the treatment of NP.Therefore we observe the effects of RSWT on a NP model induced by chronic constriction injury (CCI) in rats.Methods Four different energy densities (1.0,1.5,2.0 and 2.5 bar) RSWT administered as a single session or repeated sessions in rats with NP induced by CCI of the sciatic nerve.The analgesic effect was assessed by measuring mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL).The safety was assessed through calculating sciatic functional index (SFI).Results MWT and TWL increased after a single session of RSWT from day 1 to day 5 but retumed to baseline levels by day 10.Following repeated sessions of RSWT,both the MWT and TWL were significantly higher than NP group (P < 0.01)for at least 4 weeks.In addition,no significant changes of SFI were observed in any groups after repeated sessions of RSWT and no increased pain or other side effects in any animals.Conclusions A single session of RSWT is rapidly effective in the treatment of CCI,but the efficacy maintained in a short period.However,repeated sessions of RSWT have prolonged efficacy.

  19. Effects of chronic heat stress on plasma concentration of secreted heat shock protein 70 in growing feedlot cattle.

    Science.gov (United States)

    Gaughan, J B; Bonner, S L; Loxton, I; Mader, T L

    2013-01-01

    Sixty Angus steers (449.2±11.0 kg) with implanted body temperature (BT) transmitters were used in a 110-d study to determine the effect of chronic stress (housing, diet, and climate) on extracellular heat shock protein 70 (eHsp70) concentration in plasma. The steers were a subset of a larger study involving 164 steers. Before the start of the study (d -31), 63 steers were implanted with a BT transmitter between the internal abdominal muscle and the peritoneum at the right side flank. Steers were housed in 20 pens (10 with shade and 10 without). Within each pen, 3 steers had a transmitter, and BT was recorded at 30-min intervals throughout the study. On d 0, 30, 60, 90, and 110, steers were weighed, BCS assessed (1 to 9 scale in which 1=emaciated and 9=obese), and 10 mL of blood from the coccygeal vein was collected for determination of inducible heat shock protein 70 (Hsp70) concentration by ELISA. Climatic variables (ambient temperature, relative humidity, solar radiation, black globe temperature, and wind speed) were obtained every 30 min from an on-site weather station. The relationship between the climatic variables and Hsp70 concentration were examined. As we failed to detect an effect of shade, all data were pooled. Mean BT over the duration of the study was 39.6±0.10°C. Mean BT was lowest (38.7±0.10°C) on d 0 and highest on d 110 (40.2°C±0.10). The Hsp70 concentration was least on d 0 (2.33±0.47 ng/mL) and greatest on d 30 (8.08±0.78 ng/mL). The Hsp70 concentration decreased from d 30 but remained above the d-0 concentrations on d 60, 90, and 110. There was a strong relationship between Hsp70 concentration and ambient temperature (r2=0.86; P38.6°C. The Hsp70 concentration is a reliable indicator of chronic stress but is not a reliable indicator of a single stressor when animals are exposed to multiple chronic stressors.

  20. Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham-controlled study

    Institute of Scientific and Technical Information of China (English)

    ZENG Xiao-yong; LIANG Chen; YE Zhang-qun

    2012-01-01

    Background Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a clinical syndrome characterized by pain in the perineum,pelvis,suprapubic area,or external genitalia and variable degrees of voiding and ejaculatory disturbance.The analgesic effect of extracorporeal shock wave treatment (ESWT) was an interesting phenomenon with an unclear mechanism discovered by chance in the applications for urolithiasis,on which ESWT has become an increasingly popular therapeutic approach as an alternative option for the treatment of a number of soft tissue complaints.In this study,we aimed to evaluate the feasibility and efficacy of ESWT in non-inflammatory (ⅢB) CP/CPPS.Methods Men diagnosed with ⅢB CP/CPPS were randomized to either ESWT (group 1,n=40) or the control (group 2,n=40).Group 1 received 20 000 shock wave impulses in 10 sessions over a two-week period,whereas group 2 received only a sham procedure.The total scores and sub-domain scores of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) for both groups were assessed at baseline,mid-treatment,end-point,and 4-week and 12-week follow-up visits.Results The mean total NIH-CPSI score of group 1 was significantly decreased from baseline at all post-treatment time points (P <0.01 for all).Decreases in pain domain and quality of life (QOL) scores were also significant.In group 2,no significant decreases of total NIH-CPSI score and pain domain score were found at all post-treatment time points.At the end-point of treatment,71.1% of group 1 exhibited perceptible improvement in total NIH-CPSI compared with 27.0% of group 2 (P <0.001); additionally,28.9% of group 1 exhibited clinically significant improvement compared with 10.8% of group 2 (P <0.01).Moreover,a greater number of patients in group 1 at 4-week and 12-week follow-up were rated as responders (perceptible and clinically significant response) compared with group 2.Conclusion ESWT exhibits a potentially therapeutic

  1. High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy: A Prospective, Observational Cohort Study.

    Science.gov (United States)

    Duma, Andreas; Pal, Swatilika; Johnston, Joshua; Helwani, Mohammad A; Bhat, Adithya; Gill, Bali; Rosenkvist, Jessica; Cartmill, Christopher; Brown, Frank; Miller, J Philip; Scott, Mitchell G; Sanchez-Conde, Francisco; Jarvis, Michael; Farber, Nuri B; Zorumski, Charles F; Conway, Charles; Nagele, Peter

    2017-04-01

    While electroconvulsive therapy is widely regarded as a lifesaving and safe procedure, evidence regarding its effects on myocardial cell injury is sparse. The objective of this investigation was to determine the incidence and magnitude of new cardiac troponin elevation after electroconvulsive therapy using a novel high-sensitivity cardiac troponin I assay. This was a prospective cohort study in adult patients undergoing electroconvulsive therapy in a single academic center (up to three electroconvulsive therapy treatments per patient). The primary outcome was new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy, defined as an increase of high-sensitivity cardiac troponin I greater than 100% after electroconvulsive therapy compared to baseline with at least one value above the limit of quantification (10 ng/l). Twelve-lead electrocardiogram and high-sensitivity cardiac troponin I values were obtained before and 15 to 30 min after electroconvulsive therapy; in a subset of patients, an additional 2-h high-sensitivity cardiac troponin I value was obtained. The final study population was 100 patients and a total of 245 electroconvulsive therapy treatment sessions. Eight patients (8 of 100; 8%) experienced new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy with a cumulative incidence of 3.7% (9 of 245 treatments; one patient had two high-sensitivity cardiac troponin I elevations), two of whom had a non-ST-elevation myocardial infarction (incidence 2 of 245; 0.8%). Median high-sensitivity cardiac troponin I concentrations did not increase significantly after electroconvulsive therapy. Tachycardia and/or elevated systolic blood pressure developed after approximately two thirds of electroconvulsive therapy treatments. Electroconvulsive therapy appears safe from a cardiac standpoint in a large majority of patients. A small subset of patients with preexisting cardiovascular risk factors, however, may develop new

  2. Electroconvulsive Therapy. Consensus Development Conference Statement, Vol. 5, No. 11.

    Science.gov (United States)

    National Institutes of Health (DHHS), Bethesda, MD.

    Electroconvulsive therapy (ECT), a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure, has been in use for over 45 years. Controversies still exist today concerning the use of ECT. In 1985, the National Institutes of Health and the National Institute of Mental Health held…

  3. Anaesthesia for electroconvulsive therapy - new tricks for old drugs

    DEFF Research Database (Denmark)

    Stripp, Tobias Kvist; Jorgensen, Martin Balslev; Olsen, Niels Vidiendal

    2017-01-01

    OBJECTIVE: The objective of this review is to investigate existing literature in order to delineate whether the use of anaesthesia and timing of seizure induction in a new and optimised way may improve the efficacy of electroconvulsive therapy (ECT). METHODS: PubMed/MEDLINE was searched...

  4. British nurses' attitudes to electroconvulsive therapy, 1945-2000.

    Science.gov (United States)

    Adams, John

    2015-10-01

    The aim of the study was to collect and analyse historical material on nurses' attitudes to electroconvulsive therapy in Britain between 1945-2000. Electroconvulsive therapy became widely used in Britain from the late 1940s onwards and remains in current use, but became one of the main targets of the 'antipsychiatry' movement of the 1960s and 1970s. A cultural history design was used to recreate the perspectives of mental health nurses in the period under review. A range of primary sources including journal articles, textbooks and oral history sources were combined to create a coherent historical account. The controversy surrounding electroconvulsive therapy created a deep-seated ambivalence towards it among mental health nurses. While a sizeable minority were critical of its use and may have taken steps to avoid involvement with it, most acquiesced in providing the treatment. Recorded incidents of outright refusal to participate are few. Mental health nurses' views on electroconvulsive therapy are reflective of the profession's growing knowledge of the use of evidence in debating whether particular therapies should be used. © 2015 John Wiley & Sons Ltd.

  5. Impedance testing on cochlear implants after electroconvulsive therapy.

    Science.gov (United States)

    McRackan, Theodore R; Rivas, Alejandro; Hedley-Williams, Andrea; Raj, Vidya; Dietrich, Mary S; Clark, Nathaniel K; Labadie, Robert F

    2014-12-01

    Cochlear implants (CI) are neural prostheses that restore hearing to individuals with profound sensorineural hearing loss. The surgically implanted component consists of an electrode array, which is threaded into the cochlea, and an electronic processor, which is buried under the skin behind the ear. The Food and Drug Administration and CI manufacturers contend that electroconvulsive therapy (ECT) is contraindicated in CI recipients owing to risk of damage to the implant and/or the patient. We hypothesized that ECT does no electrical damage to CIs. Ten functional CIs were implanted in 5 fresh cadaveric human heads. Each head then received a consecutive series of 12 unilateral ECT sessions applying maximum full pulse-width energy settings. Electroconvulsive therapy was delivered contralaterally to 5 CIs and ipsilaterally to 5 CIs. Electrical integrity testing (impedance testing) of the electrode array was performed before and after CI insertion, and after the first, third, fifth, seventh, ninth, and 12th ECT sessions. Electroconvulsive therapy was performed by a staff psychiatrist experienced with the technique. Explanted CIs were sent back to the manufacturer for further integrity testing. No electrical damage was identified during impedance testing. Overall, there were statistically significant decreases in impedances (consistent with no electrical damage) when comparing pre-ECT impedance values to those after 12 sessions. There was no statistically significant difference (P > 0.05) in impedance values comparing ipsilateral to contralateral ECT. Manufacturer testing revealed no other electrical damage to the CIs. Electroconvulsive therapy does not seem to cause any detectable electrical injury to CIs.

  6. Successful maintenance electroconvulsive therapy for more than seven years

    NARCIS (Netherlands)

    Wijkstra, J; Nolen, WA

    We report on a patient with recurrent major depressive episodes with psychotic features who was successfully treated with maintenance electroconvulsive treatment (M-ECT) over a long period without the need for concurrent treatment with an antidepressant or mood stabilizer. She started ECT in 1996

  7. Effect of Premedication with Oral Clonidine on Hemodynamic Response during Electroconvulsive Therapy.

    Science.gov (United States)

    Deganwa, Mangi Lal; Sharma, Rajesh; Khare, Avneesh; Sharma, Divya

    2017-01-01

    Electroconvulsive therapy (ECT) is the most effective treatment available for the acute treatment of depression in patients who do not respond to medications. It is generally used as a second line treatment for many psychological disorders, mainly major depression and schizophrenia where medication is not effective. ECT is often associated with some complications such as hypertension, tachycardia arrhythmia and even myocardial infarction. Various methods have been used for prevention or control of these cardiovascular side effects. The aim of this study was evaluating the effect of oral clonidine (0.3 mg) with control group to know the effect of oral clonidine on hemodynamic response during ECT. This prospective randomized crossover clinical trial was performed on 25 patients aged 20-50 years, weight 50-70 kg with ASA I and II who were candidates for ECT. Prior to ECT, each patient received oral doses of clonidine (0.3 mg) or a placebo 90 minutes before ECT. Baseline Heart rate, systolic, diastolic and mean arterial pressures were noted just before securing the intravenous cannula. The same parameters were noted after induction, immediately after seizure cessation following delivery of the electric shock and at 1 minute interval for 10 minutes. Data was analyzed by ANOVA test (analysis of variance). P heart rate and mean arterial pressure by clonidine (0.3 mg) was evident and statistically significant when compared with control group. Oral clonidine (0.3 mg) decreases the acute hypertensive response after electroconvulsive therapy; however, this antihypertensive effect was achieved by decreasing the blood pressure before the electrical stimulus.

  8. A Systematic Review of the Combined Use of Electroconvulsive Therapy and Psychotherapy for Depression

    Science.gov (United States)

    McClintock, Shawn M.; Brandon, Anna R.; Husain, Mustafa M.; Jarrett, Robin B.

    2011-01-01

    Objective Electroconvulsive therapy (ECT) is one of the most effective treatments for severe Major Depressive Disorder (MDD). However, after acute phase treatment and initial remission, relapse rates are significant. Strategies to prolong remission include continuation phase ECT, pharmacotherapy, psychotherapy, or their combinations. This systematic review synthesizes extant data regarding the combined use of psychotherapy with ECT for the treatment of patients with severe MDD and offers the hypothesis that augmenting ECT with depression-specific psychotherapy represents a promising strategy for future investigation. Methods The authors performed two independent searches in PsychInfo (1806 – 2009) and MEDLINE (1948 – 2009) using combinations of the following search terms: Electroconvulsive Therapy (including ECT, ECT therapy, electroshock therapy, EST, shock therapy) and Psychotherapy (including cognitive behavioral, interpersonal, group, psychodynamic, psychoanalytic, individual, eclectic, and supportive). We included in this review a total of six articles (English language) that mentioned ECT and psychotherapy in the abstract, and provided a case report, series, or clinical trial. We examined the articles for data related to ECT and psychotherapy treatment characteristics, cohort characteristics, and therapeutic outcome. Results Although research over the past seven decades documenting the combined use of ECT and psychotherapy is limited, the available evidence suggests that testing this combination has promise and may confer additional, positive functional outcomes. Conclusions Significant methodological variability in ECT and psychotherapy procedures, heterogeneous patient cohorts, and inconsistent outcome measures prevent strong conclusions; however, existing research supports the need for future investigations of combined ECT and psychotherapy in well-designed, controlled clinical studies. Depression-specific psychotherapy approaches may need special

  9. [Ketamine as anesthetic agent in electroconvulsion therapy].

    Science.gov (United States)

    Janke, C; Bumb, J M; Aksay, S S; Thiel, M; Kranaster, L; Sartorius, A

    2015-05-01

    Electroconvulsive therapy (ECT) is a well-established, safe and effective treatment for severe psychiatric disorders. Ketamine is known as a core medication in anesthesiology and has recently gained interest in ECT practice as there are three potential advantages: (1) ketamine has no anticonvulsive actions, (2) according to recent studies ketamine could possess a unique intrinsic antidepressive potential and (3) ketamine may exhibit neuroprotective properties, which again might reduce the risk of cognitive side effects associated with ECT. The use of ketamine in psychiatric patients has been controversially discussed due to its dose-dependent psychotropic and psychotomimetic effects. This study was carried out to test if the occurrence of side effects is comparable and if seizure quality is better with ketamine when compared to thiopental. This retrospective study analyzed a total of 199 patients who received ketamine anesthesia for a total of 2178 ECT sessions. This cohort was compared to patients who were treated with thiopental for 1004 ECT sessions. A repeated measurement multiple logistic regression analysis revealed significant advantages in the ketamine group for seizure concordance and postictal suppression (both are surrogates for central inhibition). S-ketamin also necessitated the use of a higher dose of urapidil and a higher maximum postictal heart frequency. Clinically relevant psychiatric side effects were rare in both groups. No psychiatric side effects occurred in the subgroup of patients with schizophrenia (ketamine: n = 30). The mean dose of S-ketamine used increased in the first years but stabilized at 63 mg per patient in 2014. From these experiences it can be concluded that S-ketamine can be recommended at least as a safe alternative to barbiturates.

  10. Maintenance electroconvulsive therapy up to 12 years.

    Science.gov (United States)

    Elias, Alby; Chathanchirayil, Saji J; Bhat, Ravi; Prudic, Joan

    2014-03-01

    Maintenance electroconvulsive therapy (m-ECT) is effective in preventing recurrences of depressive episodes. There is little information on long-term m-ECT extending over several years and its impact on cognitive functions. This study was an attempt to determine the efficacy and side effects of long-term m-ECT. Depressive episodes and admissions before m-ECT for a period equal to the duration of m-ECT and during m-ECT were compared using medical records. Cognitive functions assessed by Mini-Mental State Examination (MMSE) before and after m-ECT were compared along with the review of Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). 17 patients had m-ECT that extended from 6 to 153 months (mean 39, SD=44.46). The average number of episodes before and during m-ECT was 2.47 (SD=2.23) and 0.88 (SD=1.31) respectively (Wilcoxon ranked test Z=3.06, r=0.55, two-tailed p=0.002). Average number of admissions dropped from 2.05 (SD=1.88) to 0.23 (SD=0.43) during m-ECT (Z=3.471, r=0.71, p=0.001). The average time to recurrence was 24.24 months (SD=25.20) with longest depression free survival of 105 months. There was no significant difference in MMSE score before and after the commencement m-ECT or progressive deterioration in NUCOG score. This study was limited by retrospective nature of data collection, small sample size, confounding effects of antidepressants along with m-ECT and absence of a highly sensitive cognitive screening tool that can capture all types of cognitive impairments following m-ECT. In a naturalistic setting the efficacy of m-ECT may extend over several years while cognitive functions remain largely unaffected. © 2013 Elsevier B.V. All rights reserved.

  11. Anaesthesia for electroconvulsive therapy: An overview with an update on its role in potentiating electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    Pavan Kumar Kadiyala

    2017-01-01

    Full Text Available Despite advances in pharmacotherapy, electroconvulsive therapy (ECT remains a mainstay treatment option in psychiatry since its introduction in 1930s. It can be used primarily in severe illnesses when there is an urgent need for treatment or secondarily after failure or intolerance to pharmacotherapy. The 'unmodified' technique of ECT was practised initially, with a high incidence of musculoskeletal complications. Several modifications including general anaesthesia and muscle relaxation are used to increase the safety and patient acceptability of ECT. Various anaesthetic techniques including medications are considered to provide adequate therapeutic seizure, simultaneously controlling seizure-induced haemodynamic changes and side effects. A brief review of literature on choice of these anaesthetic techniques is discussed. This article is intended to reinforce the knowledge of clinicians, who may have limited exposure to ECT procedure. Importance is given to the recent updates on the role of induction agents in potentiating therapeutic response to ECT in psychiatric disorders.

  12. Extracorporeal shock-wave therapy for chronic lateral tennis elbow--prediction of outcome by imaging.

    Science.gov (United States)

    Maier, M; Steinborn, M; Schmitz, C; Stäbler, A; Köhler, S; Veihelmann, A; Pfahler, M; Refior, H J

    2001-07-01

    Today the clinical use of extracorporeal shockwave application (ESWA) for the treatment of lateral tennis elbow is hampered by the lack of results from randomized controlled trials and of predictive parameters of clinical outcome. The present prospective study aimed to provide the latter by means of magnetic resonance imaging (MRI). Twenty-three female and 19 male patients with unilateral chronic tennis elbow of the dominant site were clinically examined before and after repetitive low-energy ESWA. MRI was performed before ESWA to evaluate signal intensity changes or contrast enhancement of the common extensor tendon and the lateral epicondyle. After ESWA (mean follow-up period 18.6 months for all patients), clinical evaluation showed a significantly better mean clinical performance after ESWA than before treatment. Interestingly, male patients showed a significantly better mean clinical performance after ESWA than female patients, and male and female patients differed significantly in the signal intensity of the common extension tendon cross-section and tendon thickening on MRI. For female patients, MRI scans could be applied for predicting a positive clinical outcome of ESWA. This study reports the first indication of predictability of positive clinical outcome of the treatment of chronic lateral tennis elbow by ESWA using imaging prior to treatment. This may serve as an important step towards overcoming the therapeutic nihilism with respect to the non-operative management of this condition recently in the literature.

  13. Treatment of chronic plantar fasciitis with extra corporeal shock wave therapy: ultrasonographic morphological aspect and functional evaluation

    Directory of Open Access Journals (Sweden)

    Roberto Androson

    2013-12-01

    Full Text Available Objective: This paper has the purpose to analyze prospectively the treatment results in patients with chronic plantar fasciitis resistant to conservative treatment who underwent extracorporeal shock wave therapy (ESWT. Methods: We evaluated 30 patients (36 feet; 16 (53.3% patients were male and 14 (47.7% female with mean age of 48.7 y.o., varying from 33 to 78 y.o.; 16 (53.3% present the problem on the left side, 14 (46.7% on the right ones and 6 (20% bilateral; the symptomatology varied from 6 to 60 months, with the average of 13.58 months. These patients were submitted to a weekly ESWT session for 4 consecutive weeks. We measured the plantar fascia thickness millimeters with ultrasound and we applied American Orthopaedic Foot and Ankle Society (AOFAS scale for ankle and hindfoot, and Roles & Maudsley scales in pre ESWT, after one, three and six months after and decrease in the plantar fascia thickness by the ultrasound (p = 0.011 along the different moments studied. Results: We observed improvement of the evaluated criteria (p < 0.001 and plantar fascia thickness by ultrasound (p = 0.011 at different time points studied. Conclusion: The ESWT can be considered an important tool in the primary or adjuvant treatment of the chronic plantar fasciitis when associated with conventional therapies. This methodology is safe, non-invasive and provides precocious rehabilitation and return to regular activities considering the results of the statistical analysis. This resource provides decrease in the thickness of the plantar fascia.

  14. Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors.

    Science.gov (United States)

    Martin, Donel M; Gálvez, Verònica; Loo, Colleen K

    2015-06-19

    Loss of personal memories experienced prior to receiving electroconvulsive therapy is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, electroconvulsive therapy treatment factors, and clinical indicators measured early in the electroconvulsive therapy course may help clinicians minimize these side effects through better management of the electroconvulsive therapy treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following electroconvulsive therapy. Seventy-four depressed participants with major depressive disorder were administered electroconvulsive therapy 3 times per week using either a right unilateral or bitemporal electrode placement and brief or ultrabrief pulse width. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview - Short Form) were tested at baseline and after the last electroconvulsive therapy treatment. Time to reorientation was measured immediately following the third and sixth electroconvulsive therapy treatments. Results confirmed the utility of measuring time to reorientation early during the electroconvulsive therapy treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of electroconvulsive therapy treatments, older age was associated with increased time to reorientation. Consistency of verbal fluency performance was moderately correlated with change in Columbia Autobiographical Memory Interview - Short Form scores following right unilateral electroconvulsive therapy. Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be particularly considered for

  15. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.

    Science.gov (United States)

    Bannuru, Raveendhara R; Flavin, Nina E; Vaysbrot, Elizaveta; Harvey, William; McAlindon, Timothy

    2014-04-15

    Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. Extracorporeal shock-wave therapy (ESWT) has been suggested as an alternative treatment. To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013. Randomized, controlled trials (RCTs) comparing high-energy versus low-energy ESWT or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. Outcome measures included pain (visual analogue scale score), functional assessment (Constant-Murley score), and resolution of calcifications. Three independent reviewers abstracted data and determined eligibility and quality by consensus. Twenty-eight RCTs met the inclusion criteria. Studies were heterogeneous. Twenty RCTs compared ESWT energy levels and placebo and consistently showed that high-energy ESWT was significantly better than placebo in decreasing pain and improving function and resorption of calcifications in calcific tendinitis. No significant difference was found between ESWT and placebo in treatment of noncalcific tendinitis. The number of RCTs was small, and the studies were heterogeneous. High-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications. This therapy may be underutilized for a condition that can be difficult to manage. None.

  16. Extracorporeal Shock Wave Therapy reduces upper limb spasticity and improves motricity in patients with chronic hemiplegia: a case series.

    Science.gov (United States)

    Troncati, Franco; Paci, Matteo; Myftari, Tefta; Lombardi, Bruna

    2013-01-01

    Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown. To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia. Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale. MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit. Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment.

  17. DETECTION OF IMMUNOGLOBULINS, ANTIBODIES TO HEAT-SHOCK PROTEINS AND IL-8 CYTOKINE IN SALIVA FROM THE PATIENTS WITH CHRONIC PERIODONTAL DISEASES

    Directory of Open Access Journals (Sweden)

    N. N. Tsybikov

    2010-01-01

    Full Text Available  Examination of the patients with chronic generalized periodontitis revealed a sufficient increase in all immunoglobulin classes, i.e., IgG, IgM, IgA, sIgA, as well as increased IL-8 concentration in their salivary samples. Emergence of antibodies to heat-shock proteins suggests a pathogenetic role of chaperon-like proteins in development of periodontal diseases.

  18. Review of electroconvulsive therapy practice from a tertiary Child and Adolescent Psychiatry Centre.

    Science.gov (United States)

    Jacob, Preeti; Gogi, Prabhu Kiran Vishwanath; Srinath, Shoba; Thirthalli, Jagadisha; Girimaji, Satish; Seshadri, Shekhar; Sagar, John Vijay

    2014-12-01

    The use of electroconvulsive therapy (ECT) in children and adolescents is a controversial issue. This study was done to examine the pattern and practice as well as the outcome of electroconvulsive therapy administered to children and adolescents admitted to a tertiary care centre. A 10 year retrospective chart review of all children and adolescents (up to 16 years of age) admitted in the Child and Adolescent Psychiatry Centre, National Institute of Mental Health and Neurosciences (NIMHANS) who had received at least 1 session of ECT was done. Information regarding diagnosis, reasons for prescribing electroconvulsive therapy, details regarding the procedure and outcome variables was collected from the records. Clinical Global Impressions (CGI) scale rating of the severity of illness and improvement seen were done by 2 trained psychiatrists independently. 22 children and adolescents received electroconvulsive therapy over 10 years. There were an equal number of boys and girls. All received modified ECT. Most patients who received electroconvulsive therapy were severely ill. Catatonic symptoms 54.5% (12) were the most common reason for prescribing electroconvulsive therapy. It was efficacious in 77.3% (17) of the patients. Electroconvulsive therapy was relatively safe, and most experienced no acute side effects. 68.2% (15) who were on follow up and did not experience any long term side effects due to the electroconvulsive therapy. Electroconvulsive therapy has a place in the acute management of severe childhood psychiatric disorders. Further long term prospective studies are required. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Delays in accessing electroconvulsive therapy: a comparison between two urban and two rural populations in Australia.

    Science.gov (United States)

    Johnston, Natalie E

    2015-10-01

    A comparison of the timing, rates and characteristics of electroconvulsive therapy use between urban and rural populations. The medical records of patients who received an acute course of electroconvulsive therapy at two rural and two urban psychiatric hospitals in New South Wales (NSW), Australia, in 2010 were reviewed retrospectively. Main outcome measures were the time from symptom onset, diagnosis and admission to commencing electroconvulsive therapy. Rates of use of electroconvulsive therapy were also compared between rural and urban hospitals using NSW statewide data. There was a significant delay in the time it took for rural patients to receive electroconvulsive therapy compared with urban patients when measured both from the time of symptom onset and from when they received a diagnosis. There were corresponding delays in the time taken for rural patients to be admitted to hospital compared with urban patients. There was no difference in the time it took to commence electroconvulsive therapy once a patient was admitted to hospital. NSW statewide urban-rural comparisons showed rates of electroconvulsive therapy treatment were significantly higher in urban hospitals. Patients in rural areas receive electroconvulsive therapy later in their acute illness due to delays in being admitted to hospital. The rate of use of electroconvulsive therapy also differs geographically. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  20. Anaphylactic Shock Secondary to Intravenous Iron Sucrose in Chronic Kidney Disease.

    Science.gov (United States)

    Behera, Vineet; Chauhan, Rajeev; Sinha, Smriti; Nair, Velu

    2015-09-01

    Intravenous (IV) iron is an essential component of therapy of anemia of chronic kidney disease (CKD). We present a rare case in which iron sucrose was infused to a patient of CKD and resulted in severe anaphylaxis and cardiac arrest minutes after starting the infusion. He was aggressively resuscitated with adrenaline and other measures following which he recovered. The use of parenteral iron is associated with several adverse drug reactions (ADR) which were seen with preparations like iron dextran but became rare with the use of newer safe preparations like iron sucrose or gluconate. The ADR can be mild or can have severe life threatening features like syncope, cardiac arrhythmias, seizures, bronchospasm and rarely cardio respiratory arrest like in our case. Iron sucrose is generally given as a IV infusion of 100-200 mg over 15-30 min and has a very low rate of ADR even with higher doses or bolus injections. But still necessary precautions and appropriate monitoring must be done in all patients. The patients who are allergic to iron sucrose may be treated with other safer preparations or by desensitisation techniques.

  1. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response

    OpenAIRE

    Luchini, Federica; Medda, Pierpaolo; Mariani, Michela Giorgi; Mauri, Mauro; Toni, Cristina; Perugi, Giulio

    2015-01-01

    Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelopmental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy (ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be co...

  2. Maintenance electroconvulsive therapy in autistic catatonia: a case series review.

    Science.gov (United States)

    Wachtel, Lee E; Hermida, Adriana; Dhossche, Dirk M

    2010-05-30

    The usage of electroconvulsive therapy for the acute resolution of catatonia in autistic children and adults is a novel area that has received increased attention over the past few years. Reported length of the acute ECT course varies among these patients, and there is no current literature on maintenance ECT in autism. The maintenance ECT courses of three patients with autism who developed catatonia are presented. Clinical, research, legal, and administrative implications for ECT treatment in this special population are discussed.

  3. Use of Electroconvulsive Therapy in an Adolescent Patient with Catatonia

    OpenAIRE

    Sandeep Grover; Natasha Kate; Gaurav Gupta

    2014-01-01

    There is lot of skepticism about the use of electroconvulsive therapy (ECT) in children and adolescents. However, available literature suggests that use of ECT can be at times life-saving in adolescents, especially those presenting with severe catatonia. We treated a 16-year-old female who presented to us with catatonia with a course of nine ECTs, with which she showed marked improvement. Review of the literature suggests that ECT should be considered as the second line treatment in the manag...

  4. Pivotal role of tissue plasminogen activator in the mechanism of action of electroconvulsive therapy.

    Science.gov (United States)

    Hoirisch-Clapauch, Silvia; Mezzasalma, Marco A U; Nardi, Antonio E

    2014-02-01

    Electroconvulsive therapy is an important treatment option for major depressive disorders, acute mania, mood disorders with psychotic features, and catatonia. Several hypotheses have been proposed as electroconvulsive therapy's mechanism of action. Our hypothesis involves many converging pathways facilitated by increased synthesis and release of tissue-plasminogen activator. Human and animal experiments have shown that tissue-plasminogen activator participates in many mechanisms of action of electroconvulsive therapy or its animal variant, electroconvulsive stimulus, including improved N-methyl-D-aspartate receptor-mediated signaling, activation of both brain-derived neurotrophic factor and vascular endothelial growth factor, increased bioavailability of zinc, purinergic release, and increased mobility of dendritic spines. As a result, tissue-plasminogen activator helps promote neurogenesis in limbic structures, modulates synaptic transmission and plasticity, improves cognitive function, and mediates antidepressant effects. Notably, electroconvulsive therapy seems to influence tissue-plasminogen activator metabolism. For example, electroconvulsive stimulus increases the expression of glutamate decarboxylase 65 isoform in γ-aminobutyric acid-releasing neurons, which enhances the release of tissue-plasminogen activator, and the expression of p11, a protein involved in plasminogen and tissue-plasminogen activator assembling. This paper reviews how electroconvulsive therapy correlates with tissue-plasminogen activator. We suggest that interventions aiming at increasing tissue-plasminogen activator levels or its bioavailability - such as daily aerobic exercises together with a carbohydrate-restricted diet, or normalization of homocysteine levels - be evaluated in controlled studies assessing response and remission duration in patients who undergo electroconvulsive therapy.

  5. Antipsychotic Polypharmacy in a Treatment-Refractory Schizophrenia Population Receiving Adjunctive Treatment With Electroconvulsive Therapy

    DEFF Research Database (Denmark)

    Kristensen, Diana; Hageman, Ida; Bauer, Jeanett

    2013-01-01

    Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT).......Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT)....

  6. Effects of chronic heat stress on the expressions of heat shock proteins 60, 70, 90, A2, and HSC70 in the rabbit testis.

    Science.gov (United States)

    Pei, Yangli; Wu, Yingjie; Qin, Yinghe

    2012-01-01

    Few studies have focused on the expression of heat shock proteins (HSPs) after chronic heat stress. The objective of this study was to investigate the effect of chronic high temperature-humidity index treatment on the expressions of HSP60, HSP70, HSP90, HSPA2 and HSC70, in the Rex rabbit testis and the expressions of these proteins after recovery from the chronic heat shock. Thirty mature male rabbits of the same age were randomly divided into three groups: control, heat stress, and recovery. The western blot results showed that the expressional levels of HSP60, HSP90, and HSC70 increased significantly and HSPA2 was elevated slightly after a 9-week heat treatment. HSP70 was absent in the control testis and had a high level of expression after heat stress. All of these proteins partially reverted back to normal levels after a 9-week recovery. The immunohistochemical results indicated that the expression patterns of HSP60, HSP90, HSPA2, and HSC70 did not change.

  7. ["Shock" therapies in Nazi Germany. The example of Berlin psychiatry].

    Science.gov (United States)

    Rzesnitzek, L

    2014-09-01

    The idea that "shock" therapies were introduced by "Nazi-Psychiatry" very early and used radically in a cruel way darkens the image of these therapies until today. A case analysis of patient files of psychiatric hospitals in Berlin is used to recapitulate the introduction of insulin coma, metrazol and electroconvulsive therapy during the National Socialism era. Contrary to the false assumption that these "shock" therapies would have been introduced and preferred by psychiatrists involved with the Nazi regime and "euthanasia", in the case of Berlin these therapies were delayed by them and seldom used.

  8. Clinical analysis of safety and effectiveness of electroconvulsive therapy [Analiza kliniczna skuteczności i bezpieczeństwa leczenia elektrowstrząsowego

    Directory of Open Access Journals (Sweden)

    Dąbrowski, Marek

    2012-06-01

    Full Text Available Aim. The aim of the study was to assess efficacy and safety of electroconvulsive therapy. Methods. 43 patients included into the study were hospitalised in The Institute of Psychiatry and Neurology and received all together over 400 bilateral electroconvulsive procedures. Most of the patients (N=25 were qualified for electroconvulsive therapy due to treatment resistant depression (58.1%. Six patients: 2 with catatonia and 4 with depression had life saving indications for electroconvulsive therapy. Three patients (7% were excluded from electroconvulsive therapy, following 1 or 2 electroconvulsive procedures. Forty patients continued electroconvulsive therapy. Results. There were no complications and serious adverse events in patients who continued electroconvulsive therapy. Generally, electroconvulsive therapy was well tolerated and treatment had been cut down in only one case due to adverse events and high risk related to the procedure. Transient cardiac arrhythmias (10% of patients were the most often occurring adverse events and patients (35% mostly reported headaches. We observed remission in 22 patients (58% and improvement in 14 patients (35% following electroconvulsive treatment. Only 4 patients (10% had no benefit after a series of electroconvulsive procedures. Electroconvulsive treatment was most effective in patients with catatonia (80% patients had full recovery and in depressive patients with bipolar disorder (73% patients had full recovery. Conclusion. Electroconvulsive procedures were safe and effective. Electroconvulsive treatment was most effective in catatonic patients with schizophrenia and in depressive patients with bipolar disorder.

  9. Electroconvulsive therapy in adolescents: a retrospective study from north India.

    Science.gov (United States)

    Grover, Sandeep; Malhotra, Savita; Varma, Sannidhya; Chakrabarti, Subho; Avasthi, Ajit; Mattoo, Surendra K

    2013-06-01

    There are minimal data on the use of electroconvulsive therapy (ECT) in adolescents from India. The present study aimed to evaluate the clinical profile and effectiveness of ECT in adolescents (aged 13-18 years). A retrospective chart review was carried out to identify adolescents (aged 13-18 years) who had received ECT during the period 1999-2011. During the study period, 39 such patients received ECT; complete records of 25 patients were available. Details regarding their sociodemographic, clinical, and treatment data were extracted from these records for the present study. During the study period, 658 patients received ECT, of which 39 were aged 18 or younger (5.9%). Schizophrenia (n = 14; 56%) was the commonest diagnosis for which ECT was used in adolescents, followed by depression (n = 3; 12%). Catatonic symptoms (n = 17; 68%) were the most common symptoms among these subjects. Electroconvulsive therapy was considered as a treatment of choice taking the clinical picture account in about three fourths of the patients (n = 19; 76%). The mean (SD) numbers of ECTs administered per patient were 10.1 (4.87) (range, 2-21). The mean (SD) response rate to ECT was 76% (23.3%) (range, 31%-100%). Response rates according to diagnosis were the following: 76.3% for schizophrenia, 87.2% for depression, 81.8% for psychosis (not otherwise specified), and 77.7% for acute and transient psychosis. Response rate in patients with catatonia was 91.6%. Prolonged seizures, nausea and vomiting, and headache were reported in 2 cases each. Electroconvulsive therapy is used less frequently in children and adolescents compared to the older patients. This study shows that ECT is effective in the treatment of severe psychiatric disorders in adolescents and is associated with the same frequency of adverse effects as the adults.

  10. Anticonvulsant Mechanisms of Electroconvulsive Therapy and Relation to Therapeutic Efficacy.

    Science.gov (United States)

    Duthie, Ashleigh C; Perrin, Jennifer S; Bennett, Daniel M; Currie, James; Reid, Ian C

    2015-09-01

    Electroconvulsive therapy (ECT) is held to confer anticonvulsant effects, although the role of rise in seizure threshold upon clinical effect is uncertain. This study investigated the relationship in a large, consecutive, retrospective sample of patients receiving ECT in Aberdeen. We have tested the hypotheses of previous authors to further examine the relationship between seizure and therapeutic effect as well as discuss the potential underlying neurobiological mechanisms. All patients receiving ECT at the Royal Cornhill Hospital between 2000 and the end of 2008 were identified from the Scottish ECT Accreditation Network. Electroconvulsive therapy was administered twice weekly with a bifrontotemporal electrode placement using routine dosage schedules. Data were gathered from the Scottish ECT Accreditation Network and case notes regarding ECT course and clinical effect. The seizure threshold increased in 219 (94.4%) patients, stayed the same in 13 (5.6%) patients, and decreased in 0 patient (n = 232). No significant relationship was present between change in seizure threshold and change in Montgomery-Asberg Depression Rating Scale score (P = 0.39; Kendall τ b r = 0.047; n = 182), although responders did display greater increase in seizure threshold than nonresponders. Electroconvulsive therapy confers anticonvulsant effects in a consecutive sample of real-life patients. Neither initial seizure threshold nor magnitude of seizure threshold increase is a predictor of clinical response to ECT. A rise in seizure threshold is not essential for therapeutic effect but may represent an important marker of underlying neuronal state. The evidence reviewed in this article supports a link between neuroplastic effects of ECT and the evidenced rise in seizure threshold.

  11. Patient with intractable delirium successfully treated with electroconvulsive therapy

    DEFF Research Database (Denmark)

    Lindgren, Eske; Hageman, Ida

    2014-01-01

    Delirium is a frequent and serious condition often seen in hospitalized patients, especially the elderly. Treatment of the somatic illness causing the delirium, and antipsychotic medication will usually resolve the condition. Sometimes, however, the condition is refractory towards medical treatment...... and in this situation electroconvulsive therapy (ECT) can be a quick and efficient treatment. In this case report of a 26-year-old man a post-operative intractable delirium persisting for three weeks was efficiently and swiftly relieved by three consecutive ECTs. The patient was discharged without need for further...

  12. Use of electroconvulsive therapy in an adolescent patient with catatonia

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2014-01-01

    Full Text Available There is lot of skepticism about the use of electroconvulsive therapy (ECT in children and adolescents. However, available literature suggests that use of ECT can be at times life-saving in adolescents, especially those presenting with severe catatonia. We treated a 16-year-old female who presented to us with catatonia with a course of nine ECTs, with which she showed marked improvement. Review of the literature suggests that ECT should be considered as the second line treatment in the management of catatonia in adolescents.

  13. Catatonia associated with hyponatremia treated with electroconvulsive therapy.

    Science.gov (United States)

    Grover, Sandeep; Kattharaghatta Girigowda, Vijay; Aggarwal, Munish; Malhotra, Nidhi

    2012-09-01

    Catatonia has been reported to occur in various brain pathologies and systemic conditions. We present a case of catatonia associated with hyponatremia treated with a course of electroconvulsive therapy. A 48-year-old woman presented with catatonia and, upon investigation, was found to have persistent/recurrent hyponatremia. Upon investigation also, she was found to have adrenal insufficiency. Her symptoms of catatonia did not respond to correction of hyponatremia, a course of lorazepam, after which she was treated with ECT, with which her catatonia improved.

  14. Postpartum catatonia treated with electroconvulsive therapy: a case report.

    Science.gov (United States)

    Strain, Angela Katherine; Meltzer-Brody, Samantha; Bullard, Elizabeth; Gaynes, Bradley N

    2012-01-01

    Catatonia is a rare syndrome that occurs in mood and psychotic disorders, and general medical conditions. Postpartum depression affects 10%-15% of women within 6 months after delivery. Postpartum psychosis affects 0.1%-0.5% of women within weeks after delivery, though it can occur within hours; it carries risk for suicide and infanticide. There is limited evidence available to guide treatment. We review a case of postpartum psychosis that presented with catatonia and was resistant to medications, but responded to electroconvulsive therapy.

  15. Electroconvulsive therapy (ECT) in literature: Sylvia Plath's The Bell Jar.

    Science.gov (United States)

    Kellner, Charles H

    2013-01-01

    Sylvia Plath's well-known novel, The Bell Jar, recounts her experience of a severe depressive episode. In the novel, the protagonist is treated with electroconvulsive therapy (ECT), as was Plath in life. The first ECT is given in the now-obsolete "unmodified" form, without general anesthesia. Later in the story, she receives ECT again, this time with full general anesthesia and muscle relaxation, as is the standard of care today. This chapter examines how the novelistic descriptions of the treatment compare with actual clinical practice.

  16. Electroconvulsive therapy with S-ketamine anesthesia for catatonia in coexisting depression and dementia.

    Science.gov (United States)

    Litvan, Zsuzsa; Bauer, Martin; Kasper, Siegfried; Frey, Richard

    2017-07-01

    Information on efficacy and safety of electroconvulsive therapy in patients with dementia is sparse. The current case report describes a patient suffering from severe depression and dementia who received electroconvulsive therapy with S-ketamine anesthesia at our psychiatric intensive care unit for the treatment of her therapy-resistant catatonic stupor. The patient's condition improved remarkably through the treatment. By the end of 16 electroconvulsive therapy sessions, her catatonic symptoms remitted entirely, her affect was brighter and she performed markedly better at the cognitive testing.

  17. Decreasing adverse outcomes of unmodified electroconvulsive therapy: suggestions and possibilities.

    Science.gov (United States)

    Gallegos, Jesus; Vaidya, Punit; D'Agati, Douglas; Jayaram, Geetha; Nguyen, Thai; Tripathi, Adarsh; Trivedi, Jitendra K; Reti, Irving M

    2012-06-01

    Electroconvulsive therapy (ECT) is far and away the most effective treatment for depression and quite effective for a range of other psychiatric conditions that are unresponsive to medication. Electroconvulsive therapy in the developed world has been administered with anesthesia, muscle relaxants, and ventilation since the mid-1950s following 20 years of unmodified treatment. However, in much of the developing world, ECT continues to be administered unmodified because of lack of resources. We review the efficacy of unmodified compared with modified treatment. We also review the potential drawbacks of unmodified treatment including fear and anxiety, worse postictal confusion, fracture risk, and the negative effects of unmodified treatment on how ECT is perceived in the general community. Finally, we consider potential solutions in developing countries to minimize adverse outcomes of unmodified treatment by pretreating patients either with low-dose benzodiazepines or sedating, but not anesthetizing, dosages of anesthetic agents. Randomized controlled trials are necessary before either of these options could be considered an acceptable alternative to completely unmodified treatment when modified treatment is unavailable.

  18. Electroconvulsive Therapy - What Do Patients Think Of Their Treatment?

    Science.gov (United States)

    Maguire, S; Rea, S M; Convery, P

    2016-09-01

    The Regulation and Quality Improvement Authority (RQIA) monitors the administration of electroconvulsive therapy (ECT) in Northern Ireland (NI). As part of their inspection methodology RQIA wished to include feedback from ECT patients. The aim of this report is to summarise the opinions of ECT patients over a 1-year period and to compare their feedback about treatment with the standards of best practice, as defined by the Electroconvulsive Therapy Accreditation Service (ECTAS). RQIA was granted permission to use the ECTAS patient questionnaire. The questionnaire was distributed to all the ECT clinics in NI and staff were requested to give them to patients who had received a course of ECT. A total of 42 individuals returned questionnaires, 24 females (57.1%) and 18 (42.9%) males. The response rate was 26%. Almost half of respondents were detained under the Mental Health (Northern Ireland) Order 1986 (n=19, 45.2%), with one third receiving ECT as a day patient (n=14, 33.3%). Respondents reported having detailed information about ECT, with ECTAS standards 4.2 and 4.3 being affirmed in over 80% of cases. Eighty percent of respondents (n=34) believed they benefited from ECT. The results are mainly favourable towards ECT. The majority felt they benefited from treatment.

  19. Postpartum electroconvulsive therapy: a systematic review and case report.

    Science.gov (United States)

    Gressier, Florence; Rotenberg, Samuel; Cazas, Odile; Hardy, Patrick

    2015-01-01

    Postpartum depression can have devastating consequences on the mother and child. Prompt treatment is challenging. Whereas electroconvulsive therapy (ECT) is considered to be an effective treatment modality in severe depression and brings about rapid clinical improvement, little is known about ECT during the postpartum period. We systematically reviewed the literature on the use of ECT during the postpartum period using PubMed, Institute for Scientific Information Web of Knowledge and PsycINFO databases until September 2014, using the search terms "electroconvulsive therapy" or "ECT" and "postpartum". Then, we described the successful treatment with ECT and the joint mother-baby hospitalization of a woman with severe depression. Eight case reports and 8 studies were identified. All of the studies reported that ECT is effective in the postpartum period. It is well tolerated, provides a fast response and allows for breastfeeding. In addition, our case report showed the benefits of the hospitalization of the mother-baby unit. Combined ECT and joint mother-baby hospitalization could be a valuable treatment by targeting both the mother-infant relationship and the maternal depressive symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. The role of clinical pharmacology and pharmacogenetics in electroconvulsive therapy : from safety to efficacy

    NARCIS (Netherlands)

    Mirzakhani, Hooman

    2016-01-01

    Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to produce generalized seizure for the treatment of selected psychiatric disorders, mostly treatment resistant depression, acute mania, and schizophrenic syndromes. Safety of ECT increases the

  1. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial.

    Science.gov (United States)

    Kolk, A; Yang, K G Auw; Tamminga, R; van der Hoeven, H

    2013-11-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ≤ 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment.

  2. Current electroconvulsive therapy practice and research in the geriatric population

    Science.gov (United States)

    Kerner, Nancy; Prudic, Joan

    2014-01-01

    SUMMARY Electroconvulsive therapy (ECT) is utilized worldwide for various severe and treatment-resistant psychiatric disorders. Research studies have shown that ECT is the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis. For patients who suffer from intractable catatonia and neuroleptic malignant syndrome, ECT can be life saving. For elderly patients who cannot tolerate or respond poorly to medications and who are at a high risk for drug-induced toxicity or toxic drug interactions, ECT is the safest treatment option. Organic causes are frequently associated with late-life onset of neuropsychiatric conditions, such as parkinsonism, dementia and stroke. ECT has proven to be efficacious even when these conditions are present. During the next decade, research studies should focus on the use of ECT as a synergistic therapy, to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence. PMID:24778709

  3. Mirror-Image Study of Maintenance Electroconvulsive Therapy.

    Science.gov (United States)

    Mota, Jorge; Rodrigues-Silva, Nuno

    2016-06-01

    Electroconvulsive therapy (ECT) is a technique with proven efficacy in the treatment of severe psychiatric disorders. However, studies regarding its use as a maintenance therapy are scarce. The aim of the present study was to build knowledge in this area. Data from 28 patients receiving maintenance ECT (M-ECT) were retrospectively collected and analyzed using a mirror-image design. Length of stay and readmissions were compared before M-ECT (control condition) and after M-ECT (experimental condition). Our results showed a decrease in both length of stay and number of readmissions after M-ECT, although the decrease in readmissions was moderated by a site effect. The present study results reveal the potential benefit of M-ECT. Further studies are urgently needed to establish its usefulness as an alternative treatment for severe psychiatric disorders.

  4. Research on electroconvulsive therapy in India: An overview

    Science.gov (United States)

    Gangadhar, Bangalore N.; Phutane, Vivek H.; Thirthalli, Jagadisha

    2010-01-01

    The contribution of researchers from India in the field of electroconvulsive therapy (ECT) has been substantial. Over 250 papers have been published by authors from India in the past five decades on this issue; about half of these have appeared in the Indian Journal of Psychiatry. This article summarizes the papers on ECT research that have appeared in the Journal. A bulk of these articles has focused on establishing the efficacy in different disorders. Considerable numbers of papers describe refinement in the ECT procedure, including anesthetic modification, ECT machine and EEG monitoring. Papers on neurobiology of ECT and long-term follow-up of ECT-treated patients form a minority. Despite the decline in the use of ECT across the globe, papers on ECT have only increased in the recent decades in the Journal. PMID:21836706

  5. How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms

    Science.gov (United States)

    Singh, Amit; Kar, Sujita Kumar

    2017-01-01

    Electroconvulsive therapy (ECT) is a time tested treatment modality for the management of various psychiatric disorders. There have been a lot of modifications in the techniques of delivering ECT over decades. Despite lots of criticisms encountered, ECT has still been used commonly in clinical practice due to its safety and efficacy. Research evidences found multiple neuro-biological mechanisms for the therapeutic effect of ECT. ECT brings about various neuro-physiological as well as neuro-chemical changes in the macro- and micro-environment of the brain. Diverse changes involving expression of genes, functional connectivity, neurochemicals, permeability of blood-brain-barrier, alteration in immune system has been suggested to be responsible for the therapeutic effects of ECT. This article reviews different neurobiological mechanisms responsible for the therapeutic efficacy of ECT. PMID:28783929

  6. Electroconvulsive therapy for catatonia in juvenile neuropsychiatric lupus.

    Science.gov (United States)

    Leon, T; Aguirre, A; Pesce, C; Sanhueza, P; Toro, P

    2014-09-01

    Neuropsychiatric manifestations are serious and frequent complications of systemic lupus erythematous (SLE). Catatonia is a neuropsychiatric disorder characterized by motor disturbance (including waxy flexibility and catalepsy), stupor, excitement, negativism, mutism, echopraxia and echolalia. Catatonia associated with SLE has been only rarely reported, especially in children. Here we present a case of a 14-year-old patient encountered in consultation-liaison psychiatry who presented catatonia associated with SLE. Her catatonia was refractory to treatment with pulse methylprednisolone, intravenous cyclophosphamide and rituximab. The patient responded to a combined therapy of electroconvulsive therapy and benzodiazepines. The present case suggests that although rarely reported, catatonia seen in the background of SLE should be promptly identified and treated to reduce the morbidity.

  7. Prolonged apnea following modified electroconvulsive therapy with suxamethonium

    Directory of Open Access Journals (Sweden)

    T M Omprakash

    2011-01-01

    Full Text Available A 36-year-old male from an urban middleclass family with strained relationship among family members was referred from a corporate hospital for further management of psychological problem. As he was attempting suicide repeatedly, Electroconvulsive Therapy (ECT was planned. After preoperative assessment and preparation, modified ECT was done with thiopentone and 0.5 mg/kg of suxamethonium. Apnea following suxamethonium was prolonged for 2 hours. Subsequent enquiry revealed that patient was treated for organophosphate poisoning and was on ventilator support for 15 days. This was concealed by the relatives. On searching patient previous records, Butyrylcholinesterase levels were very low, i.e., 350 u/l (normal reference range is 5 500 - 12 500 u/l. Prolonged suxamethonium apnea should be anticipated in patients with recent history of organophosphate poisoning; it is advisable to estimate the levels of butyrylcholinesterase and avoid suxamethonium in patients with low enzyme levels.

  8. Association of Electroconvulsive Therapy With Psychiatric Readmissions in US Hospitals.

    Science.gov (United States)

    Slade, Eric P; Jahn, Danielle R; Regenold, William T; Case, Brady G

    2017-08-01

    Although electroconvulsive therapy (ECT) is considered the most efficacious treatment available for individuals with severe affective disorders, ECT's availability is limited and declining, suggesting that information about the population-level effects of ECT is needed. To examine whether inpatient treatment with ECT is associated with a reduction in 30-day psychiatric readmission risk in a large, multistate sample of inpatients with severe affective disorders. A quasi-experimental instrumental variables probit model of the association correlation of ECT administration with patient risk of 30-day readmission was estimated using observational, longitudinal data on hospital inpatient discharges from US general hospitals in 9 states. From a population-based sample of 490 252 psychiatric inpatients, a sample was drawn that consisted of 162 691 individuals with a principal diagnosis of major depressive disorder (MDD), bipolar disorder, or schizoaffective disorder. The key instrumental variable used in the analysis was ECT prevalence in the prior calendar year at the treating hospital. To examine whether ECT's association with readmissions was heterogeneous across population subgroups, analyses included interactions of ECT with age group, sex, race/ethnicity, and diagnosis group. The study was conducted from August 27, 2015, to March 7, 2017. Readmission within 30 days of being discharged. Overall, 2486 of the 162 691 inpatients (1.5%) underwent ECT during their index admission. Compared with other inpatients, those who received ECT were older (mean [SD], 56.8 [16.5] vs 45.9 [16.5] years; P Electroconvulsive therapy may be associated with reduced short-term psychiatric inpatient readmissions among psychiatric inpatients with severe affective disorders. This potential population health effect may be overlooked in US hospitals' current decision making regarding the availability of ECT.

  9. Beta-blocking agents during electroconvulsive therapy: a review.

    Science.gov (United States)

    Boere, E; Birkenhäger, T K; Groenland, T H N; van den Broek, W W

    2014-07-01

    Electroconvulsive therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'electroconvulsive therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. The Relationship between Symptom Relief and Psychosocial Functional Improvement during Acute Electroconvulsive Therapy for Patients with Major Depressive Disorder.

    Science.gov (United States)

    Lin, Ching-Hua; Yang, Wei-Cheng

    2017-07-01

    We aimed to compare the degree of symptom relief to psychosocial functional (abbreviated as "functional") improvement and explore the relationships between symptom relief and functional improvement during acute electroconvulsive therapy for patients with major depressive disorder. Major depressive disorder inpatients (n=130) requiring electroconvulsive therapy were recruited. Electroconvulsive therapy was generally performed for a maximum of 12 treatments. Symptom severity, using the 17-item Hamilton Depression Rating Scale, and psychosocial functioning (abbreviated as "functioning"), using the Modified Work and Social Adjustment Scale, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale scores were converted to T-score units to compare the degrees of changes between depressive symptoms and functioning after electroconvulsive therapy. Structural equation modeling was used to test the relationships between 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale during acute electroconvulsive therapy. One hundred sixteen patients who completed at least the first 3 electroconvulsive therapy treatments entered the analysis. Reduction of 17-item Hamilton Depression Rating Scale T-scores was significantly greater than that of Modified Work and Social Adjustment Scale T-scores at assessments 2, 3, 4, and 5. The model analyzed by structural equation modeling satisfied all indices of goodness-of-fit (chi-square = 32.882, P =.107, TLI = 0.92, CFI = 0.984, RMSEA = 0.057). The 17-item Hamilton Depression Rating Scale change did not predict subsequent Modified Work and Social Adjustment Scale change. Functioning improved less than depressive symptoms during acute electroconvulsive therapy. Symptom reduction did not predict subsequent functional improvement

  11. Streptococcal toxic shock syndrome occurred during postoperative radiotherapy in a cancer patient with preexisting lymphedema and chronic illness -case report-

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young; Oh, Yoon Kyeong; Kim, Dong Min [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2006-12-15

    A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS.

  12. Cardiogenic shock

    Science.gov (United States)

    Shock - cardiogenic ... electrical system of the heart (heart block) Cardiogenic shock occurs when the heart is unable to pump ... orthostatic hypotension) Weak (thready) pulse To diagnose cardiogenic shock, a catheter (tube) may be placed in the ...

  13. The Effect of Radial Extracorporeal Shock Wave Stimulation on Upper Limb Spasticity in Chronic Stroke Patients: A Single-Blind, Randomized, Placebo-Controlled Study.

    Science.gov (United States)

    Dymarek, Robert; Taradaj, Jakub; Rosińczuk, Joanna

    2016-08-01

    The main purpose of this study was to determine the clinical, electrophysiological and thermal effects of radial extracorporeal shock wave (rESW) stimulation on upper limb muscles affected by spasticity in patients with chronic stroke. Patients included in the study were randomly assigned into the following two groups: 30 patients stimulated with active rESW (A); and 30 patients stimulated with placebo rESW (B). All patients were analyzed using the Modified Ashworth Scale (MAS) to test the spasticity levels of the elbow (E), radio carpal (RC) and fingers (FF) joints; surface electromyography (sEMG) was performed for the resting bioelectrical activity registration of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) muscles; and infrared thermal imaging (IRT) was used to assess the temperature distributions of the carpal flexor muscles (CFM). All assessments were performed at baseline (t0), immediately after rESW (t1) as well as 1 and 24 h following its finalization (t2 and t3). Patients treated with active rESW showed a statistically significant reduction in the MAS score for the RC joint at t1 and for the FF joints at t1, t2 and t3 (p  0.05). Applications of rESW demonstrating positive effects at reducing the level of spastic hypertonia of the upper limb muscles in patients with chronic stroke. ESW treatments should be considered as a potential anti-spastic effect to regulate vasculature.

  14. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

    DEFF Research Database (Denmark)

    Nielsen, R M; Olsen, K S; Lauritsen, Anne Øberg

    2014-01-01

    with electroconvulsive therapy (ECT) after failure of conventional medical therapy. RESULTS: The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved...

  15. Fatal group A streptococcal necrotizing fasciitis and toxic shock syndrome in a patient with psoriasis and chronic renal impairment.

    Science.gov (United States)

    Chong, Alvin H; Burrows, Nigel P

    2002-08-01

    A 78-year-old woman presented with rapid onset of skin pain which evolved into oedema, discoloration and infarction. She was diagnosed with group A beta-haemolytic streptococcus (Streptococcus pyogenes) necrotizing fasciitis and streptococcal toxic shock syndrome. The patient had a past history of psoriasis and end-stage renal impairment. Despite treatment with multiple antibiotics in an intensive care unit, the skin infarction involving the upper trunk continued to expand and the patient died within 24 hours of hospital admission. Group A streptococcus and Staphylococcus aureus were cultured from a tissue biopsy. Renal failure and compromised skin barrier function are known to predispose to invasive streptococcal infections, but necrotizing fasciitis has only rarely been reported in association with psoriasis. This case illustrates the fulminant nature of the infection.

  16. Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series

    OpenAIRE

    Vito Pavone; Luca Cannavò; Antonio Di Stefano; Gianluca Testa; Luciano Costarella; Giuseppe Sessa

    2016-01-01

    Introduction. We report the results of a series of 40 patients with chronic insertional Achilles tendinopathy treated with low-energy ESWT after the failure of a 3-month program of eccentric exercises alone. Methods and Materials. 40 patients, 28 (70%) males and 12 (30%) females, were treated between January and December 2014. All patients were previously treated with only eccentric exercises for a 3-month period. The treatment protocol included 4 sessions of ESWT with a 2-week interval, from...

  17. A detailed modular analysis of heat-shock protein dynamics under acute and chronic stress and its implication in anxiety disorders.

    Science.gov (United States)

    Sriram, K; Rodriguez-Fernandez, Maria; Doyle, Francis J

    2012-01-01

    Physiological and psychological stresses cause anxiety disorders such as depression and post-traumatic stress disorder (PTSD) and induce drastic changes at a molecular level in the brain. To counteract this stress, the heat-shock protein (HSP) network plays a vital role in restoring the homeostasis of the system. To study the stress-induced dynamics of heat-shock network, we analyzed three modules of the HSP90 network--namely trimerization reactions, phosphorylation-dephosphorylation reactions, and the conversion of HSP90 from an open to a closed conformation--and constructed a corresponding nonlinear differential equation model based on mass action kinetics laws. The kinetic parameters of the model were obtained through global optimization, and sensitivity analyses revealed that the most sensitive parameters are the kinase and phosphatase that drive the phosphorylation-dephosphorylation reactions. Bifurcation analysis carried out with the estimated kinetic parameters of the model with stress as bifurcation parameter revealed the occurrence of "mushroom", a type of complex dynamics in which S-shaped and Z-shaped hysteretic bistable forms are present together. We mapped the molecular events responsible for generating the mushroom dynamics under stress and interpreted the occurrence of the S-shaped hysteresis to a normal level of stress, and the Z-shaped hysteresis to the HSP90 variations under acute and chronic stress in the fear conditioned system, and further, we hypothesized that this can be extended to stress-related disorders such as depression and PTSD in humans. Finally, we studied the effect of parameter variations on the mushroom dynamics to get insight about the role of phosphorylation-dephosphorylation parameters in HSP90 network in bringing about complex dynamics such as isolas, where the stable steady states in a bistable system are isolated and separated from each other and not connected by an unstable steady state.

  18. A detailed modular analysis of heat-shock protein dynamics under acute and chronic stress and its implication in anxiety disorders.

    Directory of Open Access Journals (Sweden)

    K Sriram

    Full Text Available Physiological and psychological stresses cause anxiety disorders such as depression and post-traumatic stress disorder (PTSD and induce drastic changes at a molecular level in the brain. To counteract this stress, the heat-shock protein (HSP network plays a vital role in restoring the homeostasis of the system. To study the stress-induced dynamics of heat-shock network, we analyzed three modules of the HSP90 network--namely trimerization reactions, phosphorylation-dephosphorylation reactions, and the conversion of HSP90 from an open to a closed conformation--and constructed a corresponding nonlinear differential equation model based on mass action kinetics laws. The kinetic parameters of the model were obtained through global optimization, and sensitivity analyses revealed that the most sensitive parameters are the kinase and phosphatase that drive the phosphorylation-dephosphorylation reactions. Bifurcation analysis carried out with the estimated kinetic parameters of the model with stress as bifurcation parameter revealed the occurrence of "mushroom", a type of complex dynamics in which S-shaped and Z-shaped hysteretic bistable forms are present together. We mapped the molecular events responsible for generating the mushroom dynamics under stress and interpreted the occurrence of the S-shaped hysteresis to a normal level of stress, and the Z-shaped hysteresis to the HSP90 variations under acute and chronic stress in the fear conditioned system, and further, we hypothesized that this can be extended to stress-related disorders such as depression and PTSD in humans. Finally, we studied the effect of parameter variations on the mushroom dynamics to get insight about the role of phosphorylation-dephosphorylation parameters in HSP90 network in bringing about complex dynamics such as isolas, where the stable steady states in a bistable system are isolated and separated from each other and not connected by an unstable steady state.

  19. Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series

    Directory of Open Access Journals (Sweden)

    Vito Pavone

    2016-01-01

    Full Text Available Introduction. We report the results of a series of 40 patients with chronic insertional Achilles tendinopathy treated with low-energy ESWT after the failure of a 3-month program of eccentric exercises alone. Methods and Materials. 40 patients, 28 (70% males and 12 (30% females, were treated between January and December 2014. All patients were previously treated with only eccentric exercises for a 3-month period. The treatment protocol included 4 sessions of ESWT with a 2-week interval, from 800 shots in each one (4 Hz, 14 KeV, together with eccentric exercises. Visual Analogue Scale (VAS and American Orthopedic Foot and Ankle Society (AOFAS Hindfoot score were recorded. Results. At the 12-month follow-up, 26 (65.0% patients did not complain about pain (VAS 4. There was no significative improvement in both scores after eccentric exercises alone. Mean VAS improvement was 5.8±1.3 SD points (P<0.001. Mean AOFAS Hindfoot score improvement was 19.8±5.0 SD points (P<0.001. Conclusions. ESWT is recommended, in combination with an eccentric exercise program, in patients with chronic Achilles tendinopathy being both insertional and not.

  20. Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series

    Science.gov (United States)

    Pavone, Vito; Di Stefano, Antonio; Testa, Gianluca; Costarella, Luciano; Sessa, Giuseppe

    2016-01-01

    Introduction. We report the results of a series of 40 patients with chronic insertional Achilles tendinopathy treated with low-energy ESWT after the failure of a 3-month program of eccentric exercises alone. Methods and Materials. 40 patients, 28 (70%) males and 12 (30%) females, were treated between January and December 2014. All patients were previously treated with only eccentric exercises for a 3-month period. The treatment protocol included 4 sessions of ESWT with a 2-week interval, from 800 shots in each one (4 Hz, 14 KeV), together with eccentric exercises. Visual Analogue Scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score were recorded. Results. At the 12-month follow-up, 26 (65.0%) patients did not complain about pain (VAS 4). There was no significative improvement in both scores after eccentric exercises alone. Mean VAS improvement was 5.8 ± 1.3 SD points (P < 0.001). Mean AOFAS Hindfoot score improvement was 19.8 ± 5.0 SD points (P < 0.001). Conclusions. ESWT is recommended, in combination with an eccentric exercise program, in patients with chronic Achilles tendinopathy being both insertional and not. PMID:27843949

  1. Investigating the Effect of Extracorporeal Shock Wave Therapy on reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial

    Directory of Open Access Journals (Sweden)

    Saeid Khosrawi

    2017-01-01

    Full Text Available Background: Knee pain, is one of the most common causes of patients' referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. Materials and Methods: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months, who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT. Pain scores of all patients were measured using the Visual Analog Scale (VAS and McGill Pain Questionnaire (MPQ (total and present pain indexes [TPIs and PPIs] before intervention, immediately after intervention (3rd week, and after 8 weeks. The pain scores were then compared and statistically analyzed. Results: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week: P=0.02, P= 0.04 respectively; and 8 weeks after the end of treatment: P=0.01, P= 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001. Conclusion: The results showed that ESWT could be effective in reducing the pain and treating PAB.

  2. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis

    Directory of Open Access Journals (Sweden)

    Amir Moayednia

    2014-01-01

    Full Text Available Background: There is limited evidence about the chronic pelvic pain syndrome (CPPS treatment by shockwave therapy, and the aim of this study was to evaluate the effect of extracorporeal shockwave therapy on CPPS due to non bacterial prostatitis in a long-term period. Materials and Methods: In a follow-up survey, 40 patients with CPPS (that were randomly distributed into the treatment or sham groups were evaluated at 16, 20, and 24 weeks. In the treatment group, patients were treated by extracorporeal shock wave therapy (ESWT once a week for 4 weeks by a protocol of 3000 impulses, 0.25 mJ/m 2 and 3 Hz of frequency. 0.05 mJ/m 2 were added in each week. In the sham group, the same protocol was applied, but with the probe being turned off. The follow-up assessments were done by visual analog scale for pain and National Institutes of Health-developed Chronic Prostatitis Symptom Index (NIH-CPSI. Data were compared using independent t-test or analysis of variences. Results: Three patients did not complete the study protocol, 37 patients were evlauated (19 patients in treatment and 18 patients in the sham group. At week 24, the mean of pain score, urinary score, quality-of-life and NIH-CPSI score between two groups were not statistically different. Conclusion: Although, ESWT therapy as a safe and effective therapy in CPPS in short-term follow-up has been established, its long-term efficacy was not supported by this study.

  3. Chronic over-expression of heat shock protein 27 attenuates atherogenesis and enhances plaque remodeling: a combined histological and mechanical assessment of aortic lesions.

    Directory of Open Access Journals (Sweden)

    Charles M Cuerrier

    Full Text Available AIMS: Expression of Heat Shock Protein-27 (HSP27 is reduced in human coronary atherosclerosis. Over-expression of HSP27 is protective against the early formation of lesions in atherosclerosis-prone apoE(-/- mice (apoE(-/-HSP27(o/e - however, only in females. We now seek to determine if chronic HSP27 over-expression is protective in a model of advanced atherosclerosis in both male and female apoE(-/- mice. METHODS AND RESULTS: After 12 weeks on a high fat diet, serum HSP27 levels rose more than 16-fold in male and female apoE(-/-HSP27(o/e mice, although females had higher levels than males. Relative to apoE(-/- mice, female apoE(-/-HSP27(o/e mice showed reductions in aortic lesion area of 35% for en face and 30% for cross-sectional sinus tissue sections - with the same parameters reduced by 21% and 24% in male cohorts; respectively. Aortic plaques from apoE(-/-HSP27(o/e mice showed almost 50% reductions in the area occupied by cholesterol clefts and free cholesterol, with fewer macrophages and reduced apoptosis but greater intimal smooth muscle cell and collagen content. The analysis of the aortic mechanical properties showed increased vessel stiffness in apoE(-/-HSP27(o/e mice (41% in female, 34% in male compare to apoE(-/- counterparts. CONCLUSIONS: Chronic over-expression of HSP27 is atheroprotective in both sexes and coincides with reductions in lesion cholesterol accumulation as well as favorable plaque remodeling. These data provide new clues as to how HSP27 may improve not only the composition of atherosclerotic lesions but potentially their stability and resilience to plaque rupture.

  4. Human Myeloid-derived Suppressor Cells are Associated With Chronic Immune Suppression After Severe Sepsis/Septic Shock.

    Science.gov (United States)

    Mathias, Brittany; Delmas, Amber L; Ozrazgat-Baslanti, Tezcan; Vanzant, Erin L; Szpila, Benjamin E; Mohr, Alicia M; Moore, Frederick A; Brakenridge, Scott C; Brumback, Babette A; Moldawer, Lyle L; Efron, Philip A

    2017-04-01

    We hypothesized that after sepsis in humans, MDSCs will be persistently increased, functionally immunosuppressive, and associated with adverse clinical outcomes. Cancer and sepsis have surprisingly similar immunologic responses and equally dismal long term consequences. In cancer, increased myeloid-derived suppressor cells (MDSCs) induce detrimental immunosuppression, but little is known about the role of MDSCs after sepsis. Blood was obtained from 74 patients within 12 hours of severe sepsis/septic shock (SS/SS), and at set intervals out to 28 days, and also in 18 healthy controls. MDSCs were phenotyped for cell surface receptor expression and enriched by cell sorting. Functional and genome-wide expression analyses were performed. Multiple logistic regression analysis was conducted to determine if increased MDSC appearance was associated with in-hospital and long-term outcomes. After SS/SS, CD33CD11bHLA-DR MDSCs were dramatically increased out to 28 days (P < 0.05). When co-cultured with MDSCs from SS/SS patients, antigen-driven T-cell proliferation and TH1/TH2 cytokine production were suppressed (P < 0.05). Additionally, septic MDSCs had suppressed HLA gene expression and up-regulated ARG1 expression (P < 0.05). Finally, SS/SS patients with persistent increased percentages of blood MDSCs had increased nosocomial infections, prolonged intensive care unit stays, and poor functional status at discharge (P < 0.05). After SS/SS in humans, circulating MDSCs are persistently increased, functionally immunosuppressive, and associated with adverse outcomes. This novel observation warrants further studies. As observed in cancer immunotherapy, MDSCs could be a novel component in multimodality immunotherapy targeting detrimental inflammation and immunosuppression after SS/SS to improve currently observed dismal long-term outcomes.

  5. Time Trends and Variations in Electroconvulsive Treatment in Denmark 2008 to 2014

    DEFF Research Database (Denmark)

    Hundrup, Eva; Osler, Merete; Jørgensen, Martin Balslev

    2017-01-01

    OBJECTIVE: The aim of this study was to determine status and variations in the practice of electroconvulsive treatment (ECT) in Denmark in patient characteristics, indications, treatment patterns, and hospital region. METHOD: All 140,627 ECTs registered in the Danish National Patient Registry...... the study period. The rate was highest in women and increased with age. There were modest, however, stable regional differences in rates (extremal quotient = 1.4). Electroconvulsive treatment was most commonly used in patients with depression with (19.4%) or without (54.9%) psychotic symptoms. The median...

  6. Electroconvulsive therapy in a man with comorbid severe obesity, binge eating disorder, and bipolar disorder.

    Science.gov (United States)

    Rapinesi, Chiara; Del Casale, Antonio; Serata, Daniele; Caccia, Federica; Di Pietro, Simone; Scatena, Paola; Carbonetti, Paolo; Fensore, Claudio; Angeletti, Gloria; Tatarelli, Roberto; Kotzalidis, Georgios D; Girardi, Paolo

    2013-06-01

    A 41-year-old man with comorbid binge-eating disorder, severe obesity, and bipolar disorder since the age of 20 years, resistant to drug and psychotherapy combinations, worsened progressively. Relentless weight gain forced him to immobility and dependence on others. He was hospitalized for a mixed-mood episode with anxiety, mystical delusions, and auditory hallucinations. To overcome treatment resistance, we suggested electroconvulsive therapy. After 1 electroconvulsive therapy cycle, psychological symptoms promptly improved. He received clozapine and lithium. After 2 years, he reached normal weight and fair psychopathological compensation.

  7. Electroconvulsive therapy for the treatment of organic catatonia due to viral encephalitis.

    Science.gov (United States)

    Shukla, Lekhansh; Narayanaswamy, Janardhanan C; Gopinath, Srinath; Math, Suresh Bada

    2012-09-01

    Catatonia is a common presentation to psychiatric services in developing countries. Medical causes of catatonia are common and are difficult to treat. A 20-year-old woman presented with an acute illness consisting of fever, delirium, perceptual abnormalities, and catatonic state. After trials with antiviral medications, benzodiazepines, and atypical antipsychotic medications, she was treated with 6 sessions of electroconvulsive therapy with complete recovery and no complications. Catatonia arising in the background of organic pathology can be treated on similar lines as in other psychiatric disorders. Electroconvulsive therapy can be a safe option that needs consideration in such cases after ruling out the contraindications.

  8. Electroconvulsive therapy, the placebo effect and informed consent.

    Science.gov (United States)

    Blease, Charlotte Rosalind

    2013-03-01

    Major depressive disorder is not only the most widespread mental disorder in the world, it is a disorder on the rise. In cases of particularly severe forms of depression, when all other treatment options have failed, the use of electroconvulsive therapy (ECT) is a recommended treatment option for patients. ECT has been in use in psychiatric practice for over 70 years and is now undergoing something of a restricted renaissance following a sharp decline in its use in the 1970s. Despite its success in treating severe depression there is continued debate as to the effectiveness of ECT: in some studies, it is argued that ECT is marginally more effective than sham ECT. In addition, there is still no clear explanation of how ECT works; among the range of hypotheses proposed it is claimed that ECT may work by harnessing placebo effects. In light of the uncertainties over the mechanism of action of ECT and given the risk of serious side effects that ECT may produce, I contend that the process of informed consent must include comprehensive accounts of these uncertainties. I examine the possible consequences of providing adequate information to potential ECT patients, including the consideration that ECT may still prove to be effective even if physicians are open about the possibility of it working as a placebo. I conclude that if we value patient autonomy as well as the professional reputation of medical practitioners, a fuller description of ECT must be provided to patients and their carers.

  9. Electroconvulsive therapy-induced ECG changes simulating a myocardial infarction.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C; Chandy, F; Kim, B

    1983-09-01

    Electroconvulsive therapy (ECT) can produce various cardiac arrhythmias; however, to our knowledge, no other alterations have been described in the ECG. A 75-year-old woman was admitted to the Methodist Hospital in Brooklyn, NY, because of depression. She had had no cardiac symptoms and had been in good health. She was not receiving any medications. Physical examination showed no abnormalities. Findings from the routine laboratory tests, a chest roentgenogram, and the initial ECG were normal. In view of the severe depression, a series of ECTs were given to the patient during a two-week period. A repeated ECG showed deep T-wave inversions in leads I, II, III, aVF, and V1 to V6. The patient was completely asymptomatic. Serial enzyme determinations were normal. A brain scan, gated-pool scan, computed tomography scan of the head, and a technetium Tc 99m pyrophosphate scan were all normal. Serial ECGs showed a persistence of the deep T-wave inversions. There were no QRS changes. There was no evidence of a cerebral vascular accident or pericarditis. The T-wave changes in our patient were not due to a myocardial infarction. Thus, ECT can produce striking T-wave abnormalities in the ECG that can simulate an acute myocardial infarction.

  10. Knowledge and attitudes of residents regarding electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    Gokay Alpak

    2015-02-01

    Full Text Available AIM: To determine the knowledge and attitudes of non-psychiatry residents about electroconvulsive therapy (ECT and additionally to make a comparison between residents of medical sciences and surgical sciences. METHODS: The study consisted of 176 medical school graduates in their residency training (119 medical sciences, 57 surgical sciences at a university hospital. All subjects are asked to fill a questionnaire prepared by the authors. RESULTS: Among all, 58 of the medical sciences residents (48.7%, and 32 of the surgical sciences residents (56.1% had reported that they have never observed any ECT session. There was no statistically significant difference between the residents of the two groups in terms of theirs attitudes towards ECT (p>0.05. The residents of surgical sciences differed from the others only in their response to the question that sought answer whether they would agree to have any of their relatives to undergo ECT. They more often disagreed to this statement (p=0.02. CONCLUSIONS: The knowledge and attitudes of residents in medical, and surgical sciences about ECT seemed to be similar. Despite their significant amount of knowledge about ECT the residents showed similar attitudes towards it with the patients and their caregivers that were previously reported in the literature. Additionally, the results also suggest that current training in medical schools need a revision that would eventually improve attitudes of medical graduates towards ECT. [TAF Prev Med Bull 2015; 14(1.000: 33-38

  11. Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report

    Directory of Open Access Journals (Sweden)

    Julio Cesar Lazaro

    2014-07-01

    Full Text Available Introduction Electroconvulsive therapy (ECT is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods Case report and literature review. Results A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. Conclusion The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks.

  12. Use of electroconvulsive therapy in the Baltic states.

    Science.gov (United States)

    Lõokene, Margus; Kisuro, Aigars; Mačiulis, Valentinas; Banaitis, Valdas; Ungvari, Gabor S; Gazdag, Gábor

    2014-07-01

    While the use of electroconvulsive therapy (ECT) has been investigated worldwide, nothing is known about its use in the Baltic states. The purpose of this study was thus to explore ECT practice in the three Baltic countries. A 21-item, semi-structured questionnaire was sent out to all psychiatric inpatient settings that provided ECT in 2010. In Lithuania, four services provided ECT in 2010. Only modified ECT with anaesthesia and muscle relaxation is performed in the country. In 2010, approximately 120 patients received ECT, i.e., 0.375 patients/10,000 population. Only two centres offer ECT in Latvia. The first centre treated only three patients with ECT in 2010, while the second centre six patients. In both centres outdated Soviet machines are used. The main indication for ECT was severe, malignant catatonia. ECT is practiced in five psychiatric facilities in Estonia. In 2010, it was used in the treatment of 362 patients (17% women) nationwide, i.e., 2.78 patients/10,000 population. Only a senior psychiatrist may indicate ECT in Estonia and pregnancy is no contraindication. In 2010, the main indication for ECT was schizophrenia (47.8%). This 2010 survey revealed significant differences in the use and availability of ECT between the Baltic countries.

  13. Multifactorial Determinants of the Neurocognitive Effects of Electroconvulsive Therapy

    Science.gov (United States)

    McClintock, Shawn M.; Choi, Jimmy; Deng, Zhi-De; Appelbaum, Lawrence G.; Krystal, Andrew D.; Lisanby, Sarah H.

    2014-01-01

    For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper is to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the utility of this important and widely used intervention tool for neuropsychiatric diseases. PMID:24820942

  14. General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy

    Science.gov (United States)

    Narayanan, Aravind; Lal, Chandar; Al-Sinawi, Hamed

    2017-01-01

    Objectives This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. Methods This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. Results A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). Conclusion All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined. PMID:28417028

  15. Electroconvulsive therapy use in adolescents: a systematic review

    Science.gov (United States)

    2013-01-01

    Background Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents. Methods Systematic review, performed in November 2012, conformed to the PRISMA statement. Results From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure. Conclusions ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies. PMID:23718899

  16. Rocuronium-Sugammadex in Anesthesia for Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    Nilay Tas

    2016-03-01

    Full Text Available Electroconvulsive therapy (ECT is a form of treatment which is very effective in many psychiatric disorders. The administration of anesthesia plays a positive role in the success of ECT and improves the oxygenation of the body during the process. Succinylcholine, is a depolarizing neuromuscular blocker of choice, the most common agent used to provide muscular relaxation during ECT. Alternative neuromusculer blokers have been used during anesthesia because of contraindications and serious side effects of succinylcholine. Rocuronium is a nondepolarizing neuromuscular blocker with inter-mediate time of action which may be used safely during ECT. Although relatively late onset of action and long half life compared to succinylcholine may seem as drawbacks, the new generation reversing agents like suggamadex have made these disadvantages ignorable. Sugammadex, a new generation neuromuscular blocker reversal agent, not having serious side effects as much as the classic reversals, such as cardiovascular side effects, is playing an important role in anesthesiology practice. In recent years, rocuronium-sugammadex combination is being included in the ECT practice extensively. In this paper, the usability of rocuronium-sugammadex combination as an alternative to succinylcholine has been revised. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(1: 76-84

  17. Mental Health Care Bill 2013: The Place of Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    Bangalore N Gangadhar

    2015-01-01

    Full Text Available Electroconvulsive therapy (ECT is one of the oldest medical treatments in psychiatry. The practice has evolved over the years, and the indications have become better defined now. Notwithstanding these, it remains a highly regulated and scrutinized practice. Indian laws specifically related to ECT do not exist till date though this would change if the purported mental health care bill 2013 becomes the law of the land. ECT gets both direct and indirect mention at various places in the bill with far-reaching consequences impacting patients, families, and the professionals. Ban on “ECT as an emergency treatment option” and on “unmodified ECT” is being sought. In addition, ECT in minors is slated to come under stricter regulation. ECT could also get implicated under the “advance directives” provisions of the bill. This naturally has triggered vociferous debates throughout the country between the supporters as well as detractors of ECT. A number of ethical, professional, logistic, and clinical concerns are being discussed. In this background, we attempt to critically evaluate the bill with regard to ECT in the background of the existent scientific and legal literature. We provide possible future directions with regard to ECT practice and its regulation.

  18. [Assessment of individual clinical outcomes: regarding an electroconvulsive therapy case].

    Science.gov (United States)

    Iraurgi, Ioseba; Gorbeña, Susana; Martínez-Cubillos, Miren-Itxaso; Escribano, Margarita; Gómez-de-Maintenant, Pablo

    2015-01-01

    Evaluation of therapeutic results and of the efficacy and effectiveness of treatments is an area of interest both for clinicians and researchers. In general, randomized controlled trial designs have been used as the methodology of choice in which intergroup comparisons are made having a minimum of participants in each arm of treatment. However, these procedures are seldom used in daily clinical practice. Despite this fact, the evaluation of treatment results for a specific patient is important for the clinician in order to address if therapeutic goals have been accomplished both in terms of statistical significance and clinical meaningfulness. The methodology based on the reliable change index (Jacobson y Truax)1 provides an estimate of these two criteria. The goal of this article is to propose a procedure to apply the methodology with a single case study of a woman diagnosed with major depression and treated with electroconvulsive therapy. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  19. Electroconvulsive Therapy In Neuropsychiatry : Relevance Of Seizure Parameters

    Directory of Open Access Journals (Sweden)

    Gangadhar BN

    2000-01-01

    Full Text Available Electroconvulsive therapy (ECT is used to induce therapeutic seizures in various clinical conditions. It is specifically useful in depression, catatonia, patients with high suicidal risk, and those intolerant to drugs. Its beneficial effects surpass its side effects. Memory impairment is benign and transient. Its mechanism of action is unknown, though numerous neurotransmitters and neuroreceptors have been implicated. The standards of ECT practice are well established but still evolving in some particularly in unilateral ECT. Assessment of threshold by formula method may deliver higher stimulus dose compared with titration method. Cerebral seizure during ECT procedure is necessary. Motor (cuff method and EEG seizure monitoring are mandatory. Recent studies have shown some EEG parameters (amplitude, fractal dimension, symmetry, and post ictal suppression to be associated with therapeutic outcome. Besides seizure monitoring, measuring other physiological parameters such as heart rate (HR and blood pressure (BP may be useful indicators of therapeutic response. Use of ECT in neurological conditions as well as its application in psychiatric illnesses associated with neurological disorders has also been reviewed briefly.

  20. Mouse repeated electroconvulsive seizure (ECS) does not reverse social stress effects but does induce behavioral and hippocampal changes relevant to electroconvulsive therapy (ECT) side-effects in the treatment of depression

    Science.gov (United States)

    Sigrist, Hannes; Seifritz, Erich; Fikse, Lianne; Bosker, Fokko J.; Schoevers, Robert A.; Klein, Hans C.

    2017-01-01

    Electroconvulsive therapy (ECT) is an effective treatment for depression, but can have negative side effects including amnesia. The mechanisms of action underlying both the antidepressant and side effects of ECT are not well understood. An equivalent manipulation that is conducted in experimental animals is electroconvulsive seizure (ECS). Rodent studies have provided valuable insights into potential mechanisms underlying the antidepressant and side effects of ECT. However, relatively few studies have investigated the effects of ECS in animal models with a depression-relevant manipulation such as chronic stress. In the present study, mice were first exposed to chronic social stress (CSS) or a control procedure for 15 days followed by ECS or a sham procedure for 10 days. Behavioral effects were investigated using an auditory fear conditioning (learning) and expression (memory) test and a treadmill-running fatigue test. Thereafter, immunohistochemistry was conducted on brain material using the microglial marker Iba-1 and the cholinergic fibre marker ChAT. CSS did not increase fear learning and memory in the present experimental design; in both the control and CSS mice ECS reduced fear learning and fear memory expression. CSS induced the expected fatigue-like effect in the treadmill-running test; ECS induced increased fatigue in CSS and control mice. In CSS and control mice ECS induced inflammation in hippocampus in terms of increased expression of Iba-1 in radiatum of CA1 and CA3. CSS and ECS both reduced acetylcholine function in hippocampus as indicated by decreased expression of ChAT in several hippocampal sub-regions. Therefore, CSS increased fatigue and reduced hippocampal ChAT activity and, rather than reversing these effects, a repeated ECS regimen resulted in impaired fear learning-memory, increased fatigue, increased hippocampal Iba-1 expression, and decreased hippocampal ChAT expression. As such, the current model does not provide insights into the

  1. No loss of hippocampal hilar somatostatinergic neurons after repeated electroconvulsive shock

    DEFF Research Database (Denmark)

    Dalby, Nils Ole; Tønder, N; Wolby, D P;

    1996-01-01

    Electrically induced seizures with anesthesia and muscle relaxation (ECT) is commonly used in the therapy of psychotic depression in humans. Unmodified electroshock (ECS) is used as a model for epilepsy in the rat. In several seizure models of epilepsy, in particular the dentate hilar somatostatin...

  2. Study of effects of donepezil and aspirin on working memory in rats using electroconvulsive shock model

    Directory of Open Access Journals (Sweden)

    Rahul M. Manjare

    2014-12-01

    Conclusion: Neuroinflammation plays an important role in the pathophysiology of neurodegenerative disorder like AD. Combination of aspirin with donepezil increased the nootropic and neuroprotective effect of aspirin and thus may hold great clinical significance in such disorders. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1012-1015

  3. Successful and rapid response to electroconvulsive therapy of a suicidal patient with comorbid bipolar I disorder and histrionic personality disorder.

    Science.gov (United States)

    Rapinesi, Chiara; Serata, Daniele; Del Casale, Antonio; Simonetti, Alessio; Milioni, Mara; Mazzarini, Lorenzo; Scatena, Paola; Fensore, Claudio; Carbonetti, Paolo; Kotzalidis, Giorgio D; Tatarelli, Roberto; Pompili, Maurizio; Girardi, Paolo

    2012-03-01

    A woman with bipolar disorder I, histrionic personality disorder, and suicidal ideation with repeated suicide attempts, who had been treated for 2 years with mood stabilizers, antipsychotics, and benzodiazepines, received a total of 8 bitemporal-biparietal electroconvulsive therapy sessions. Her suicidal ideation and self-harm behavior disappeared immediately after the first session and her psychopathology soon after. This supports the existence of a relatively independent suicidal syndrome and confirms data on its immediate responsiveness to electroconvulsive therapy. Electroconvulsive therapy must not be long withheld from patients with such characteristics to reduce unnecessary sufferance and suicidality.

  4. Hypovolemic shock

    Science.gov (United States)

    ... thready Tests that may be done include: Blood chemistry, including kidney function tests and those tests looking ... severe shock. Severe hypovolemic shock may lead to death, even with immediate medical attention. Older adults are ...

  5. An electroconvulsive therapy procedure impairs reconsolidation of episodic memories in humans

    NARCIS (Netherlands)

    Kroes, M.C.W.; Tendolkar, I.; Wingen, G.A. van; Waarde, J.A. van; Strange, B.A.; Fernandez, G.S.E.

    2014-01-01

    Despite accumulating evidence for a reconsolidation process in animals, support in humans, especially for episodic memory, is limited. Using a within-subjects manipulation, we found that a single application of electroconvulsive therapy following memory reactivation in patients with unipolar depress

  6. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis.

    LENUS (Irish Health Repository)

    Semkovska, Maria

    2010-09-15

    Electroconvulsive therapy (ECT) is the most acutely effective treatment for depression, but is limited by cognitive side effects. However, research on their persistence, severity, and pattern is inconsistent. We aimed to quantify ECT-associated cognitive changes, specify their pattern, and determine progression.

  7. Methohexitone, propofol and etomidate in electroconvulsive therapy for depression: a naturalistic comparison study.

    LENUS (Irish Health Repository)

    Eranti, Savithasri V

    2009-02-01

    Methohexitone has been the most widely used anaesthetic for electroconvulsive therapy (ECT). However, recent scarcity and erratic availability has led to use of other anaesthetics with differing effects upon ECT. We compared treatment parameters and response to ECT in patients anaesthetised with different anaesthetics in a routine clinical setting.

  8. Electroconvulsive therapy increases hippocampal and amygdala volume in therapy refractory depression : A longitudinal pilot study

    NARCIS (Netherlands)

    Tendolkar, Indira; van Beek, Marleen; van Oostrom, Iris; Mulder, Marlies; Janzing, Joost; Voshaar, Richard Oude; van Eijndhoven, Philip

    2013-01-01

    Electroconvulsive therapy (ECT) is the most potent biological therapy in depression. Animal studies suggest that ECT acts via neuroplasticity effects on limbic structures involved in the pathophysiology of depression but in vivo evidence at the human system level is scarce. Therefore, the aim of the

  9. Electroconvulsive therapy: predictors and trends in utilization from 1976 to 2000

    DEFF Research Database (Denmark)

    Munk-Olsen, Trine; Laursen, Thomas Munk; Videbech, Poul

    2006-01-01

    BACKGROUND: Use of electroconvulsive therapy (ECT) may have changed during the last decades due to advances in psychopharmacology and organizational changes of psychiatric care. OBJECTIVES: To identify predictors for receiving ECT for the first time and to describe temporal trends in ECT...

  10. Elevated dopamine D1 receptor availability in striatum of Göttingen minipigs after electroconvulsive therapy

    DEFF Research Database (Denmark)

    Landau, Anne M; Alstrup, Aage Ko; Audrain, Helene

    2017-01-01

    Electroconvulsive therapy (ECT), a direct form of brain stimulation, is an effective antidepressant. We hypothesized that the beneficial effects of ECT are mediated by increased dopaminergic neurotransmission, in which the baseline activity of D1 receptors may predict the response to ECT. We...

  11. Brief Report: Electroconvulsive Therapy for Malignant Catatonia in an Autistic Adolescent

    Science.gov (United States)

    Wachtel, Lee Elizabeth; Griffin, Margaret Merrie; Dhossche, Dirk Marcel; Reti, Irving Michael

    2010-01-01

    A 14-year-old male with autism and mild mental retardation developed malignant catatonia characterized by classic symptoms of catatonia, bradycardia and hypothermia. Bilateral electroconvulsive therapy and lorazepam were required for resolution. The case expands the occurrence of catatonia in autism into its malignant variant.

  12. Electroconvulsive therapy increases hippocampal and amygdala volume in therapy refractory depression : A longitudinal pilot study

    NARCIS (Netherlands)

    Tendolkar, Indira; van Beek, Marleen; van Oostrom, Iris; Mulder, Marlies; Janzing, Joost; Voshaar, Richard Oude; van Eijndhoven, Philip

    2013-01-01

    Electroconvulsive therapy (ECT) is the most potent biological therapy in depression. Animal studies suggest that ECT acts via neuroplasticity effects on limbic structures involved in the pathophysiology of depression but in vivo evidence at the human system level is scarce. Therefore, the aim of the

  13. Electroconvulsive Therapy as a Powerful Treatment for Delirium A Case Report

    NARCIS (Netherlands)

    van den Berg, Karen S.; Marijnissen, Radboud M.; van Waarde, Jeroen A.

    Objective The aim of the study was to describe the successful treatment of delirium with electroconvulsive therapy (ECT). Methods The method of the study was a case report. Results A 75-year-old man, with a recently diagnosed carcinoma of the parotid gland, was admitted with a fluctuating

  14. Brief Report: Electroconvulsive Therapy for Malignant Catatonia in an Autistic Adolescent

    Science.gov (United States)

    Wachtel, Lee Elizabeth; Griffin, Margaret Merrie; Dhossche, Dirk Marcel; Reti, Irving Michael

    2010-01-01

    A 14-year-old male with autism and mild mental retardation developed malignant catatonia characterized by classic symptoms of catatonia, bradycardia and hypothermia. Bilateral electroconvulsive therapy and lorazepam were required for resolution. The case expands the occurrence of catatonia in autism into its malignant variant.

  15. Epigenetic regulation of Dnmt3a> and Arc gene expression after electroconvulsive stimulation in the rat

    DEFF Research Database (Denmark)

    Dyrvig, Mads; Gøtzsche, Casper René; Woldbye, David P. D.

    2015-01-01

    Electroconvulsive therapy (ECT) remains one of the most effective treatments of major depression. Unfortunately, some patients report side effects, of which the most prominent are memory deficits. The immediate early gene Arc plays a critical role in the maintenance phase of long-term potentiatio...

  16. Efficacy of Electroconvulsive Therapy for Comorbid Frontotemporal Dementia with Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Sean Paul

    2013-01-01

    Full Text Available Challenges encountered in the diagnosis and treatment of frontotemporal dementia (FTD are further confounded when presented with comorbid psychiatric disorder. Here we report a case of progressive FTD in a patient with a long history of bipolar affective disorder (BAD 1, depressed type. We also report beneficial effects of electroconvulsive therapy and its potential application in similar comorbid disorders.

  17. Unaltered Neuronal and Glial Counts in Animal Models of Magnetic Seizure Therapy and Electroconvulsive Therapy

    DEFF Research Database (Denmark)

    Dwork, A.J.; Christensen, J.R.; Larsen, K.B.

    2009-01-01

    Anatomical evidence of brain damage from electroconvulsive therapy (ECT) is lacking; but there are no modern stereological studies in primates documenting its safety. Magnetic seizure therapy (MST) is under development as a less invasive form of convulsive therapy, and there is only one prior...

  18. Neuropsychological effects and attitudes in patients following electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    Miriam Feliu

    2008-06-01

    Full Text Available Miriam Feliu1,2, Christopher L Edwards1,2,3, Shiv Sudhakar4, Camela McDougald1, Renee Raynor5, Stephanie Johnson6, Goldie Byrd7, Keith Whitfield8, Charles Jonassaint8, Heather Romero1, Lekisha Edwards1, Chante’ Wellington1, LaBarron K Hill9, James Sollers, III9, Patrick E Logue11Department of Psychiatry and Behavioral Sciences; 2Duke Pain and Palliative Care Center; 3Department of Medicine, Division of Hematology; 4Drexel University Medical School; 5Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; 6Science Directorate, American Psychological Association; 7Department of Biology, North Carolina A&T State University; 8Department of Psychology, Duke University; 9Department of Psychology, The Ohio State UniversityAbstract: The current study examined the effects of electroconvulsive therapy (ECT on neuropsychological test performance. Forty-six patients completed brief neuropsychological and psychological testing before and after receiving ECT for the treatment of recalcitrant and severe depression. Neuropsychological testing consisted of the Levin Selective Reminding Test (Levin and Wechsler Memory Scale-Revised Edition (WMS-R. Self-report measures included the Beck Depression Inventory (BDI, the Short-Term Memory Questionnaire (STMQ, and several other measures of emotional functioning and patient attitudes toward ECT. The mean number of days between pre-ECT and post-ECT testing was 24. T-test revealed a significant decrease in subjective ratings of depression as rated by the BDI, t(45 = 9.82, P < 0.0001 (Pre-BDI = 27.9 ± 20.2; post-BDI = 13.5 ± 9.7. Objective ratings of memory appeared impaired following treatment, and patients’ self-report measures of memory confirmed this decline. More specifically, repeated measures MANOVA [Wilks Lambda F(11,30 = 4.3, p < 0.001] indicated significant decreases for measures of immediate recognition memory (p < 0.005, long-term storage (p < 0.05, delayed prose passage recall (p < 0

  19. Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy

    Science.gov (United States)

    Şenyurt, Mahmut; Aybek, Hulya; Herken, Hasan; Kaptanoglu, Bunyamin; Korkmaz, Ali

    2017-01-01

    Objective Electroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress. Methods Fourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs. Results TOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006). Conclusion As a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed. PMID:28138109

  20. Contemporary use and practice of electroconvulsive therapy worldwide

    Science.gov (United States)

    Leiknes, Kari Ann; Jarosh-von Schweder, Lindy; Høie, Bjørg

    2012-01-01

    To explore contemporary (from 1990) utilization and practice of electroconvulsive therapy (ECT) worldwide. Systematic search (limited to studies published 1990 and after) was undertaken in the databases Medline, Embase, PsycINFO, SveMed, and EBSCO/Cinahl. Primary data-based studies/surveys with reported ECT utilization and practice in psychiatric institutions internationally, nationally, and regionally; city were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria, and extracted ECT utilization and practice data from those retrieved in full text. Seventy studies were included, seven from Australia and New Zealand, three Africa, 12 North and Latin America, 33 Europe, and 15 Asia. Worldwide ECT differences and trends were evident, average number ECTs administered per patient were eight; unmodified (without anesthesia) was used in Asia (over 90%), Africa, Latin America, Russia, Turkey, Spain. Worldwide preferred electrode placement was bilateral, except unilateral at some places (Europe and Australia/New Zealand). Although mainstream was brief-pulse wave, sine-wave devices were still used. Majority ECT treated were older women with depression in Western countries, versus younger men with schizophrenia in Asian countries. ECT under involuntary conditions (admissions), use of ambulatory-ECT, acute first line of treatment, as well as administered by other professions (geriatricians, nurses) were noted by some sites. General trends were only some institutions within the same country providing ECT, training inadequate, and guidelines not followed. Mandatory reporting and overall country ECT register data were sparse. Many patients are still treated with unmodified ECT today. Large global variation in ECT utilization, administration, and practice advocates a need for worldwide sharing of knowledge about ECT, reflection, and learning from each other's experiences. PMID:22741102

  1. ELECTROCONVULSIVE THERAPY AMONG ADOLESCENT PSYCHIATRIC PATIENTS- A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Lakshimi Borgohain

    2017-05-01

    Full Text Available BACKGROUND Electroconvulsive Therapy (ECT among adolescent psychiatric patient is rarely used and studies in this regard are also rare, while its need is of great importance. Aim of this study was to study the prevalence of ECT in common psychiatric illnesses among adolescent age group, where it is indicated and outcome of ECT in those psychiatric patients. MATERIALS AND METHODS All data were collected retrospectively from the chart review for those adolescents aged between 12 to 18 years who received ECT during the period of 2008 - 2012. During the study period a total of 554 patients received ECT, among whom 104 were adolescents. RESULTS Adolescent patients were 18.77% in the whole ECT sample; the average age of the adolescents was 16.33 years and number of patients were more with older age. Among all the patients, 48.08% had positive family history of mental illness and 81.73% were from lower Socioeconomic Class. The use of ECT was more with schizophrenia (n= 63, 60.57% and acute and transient psychotic disorder (n= 30, 28.85%. The most common indication was agitation and aggression (n= 29, 27.88% followed by poor medication response (n= 19, 18.27%. Good response is found in most of the cases (n= 88, 84.62%, only a few percentage of cases showed minor and transient adverse event. CONCLUSION The result of our study suggests that prevalence of ECT among adolescent psychiatric patients is quite high and ECT is a safe and effective method of treatment in the adolescent psychiatric patients, especially those patients who are severely ill and poorly responding to medication.

  2. Knowledge and Attitude of Nursing Students toward Electroconvulsive Therapy

    Science.gov (United States)

    Sharma, Nitasha; Ghai, Sandhya; Grover, Sandeep

    2017-01-01

    Background: Electroconvulsive therapy (ECT) is one of the commonly used treatment modalities for patients with severe mental disorders. However, acceptance of ECT by the patient and relatives often depends on how the health-care professionals themselves present the treatment modality to the patients and their relatives. There is a lack of information about the knowledge and attitude toward ECT among health professionals. Aim: This study aimed to evaluate the knowledge about and attitude toward ECT among nursing students. Methodology: Knowledge of and attitudes toward ECT among nursing students were assessed using ECT knowledge and attitude questionnaires. Results: The study included 183 nursing students. Majority (n = 62; 60.8%) of the participants obtained information about ECT from media (movies, television, print media, etc.). None of the students had full knowledge about ECT. Although a significant proportion of students had knowledge about the ECT procedure and consent procedure, majority of them had poor knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitudes were also highly prevalent, with more than two-thirds of the participants having negative attitudes toward ECT on more than half of the attitude items of the scale. Total knowledge score positively correlated with total attitude score, suggesting that higher knowledge was associated with more positive attitude. Conclusions: Although nursing students have knowledge about basic ECT procedure and consent, they lack knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitude toward ECT is also highly prevalent among nursing students. Accordingly, there is a need to improve the knowledge and address the negative attitude of nursing students, which may ultimately lead to better acceptance of the treatment. PMID:28936064

  3. Informed consent for special procedures: electroconvulsive therapy and psychosurgery.

    Science.gov (United States)

    Beloucif, Sadek

    2013-04-01

    Informed consent has become the cornerstone of the expression of patient's autonomy for ethical and sound patient-physician relationships. However, some severe psychiatric diseases markedly hinder the ability of selected patients to ensure a proper consent. Confronted with mentally disabled individuals whose condition may lead to violence or inflicting it on others, society must carry out its duty of protecting those who are particularly vulnerable, while respecting and protecting these disabled individuals. The recent update in the indications and more detailed understanding of electroconvulsive therapy, and the technical ability of obtaining less invasive or reversible techniques of psychosurgery, has renewed interest in these impressive and efficient techniques. Specifically, the emergence of new and promising cerebral neurostimulation techniques for treating Parkinson's disease have led to considering their extension to severe psychiatric disorders. This method can mimic the effects of 'conventional' psychosurgery, but in a potentially reversible and adaptable way, thus avoiding many undesirable side-effects of lesional surgery. Ensuring an ethical decision-making process and the appropriateness of consent becomes of paramount importance. Consent can be relatively easy to secure in selected patients who are often fully aware of their torments (such as those suffering from severe refractory depression of obsessive-compulsive disorders) whose suffering may be such that they are ready to accept, or for that matter demand, such actions. However, the duty of physicians is to realize that pains should always be taken to do as much good (and as little harm) as possible, while respecting the freedom of decision of those who seek to help.

  4. Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?

    Science.gov (United States)

    Gough, Jessica L; Coebergh, Jan; Chandra, Brunda; Nilforooshan, Ramin

    2016-01-01

    Autoimmune encephalitis is a poorly understood condition that can present with a combination of neurological and psychiatric symptoms, either of which may predominate. There are many autoantibodies associated with a variety of clinical syndromes - anti-N-Methyl-D-Aspartate receptor (NMDAR) is the commonest. Currently, the most widely used therapy is prompt plasmapheresis and steroid treatment (and tumour resection if indicated), followed by second line immunosuppression if this fails. Given the growing awareness of autoimmune encephalitis as an entity, it is increasingly important that we consider it as a potential diagnosis in order to provide timely, effective treatment. We discuss several previously published case reports and one new case. These reports examined the effects of electroconvulsive therapy (ECT) on patients with autoimmune encephalitis, particularly those in whom psychiatric symptoms are especially debilitating and refractory to standard treatment. We also discuss factors predicting good outcome and possible mechanisms by which ECT may be effective. Numerous cases, such as those presented by Wingfield, Tsutsui, Florance, Sansing, Braakman and Matsumoto, demonstrate effective use of ECT in anti-NMDAR encephalitis patients with severe psychiatric symptoms such as catatonia, psychosis, narcolepsy and stupor who had failed to respond to standard treatments alone. We also present a new case of a 71-year-old female who presented to a psychiatric unit initially with depression, which escalated to catatonia, delusions, nihilism and auditory hallucinations. After anti-NMDAR antibodies were isolated, she was treated by the neurology team with plasmapheresis and steroids, with a partial response. She received multiple sessions of ECT and her psychiatric symptoms completely resolved and she returned to her premorbid state. For this reason, we suggest that ECT should be considered, particularly in those patients who are non-responders to standard therapies. PMID

  5. Eletroconvulsoterapia na depressão maior: aspectos atuais Electroconvulsive therapy in major depression: current aspects

    Directory of Open Access Journals (Sweden)

    Paula Barros Antunes

    2009-05-01

    Full Text Available OBJETIVO: A eficácia da eletroconvulsoterapia em tratar sintomas depressivos está estabelecida por meio de inúmeros estudos desenvolvidos durante as últimas décadas. A eletroconvulsoterapia é o tratamento biológico mais efetivo para depressão atualmente disponível. O objetivo deste estudo foi demonstrar o papel da eletroconvulsoterapia no tratamento da depressão e destacar aspectos atuais relativos à sua prática. MÉTODO: Foram revisados na literatura estudos de eficácia, remissão de sintomas, fatores preditores de resposta, assim como aspectos atuais acerca da qualidade de vida, percepção dos pacientes, mecanismo de ação, técnica e prejuízo cognitivos. RESULTADOS: Os principais achados desta revisão foram: 1 a eletroconvulsoterapia é mais efetiva do que qualquer medicação antidepressiva; 2 a remissão da depressão com a eletroconvulsoterapia varia, em geral, de 50 a 80%; 3 Ainda é controverso o efeito da eletroconvulsoterapia nos níveis de fator neurotrófico derivado do cérebro (acho que aqui pode colocar entre parenteses o "BNDF"; 4 a eletroconvulsoterapia tem efeito positivo na melhora da qualidade de vida; 5 os pacientes submetidos à eletroconvulsoterapia, em geral, têm uma percepção positiva do tratamento. CONCLUSÃO: A eletroconvulsoterapia permanece sendo um tratamento altamente eficaz em pacientes com depressão resistente. Com o avanço da sua técnica, a eletroconvulsoterapia tornou-se um procedimento ainda mais seguro e útil tanto para a fase aguda, quanto para a prevenção de novos episódios depressivos.OBJECTIVE: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and

  6. Chronic fatigue syndrome: acute infection and history of physical activity affect resting levels and response to exercise of plasma oxidant/antioxidant status and heat shock proteins.

    Science.gov (United States)

    Jammes, Y; Steinberg, J G; Delliaux, S

    2012-07-01

    A history of high-level physical activity and/or acute infection might constitute stress factors affecting the plasma oxidant-antioxidant status and levels of heat shock proteins (HSPs) in patients with chronic fatigue syndrome (CFS). This case-control study compared data from 43 CFS patients to results from a matched control group of 23 healthy sedentary subjects. Five patients had no relevant previous history (group I). Eighteen had practised high-level sport (group II), and severe acute infection had been diagnosed in nine patients (group III). A combination of sport practice and infection was noted in 11 patients (group IV). After examination at rest, all subjects performed a maximal cycling exercise test. Plasma levels of two markers of oxidative stress [thiobarbituric acid reactive substances (TBARS) and reduced ascorbic acid (RAA)] and both HSP27 and HSP70 were measured. At rest, compared with the control group, the TBARS level was higher in groups II, III and IV patients, and the RAA level was lower in groups III and IV. In addition, HSP70 levels were significantly lower in all CFS groups, compared with controls, but negative correlations were found between resting HSP27 and HSP70 levels and the history of physical activity. After exercise, the peak level of TBARS significantly increased in groups II, III and IV, and the variations in HSP27 and HSP70 were attenuated or suppressed, with the greatest effects in groups III and IV. The presence of stress factors in the history of CFS patients is associated with severe oxidative stress and the suppression of protective HSP27 and HSP70 responses to exercise. © 2011 The Association for the Publication of the Journal of Internal Medicine.

  7. Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial.

    Science.gov (United States)

    Li, Tsung-Ying; Chang, Chih-Ya; Chou, Yu-Ching; Chen, Liang-Cheng; Chu, Heng-Yi; Chiang, Shang-Lin; Chang, Shin-Tsu; Wu, Yung-Tsan

    2016-05-01

    Recently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.

  8. Heat Shock Proteins 60 and 70 Specific Proinflammatory and Cytotoxic Response of CD4+CD28null Cells in Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Ashok K. Yadav

    2013-01-01

    Full Text Available Background. CD4+CD28null T cells are expanded in peripheral blood of patients with chronic kidney disease and associated with subclinical atherosclerosis. However, triggers for the oligoclonal expansion and activation of these cells are not clear. Methods. We investigated twenty-five stage V-IV chronic kidney disease (CKD patients and eight healthy subjects (HC. Peripheral mononuclear cells were isolated and incubated with heat shock protein- (HSP 60 and 70. CD4+CD28null and CD4+CD28+ cells were sorted by flowcytometry and antigen specific response was assessed by the mRNA and protein expression of interferon (IFN-γ, perforin, and granzyme B using qRT-PCR and Elispot. Results. The basal mRNA expression of IFN-γ, perforin, and granzyme B in CD4+CD28null cells was higher in subjects with CKD compared to that in HC (P<0.0001. Subjects with CKD also showed expression of IFN-γ, perforin, and granzyme B in the CD4+CD28+ subset, but this was much weaker than that seen in the CD4+CD28null population (P<0.0001. We did not note the expression of these molecules at mRNA or protein level in either subset of CD4 cells in HC. After incubation with HSP60 and HSP70, CD4+CD28null cells showed increased expression at mRNA (P<0.001 and protein level (P<0.001. CD4+CD28+ cells also showed a weak increase in expression. No antigen-specific response was noted in HC. Conclusion. These data show that CD4+CD28null cells in subjects with CKD react with HSP60 and HSP70 by upregulating the expression of IFN-γ, perforin and granzyme B. Increased circulating level of HSP60 and HSP70 might play a role in initiation and/or progression of atherosclerosis in CKD subjects through perturbation of CD4+CD28null cells.

  9. Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results

    Directory of Open Access Journals (Sweden)

    Iancu I

    2015-03-01

    chronically hospitalized patients. It improves general functioning and reduces verbal aggression and self-harm. More research using other aggression tools is needed to determine its effects and to reproduce our findings in prospective and controlled studies. Keywords: electroconvulsive therapy, schizophrenia, maintenance, multiple sessions 

  10. The effect of electroconvulsive therapy on executive functioning in a treatment-resistant man with depression: a case report.

    Science.gov (United States)

    Getz, Glen E; Edner, Benjamin J; Nickell, P V

    2014-03-01

    This case examines the executive functioning in a 42-year-old married white man before receiving and after an index course of electroconvulsive therapy for 4 weeks using right unilateral lead placement. Results indicate clear cognitive improvements on objective measures of executive functioning, attention, and memory after electroconvulsive therapy. However, the patient expressed continued elevated impairments on the subjective questionnaire examining behaviors thought to be controlled by executive functioning.

  11. [Cardiogenic shock].

    Science.gov (United States)

    Houegnifioh, Komlanvi Kafui; Gfeller, Etienne; Garcia, Wenceslao; Ribordy, Vincent

    2014-08-13

    Cardiogenic shock, especially when it complicates a myocardial infarction, is still associated with high mortality rate. Emergency department or first care physicians are often the first providers to assess the cardiogenic shock patient, and plays thereby a key role in achieving a timely diagnosis and treatment. This review will detail the actual physiopathology understanding of the cardiogenic shock, its diagnosis and management focusing on the care within the emergency department.

  12. Reentry Shock

    Institute of Scientific and Technical Information of China (English)

    Dorine; Houston

    1998-01-01

    Dear Xiao Lan, You remember the pain of culture and reentry shock; humor me please; let mereview the facts for the sake of the students you are sending here in greater numbers.Culture shock is the emotional pain that people experience when they visit a newcountry and find customs, experiences, smells, and non-verbal communication stylesto be different from their own country.

  13. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: short review of the pathophysiology and diagnostic approach.

    Science.gov (United States)

    Manne, Janaki R; Kasirye, Yusuf; Epperla, Narendranath; Garcia-Montilla, Romel J

    2012-08-01

    Acute pulmonary edema complicating electroconvulsive therapy is an extremely uncommon event that has rarely been described in the literature. Different theories, including one suggesting a cardiogenic component, have been proposed to explain its genesis. The present report describes a classic presentation of this condition with review of its potential mechanisms and diagnostic approach. After successful completion of a session of electroconvulsive therapy, a 42-year-old woman with major depressive disorder developed acute systemic high blood pressure, shortness of breath, and hemoptysis. A chest radiograph demonstrated diffuse bilateral pulmonary infiltrates. Initially cardiogenic pulmonary edema was presumed, but an extensive diagnostic work-up demonstrated normal systolic and diastolic left ventricular function, and with only supportive measures, a complete clinical and radiographic recovery was achieved within 48 hours. The present case does not support any cardiogenic mechanism in the genesis of this condition.

  14. Electroconvulsive stimulation results in long-term survival of newly generated hippocampal neurons in rats

    DEFF Research Database (Denmark)

    Olesen, Mikkel Vestergaard; Wörtwein, Gitta; Folke, Jonas

    2017-01-01

    Electroconvulsive stimulation (ECS) is one of the strongest stimulators of hippocampal neurogenesis in rodents that represents a plausible mechanism for the efficacy of electroconvulsive therapy (ECT) in major depressive disorder. Using design-based stereological cell counting, we recently...... documented an initial 2.6-fold increase in neurogenesis following a clinical relevant schedule of ECS, a treatment also rescuing depression-like behavior in rats. However, these results gave no demonstration of the longevity of newly generated neurons. The present study is a direct continuation...... in neurogenesis facilitates the behavioral outcome of the forced swim test (FST), an animal model of depression. The results showed that ECS in conjunction with CRS stimulates hippocampal neurogenesis, and that a significant quantity of the newly formed hippocampal neurons survives up to 12 months. The new Brd...

  15. Electroconvulsive Therapy as a Powerful Treatment for Delirium: A Case Report.

    Science.gov (United States)

    van den Berg, Karen S; Marijnissen, Radboud M; van Waarde, Jeroen A

    2016-03-01

    The aim of the study was to describe the successful treatment of delirium with electroconvulsive therapy (ECT). The method of the study was a case report. A 75-year-old man, with a recently diagnosed carcinoma of the parotid gland, was admitted with a fluctuating psychiatric syndrome. Delirium was diagnosed, although an acute underlying somatic cause could not be readily established. Antipsychotics and benzodiazepines were not effective. After 7 sessions of ECT, all symptoms ceased. This enabled him to receive radiotherapy for his tumor and enjoy a good quality of life for the remaining 8 months of his life. Electroconvulsive therapy is not only a powerful treatment for catatonia, neuroleptic malignant syndrome, and delirious mania but also for the most commonly occurring fluctuating psychiatric syndrome--delirium.

  16. Is electroconvulsive therapy effective as augmentation in clozapine-resistant schizophrenia?

    Science.gov (United States)

    Kittsteiner Manubens, Lucas; Lobos Urbina, Diego; Aceituno, David

    2016-10-14

    Clozapine is considered to be the most effective antipsychotic drug for patients with treatment resistant schizophrenia, but up to a third of the patients do not respond to this treatment. Various strategies have been tried to augment the effect of clozapine in non-responders, one of these strategies being electroconvulsive therapy. However, its efficacy and safety are not yet clear. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including 55 studies, among them six randomized controlled trials addressing clozapine-resistant schizophrenia. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded electroconvulsive therapy probably augments response to clozapine in patients with treatment resistant schizophrenia, but it is not possible to determine if it leads to cognitive adverse effects because the certainty of the evidence is very low.

  17. Hypocapnia and hyperoxia induction using a hyperventilation protocol in electroconvulsive therapy.

    Science.gov (United States)

    de Arriba-Arnau, Aida; Dalmau, Antonia; Salvat-Pujol, Neus; Soria, Virginia; Bocos, Javier; Menchón, José Manuel; Urretavizcaya, Mikel

    Hyperventilation in electroconvulsive therapy sessions has been associated with seizure threshold, seizure characteristics, and cognitive effects. There is no consensus on the optimal procedure of applying hyperventilation manoeuvres during electroconvulsive therapy. Prospective evaluation of the effects of systematic use of hyperventilation manoeuvres with facial mask and capnography (protocolized hyperventilation [pHV]), on ventilation parameters and on seizures. The study included a sample of 130 sessions (65 performed according to hyperventilation standard practice and 65 successive sessions, with pHV) of 35 patients over a period of 10 weeks. The pHV manoeuvres reduced exhaled CO2 and increased O2 saturation significantly (Pelectroconvulsive therapy procedure without adding costs. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Electroconvulsive therapy for depression in Parkinson's disease: systematic review of evidence and recommendations.

    Science.gov (United States)

    Borisovskaya, Anna; Bryson, William Culbertson; Buchholz, Jonathan; Samii, Ali; Borson, Soo

    2016-04-01

    We performed a systematic review of evidence regarding treatment of depression in Parkinson's disease (PD) utilizing electroconvulsive therapy. The search led to the inclusion of 43 articles, mainly case reports or case series, with the largest number of patients totaling 19. The analysis included 116 patients with depression and PD; depression improved in 93.1%. Where motor symptoms' severity was reported, 83% of patients improved. Cognition did not worsen in the majority (94%). Many patients experienced delirium or transient confusion, sometimes necessitating discontinuation of electroconvulsive therapy (ECT). Little is known about maintenance ECT in this population. ECT can benefit patients suffering from PD and depression. We recommend an algorithm for treatment of depression in PD, utilizing ECT sooner rather than later.

  19. Drug resistant neuroleptic malignant syndrome and the role of electroconvulsive therapy.

    Science.gov (United States)

    Hashim, Husnain; Zeb-un-Nisa; Alrukn, Suhail Abdulla Mohammad; Al Madani, Abubaker Abdul Rahman Shaffi

    2014-04-01

    Neuroleptic malignant syndrome is considered as a rare but potentially fatal complication of neuroleptic medications e.g.,antipsychotics, sedatives and anti emetics. It is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome often develops after the start of antipsychotic or a sudden increase in dosage of the neuroleptic medication or in states of dehydration. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. In rare cases where drugs treatment remains ineffective a trial of electroconvulsive therapy is being given. The case presented is a drug resistant case of Neuroleptic Malignant Syndrome where finally electroconvulsive therapy was effective.

  20. Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Yousefi A

    2010-02-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Neuroleptic malignant syndrome is an idiosyncratic and potentially fatal reaction to neuroleptic drugs and is characterized by fever, muscular rigidity, altered mental status, autonomic dysfunction, elevated serum CPK and leucocytosis Neuroleptic malignant syndrome is treated with dantrolene, bromocriptin, amantadin and electroconvulsive therapy."n"nCase: A 22 years old, schizophrenic female was refered to the Emergency ward of Roozbeh hospital in Tehran, Iran in December 2008 with aggression, impulsivity, and reduced sleep. After injection of haloperidol, the patient developed a high grade fever, diaphoresis and muscular stiffness. She was diagnosed as neuroleptic malignant syndrome and the treatment with dantrolen, bromocriptin and amantadin initiated. Although fever subsided, other signs continued, therefore we applied electroconvulsive therapy to this case."n"nConclusion: Due to excellent response of the patient to electroconvulsive therapy and the rare reports of electroconvulsive therapy in neuroleptic malignant syndrome in the Iranian population, this case may lead to develop studies for further investigations of this issue.

  1. Butyrylcholinesterase gene mutations in patients with prolonged apnea after succinylcholine for electroconvulsive therapy

    DEFF Research Database (Denmark)

    Mollerup, Hannah Malthe; Gätke, M R

    2011-01-01

    patients undergoing electroconvulsive therapy (ECT) often receive succinylcholine as part of the anesthetic procedure. The duration of action may be prolonged in patients with genetic variants of the butyrylcholinesterase enzyme (BChE), the most common being the K- and the A-variants. The aim...... of the study was to assess the clinical significance of genetic variants in butyrylcholinesterase gene (BCHE) in patients with a suspected prolonged duration of action of succinylcholine after ECT....

  2. Effect of electroconvulsive therapy without anticonvulsive premedication on serum growth hormone in man.

    Science.gov (United States)

    Vigas, M; Stowasserová, N; Németh, S; Jurcovicová, J

    1975-01-01

    Serum concentrations of human growth hormone (HGH) were measured in psychiatric patients during the first, third and sixth electroconvulsive therapy (ECT) without anticonvulsive premedication. Serum HGH increased 30 min after the application of current and no differences were found between responses to 1st, 3rd, or 6th ECT. Maximal increase of serum glucose was seen after the first ECT and gradual decreases after the 3rd and 6th ECT were observed

  3. Butyrylcholinesterase gene mutations in patients with prolonged apnea after succinylcholine for electroconvulsive therapy

    DEFF Research Database (Denmark)

    Mollerup, Hannah Malthe; Gätke, M R

    2011-01-01

    patients undergoing electroconvulsive therapy (ECT) often receive succinylcholine as part of the anesthetic procedure. The duration of action may be prolonged in patients with genetic variants of the butyrylcholinesterase enzyme (BChE), the most common being the K- and the A-variants. The aim...... of the study was to assess the clinical significance of genetic variants in butyrylcholinesterase gene (BCHE) in patients with a suspected prolonged duration of action of succinylcholine after ECT....

  4. Effect of Premedication with Oral Clonidine on Hemodynamic Response during Electroconvulsive Therapy

    OpenAIRE

    Deganwa, Mangi Lal; Sharma, Rajesh; Khare, Avneesh; Sharma, Divya

    2017-01-01

    Background: Electroconvulsive therapy (ECT) is the most effective treatment available for the acute treatment of depression in patients who do not respond to medications. It is generally used as a second line treatment for many psychological disorders, mainly major depression and schizophrenia where medication is not effective. ECT is often associated with some complications such as hypertension, tachycardia arrhythmia and even myocardial infarction. Various methods have been used for prevent...

  5. Effects of electroconvulsive therapy and desipramine on neuroendocrine responses to the clonidine challenge test.

    OpenAIRE

    Coote, M; Wilkins, A.; Werstiuk, E S; Steiner, M.

    1998-01-01

    OBJECTIVE: To investigate responses to the clonidine challenge test in depression, and after electroconvulsive therapy (ECT) or desipramine treatment for depression, in order to determine the usefulness of noradrenergic responses to clonidine as a state or trait marker in depression. PATIENTS: Twenty-six patients with depression and 15 control subjects. SETTING: The psychiatric ward of St. Joseph's Hospital in Hamilton. INTERVENTIONS: In the patients with depression: clonidine challenge pre- ...

  6. Efficacy of electroconvulsive therapy in Fahr disease associated with bipolar psychotic disorder: a case report.

    Science.gov (United States)

    Casamassima, Francesco; Lattanzi, Lorenzo; Perlis, Roy H; Fratta, Sara; Litta, Antonella; Longobardi, Antonio; Stange, Jonathan P; Tatulli, Alessandro; Cassano, Giovanni B

    2009-09-01

    We report a case of a patient with Fahr disease affected by bipolar disorder type I with psychotic symptoms. The complex clinical picture, characterized by both neurological and psychiatric symptoms, proved to be partially or completely resistant to several pharmacological trials. On the contrary, a marked improvement of clinical picture occurred after a cycle of 10 sessions of electroconvulsive therapy, followed by a complete and sustained resolution of mood, cognitive, motor, and behavioral symptoms during the next 4 years.

  7. Electroconvulsive therapy in a child suffering from acute and transient psychotic disorder with catatonic features

    Directory of Open Access Journals (Sweden)

    Satyakam Mohapatra

    2015-01-01

    Full Text Available Electroconvulsive therapy (ECT is a recognized and effective treatment in adults for several psychiatric disorders. However, the lack of knowledge and experience with the use of ECT among child and adolescent psychiatrists is an obstacle to its appropriate use. Treatment using ECT in children of prepubertal age has been less reported. We present a case of 10-year-old child with a diagnosis of acute and transient psychotic disorder with catatonic features, where we have used ECT successfully.

  8. Reorganization of Anatomical Connectome following Electroconvulsive Therapy in Major Depressive Disorder

    OpenAIRE

    Jinkun Zeng; Qinghua Luo; Lian Du; Wei Liao; Yongmei Li; Haixia Liu; Dan Liu; Yixiao Fu; Haitang Qiu; Xirong Li; Tian Qiu; Huaqing Meng

    2015-01-01

    Objective. Electroconvulsive therapy (ECT) is considered one of the most effective and fast-acting treatment options for depressive episodes. Little is known, however, about ECT's enabling brain (neuro)plasticity effects, particular for plasticity of white matter pathway. Materials and Methods. We collected longitudinal diffusion tensor imaging in the first-episode, drug-naïve major depressive disorder (MDD) patients (n = 24) before and after a predefined time window ECT treatment. We constru...

  9. Supportive Nursing Care and Satisfaction of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

    OpenAIRE

    Navidian, Ali; EBRAHIMI, Hossein; Keykha, Roghaieh

    2015-01-01

    Background: Patient satisfaction is the most important criterion in evaluating the quality of care. Besides, its assessment in patients with severe mental disorder treated by electroconvulsive therapy (ECT) is highly appropriate. The ECT is accompanied by lower satisfaction and may exacerbate the patients’ condition. Objectives: The current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ECT. Patients and Methods: This randomized contro...

  10. Treatment-resistant, five-year long, postpartum-onset Capgras episode resolving after electroconvulsive therapy.

    Science.gov (United States)

    Rapinesi, Chiara; Kotzalidis, Georgios D; Del Casale, Antonio; Ferri, Vittoria Rachele; Di Pietro, Simone; Scatena, Paola; Serata, Daniele; Danese, Emanuela; Sani, Gabriele; Koukopoulos, Alexia E; Angeletti, Gloria; Girardi, Paolo

    2015-01-01

    Postpartum psychosis, which rarely presents with Capgras syndrome (delusional misidentification), requires rapid symptom resolution. First-line drugs have important drawbacks, such as delayed onset of clinical response and secretion in breast milk. In this report, we report successful treatment of a treatment-resistant woman presenting with treatment-resistant Capgras syndrome, with onset during postpartum. A 36-year-old woman had presented with Capgras syndrome during postpartum. For more than five years, she believed her son and other family members were substituted by impostors. All adequately administrated treatments were unsuccessful. We suggested electroconvulsive therapy to overcome treatment resistance. After six electroconvulsive therapy sessions, delusions of doubles subsided and other symptoms improved. She was discharged two weeks later with a mood stabilizer and low-dose atypical antipychotic combination and is well at the one-and-a-half-year follow-up. Electroconvulsive therapy followed by a mood stabilizer-antipsychotic drug combination showed rapid, permanent, and effective control of long-standing Capgras syndrome in a young woman. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. Effectiveness of an Educational Intervention on Medical Students' Knowledge About and Attitude Towards Electroconvulsive Therapy.

    Science.gov (United States)

    Solomon, Susan; Simiyon, Manjula; Vedachalam, Ahalya

    2016-04-01

    This study was done to determine the effectiveness of a lecture and exposure to electroconvulsive therapy (ECT) followed by interaction with patient, on medical students' knowledge about and attitude towards electroconvulsive therapy. A questionnaire was administered to second year medical students to determine their baseline knowledge about and attitude towards electroconvulsive therapy. Following this, they underwent two educational interventions, a lecture on ECT and exposure to the procedure and interaction with the patient and relative, and their knowledge and attitude were reassessed after each intervention using the same questionnaire. Eighty-one students completed all the three assessments. Students' knowledge about ECT at baseline was minimal (mean 3.58 out of 12). Their knowledge increased significantly after the lecture (mean 10.3), and there was further increase following exposure to the procedure and subsequent interaction with the patient and relative (mean 11.1). At baseline, students had an overall negative attitude towards ECT. There was significant improvement on all attitude items following the lecture. Exposure to the procedure resulted in further improvement in attitude regarding whether ECT is a cruel treatment and has to be used as a last resort. Exposure to ECT in lecture and clinical scenarios followed by interaction with the patient should be included in the undergraduate medical curriculum to improve students' knowledge and attitude about this safe, effective, and potentially lifesaving treatment modality.

  12. Clinical Research of the Therapy of Extracorporeal Shock Wave to Chronic Acalculous Cholecystitis%体外冲击波治疗慢性非结石性胆囊炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    唐海涛; 李春恒; 赵红燕

    2015-01-01

    Objective This article aims to conduct the clinical observation and clinical research of extracorporeal shock wave therapy to chronic acalculous cholecystitis .Methods Divide 80 cases of patients of chronic acalculous chole-cystitis into 2 groups, with 40 cases in each group; as for the treatment group , the JDPN -VB model extracorporeal shock wave lithotripter by Shanghai Jiao Tong University is adopted to take the right upper quadrant as the shock wave path, and in prone position , to conduct the extracorporeal shock wave therapy to the gallbladder with the therapy voltage of 8 -10kv and the times of shock wave of 1000, and with the intervals of 2 weeks between two times;2 times are taken as 1 course of treatment; as for the control group , the anti-inflammatory and cholagogic medicines are taken for four weeks.Four weeks after the start of therapy , the two groups of patients are evaluated about the changes of clinical index be-fore and after the chronic acalculous cholecystitis .Results After 4 weeks of therapy , it is found that the single index im-provement degree and comprehensive therapeutic effect such as the clinical symptoms and the change in gallbladder Color Doppler Ultrasound of the treatment group are all obviously superior to that of the control group .Conclusions The extra-corporeal shock wave is a new effective method for the therapy of chronic acalculous cholecystitis ;it has the advantages of rapid effectiveness , safe and reliable and with effective therapy;worthy of clinic popularization and application .%目的:体外冲击波治疗慢性非结石性胆囊炎的疗效观察及临床研究。方法对80例慢性非结石性胆囊炎患者随机分成2组,每组40例;治疗组采用上海交大JDPN-VB型体外冲击波碎石机,以右上腹部为冲击波路径,俯卧位,对病变胆囊进行体外冲击波治疗,每次治疗电压选择8~10 kV,冲击波次数为1000次,间隔2周治疗下一次,2次为1个疗程;对

  13. Are gauge shocks really shocks?

    CERN Document Server

    Alcubierre, M

    2005-01-01

    The existence of gauge pathologies associated with the Bona-Masso family of generalized harmonic slicing conditions is proven for the case of simple 1+1 relativity. It is shown that these gauge pathologies are true shocks in the sense that the characteristic lines associated with the propagation of the gauge cross, which implies that the name ``gauge shock'' usually given to such pathologies is indeed correct. These gauge shocks are associated with places where the spatial hypersurfaces that determine the foliation of spacetime become non-smooth.

  14. Effect of Multivessel Coronary Disease With or Without Concurrent Chronic Total Occlusion on One-Year Mortality in Patients Treated With Primary Percutaneous Coronary Intervention for Cardiogenic Shock

    NARCIS (Netherlands)

    R.J. van der Schaaf; B.E. Claessen; M.M. Vis; L.P. Hoebers; K.T. Koch; J.,Jr Baan; M. Meuwissen; A.E. Engstrom; W.J. Kikkert; J.G.P. Tijssen; R.J. de Winter; J.J. Piek; J.P.S. Henriques

    2010-01-01

    Despite early revascularization, mortality remains high in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. It has been shown that the effect of multivessel disease (MVD) on mortality in patients with STEM I treated with primary percutaneous coronary

  15. Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Ilknur Aschermann

    2017-02-01

    Full Text Available Background/Aims: Chronic leg ulcers (CLUs are globally a major cause of morbidity and mortality with increasing prevalence. Their treatment is highly challenging, and many conservative, surgical or advanced therapies have been suggested, but with little overall efficacy. Since the 1980s extracorporal shock wave therapy (ESWT has gained interest as treatment for specific indications. Here, we report that patients with CLU showed wound healing after ESWT and investigated the underlying molecular mechanisms. Methods: We performed cell proliferation and migration assays, FACS- and Western blot analyses, RT-PCR, and Affymetrix gene expression analyses on human keratinocytes and fibroblasts, and a tube formation assay on human microvascular endothelial cells to assess the impact of shock waves in vitro. In vivo, chronic therapy-refractory leg ulcers were treated with ESWT, and wound healing was assessed. Results: Upon ESWT, we observed morphological changes and increased cell migration of keratinocytes. Cell-cycle regulatory genes were upregulated, and proliferation induced in fibroblasts. This was accompanied by secretion of pro-inflammatory cytokines from keratinocytes, which are known to drive wound healing, and a pro-angiogenic activity of endothelial cells. These observations were transferred “from bench to bedside”, and 60 consecutive patients with 75 CLUs with different pathophysiologies (e.g. venous, mixed arterial-venous, arterial were treated with ESWT. In this setting, 41% of ESWT-treated CLUs showed complete healing, 16% significant improvement, 35% improvement, and 8% of the ulcers did not respond to ESWT. The induction of healing was independent of patient age, duration or size of the ulcer, and the underlying pathophysiology. Conclusions: The efficacy of ESWT needs to be confirmed in controlled trials to implement ESWT as an adjunct to standard therapy or as a stand-alone treatment. Our results suggest that EWST may advance the

  16. Catatonia after deep brain stimulation successfully treated with lorazepam and right unilateral electroconvulsive therapy: a case report.

    Science.gov (United States)

    Quinn, Davin K; Rees, Caleb; Brodsky, Aaron; Deligtisch, Amanda; Evans, Daniel; Khafaja, Mohamad; Abbott, Christopher C

    2014-09-01

    The presence of a deep brain stimulator (DBS) in a patient who develops neuropsychiatric symptoms poses unique diagnostic challenges and questions for the treating psychiatrist. Catatonia has been described only once, during DBS implantation, but has not been reported in a successfully implanted DBS patient. We present a case of a patient with bipolar disorder and renal transplant who developed catatonia after DBS for essential tremor. The patient was successfully treated for catatonia with lorazepam and electroconvulsive therapy after careful diagnostic workup. Electroconvulsive therapy has been successfully used with DBS in a handful of cases, and certain precautions may help reduce potential risk. Catatonia is a rare occurrence after DBS but when present may be safely treated with standard therapies such as lorazepam and electroconvulsive therapy.

  17. Clinical study on the treatment of chronic pelvic inflammatory disease byabdominal extracorporeal shock%体外冲击波经腹治疗慢性盆腔炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    贾桂英; 吕艺; 唐海涛; 胡欣姝

    2014-01-01

    目的:体外冲击波治疗慢性盆腔炎的临床疗效观察。方法对200例慢性盆腔炎患者随机分成2组;治疗组采用体外冲击波定位于盆腔炎B超可见病理改变部位,以下腹部为冲击波路径的治疗方法,发挥最大的生物效应,每周治疗一次,连续治疗4次为一疗程(避开月经期和排卵期),每次治疗电压选择8~10kv,冲击波次数为1000次。对照组采用微波理疗,频率30hz,每次时间20分钟。评估慢性盆腔炎治疗前后两组临床指标的变化。结果治疗3个月后,发现治疗组慢性盆腔炎的临床症状较治疗前有较好的改变,病理改变恢复程度明显优于对照组。结论体外冲击波是治疗慢性盆腔炎行之有效的新方法,无辐射,无毒副作用,近远期疗效显著,恰当选择能量,无明显不良并发症,临床疗效显著。%to observe the clinical curative effect of objectiveextracorporeal shock wave therapy on chronic pelvic inlfammatory disease. Methods 200 cases of chronic pelvic inlfammatory disease were randomly divided into 2 groups;treatment group were treated withextracorporeal shock wave in pelvic inflammatory disease B ultrasoundvisible pathological ch anges position, treatment following abdominalshock wave path, play the biological effects of the largest, weekly treatment, continuous treatment of 4 times for a course of treatment (to avoid the menstrual period and ovulation period each treatment), voltage8 ~ 10kV, the shock wave 1000 times. the control group usingmicrowave therapy, the frequency of 30Hz, every time 20 minutes. To assess the changes before and after treatment of chronic pelvic inlfammation in two groups of clinical indicators. Results 3 months after treatment than before treatment, found that clinical symptoms of chronic pelvic inflammatory disease treatment group had better change,pathological change degree of recovery was better than the control group. Conclusion

  18. Basic Shock Physiology and Critical Care.

    Science.gov (United States)

    Roberts, Brian K

    2016-05-01

    Veterinarians practicing emergency medicine and/or working with exotic animals must be well versed in the pathophysiology of shock because many exotic pets present with an acute crisis or an acute manifestation of a chronic process causing poor organ perfusion. This article discusses the pathophysiology of shock and the systemic inflammatory response syndrome, which may lead to organ dysfunction, organ failure, sepsis, and death. The physiology of perfusion, perfusion measurements, categories of shock, and altered function of the immune system, gastrointestinal barrier, and coagulation system are discussed. Veterinarians providing emergency care to patients with shock must also be aware of comorbidities. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Does a single session of electroconvulsive therapy alter the neural response to emotional faces in depression? A randomised sham-controlled functional magnetic resonance imaging study.

    Science.gov (United States)

    Miskowiak, Kamilla W; Kessing, Lars V; Ott, Caroline V; Macoveanu, Julian; Harmer, Catherine J; Jørgensen, Anders; Revsbech, Rasmus; Jensen, Hans M; Paulson, Olaf B; Siebner, Hartwig R; Jørgensen, Martin B

    2017-09-01

    Negative neurocognitive bias is a core feature of major depressive disorder that is reversed by pharmacological and psychological treatments. This double-blind functional magnetic resonance imaging study investigated for the first time whether electroconvulsive therapy modulates negative neurocognitive bias in major depressive disorder. Patients with major depressive disorder were randomised to one active ( n=15) or sham electroconvulsive therapy ( n=12). The following day they underwent whole-brain functional magnetic resonance imaging at 3T while viewing emotional faces and performed facial expression recognition and dot-probe tasks. A single electroconvulsive therapy session had no effect on amygdala response to emotional faces. Whole-brain analysis revealed no effects of electroconvulsive therapy versus sham therapy after family-wise error correction at the cluster level, using a cluster-forming threshold of Z>3.1 ( p2.3; pelectroconvulsive therapy-induced changes in parahippocampal and superior frontal responses to fearful versus happy faces as well as in fear-specific functional connectivity between amygdala and occipito-temporal regions. Across all patients, greater fear-specific amygdala - occipital coupling correlated with lower fear vigilance. Despite no statistically significant shift in neural response to faces after a single electroconvulsive therapy session, the observed trend changes after a single electroconvulsive therapy session point to an early shift in emotional processing that may contribute to antidepressant effects of electroconvulsive therapy.

  20. Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy A randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Lingxi Wu; Handong Zou; Qingshan Zhou; Zhongchun Liu; Bangchang Cheng

    2008-01-01

    BACKGROUND: Preemptive analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE: To treat psychiatric patients with intravenous (i.v.) injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN: A randomized controlled observation. SETTING: Renmin Hospital of Wuhan University.PARTICIPANTS: A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group (n = 60) and treatment group (n = 60). In the control group, there were 42 males and 18 females, aged 17–50 years, with a mean age of (34 ± 11) years. The patients weighed 50–70 kg, with a mean body mass of (63 ± 18) kg. In the treatment group, there were 40 males and 20 females, aged 20–54 years, with a mean age of (36 ± 13) years. The patients weighed 48–72 kg, with a mean body mass of (64 ± 16) kg. Approval was obtained from the Hospital's Ethics Committee. Informed consents were obtained from the patients' relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus (CORPERATION, USA) was used.METHODS: ① Treatments: In the control group, the patients were anesthetized by I.v. Injection of propofol (AstraZeneca, Italy, No.CN309) containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the

  1. [Neurogenic shock].

    Science.gov (United States)

    Meister, Rafael; Pasquier, Mathieu; Clerc, David; Carron, Pierre-Nicolas

    2014-08-13

    The neurogenic shock is a common complication of spinal cord injury, especially when localized at the cervical level. Characterized by a vasoplegia (hypotension) and bradycardia, the neurogenic shock is secondary to the damage of the sympathetic nervous system. The clinical presentation often includes tetraplegia, with or without respiratory failure. Early treatment aims to minimize the occurrence of secondary spinal cord lesions resulting from systemic ischemic injuries. Medical management consists in a standardized ABCDE approach, in order to stabilize vital functions and immobilize the spine. The hospital care includes performing imaging, further measures of neuro-resuscitation, and coordinated surgical assessment and treatment of any other injury.

  2. Rocuronium as muscle relaxant for electroconvulsive therapy in a patient with adult-onset muscular dystrophy.

    Science.gov (United States)

    Bryson, Ethan O; Aloysi, Amy S; Katz, Maya; Popeo, Dennis; Kellner, Charles H

    2011-12-01

    Adult-onset muscular dystrophy is an inherited myopathy characterized by a variable degree of progressive muscle weakness and degeneration. Although not usually fatal, significant muscle weakness results in an up-regulation of acetylcholine receptors on the less responsive postjunctional muscles. The resulting profound potassium release when these receptors are stimulated by the depolarizing muscle relaxant succinylcholine can result in potentially fatal cardiac arrhythmias. We report a case of electroconvulsive therapy safely administered in a 61-year-old man with adult-onset muscular dystrophy requiring muscle relaxation with rocuronium.

  3. Electroconvulsive therapy in a terminally ill patient: when every day of improvement counts.

    Science.gov (United States)

    Mulder, Marlies E; Verwey, Bastiaan; van Waarde, Jeroen A

    2012-03-01

    Electroconvulsive therapy (ECT) is seldom used in a palliative setting. Although literature on the application of ECT in terminally ill patients is sparse, ECT may be useful to rapidly improve the quality of life in these patients. We present the case of a 71-year-old man with metastasized pancreas carcinoma complicated by severe depression. After 3 ECT sessions, the communication between the patient and his family in the last moments of his life improved. We conclude that ECT should be considered to treat mood disorders in terminally ill patients when every day of improvement counts.

  4. Alpha-adrenergic regulation of growth hormone release after electroconvulsive therapy in man.

    Science.gov (United States)

    Vigas, M; Wiedermann, V; Németh, S; Jurcovicová, J; Zigo, L

    1976-01-01

    When electroshcok therapy was administered to male psychiatric patients without anticonvulsive premedication, serum growth hormone (GH) increased; the increase was not prevented by an infusion of 20% glucose (5 ml per min) 20 min prior to electroshock. Therefore, the GH rise is not caused by muscle exercise during convulsions. Infusing 30 mg of phentolamine 40 min prior to electroshcok inhibited the GH response. Phentolamine's effect shows that the stress-induced GH release that follows electroconvulsive therapy is mediated by alpha-adrenergic neurons.

  5. Treatment of post-electroconvulsive therapy delirium and agitation with donepezil.

    Science.gov (United States)

    Logan, Christopher J; Stewart, Jonathan T

    2007-03-01

    Delirium and agitation are commonly encountered after administration of electroconvulsive therapy (ECT). Management is generally fairly straightforward, although some patients may have a severe, prolonged, or refractory course. We recently cared for a 65-year-old man who consistently developed severe and very prolonged post-ECT delirium that did not respond to typical pharmacological agents; the duration of delirium was dramatically shortened by the addition of donepezil. Cholinesterase inhibitors may have a place in mitigating severe and prolonged post-ECT delirium.

  6. Risk of long-lasting negative cognitive consequences after electroconvulsive therapy

    DEFF Research Database (Denmark)

    Svendsen, Anne Marie; Miskowiak, Kamilla; Vinberg, Maj

    2013-01-01

    This case study describes a patient who had a unipolar depression and experienced long-lasting cognitive problems after electroconvulsive therapy (ECT). Neuropsychological testing revealed lower scores on measures of learning, memory and sustained attention. These results stress the importance...... of informing patients who have ECT of the potential cognitive consequences of this treatment as it may influence the patients' functional capabilities. Prospective studies are needed since we do not have sufficient knowledge regarding the 3-5% of these patients who experience sustained cognitive problems....

  7. Prevalence and correlates of electroconvulsive therapy delivery in 1001 obsessive-compulsive disorder outpatients.

    Science.gov (United States)

    Dos Santos-Ribeiro, Samara; Lins-Martins, Natália M; Frydman, Ilana; Conceição do Rosário, Maria; Ferrão, Ygor A; Shavitt, Roseli G; Yücel, Murat; Miguel, Euripedes C; Fontenelle, Leonardo F

    2016-05-30

    Individuals with obsessive-compulsive disorder (OCD) who sought treatment in seven different specialized centers (n=1001) were evaluated with a structured assessment battery. Thirteen OCD patients (1.3% of the sample) reported having been treated with electroconvulsive therapy (ECT) in the past. They were older and exhibited higher global severity of OCD symptoms, but were less likely to display symmetry/ordering and contamination/washing symptoms. They also had greater suicidality and increased rates of psychosis. Finally, OCD patients exposed to ECT were more frequently treated with antipsychotics, although they did not differ in terms of responses to adequate trials with serotonin reuptake inhibitors.

  8. Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    N Manjunatha

    2011-01-01

    Full Text Available Few studies reported the efficacy and safety in combination of clozapine and electroconvulsive therapy (ECT in schizophrenia; systematic studies are lacking. Side effects like seizure, and confusional state are reported. Authors report two cases of delayed onset/protracted delirium with ECT and clozapine in schizophrenia, one of whom developed aspiration pneumonitis possibly due to clozapine hyper-salivation. Delirium improved with stopping of ECT and clozapine. Clozapine monotherapy restarted to previous dosages in both cases without recurrence of delirium. Authors recommend for careful monitoring for delirium in ECT augmentation on high dose clozapine. Unilateral ECT may be preferred for augmenting clozapine.

  9. Use of Orally Disintegrating Olanzapine During Electroconvulsive Therapy for Prevention of Postictal Agitation.

    Science.gov (United States)

    Hermida, Adriana P; Janjua, A Umair; Tang, Yilang; Syre, Sharyn R; Job, Gregory; McDonald, William M

    2016-11-01

    A major medical problem for patients undergoing electroconvulsive therapy (ECT) is the occurrence of postictal agitation (PIA). This phenomenon is associated with confusion and disorientation that can have severe clinical implications for the safety of the patient and health care professionals. Many different pharmacological strategies have been used to prevent PIA. We present data on 40 patients who suffered from PIA after a course of ECT and evaluate the prophylactic use of orally disintegrating olanzapine in the prevention of PIA in subsequent ECT treatments.

  10. Temporal lobe epilepsy following maintenance electroconvulsive therapy-Electrical kindling in the human brain?

    Science.gov (United States)

    Bryson, Alexander; Gardner, Helen; Wilson, Ian; Rolfe, Tim; Archer, John

    2016-11-01

    Maintenance electroconvulsive therapy (ECT) is sometimes prescribed for refractory psychiatric conditions. We describe five patients who received maintenance ECT and developed florid temporal epileptiform abnormalities on electroencephalography (EEG) despite no history of epilepsy and normal neuroimaging. All patients had received regular ECT for at least 8 months. Three patients had clinical events consistent with epileptic seizures, and video-EEG monitoring captured electrographic seizures in two patients. After cessation of ECT the EEGs normalized in all patients, and no further clinical seizures occurred. Maintenance ECT may predispose to epilepsy with a seizure focus in the temporal lobe. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  11. Glenside Hospital's role in the introduction of electroconvulsive therapy and psychosurgery to Australian psychiatry.

    Science.gov (United States)

    Goldney, Robert; Adams, Rob

    2009-02-01

    This paper records the introduction of electroconvulsive therapy (ECT) and psychosurgery to Australia at Parkside Mental Hospital (present day Glenside Hospital) in South Australia. A review of treatment provided at Glenside Hospital since its inception in 1870. The desperate plight of patients and the limited array of interventions leading up to the introduction of ECT and psychosurgery are noted. Their introduction and the early results from the treatments are described. Glenside Hospital, as Parkside Mental Hospital, pioneered the use of ECT and psychosurgery in Australia.

  12. Maintenance Electroconvulsive Therapy in a Patient with Treatment-Resistant Paranoid Schizophrenia and Comorbid Epilepsy

    Directory of Open Access Journals (Sweden)

    Beppe Micallef-Trigona

    2012-01-01

    Full Text Available The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response.

  13. Maintenance electroconvulsive therapy in a patient with treatment-resistant paranoid schizophrenia and comorbid epilepsy.

    Science.gov (United States)

    Micallef-Trigona, Beppe; Spiteri, Joseph

    2012-01-01

    The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT) and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response.

  14. Catatonia and autism: a historical review, with implications for electroconvulsive therapy.

    Science.gov (United States)

    Dhossche, Dirk M; Reti, Irving M; Wachtel, Lee E

    2009-03-01

    Current autism research is historically separated from catatonia and other childhood psychotic disorders, although catatonia and autism share several common symptoms (mutism, echolalia, stereotypic speech and repetitive behaviors, posturing, grimacing, rigidity, mannerisms, and purposeless agitation). Electroconvulsive therapy (ECT) effectively treats catatonia and catatonia-related conditions of intractable compulsions, tics, and self-injury in people with autism. We assess the incidence of catatonic symptoms in autism, examine emerging ECT indications in people with autism and related developmental disorders, and encourage ethical debate and legal-administrative action to assure equal access to ECT for people with autism.

  15. Antidepressant Effects of Electroconvulsive Therapy Correlate With Subgenual Anterior Cingulate Activity and Connectivity in Depression

    OpenAIRE

    LIU Yi; DU, LIAN; Li, Yongmei; Liu, Haixia; Zhao, Wenjing; Liu, Dan; Zeng, Jinkun; Li, Xingbao; FU, YIXIAO; QIU, HAITANG; Li, Xirong; Qiu, Tian; Hu, Hua; Meng, Huaqing; Luo, Qinghua

    2015-01-01

    Abstract The mechanisms underlying the effects of electroconvulsive therapy (ECT) in major depressive disorder (MDD) are not fully understood. Resting-state functional magnetic resonance imaging (rs-fMRI) is a new tool to study the effects of brain stimulation interventions, particularly ECT. The authors aim to investigate the mechanisms of ECT in MDD by rs-fMRI. They used rs-fMRI to measure functional changes in the brain of first-episode, treatment-naive MDD patients (n = 23) immediately be...

  16. Mouse repeated electroconvulsive seizure (ECS) does not reverse social stress effects but does induce behavioral and hippocampal changes relevant to electroconvulsive therapy (ECT) side-effects in the treatment of depression

    NARCIS (Netherlands)

    van Buel, Erin M; Sigrist, Hannes; Seifritz, Erich; Fikse, Lianne; Bosker, Fokko J; Schoevers, Robert A; Klein, Hans C; Pryce, Christopher R; Eisel, Ulrich Lm

    2017-01-01

    Electroconvulsive therapy (ECT) is an effective treatment for depression, but can have negative side effects including amnesia. The mechanisms of action underlying both the antidepressant and side effects of ECT are not well understood. An equivalent manipulation that is conducted in experimental

  17. A functional MRI marker may predict the outcome of electroconvulsive therapy in severe and treatment-resistant depression

    NARCIS (Netherlands)

    van Waarde, J.A.; Scholte, H.S.; van Oudheusden, L.J.B.; Verwey, B.; Denys, D.; van Wingen, G.A.

    2015-01-01

    Electroconvulsive therapy (ECT) is effective even in treatment-resistant patients with major depression. Currently, there are no markers available that can assist in identifying those patients most likely to benefit from ECT. In the present study, we investigated whether resting-state network connec

  18. Low-dose esmolol bolus reduces seizure duration during electroconvulsive therapy: a double-blind, placebo-controlled study

    NARCIS (Netherlands)

    W.W. van den Broek (Walter); A.F. Leentjens; A. Kusuma (Ari); J.A. Bruijn (Jan); P.G.H. Mulder (Paul)

    1999-01-01

    textabstractWe have measured the effect of a bolus dose of esmolol 80 mg i.v. on heart rate, and systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures during electroconvulsive therapy (ECT). We also assessed seizure duration using both the cuff method and tw

  19. Regulation of the galanin system by repeated electroconvulsive seizures in mice

    DEFF Research Database (Denmark)

    Christiansen, S H; Woldbye, D P D

    2010-01-01

    Even though induction of seizures by electroconvulsive stimulation (ECS) is a treatment widely used for major depression in humans, the working mechanism of ECS remains uncertain. The antiepileptic effect of ECS has been suggested to be involved in mediating the therapeutic effect of ECS. The neu......Even though induction of seizures by electroconvulsive stimulation (ECS) is a treatment widely used for major depression in humans, the working mechanism of ECS remains uncertain. The antiepileptic effect of ECS has been suggested to be involved in mediating the therapeutic effect of ECS....... The neuropeptide galanin exerts antiepileptic and antidepressant-like effects and has also been implicated in the pathophysiology of depression. To explore a potential role of galanin in working mechanisms of ECS, the present study examined effects of repeated ECS on the galanin system using QRT-PCR, in situ......]galanin receptor binding in the piriform cortex, hippocampus, and amygdala was found to be significantly down-regulated. These data show that the galanin system is regulated by repeated ECS in a number of brain regions implicated in seizure regulation and depression. These changes may play a role...

  20. Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia.

    Science.gov (United States)

    Acharya, Deepa; Harper, David G; Achtyes, Eric D; Seiner, Stephen J; Mahdasian, Jack A; Nykamp, Louis J; Adkison, Lesley; Van der Schuur White, Lori; McClintock, Shawn M; Ujkaj, Manjola; Davidoff, Donald A; Forester, Brent P

    2015-03-01

    Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge. Twenty-three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen-Mansfield Agitation Inventory-Short Form, Neuropsychiatric Inventory-Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course. Regression analyses revealed a significant decrease from baseline to discharge on the Cohen-Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. Copyright © 2014 John Wiley & Sons, Ltd.

  1. Electroconvulsive treatment of a patient with Parkinson’s disease and moderate depression

    Directory of Open Access Journals (Sweden)

    John Erik Berg

    2011-02-01

    Full Text Available Depression is a usual comorbidity in patients with Parkinson’s disease. It has been known for more than 50 years that electroconvulsive treatment (ECT has a positive effect on the muscular symptoms of Parkinson’s disease. Many countries do not allow giving ECT for this indication. We have recently treated a resident patient in an acute psychiatric facility referred to the hospital with moderate depressive symptoms and strong suicidal ideation. Before and after a series of ECT he filled out the Beck Depression Inventory and the Antonovsky Sense of Coherence test. The scores before ECT were 20 and 2.69, respectively, and after 12 treatments 14 and 3.38. Both test results indicate improvement regarding level of depression and coping in life. The physiotherapists treating him observed that his rigidity was reduced and his gait improved. Muscular tonus was reduced and increased his tendency of falling as he had less tonus in muscles close to joints. Self help efficiency in daily tasks improved. He got cognitive impairment during and in the weeks after ECT. Electroconvulsive treatment should be offered to more patients with Parkinson disease and depression in order to lessen the burden of both depression and Parkinson symptoms.

  2. The study protocol of the Norwegian randomized controlled trial of electroconvulsive therapy in treatment resistant depression in bipolar disorder

    Directory of Open Access Journals (Sweden)

    Oedegaard Ketil J

    2010-02-01

    Full Text Available Abstract Background The treatment of depressive phases of bipolar disorder is challenging. The effects of the commonly used antidepressants in bipolar depression are questionable. Electroconvulsive therapy is generally considered to be the most effective treatment even if there are no randomized controlled trials of electroconvulsive therapy in bipolar depression. The safety of electroconvulsive therapy is well documented, but there are some controversies as to the cognitive side effects. The aim of this study is to compare the effects and side effects of electroconvulsive therapy to pharmacological treatment in treatment resistant bipolar depression. Cognitive changes and quality of life during the treatment will be assessed. Methods/Design A prospective, randomised controlled, multi-centre six- week acute treatment trial with seven clinical assessments. Follow up visit at 26 weeks or until remission (max 52 weeks. A neuropsychological test battery designed to be sensitive to changes in cognitive function will be used. Setting: Nine study centres across Norway, all acute psychiatric departments. Sample: n = 132 patients, aged 18 and over, who fulfil criteria for treatment resistant depression in bipolar disorder, Montgomery Åsberg Depression Rating Scale Score of at least 25 at baseline. Intervention: Intervention group: 3 sessions per week for up to 6 weeks, total up to 18 sessions. Control group: algorithm-based pharmacological treatment as usual. Discussion This study is the first randomized controlled trial that aims to investigate whether electroconvulsive therapy is better than pharmacological treatment as usual in treatment resistant bipolar depression. Possible long lasting cognitive side effects will be evaluated. The study is investigator initiated, without support from industry. Trial registration NCT00664976

  3. Culture Shock

    Institute of Scientific and Technical Information of China (English)

    宋文玲

    2004-01-01

    Specialists say that it is not easy to get used to life in a new culture.“Culture shock”is the term these specialists use when talking about the feelings that people have in a new environment.There are three stages of culture shock,say the specialists.In the first stage,the newcomers like their new environment,Then when the fresh experience

  4. Shock Waves

    CERN Document Server

    Jiang, Z

    2005-01-01

    The International Symposium on Shock Waves (ISSW) is a well established series of conferences held every two years in a different location. A unique feature of the ISSW is the emphasis on bridging the gap between physicists and engineers working in fields as different as gas dynamics, fluid mechanics and materials sciences. The main results presented at these meetings constitute valuable proceedings that offer anyone working in this field an authoritative and comprehensive source of reference.

  5. A retrospective controlled study into memory complaints reported by depressed patients after treatment with electroconvulsive therapy and pharmacotherapy or pharmacotherapy only.

    NARCIS (Netherlands)

    H. Kho King; M.F. van Vreeswijk; J.M.J. Murre

    2006-01-01

    Few studies have been conducted comparing complaints of memory problems using objective and subjective memory scales in depressed patients who received electroconvulsive therapy (ECT) + pharmacotherapy or treatment with pharmacotherapy only. Patients who suffer from depression according to the Diagn

  6. Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy: a randomized, blinded comparison of seizure duration, stimulus charge, clinical effect, and cognitive side effects

    DEFF Research Database (Denmark)

    Bauer, Jeanett; Hageman, Ida; Dam, Henrik;

    2009-01-01

    OBJECTIVES:: To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, clinical effect, and cognitive side effects. METHODS:: Randomized, blinded study of 62 depressed patients treated with bilateral ECT. Algorithm...

  7. [Efficacy of continuation and maintenance electroconvulsive therapy (c/m ECT) in the treatment of patients with therapy-resistant affective disorders: a retrospective analysis].

    Science.gov (United States)

    Post, Thomas; Kemmler, Georg; Krassnig, Tristan; Brugger, Anita; Hausmann, Armand

    2015-01-01

    Continuation and maintenance electroconvulsive therapy (c/m ECT) is a long-term treatment option in severely and chronically ill patients with mood disorders, who are unresponsive or intolerant to medication. Due to the current lack of empirical studies, c/m ECT is still a clinical tool with little evidence. We conducted a retrospective analysis of patients' charts who received c/m ECT over a 10-year period. Outcome was measured by comparing the number of pre-c/m ECT and post-c/m ECT hospitalizations, as well as inpatient days per year and mean duration of hospital stays. In 19 patients (63% female; mean age 53.5 ± 12.0 years) with either bipolar (42%) or unipolar (58%) mood disorder, with the majority of patients suffering from a depressive episode at hospital admission (95%), c/m ECT was initiated after a successful series of ECT. In a 5-year interval before and after starting c/m ECT the number of hospitalizations per year (0.87 vs. 0.28, p therapy-resistant affective disorders. Further research using a controlled study design and larger sample sizes are needed to convincingly define indication and performance of c/m ECT.

  8. [Definition of shock types].

    Science.gov (United States)

    Adams, H A; Baumann, G; Gänsslen, A; Janssens, U; Knoefel, W; Koch, T; Marx, G; Müller-Werdan, U; Pape, H C; Prange, W; Roesner, D; Standl, T; Teske, W; Werner, G; Zander, R

    2001-11-01

    Definitions of shock types. Hypovolaemic shock is a state of insufficient perfusion of vital organs with consecutive imbalance of oxygen supply and demand due to an intravascular volume deficiency with critically impaired cardiac preload. Subtypes are haemorrhagic shock, hypovolaemic shock in the narrow sense, traumatic-haemorrhagic shock and traumatic-hypovolaemic shock. Cardiac shock is caused by a primary critical cardiac pump failure with consecutive inadequate oxygen supply of the organism. Anaphylactic shock is an acute failure of blood volume distribution (distributive shock) and caused by IgE-dependent, type-I-allergic, classical hypersensibility, or a physically, chemically, or osmotically induced IgE-independent anaphylactoid hypersensibility. The septic shock is a sepsis-induced distribution failure of the circulating blood volume in the sense of a distributive shock. The neurogenic shock is a distributive shock induced by generalized and extensive vasodilatation with consecutive hypovolaemia due to an imbalance of sympathetic and parasympathetic regulation of vascular smooth muscles.

  9. Localized shocks

    CERN Document Server

    Roberts, Daniel A; Susskind, Leonard

    2014-01-01

    We study products of precursors of spatially local operators, $W_{x_{n}}(t_{n}) ... W_{x_1}(t_1)$, where $W_x(t) = e^{-iHt} W_x e^{iHt}$. Using chaotic spin-chain numerics and gauge/gravity duality, we show that a single precursor fills a spatial region that grows linearly in $t$. In a lattice system, products of such operators can be represented using tensor networks. In gauge/gravity duality, they are related to Einstein-Rosen bridges supported by localized shock waves. We find a geometrical correspondence between these two descriptions, generalizing earlier work in the spatially homogeneous case.

  10. Electroconvulsive therapy in treatment-resistant mania: case reports A Eletroconvulsoterapia no tratamento da mania resistente: relatos de casos

    Directory of Open Access Journals (Sweden)

    Marcia Britto de Macedo Soares

    2002-02-01

    Full Text Available Electroconvulsive therapy is known to be effective in the treatment of mood disorders, more specifically for depression and mania. Although a large body of evidence confirms the efficacy of electroconvulsive therapy in the treatment of mania, few prospective studies have been done to assess its effectiveness in treatment-resistant manic episodes. These case reports describe the initial results of a study that is being conducted to evaluate the efficacy of Electroconvulsive therapy among treatment-resistant bipolar patients. METHODS: Three manic patients (according to DSM-IV criteria who were considered treatment-resistant underwent a series of 12 bilateral Electroconvulsive therapy sessions. Before the treatment and then weekly, they were evaluated with the following rating scales: Young Mania Rating Scale, Hamilton Rating Scale for Depression, Brief Psychiatric Rating Scale, and Clinical Global Impressions-Bipolar Version. RESULTS: The 3 patients showed a satisfactory response to Electroconvulsive therapy, although some differences in the course of response were observed. CONCLUSION: These case reports suggest that Electroconvulsive therapy needs further evaluation for the treatment of resistant bipolar patients.A Eletroconvulsoterapia é uma alternativa reconhecidamente eficaz no tratamento dos transtornos do humor. Embora vários estudos tenham confirmado a eficácia desta modalidade terapêutica no tratamento da mania aguda, poucos estudos foram realizados em pacientes maníacos resistentes à farmacoterapia. Esses relatos de casos descrevem resultados preliminares de um projeto de pesquisa que tem por objetivo avaliar a eficácia da Eletroconvulsoterapia no tratamento de transtornos bipolares resistentes. MÉTODOS: Três pacientes com diagnóstico de mania (de acordo com os critérios do DSM-IV, considerados resistentes ao tratamento medicamentoso, foram submetidos a 12 aplicações bilaterais de Eletroconvulsoterapia. Antes do tratamento e

  11. Electroconvulsive therapy-induced brain functional connectivity predicts therapeutic efficacy in patients with schizophrenia: a multivariate pattern recognition study.

    Science.gov (United States)

    Li, Peng; Jing, Ri-Xing; Zhao, Rong-Jiang; Ding, Zeng-Bo; Shi, Le; Sun, Hong-Qiang; Lin, Xiao; Fan, Teng-Teng; Dong, Wen-Tian; Fan, Yong; Lu, Lin

    2017-05-11

    Previous studies suggested that electroconvulsive therapy can influence regional metabolism and dopamine signaling, thereby alleviating symptoms of schizophrenia. It remains unclear what patients may benefit more from the treatment. The present study sought to identify biomarkers that predict the electroconvulsive therapy response in individual patients. Thirty-four schizophrenia patients and 34 controls were included in this study. Patients were scanned prior to treatment and after 6 weeks of treatment with antipsychotics only (n = 16) or a combination of antipsychotics and electroconvulsive therapy (n = 13). Subject-specific intrinsic connectivity networks were computed for each subject using a group information-guided independent component analysis technique. Classifiers were built to distinguish patients from controls and quantify brain states based on intrinsic connectivity networks. A general linear model was built on the classification scores of first scan (referred to as baseline classification scores) to predict treatment response. Classifiers built on the default mode network, the temporal lobe network, the language network, the corticostriatal network, the frontal-parietal network, and the cerebellum achieved a cross-validated classification accuracy of 83.82%, with specificity of 91.18% and sensitivity of 76.47%. After the electroconvulsive therapy, psychosis symptoms of the patients were relieved and classification scores of the patients were decreased. Moreover, the baseline classification scores were predictive for the treatment outcome. Schizophrenia patients exhibited functional deviations in multiple intrinsic connectivity networks which were able to distinguish patients from healthy controls at an individual level. Patients with lower classification scores prior to treatment had better treatment outcome, indicating that the baseline classification scores before treatment is a good predictor for treatment outcome. CONNECTIVITY NETWORKS

  12. 冲击波对慢性非结石性胆囊炎患者胆囊收缩功能影响的临床观察%Clinical Observation of the Influence of Shock Wave to the Gallbladder Systolic Function of Chronic Acalculous Cholecystitis Patients

    Institute of Scientific and Technical Information of China (English)

    唐海涛; 李春恒; 赵红燕

    2015-01-01

    Objective This article aims to discuss about the influence of extracorporeal shock wave on the gallbladder systolic function of chronic acalculous cholecystitis patients. Methods Adopt the JDPN - VB model extracorporeal shock wave lithotripter by Shanghai Jiaotong University for the 40 cases of chronic acalculous cholecystitis patients;take the right upper quadrant as the shock wave path,and in prone position,to conduct the extracorporeal shock wave therapy to the cholelithiasis;with the therapy voltage of 8~ 10 kv and the times of shock wave of 1000,to conduct statistics to the changes of gallbladder systolic percentage before and one month after the shock wave therapy. Results The gallbladder systolic percentage is obviously increased for the 40 cases of chronic acalculous cholecystitis patients after the extracorporeal shock wave therapy than before,with obvious difference and the statistical sig-nificance(P ﹤ 0. 05). Conclusion The extracorporeal shock wave can effectively improve the gallbladder systolic function.%目的:探讨体外冲击波对慢性非结石性胆囊炎病人胆囊收缩功能的影响。方法对40例慢性非结石性胆囊炎患者采用上海交大 JDPN - VB 型体外冲击波碎石机,以右上腹部为冲击波路径,俯卧位,对病变胆囊进行体外冲击波治疗,治疗电压选择8~10 KV,冲击波次数为1000次,于治疗前及冲击波治疗后一个月统计胆囊收缩率变化情况。结果40例慢性非结石性胆囊炎患者经体外冲击波治疗后胆囊收缩率较治疗前明显升高,差异具有统计学意义( P ﹤0.05)。结论体外冲击波可以有效地改善胆囊的收缩功能。

  13. Rocuronium-sugammadex for electroconvulsive therapy management in neuroleptic malignant syndrome: A case report.

    Science.gov (United States)

    Casas Reza, P; Gestal Vázquez, M; Outeiro Rosato, Á; López Álvarez, S; Diéguez García, P

    2017-02-01

    Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Care, Control, and the Electroconvulsive Therapy Ritual: Making Sense of Polarized Patient Narratives.

    Science.gov (United States)

    Knight, Fauzia; Ridge, Damien; McShane, Rupert; Ryan, Sara; Griffith, Laura

    2017-09-01

    Despite evidence of short-term effectiveness of ECT (electroconvulsive therapy), both positive and negative patient reports are common. However, research examining these polarized accounts has not adequately elucidated why such divergences occur. We thus sought to examine opposing patient narratives to better understand underlying meanings. Eighteen interviews were conducted with U.K.-based people who had experienced the treatment. Our analysis revealed that the quality of relations with staff, ECT artifacts (e.g., the ECT suite), and perceived outcomes all play a role in divergent accounts. Positive reflections on ECT emerged alongside narratives of trust in staff, comfort with ECT, and perception of sufficient personal control. Conversely, where negative evaluations of ECT predominated, there was anger associated with a lack of control, a belief that ECT made little sense, and was linked to past abuses and/or the unacceptability of side effects. We discuss the implications of our findings for professionals.

  15. Titanium alloys as fixation device material for cranioplasty and its safety in electroconvulsive therapy.

    Science.gov (United States)

    Kaido, Takanobu; Noda, Takamasa; Otsuki, Taisuke; Kaneko, Yuu; Takahashi, Akio; Nakai, Tetsuji; Nabatame, Maki; Tani, Mariko

    2011-03-01

    Here, we report the case of a patient successfully treated by a series of electroconvulsive therapy (ECT) who had implanted skull fixation devices made of titanium alloy. The patient was a 57-year-old man with bipolar I disorder. He was hospitalized for the treatment of manic symptoms of bipolar I disorder with pharmacotherapy and ECT. He sustained a fall and hit his head hard on the ground. Acute subdural hematoma developed, and emergent surgery to remove the hematoma was carried out. Cranioplasty was performed using fixation devices made of titanium alloy (Ti 6Al-4V). In order to control his manic symptoms, a series of ECT was readministered from 1 week after surgery. No adverse effects occurred. Devices must be investigated and chosen very carefully for permanent implantation, especially in patients during a course of ECT.

  16. Maintenance electroconvulsive therapy for comorbid pharmacotherapy-refractory obsessive-compulsive and schizoaffective disorder

    Directory of Open Access Journals (Sweden)

    Hanisch F

    2009-08-01

    Full Text Available Abstract Objective There is a high comorbidity of schizophrenia and obsessive-compulsory disorder (OCD associated with more severe symptoms. Standard pharmacotherapy achieve symptom improvement in approximately 60% only. Results We report about a 48-old women treated for depression which developed successively psychotic symptoms (ideas of reference, psychotic worries, negative symptoms (blunted affect, impoverished thinking, difficulties in planning, and obsessive-compulsive symptoms (mainly repeating rituals, avoidance behaviour, collecting and hoarding. She did not respond to combined treatment with neuroleptics and high dose selective serotonin re-uptake inhibitors. She acutely improved during a course of electroconvulsive therapy (ECT and was maintained on outpatient ECTs fortnightly together with 12 mg sertindol and 45 mg mirtazapine for 42 weeks. Conclusion Maintenance ECT is not an approved therapy in OCD but might be an option in pharmacotherapy refractory cases of comorbid OCD and schizophrenic/schizoaffective disorder.

  17. Actigraphy in patients with treatment-resistant depression undergoing electroconvulsive therapy.

    Science.gov (United States)

    Winkler, Dietmar; Pjrek, Edda; Lanzenberger, Rupert; Baldinger, Pia; Eitel, Daniel; Kasper, Siegfried; Frey, Richard

    2014-10-01

    Depressive disorder is frequently accompanied by changes in psychomotor activity and disturbances of the sleep-wake cycle. The chronobiological effects of electroconvulsive therapy (ECT) in patients with treatment-resistant depression (TRD) are largely unknown. The objective of the current study was to measure the influence of ECT on patients' activity and sleep. 15 patients with unipolar TRD were treated with ECT. Activity levels were measured with wrist actigraphy before and after ECT. Remission rate (score on the 17-item Hamilton Depression Rating Scale lower than 8 points) was 40.0%. Remitters had increases of 56.0% on light activity, 49.8% on total activity, and 70.2% on circadian amplitude, while there was no significant change of these variables in subjects who did not experience remission. The circadian acrophase and actigraphic sleep-parameters were not significantly affected by treatment.

  18. Individualized Anesthetic Management for Patients Undergoing Electroconvulsive Therapy: A Review of Current Practice.

    Science.gov (United States)

    Bryson, Ethan O; Aloysi, Amy S; Farber, Kate G; Kellner, Charles H

    2017-06-01

    Electroconvulsive therapy (ECT) remains an indispensable treatment for severe psychiatric illness. It is practiced extensively in the United States and around the world, yet there is little guidance for anesthesiologists involved with this common practice. Communication between the anesthesiologist and the proceduralist is particularly important for ECT, because the choice of anesthetic and management of physiologic sequelae of the therapeutic seizure can directly impact both the efficacy and safety of the treatment. In this review, we examine the literature on anesthetic management for ECT. A casual or "one-size-fits-all" approach may lead to less-than-optimal outcomes; customizing the anesthetic management for each patient is essential and can significantly increase treatment success rate and patient satisfaction.

  19. Electroconvulsive therapy-induced brain plasticity determines therapeutic outcome in mood disorders

    Science.gov (United States)

    Dukart, Juergen; Regen, Francesca; Kherif, Ferath; Colla, Michael; Bajbouj, Malek; Heuser, Isabella; Frackowiak, Richard S.; Draganski, Bogdan

    2014-01-01

    There remains much scientific, clinical, and ethical controversy concerning the use of electroconvulsive therapy (ECT) for psychiatric disorders stemming from a lack of information and knowledge about how such treatment might work, given its nonspecific and spatially unfocused nature. The mode of action of ECT has even been ascribed to a “barbaric” form of placebo effect. Here we show differential, highly specific, spatially distributed effects of ECT on regional brain structure in two populations: patients with unipolar or bipolar disorder. Unipolar and bipolar disorders respond differentially to ECT and the associated local brain-volume changes, which occur in areas previously associated with these diseases, correlate with symptom severity and the therapeutic effect. Our unique evidence shows that electrophysical therapeutic effects, although applied generally, take on regional significance through interactions with brain pathophysiology. PMID:24379394

  20. The use of electroconvulsive therapy in a cohort of forensic psychiatric patients with schizophrenia

    DEFF Research Database (Denmark)

    Kristensen, Diana; Brandt-Christensen, Anne Mette; Ockelmann, Hans Henrik;

    2012-01-01

    BACKGROUND: In Denmark, over 2500 people are in psychiatric treatment in forensic mental health services at any one time, most suffering from schizophrenia. Many of them have illnesses that are resistant to medication. There is evidence of the effectiveness of electroconvulsive therapy (ECT......) for schizophrenia, but not explicitly for this complex forensic group. AIMS: The aim of this study was to describe the outcome of using ECT as augmentation therapy in a cohort of forensic psychiatric patients with schizophrenia who were failing to respond to antipsychotic medication. METHODS: In one university......-based psychiatric clinic, data were extracted from the medical records of all patients treated with ECT during a 6-year period. Fifty-nine of these patients were diagnosed within the schizophrenia spectrum and eight were in specialist forensic hospital services. RESULTS: The mean duration of illness...

  1. Atypical Creutzfeldt-Jakob Disease Evolution after Electroconvulsive Therapy for Catatonic Depression

    Directory of Open Access Journals (Sweden)

    Iria Grande

    2011-01-01

    Full Text Available We describe a case report of an 80-year-old woman who presented with symptomatology compatible with an episode of major depression with catatonia. After psychiatric admission, electroconvulsive therapy (ECT was applied, but symptoms progressed with cognitive impairment, bradykinesia, widespread stiffness, postural tremor, and gait disturbance. After compatible magnetic resonance imaging (MRI, diffusion changes, and electroencephalogram (EEG findings the case was reoriented to Creutzfeldt-Jakob disease (CJD. The genetic study found a methionine/valine heterozygosity at codon 129 of the prion protein gene PrPSc. On followup, a significant clinical recovery turned out. For this reason, EEG and MRI were repeated and confirmed the findings. The patient subsequently demonstrated progressive clinical deterioration and died 21 months later. The diagnosis was verified postmortem by neuropathology. The vCJD subtype MV2 is indeed characterized by early and prominent psychiatric symptoms and a prolonged disease duration however no frank clinical recovery has before been reported.

  2. Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series.

    Science.gov (United States)

    Kugler, Joseph L; Hauptman, Aaron J; Collier, Samuel J; Walton, Amy E; Murthy, Smitha; Funderburg, Linda G; Garcia, Keith S

    2015-09-01

    Catatonia is a syndrome heterogeneous with regard to presentation and etiology. Electroconvulsive therapy (ECT) remains the first-line treatment for catatonia. Literature review reveals only a few published case reports on the use of right unilateral (RUL) ECT in catatonia, 1 case report on ultrabrief RUL ECT, and an absence of evidence on the relative effectiveness and tolerability of RUL versus bilateral ECT in treating catatonia. In contrast, there are multiple reports in the literature of robustly dosed bilateral ECT, often administered on consecutive days. Reasons for choosing this intervention over the better-tolerated RUL treatment include assumptions about its relative speed and/or breadth of efficacy. Here we present a case series of 13 catatonic patients treated in an academic center over the course of the last 3 years. Our experience suggests that ultrabrief RUL ECT can rapidly and effectively treat catatonia from diverse etiologies.

  3. Life-saving electroconvulsive therapy in a patient with near-lethal catatonia.

    Science.gov (United States)

    Girardi, Paolo; Rapinesi, Chiara; Cuomo, Ilaria; Kotzalidis, Giorgio D; Del Casale, Antonio; Serata, Daniele; Campi, Sandra; Caloro, Matteo; De Chiara, Lavinia; Tamorri, Stefano Maria; Scatena, Paola; Caccia, Federica; Bersani, Francesco Saverio; Carbonetti, Paolo; Vento, Alessandro; Dimitri-Valente, Giorgia; Tatarelli, Roberto; Fensore, Claudio; Ferracuti, Stefano; Angeletti, Gloria

    2012-01-01

    A young woman with bipolar I disorder and comorbid catatonia on enteral nutrition from several months, developed a form of near-lethal catatonia with weight loss, pressure sores, muscle atrophy, electrolyte imbalance, and depression of vital signs. A compulsory treatment was necessary, and informed consent was obtained from her mother for electroconvulsive therapy (ECT). After 7 ECT sessions, the patient recovered and resumed feeding. ECT may save the life of a patient with catatonia provided that legal obstacles are overcome. Clinicians should carefully evaluate patients with near-lethal catatonia, taking into account the risk of pulmonary embolism and other fatal events. The medical-legal issues, which vary across state regulations, should be addressed in detail to avoid unnecessary and potentially harmful delay in intervention.

  4. The use of electroconvulsive therapy in a patient with juvenile systemic lupus erythematosus and catatonia.

    Science.gov (United States)

    Mon, T; L'ecuyer, S; Farber, N B; White, A J; Baszis, K W; Hearn, J K; Spiegel, T E; French, A R; Kitcharoensakkul, M

    2012-12-01

    Catatonia is a rare manifestation in patients with systemic lupus erythematosus (SLE). As catatonia can be associated with both psychiatric and organic conditions, this could create a diagnostic dilemma once this occurs in SLE patients. The report describes a 15-year-old female with SLE who developed catatonia three days after the diagnosis of SLE was made. Her catatonia was refractory to the treatment with immunosuppressive therapy, which included pulse methylprednisolone, intravenous cyclophosphamide, rituximab, intravenous immunoglobulin (IVIG) and plasmapheresis. Given her persistent catatonia, electroconvulsive therapy (ECT) was initiated three months after the onset of her symptoms. After the third ECT treatment, her mental status dramatically improved and returned nearly to baseline while she was continued on the immunosuppression. This is the first report of a successful ECT therapy in catatonic lupus in children.

  5. Electroconvulsive Therapy Treatment in a Patient With Neurosyphilis and Psychotic Disorder: Case Report and Literature Review.

    Science.gov (United States)

    Pecenak, Jan; Janik, Peter; Vaseckova, Barbora; Trebulova, Kristina

    2015-12-01

    Syphilis is an infectious disease caused by Treponema pallidum that presents clinically in different ways. Over recent years, an upsurge of new cases of syphilis has been reported, often in combination with human immunodeficiency virus infection. The clinical picture is changing because of the widespread use of antibiotics, and psychiatric manifestations may be the main reason why patients seek medical help. In most cases, treatment with penicillin and psychotropic medication is effective. Electroconvulsive therapy (ECT) is rarely used for the psychiatric manifestations of neurosyphilis: we identified only 19 cases in the literature. We report here on a 40-year-old man newly diagnosed with neurosyphilis during hospitalization for a psychotic state with depression and also review the literature. He was treated with 2 courses of penicillin and several antipsychotics. The ECT was indicated because he failed to respond well to antipsychotic treatment and developed a high risk of dangerous behavior. A series of 8 sessions of ECT rapidly relieved the psychotic symptoms.

  6. Electroconvulsive stimulations prevent stress-induced morphological changes in the hippocampus

    DEFF Research Database (Denmark)

    Hageman, I; Nielsen, M; Wörtwein, Gitta

    2008-01-01

    Stress can precipitate major depression and other disorders linked to hippocampal shrinkage. It is hypothesized but not established that treatment of these disorders reverses and prevents the hippocampal changes. Dendritic retraction of individual neurons might in concert with other pathophysiolo......Stress can precipitate major depression and other disorders linked to hippocampal shrinkage. It is hypothesized but not established that treatment of these disorders reverses and prevents the hippocampal changes. Dendritic retraction of individual neurons might in concert with other...... pathophysiological events contribute to the shrinkage phenomenon. Animal studies have shown that various stress paradigms can induce dendritic retraction in the CA3 pyramidal neurons of the hippocampus. Since electroconvulsive treatment is the most effective treatment in humans with major depression, we investigated...

  7. Hypochondriacal delusion in an elderly woman recovers quickly with electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    Annemieke Dols

    2012-01-01

    Full Text Available A 72-year-old woman without any medical and psychiatric history, suffered from nausea, pain in the epigastria and constipation for over a year. She eventually lost 20 kilograms despite nightly drip-feeding. Extensive additional tests did not reveal any clues for her complaints. She remained convinced that her symptoms were a side-effect of anti-fungal medication she used. She was diagnosed with hypochondria. In the course of time her ideas about her somatic symptoms became delusional and she was diagnosed with a hypochondriacal delusion as part of melancholia, without depressed mood or loss of interest or pleasure as prominent features. It is important to recognize melancholia as soon as possible by continually evaluating other symptoms of depression. This may enable to avoid repetitive and exhaustive somatic examinations, which are not indicated, and to start effective treatment. In our patient electroconvulsive therapy resulted in a fast and complete recovery.

  8. Subdural Hematoma: An Adverse Event of Electroconvulsive Therapy—Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ranganath R. Kulkarni

    2012-01-01

    Full Text Available Electroconvulsive therapy (ECT is commonly used in the management of medication nonresponsive depressive disorder, with proven efficacy in psychiatric practice since many decades. A rare complication of intracranial bleed following this therapeutic procedure has been reported in sporadic case reports in the English literature. We report a case of such a complication in a 42-year-old male, a known case of nonorganic medication nonresponsive depressive disorder for the last two years who required ECT application. Presenting symptoms included altered mental state, urinary incontinence, and repeated episodes of vomiting; following ECT procedure with magnetic resonance imaging (MRI of the brain suggestive of bilateral acute subdural hematoma. Despite the view that it may be used in neurological conditions without raised intracranial tension, it will be worthwhile to be vigilant during post-ECT recovery for any emergent complications.

  9. Extracorporeal Shock-Wave Therapy in Treating Chronic Pelvic Pain Syndrome in Males%体外冲击波治疗在男性慢性骨盆疼痛综合征中的应用进展

    Institute of Scientific and Technical Information of China (English)

    童亮; 吕军

    2012-01-01

    Category Ⅲ prostatitis is also called chronic pelvic pain syndrome ( CPPS ), accounting for about 90% of chronic prostatitis, and studies have suggested that its age range was from 20 to 83 years, and its incidence is between 4% to 16%. The clinical manifestations of CPPS include long - term and reduplicated pelvic region pain or discomfort, and it can last for more than 3 months. Furthermore, it may be associated with some degrees of micturition symptoms and sexual dysfunction, which seriously reduced the quality of life of the patients. At present, the etiology and pathogenesis of CPPS are unclear, and there has been no standard treatments. Extracorporeal shock - wave therapy has been used clinically in treating CPPS in males and has received good clinical effects.%Ⅲ型前列腺炎又称为慢性骨盆疼痛综合征(CPPS),约占慢性前列腺炎的90%,20~83岁男性均可发病,发病率为4%~16%.临床表现为长期、反复的骨盆区域疼痛或不适,持续时间超过3个月,可伴有不同程度的排尿症状和性功能障碍,严重影响患者的生活质量.目前,CPPS的发病机制和病因尚不明确,尚没有标准的治疗方法.临床运用体外冲击波治疗男性CPPS,收到良好的临床效果.

  10. Proteomic analysis reveals significant elevation of heat shock protein 70 in patients with chronic heart failure due to arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Wei, Ying-Jie; Huang, Yin-Xia; Shen, Ya; Cui, Chuan-Jue; Zhang, Xiao-Ling; Zhang, Hao; Hu, Sheng-Shou

    2009-12-01

    As proteins are the ultimate biological determinants of phenotype of disease, we screened altered proteins associated with heart failure due to arrhythmogenic right ventricular cardiomyopathy (ARVC) to identify biomarkers potential for rapid diagnosis of heart failure. By 2-dimensional gel electrophoresis and mass spectrometry, we identified five commonly altered proteins with more than 1.5 fold changes in eight ARVC failing hearts using eight non-failing hearts as reference. Noticeably, one of the altered proteins, heat shock protein 70 (HSP70), was increased by 1.64 fold in ARVC failing hearts compared with non-failing hearts. The increase of cardiac HSP70 was further validated by Western blot, immunochemistry, and enzyme-linked immunosorbent assay (ELISA) in failing hearts due to not only ARVC, but also dilated (DCM, n = 18) and ischemic cardiomyopathy (ICM, n = 8). Serum HSP70 was also observed to be significantly increased in heart failure patients derived from the three forms of cardiomyopathies. In addition, we observed hypoxia/serum depletion stimulation induced significantly elevation of intracellular and extracellular HSP70 in cultured neonatal rat cardiomyocytes. For the first time to our knowledge, we revealed and clearly demonstrated significant up-regulation of cardiac and serum HSP70 in ARVC heart failure patients. Our results indicate that elevated HSP70 is the common feature of heart failure due to ARVC, DCM, and ICM, which suggests that HSP70 may be used as a biomarker for the presence of heart failure due to cardiomyopathies of different etiologies and may hold diagnostic/prognostic potential in clinical practice.

  11. Ribosomal genes and heat shock proteins as putative markers for chronic, sublethal heat stress in Arctic charr: applications for aquaculture and wild fish.

    Science.gov (United States)

    Quinn, Nicole L; McGowan, Colin R; Cooper, Glenn A; Koop, Ben F; Davidson, William S

    2011-09-22

    Arctic charr thrive at high densities and can live in freshwater year round, making this species especially suitable for inland, closed containment aquaculture. However, it is a cold-water salmonid, which both limits where the species can be farmed and places wild populations at particular risk to climate change. Previously, we identified genes associated with tolerance and intolerance to acute, lethal temperature stress in Arctic charr. However, there remained a need to examine the genes involved in the stress response to more realistic temperatures that could be experienced during a summer heat wave in grow-out tanks that are not artificially cooled, or under natural conditions. Here, we exposed Arctic charr to sublethal heat stress of 15-18°C for 72 h, and gill tissues extracted before, during (i.e., at 72 h), immediately after cooling and after 72 h of recovery at ambient temperature (6°C) were used for gene expression profiling by microarray and qPCR analyses. The results revealed an expected pattern for heat shock protein expression, which was highest during heat exposure, with significantly reduced expression (approaching control levels) quickly thereafter. We also found that the expression of numerous ribosomal proteins was significantly elevated immediately and 72 h after cooling, suggesting that the gill tissues were undergoing ribosome biogenesis while recovering from damage caused by heat stress. We suggest that these are candidate gene targets for the future development of genetic markers for broodstock development or for monitoring temperature stress and recovery in wild or cultured conditions.

  12. Structural-functional brain changes in depressed patients during and after electroconvulsive therapy.

    Science.gov (United States)

    Yrondi, Antoine; Péran, Patrice; Sauvaget, Anne; Schmitt, Laurent; Arbus, Christophe

    2016-11-23

    Electroconvulsive therapy (ECT) is a non-pharmacological treatment that is effective in treating severe and treatment-resistant depression. Although the efficacy of ECT has been demonstrated to treat major depressive disorder (MDD), the brain mechanisms underlying this process remain unclear. Structural-functional changes occur with the use of ECT as a treatment for depression based on magnetic resonance imaging (MRI). For this reason, we have tried to identify the changes that were identified by MRI to try to clarify some operating mechanisms of ECT. We focus to brain changes on MRI [structural MRI (sMRI), functional MRI (fMRI) and diffusion tensor imging (DTI)] after ECT. A systematic search of the international literature was performed using the bibliographic search engines PubMed and Embase. The research focused on papers published up to 30 September 2015. The following Medical Subject Headings (MESH) terms were used: electroconvulsive therapy AND (MRI OR fMRI OR DTI). Papers published in English were included. Four authors searched the database using a predefined strategy to identify potentially eligible studies. There were structural changes according to the sMRI performed before and after ECT treatment. These changes do not seem to be entirely due to oedema. This investigation assessed the functional network connectivity associated with the ECT response in MDD. ECT response reverses the relationship from negative to positive between the two pairs of networks. We found structural-functional changes in MRI post-ECT. Because of the currently limited MRI data on ECT in the literature, it is necessary to conduct further investigations using other MRI technology.

  13. A comparison of brief pulse and ultrabrief pulse electroconvulsive stimulation on rodent brain and behaviour.

    LENUS (Irish Health Repository)

    O'Donovan, Sinead

    2012-04-27

    Brief pulse electroconvulsive therapy (BP ECT; pulse width 0.5-1.5ms) is a very effective treatment for severe depression but is associated with cognitive side-effects. It has been proposed that ultrabrief pulse (UBP; pulse width 0.25-0.30ms) ECT may be as effective as BP ECT but have less cognitive effects because it is a more physiological form of neuronal stimulation. To investigate this further, we treated normal rats with a 10 session course of either BP (0.5ms), UBP (0.3ms), or sham electroconvulsive stimulation (ECS) and measured antidepressant-related changes in dentate gyrus cell proliferation and hippocampal BDNF protein levels as well as hippocampal-dependant spatial reference memory using the water plus maze and immobility time on the forced swim test. Both BP and UBP ECS induced very similar types of motor seizures. However, BP ECS but not UBP ECS treatment led to a significant, near 3-fold, increase in cell proliferation (p=0.026) and BDNF levels (p=0.01). In the forced swim test, only BP ECS treated animals had a significantly lower immobility time (p=0.046). There was a trend for similarly reduced hippocampal-dependent memory function in both BP and UBP groups but overall there was not a significant difference between treatment and control animals when tested 10 days after completing allocated treatment. These findings show that, even though both forms of ECS elicited similar motor seizures, UBP ECS was less efficient than BP ECS in inducing antidepressant-related molecular, cellular and behavioural changes.

  14. Electroconvulsive Therapy Under General Anesthesia With Cisatracurium, Laryngeal Mask Airways, and Bispectral Index.

    Science.gov (United States)

    Liu, Cai-Cai; Qian, Xiao-Yan; An, Jian-Xiong; Yu, Zeng-Lei; Wu, Jian-Ping; Wen, Hui; Cao, Zong-Xin; Wang, Yong; Fang, Qi-Wu; Williams, John P

    2016-03-01

    Electroconvulsive therapy (ECT) has dramatically reduced musculoskeletal complications when carried out with muscle relaxants under general anesthesia. However, seizure quality can be affected by the depth of anesthesia and choice of anesthetic agent. The purpose of this study was to describe a general anesthetic technique for ECT by using laryngeal mask, bispectral index (BIS), and muscle relaxant monitoring. Twenty-one patients, between ages 18 and 70 years (American Society of Anesthesiologists physical status I-III), who underwent a total of 89 sessions of ECT were examined in a retrospective study. Anesthesia was induced by use of propofol (1.0 mg/kg) followed by cisatracurium (0.2 mg/kg). The BIS, train-of-four, and end-tidal carbon dioxide were all monitored continuously. A laryngeal mask airway was used to maintain and protect the airway during the procedure. Electroconvulsive therapy stimuli were applied bilaterally when the train-of-four was assessed as being zero and BIS scores were 70. All patients then received 5 μg sufentanil and 2 mg midazolam, while titrated to maintain the BIS value at 40 to 50, before the muscle relaxation exhibited complete recovery. The mean duration of treatment process takes approximately 82.5 minutes. Mean (SD) seizure length was 58.8 (28.3) seconds, with 4.5% incidence of restimulation per treatment. Incidence of awareness was 0%. No patients exhibited delirium, nausea, vomiting, or myalgia in the postseizure phase. Bispectral index monitoring of the depth of anesthesia may have improved seizure quality, and awareness did not occur.

  15. [Cardiac safety of electroconvulsive therapy in an elderly patient--a case report].

    Science.gov (United States)

    Karakuła-Juchnowicz, Hanna; Próchnicki, Michał; Kiciński, Paweł; Olajossy, Marcin; Pelczarska-Jamroga, Agnieszka; Dzikowski, Michał; Jaroszyński, Andrzej

    2015-10-01

    Since electroconvulsive therapy (ECT) was introduced as treatment for psychiatric disorders in 1938, it has remained one of the most effective therapeutic methods. ECT is often used as a "treatment of last resort" when other methods fail, and a life-saving procedure in acute clinical states when a rapid therapeutic effect is needed. Mortality associated with ECT is lower, compared to the treatment with tricyclic antidepressants, and comparable to that observed in so-called minor surgery. In the literature, cases of effective and safe electroconvulsive therapy have been described in patients of advanced age, with a burden of many somatic disorders. However, cases of acute cardiac episodes have also been reported during ECT. The qualification of patients for ECT and the selection of a group of patients at the highest risk of cardiovascular complications remains a serious clinical problem. An assessment of the predictive value of parameters of standard electrocardiogram (ECG), which is a simple, cheap and easily available procedure, deserves special attention. This paper reports a case of a 74-year-old male patient treated with ECT for a severe depressive episode, in the context of cardiologic safety. Both every single ECT session and the full course were assessed to examine their impact on levels of troponin T, which is a basic marker of cardiac damage, and selected ECG parameters (QTc, QRS). In the presented case ECT demonstrated its high general and cardiac safety with no negative effect on cardiac troponin (TnT) levels, corrected QT interval (QTc) duration, or other measured ECG parameters despite initially increased troponin levels, the patient's advanced age, the burden of a severe somatic disease and its treatment (anticancer therapy). © 2015 MEDPRESS.

  16. Unilateral brief-pulse electroconvulsive therapy and cognition: Effects of electrode placement, stimulus dosage and time.

    LENUS (Irish Health Repository)

    Semkovska, Maria

    2010-11-23

    To clarify advantages of unilateral electrode placement as an optimisation technique for electroconvulsive therapy (ECT) for depression, aims were to meta-analyse unilateral ECT effects on cognitive performance relative to: (1) bitemporal electrode placement, (2) electrical dosage, and (3) time interval between final treatment and cognitive reassessment. Relevant electronic databases were systematically searched through May 2009, using the terms: "electroconvulsive therapy" and ["cogniti∗", "neuropsycholog∗", "memory", "attention", "executive", "spatial", or "intellectual"]. Inclusion criteria were: independent study of depressed patients receiving unilateral or bitemporal brief-pulse ECT; within-subjects design; use of objective cognitive assessments; available mean electrical dosage for unilateral samples. Standardized pre-post ECT weighted effect sizes were computed and pooled within 16 cognitive domains by a mixed-effects model. Thirty-nine studies (1415 patients) were meta-analysed. Up to three days after final treatment, unilateral ECT was associated with significantly smaller decreases in global cognition, delayed verbal memory retrieval, and autobiographical memory, compared to bitemporal ECT. Significant publication bias was found for autobiographical memory, favouring reporting of larger percentage loss. Higher unilateral ECT electrical dosage predicted larger decreases in verbal learning, delayed verbal memory retrieval, visual recognition, and semantic memory retrieval. When retested more than three days after completing ECT, no significant differences remained between the two electrode placements; for unilateral ECT, electrical dosage no longer predicted cognitive performance whereas increasing interval between final treatment and retesting predicted growing improvement in some variables. This interval is a more useful long-term predictor of cognitive function than electrode placement or electrical dosage following unilateral ECT.

  17. Chronic smoke exposure induces rheumatoid factor and anti-heat shock protein 70 autoantibodies in susceptible mice and humans with lung disease.

    Science.gov (United States)

    Newkirk, Marianna M; Mitchell, Simeon; Procino, Michael; Li, Zhenhong; Cosio, Manuel; Mazur, Witold; Kinnula, Vuokko L; Hudson, Marie; Baron, Murray; Fritzler, Marvin J; El-Gabalawy, Hani S

    2012-04-01

    The impact of cigarette smoke (CS), a risk factor for rheumatoid arthritis (RA), on sauto-antibody production was studied in humans and mice with and without chronic lung disease (LD). Rheumatoid factor (RF), anti-cyclic citrullinated peptides (CCPs), and anti-HSP70 autoantibodies were measured in several mouse strains and in cohorts of smokers and nonsmokers with and without autoimmune disease. Chronic smoking-induced RFs in AKR/J mice, which are most susceptible to LD. RFs were identified in human smokers, preferentially in those with LD. Anti-HSP70 auto-antibodies were identified in CS-exposed AKR/J mice but not in ambient air exposed AKR/J controls. Whereas inflammation could induce anti-HSP70 IgM, smoke exposure promoted the switch to anti-HSP70 IgG autoantibodies. Elevated anti-CCP autoantibodies were not detected in CS-exposed mice or smokers. AKR/J splenocytes stimulated in vitro by immune complexes (ICs) of HSP70/anti-HSP70 antibodies produced RFs. The CD91 scavenger pathway was required as anti-CD91 blocked the HSP70-IC-induced RF response. Blocking Toll-like receptors did not influence the HSP70-IC-induced RFs. These studies identify both anti-HSP70 and RFs as serological markers of smoke-related LD in humans and mice. Identification of these autoantibodies could suggest a common environmental insult, namely CS, in a number of different disease settings. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Maintenance of recovery from severe psychotic depression following successful electroconvulsive therapy in an elderly patient with “natural support”

    Directory of Open Access Journals (Sweden)

    Mohiuddin Ahmed, PhD

    2014-09-01

    Full Text Available This is a case report of an elderly man who recovered fully from an extreme regressed level of functioning associated with psychotic depression after successful treatment with electroconvulsive therapy. He has maintained his “recovery status” without any drugs, follow-up electroconvulsive therapy, or psychotherapy by his own choice for more than five years. This case illustrates the need for the judicious use of psychiatric intervention and the willingness of the psychiatric community to encourage the maintenance of a patient's recovered functioning with “natural support,” specifically for people who value personal independence, have a strong motivation to stay well, have strong family support, and have “a good monitoring process.”

  19. Effect of Electroconvulsive Therapy on Cognitive Functions of Rats with Depression-Like Disorders Induced by Ultrasound Exposure.

    Science.gov (United States)

    Ushakova, V M; Zubkov, E A; Morozova, A Y; Gorlova, A V; Pavlov, D A; Inozemtsev, A N; Chekhonin, V P

    2017-09-01

    We studied the effect of electroconvulsive therapy on cognitive functions in rats with depression-like disorder caused by exposure to ultrasound of varying frequency (20-45 kHz). Object recognition and Morris water-maze tests revealed no negative effects of the therapy on memory. Moreover, positive effect of therapy was demonstrated that manifested in amelioration of memory disturbances in depression-like disorders in these behavioral tests. The results of this study do not support the idea about side effects of electroconvulsive therapy, in particular, development of transient amnesia, and are a prerequisite for a more thorough study of internal mechanisms of the effect of the therapy on cognitive sphere.

  20. Effectiveness of Electroconvulsive Therapy for Depression and Cotard’s Syndrome in a Patient with Frontotemporal Lobe Dementia

    Directory of Open Access Journals (Sweden)

    Toshiyuki Kobayashi

    2012-01-01

    Full Text Available In the field of psychogeriatrics, the differential diagnosis of depression and dementia, as well as the treatment of depression and comorbid dementia, is an important issue. In this paper, the authors present the case of a 72-year-old woman with Cotard’s syndrome and frontotemporal dementia (FTD who was admitted to a psychiatric hospital with delusions of negation accompanied by depressive symptoms. Pharmacotherapy over a 2-year hospitalization was unsuccessful, and she was subsequently transferred to our university hospital. A total of 18 sessions of electroconvulsive therapy released her from psychomotor inhibition, appetite loss, and Cotard’s delusions. The indication for electroconvulsive therapy in patients with dementia is discussed.

  1. Treatment resistant non-catatonic mutism in schizophrenia responding to a combination of continuation electroconvulsive therapy and neuroleptics

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2012-01-01

    Full Text Available Non-catatonic mutism in schizophrenia has been described less frequently in literature. We describe the case of a young male who presented with non-catatonic mutism, secondary to first rank symptoms, which was refractory to adequate antipsychotic trials (quetiapine, risperidone, aripiprazole, ziprasidone, and trifluperazine and responded to a combination of electroconvulsive therapy (ECT and neuroleptics partially. However, when the ECT was continued in the continuation phase, the patient started speaking.

  2. A case of catatonia in a 14-year-old girl with schizophrenia treated with electroconvulsive therapy.

    Science.gov (United States)

    Häßler, Frank; Reis, Olaf; Weirich, Steffen; Höppner, Jacqueline; Pohl, Birgit; Buchmann, Johannes

    2013-01-01

    This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

  3. 体外冲击波治疗ⅢB型前列腺炎疗效的Meta分析%Efficacy of extracorporeal shock wave therapy on chronic prostatitisⅢB:Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    葛劲超; 朱进

    2015-01-01

    Objective:To assess the effcacy of extracorporeal shock wave therapy (ESWT) on chronic prostatitisⅢB, and evaluate the quality of the literatures. Methods:We retrieved all the case-control studies on ESWT for chronic prostatitisⅢB between January 1996 to May 2015 in National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, EMbase, and Cochrane database, screened the eligible literature according to the selection and exclusion criteria, and performed meta-analyses of the included studies with the software Revman 5.1. Results:Eight eligible reports were identiifed in this study, including 323 cases and 269 controls. Meta-analysis showed a signiifcant difference on overall effectiveness between the ESWT and control groups (OR=18.32, 95%CI:4.13~81.33, Z=3.82, P=0.0001). Also, there is a significant difference of symptom score between the two groups (WMD=–5.08, 95%CI:–6.89~–3.28, Z=5.52, P<0.00001). Conclusion:ESWT exhibited a deifnite effect for the treatment of chronic prostatitisⅢB.%目的:评价体外冲击波治疗(extracorporeal shock wave therapy,ESWT)治疗ⅢB型前列腺炎的临床有效性,并对临床文献进行质量评价。方法:检索1996年1月至2015年5月中国知网(National Knowledge Infrastructure,CNKI)、万方、PubMed、EMbase、Cochrane Library数据库中有ESWT治疗ⅢB型前列腺炎对照研究的RCT文献,根据纳入和排出标准,筛选合适文献,并用RevMan 5.1软件进行统计分析。结果:共有8篇文献符合纳入标准,共计592例患者,其中治疗组323例,对照组269例。ESWT治疗ⅢB型前列腺炎的总有效率显著高于对照组(OR=18.32,95% CI:4.13~81.33,Z=3.82, P=0.0001)。二者治疗后症状积分相比,差异有显著性,(WMD=–5.08,95% CI:–6.89~–3.28, Z=5.52,P<0.00001)。结论:ESWT治疗ⅢB型前列腺炎的疗效确切,是治疗ⅢB型前列腺炎的有效方法之一。

  4. Is there a decline in cognitive functions after combined electroconvulsive therapy and antipsychotic therapy in treatment-refractory schizophrenia?

    Science.gov (United States)

    Pawełczyk, Agnieszka; Kołodziej-Kowalska, Emilia; Pawełczyk, Tomasz; Rabe-Jabłońska, Jolanta

    2015-03-01

    An analysis of literature shows that there is still little evidence concerning the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic therapy in a group of treatment-resistant schizophrenia patients. More precisely, its influence on cognitive functions is still equivocal. The aim of this study was to assess the influence of ECT combined with antipsychotic therapy on working memory, attention, and executive functions in a group of treatment-refractory schizophrenia patients. Twenty-seven patients completed the study: 14 men and 13 women, aged 21 to 55 years (mean age, 32.8 years), diagnosed with treatment-resistant schizophrenia. Each patient underwent a course of ECT sessions and was treated with antipsychotic medications. Before the ECT and within 3 days after the last ECT session, the participants were assessed with the following neuropsychological tests: Trail Making Test (TMT) and Wisconsin Cart Sorting Test (WCST). There were no significant differences in the TMT and WCST results after combined ECT and antipsychotic therapy in treatment-refractory schizophrenia patients. According to the results of the neuropsychological tests, there was no decline in attention, executive functions, or working memory. The current study shows no significant difference in attention, working memory, or executive functions after treatment with a combination of electroconvulsive and antipsychotic therapy. This suggests that combined electroconvulsive therapy may not have a negative influence on the neuropsychological functioning of patients with treatment resistant schizophrenia.

  5. Relationship between dust exposure and chronic obstructive pulmonary diseases and heat shock protein 72 and 73 in lymphocytes among coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Xing J.C.; Chen W.H.; Wang F.; Han W.H.; Ren H.M; ; Wu T.C. [Huazhong University of Science and Technology, Wuhan (China). MOE Key Laboratory of Environmental Health, School of Public Health

    2006-09-15

    To assess the expression of Hsp72 and Hsp73 in chronic obstructive pulmonary disease (COPD) and to evaluate their roles in damage from coal dust exposure. A case control study of 50 coal miners suffering from COPD and 50 healthy coal miners were selected from one coal mine. The levels of Hsp72 and Hsp73 in peripheral blood lymphocytes were determined by flow cytometry for all subjects. The expression of basic Hsp72 of peripheral blood lymphocytes for patients and controls was not different from that inducible expressed Hsp72 by 42 degrees C heat stress or by BPDE exposure. (2) The expression of Hsp72 in COPD patients was significantly lower than that in healthy coal miners. On the other hand, the expression of Hsp73 in COPD patients was higher than that in healthy coal miners. (3) A-positive relationship between the expression of Hsp72 and cumulative inhaling coal dust exposure was observed. No relationship was found between Hsp73 and cumulative inhaling coal dust exposure. The decreased expressions of Hsp72 in peripheral blood lymphocytes of COPD coal miners.

  6. Time course and duration of changes in Kv7.2 and Kv11.1 mRNA expression in the hippocampus and piriform cortex following electroconvulsive stimulations

    DEFF Research Database (Denmark)

    Hjaeresen, Marie-Louise; Hageman, Ida; Wortwein, Gitta

    2012-01-01

    A minimum of six electroconvulsive therapy (ECT) treatments has to be delivered to achieve sustained improvement in major depression. However, the mechanisms of the therapeutic actions of ECT are still debated.......A minimum of six electroconvulsive therapy (ECT) treatments has to be delivered to achieve sustained improvement in major depression. However, the mechanisms of the therapeutic actions of ECT are still debated....

  7. Extracorporeal Shock Wave Therapy for Nonunion of the Tibia

    Science.gov (United States)

    2010-03-01

    Zoellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orrhop Relar Res. 200...I ;387:72-82. 26. Wang CJ, Yang KD, Wang FS. ct al. Shock wave therapy for culcific tendinitis of the shoulder: a prospective clinical study with...Selvi E, ct al. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Ann Rheum Dis. 2(K13;62:248

  8. Collisionless electrostatic shocks

    DEFF Research Database (Denmark)

    Andersen, H.K.; Andersen, S.A.; Jensen, Vagn Orla

    1970-01-01

    An attempt was made in the laboratory to observe the standing collisionless electrostatic shocks in connection with the bow shock of the earth......An attempt was made in the laboratory to observe the standing collisionless electrostatic shocks in connection with the bow shock of the earth...

  9. Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.

    Science.gov (United States)

    Shelef, Assaf; Mazeh, Doron; Berger, Uri; Baruch, Yehuda; Barak, Yoram

    2015-06-01

    Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days. A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT. Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01). Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.

  10. Patient with Takayasu arteritis presented as cardiogenic shock.

    Science.gov (United States)

    Tacoy, Gulten; Akyel, Ahmet; Tavil, Yusuf; Cengel, Atiye

    2010-11-01

    Takayasu arteritis is a chronic inflammatory disease involving the aorta, its main branches and affects particularly young women. Symptomatic coronary artery disease and cardiogenic shock are rare signs of Takayasu arteritis. We describe a 47-year-old male patient in whom cardiogenic shock was the initial presentation of Takayasu arteritis with coronary, subclavian, celiac and total abdominal aortic occlusion.

  11. Geometrical shock dynamics for magnetohydrodynamic fast shocks

    KAUST Repository

    Mostert, W.

    2016-12-12

    We describe a formulation of two-dimensional geometrical shock dynamics (GSD) suitable for ideal magnetohydrodynamic (MHD) fast shocks under magnetic fields of general strength and orientation. The resulting area–Mach-number–shock-angle relation is then incorporated into a numerical method using pseudospectral differentiation. The MHD-GSD model is verified by comparison with results from nonlinear finite-volume solution of the complete ideal MHD equations applied to a shock implosion flow in the presence of an oblique and spatially varying magnetic field ahead of the shock. Results from application of the MHD-GSD equations to the stability of fast MHD shocks in two dimensions are presented. It is shown that the time to formation of triple points for both perturbed MHD and gas-dynamic shocks increases as (Formula presented.), where (Formula presented.) is a measure of the initial Mach-number perturbation. Symmetry breaking in the MHD case is demonstrated. In cylindrical converging geometry, in the presence of an azimuthal field produced by a line current, the MHD shock behaves in the mean as in Pullin et al. (Phys. Fluids, vol. 26, 2014, 097103), but suffers a greater relative pressure fluctuation along the shock than the gas-dynamic shock. © 2016 Cambridge University Press

  12. Radiative Shock Waves In Emerging Shocks

    Science.gov (United States)

    Drake, R. Paul; Doss, F.; Visco, A.

    2011-05-01

    In laboratory experiments we produce radiative shock waves having dense, thin shells. These shocks are similar to shocks emerging from optically thick environments in astrophysics in that they are strongly radiative with optically thick shocked layers and optically thin or intermediate downstream layers through which radiation readily escapes. Examples include shocks breaking out of a Type II supernova (SN) and the radiative reverse shock during the early phases of the SN remnant produced by a red supergiant star. We produce these shocks by driving a low-Z plasma piston (Be) at > 100 km/s into Xe gas at 1.1 atm. pressure. The shocked Xe collapses to > 20 times its initial density. Measurements of structure by radiography and temperature by several methods confirm that the shock wave is strongly radiative. We observe small-scale perturbations in the post-shock layer, modulating the shock and material interfaces. We describe a variation of the Vishniac instability theory of decelerating shocks and an analysis of associated scaling relations to account for the growth of these perturbations, identify how they scale to astrophysical systems such as SN 1993J, and consider possible future experiments. Collaborators in this work have included H.F. Robey, J.P. Hughes, C.C. Kuranz, C.M. Huntington, S.H. Glenzer, T. Doeppner, D.H. Froula, M.J. Grosskopf, and D.C. Marion ________________________________ * Supported by the US DOE NNSA under the Predictive Sci. Academic Alliance Program by grant DE-FC52-08NA28616, the Stewardship Sci. Academic Alliances program by grant DE-FG52-04NA00064, and the Nat. Laser User Facility by grant DE-FG03-00SF22021.

  13. Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression

    Directory of Open Access Journals (Sweden)

    Tominaga K

    2011-07-01

    Full Text Available Keiichiro Tominaga¹, Mioto Okazaki¹, Hisashi Higuchi¹, Itaru Utagawa¹, Etsuko Nakamura², Noboru Yamaguchi¹¹Department of Neuropsychiatry, St Marianna University School of Medicine, Miyamae-ku, Kawasaki City, Kanagawa, ²Tsurukawa Sanatorium Hospital, Machida City, Tokyo, JapanBackground: Electroconvulsive therapy (ECT has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression.Methods: This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores.Results: The mean pretreatment factor 2 score for responders (n = 7 was significantly lower than that for nonresponders (n = 11. Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and

  14. Balance and gait in older electroconvulsive therapy recipients: a pilot study

    Directory of Open Access Journals (Sweden)

    Plakiotis C

    2013-06-01

    Full Text Available Chris Plakiotis,1,2 Fay Barson,2 Bharathi Vengadasalam,3 Terry P Haines,4 Daniel W O'Connor1,2 1School of Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia; 2MonashHealth, Melbourne, VIC, Australia; 3Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 4Allied Health Research Unit, Monash University and MonashHealth, Melbourne, VIC, Australia Background: Electroconvulsive therapy (ECT is commonly used to treat depression in older adults. Despite its efficacy in this regard, an associated increase in the risk of falls in this population is a downside of treatment. ECT research has focused on the incidence of falls, but its effect on balance and gait – intrinsic factors in instability and falls – has not been studied. Our aim was to examine changes in balance and gait among older adults before and after a single ECT session and explore the effect of patient-related and treatment factors on any changes found. Methods: Participants were 21 older adults requiring ECT for depression in public psychiatric services. Patients with clinically overt mobility problems (impairing test participation or increasing the risk of falls were excluded. Balance and gait testing 1 hour pre-ECT and 1, 2 and 3 hours post-ECT included: (1 steady standing test; (2 perturbation of standing balance by self-initiated movements; (3 perturbation of standing balance by an external perturbation; and (4 timed up and go test. Results: No deterioration in test performance was found, using one-way repeated measures analysis of variance. Conclusion: Balance and gait did not deteriorate immediately after ECT. Exclusion of participants with clinically overt mobility problems and falls being better attributable to factors unrelated to balance and gait (such as post-ECT confusion may account for our findings. This research does not repudiate the occurrence of ECT-related falls but calls into question the utility of introducing routine balance and gait

  15. 电休克治疗导致认知功能损害的研究进展%Research progress of cognitive impairment caused by electro-convulsive therapy

    Institute of Scientific and Technical Information of China (English)

    赵荣江

    2015-01-01

    Electroconvulsive therapy (ECT ) is a psychiatric treatment in w hich certain amount of electric current passing patient’s head cause generalized convul‐sion so as to achieve the purpose of treating diseases .Its therapeutic action has been widely recognized , but it also caused some adverse reactions ,cognitive impairment is the most common adverse reaction and the severity and duration of cognitive impairment is related to electric shock parameters and individual difference .The main manifestations of cognitive impairments caused by ECT were short‐term disorienta‐tion and dysmnesia ,it also has different influence on intelligence .%电休克治疗是以一定量电流通过患者头部,导致全身抽搐,从而达到治疗疾病的目的。其治疗作用已经得到广泛认可,但同时也引起了一定的不良反应,其中最常见的是认知功能损害,该不良反应的程度和持续时间与电休克所应用的参数和患者个体差异有关,所致认知功能损害主要表现为短期定向力障碍和记忆障碍,另外对智力也有不同程度的影响。

  16. Prolonged induction of c-fos in neuropeptide Y- and somatostatin-immunoreactive neurons of the rat dentate gyrus after electroconvulsive stimulation

    DEFF Research Database (Denmark)

    Woldbye, D P; Greisen, M H; Bolwig, T G

    1996-01-01

    Induction of c-fos mRNA and Fos was studied in the hilus and granular layer of the dentate gyrus at various times up to 24 h after single electroconvulsive stimulation (ECS) using in situ hybridization and immunocytochemistry. In both areas of the dentate gyrus, a prominent induction of c-fos m....... The Fos-immunoreactive NPY or SS neurons only amounted to about 50% of the total hilar population of NPY or SS neurons. The present observations suggest that a subpopulation of hilar NPY and SS neurons may be central to the actions of electroconvulsive seizures in the dentate gyrus....

  17. Use of rocuronium-sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy.

    Science.gov (United States)

    Hoshi, Hiroko; Kadoi, Yuji; Kamiyama, Jiro; Nishida, Akiko; Saito, Hiroyuki; Taguchi, Masaki; Saito, Shigeru

    2011-04-01

    We compared the recovery time from neuromuscular blockade induced by rocuronium combined with sugammadex versus succinylcholine during electroconvulsive therapy (ECT). Anesthesia was induced using propofol, followed by succinylcholine (1 mg/kg) or rocuronium (0.6 mg/kg). Immediately after the seizure stopped, 16 mg/kg sugammadex was infused. Neuromuscular monitoring was performed and continued until recovery of the train-of-four ratio to 0.9. We compared the recovery time of T1 to 10 and 90% between groups. Patients were also assessed for clinical signs, such as time to first spontaneous breath from the administration of muscle relaxant and eye opening to verbal commands. Although recovery time of T1 to 10 and 90% in the rocuronium-sugammadex group was shorter than in the succinylcholine group, the difference was not statistically significant. Further, the seizure duration with succinylcholine (33 ± 8 s) was shorter than that with rocuronium-sugammadex (39 ± 4 s). In conclusion, this study demonstrates the potential benefit of use of rocuronium-sugammadex as an alternative to succinylcholine for muscle relaxation during ECT.

  18. Predictive value of Pre-treatment Amygdala volume for Electroconvulsive Therapy Response in Severely Depressed Patients

    Directory of Open Access Journals (Sweden)

    Freek eTen Doesschate

    2014-11-01

    Full Text Available Background Electroconvulsive therapy (ECT is an effective treatment for patients with severe depression. Knowledge on factors predicting therapeutic response may help to identify patients who will benefit most from the intervention. Based on the neuroplasticity hypothesis, volumes of the amygdala and hippocampus are possible candidates for predicting treatment outcome. Therefore, this prospective cohort study examines the predictive value of amygdala and hippocampal volumes for the effectiveness of ECT.Methods Prior to ECT, 53 severely unipolar depressed patients (mean age 57±14 years; 40% [n=21] male received structural magnetic resonance imaging at 1.5 Tesla. Normalized amygdala and hippocampal volumes were calculated based on automatic segmentation by FreeSurfer. Regression analyses were used to test if the normalized volumes could predict the response to a course of ECT, based on the Montgomery-Åsberg Depression Rating Scale (MADRS scores. ResultsA larger amygdala volume independently and significantly predicted a lower post-ECT MADRS score (β = -0.347, P=0.013. The left amygdala volume had greater predictive value for treatment outcome relative to the right amygdala volume. Hippocampal volume had no independent predictive value.Conclusion A larger pretreatment amygdala volume predicted more effective ECT, independent of other known predictors. Almost all patients continued their medication during the study, which might have influenced the course of treatment in ways that were not taken into account.

  19. Changes in Heart Rate Variability of Depressed Patients after Electroconvulsive Therapy

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    Erica B. Royster

    2012-01-01

    Full Text Available Objective. As few, small studies have examined the impact of electroconvulsive therapy (ECT upon the heart rate variability of patients with major depressive disorder (MDD, we sought to confirm whether ECT-associated improvement in depressive symptoms would be associated with increases in HRV linear and nonlinear parameters. Methods. After providing consent, depressed study participants (n=21 completed the Beck Depression Index (BDI, and 15-minute Holter monitor recordings, prior to their 1st and 6th ECT treatments. Holter recordings were analyzed for certain HRV indices: root mean square of successive differences (RMSSD, low-frequency component (LF/high-frequency component (HF and short-(SD1 versus long-term (SD2 HRV ratios. Results. There were no significant differences in the HRV indices of RMSDD, LF/HF, and SD1/SD2 between the patients who responded, and those who did not, to ECT. Conclusion. In the short term, there appear to be no significant improvement in HRV in ECT-treated patients whose depressive symptoms respond versus those who do not. Future studies will reveal whether diminished depressive symptoms with ECT are reliably associated with improved sympathetic/parasympathetic balance over the long-term, and whether acute changes in sympathetic/parasympathetic balance predict improved mental- and cardiac-related outcomes.

  20. An Investigation of Patient Preferences for Music Played Before Electroconvulsive Therapy.

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    Graff, Veena; Wingfield, Peter; Adams, David; Rabinowitz, Terry

    2016-09-01

    Patients often feel anxious before electroconvulsive therapy (ECT), which can lead to avoidance of treatments. Music is a noninvasive safe option to reduce anxiety in the preoperative setting. Therefore, we examined patients' preferences of listening to music while receiving ECT by providing music-by way of headphones or speakers-to participants before treatment. Patients receiving ECT were recruited for this study. Patients served as their own controls in 3 separate music intervention sessions: 1) randomization to music via headphones or speakers, 2) no music, 3) the remaining music intervention. Patients completed a questionnaire related to satisfaction and preferences of music being played before ECT. Patients received a final questionnaire at the end of the study asking which intervention they preferred. Thirty patients completed the study. Ninety percent enjoyed listening to music through speakers. Eighty percent liked listening to music through headphones. Seventeen percent preferred not having any music. The difference in preference between speakers and headphones was not significant (P = 0.563; McNemar-Bowker test). There was no association between preference at the end of the study and the initial assignment of speakers or headphones (P = 0.542 and P = 0.752, respectively; Pearson χ tests). No adverse events were reported. Music is a low-cost intervention with virtually no side effects that could be offered as an adjunctive therapy for patients receiving ECT. A significant proportion of patients liked hearing music before treatment.

  1. Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia

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    Isil Gogcegoz Gul

    2014-08-01

    Full Text Available Background : Electroconvulsive therapy (ECT has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective : The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods : In this retrospective analysis, schizophrenia patients (n = 73 were defined in three groups such as patients who received only AP treatment (only AP, patients who received acute ECT only during hospitalization (aECT+AP, patients who received acute ECT and continuation ECT (a-cECT+AP. Three groups were compared according to positive and negative syndrome scale (PANSS and Brief Psychiatric Rating Scale (BPRS scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion : Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse.

  2. Stimulation strength and focality of electroconvulsive therapy and magnetic seizure therapy in a realistic head model.

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    Lee, Won Hee; Lisanby, Sarah H; Laine, Andrew F; Peterchev, Angel V

    2014-01-01

    This study examines the characteristics of the electric field (E-field) induced in the brain by electroconvulsive therapy (ECT) and magnetic seizure therapy (MST). The electric field induced by five ECT electrode configurations (bilateral, bifrontal, right unilateral, focal electrically administered seizure therapy, and frontomedial) as well as an MST coil configuration (circular) was computed in an anatomically realistic finite element model of the human head. We computed the maps of the electric field strength relative to an estimated neural activation threshold, and used them to evaluate the stimulation strength and focality of the various ECT and MST paradigms. The results show that the median ECT stimulation strength in the brain is 3-11 times higher than that for MST, and that the stimulated brain volume is substantially higher with ECT (47-100%) than with MST (21%). Our study provides insight into the observed reduction of cognitive side effects in MST compared to ECT, and supports arguments for lowering ECT current amplitude as a means of curbing its side effects.

  3. Knowledge of and attitudes toward electroconvulsive therapy among medical students, psychology students, and the general public.

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    Aki, Ozlem Erden; Ak, Sertac; Sonmez, Yunus Emre; Demir, Basaran

    2013-03-01

    Electroconvulsive therapy (ECT) is safe and effective for the treatment of various psychiatric disorders. Despite being a well-known treatment method among health care professionals, lay people generally have a negative opinion of ECT. The present study aimed to examine knowledge of and attitudes toward ECT among medical students, psychology students, and the general public. Psychology students were included because they are among the important groups in mental health care in Turkey. A Likert-type questionnaire was administered to fifth-year medical students (n = 28), master of science and doctor of philosophy clinical psychology students (n = 35), and a sample of the general public (n = 26). The questionnaire included questions about the general principles of and indications for ECT, and sources of knowledge of and attitudes toward ECT. The medical students were the most knowledgeable about ECT, as expected. The medical students also had a more positive attitude toward ECT than the other 2 groups. More psychology students had negative attitudes on some aspects than general public sample, despite being more knowledgeable. Medical school theoretical and practical training in ECT played an important role in increasing the level of knowledge of and decreasing the prevalence of negative attitudes toward ECT among the medical students; similar training for psychology students is required to achieve similar results.

  4. Efficacy of Electroconvulsive Therapy in Treatment Resistant Schizophreinia : A double-blind study.

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    Goswami, Utpal; Kumar, Unnati; Singh, Baljit

    2003-01-01

    ECT, though not favoured in the West for treating schizophrenia, is regularly practiced in India for this indication, particularly in poorly responding/treatment resistant cases.Therefore, its role in treatment-resistant schizophrenia is a subject of systematic investigation. To compare the effectiveness and safety of Electroconvulsive therapy (ECT) in a group of treatment-resistant schizophrenia patients with a control group. Eligible and consenting patients were randomly allocated to the ECT or Sham ECT groups. Both received antipsychotic drugs.Twenty-five patients completed the study (ECT, n= IS; Sham ECT, n= 10).The study was conducted in a double-blind manner. Clinical change was assessed weekly with BPRS, CGI and adverse event measures.ANOVA for repeated measures and other post-hoc comparisons were used for data analysis. ECT treated patients improved significantly over successive weeks (p< 0.002) after 6 ECTs, whereas the group receiving sham-ECT did not In both the groups, however, CGI scores did not change significantly, suggesting a dissociated response pattern. ECT was associated with greater relief among carers and lower rehospitalization. ECT augmentation may well have a significant impact on the clinical course of patients with treatment resistance schizophrenia. It is unclear, but possible, that these changes may be reinforced and maintained by maintenance ECTs. Replication of the present investigation and further studies on maintenance ECT would be rewarding.

  5. Pattern of electroconvulsive therapy use in Spain: Proposals for an optimal practice and equitable access.

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    Sanz-Fuentenebro, Javier; Vera, Ignacio; Verdura, Ernesto; Urretavizcaya, Mikel; Martínez-Amorós, Erika; Soria, Virginia; Bernardo, Miquel

    The main aims of our study were to estimate the current rates and pattern of electroconvulsive therapy (ECT) use in Spain, as well as exploring the causes that may be limiting its use in our country. A cross-sectional survey was conducted covering every psychiatric unit in Spain as of 31 December 2012. More than half (54.9%) of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. There are wide variations with regard to ECT application rates between the different autonomous communities (0.00-1.39) and provinces (0.00-3.90). ECT was prescribed to a mean of 25.5 patients per hospital that used the technique and 4.5 in referral centre (P=.000), but wide differences were reported in the number of patients who were prescribed ECT from hospital to hospital. Although the percentage of psychiatric units applying ECT in our country is among the highest in the world, the ECT application rate in Spain is among the lowest within western countries. Large differences in ECT use have been reported across the various autonomous communities, provinces and hospitals. Thus, health planning strategies need to be implemented, as well as promoting training in ECT among health professionals, if these differences in ECT use are to be reduced. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression

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    Nordanskog, P; Larsson, M R; Larsson, E-M; Johanson, A

    2014-01-01

    Objective In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome. Method Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery–Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI. Results Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT. Conclusion The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome. PMID:23745780

  7. Changes in interleukin-6 levels during electroconvulsive therapy may reflect the therapeutic response in major depression.

    Science.gov (United States)

    Järventausta, K; Sorri, A; Kampman, O; Björkqvist, M; Tuohimaa, K; Hämäläinen, M; Moilanen, E; Leinonen, E; Peltola, J; Lehtimäki, K

    2017-01-01

    Interleukin-6 (IL-6) has been reported to be elevated in major depressive disorder (MDD) but decreased by antidepressive medication. IL-6 levels are markedly elevated both after epileptic seizures and single electroconvulsive therapy (ECT) session, but long-term changes in IL-6 levels after ECT have not been studied. The correlation between immediate and long-term changes in proinflammatory cytokines and outcome after ECT was investigated. Thirty patients suffering from MDD participated in the study. IL-6, interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1RA) levels were examined at baseline and at 2 and 4 h after the first, fifth and the last ECT sessions. The response to ECT was measured with Montgomery-Åsberg Depression Rating Scale (MADRS). ECT repeatedly caused an increase in IL-6 levels at the 4-h time point. However, the baseline IL-6 levels decreased among remitters, but not among non-remitters, towards the end of ECT. IL-1β levels were mostly below detectable level, and IL-1Ra levels did not change during and after ECT. ECT has distinct acute and long-term effects on IL-6 levels. Interestingly, the long-term effect of ECT on IL-6 seems to correlate with outcome, providing further evidence of the mechanism of action of ECT and supporting the inflammation theory in MDD. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Unilateral ultra-brief pulse electroconvulsive therapy for depression in Parkinson's disease.

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    Williams, N R; Bentzley, B S; Sahlem, G L; Pannu, J; Korte, J E; Revuelta, G; Short, E B; George, M S

    2017-04-01

    Electroconvulsive therapy (ECT) has demonstrated efficacy in treating core symptoms of Parkinson's disease (PD); however, widespread use of ECT in PD has been limited due to concern over cognitive burden. We investigated the use of a newer ECT technology known to have fewer cognitive side effects (right unilateral [RUL] ultra-brief pulse [UBP]) for the treatment of medically refractory psychiatric dysfunction in PD. This open-label pilot study included 6 patients who were assessed in the motoric, cognitive, and neuropsychiatric domains prior to and after RUL UBP ECT. Primary endpoints were changes in total score on the HAM-D-17 and GDS-30 rating scales. Patients were found to improve in motoric and psychiatric domains following RUL UBP ECT without cognitive side effects, both immediately following ECT and at 1-month follow-up. This study demonstrates that RUL UBP ECT is safe, feasible, and potentially efficacious in treating multiple domains of PD, including motor and mood, without clear cognitive side effects. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Predictors of readmission after successful electroconvulsive therapy for depression: a chart review study.

    Science.gov (United States)

    Uchida, Takahito; Kishimoto, Taishiro; Koreki, Akihiro; Nakao, Shigetsugu; Owada, Ai; Koizumi, Teruki; Saito, Atsuyuki; Sato, Minako; Sawada, Shinya; Matsuzaki, Ryuta; Petrides, Georgios; Mimura, Masaru

    2016-11-01

    The study aimed to identify the predictors for readmission after a successful electroconvulsive therapy (ECT) course. Medical charts of patients who received ECT for major depressive episodes were reviewed. Patients' demographic characteristics and treatment parameters, such as ECT charge, seizure duration, the number of ECT sessions and pharmacotherapy, were extracted. We compared differences between those who were readmitted after successful ECT within 6 and 12 months, versus those not readmitted. We also conducted a multivariate logistic regression analysis to identify the predictors for readmission. Out of 51 patients who were discharged after ECT, 27 patients met the inclusion criteria and were included in the analysis. Eight patients were readmitted within 6 months after discharge, and four more patients were readmitted during the next 6-month follow up. Comparing patients who were and were not readmitted, we found no significant differences between groups, including ECT parameters such as the number of ECT sessions, average charge and final charge. No predictors for readmission were found through multivariate analysis. Although patients who require higher ECT charge and more sessions seem to be prone to readmission, our dataset suggested that none of these types of ECT parameters were risk factors for readmission.

  10. The experience of electroconvulsive therapy and its impact on associated stigma: A meta-analysis.

    Science.gov (United States)

    Aoki, Yuta; Yamaguchi, Sosei; Ando, Shuntaro; Sasaki, Natsuki; Bernick, Peter J; Akiyama, Tsuyoshi

    2016-12-01

    Despite its efficacy and safety, electroconvulsive therapy (ECT) is underutilized, in part due to stigma associated with the treatment. The aim of this study was to test the hypothesis that experiencing ECT has an impact on associated stigma, as measured by patient and family knowledge of and attitudes toward ECT. A comprehensive literature search was conducted using MEDLINE, EMBASE and PsycINFO. Studies with cross-sectional and/or longitudinal designs were identified. Studies were further categorized into subcategories based on participant type (patients or patient family members) and outcome domain (knowledge or attitudes). Effect size (Cohen's d) was calculated for each study and then integrated into each subcategory (participant type by outcome domain) using a random effect model. Eight studies were identified as being eligible for analysis. Two studies were cross-sectional, five were longitudinal and one incorporated both designs. Analysis of the longitudinal studies indicated that experiencing ECT both increased knowledge of and improved attitudes toward ECT in patients; in family members of patients, analysis showed significant positive change in knowledge of ECT, but no significant change in attitudes toward ECT. Experience with ECT may have a positive impact on knowledge of and attitudes toward ECT. However, the quality of evidence of included studies was low; further research is required in order to clarify the relationship and to identify information of use to individuals considering ECT as a treatment option. © The Author(s) 2016.

  11. Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT.

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    Nordanskog, Pia; Hultén, Martin; Landén, Mikael; Lundberg, Johan; von Knorring, Lars; Nordenskjöld, Axel

    2015-12-01

    The use of electroconvulsive therapy (ECT) varies across countries. The aim of this study was to describe and explore the use of ECT in Sweden in 2013. The Swedish mandatory patient register of the National Board of Health and Welfare includes information on diagnoses and treatments, including ECT. All 56 hospitals that provide ECT in Sweden also report to the nonmandatory national quality register for ECT, which contains information on patient and treatment characteristics. In this study, we combined data from both registers. In addition, all hospitals responded to a survey concerning equipment and organization of ECT. We identified 3972 unique patients who received ECT in Sweden in 2013. This translates into 41 ECT-treated individuals per 100,000 inhabitants. Of these patients, 85% opted to participate in the quality register. The median age was 55 years (range, 15-94 years), and 63% were women. The indication was depression in 78% of the treatment series. Of 4 711 hospitalized patients with severe depression, 38% received ECT. The median number of treatments per index series was 7. Unilateral treatment was used in 86% of the series. In Sweden, ECT is used at a relatively high rate as compared with other western countries, and the rate was unchanged from the last survey in 1975. However, there is room for improvement in the specificity of use and availability of ECT for disorders where ECT is considered a first-line treatment.

  12. Improvement in verbal memory performance in depressed in-patients after treatment with electroconvulsive therapy.

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    Biedermann, S V; Bumb, J M; Demirakca, T; Ende, G; Sartorius, A

    2016-12-01

    Electroconvulsive therapy (ECT) is a highly effective and well-tolerated therapy for severe and treatment-resistant depression. Cognitive side-effects are still feared by some patients and clinicians. Importantly, cognitive impairments are among the most disabling symptoms of depression itself. Patients suffering from a severe episode of depression were treated with either ECT or treatment as usual (TAU) in an in-patient setting. Matched healthy participants served as controls (HC). Verbal memory was tested with the California Verbal Learning Test (CVLT) before the specific treatment started (ECT = 15, TAU = 16, HC = 31) and 2 months after the last ECT session or 2 months after discharge respectively. Before the specific treatment started, depressed patients performed substantially worse compared with HC in total, short- and long-delay recall in the CVLT, while the ECT group showed the worst performance. More severely depressed patients showed worse performances in these measures. Intriguingly, verbal memory showed a significant improvement in ECT-treated patients, but not in the other groups. No differences between the groups were found at follow-up. Contrary to the widely feared assumption that ECT has long-term impact on memory functions, we found evidence that ECT is superior to TAU in improving verbal memory in depressed patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Psychotic symptoms as a complication of electroconvulsive therapy - a case report.

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    Antosik-Wójcińska, Anna; Chojnacka, Magdalena; Święcicki, Łukasz

    2017-02-26

    We report a patient who experienced atypical symptoms in the course of electroconvulsive therapy (ECT). During ECT treatment patient experienced psychotic symptoms which should be differentiated with prolonged delirium and nonconvulsive status epilepticus. 46-year-old female was referred to hospital with a diagnosis of major depressive disorder with no psychotic features in the course of recurrent depression. Despite several changes of pharmacological treatment no improvement was achieved, therefore it was decided to initiate ECT. Physical and neurological examination revealed no deviations from the norm. The results of other tests (CT and EEG) were normal. 4 bilateral, bitemporal ECT procedures were performed. The course of each procedure was typical, the same doses of anesthetic medication and pulse dose was administered throughout all of the procedures. The duration of seizure was 32-40 s. Despite this mental symptoms observed during the course of the treatment differed from known to the authors from both their own experience and from literature. Delusions of reference, persecution, agitation, oneiric delusions and olfactory hallucinations which appeared after the 4th ECT session maintained for 14 days and resolved after treatment with olanzapine. To the best of our knowledge, this is the first report on delusions of reference and persecution, oneiric delusions and olfactory hallucinations associated with the course of ECT.

  14. A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy.

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    Loo, Colleen K; Katalinic, Natalie; Smith, Deirdre J; Ingram, Anna; Dowling, Nathan; Martin, Donel; Addison, Kerryn; Hadzi-Pavlovic, Dusan; Simpson, Brett; Schweitzer, Isaac

    2014-12-05

    Some studies suggest better overall outcomes when right unilateral electroconvulsive therapy (RUL ECT) is given with an ultrabrief, rather than brief, pulse width. The aim of the study was to test if ultrabrief-pulse RUL ECT results in less cognitive side effects than brief- pulse RUL ECT, when given at doses which achieve comparable efficacy. One hundred and two participants were assigned to receive ultrabrief (at 8 times seizure threshold) or brief (at 5 times seizure threshold) pulse RUL ECT in a double-blind, randomized controlled trial. Blinded raters assessed mood and cognitive functioning over the ECT course. Efficacy outcomes were not found to be significantly different. The ultrabrief group showed less cognitive impairment immediately after a single session of ECT, and over the treatment course (autobiographical memory, orientation). In summary, when ultrabrief RUL ECT was given at a higher dosage than brief RUL ECT (8 versus 5 times seizure threshold), efficacy was comparable while cognitive impairment was less. © The Author 2014. Published by Oxford University Press on behalf of CINP.

  15. The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis.

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    Tørring, N; Sanghani, S N; Petrides, G; Kellner, C H; Østergaard, S D

    2017-05-01

    Electroconvulsive therapy (ECT) remains underutilized because of fears of cognitive and medical risks, including the risk of death. In this study, we aimed to assess the mortality rate of ECT by means of a systematic review and pooled analysis. The study was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The ECT-related mortality rate was calculated as the total number of ECT-related deaths reported in the included studies divided by the total number of ECT treatments. Fifteen studies with data from 32 countries reporting on a total of 766 180 ECT treatments met the inclusion criteria. Sixteen cases of ECT-related death were reported in the included studies yielding an ECT-related mortality rate of 2.1 per 100 000 treatments (95% CI: 1.2-3.4). In the nine studies that were published after 2001 (covering 414 747 treatments), there was only one reported ECT-related death. The ECT-related mortality rate was estimated at 2.1 per 100 000 treatments. In comparison, a recent analysis of the mortality of general anesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100 000. Our findings document that death caused by ECT is an extremely rare event. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Reorganization of Anatomical Connectome following Electroconvulsive Therapy in Major Depressive Disorder

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    Jinkun Zeng

    2015-01-01

    Full Text Available Objective. Electroconvulsive therapy (ECT is considered one of the most effective and fast-acting treatment options for depressive episodes. Little is known, however, about ECT’s enabling brain (neuroplasticity effects, particular for plasticity of white matter pathway. Materials and Methods. We collected longitudinal diffusion tensor imaging in the first-episode, drug-naïve major depressive disorder (MDD patients n=24 before and after a predefined time window ECT treatment. We constructed large-scale anatomical networks derived from white matter fiber tractography and evaluated the topological reorganization using graph theoretical analysis. We also assessed the relationship between topological reorganization with improvements in depressive symptoms. Results. Our investigation revealed three main findings: (1 the small-worldness was persistent after ECT series; (2 anatomical connections changes were found in limbic structure, temporal and frontal lobes, in which the connection changes between amygdala and parahippocampus correlate with depressive symptom reduction; (3 significant nodal strength changes were found in right paralimbic network. Conclusions. ECT elicits neuroplastic processes associated with improvements in depressive symptoms that act to specific local ventral frontolimbic circuits, but not small-world property. Overall, ECT induced topological reorganization in large-scale brain structural network, opening up new avenues to better understand the mode of ECT action in MDD.

  17. Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital

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    Amilton dos Santos Jr.

    2013-01-01

    Full Text Available Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02. Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5% reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.

  18. Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy?

    Science.gov (United States)

    Simsek, Gulnihal Gokce; Zincir, Selma; Gulec, Huseyin; Eksioglu, Sevgin; Semiz, Umit Basar; Kurtulmus, Yasemin Sipka

    2015-08-01

    The aim of this study is to investigate the relationship between features of electroencephalography (EEG), including seizure time, energy threshold level and post-ictal suppression time, and clinical variables, including treatment outcomes and side-effects, among schizophrenia inpatients undergoing electroconvulsive therapy (ECT). This is a naturalistic follow-up study on schizophrenia patients, diagnosed using DSM-IV-TR criteria, treated by a psychosis inpatient service. All participants completed the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) scale, the Frontal Assessment Battery (FAB) and a Data Collection Form. Assessments were made before treatment, during ECT and after treatment. Statistically significant improvements in both clinical and cognitive outcome were noted after ECT in all patients. Predictors of improvement were sought by evaluating electrophysiological variables measured at three time points (after the third, fifth and seventh ECT sessions). Logistic regression analysis showed that clinical outcome/improvement did not differ by seizure duration, threshold energy level or post-ictal suppression time. We found that ictal EEG parameters measured at several ECT sessions did not predict clinical recovery/outcomes. This may be because our centre defensively engages in "very specific patient selection" when ECT is contemplated. ECT does not cause short-term cognitive functional impairment and indeed improves cognition, because symptoms of the schizophrenic episode are alleviated.

  19. Accessibility, standards and challenges of electroconvulsive therapy in Western industrialized countries: a German example.

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    Loh, Nico; Nickl-Jockschat, Thomas; Sheldrick, Abigail Jane; Grözinger, Michael

    2013-08-01

    The aim of the study was to document the present situation of electroconvulsive therapy (ECT) in Germany, compare its handling with regard to other industrialized countries and with regard to a survey 12 years ago. A questionnaire on the frequency and type of administration of ECT in 2008 was sent electronically to 423 psychiatric hospitals. As needed, up to five reminders were carried out by telephone. On this occasion, the question of whether ECT is administered, could be clarified for each hospital. A total of 43% (183/423) of hospitals declared to administer ECT; 63% (115/183) reported nearly 20,000 treatments. A total incidence of 30,000 treatments performed on 2800 individual patients was estimated. This means that 3.4 patients per 10(5) inhabitants, 0.4‰ of all depressed patients, and about 1% of depressed inpatients, are treated with ECT in Germany. The frequency of application has increased during the last 12 years by a factor of more than 2.5 in Germany. In Western industrialized countries, numbers vary by a factor of more than 10 amongst the countries with a slow trend of equalization. The mode of implementation and the areas of conflict in which the therapy stands seem to be similar.

  20. The Optical Fractionator Technique to Estimate Cell Numbers in a Rat Model of Electroconvulsive Therapy.

    Science.gov (United States)

    Olesen, Mikkel Vestergaard; Needham, Esther Kjær; Pakkenberg, Bente

    2017-07-09

    Stereological methods are designed to describe quantitative parameters without making assumptions about size, shape, orientation and distribution of cells or structures. These methods have been revolutionary for quantitative analysis of the mammalian brain, in which volumetric cell populations are too high to count manually, and stereology is now the technique of choice whenever estimates of three-dimensional quantities need to be extracted from measurements on two-dimensional sections. All stereological methods are in principle unbiased; however, they rely on proper knowledge about the structure of interest and the characteristics of the tissue. Stereology is based on Systematic Uniformly Random Sampling (SURS), with adjustment of sampling to the most efficient level in respect to precision, providing reliable, quantitative information about the whole structure of interest. Here we present the optical fractionator in conjunction with BrdU immunohistochemistry to estimate the production and survival of newly-formed neurons in the granule cell layer (including the sub-granular zone) of the rat hippocampus following electroconvulsive stimulation, which is among the most potent stimulators of neurogenesis. The optical fractionator technique is designed to provide estimates of the total number of cells from thick sections sampled from the full structure. Thick sections provide the opportunity to observe cells in their full 3-D extent and thus, allow for easy and robust cell classification based on morphological criteria. When correctly implemented, the sensitivity and efficiency of the optical fractionator provides accurate estimates with a fixed and predetermined precision.

  1. Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression.

    Science.gov (United States)

    Kayser, Sarah; Bewernick, Bettina H; Grubert, Christiane; Hadrysiewicz, Barbara L; Axmacher, Nikolai; Schlaepfer, Thomas E

    2011-05-01

    Major depression is a common mental health problem and associated with significant morbidity and mortality, including impaired social and physical functioning and increased risk for suicide. Electroconvulsive therapy (ECT) is highly efficacious in treatment-resistant depressive disorders, but cognitive side effects are frequently associated with the treatment. Magnetic seizure therapy (MST) is a form of convulsive therapy, using magnetic fields in order to induce therapeutic seizures. First studies suggested that cognitive side effects of MST, including postictal recovery time, are more benign than those resulting from ECT treatment. In this open-label study we tested the hypothesis that MST is associated with clinically significant antidepressant effects in treatment-resistant depression (TRD) as an add-on therapy to a controlled pharmacotherapy. Twenty patients suffering from TRD were randomly assigned to receive either MST or ECT starting from July 2006 until November 2008. Primary outcome measure was antidepressant response assessed by Montgomery Åsberg Depression Scale. Secondary outcome measures included Hamilton Depression Rating Scale, Hamilton Anxiety Scale, Beck Depression Inventory and 90-Item Symptom Checklist. Antidepressant response (improvement of 50% in MADRS ratings) was statistically significant and of similar size in both treatment groups. Cognitive side effects were observed in neither group. Characteristics in MST- and ECT-induced seizures were comparable, especially regarding ictal activity and postictal suppression. Thus, MST may be a potential alternative to ECT if efficacy and safety are validated in larger clinical trials.

  2. Pain thresholds during and after treatment of severe depression with electroconvulsive therapy.

    Science.gov (United States)

    Gormsen, Lise; Ribe, Anette Riisgaard; Raun, Peter; Rosenberg, Raben; Videbech, Poul; Vestergaard, Per; Bach, Flemming W; Jensen, Troels S

    2004-10-01

    Pain and depression are often associated suggesting that both conditions share a common neurobiological mechanism, which modulate emotional function and processing of noxious information. Pain thresholds are hypothesized to be altered in depressed patients and normalized with the amelioration of depression. The purpose of this study was therefore to determine pain thresholds in patients during and after treatment with electroconvulsive therapy (ECT) of severe depression and in healthy controls. Seventeen depressed patients (Hamilton depression score > 18) and an age and gender matched control group of same size participated in the study. Pain detection and tolerance thresholds to pressure and pain tolerance thresholds to the Cold Pressor Test by exposure to ice-water was measured twice in depressed patients during and after ECT and twice in controls with a similar time interval. While ECT significantly improved Hamilton depression score (from mean 23.9 (SD:5) to mean 12.5 (SD:5.7)) there was no significant change in pain thresholds during and after ECT in the patient group. However, depressed patients had significantly lower pain tolerance in the Cold Pressor Test on both examinations and on pressure pain tolerance on the second examination day than their corresponding control subjects. The differential effect of ECT on depression score and pain processing indicate that mood and noxious processing are not medicated directly by the same systems but that a complex relationship between pain and depression exists.

  3. Electroconvulsive therapy in the presence of deep brain stimulation implants: electric field effects.

    Science.gov (United States)

    Deng, Zhi-De; Hardesty, David E; Lisanby, Sarah H; Peterchev, Angel V

    2010-01-01

    The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBS electrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants.

  4. The Relationship Between Cortical Inhibition and Electroconvulsive Therapy in the Treatment of Major Depressive Disorder.

    Science.gov (United States)

    Voineskos, Daphne; Levinson, Andrea J; Sun, Yinming; Barr, Mera S; Farzan, Faranak; Rajji, Tarek K; Fitzgerald, Paul B; Blumberger, Daniel M; Daskalakis, Zafiris J

    2016-12-09

    Dysfunctional cortical inhibition (CI) is postulated as a key neurophysiological mechanism in major depressive disorder. Electroconvulsive therapy (ECT) is the treatment of choice for resistant depression and ECT has been associated with enhanced CI. The objective of this study was to evaluate the relationship between CI and ECT response in resistant depression. Twenty-five patients with treatment resistant depression underwent an acute course of ECT. CI was indexed by the cortical silent period (CSP) and short-interval cortical inhibition (SICI), through TMS-EMG. CI and clinical response was measured prior to beginning an acute ECT course and within 48 hours of the last ECT treatment in the course. Clinical response to ECT was assessed by HDRS-17 before and after an acute course of ECT. We found that there was a significant difference in CSP at baseline between responder and non-responder groups (p = 0.044). Baseline CSP predicted therapeutic response to ECT with sensitivity of 80% and specificity of 60%. There were no changes in CSP or SICI after administration of the ECT course. Our findings suggest that duration of pre-treatment CSP may be a useful predictor of therapeutic response to ECT in patients with TRD.

  5. Response rate of catatonia to electroconvulsive therapy and its clinical correlates.

    Science.gov (United States)

    Raveendranathan, Dhanya; Narayanaswamy, Janardhanan C; Reddi, Senthil V

    2012-08-01

    Electroconvulsive therapy (ECT) is an important treatment for catatonia. We aimed to study the response rate of catatonia treated with ECT and its clinical correlates in a large sample of inpatients. The ECT parameters of all patients (n = 63) admitted with catatonia between the months of January and December 2007 were examined. The number of ECTs administered, seizure threshold, failure to achieve adequate seizures and clinical signs pertaining to catatonia were analyzed. Response was considered as complete resolution of catatonic symptoms with Bush Francis Catatonia Rating Scale (BFCRS) score becoming zero. ECT was mostly started after failed lorazepam treatment except in 6 patients where ECT was the first choice. Patients who responded in 4 ECT sessions were considered fast responders (mean session number for response is 4 sessions) and response with 5 or more ECTs was considered slow response. Fast responders had significantly lower duration of catatonia (19.67 ± 21.66 days, P = 0.02) and higher BFCRS score at presentation (17.25 ± 6.21, P = 0.03). Presence of waxy flexibility and gegenhalten (22.60% vs. 0%, P = 0.01) predicted faster response, whereas presence of echophenomena (3.2% vs. 24.0%) predicted slow response. The response rate to catatonia appears to be associated with the severity and duration of catatonia, and the presence of certain catatonic signs.

  6. Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial

    Science.gov (United States)

    Fernie, Gordon; Currie, James; Perrin, Jennifer S.; Stewart, Caroline A.; Anderson, Virginica; Bennett, Daniel M.; Hay, Steven; Reid, Ian C.

    2017-01-01

    Background Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs). Aims To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic. Method Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760.) Results No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course. Conclusions Ketamine as an anaesthetic does not enhance the efficacy of ECT. PMID:28254962

  7. Reorganization of Anatomical Connectome following Electroconvulsive Therapy in Major Depressive Disorder

    Science.gov (United States)

    Zeng, Jinkun; Luo, Qinghua; Du, Lian; Liao, Wei; Li, Yongmei; Liu, Haixia; Liu, Dan; Fu, Yixiao; Qiu, Haitang; Li, Xirong; Qiu, Tian; Meng, Huaqing

    2015-01-01

    Objective. Electroconvulsive therapy (ECT) is considered one of the most effective and fast-acting treatment options for depressive episodes. Little is known, however, about ECT's enabling brain (neuro)plasticity effects, particular for plasticity of white matter pathway. Materials and Methods. We collected longitudinal diffusion tensor imaging in the first-episode, drug-naïve major depressive disorder (MDD) patients (n = 24) before and after a predefined time window ECT treatment. We constructed large-scale anatomical networks derived from white matter fiber tractography and evaluated the topological reorganization using graph theoretical analysis. We also assessed the relationship between topological reorganization with improvements in depressive symptoms. Results. Our investigation revealed three main findings: (1) the small-worldness was persistent after ECT series; (2) anatomical connections changes were found in limbic structure, temporal and frontal lobes, in which the connection changes between amygdala and parahippocampus correlate with depressive symptom reduction; (3) significant nodal strength changes were found in right paralimbic network. Conclusions. ECT elicits neuroplastic processes associated with improvements in depressive symptoms that act to specific local ventral frontolimbic circuits, but not small-world property. Overall, ECT induced topological reorganization in large-scale brain structural network, opening up new avenues to better understand the mode of ECT action in MDD. PMID:26770836

  8. Electric field characteristics of electroconvulsive therapy with individualized current amplitude: a preclinical study.

    Science.gov (United States)

    Lee, Won Hee; Lisanby, Sarah H; Laine, Andrew F; Peterchev, Angel V

    2013-01-01

    This study examines the characteristics of the electric field induced in the brain by electroconvulsive therapy (ECT) with individualized current amplitude. The electric field induced by bilateral (BL), bifrontal (BF), right unilateral (RUL), and frontomedial (FM) ECT electrode configurations was computed in anatomically realistic finite element models of four nonhuman primates (NHPs). We generated maps of the electric field strength relative to an empirical neural activation threshold, and determined the stimulation strength and focality at fixed current amplitude and at individualized current amplitudes corresponding to seizure threshold (ST) measured in the anesthetized NHPs. The results show less variation in brain volume stimulated above threshold with individualized current amplitudes (16-36%) compared to fixed current amplitude (30-62%). Further, the stimulated brain volume at amplitude-titrated ST is substantially lower than that for ECT with conventional fixed current amplitudes. Thus individualizing the ECT stimulus current could compensate for individual anatomical variability and result in more focal and uniform electric field exposure across different subjects compared to the standard clinical practice of using high, fixed current for all patients.

  9. DIFFUSIVE SHOCK ACCELERATION AT COSMOLOGICAL SHOCK WAVES

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyesung [Department of Earth Sciences, Pusan National University, Pusan 609-735 (Korea, Republic of); Ryu, Dongsu, E-mail: kang@uju.es.pusan.ac.kr, E-mail: ryu@canopus.cnu.ac.kr [Department of Astronomy and Space Science, Chungnam National University, Daejeon 305-764 (Korea, Republic of)

    2013-02-10

    We reexamine nonlinear diffusive shock acceleration (DSA) at cosmological shocks in the large-scale structure of the universe, incorporating wave-particle interactions that are expected to operate in collisionless shocks. Adopting simple phenomenological models for magnetic field amplification (MFA) by cosmic-ray (CR) streaming instabilities and Alfvenic drift, we perform kinetic DSA simulations for a wide range of sonic and Alfvenic Mach numbers and evaluate the CR injection fraction and acceleration efficiency. In our DSA model, the CR acceleration efficiency is determined mainly by the sonic Mach number M{sub s} , while the MFA factor depends on the Alfvenic Mach number and the degree of shock modification by CRs. We show that at strong CR modified shocks, if scattering centers drift with an effective Alfven speed in the amplified magnetic field, the CR energy spectrum is steepened and the acceleration efficiency is reduced significantly, compared to the cases without such effects. As a result, the postshock CR pressure saturates roughly at {approx}20% of the shock ram pressure for strong shocks with M{sub s} {approx}> 10. In the test-particle regime (M{sub s} {approx}< 3), it is expected that the magnetic field is not amplified and the Alfvenic drift effects are insignificant, although relevant plasma physical processes at low Mach number shocks remain largely uncertain.

  10. Streptococcal toxic shock syndrome

    OpenAIRE

    Gvozdenović Ljiljana; Pasternak Janko; Milovanović Stanislav; Ivanov Dejan; Milić Saša

    2010-01-01

    Introduction. Streptococcal toxic shock syndrome is now recognized as a toxin-mediated, multisystem illness. It is characterized by an early onset of shock with multiorgan failure and continues to be associated with high morbidity and mortality, caused by group A Streptococcus pyogenes. The symptoms for staphylococcal and streptococcal toxic shock syndrome are similar. Streptococcal toxic shock syndrome was not well described until 1993, when children who had suffered from varicella pre...

  11. Biomass shock pretreatment

    Science.gov (United States)

    Holtzapple, Mark T.; Madison, Maxine Jones; Ramirez, Rocio Sierra; Deimund, Mark A.; Falls, Matthew; Dunkelman, John J.

    2014-07-01

    Methods and apparatus for treating biomass that may include introducing a biomass to a chamber; exposing the biomass in the chamber to a shock event to produce a shocked biomass; and transferring the shocked biomass from the chamber. In some aspects, the method may include pretreating the biomass with a chemical before introducing the biomass to the chamber and/or after transferring shocked biomass from the chamber.

  12. Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial.

    Science.gov (United States)

    Brakemeier, Eva-Lotta; Merkl, Angela; Wilbertz, Gregor; Quante, Arnim; Regen, Francesca; Bührsch, Nicole; van Hall, Franziska; Kischkel, Eva; Danker-Hopfe, Heidi; Anghelescu, Ion; Heuser, Isabella; Kathmann, Norbert; Bajbouj, Malek

    2014-08-01

    Although electroconvulsive therapy (ECT) is the most effective acute antidepressant intervention, sustained response rates are low. It has never been systematically assessed whether psychotherapy, continuation ECT, or antidepressant medication is the most efficacious intervention to maintain initial treatment response. In a prospective, randomized clinical trial, 90 inpatients with major depressive disorder (MDD) were treated with right unilateral ultra-brief acute ECT. Electroconvulsive therapy responders received 6 months guideline-based antidepressant medication (MED) and were randomly assigned to add-on therapy with cognitive-behavioral group therapy (CBT-arm), add-on therapy with ultra-brief pulse continuation electroconvulsive therapy (ECT-arm), or no add-on therapy (MED-arm). After the 6 months of continuation treatment, patients were followed-up for another 6 months. The primary outcome parameter was the proportion of patients who remained well after 12 months. Of 90 MDD patients starting the acute phase, 70% responded and 47% remitted to acute ECT. After 6 months of continuation treatment, significant differences were observed in the three treatment arms with sustained response rates of 77% in the CBT-arm, 40% in the ECT-arm, and 44% in the MED-arm. After 12 months, these differences remained stable with sustained response rates of 65% in the CBT-arm, 28% in the ECT-arm, and 33% in the MED-arm. These results suggest that ultra-brief pulse ECT as a continuation treatment correlates with low sustained response rates. However, the main finding implicates cognitive-behavioral group therapy in combination with antidepressants might be an effective continuation treatment to sustain response after successful ECT in MDD patients. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  13. Delivery of electroconvulsive therapy in Canada: a first national survey report on usage, treatment practice, and facilities.

    Science.gov (United States)

    Martin, Barry A; Delva, Nicholas John; Graf, Peter; Gosselin, Caroline; Enns, Murray W; Gilron, Ian; Jewell, Mark; Lawson, James Stuart; Milev, Roumen; Patry, Simon; Chan, Peter K Y

    2015-06-01

    The aims of this study were to document electroconvulsive therapy use in Canada with respect to treatment facilities and caseloads based on a survey of practice (Canadian Electroconvulsive Therapy Survey/Enquete Canadienne Sur Les Electrochocs-CANECTS/ECANEC) and to consider these findings in the context of guideline recommendations. All 1273 registered hospitals in Canada were contacted, and 175 sites were identified as providing electroconvulsive therapy; these sites were invited to complete a comprehensive questionnaire. The survey period was calendar year 2006 or fiscal year 2006/2007. National usage rates were estimated from the responses. Sixty-one percent of the sites completed the questionnaire; a further 10% provided caseload data. Seventy were identified as general; 31, as university teaching; and 21, as provincial psychiatric/other single specialty (psychiatric) hospitals. Caseload volumes ranged from a mean of fewer than 2 to greater than 30 treatments per week. Estimated national usage during the 1-year survey period was 7340 to 8083 patients (2.32-2.56 per 10,000 population) and 66,791 to 67,424 treatments (2.11-2.13 per 1000 population). The diagnostic indications, admission status, and protocols for course end points are described. The usage rates are in keeping with earlier Canadian data and with those from other jurisdictions. The difficulty obtaining caseload data from individual hospitals is indicative of the need for standardized data collection to support both clinical research and quality assurance. The wide variation in protocols for number of treatments per course indicates a need for better informed clinical guidelines. The broad range of caseload volumes suggests the need to review the economies of scale in the field.

  14. A new method to model electroconvulsive therapy in rats with increased construct validity and enhanced translational value.

    Science.gov (United States)

    Theilmann, Wiebke; Löscher, Wolfgang; Socala, Katarzyna; Frieling, Helge; Bleich, Stefan; Brandt, Claudia

    2014-06-01

    Electroconvulsive therapy is the most effective therapy for major depressive disorder (MDD). The remission rate is above 50% in previously pharmacoresistant patients but the mechanisms of action are not fully understood. Electroconvulsive stimulation (ECS) in rodents mimics antidepressant electroconvulsive therapy (ECT) in humans and is widely used to investigate the underlying mechanisms of ECT. For the translational value of findings in animal models it is essential to establish models with the highest construct, face and predictive validity possible. The commonly used model for ECT in rodents does not meet the demand for high construct validity. For ECT, cortical surface electrodes are used to induce therapeutic seizures whereas ECS in rodents is exclusively performed by auricular or corneal electrodes. However, the stimulation site has a major impact on the type and spread of the induced seizure activity and its antidepressant effect. We propose a method in which ECS is performed by screw electrodes placed above the motor cortex of rats to closely simulate the clinical situation and thereby increase the construct validity of the model. Cortical ECS in rats induced reliably seizures comparable to human ECT. Cortical ECS was more effective than auricular ECS to reduce immobility in the forced swim test. Importantly, auricular stimulation had a negative influence on the general health condition of the rats with signs of fear during the stimulation sessions. These results suggest that auricular ECS in rats is not a suitable ECT model. Cortical ECS in rats promises to be a valid method to mimic ECT. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Epigenetic regulation of Arc and c-Fos in the hippocampus after acute electroconvulsive stimulation in the rat

    DEFF Research Database (Denmark)

    Dyrvig, Mads; Hansen, Henrik H; Christiansen, Søren Hofman Oliveira

    2012-01-01

    Electroconvulsive stimulation (ECS) remains one of the most effective treatments of major depression. However, the underlying molecular changes still remain to be elucidated. Since ECS causes rapid and significant changes in gene expression we have looked at epigenetic regulation of two important...... immediate early genes that are both induced after ECS: c-Fos and Arc. We examined Arc and c-Fos protein expression and found Arc present over 4 h, in contrast to c-Fos presence lasting only 1 h. Both genes had returned to baseline expression at 24 h post-ECS. Histone H4 acetylation (H4Ac) is one...

  16. Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment- and Electroconvulsive Therapy-Refractory Mania: Old Horse, New Trick.

    Science.gov (United States)

    Modak, Tamonud; Kumar, Saurabh; Pal, Arghya; Gupta, Rishab; Pattanayak, Raman Deep; Khandelwal, Sudhir Kumar

    2017-01-01

    A 22-year-old male diagnosed with bipolar affective disorder presented to us with a 3(rd) episode mania resistant to both olanzapine and haloperidol as well as electroconvulsive therapy. He, however, responded to chlorpromazine (CPZ) which was also effective as a mood stabilizer. The patient had a relapse of his illness when CPZ was stopped and responded again when it was started. The case demonstrates that CPZ may have a role in as both an anti-manic agent and for the maintenance for bipolar disorders. The possible underlying mechanism for this role is also discussed.

  17. Simulating radiative shocks in nozzle shock tubes

    Science.gov (United States)

    van der Holst, B.; Tóth, G.; Sokolov, I. V.; Daldorff, L. K. S.; Powell, K. G.; Drake, R. P.

    2012-06-01

    We use the recently developed Center for Radiative Shock Hydrodynamics (CRASH) code to numerically simulate laser-driven radiative shock experiments. These shocks are launched by an ablated beryllium disk and are driven down xenon-filled plastic tubes. The simulations are initialized by the two-dimensional version of the Lagrangian Hyades code which is used to evaluate the laser energy deposition during the first 1.1 ns. Later times are calculated with the CRASH code. CRASH solves for the multi-material hydrodynamics with separate electron and ion temperatures on an Eulerian block-adaptive-mesh and includes a multi-group flux-limited radiation diffusion and electron thermal heat conduction. The goal of the present paper is to demonstrate the capability to simulate radiative shocks of essentially three-dimensional experimental configurations, such as circular and elliptical nozzles. We show that the compound shock structure of the primary and wall shock is captured and verify that the shock properties are consistent with order-of-magnitude estimates. The synthetic radiographs produced can be used for comparison with future nozzle experiments at high-energy-density laser facilities.

  18. Simulating radiative shocks in nozzle shock tubes

    CERN Document Server

    van der Holst, B; Sokolov, I V; Daldorff, L K S; Powell, K G; Drake, R P

    2011-01-01

    We use the recently developed Center for Radiative Shock Hydrodynamics (CRASH) code to numerically simulate laser-driven radiative shock experiments. These shocks are launched by an ablated beryllium disk and are driven down xenon-filled plastic tubes. The simulations are initialized by the two-dimensional version of the Lagrangian Hyades code which is used to evaluate the laser energy deposition during the first 1.1ns. The later times are calculated with the CRASH code. This code solves for the multi-material hydrodynamics with separate electron and ion temperatures on an Eulerian block-adaptive-mesh and includes a multi-group flux-limited radiation diffusion and electron thermal heat conduction. The goal of the present paper is to demonstrate the capability to simulate radiative shocks of essentially three-dimensional experimental configurations, such as circular and elliptical nozzles. We show that the compound shock structure of the primary and wall shock is captured and verify that the shock properties a...

  19. Sepsis and septic shock

    Science.gov (United States)

    Hotchkiss, Richard S.; Moldawer, Lyle L.; Opal, Steven M.; Reinhart, Konrad; Turnbull, Isaiah R.; Vincent, Jean-Louis

    2017-01-01

    For more than two decades, sepsis was defined as a microbial infection that produces fever (or hypothermia), tachycardia, tachypnoea and blood leukocyte changes. Sepsis is now increasingly being considered a dysregulated systemic inflammatory and immune response to microbial invasion that produces organ injury for which mortality rates are declining to 15–25%. Septic shock remains defined as sepsis with hyperlactataemia and concurrent hypotension requiring vasopressor therapy, with in-hospital mortality rates approaching 30–50%. With earlier recognition and more compliance to best practices, sepsis has become less of an immediate life-threatening disorder and more of a long-term chronic critical illness, often associated with prolonged inflammation, immune suppression, organ injury and lean tissue wasting. Furthermore, patients who survive sepsis have continuing risk of mortality after discharge, as well as long-term cognitive and functional deficits. Earlier recognition and improved implementation of best practices have reduced in-hospital mortality, but results from the use of immunomodulatory agents to date have been disappointing. Similarly, no biomarker can definitely diagnose sepsis or predict its clinical outcome. Because of its complexity, improvements in sepsis outcomes are likely to continue to be slow and incremental. PMID:28117397

  20. When Shock Waves Collide

    CERN Document Server

    Hartigan, P; Frank, A; Hansen, E; Yirak, K; Liao, A S; Graham, P; Wilde, B; Blue, B; Martinez, D; Rosen, P; Farley, D; Paguio, R

    2016-01-01

    Supersonic outflows from objects as varied as stellar jets, massive stars and novae often exhibit multiple shock waves that overlap one another. When the intersection angle between two shock waves exceeds a critical value, the system reconfigures its geometry to create a normal shock known as a Mach stem where the shocks meet. Mach stems are important for interpreting emission-line images of shocked gas because a normal shock produces higher postshock temperatures and therefore a higher-excitation spectrum than an oblique one does. In this paper we summarize the results of a series of numerical simulations and laboratory experiments designed to quantify how Mach stems behave in supersonic plasmas that are the norm in astrophysical flows. The experiments test analytical predictions for critical angles where Mach stems should form, and quantify how Mach stems grow and decay as intersection angles between the incident shock and a surface change. While small Mach stems are destroyed by surface irregularities and ...

  1. Clinical Effectiveness and Cognitive Impact of Electroconvulsive Therapy for Schizophrenia: A Large Retrospective Study.

    Science.gov (United States)

    Kaster, Tyler S; Daskalakis, Zafiris J; Blumberger, Daniel M

    2017-04-01

    To determine the clinical effectiveness and cognitive impact of electroconvulsive therapy (ECT) in a large clinical sample of patients with schizophrenia and explore factors associated with treatment response and transient cognitive impairment. We examined the clinical records of 144 patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who were treated at an academic mental health hospital from October 2009 to August 2014. These patients received 171 acute courses of ECT; we attempted to determine their treatment response and transient cognitive impairment from ECT. We explored the impact of various factors including ECT indication, clinical characteristics, medication during ECT, and technical parameters on treatment response and transient cognitive impairment. Treatment with ECT resulted in a 76.7% response rate. Factors associated with a better response to ECT were absence of treatment with antiepileptic medication (17.9% vs 3.9%, P = .007), a previous good response to ECT (36.4% vs 15.4%, P = .017), and primary indication for ECT referral other than failed pharmacotherapy (89.7% vs 69.8%, P = .012). Factors not associated with treatment response included age, clozapine treatment, and benzodiazepine treatment (P > .05). Treatment with ECT caused transient cognitive impairment in 9% of treatment courses; no demographic or clinical factors were associated with cognitive impairment. This work demonstrates the effectiveness of ECT for schizophrenia treatment and several factors associated with treatment response. The rate of transient cognitive impairment is lower than expected based on the rate of cognitive impairment seen in ECT for depression. ECT appears to be an effective treatment option for schizophrenia that is tolerated by the majority of patients.

  2. Assessment of Arterial Oxygen Saturation by Pulse Oximetry Before, During and After Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    SH Tarig

    2006-07-01

    Full Text Available Introduction & Objective: Electroconvulsive therapy (ECT is used widely in psychiatric practice. The goal of anesthesia for ECT is the prevention of complications such as discomfort, fractures, aspiration of gastric contents and hypoxia. However, general anesthesia can cause some adverse effects as hypoxia. Prevention and treatment of hypoxia is important due to its undesirable effects on seizure duration and cardiovascular system. This study was designed to detect the incidence and probable times of desaturation in patients receiving ECT. Materials & Methods: This prospective randomized clinical trial was carried out on 100 patients (18-50 y/o with ASA I or II who were scheduled for ECT. After pre-oxygenation and similar anesthesia induction the patients received ECT. The patients were ventilated by oxygen and face masked until the return of their spontaneous respiration with adequate tidal volume and respiratory rate. Then they were transferred to recovery room where there was no oxygen supplementation. Oxygen saturation was measured by a Nell core pulse oximeter and was recorded at six stages: before and after anesthesia induction, during ECT, after ECT, 5 minutes after entering recovery room and before leaving there. The data were analyzed by standard statistical tests using SPSS software Results: Data analysis revealed that desaturation was not noticed at any stage except for the 5th stage (5 minutes after entering recovery room, when 13% of patients developed Sao2% less than 90%. Also there was a significant difference between Sao2% of patients between this stage (5th and other stages (p<0.001. Conclusion: According to our findings, appropriate oxygen supplementation and pulse oximetry monitoring during recovery period after ECT can be recommend

  3. Effects of Pulse Width and Electrode Placement on the Efficacy and Cognitive Effects of Electroconvulsive Therapy

    Science.gov (United States)

    Sackeim, Harold A.; Prudic, Joan; Nobler, Mitchell S.; Fitzsimons, Linda; Lisanby, Sarah H.; Payne, Nancy; Berman, Robert M.; Brakemeier, Eva-Lotta; Perera, Tarique; Devanand, D. P.

    2009-01-01

    BACKGROUND While electroconvulsive therapy (ECT) in major depression is effective, cognitive effects limit its use. Reducing the width of the electrical pulse and using the right unilateral electrode placement may decrease adverse cognitive effects, while preserving efficacy. METHODS In a double-masked study, we randomly assigned 90 depressed patients to right unilateral ECT at 6 times seizure threshold or bilateral ECT at 2.5 times seizure threshold, using either a traditional brief pulse (1.5 ms) or an ultrabrief pulse (0.3 ms). Depressive symptoms and cognition were assessed before, during, and immediately, two, and six months after therapy. Patients who responded were followed for a one-year period. RESULTS The final remission rate for ultrabrief bilateral ECT was 35 percent, compared with 73 percent for ultrabrief unilateral ECT, 65 percent for standard pulse width bilateral ECT, and 59 percent for standard pulse width unilateral ECT (all P’s<0.05 after covariate adjustment). The ultrabrief right unilateral group had less severe cognitive side effects than the other 3 groups in virtually all primary outcome measures assessed in the acute postictal period, and during and immediately following therapy. Both the ultrabrief stimulus and right unilateral electrode placement produced less short- and long-term retrograde amnesia. Patients rated their memory deficits as less severe following ultrabrief right unilateral ECT compared to each of the other three conditions (P<0.001). CONCLUSIONS The use of an ultrabrief stimulus markedly reduces adverse cognitive effects, and when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy. (ClinicalTrials.gov number, NCT00487500.) PMID:19756236

  4. Adjunctive psychotropic medications during electroconvulsive therapy in the treatment of depression, mania, and schizophrenia.

    Science.gov (United States)

    Haskett, Roger F; Loo, Colleen

    2010-09-01

    Current guidelines regarding concomitant antidepressants during electroconvulsive therapy (ECT) are inconsistent. Although the American Psychiatric Association Task Force on ECT discouraged combination antidepressant treatment, owing to the minimal evidence for enhanced efficacy and concern about increased adverse effects, combination treatment is recommended and considered routine for many practitioners in the United States and other parts of the world. Considering the increasing levels of treatment resistance among patients referred for ECT and the high relapse rate after acute ECT, the role of concomitant antidepressant pharmacotherapy during ECT should be reevaluated. More research, however, is needed to explore the impact of administering specific antidepressants during acute and maintenance ECT (M-ECT), on antidepressant efficacy and cognitive adverse effects. This will require appropriately controlled studies of ECT medication combinations that include attention to a range of cognitive function measures and clinical response. In addition, the role of combination ECT and psychotropic medication in the treatment of mania and schizophrenia continues to receive attention, particularly in those patients who have shown inadequate responses to psychotropic medication alone. Although there is insufficient evidence to support the routine addition of antipsychotic medications to ECT during the treatment of acute mania, the literature suggests that it is unnecessary to discontinue antipsychotic medication when ECT is added to the treatment of a manic patient that has been unresponsive to pharmacological treatment. Despite the lack of well-controlled studies, the existing literature suggests that combination ECT and antipsychotic treatment is a useful option for patients with schizophrenia who are unresponsive to pharmacological interventions alone, and its adverse effect profile does not seem different from that seen with ECT alone.

  5. Resolution of Cognitive Adverse Effects of Electroconvulsive Therapy in Persons with Schizophrenia: A Prospective Study.

    Science.gov (United States)

    Kumar, Channaveerachari Naveen; Phutane, Vivek Haridas; Thirthalli, Jagadisha; Jayaram, Naveen; Kesavan, Muralidharan; Mehta, Urvakhsh Meherwan; Tyagi, Vidhi; Gangadhar, Bangalore N

    2017-01-01

    Cognitive impairments are among the most important adverse effects of electroconvulsive therapy (ECT). Although much is known about them in patients with depression, there is very little information about these in persons with schizophrenia. In this study, we examined the persistence of cognitive impairments in a subsample of patients (n = 49) with schizophrenia who had earlier participated in a clinical trial comparing the therapeutic and cognitive efficacy of bifrontal ECT (BFECT; n = 23) and bitemporal ECT (BTECT; n = 29) electrode placements. Total scores on Hindi Mental State Examination, processing speed, working memory, and verbal fluency were assessed in these patients at two points: first, at the end of their respective ECT course and at the follow-up (mean [standard deviation] = 98.7 [38.3] days). The course of cognitive impairments was assessed in all patients (n = 49) as a single group. Further, BFECT and BTECT patients were also compared with one another. ECT-induced acute cognitive impairments in patients with schizophrenia had normalized by the end of 3 months' follow-up post-ECT. All the tested parameters in the realm of Hindi Mental Status Examination, speed of processing, sequencing, spatial and working memory and verbal fluency showed recovery. Further, across all tests, BFECT and BTECT ultimately had similar scores at the follow-up though BFECT performed relatively better with regards to the acute effects. In fact, worst performing BTECT group caught up to recover to comparable levels of performance by the end of follow-up. In patients with schizophrenia, most of acute ECT-induced cognitive impairments recover by the end of 3 months' post-ECT. Further, different electrode placements do not seem to make any difference regarding ultimate recovery of cognitive deficits. Future prospective studies are needed that could address the limitations of this study.

  6. A Follow-up Study of Electroconvulsive Therapy in Children and Adolescents.

    Science.gov (United States)

    Mitchell, Shanti; Hassan, Ehmer; Ghaziuddin, Neera

    2017-09-20

    Electroconvulsive therapy (ECT) is an effective and a safe treatment for several severe psychiatric disorders across the age span. However, its use remains controversial and highly stigmatized especially among patients under 18 years. In this study, we examined current symptoms, attitudes, perception, and functioning of patients treated with ECT when they were less than 18 years old. Participants had received ECT before age 18, between 1989 and 2015, at a tertiary medical center. Institutional review board-approval was obtained, and study documents (cover letter, consent, self-ratings scales for depression, anxiety, global functioning, and suicidality) were mailed. Based on self-rated depression, 59.1% (13/22) participants indicated mild or no depression; 65% (13/20) reported mild or no anxiety; the majority, 84.3% (16/19) perceived ECT as having improved their overall illness; and 27.3% (6/22) among the respondents reported no clinical impairment on a global functioning scale, whereas 72.7% (16/22) reported significant or severe impairment. Despite reports of ongoing impaired global functioning among some participants, adequate academic performance (83.3%, 5/6) and mild or no suicidality (78.3%, 18/23) were endorsed by the majority reported. The majority of participants who had received ECT before age 18 years reported mild or absence of depression and anxiety on self-rated follow-up measures after treatment with ECT. Most notably, the majority reported absence of suicidality and adequate academic performance. A number of respondents, however, continued to endorse global impairment, which may be a reflection of their baseline severe illness, which had warranted treatment with ECT.

  7. Variation of plasma cortisol levels in patients with depression after treatment with bilateral electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    Daniel Fortunato Burgese

    2015-03-01

    Full Text Available Introduction: More than 60 years after the introduction of modern psychopharmacology, electroconvulsive therapy (ECT continues to be an essential therapeutic modality in the treatment of mental disorders, but its mechanism of action remains unclear. Hormones play an essential role in the development and expression of a series of behavioral changes. One aspect of the influence of hormones on behavior is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs and ECT.Objective: We measured blood levels of the hormone cortisol in patients with unipolar depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV and compared results with levels found in healthy adults.Method: Blood cortisol levels were measured before the beginning of treatment with ECT, at the seventh session, and at the last session, at treatment completion. Depression symptoms were assessed using the Beck Depression Inventory (BDI.Results: Cortisol levels remained stable in both men and women between the seventh and the last sessions of ECT; values ranged from 0.686±9.6330 g/dL for women, and there was a mean decrease of 5.825±6.0780 g/dL (p = 0.024. Mean number of ECT sessions was 12. After the seventh and the last ECT sessions, patients with depression and individuals in the control group had similar cortisol levels, whereas BDI scores remained different.Conclusion: Cortisol levels decreased during ECT treatment. ECT seems to act as a regulator of the hypothalamic-pituitaryadrenal axis.

  8. Modulation of intrinsic brain activity by electroconvulsive therapy in major depression

    Science.gov (United States)

    Leaver, Amber M.; Espinoza, Randall; Pirnia, Tara; Joshi, Shantanu H.; Woods, Roger P.; Narr, Katherine L.

    2015-01-01

    Introduction One of the most effective interventions for intractable major depressive episodes is electroconvulsive therapy (ECT). Because ECT is also relatively fast-acting, longitudinal study of its neurobiological effects offers critical insight into the mechanisms underlying depression and antidepressant response. Here we assessed modulation of intrinsic brain activity in corticolimbic networks associated with ECT and clinical response. Methods We measured resting-state functional connectivity (RSFC) in patients with treatment-resistant depression (n=30), using functional magnetic resonance imaging (fMRI) acquired before and after completing a treatment series with right-unilateral ECT. Using independent component analysis, we assessed changes in RSFC with 1) symptom improvement and 2) ECT regardless of treatment outcome in patients, with reference to healthy controls (n=33, also scanned twice). Results After ECT, consistent changes in RSFC within targeted depression-relevant functional networks were observed in the dorsal anterior cingulate (ACC), mediodorsal thalamus (mdTh), hippocampus, and right anterior temporal, medial parietal, and posterior cingulate cortex in all patients. In a separate analysis, changes in depressive symptoms were associated with RSFC changes in the dorsal ACC, mdTh, putamen, medial prefrontal, and lateral parietal cortex. RSFC of these regions did not change in healthy controls. Conclusions Neuroplasticity underlying clinical change was in part separable from changes associated with the effects of ECT observed in all patients. However, both ECT and clinical change were associated with RSFC modulation in dorsal ACC, mdTh and hippocampus, which may indicate that these regions underlie the mechanisms of clinical outcome in ECT and may be effective targets for future neurostimulation therapies. PMID:26878070

  9. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

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    Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.

    1984-01-01

    Electroconvulsive therapy (ECT) is frequently used in the treatment of major depression and other psychiatric disorders; its mechanism of action is not established, but previous evidence suggests that it is associated with postictal metabolic suppression. The authors have used measurements of rCBF as an index of cortical metabolic activity to study the acute effects of ECT. Measurements of rCBF were made in 32 cortical regions in 10 patients (pts) following one minute breathing of Xe-133 (5mCi/L); the measurements were performed 30min before and 50min after ECT. Bilateral ECT was administered to six pts (five diagnosed as major depressives and one schizophrenic) and unilateral ECT to four (all diagnosed as unipolar or bipolar affective disorder). The total rCBF material consists of 52 measurements in these pts, made before and after 16 bilateral and 10 unilateral treatments. ECT was found to cause significant reduction of rCBF. Mean hemispheric flows (using the Initial Slope Index to measure grey-matter flow) were reduced by about 5% in both hemispheres following bilateral treatment. Unilateral treatment caused a 9% reduction of flow in the treated hemisphere, but only 2% contralaterally. Regional patterns of flow decreases also differed between the two treatment modes: bilateral frontal reductions were found after bilateral treatment, whereas unilateral ECT caused a widespread flow reduction in the treated hemisphere, and almost no effect contralaterally. These results suggest that rCBF studies are useful for assessing ECT, and indicate that the acute cerebral effects of ECT vary with the mode of treatment.

  10. Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Takekita, Yoshiteru; Suwa, Taro; Sunada, Naotaka; Kawashima, Hirotsugu; Fabbri, Chiara; Kato, Masaki; Tajika, Aran; Kinoshita, Toshihiko; Furukawa, Toshi A; Serretti, Alessandro

    2016-12-01

    In electroconvulsive therapy (ECT), remifentanil is often used concurrently with anesthetics. The objective of this study was to provide an up-to-date and comprehensive review on how the addition of remifentanil to anesthetics affects seizure duration and circulatory dynamics in mECT. We performed a meta-analysis of RCTs that investigated seizure duration and circulatory dynamics in patients treated with ECT using anesthetics alone (non-remifentanil group) and with anesthetics plus remifentanil (remifentanil group). A total of 13 RCTs (380 patients and 1024 ECT sessions) were included. The remifentanil group showed a significantly prolonged seizure duration during ECT compared to the non-remifentanil group [motor: 9 studies, SMD = 1.25, 95 % CI (0.21, 2.29), p = 0.02; electroencephalogram: 8 studies, SMD = 0.98, 95 % CI (0.14, 1.82), p = 0.02]. The maximum systolic blood pressure (SBP) was significantly reduced in the remifentanil group compared to the non-remifentanil group [7 studies, SMD = -0.36, 95 % CI (-0.65, 0.07), p = 0.02]. Substantial heterogeneity was observed for meta-analyses for seizure durations, but a pre-planned subgroup analysis revealed that seizure duration was prolonged only when the use of the anesthetic dose was reduced in the remifentanil group. The results of our study suggest that addition of remifentanil to anesthesia in ECT may lead to prolonged seizure duration when it allows the use of reduced anesthetic doses. Further, the addition of remifentanil was associated with reduced maximum SBP.

  11. Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

    Science.gov (United States)

    Peterchev, Angel V; Krystal, Andrew D; Rosa, Moacyr A; Lisanby, Sarah H

    2015-01-01

    Electroconvulsive therapy (ECT) at conventional current amplitudes (800–900 mA) is highly effective but carries the risk of cognitive side effects. Lowering and individualizing the current amplitude may reduce side effects by virtue of a less intense and more focal electric field exposure in the brain, but this aspect of ECT dosing is largely unexplored. Magnetic seizure therapy (MST) induces a weaker and more focal electric field than ECT; however, the pulse amplitude is not individualized and the minimum amplitude required to induce a seizure is unknown. We titrated the amplitude of long stimulus trains (500 pulses) as a means of determining the minimum current amplitude required to induce a seizure with ECT (bilateral, right unilateral, bifrontal, and frontomedial electrode placements) and MST (round coil on vertex) in nonhuman primates. Furthermore, we investigated a novel method of predicting this amplitude-titrated seizure threshold (ST) by a non-convulsive measurement of motor threshold (MT) using single pulses delivered through the ECT electrodes or MST coil. Average STs were substantially lower than conventional pulse amplitudes (112–174 mA for ECT and 37.4% of maximum device amplitude for MST). ST was more variable in ECT than in MST. MT explained 63% of the ST variance and is hence the strongest known predictor of ST. These results indicate that seizures can be induced with less intense electric fields than conventional ECT that may be safer; efficacy and side effects should be evaluated in clinical studies. MT measurement could be a faster and safer alternative to empirical ST titration for ECT and MST. PMID:25920013

  12. Antidepressant Effects of Electroconvulsive Therapy Correlate With Subgenual Anterior Cingulate Activity and Connectivity in Depression

    Science.gov (United States)

    Liu, Yi; Du, Lian; Li, Yongmei; Liu, Haixia; Zhao, Wenjing; Liu, Dan; Zeng, Jinkun; Li, Xingbao; Fu, Yixiao; Qiu, Haitang; Li, Xirong; Qiu, Tian; Hu, Hua; Meng, Huaqing; Luo, Qinghua

    2015-01-01

    Abstract The mechanisms underlying the effects of electroconvulsive therapy (ECT) in major depressive disorder (MDD) are not fully understood. Resting-state functional magnetic resonance imaging (rs-fMRI) is a new tool to study the effects of brain stimulation interventions, particularly ECT. The authors aim to investigate the mechanisms of ECT in MDD by rs-fMRI. They used rs-fMRI to measure functional changes in the brain of first-episode, treatment-naive MDD patients (n = 23) immediately before and then following 8 ECT sessions (brief-pulse square-wave apparatus, bitemporal). They also computed voxel-wise amplitude of low-frequency fluctuation (ALFF) as a measure of regional brain activity and selected the left subgenual anterior cingulate cortex (sgACC) to evaluate functional connectivity between the sgACC and other brain regions. Increased regional brain activity measured by ALFF mainly in the left sgACC following ECT. Functional connectivity of the left sgACC increased in the ipsilateral parahippocampal gyrus, pregenual ACC, contralateral middle temporal pole, and orbitofrontal cortex. Importantly, reduction in depressive symptoms were negatively correlated with increased ALFF in the left sgACC and left hippocampus, and with distant functional connectivity between the left sgACC and contralateral middle temporal pole. That is, across subjects, as depression improved, regional brain activity in sgACC and its functional connectivity increased in the brain. Eight ECT sessions in MDD patients modulated activity in the sgACC and its networks. The antidepressant effects of ECT were negatively correlated with sgACC brain activity and connectivity. These findings suggest that sgACC-associated prefrontal-limbic structures are associated with the therapeutic effects of ECT in MDD. PMID:26559309

  13. Electroconvulsive therapy and structural neuroplasticity in neocortical, limbic and paralimbic cortex

    Science.gov (United States)

    Pirnia, T; Joshi, S H; Leaver, A M; Vasavada, M; Njau, S; Woods, R P; Espinoza, R; Narr, K L

    2016-01-01

    Electroconvulsive therapy (ECT) is a highly effective and rapidly acting treatment for severe depression. To understand the biological bases of therapeutic response, we examined variations in cortical thickness from magnetic resonance imaging (MRI) data in 29 patients scanned at three time points during an ECT treatment index series and in 29 controls at two time points. Changes in thickness across time and with symptom improvement were evaluated at high spatial resolution across the cortex and within discrete cortical regions of interest. Patients showed increased thickness over the course of ECT in the bilateral anterior cingulate cortex (ACC), inferior and superior temporal, parahippocampal, entorhinal and fusiform cortex and in distributed prefrontal areas. No changes across time occurred in controls. In temporal and fusiform regions showing significant ECT effects, thickness differed between patients and controls at baseline and change in thickness related to therapeutic response in patients. In the ACC, these relationships occurred in treatment responders only, and thickness measured soon after treatment initiation predicted the overall ECT response. ECT leads to widespread neuroplasticity in neocortical, limbic and paralimbic regions and changes relate to the extent of antidepressant response. Variations in ACC thickness, which discriminate treatment responders and predict response early in the course of ECT, may represent a biomarker of overall clinical outcome. Because post-mortem studies show focal reductions in glial density and neuronal size in patients with severe depression, ECT-related increases in thickness may be attributable to neuroplastic processes affecting the size and/or density of neurons and glia and their connections. PMID:27271858

  14. Use of electroconvulsive therapy for Asian patients with schizophrenia (2001-2009): Trends and correlates.

    Science.gov (United States)

    Xiang, Yu-Tao; Ungvari, Gabor S; Correll, Christoph U; Chiu, Helen F K; Lai, Kelly Y C; Wang, Chuan-Yue; Si, Tian-Mei; Lee, Edwin H M; He, Yan-Ling; Yang, Shu-Yu; Chong, Mian-Yoon; Kua, Ee-Heok; Fujii, Senta; Sim, Kang; Yong, Michael K H; Trivedi, Jitendra K; Chung, Eun-Kee; Udomratn, Pichet; Chee, Kok-Yoon; Sartorius, Norman; Tan, Chay-Hoon; Shinfuku, Naotaka

    2015-08-01

    Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophrenia patients in Asia between 2001 and 2009 and its independent demographic and clinical correlates. Data on 6761 hospitalized schizophrenia patients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data-collection procedure. The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter-country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35-64-year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second-generation antipsychotic medications compared to those who were not treated with ECT (R(2)  = 0.264, P < 0.001). ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

  15. Electroconvulsive therapy clinical database: Influence of age and gender on the electrical charge.

    Science.gov (United States)

    Salvador Sánchez, Javier; David, Mónica Delia; Torrent Setó, Aurora; Martínez Alonso, Montserrat; Portella Moll, Maria J; Pifarré Paredero, Josep; Vieta Pascual, Eduard; Mur Laín, María

    The influence of age and gender in the electrical charge delivered in a given population was analysed using an electroconvulsive therapy (ECT) clinical database. An observational, prospective, longitudinal study with descriptive analysis was performed using data from a database that included total bilateral frontotemporal ECT carried out with a Mecta spECTrum 5000Q(®) in our hospital over 6 years. From 2006 to 2012, a total of 4,337 ECT were performed on 187 patients. Linear regression using mixed effects analysis was weighted by the inverse of the number of ECT performed on each patient per year of treatment. The results indicate that age is related with changes in the required charge (P=.031), as such that the older the age a higher charge is needed. Gender is also associated with changes in charge (P=.014), with women requiring less charge than men, a mean of 87.3mC less. When the effects of age and gender are included in the same model, both are significant (P=.0080 and P=.0041). Thus, for the same age, women require 99.0mC less charge than men, and in both genders the charge increases by 2.3mC per year. From our study, it is concluded that the effect of age on the dosage of the electrical charge is even more significant when related to gender. It would be of interest to promote the systematic collection of data for a better understanding and application of the technique. Copyright © 2015 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. A preliminary trial of extracorporeal shock waves for the treatment of ⅢB chronic prostatitis%体外冲击波治疗ⅢB型前列腺炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    曾晓勇; 叶章群; 李平; 陈志强; 杜广辉; 周惜才

    2009-01-01

    Objective To assess the effect of extracorporeal shock waves(ESWs)as a treatment for ⅢB chronic prostatitis(CP).Methods Forty-six men with ⅢB CP were randomly divided into an experimental group (n=34)and a control group(n=12).The patients in experimental group received low energy ESW treatment,20000 impulses in 10 sessions over 2 weeks.The patients in control group received sham ESW treatment without shock waves energy under the same other conditions as in experimental group.Pain,urination and quality of life/impact were assessed with National Institutes of Health-chronic prostatitis symptom index(NIH-CPSI).Both groups were assessed at baseline,post-treatment and at a 4-week follow-up.Resuits The total NIH-CPSI scores,pain scores and quality of life/impact scores in experimental group decreased significantly post-treatment(P<0.01),but urination scores did not(P>0.05).Similar decreases of these scores were also found in control group post-treatment.The total NIH-CPSl scores and pain scores maintained at a lower level at the 4-week follow-up in experimental group,but the scores returned to the level as pre-treatment in control group.The effectiveness rates and prominent effectiveness rates in experimental group were significantly higher than those in control group post-treatment and at the 4-week follow-up(all P<0.05). Conclusions ESWs was effective in the treatment for ⅢB CP.After ESWs treatment pain alleviated,symptoms reducea and quality of life improved.%目的 初步评价体外冲击波(ESW)治疗慢性前列腺炎的可行性及临床疗效.方法 将46例ⅢB型慢性前列腺炎患者随机分为治疗组(34例)及对照组(12例).治疗组患者给予低能量级别ESW治疗,每次治疗时ESW冲击数量为2 000次,每周治疗5次,治疗2周为1个疗程(共治疗10次);对照组接受模拟ESW治疗,期间ESW治疗仪无能量输出.2组患者分别于治疗前、治疗1个疗程及治疗结束后4周时进行慢性前列腺

  17. Increased BDNF levels after electroconvulsive therapy in patients with major depressive disorder: A meta-analysis study.

    Science.gov (United States)

    Rocha, Renan Boeira; Dondossola, Eduardo Ronconi; Grande, Antônio José; Colonetti, Tamy; Ceretta, Luciane Bisognin; Passos, Ives C; Quevedo, Joao; da Rosa, Maria Inês

    2016-12-01

    We performed a systematic review and meta-analysis to estimate brain-derived neurotrophic factor (BDNF) level in patients with major depressive disorder (MDD) after electroconvulsive therapy (ECT). A comprehensive search of the Cochrane Library, MEDLINE, LILACS, Grey literature, and EMBASE was performed for papers published from January 1990 to April 2016. The following key terms were searched: "major depressive disorder", "unipolar depression", "brain-derived neurotrophic factor", and "electroconvulsive therapy". A total of 252 citations were identified by the search strategy, and nine studies met the inclusion criteria of the meta-analysis. BDNF levels were increased among patients with MDD after ECT (P value = 0.006). The standardized mean difference was 0.56 (95% CI: 0.17-0.96). Additionally, we found significant heterogeneity between studies (I(2) = 73%). Our findings suggest a potential role of BDNF as a marker of treatment response after ECT in patients with MDD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review.

    Science.gov (United States)

    Nielsen, R M; Olsen, K S; Lauritsen, A Oe; Boesen, H C

    2014-10-01

    Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. We treated 5 cases of severe protracted delirium in our ICU with electroconvulsive therapy (ECT) after failure of conventional medical therapy. The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series.

    Science.gov (United States)

    Rodriguez-Jimenez, Roberto; Bagney, Alexandra; Torio, Iosune; Caballero, Montserrat; Ruiz, Pedro; Rivas, Francisco de Paula Jose; Jimenez-Arriero, Miguel Angel

    2015-01-01

    Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there is a limited nubber of studies that investigate clinical management, associated costs, and perceived quality variables. A series of 8 cases included during the first 18 months of the Continuation/Maintenance Electroconvulsive Therapy Program of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (Clinical Global Impression-Improvement Scale, length of hospitalization, number of Emergency Department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy program were compared for each patient, as well as associated costs and perceived quality. After inclusion in the program, 50.0% of patients reported feeling « much better » and 37.5% « moderately better » in the Clinical Global Impression-Improvement Scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy program, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalization (P = .012), 26 Emergency Department visits (P = .011) and 22 urgent admissions (P = .010) during the same period before inclusion in the program. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with Emergency Department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of patients assessed the care and treatment received as being « very satisfactory », and 12.5% as « satisfactory ». This continuation/maintenance electroconvulsive therapy program has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights

  20. Extracorporeal shock wave therapy for tendinopathies.

    Science.gov (United States)

    Seil, Romain; Wilmes, Philippe; Nührenbörger, Christian

    2006-07-01

    Shock waves, as applied in urology and gastroenterology, were introduced in the middle of the last decade in Germany to treat different pathologies of the musculoskeletal system, including epicondylitis of the elbow, plantar fasciitis, and calcifying and noncalcifying tendinitis of the rotator cuff. With the noninvasive nature of these waves and their seemingly low complication rate, extracorporeal shock wave therapy (ESWT) seemed a promising alternative to the established conservative and surgical options in the treatment of patients with chronically painful conditions. However, the apparent advantages of the method led to a rapid diffusion and even inflationary use of ESWT; prospective, randomized studies on the mechanisms and effects of shock waves on musculoskeletal tissues were urgently needed to define more accurate indications and optimize therapeutic outcome. This review covers recent international research in the field and presents actual indications and results in therapy of musculoskeletal conditions with ESWT.

  1. Toxic Shock Syndrome (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Toxic Shock Syndrome KidsHealth > For Parents > Toxic Shock Syndrome Print ... en español Síndrome de shock tóxico About Toxic Shock Syndrome Toxic shock syndrome (TSS) is a serious ...

  2. Streptococcal toxic shock syndrome

    Directory of Open Access Journals (Sweden)

    Gvozdenović Ljiljana

    2010-01-01

    Full Text Available Introduction. Streptococcal toxic shock syndrome is now recognized as a toxin-mediated, multisystem illness. It is characterized by an early onset of shock with multiorgan failure and continues to be associated with high morbidity and mortality, caused by group A Streptococcus pyogenes. The symptoms for staphylococcal and streptococcal toxic shock syndrome are similar. Streptococcal toxic shock syndrome was not well described until 1993, when children who had suffered from varicella presented roughly 2-4 weeks later with a clinical syndrome highly suggestive of toxic shock syndrome. Characteristics, complications and therapy. It is characterized by a sudden onset of fever, chills, vomiting, diarrhea, muscle aches and rash. It can rapidly progress to severe and intractable hypotension and multisystem dysfunction. Almost every organ system can be involved. Complications of streptococcal toxic shock syndrome may include kidney failure, liver failure and even death. Crystalloids and inotropic agents are used to treat the hypovolemic shock aggressively, with close monitoring of the patient’s mean arterial pressure and central venous pressure. An immediate and aggressive management of hypovolemic shock is essential in streptococcal toxic shock syndrome. Targeted antibiotics are indicated; penicillin or a betalactam antibiotic is used for treating group A streptococci, and clindamycin has emerged as a key portion of the standard treatment.

  3. When Shock Waves Collide

    Science.gov (United States)

    Hartigan, P.; Foster, J.; Frank, A.; Hansen, E.; Yirak, K.; Liao, A. S.; Graham, P.; Wilde, B.; Blue, B.; Martinez, D.; Rosen, P.; Farley, D.; Paguio, R.

    2016-06-01

    Supersonic outflows from objects as varied as stellar jets, massive stars, and novae often exhibit multiple shock waves that overlap one another. When the intersection angle between two shock waves exceeds a critical value, the system reconfigures its geometry to create a normal shock known as a Mach stem where the shocks meet. Mach stems are important for interpreting emission-line images of shocked gas because a normal shock produces higher postshock temperatures, and therefore a higher-excitation spectrum than does an oblique shock. In this paper, we summarize the results of a series of numerical simulations and laboratory experiments designed to quantify how Mach stems behave in supersonic plasmas that are the norm in astrophysical flows. The experiments test analytical predictions for critical angles where Mach stems should form, and quantify how Mach stems grow and decay as intersection angles between the incident shock and a surface change. While small Mach stems are destroyed by surface irregularities and subcritical angles, larger ones persist in these situations and can regrow if the intersection angle changes to become more favorable. The experimental and numerical results show that although Mach stems occur only over a limited range of intersection angles and size scales, within these ranges they are relatively robust, and hence are a viable explanation for variable bright knots observed in Hubble Space Telescope images at the intersections of some bow shocks in stellar jets.

  4. Anti-Shock Garment

    Science.gov (United States)

    1996-01-01

    Ames Research Center developed a prototype pressure suit for hemophiliac children, based on research of astronauts' physiological responses in microgravity. Zoex Corporation picked up the design and patents and developed an anti-shock garment for paramedic use. Marketed by Dyna Med, the suit reverses the effect of shock on the body's blood distribution by applying counterpressure to the legs and abdomen, returning blood to vital organs and stabilizing body pressure until the patient reaches a hospital. The DMAST (Dyna Med Anti-Shock Trousers) employ lower pressure than other shock garments, and are non-inflatable.

  5. Chiral Shock Waves

    CERN Document Server

    Sen, Srimoyee

    2016-01-01

    We study shock waves in relativistic chiral matter. We argue that the conventional Rankine- Hugoinot relations are modified due to the presence of chiral transport phenomena. We show that the entropy discontinuity in a weak shock wave is linearly proportional to the pressure discontinuity when the effect of chiral transport becomes sufficiently large. We also show that rarefaction shock waves, which do not exist in usual nonchiral fluids, can appear in chiral matter. These features are exemplified by shock propagation in dense neutrino matter in the hydrodynamic regime.

  6. Diffusive Shock Acceleration at Cosmological Shock Waves

    CERN Document Server

    Kang, Hyesung

    2012-01-01

    We reexamine nonlinear diffusive shock acceleration (DSA) at cosmological shocks in the large scale structure of the Universe, incorporating wave-particle interactions that are expected to operate in collisionless shocks. Adopting simple phenomenological models for magnetic field amplification (MFA) by cosmic-ray (CR) streaming instabilities and Alfv'enic drift, we perform kinetic DSA simulations for a wide range of sonic and Alfv'enic Mach numbers and evaluate the CR injection fraction and acceleration efficiency. In our DSA model the CR acceleration efficiency is determined mainly by the sonic Mach number Ms, while the MFA factor depends on the Alfv'enic Mach number and the degree of shock modification by CRs. We show that at strong CR modified shocks, if scattering centers drift with an effective Alfv'en speed in the amplified magnetic field, the CR energy spectrum is steepened and the acceleration efficiency is reduced significantly, compared to the cases without such effects. As a result, the postshock C...

  7. Toxic Shock Syndrome (For Teens)

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Toxic Shock Syndrome KidsHealth > For Teens > Toxic Shock Syndrome Print ... it, then take some precautions. What Is Toxic Shock Syndrome? If you're a girl who's had ...

  8. Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

    Directory of Open Access Journals (Sweden)

    Aksay SS

    2017-05-01

    Full Text Available Suna Su Aksay,1 Jan Malte Bumb,2 Dmitry Remennik,3 Manfred Thiel,3 Laura Kranaster,1 Alexander Sartorius,1 Christoph Janke3 1Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH, Medical Faculty Mannheim, University of Heidelberg, 2Department of Addictive Behavior and Addiction Medicine,Central Institute of Mental Health (CIMH, Medical Faculty Mannheim, University of Heidelberg, 3Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany Objectives: Postictal agitation (PIA represents one of the most common complications during a modified electroconvulsive therapy (ECT course. Its clinical management can be challenging especially in cases with poor response to benzodiazepines. Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist acting predominantly in the locus coeruleus, exerts sedative effects without causing relevant respiratory depression. To the best of our knowledge, this is the first study that aimed to assess the impact of dexmedetomidine use with S-ketamine anesthesia on PIA reduction in ECT.Patients and methods: We retrospectively analyzed 7 patients who underwent 178 ECT sessions with S-ketamine anesthesia between June 2011 and July 2015 at the Central Institute of Mental Health Mannheim. In 101 sessions, the patients received dexmedetomidine in combination with S-ketamine anesthesia. The decision for dexmedetomidine use was based on individual clinical presentation (patients with positive PIA history. A multivariate repeated measurement logistic regression analysis was conducted to investigate the effect of dexmedetomidine use on the occurrence of PIA. We hypothesized that the use of dexmedetomidine reduced the incidence of PIA also in combination with S-ketamine anesthesia.Results: The prevalence of PIA in ECT sessions with dexmedetomidine administration was lower (mean per patient, 34% vs 62%. In the multivariate logistic regression

  9. Electroconvulsive therapy (ECT) for treating agitation in dementia (major neurocognitive disorder) - a promising option.

    Science.gov (United States)

    Glass, Oliver M; Forester, Brent P; Hermida, Adriana P

    2017-05-01

    Agitation in patients with dementia increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with dementia have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of ECT for the treatment of agitation in patients with dementia (major neurocognitive disorder). We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning ECT for treating agitation in dementia using the title search terms "ECT agitation dementia;" "ECT aggression dementia;" "ECT Behavior and Psychological Symptoms of Dementia;" and "ECT BPSD." The term "dementia" was also interchanged with "Major Neurocognitive Disorder." No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients. Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, ECT has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT. Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome

  10. [Electroconvulsive therapy and level of evidence: From causality to dose-effect relationship].

    Science.gov (United States)

    Micoulaud-Franchi, J-A; Quilès, C; Cermolacce, M; Belzeaux, R; Adida, M; Fakra, E; Azorin, J-M

    2016-12-01

    The first objective of this article is to summarize the history of electroconvulsive therapy (ECT) in psychiatry in order to highlight the transition from clinical level of evidence based on phenomenological descriptions to controlled trial establishing causal relationship. The second objective is to apply the criteria of causation for ECT, to focus on the dose-effect relationship criteria, and thus to analyze the conditions of application of these criteria for ECT. A literature review exploring the use of electricity, ECT and electroencephalography (EEG) in psychiatry was conducted. The publications were identified from the Pubmed and GoogleScholar electronic databases. The scientific literature search of international articles was performed in July 2016. In 1784, a Royal commission established in France by King Louis XVI tested Mesmer's claims concerning animal magnetism. By doing that, the commission, including such prominent scientists as the chemist Anton Lavoisier and the scientist and researcher on electricity and therapeutics Benjamin Franklin, played a central role in establishing the criteria needed to assess the level of evidence of electrical therapeutics in psychiatry. Surprisingly, it is possible to identify the classical Bradford Hill criteria of causation in the report of the commission, except the dose-effect relationship criteria. Since then, it has been conducted blinded randomized controlled trials that confirmed the effectiveness of ECT against ECT placebos for the treatment of psychiatric disorders. At present, the dose-effect relationship criteria can be analyzed through an EEG quality assessment of ECT-induced seizures. EEG quality assessment includes several indices: TSLOW (time to onset of seizure activity ≤5Hz, seconds), peak mid-ictal amplitude (mm), regularity (intensity or morphology of the seizure (0-6)), stereotypy (global seizure patterning, 0-3) and post-ictal suppression (0-3). A manual rating sheet is needed to score theses

  11. Effect of Ketamine, Thiopental and Ketamine–Thiopental Combination during Electroconvulsive Therapy for Depression

    Science.gov (United States)

    Kuşçu, Özlem Özkan; Karacaer, Feride; Biricik, Ebru; Güleç, Ersel; Tamam, Lut; Güneş, Yasemin

    2015-01-01

    Objective We aimed to evaluate the effect of anaesthesia with thiopental (4 mg kg−1), ketamine (1 mg kg−1) and ketamine–thiopental (1 mg kg−1 and 4 mg kg−1, respectively) combination during electroconvulsive therapy (ECT) on the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A) and haemodynamic variables in patients with resistant major depression. Methods Patients with HDRS scores above 17 were included. The patients were randomly divided into three groups according to the anaesthesia used. Group 1 was given thiopental (4 mg kg−1), Group 2 was given ketamine (1 mg kg−1) and Group 3 was given ketamine (1 mg kg−1) and thiopental (4 mg kg−1). Succinylcholine (1 mg kg−1) was administered in all patients for muscle relaxation. HDRS and HAM-A scores were evaluated before ECT, after 3, 6. ECT and after the final ECT. Systolic and diastolic blood pressures, heart rates and oxygen saturations were recorded before and after anaesthesia induction and after the ECT procedure. Seizure duration was recorded. Results Fifty-eight patients were included in the study. Thirty (52%) patients were male and 28 (48%) were female. The mean age was 42.7±15.8 years in Group 1, 44.8±11 years in Group 2 and 38.6±6.8 years in Group 3. In all groups, HDRS scores were reduced compared with the baseline values. There was no statistical significant difference between the groups regarding HDRS scores. HAM-A scores were higher in Group 2 and Group 3. Systolic and diastolic blood pressures and heart rate values were lower in Group 1 and the difference was statistically significant. Conclusion In this study, anaesthesia induced with thiopental, ketamine and thiopental–ketamine combination was observed to not result in a difference in ECT for patients with treatment-resistant depression. Ketamine at a dose of 1 mg kg−1 given just before ECT did not enhance the antidepressant effect of ECT; however, anxiety scores were increased with ketamine

  12. Electroconvulsive Therapy Alone for Schizophrenia: A Meta-analysis of Randomized, Single-blind, Controlled Trials [RETRACTED].

    Science.gov (United States)

    Zheng, Wei; Xiang, Ying-Qiang; Ungvari, Gabor S; Ng, Chee H; Chiu, Helen F K; Liu, Zheng-Rong; Cao, Xiao-Lan; Guo, Tong; Wang, Harry H X; Seiner, Stephen J; Xiang, Yu-Tao

    2016-08-03

    Electroconvulsive therapy (ECT) is a common treatment in practice for schizophrenia in most developing countries. This is a meta-analysis of the efficacy and safety of ECT alone versus antipsychotic (AP) monotherapy for schizophrenia using randomized, single-blind, controlled trial (RCT) data. Two assessors independently extracted data. Standardized and weighted mean difference (SMD/WMD), odds ratios (ORs) ± 95% confidence intervals (CIs), and number needed to harm (NNH) were calculated by Review Manager Version 5.3 and the Comprehensive Meta-Analysis Version 2 software. Five RCTs (n = 365; age, 34.1 ± 4.7 years; percentage of male, 52.8 ± 9.5; range on the Jaded scale, 2-3) were identified and analyzed. Electroconvulsive therapy alone was superior to AP monotherapy with chlorpromazine, haloperidol, paliperidone, clozapine, and risperidone, respectively, regarding symptomatic improvement at last-observation end point (SMD, -0.84; P = 0.02; I = 89%). Improvement with ECT separated from AP as early as weeks 1 to 2 (SMD, -1.26; P = 0.01; I = 89%). Meta-analysis of the end point memory quotient of the Wechsler Memory Scale-Revised, Chinese version, revealed that the ECT alone group had poorer memory performance than the AP group (WMD, -9.34; P < 0.00001; I = 0%), but the difference lost its significance within 2 weeks after ECT (WMD, 0.09 to -6.54; P = 0.11-0.97; I = 0%). Compared with AP monotherapy, ECT was associated with more memory impairment (OR, 14.11; P = 0.004; NNH, 6) but with less akathisia (OR, 0.06; P = 0.0009; NNH, 6), tremor (OR, 0.08; P = 0.02; NNH, 7), and tachycardia (OR, 0.06; P = 0.006; NNH, 5). There were no significant differences in other adverse events and all-cause discontinuation. Electroconvulsive therapy alone could be an effective and safe treatment option for schizophrenia, with transient memory impairment and headache being the major side effects.

  13. Climate shocks and conflict

    NARCIS (Netherlands)

    Papaioannou, Kostadis J.

    2016-01-01

    This paper offers a historical micro-level analysis of the impact of climate shocks on the incidence of civil conflict in colonial Nigeria (1912-1945). Primary historical sources on court cases, prisoners and homicides are used to capture conflict. To measure climate shocks we use the deviation f

  14. [Historical vision of shock].

    Science.gov (United States)

    Dosne Pasqualini, C

    1998-01-01

    The concept of shock and its close relationship with that of stress dates back to the experiments of Hans Selye initiated in 1936 at McGill University in Montreal, with whom I collaborated between 1939 and 1942. It was demonstrated that the General Adaptation Syndrome begins with an Alarm Reaction, which consists of a Stage of Shock and one of Counter-Shock, followed by a Stage of Adaptation and finally a Stage of Exhaustion. My Ph.D. thesis concluded that shock was due to an adrenal insufficiency postulating that active metabolic processes drain the body of certain essential compounds the lack of which causes shock. My interest in the role of the glucose metabolism in shock led me to work with Bernardo Houssay in 1942 at the Institute of Physiology of the University of Buenos Aires and in 1944 with C.N.H. Long at Yale University. There I developed a method for the induction of hemorrhagic shock in the guinea pig with 94% lethality; curiously, the administration of 200 mg of ascorbic acid prevented death. Upon my return to Buenos Aires, these results were confirmed and moreover, it was demonstrated that the administration of cortisone led to 40% survival of the animals while desoxycorticosterone had no effect. At the time, no explanation was available but to-day, half a century later, this Symposium should be able to explain the mechanisms leading to death by hemorrhagic shock.

  15. [Shock waves in orthopedics].

    Science.gov (United States)

    Haupt, G

    1997-05-01

    Extracorporeal shock waves have revolutionized urological stone treatment. Nowadays shock waves are widely used in orthopedics, too. This article reviews the applications of extracorporeal shock waves on bone and adjacent soft tissue. The osteoneogenetic effect of extracorporeal shock waves has been proven and can be used to treat pseudarthrosis with a success rate of around 75%. Shock waves have a positive effect in tennis and golfer's elbow, calcaneal spur, and the complex called "periarthritis humero-scapularis." The mechanism for this is not yet known, and results from large prospective and randomized studies are still lacking. However, the treatment has been performed many thousands of times. In patients in whom conservative treatment has failed surgery used to be the only choice, but its success rate barely exceeds that of shock wave therapy and surgery can still be done if shock wave therapy fails. Extracorporeal shock waves will have an impact on orthopedics comparable to its effect in urology. Scientific evaluations, professional certifications, quality assurance and reimbursement issues present great challenges.

  16. The Shock Routine

    DEFF Research Database (Denmark)

    van Hooren, Franca; Kaasch, Alexandra; Starke, Peter

    2014-01-01

    in Australia, Belgium, the Netherlands and Sweden over the course of four global economic shocks, we ask whether the notion of critical junctures is useful in understanding the nature of change triggered by crisis. The main empirical finding is that fundamental change in the aftermath of an exogenous shock...

  17. Our Favorite Film Shocks

    DEFF Research Database (Denmark)

    Willerslev, Rane; Suhr, Christian

    2014-01-01

    shocks? In this text we exchange personal experiences of cinematic shocks and ponder over these questions as related to wider theories on human trauma, emancipation, and enlightenment. In conclusion we argue for a revision of anthropological notions of validity in terms of the efficacy of the cinematic...

  18. Reflection of curved shock waves

    Science.gov (United States)

    Mölder, S.

    2017-03-01

    Shock curvatures are related to pressure gradients, streamline curvatures and vorticity in flows with planar and axial symmetry. Explicit expressions, in an influence coefficient format, are used to relate post-shock pressure gradient, streamline curvature and vorticity to pre-shock gradients and shock curvature in steady flow. Using higher order, von Neumann-type, compatibility conditions, curved shock theory is applied to calculate the flow near singly and doubly curved shocks on curved surfaces, in regular shock reflection and in Mach reflection. Theoretical curved shock shapes are in good agreement with computational fluid dynamics calculations and experiment.

  19. Reflection of curved shock waves

    Science.gov (United States)

    Mölder, S.

    2017-09-01

    Shock curvatures are related to pressure gradients, streamline curvatures and vorticity in flows with planar and axial symmetry. Explicit expressions, in an influence coefficient format, are used to relate post-shock pressure gradient, streamline curvature and vorticity to pre-shock gradients and shock curvature in steady flow. Using higher order, von Neumann-type, compatibility conditions, curved shock theory is applied to calculate the flow near singly and doubly curved shocks on curved surfaces, in regular shock reflection and in Mach reflection. Theoretical curved shock shapes are in good agreement with computational fluid dynamics calculations and experiment.

  20. Clinical observation of extracorporeal shock wave therapy for chronic non-calcific tendinopathy of the supraspinatus%体外冲击波治疗非钙化性冈上肌肌腱炎疗效观察

    Institute of Scientific and Technical Information of China (English)

    谷玉静; 林松; 冯晓东

    2014-01-01

    Objective To observe the clinical effects of extracorporeal shock wave therapy ( ESWT ) for chronic non-calcific tendinopathy of the supraspinatus.Methods From April 2011 to April 2013, 53 patients with chronic non-calciifc tendinopathy of the supraspinatus were adopted, whose average age was ( 40.42±1.33 ) years old. They were randomly divided into treatment group (n=26 ) and control group (n=27 ). The patients in both groups received infrared ray therapy. Besides, the patients in the treatment group received low-dose ESWT and the patients in the control group accepted placebo therapy. The Constant-Murley score ( CMS ) was used to assess the improvement of the shoulder function in both groups before the treatment and at 1 and 3months after the treatment.Results The patients in both groups were followed up for at least 3 months, and no severe side effects were noticed during the treatment. In the treatment group, the scores of Visual Analogue Scale ( VAS ), activity of daily living ( ADL ) scale, range of motion ( ROM ) scale, muscle strength grading scale and CMS were ( 2.08±0.80 ) points, ( 8.65±1.65 ) points, ( 12.77±3.10 ) points, ( 10.38±1.13 ) points and ( 33.88±4.08 ) points before the treatment, which were increased to ( 8.00±0.89 ) points, ( 12.96±1.40 ) points, ( 20.58±5.68 ) points, ( 13.50±1.24 ) points and ( 54.04±5.17 ) points at 1 month after the treatment and ( 11.08±1.47 ) points, ( 17.96±1.11 ) points, ( 30.46±4.43 ) points, ( 15.92±2.47 ) points and ( 75.42±6.35 ) points at 3 months after the treatment. When all the scores stated above and the total CMS score before the treatment were compared with that at 1 and 3 months after the treatment respectively, statistically signiifcant differences existed (P0.05 ). At 1 month after the treatment, there were statistically signiifcant differences between the 2 groups in all the scores and the total CMS score except the muscle strength grading score (P<0.05 ). At 3 months after the

  1. Use of electroconvulsive therapy in an elderly after 5 weeks of myocardial infraction with 30% cardiac output

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2015-01-01

    Full Text Available There is limited literature on the use of electroconvulsive therapy (ECT in patients with recent myocardial infarction and in those with reduced cardiac output. In this report, we describe the safe use of ECT in a 70-year-male suffering from severe depressive episode with psychotic symptoms. He had a history of poor response to adequate pharmacotherapy and had suffered from myocardial infraction (MI, about 3 weeks prior to admission to the psychiatric unit. In view of severe depression associated with marked anxiety, agitation, psychotic symptoms, and poor food intake he was started on ECT after 5 weeks of MI when his cardiac output was only 30%. He received nine sessions of ECT without any cardiac complications and his depression remitted with ECT.

  2. Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review.

    Science.gov (United States)

    Bica, B E R G; Moro, A L D; Hax, V; Nicol, N A; Campos, G S; Rivera, L M S; da Costa, A F C; Xavier, R M; Monticielo, O A

    2015-10-01

    Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

  3. Heat Shock Proteins and Diabetes.

    Science.gov (United States)

    Zilaee, Marzie; Shirali, Saeed

    2016-12-01

    Diabetes is a chronic disease, and its prevalence continues to rise and can increase the risk for the progression of microvascular (such as nephropathy, retinopathy and neuropathy) and also macrovascular complications. Diabetes is a condition in which the oxidative stress and inflammation rise. Heat shock proteins (HSPs) are a highly conserved family of proteins that are expressed by all cells exposed to environmental stress, and they have diverse functions. In patients with diabetes, the expression and levels of HSPs decrease, but these chaperones can aid in improving some complications of diabetes, such as oxidative stress and inflammation. (The suppression of some HSPs is associated with a generalized increase in tissue inflammation.) In this review, we summarize the current understanding of HSPs in diabetes as well as their complications, and we also highlight their potential role as therapeutic targets in diabetes. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  4. Genetic fate mapping of type-1 stem cell-dependent increase in newborn hippocampal neurons after electroconvulsive seizures.

    Science.gov (United States)

    Weber, Tillmann; Baier, Vera; Lentz, Katharina; Herrmann, Elke; Krumm, Bertram; Sartorius, Alexander; Kronenberg, Golo; Bartsch, Dusan

    2013-12-01

    Electroconvulsive therapy (ECT) is a uniquely effective treatment for major depressive disorder. An increase in hippocampal neurogenesis is implicated in the recovery from depression. We used an inducible genetic mouse model in which only GFAP-expressing stem-like cells (type-1 cells) and their progeny are selectively labeled with the reporter protein β-galactosidase to track the process of neurogenesis in the dentate gyrus over 3 months following electroconvulsive seizures (ECS), the mouse equivalent of ECT. All ECS protocols tested induced a transient increase in type-1 cell divisions. While this led to an expansion of the type-1 cell pool after high-frequency ECS sessions for 5 consecutive days (5-ECS), asymmetric divisions drove neurogenesis by giving rise to Doublecortin (DCX)-expressing neuroblasts that matured into NeuN+ neurons. Significantly, the increase in newly generated DCX+ and NeuN+ cells after 5-ECS could be traced back to proliferating type-1 cells. Low-frequency continuation ECS (c-ECS) consisting of five single ECS sessions administered every 2 weeks resulted in a similar increase in newborn neurons as the high-frequency 5-ECS protocol. Moreover, the combination of 5-ECS and c-ECS led to a further significant increase in newborn neurons, suggesting a cellular mechanism responsible for the propitious effects of high-frequency ECT followed by continuation ECT in severely depressed patients. The ability of high- and low-frequency ECS to induce normally quiescent type-1 cells to proliferate and generate new neurons sets it apart from other antidepressant treatments and may underlie the superior clinical efficacy of ECT.

  5. Vasogenic shock physiology

    Directory of Open Access Journals (Sweden)

    Sotiria Gkisioti

    2011-01-01

    Full Text Available Sotiria Gkisioti, Spyros D MentzelopoulosDepartment of Intensive Care Medicine, University of Athens Medical School, Evaggelismos General Hospital, Athens, GreeceAbstract: Shock means inadequate tissue perfusion by oxygen-carrying blood. In vasogenic shock, this circulatory failure results from vasodilation and/or vasoplegia. There is vascular hyporeactivity with reduced vascular smooth muscle contraction in response to α1 adrenergic agonists. Considering vasogenic shock, one can understand its utmost importance, not only because of its association with sepsis but also because it can be the common final pathway for long-lasting, severe shock of any cause, even postresuscitation states. The effective management of any patient in shock requires the understanding of its underlying physiology and pathophysiology. Recent studies have provided new insights into vascular physiology by revealing the interaction of rather complicated and multifactorial mechanisms, which have not been fully elucidated yet. Some of these mechanisms, such as the induction of nitric oxide synthases, the activation of adenosine triphosphate-sensitive potassium channels, and vasopressin deficiency, have gained general acceptance and are considered to play an important role in the pathogenesis of vasodilatory shock. The purpose of this review is to provide an update on the pathogenesis of vasogenic shock.Keywords: nitric oxide synthases, KATP channels, vasopressin, H2S, vasoplegic syndrome

  6. Electroconvulsive stimulations normalizes stress-induced changes in the glucocorticoid receptor and behaviour

    DEFF Research Database (Denmark)

    Hageman, Ida; Nielsen, Marianne; Wörtwein, Gitta

    2009-01-01

    Animal models of chronic stress, such as 21 days of 6h/daily restraint stress cause changes in neuronal morphology in the hippocampus and alter behaviour. These changes are partly mediated by the glucocorticoids. The objective of this study was threefold: (1) to study how this particular chronic ...

  7. A cylindrical converging shock tube for shock-interface studies.

    Science.gov (United States)

    Luo, Xisheng; Si, Ting; Yang, Jiming; Zhai, Zhigang

    2014-01-01

    A shock tube facility for generating a cylindrical converging shock wave is developed in this work. Based on the shock dynamics theory, a specific wall profile is designed for the test section of the shock tube to transfer a planar shock into a cylindrical one. The shock front in the converging part obtained from experiment presents a perfect circular shape, which proves the feasibility and reliability of the method. The time variations of the shock strength obtained from numerical simulation, experiment, and theoretical estimation show the desired converging effect in the shock tube test section. Particular emphasis is then placed on the problem of shock-interface interaction induced by cylindrical converging shock waves. For this purpose, membrane-less gas cylinder is adopted to form the interface between two different fluids while the laser sheet technique to visualize the flow field. The result shows that it is convenient to perform such experiments in this facility.

  8. Electric foot shock stress: a useful tool in neuropsychiatric studies.

    Science.gov (United States)

    Bali, Anjana; Jaggi, Amteshwar Singh

    2015-01-01

    Electric foot shock is a complex stressor with both physical and emotional components. It has been employed as an important tool to develop diverse animal models in the field of psychopharmacology. The electric foot shock paradigm includes acute or chronic exposures of shocks of varying intensity and duration on an electrified grid floor in an electric foot shock apparatus. Research evidence reveals that foot shocks of varying intensity produce behavioral and neurochemical changes reflecting depression, anxiety, and post-traumatic stress disorder (PTSD) in humans. Animals generally do not habituate to foot shocks in comparison to other stressors, including loud noise, bright light, and hot and cold temperatures. Additionally, it offers an experimental advantage of control over intensity and duration; therefore, by varying its application parameters, different disorder models have been created. Electric foot shock fear conditioning-induced ultrasonic vocalization and fear-potentiated startle have been explored to develop models of anxiety and panic. Similarly, fear conditioning in the form of foot shock exposure followed by situational reminders has been used to develop a model of PTSD. Electric foot shock-induced conflict has been explored to develop operant conflict models (Geller-Seifter and Vogel tests), which in turn are pharmacologically validated to screen potential anti-anxiety agents. Inescapable electric shock-induced 'learned helplessness' mimics the symptomology of depression, and this phenomenon has been employed to develop the model of depression. The present review describes the pharmacologically validated models of anxiety, depression, and PTSD involving electric foot shock as an aversive stimulus.

  9. The effects of sodium valproate and its metabolites (5-OH-VPA and 4-OH-VPA) on electroconvulsions in rats.

    Science.gov (United States)

    Sobaniec, W; Sobaniec-Lotowska, M

    1994-01-01

    Effects of sodium valproate (VPA) and the omega-oxidation metabolites (5-OH-VPA and 4-OH-VPA) on the electroconvulsions in rats were analyzed. The drug (100 and 200 mg/kg/day) revealed marked dose-related anticonvulsant effect which manifested themselves by shortening the convulsions time and their intensity. The anticonvulsant effect of the omega-oxidation (50, 100 and 200 mg/kg/day) were weaker compared with the parent drugs.

  10. Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression.

    Science.gov (United States)

    Lihua, Peng; Su, Min; Ke, Wei; Ziemann-Gimmel, Patrick

    2014-04-11

    Depression is a common mental disorder. It affects millions of people worldwide and is considered by the World Health Organization (WHO) to be one of the leading causes of disability. Electroconvulsive therapy (ECT) is a well-established treatment for severe depression. Intravenous anaesthetic medication is used to minimize subjective unpleasantness and adverse side effects of the induced tonic-clonic seizure. The influence of different anaesthetic medications on the successful reduction of depressive symptoms and adverse effects is unclear. This review evaluated the effects of different regimens of intravenous sedatives and hypnotics on anti-depression efficacy, recovery and seizure duration in depressed adults undergoing ECT. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12); MEDLINE via Ovid SP (from 1966 to 31 December 2012); and EMBASE via Ovid SP (from 1966 to 31 December 2012). We handsearched related journals and applied no language restrictions. We included randomized controlled trials (RCTs) and cross-over trials evaluating the effects of different intravenous sedatives and hypnotics for ECT. We excluded studies and trials using placebo or inhalational anaesthetics and studies that used no anaesthetic. Two review authors independently assessed trial quality and extracted data. When possible, data were pooled and risk ratios (RRs) and mean differences (MDs), each with 95% confidence intervals (CIs), were computed using the Cochrane Review Manager statistical package (RevMan). We included in the review 18 RCTs (599 participants; published between 1994 and 2012). Most of the included trials were at high risk of bias.We analysed the results of studies comparing six different intravenous anaesthetics.Only a few studies comparing propofol with methohexital (four studies) and with thiopental (three studies) could be pooled.No difference was noted in the reduction of depression scores observed in participants treated with

  11. Effect of olanzapine combined with modified electroconvulsive therapy on cytokines, sTNFRs and neural electrophysiological characteristics in patients with schizophrenia

    Institute of Scientific and Technical Information of China (English)

    Wei Cheng

    2016-01-01

    Objective:To analyze the effect of olanzapine combined with modified electroconvulsive therapy on cytokines, sTNFRs and neural electrophysiological characteristics in patients with schizophrenia.Methods:Patients with schizophrenia treated in our hospital between March 2013 and March 2016 were selected and randomly divided into two groups, the observation group received olanzapine combined with modified electroconvulsive therapy, and the control group received olanzapine therapy. After 6 weeks of treatment, serum levels of soluble tumor necrosis factor receptor (sTNFR), acute phase reaction proteins and brain function indexes as well as the neural electrophysiological characteristics were compared between the two groups.Results:After 6 weeks of treatment, serum sTNFRs, CRP, CER and AAG content of observation group were lower than those of control group while TRF content was higher than that of control group; serum brain function indexes NGF and BDNF content were higher than those of control group while GFAP, S100B, NSE and Hcy content were lower than those of control group; nerve electrophysiology indexes P300, LPP and ERN amplitude were higher than those of control group while LPP amplitude was lower than that of control group. Conclusions:Olanzapine combined with modified electroconvulsive therapy can optimize the condition of schizophrenia, reduce the abnormal degree of nerve electrophysiology and help to improve treatment outcome.

  12. Collisionless parallel shocks

    Science.gov (United States)

    Khabibrakhmanov, I. KH.; Galeev, A. A.; Galinskii, V. L.

    1993-01-01

    Consideration is given to a collisionless parallel shock based on solitary-type solutions of the modified derivative nonlinear Schroedinger equation (MDNLS) for parallel Alfven waves. The standard derivative nonlinear Schroedinger equation is generalized in order to include the possible anisotropy of the plasma distribution and higher-order Korteweg-de Vies-type dispersion. Stationary solutions of MDNLS are discussed. The anisotropic nature of 'adiabatic' reflections leads to the asymmetric particle distribution in the upstream as well as in the downstream regions of the shock. As a result, nonzero heat flux appears near the front of the shock. It is shown that this causes the stochastic behavior of the nonlinear waves, which can significantly contribute to the shock thermalization.

  13. Shock structures of astrospheres

    CERN Document Server

    Scherer, Klaus; Kleimann, Jens; Wiengarten, Tobias; Bomans, Dominik J; Weis, Kerstin

    2015-01-01

    The interaction between a supersonic stellar wind and a (super-)sonic interstellar wind has recently been viewed with new interest. We here first give an overview of the modeling, which includes the heliosphere as an example of a special astrosphere. Then we concentrate on the shock structures of fluid models, especially of hydrodynamic (HD) models. More involved models taking into account radiation transfer and magnetic fields are briefly sketched. Even the relatively simple HD models show a rich shock structure, which might be observable in some objects. We employ a single fluid model to study these complex shock structures, and compare the results obtained including heating and cooling with results obtained without these effects. Furthermore, we show that in the hypersonic case valuable information of the shock structure can be obtained from the Rankine-Hugoniot equations. We solved the Euler equations for the single fluid case and also for a case including cooling and heating. We also discuss the analytic...

  14. Counseling For Future Shock

    Science.gov (United States)

    Morgan, Lewis B.

    1974-01-01

    In this article the author looks at some of the searing prophecies made by Alvin Toffler in his book Future Shock and relates them to the world of the professional counselor and the clientele the counselor attempts to serve. (Author)

  15. Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Denollet, Johan; Tekle, Fetene B; Pedersen, Susanne S.;

    2013-01-01

    Clinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice....

  16. [Pathophysiology of hemorragic shock].

    Science.gov (United States)

    Copotoiu, R; Cinca, E; Collange, O; Levy, F; Mertes, P-M

    2016-11-01

    This review addresses the pathophysiology of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume, which may lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The initial neuroendocrine response is mainly a sympathetic activation. Haemorrhagic shock is associated altered microcirculatory permeability and visceral injury. It is also responsible for a complex inflammatory response associated with hemostasis alteration. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Relativistic Radiation Mediated Shocks

    CERN Document Server

    Budnik, Ran; Sagiv, Amir; Waxman, Eli

    2010-01-01

    The structure of relativistic radiation mediated shocks (RRMS) propagating into a cold electron-proton plasma is calculated and analyzed. A qualitative discussion of the physics of relativistic and non relativistic shocks, including order of magnitude estimates for the relevant temperature and length scales, is presented. Detailed numerical solutions are derived for shock Lorentz factors $\\Gamma_u$ in the range $6\\le\\Gamma_u\\le30$, using a novel iteration technique solving the hydrodynamics and radiation transport equations (the protons, electrons and positrons are argued to be coupled by collective plasma processes and are treated as a fluid). The shock transition (deceleration) region, where the Lorentz factor $ \\Gamma $ drops from $ \\Gamma_u $ to $ \\sim 1 $, is characterized by high plasma temperatures $ T\\sim \\Gamma m_ec^2 $ and highly anisotropic radiation, with characteristic shock-frame energy of upstream and downstream going photons of a few~$\\times\\, m_ec^2$ and $\\sim \\Gamma^2 m_ec^2$, respectively.P...

  18. Shock Detector for SURF model

    Energy Technology Data Exchange (ETDEWEB)

    Menikoff, Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-01-11

    SURF and its extension SURFplus are reactive burn models aimed at shock initiation and propagation of detonation waves in high explosives. A distinctive feature of these models is that the burn rate depends on the lead shock pressure. A key part of the models is an algorithm to detect the lead shock. Typically, shock capturing hydro algorithms have small oscillations behind a shock. Here we investigate how well the shock detection algorithm works for a nearly steady propagating detonation wave in one-dimension using the Eulerian xRage code.

  19. Shock Detector for SURF model

    Energy Technology Data Exchange (ETDEWEB)

    Menikoff, Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-01-11

    SURF and its extension SURFplus are reactive burn models aimed at shock initiation and propagation of detonation waves in high explosives. A distinctive feature of these models is that the burn rate depends on the lead shock pressure. A key part of the models is an algorithm to detect the lead shock. Typically, shock capturing hydro algorithms have small oscillations behind a shock. Here we investigate how well the shock detection algorithm works for a nearly steady propagating detonation wave in one-dimension using the Eulerian xRage code.

  20. Physics of Collisionless Shocks Space Plasma Shock Waves

    CERN Document Server

    Balogh, André

    2013-01-01

    The present book provides a contemporary systematic treatment of shock waves in high-temperature collisionless plasmas as are encountered in near Earth space and in Astrophysics. It consists of two parts. Part I develops the complete theory of shocks in dilute hot plasmas under the assumption of absence of collisions among the charged particles when the interaction is mediated solely by the self-consistent electromagnetic fields. Such shocks are naturally magnetised implying that the magnetic field plays an important role in their evolution and dynamics. This part treats both subcritical shocks, which dissipate flow energy by generating anomalous resistance or viscosity, and supercritical shocks. The main emphasis is, however, on super-critical shocks where the anomalous dissipation is insufficient to retard the upstream flow. These shocks, depending on the direction of the upstream magnetic field, are distinguished as quasi-perpendicular and quasi-parallel shocks which exhibit different behaviours, reflecti...

  1. Shock wave reflection phenomena

    CERN Document Server

    Ben-dor, Gabi

    2007-01-01

    This book provides a comprehensive state-of-the-knowledge description of the shock wave reflection phenomena from a phenomenological point of view. The first part is a thorough introduction to oblique shock wave reflections, presenting the two major well-known reflection wave configurations, namely, regular (RR) and Mach (MR) reflections, the corresponding two- and three-shock theories, their analytical and graphical solution and the proposed transition boundaries between these two reflection-wave configurations. The second, third and fourth parts describe the reflection phenomena in steady, pseudo-steady and unsteady flows, respectively. Here, the possible specific types of reflection wave configurations are described, criteria for their formation and termination are presented and their governing equations are solved analytically and graphically and compared with experimental results. The resolution of the well-known von Neumann paradox and a detailed description of two new reflection-wave configurations - t...

  2. [Traumatic neurogenic shock].

    Science.gov (United States)

    Maurin, O; de Régloix, S; Caballé, D; Arvis, A-M; Perrochon, J-C; Tourtier, J-P

    2013-05-01

    Traumatic neurogenic shock is a rare but serious complication of spinal cord injury. It associates bradycardia and hypotension caused by a medullary trauma. It is life-threatening for the patient and it aggravates the neurological deficit. Strict immobilization and a quick assessment of the gravity of cord injury are necessary as soon as prehospital care has begun. Initial treatment requires vasopressors associated with fluid resuscitation. Steroids are not recommended. Early decompression is recommended for incomplete deficit seen in the first 6 hours. We relate the case of secondary spinal shock to a luxation C6/C7 treated in prehospital care.

  3. [Corticosteroids and septic shock].

    Science.gov (United States)

    Bouletreau, P; Petit, P; Latarjet, J

    1976-01-01

    According to the data in the literature, the authors attempted to sum-up present attitudes on the value of corticoids in the treatment of septic shock. If their cardiovascular effects after a period of enthusiasm, are presently rather controversial, their cellular and sub-cellular actions, on the lysosomal membranes, capillary permeability and perhaps the intimate mechanisms of cellular oxygenation seem to be more real. However, the contra-indications which persist in the results of clinical works have resulted in the fact that the exact place of cortico-steroids in the therapeutic arsenal of septic shock still remains to be specified.

  4. Culture shock and travelers.

    Science.gov (United States)

    Stewart, L; Leggat, P A

    1998-06-01

    As travel has become easier and more affordable, the number of people traveling has risen sharply. People travel for many and varied reasons, from the business person on an overseas assignment to backpackers seeking new and exotic destinations. Others may take up residence in different regions, states or countries for family, business or political reasons. Other people are fleeing religious or political persecution. Wherever they go and for whatever reason they go, people take their culture with them. Culture, like language, is acquired innately in early childhood and is then reinforced through formal and complex informal social education into adulthood. Culture provides a framework for interpersonal and social interactions. Therefore, the contact with a new culture is often not the exciting or pleasurable experience anticipated. When immersed in a different culture, people no longer know how to act when faced with disparate value systems. Contact with the unfamiliar culture can lead to anxiety, stress, mental illness and, in extreme cases, physical illness and suicide. "Culture shock" is a term coined by the anthropologist Oberg. It is the shock of the new. It implies that the experience of the new culture is an unpleasant surprise or shock, partly because it is unexpected and partly because it can lead to a negative evaluation of one's own culture. It is also known as cross-cultural adjustment, being that period of anxiety and confusion experienced when entering a new culture. It affects people intellectually, emotionally, behaviorally and physically and is characterized by symptoms of psychological distress. Culture shock affects both adults and children. In travelers or workers who have prolonged sojourns in foreign countries, culture shock may occur not only as they enter the new culture, but also may occur on their return to their original culture. Children may also experience readjustment problems after returning from leading sheltered lives in expatriate

  5. Characteristics of Weak Interplanetary Shocks and Shock-like Events

    Science.gov (United States)

    Balogh, A.; Gloag, J. M.

    The variation of magnetic and plasma parameters across the discontinuity of a colli- sionless shock wave are clearly understood and presented in MHD theory. The anal- ysis of 116 shock waves appearing on the Ulysses shock list in the period mid 1996 to the end of 1999 show that in the cases of the stronger shock waves, measured by the ratio of downstream to upstream magnetic field magnitudes, this MHD descrip- tion is adequate. However in the case of many of the weaker shocks there are events which are not clearly characterised in MHD terms and in these cases plasma param- eters are particularly difficult to interpret. To explore the issues associated with these very weak shocks further, a set of shock-like events is considered which have shock characteristics in the high frequency wave data measured by the plasma wave inves- tigation(URAP) but are not considered to be clearly shock waves purely considering magnetic and plasma data. These shock-like events are thought to extend the spectrum of interplanetary shocks at the very weakest end and possibly beyond what should be considered a collisionless shock wave.

  6. Flow behind concave shock waves

    Science.gov (United States)

    Mölder, S.

    2017-03-01

    Curved shock theory is introduced and applied to calculate the flow behind concave shock waves. For sonic conditions, three characterizing types of flow are identified, based on the orientation of the sonic line, and it is shown that, depending on the ratio of shock curvatures, a continuously curving shock can exist with Type III flow, where the sonic line intercepts the reflected characteristics from the shock, thus preventing the formation of a reflected shock. The necessary shock curvature ratio for a Type III sonic point does not exist for a hyperbolic shock so that it will revert to Mach reflection for all Mach numbers. A demonstration is provided, by CFD calculations, at Mach 1.2 and 3.

  7. Flow behind concave shock waves

    Science.gov (United States)

    Mölder, S.

    2017-09-01

    Curved shock theory is introduced and applied to calculate the flow behind concave shock waves. For sonic conditions, three characterizing types of flow are identified, based on the orientation of the sonic line, and it is shown that, depending on the ratio of shock curvatures, a continuously curving shock can exist with Type III flow, where the sonic line intercepts the reflected characteristics from the shock, thus preventing the formation of a reflected shock. The necessary shock curvature ratio for a Type III sonic point does not exist for a hyperbolic shock so that it will revert to Mach reflection for all Mach numbers. A demonstration is provided, by CFD calculations, at Mach 1.2 and 3.

  8. Shock compression of polyvinyl chloride

    Science.gov (United States)

    Neogi, Anupam; Mitra, Nilanjan

    2016-04-01

    This study presents shock compression simulation of atactic polyvinyl chloride (PVC) using ab-initio and classical molecular dynamics. The manuscript also identifies the limits of applicability of classical molecular dynamics based shock compression simulation for PVC. The mechanism of bond dissociation under shock loading and its progression is demonstrated in this manuscript using the density functional theory based molecular dynamics simulations. The rate of dissociation of different bonds at different shock velocities is also presented in this manuscript.

  9. The special relativistic shock tube

    Science.gov (United States)

    Thompson, Kevin W.

    1986-01-01

    The shock-tube problem has served as a popular test for numerical hydrodynamics codes. The development of relativistic hydrodynamics codes has created a need for a similar test problem in relativistic hydrodynamics. The analytical solution to the special relativistic shock-tube problem is presented here. The relativistic shock-jump conditions and rarefaction solution which make up the shock tube are derived. The Newtonian limit of the calculations is given throughout.

  10. Shock conditions for hypoelastic materials

    Science.gov (United States)

    Renardy, Michael; Rogers, Robert C.

    1993-10-01

    The equations governing the motion of hypoelastic materials (and related models of non-Newtonian fluids) are not in conservation form. Hence there is no obvious formulation of Rankine-Hugoniot jump conditions across a shock. In this paper we demonstrate that a viscosity criterion can be used to obtain meaningful shock conditions. In particular, we discuss shocks of small amplitude. The shock conditions obtained will in general depend on the form of the viscosity term.

  11. STEREO interplanetary shocks and foreshocks

    Energy Technology Data Exchange (ETDEWEB)

    Blanco-Cano, X. [Instituto de Geofisica, UNAM, CU, Coyoacan 04510 DF (Mexico); Kajdic, P. [IRAP-University of Toulouse, CNRS, Toulouse (France); Aguilar-Rodriguez, E. [Instituto de Geofisica, UNAM, Morelia (Mexico); Russell, C. T. [ESS and IGPP, University of California, Los Angeles, 603 Charles Young Drive, Los Angeles, CA 90095 (United States); Jian, L. K. [NASA Goddard Space Flight Center, Greenbelt, MD and University of Maryland, College Park, MD (United States); Luhmann, J. G. [SSL, University of California Berkeley (United States)

    2013-06-13

    We use STEREO data to study shocks driven by stream interactions and the waves associated with them. During the years of the extended solar minimum 2007-2010, stream interaction shocks have Mach numbers between 1.1-3.8 and {theta}{sub Bn}{approx}20-86 Degree-Sign . We find a variety of waves, including whistlers and low frequency fluctuations. Upstream whistler waves may be generated at the shock and upstream ultra low frequency (ULF) waves can be driven locally by ion instabilities. The downstream wave spectra can be formed by both, locally generated perturbations, and shock transmitted waves. We find that many quasiperpendicular shocks can be accompanied by ULF wave and ion foreshocks, which is in contrast to Earth's bow shock. Fluctuations downstream of quasi-parallel shocks tend to have larger amplitudes than waves downstream of quasi-perpendicular shocks. Proton foreshocks of shocks driven by stream interactions have extensions dr {<=}0.05 AU. This is smaller than foreshock extensions for ICME driven shocks. The difference in foreshock extensions is related to the fact that ICME driven shocks are formed closer to the Sun and therefore begin to accelerate particles very early in their existence, while stream interaction shocks form at {approx}1 AU and have been producing suprathermal particles for a shorter time.

  12. Changes in EEG complexity with electroconvulsive therapy in a patient with autism spectrum disorders: a multiscale entropy approach

    Directory of Open Access Journals (Sweden)

    Ryoko eOkazaki

    2015-02-01

    Full Text Available Autism spectrum disorders (ASD are heterogeneous neurodevelopmental disorders that are reportedly characterized by aberrant neural networks. Recently developed multiscale entropy analysis (MSE can characterize the complexity inherent in EEG dynamics over multiple temporal scales in the dynamics of neural networks. We encountered an 18-year-old man with ASD whose refractory catatonic obsessive–compulsive symptoms were improved dramatically after electroconvulsive therapy (ECT. In this clinical case study, we strove to clarify the neurophysiological mechanism of ECT in ASD by assessing EEG complexity using MSE. Along with ECT, the frontocentral region showed decreased EEG complexity at higher temporal scales, whereas the occipital region expressed an increase at lower temporal scales. Furthermore, these changes were associated with clinical improvement associated with the elevation of brain-derived neurotrophic factor, which is a molecular hypothesis of ECT, playing key roles in ASD pathogenesis. Changes in EEG complexity in a region-specific and temporal scale-specific manner we found might reflect atypical EEG dynamics in ASD. Although MSE is not a direct approach to measuring neural connectivity and the results are from only a single case, they might reflect specific aberrant neural network activity and the therapeutic neurophysiological mechanism of ECT in ASD.

  13. Effects of electroconvulsive therapy on amygdala function in major depression - a longitudinal functional magnetic resonance imaging study.

    Science.gov (United States)

    Redlich, R; Bürger, C; Dohm, K; Grotegerd, D; Opel, N; Zaremba, D; Meinert, S; Förster, K; Repple, J; Schnelle, R; Wagenknecht, C; Zavorotnyy, M; Heindel, W; Kugel, H; Gerbaulet, M; Alferink, J; Arolt, V; Zwanzger, P; Dannlowski, U

    2017-09-01

    Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. However, little is known regarding brain functional processes mediating ECT effects. In a non-randomized prospective study, functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice, about 6 weeks apart, in patients with major depressive disorder (MDD) before and after treatment with ECT (ECT, n = 24). Additionally, a control sample of MDD patients treated solely with pharmacotherapy (MED, n = 23) and a healthy control sample (HC, n = 22) were obtained. Before therapy, both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC. After treatment, a decrease in amygdala activity to negative stimuli was discerned in both patient samples indicating a normalization of amygdala function, suggesting mechanisms potentially unspecific for ECT. Moreover, a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample (r spearman = -0.48, p = 0.044), and by tendency also for the MED sample (r spearman = -0.38, p = 0.098). However, we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement, neither for the ECT sample, nor for the MED sample. In sum, the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design, thus validating and extending our knowledge gained from previous treatment studies. A limitation was that ECT patients received concurrent medication treatment.

  14. The electroconvulsive therapy and anesthesia exercise (ECTAE): the creation of an interdisciplinary learning activity for medical students.

    Science.gov (United States)

    Li, Descartes; Hall, Stephen E; Tong, Lowell D; Rollins, Mark D

    2013-09-01

    Demonstration of the effectiveness for medical student teaching of the electroconvulsive therapy (ECT)-anesthesia exercise (ECTAE). The ECTAE is a self-directed, interdisciplinary (psychiatry and anesthesia) learning exercise. Students are taught the assessment of mood and cognition using structured interviewing methods (psychiatry), basic airway and pharmacologic management (anesthesia), and informed consent and interdisciplinary communication (both). There are online pre-exercise and postexercise assessments. Third-year medical students reviewed educational reference materials, participated in ECT clinical encounters with both psychiatry and anesthesia, and debriefed after completion of the interdisciplinary exercise. The impact of the exercise was evaluated through online pre- and postexercise assessments. Quantitative and qualitative results for 3 student cohorts (2007 through 2010) were analyzed. Thirty-eight students participated the study over 3 years. Mean scores for 21 true-false questions increased from 14.3 to 17.5 (n = 30) with P activity for medical students, which incorporates cross-disciplinary learning objectives through self-directed exercises, online assessments, and actual clinical experience of ECT. It improves student knowledge of both psychiatry and anesthesia learning objectives, as well as increasing comfort about ECT. Further research could determine if this activity is easily transportable to other academic settings.

  15. Efficacy of memoral herbal on prevention of electroconvulsive therapy-induced memory impairment in mood disorder patients (isfahan - iran 2011).

    Science.gov (United States)

    Mousavi, Seyed Ghafur; Mohsen, Ghasemi; Reza, Maracy M; Amrollah, Ebrahimi; Majid, Barekatain; Fariba, Noori

    2012-07-01

    Electroconvulsive therapy (ECT) is one of the most efficacious treatment for major depressive disorder (MDD), it is also used as a rapid and efficacious treatment for other psychiatric disorders, especially treatment resistant ones. The cognitive impairment is one of the most important side effects of ECT. This study examined the Memoral herbal efficacy in prevention of ECT-induced memory impairment. In a randomized clinical trial, 70 patients with mood disorders who were candidates for ECT enrolled in either Memoral or Control group, and received either Memoral or placebo. The memory was assessed by Addenbrook Cognitive Examination (ACE), and the findings were analyzed by ANOVA under SPSS18. The Memoral group patients showed significantly higher total ACE scores than placebo group (P memory subscales not only never decreased during the study in Memoral group, but also increased. There was no significant difference between these scores of Memoral and placebo groups for the subscales of language and visuospacial ability. The Memoral herbal is an efficacious and safe choice in prevention of ECT- induced cognitive impairment.

  16. The Use of Lorazepam and Electroconvulsive Therapy in the Treatment of Catatonia: Treatment Characteristics and Outcomes in 60 Patients.

    Science.gov (United States)

    Unal, Ahmet; Altindag, Abdurrahman; Demir, Bahadir; Aksoy, Ihsan

    2017-06-20

    Lorazepam and electroconvulsive therapy (ECT) are effective treatments for catatonia. However, systematic data on these treatments in catatonia are limited. In the present study, we aimed to investigate the clinical and treatment-related characteristics of patients with catatonia who underwent lorazepam and/or ECT. Between January 2012 and December 2016, we received 60 patients with catatonia hospitalized in the Gaziantep University Faculty of Medicine Clinic of Psychiatry. Lorazepam and/or ECT were used in the patients' treatment schedule. Treatment results were evaluated using the Bush-Francis Catatonia Rating Scale and Clinical Global Impression-Improvement. Thirty-five patients (58.3%) in the sample were in their first catatonic episode. The most common comorbidity was mood disorder (n = 34, 56.7%), whereas the most frequent catatonic sign was mutism (n = 43, 71.7%). Moreover, 31 patients (51.7%) had some form of medical comorbidity. Cerebral abnormalities were detected in computed tomography/magnetic resonance imaging in 22 patients (36.7%). Furthermore, 95% of the patients (n = 57) fully recovered after administration of the treatment. Lorazepam is a reasonable initial choice in the treatment of catatonia, with rapid consideration for ECT if there is no rapid response to lorazepam.

  17. Short-Term Effects of Electroconvulsive Therapy on Subjective and Actigraphy-Assessed Sleep Parameters in Severely Depressed Inpatients

    Directory of Open Access Journals (Sweden)

    Alexander Hoogerhoud

    2015-01-01

    Full Text Available Background. Sleep disturbances are a key feature of major depression. Electroconvulsive treatment (ECT may improve polysomnography-assessed sleep characteristics, but its short-term effects on actigraphy-assessed and subjective sleep characteristics are unknown. We therefore aimed to assess the effects of ECT on subjective and objective sleep parameters in a proof-of-principle study. Methods. We assessed subjective and objective sleep parameters in 12 severely depressed patients up to 5 consecutive days during their ECT course, corresponding to a total of 43 nights (including 19 ECT sessions. The 12 patients were 83% female and on average 62 (standard deviation (SD 14 years old and had an average MADRS score of 40 at baseline (SD 21. Results. Subjective and objective sleep parameters were not directly affected by ECT. The subjective sleep efficiency parameter was similar on the day after ECT and other days. ECT did not affect the number of errors in the Sustained Attention to Response Task. Patients subjectively underestimated their total sleep time by 1.4 hours (P<0.001 compared to actigraphy-assessed sleep duration. Conclusion. ECT did not affect subjective and actigraphy-assessed sleep in the short term. Depressed patients profoundly underestimated their sleep duration.

  18. Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode.

    Science.gov (United States)

    Hassamal, Sameer; Jolles, Paul; Pandurangi, Ananda

    2016-11-01

    AB, a 74-year-old Caucasian woman, was admitted for acute onset of psychosis, anxiety, and cognitive impairment. Pharmacotherapy was unsuccessful and the patient was referred for electroconvulsive therapy (ECT). Pre-ECT, (18) F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography showed extensive frontal, parietal, and temporal cortical hypometabolism suggestive of a neurodegenerative disease. After eight ECT sessions, the psychotic and anxiety symptoms as well as the cognitive impairment resolved. The rapid improvement in symptoms was more suggestive of a psychotic episode rather than dementia. Two days after the ECT course, (18) F-fluorodeoxyglucose-PET/computed tomography showed improvements in cerebral cortical hypometabolism, especially in the left parietal cortex, left temporal/occipital cortex. and bifrontal regions. At a follow-up visit 2 months after the ECT course, the psychotic episode was still in remission, and (18) F-fluorodeoxyglucose-PET/computed tomography continued to show improved cerebral cortical hypometabolism in these areas. This case illustrated the effect of ECT in reversing cerebral glucose hypometabolism on PET. The improvement in cerebral glucose hypometabolism may represent the neurophysiological mechanism of ECT in the treatment of a psychotic episode. Improved cerebral glucose hypometabolism was present 2 months post-ECT, which suggests that ECT caused sustained functional neural changes. © 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.

  19. Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study

    Science.gov (United States)

    Cano, M; Martínez-Zalacaín, I; Bernabéu-Sanz, Á; Contreras-Rodríguez, O; Hernández-Ribas, R; Via, E; de Arriba-Arnau, A; Gálvez, V; Urretavizcaya, M; Pujol, J; Menchón, J M; Cardoner, N; Soriano-Mas, C

    2017-01-01

    Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action. PMID:28170003

  20. Does Gender Influence Electroconvulsive Therapy Sessions Required across Psychiatric Diagnoses? A 5-Year Experience from a Single Center

    Science.gov (United States)

    Manohar, Harshini; Subramanian, Karthick; Menon, Vikas; Kattimani, Shivanand

    2017-01-01

    Context: There is a paucity of systematic data reflecting the practice of electroconvulsive therapy (ECT) from developing countries. Aim: We aimed to identify the number of ECT sessions required to yield response and gender diffeferences in the number of sessions across various diagnostic categories. Setting and Design: A record-based study from a teaching cum tertiary care hospital in South India. Subjects and Methods: Case records of patients who received modified ECT from January 2011 to January 2016 were reviewed. The sociodemographic details and ECT-related data were collected. Psychiatric diagnoses were ascertained as per the International Classification of Diseases, 10th Revision criteria. Statistical Analysis Used: Kruskal–Wallis test and Mann–Whitney U-test. Results: Among 148 patients, 82 (55.4%) had mood disorder (bipolar disorder and recurrent depressive disorder), 43 (29.1%) had schizophrenia, and 22 (14.9%) had other acute and transient psychotic disorders (ATPDs). Patients with mood disorders, schizophrenia, and other ATPD received 7.3 (± 3.8), 9.7 (± 6.1), and 5.4 (± 2.0) ECT sessions, respectively, to achieve response. There was no gender difference in the number of sessions received. Conclusion: Our findings show that number of ECT sessions required to yield response may be disorder-specific. Gender does not influence the ECT dose requirement. Variations in ECT parameters across settings may limit the generalizability of results. PMID:28694625

  1. The effects of electroconvulsive therapy on tardive dystonia or dyskinesia induced by psychotropic medication: a retrospective study

    Directory of Open Access Journals (Sweden)

    Yasui-Furukori N

    2014-07-01

    Full Text Available Norio Yasui-Furukori,1 Atsuhiro Kikuchi,1 Hiroshi Katagai,1,2 Sunao Kaneko11Department of Neuropsychiatry, Hirosaki University School of Medicine, 2Department of Neuropsychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, JapanBackground: Tardive dystonia and dyskinesia are potentially irreversible neurological syndromes. Successful electroconvulsive treatment (ECT has been reported by multiple sources; however, the existing retrospective reviews and open prospective trials provide little information on the response rate.Methods: Eighteen consecutive patients with tardive dystonia or dyskinesia received a standard course of ECT to treat abnormal movement. The severity of the tardive dystonia and dyskinesia was evaluated using the Abnormal Involuntary Movement Scale (AIMS before and after the course of ECT. The patients who displayed a greater than 50% improvement in the AIMS score were classified as the responders.Results: The mean AIMS score decreased from 19.1±4.7 to 9.6±4.2. There were seven responders among the 18 patients, which yielded a 39% response rate. Conclusion: ECT has a moderate but significant effect on tardive dystonia and dyskinesia. Keywords: tardive dystonia, tardive diskinesia, ECT, medication

  2. Electric field strength and focality in electroconvulsive therapy and magnetic seizure therapy: a finite element simulation study

    Science.gov (United States)

    Deng, Zhi-De; Lisanby, Sarah H.; Peterchev, Angel V.

    2011-02-01

    We present the first computational study comparing the electric field induced by various electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) paradigms. Four ECT electrode configurations (bilateral, bifrontal, right unilateral, and focal electrically administered seizure therapy) and three MST coil configurations (circular, cap, and double cone) were modeled. The model incorporated a modality-specific neural activation threshold. ECT (0.3 ms pulse width) and MST induced the maximum electric field of 2.1-2.5 V cm-1 and 1.1-2.2 V cm-1 in the brain, corresponding to 6.2-7.2 times and 1.2-2.3 times the neural activation threshold, respectively. The MST electric field is more confined to the superficial cortex compared to ECT. The brain volume stimulated was much larger with ECT (up to 100%) than with MST (up to 8.2%). MST with the double-cone coil was the most focal, and bilateral ECT was the least focal. Our results suggest a possible biophysical explanation of the reduced side effects of MST compared to ECT. Our results also indicate that the conventional ECT pulse amplitude (800-900 mA) is much higher than necessary for seizure induction. Reducing the ECT pulse amplitude should be explored as a potential means of diminishing side effects.

  3. [Selective alteration of the declarative memory systems in patients treated with a high number of electroconvulsive therapy sessions].

    Science.gov (United States)

    Rami-González, L; Boget-Llucià, T; Bernardo, M; Marcos, T; Cañizares-Alejos, S; Penadés, R; Portella, M J; Castelví, M; Raspall, T; Salamero, M

    The reversible electrochemical effects of electroconvulsive therapy (ECT) on specific areas of the brain enable the neuroanatomical bases of some cognitive functions to be studied. In research carried out on memory systems, a selective alteration of the declarative ones has been observed after treatment with ECT. Little work has been done to explore the differential alteration of the memory subsystems in patients with a high number of ECT sessions. AIM. To study the declarative and non declarative memory system in psychiatric patients submitted to maintenance ECT treatment, with a high number of previous ECT sessions. 20 patients submitted to treatment with ECT (10 diagnosed as having depression and 10 with schizophrenia) and 20 controls, who were paired by age, sex and psychopathological diagnosis. For the evaluation of the declarative memory system, the Wechsler Memory Scale (WMS) logical memory test was used. The Hanoi Tower procedural test was employed to evaluate the non declarative system. Patients treated with ECT performed worse in the WMS logical memory test, but this was only significant in patients diagnosed as suffering from depression. No significant differences were observed in the Hanoi Tower test. A selective alteration of the declarative systems was observed in patients who had been treated with a high number of ECT sessions, while the non declarative memory systems remain unaffected.

  4. [Clinical Characteristics of 276 Patients Treated with Electroconvulsive Therapy at a University Clinic in Medellín, Colombia].

    Science.gov (United States)

    Ocampo, María Victoria; Ramírez, Clara Isabel; Franco, José G; Gómez, Lina María; Cardona, Gloria; Restrepo, Carolina

    2012-06-01

    To describe the socio-demographic and clinical characteristics of patients undergoing Electroconvulsive Therapy with Anesthesia and Relaxation (ECTAR) for 10 years in a university clinic. Review of 276 medical records of patients who had undergone ECTAR between 1997 and 2007 at the Clínica Universitaria Bolivariana de Medellín, Colombia. Data was collected through an instrument designed for that purpose and then was analyzed. During 10 years, more than 2000 ECT procedures were performed; most of the patients were female 67.4%, between 15 and 86 years old. The first indication was a major depressive episode without psychotic symptoms (56.5%) almost half of the patients had a minor and temporary complication, and no major complications or deaths were reported. Pre-oxygenation, intravenous anesthesia and muscular relaxation were used in all procedures. The ECT used in a third-level hospital with participation of a trained, interdisciplinary team (psychiatrist, anesthesiologist, nursing assistants) and the use of the modified technique (oxygenation, monitoring, general anesthesia, and relaxation is safe for certain psychiatric pathologies disorders that have not responded to medication or when medication is counter-indicated. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  5. Teleconnected food supply shocks

    Science.gov (United States)

    Bren d'Amour, Christopher; Wenz, Leonie; Kalkuhl, Matthias; Steckel, Jan Christoph; Creutzig, Felix

    2016-03-01

    The 2008-2010 food crisis might have been a harbinger of fundamental climate-induced food crises with geopolitical implications. Heat-wave-induced yield losses in Russia and resulting export restrictions led to increases in market prices for wheat across the Middle East, likely contributing to the Arab Spring. With ongoing climate change, temperatures and temperature variability will rise, leading to higher uncertainty in yields for major nutritional crops. Here we investigate which countries are most vulnerable to teleconnected supply-shocks, i.e. where diets strongly rely on the import of wheat, maize, or rice, and where a large share of the population is living in poverty. We find that the Middle East is most sensitive to teleconnected supply shocks in wheat, Central America to supply shocks in maize, and Western Africa to supply shocks in rice. Weighing with poverty levels, Sub-Saharan Africa is most affected. Altogether, a simultaneous 10% reduction in exports of wheat, rice, and maize would reduce caloric intake of 55 million people living in poverty by about 5%. Export bans in major producing regions would put up to 200 million people below the poverty line at risk, 90% of which live in Sub-Saharan Africa. Our results suggest that a region-specific combination of national increases in agricultural productivity and diversification of trade partners and diets can effectively decrease future food security risks.

  6. Early Treatment in Shock

    Science.gov (United States)

    2011-06-01

    of L-arginine resuscitation in shock were carried out by An-1 gele , Chaudry, and co-workers. 6-10 They used the rat model, bleeding to 40 mm Hg in...17 14. Preissler G, Lothe F, Ebersberger U, Huff I, Bittmann I, Messmer K, Jauch KW, An-18 gele , MK. Recipient treatment with L-arginine

  7. A Shocking New Pump

    Science.gov (United States)

    2000-01-01

    Hydro Dynamics, Inc. received a technical helping hand from NASA that made their Hydrosonic Pump (HPump) a reality. Marshall engineers resolved a bearing problem in the rotor of the pump and recommended new bearings, housings and mounting hardware as a solution. The resulting HPump is able to heat liquids with greater energy efficiency using shock waves to generate heat.

  8. Planetary Bow Shocks

    CERN Document Server

    Treumann, R A

    2008-01-01

    Our present knowledge of the properties of the various planetary bow shocks is briefly reviewed. We do not follow the astronomical ordering of the planets. We rather distinguish between magnetised and unmagnetised planets which groups Mercury and Earth with the outer giant planets of the solar system, Mars and Moon in a separate group lacking magnetic fields and dense atmospheres, and Venus together with the comets as the atmospheric celestial objects exposed to the solar wind. Asteroids would, in this classification, fall into the group together with the Moon and should behave similarly though being much smaller. Extrasolar planets are not considered as we have only remote information about their behaviour. The presentation is brief in the sense that our in situ knowledge is rather sporadic yet, depending on just a countable number of bow shock crossings from which just some basic conclusions can be drawn about size, stationarity, shape and nature of the respective shock. The only bow shock of which we have ...

  9. Shock compression of nitrobenzene

    Science.gov (United States)

    Kozu, Naoshi; Arai, Mitsuru; Tamura, Masamitsu; Fujihisa, Hiroshi; Aoki, Katsutoshi; Yoshida, Masatake; Kondo, Ken-Ichi

    1999-06-01

    The Hugoniot (4 - 30 GPa) and the isotherm (1 - 7 GPa) of nitrobenzene have been investigated by shock and static compression experiments. Nitrobenzene has the most basic structure of nitro aromatic compounds, which are widely used as energetic materials, but nitrobenzene has been considered not to explode in spite of the fact its calculated heat of detonation is similar to TNT, about 1 kcal/g. Explosive plane-wave generators and diamond anvil cell were used for shock and static compression, respectively. The obtained Hugoniot consists of two linear lines, and the kink exists around 10 GPa. The upper line agrees well with the Hugoniot of detonation products calculated by KHT code, so it is expected that nitrobenzene detonates in that area. Nitrobenzene solidifies under 1 GPa of static compression, and the isotherm of solid nitrobenzene was obtained by X-ray diffraction technique. Comparing the Hugoniot and the isotherm, nitrobenzene is in liquid phase under experimented shock condition. From the expected phase diagram, shocked nitrobenzene seems to remain metastable liquid in solid phase region on that diagram.

  10. Toxic shock syndrome

    Science.gov (United States)

    ... chap 196. Read More Acute kidney failure Heart failure - overview Shock Review Date 4/12/2016 Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department ...

  11. Health Shocks and Retirement:

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Larsen, Mona

    benefits in Denmark nor by the promotion of corporate social responsibility initiatives since the mid-1990s. In the late 1990s, however, the retirement rate following a health shock is reduced to 3% with the introduction of the subsidized employment program (fleksjob) but this effect is not strongly...

  12. Treatment of nonunions of long bone fractures with shock waves

    Science.gov (United States)

    Wang, Ching-Jen

    2003-10-01

    A prospective clinical study investigated the effectiveness of shock waves in the treatment of 72 patients with 72 nonunions of long bone fractures (41 femurs, 19 tibias, 7 humeri, 1 radius, 3 ulnas and 1 metatarsal). The doses of shock waves were 6000 impulses at 28 kV for the femur and tibia, 3000 impulses at 28 kV for the humerus, 2000 impulses at 24 kV for the radius and ulna, and 1000 impulses at 20 kV for the metatarsal. The results of treatment were assessed clinically, and fracture healing was assessed with plain x-rays and tomography. The rate of bony union was 40% at 3 months, 60.9% at 6 months and 80% at 12 months followup. Shock wave treatment was most successful in hypertrophic nonunions and nonunions with a defect and was least effective in atrophic nonunions. There were no systemic complications or device-related problems. Local complications included petechiae and hematoma formation that resolved spontaneously. In the author's experience, the results of the shock wave treatment were similar to the results of surgical treatment for chronic nonunions with no surgical risks. Shock wave treatment is a safe and effective alternative method in the treatment of chronic nonunions of long bones.

  13. In situ local shock speed and transit shock speed

    Directory of Open Access Journals (Sweden)

    S. Watari

    Full Text Available A useful index for estimating the transit speeds was derived by analyzing interplanetary shock observations. This index is the ratio of the in situ local shock speed and the transit speed; it is 0.6–0.9 for most observed shocks. The local shock speed and the transit speed calculated for the results of the magnetohydrodynamic simulation show good agreement with the observations. The relation expressed by the index is well explained by a simplified propagation model assuming a blast wave. For several shocks the ratio is approximately 1.2, implying that these shocks accelerated during propagation in slow-speed solar wind. This ratio is similar to that for the background solar wind acceleration.

    Keywords. Interplanetary physics (Flare and stream dynamics; Interplanetary shocks; Solar wind plasma

  14. Shock Dynamics in Stellar Outbursts. I. Shock Formation

    Science.gov (United States)

    Ro, Stephen; Matzner, Christopher D.

    2017-05-01

    Wave-driven outflows and non-disruptive explosions have been implicated in pre-supernova outbursts, supernova impostors, luminous blue variable eruptions, and some narrow-line and superluminous supernovae. To model these events, we investigate the dynamics of stars set in motion by strong acoustic pulses and wave trains, focusing on nonlinear wave propagation, shock formation, and an early phase of the development of a weak shock. We identify the shock formation radius, showing that a heuristic estimate based on crossing characteristics matches an exact expansion around the wave front and verifying both with numerical experiments. Our general analytical condition for shock formation applies to one-dimensional motions within any static environment, including both eruptions and implosions. We also consider the early phase of shock energy dissipation. We find that waves of super-Eddington acoustic luminosity always create shocks, rather than damping by radiative diffusion. Therefore, shock formation is integral to super-Eddington outbursts.

  15. Extracorporeal shock wave therapy (ESWT) in urology

    DEFF Research Database (Denmark)

    Fojecki, Grzegorz Lukasz; Thiessen, Stefan; Osther, Palle Jörn Sloth

    2017-01-01

    PURPOSE: The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders. METHODS: We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline...... and PubMed was carried out. The systematic review was performed according to PRISMA guidelines. RESULTS: We identified 10 trials on 3 urological indications. Two of 3 trials on Peyronie's disease (PD) involving 238 patients reported improvement in pain; however, no clinical significant changes in penile......i) responders in 2 of 4 trials and 3 of 4 trials, respectively. Three studies on chronic pelvic pain (CPP) engaging 200 men reported positive changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). There was considerable heterogeneity between trials both with regard...

  16. Shock detachment from curved wedges

    Science.gov (United States)

    Mölder, S.

    2017-03-01

    Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.

  17. Shock detachment from curved wedges

    Science.gov (United States)

    Mölder, S.

    2017-09-01

    Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.

  18. Resistant tennis elbow: shock-wave therapy versus percutaneous tenotomy

    OpenAIRE

    2007-01-01

    Fifty-six patients who suffered from chronic persistent tennis elbow of more than six months duration were randomly assigned to two active treatment groups. Group 1 (n = 29) received high-energy extracorporeal shock wave treatment (ESWT; 1,500 shocks) at 18 kV (0.22 mJ/mm2) without local anaesthesia; group 2 (n = 27) underwent percutaneous tenotomy of the common extensor origin. Both groups achieved improvement from the base line at three weeks, six weeks, 12 weeks and 12 months post-interven...

  19. Vaginal toxic shock reaction triggering desquamative inflammatory vaginitis.

    Science.gov (United States)

    Pereira, Nigel; Edlind, Thomas D; Schlievert, Patrick M; Nyirjesy, Paul

    2013-01-01

    The study aimed to report 2 cases of desquamative inflammatory vaginitis associated with toxic shock syndrome toxin 1 (TSST-1)-producing Staphylococcus aureus strains. Case report of 2 patients, 1 with an acute and 1 with a chronic presentation, diagnosed with desquamative inflammatory vaginitis on the basis of clinical findings and wet mount microscopy. Pretreatment and posttreatment vaginal bacterial and yeast cultures were obtained. Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial culture results after oral antibiotic therapy were negative. Desquamative inflammatory vaginitis may be triggered through TSST-1-mediated vaginal toxic shock reaction.

  20. Shock metamorphism of deformed quartz

    Science.gov (United States)

    Gratz, Andrew J.; Christie, John; Tyburczy, James; Ahrens, Thomas; Pongratz, Peter

    1988-01-01

    The effect produced by shock loading (to peak pressures of 12 and 24) on deformed synthetic quartz containing a dislocation and abundant bubbles and small inclusions was investigated, and the relationships between preexisting dislocation density shock lamellae in the target material were examined. The resultant material was found to be inhomogeneously deformed and extremely fractured. Results of TEM examinations indicate that no change in dislocation density was caused by shock loading except in regions containing shock lamellae, where the dislocation density was lowered. The shock-induced defects tend to nucleate on and be controlled by preexisting stress concentrators; shock lamellae, glassy veins, and most curviplanar defects form in tension, presumably during release. An extremely mobile silica fluid is formed and injected into fractures during release, which forcibly removes crystalline fragments from vein walls. It is concluded that shock deformation in quartz is dominated by fracture and melting.

  1. Bubble Dynamics and Shock Waves

    CERN Document Server

    2013-01-01

    This volume of the Shock Wave Science and Technology Reference Library is concerned with the interplay between bubble dynamics and shock waves. It is divided into four parts containing twelve chapters written by eminent scientists. Topics discussed include shock wave emission by laser generated bubbles (W Lauterborn, A Vogel), pulsating bubbles near boundaries (DM Leppinen, QX Wang, JR Blake), interaction of shock waves with bubble clouds (CD Ohl, SW Ohl), shock propagation in polydispersed bubbly liquids by model equations (K Ando, T Colonius, CE Brennen. T Yano, T Kanagawa,  M Watanabe, S Fujikawa) and by DNS (G Tryggvason, S Dabiri), shocks in cavitating flows (NA Adams, SJ Schmidt, CF Delale, GH Schnerr, S Pasinlioglu) together with applications involving encapsulated bubble dynamics in imaging (AA Doinikov, A Novell, JM Escoffre, A Bouakaz),  shock wave lithotripsy (P Zhong), sterilization of ships’ ballast water (A Abe, H Mimura) and bubbly flow model of volcano eruptions ((VK Kedrinskii, K Takayama...

  2. Rapid improvement of depression and psychotic symptoms in Huntington's disease: a retrospective chart review of seven patients treated with electroconvulsive therapy.

    Science.gov (United States)

    Cusin, Cristina; Franco, Felipe Boschini; Fernandez-Robles, Carlos; DuBois, Christina M; Welch, Charles A

    2013-01-01

    Many patients with Huntington's disease (HD) develop psychiatric symptoms such as depression and psychosis. For severe symptoms, electroconvulsive therapy (ECT) can be a valuable treatment. In this case series, we identified seven patients with HD who received ECT at Massachusetts General Hospital in the past 20 years. In all cases, ECT was well tolerated and produced improvement in psychiatric and behavioral symptoms. Our case series supports the hypothesis of a positive risk-benefit ratio for ECT in patients with HD and severe depression or psychosis. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Simulations of Relativistic Collisionless Shocks: Shock Structure and Particle Acceleration

    Energy Technology Data Exchange (ETDEWEB)

    Spitkovsky, Anatoly; /KIPAC, Menlo Park

    2006-04-10

    We discuss 3D simulations of relativistic collisionless shocks in electron-positron pair plasmas using the particle-in-cell (PIC) method. The shock structure is mainly controlled by the shock's magnetization (''sigma'' parameter). We demonstrate how the structure of the shock varies as a function of sigma for perpendicular shocks. At low magnetizations the shock is mediated mainly by the Weibel instability which generates transient magnetic fields that can exceed the initial field. At larger magnetizations the shock is dominated by magnetic reflections. We demonstrate where the transition occurs and argue that it is impossible to have very low magnetization collisionless shocks in nature (in more than one spatial dimension). We further discuss the acceleration properties of these shocks, and show that higher magnetization perpendicular shocks do not efficiently accelerate nonthermal particles in 3D. Among other astrophysical applications, this may pose a restriction on the structure and composition of gamma-ray bursts and pulsar wind outflows.

  4. Desalination shocks in microstructures

    CERN Document Server

    Mani, Ali

    2011-01-01

    Salt transport in bulk electrolytes is limited by diffusion and convection, but in microstructures with charged surfaces (e.g. microfluidic devices, porous media, soils, or biological tissues) surface conduction and electro-osmotic flow also contribute to ionic fluxes. For small applied voltages, these effects lead to well known linear electrokinetic phenomena. In this paper, we predict some surprising nonlinear dynamics that can result from the competition between bulk and interfacial transport at higher voltages. When counter-ions are selectively removed by a membrane or electrode, a "desalination shock" can propagate through the microstructure, leaving in its wake an ultrapure solution, nearly devoid of co-ions and colloidal impurities. We elucidate the basic physics of desalination shocks and develop a mathematical theory of their existence, structure, and stability, allowing for slow variations in surface charge or channel geometry. Via asymptotic approximations and similarity solutions, we show that des...

  5. Bow shock data analysis

    Science.gov (United States)

    Zipf, Edward C.; Erdman, Peeter W.

    1994-08-01

    The University of Pittsburgh Space Physics Group in collaboration with the Army Research Office (ARO) modeling team has completed a systematic organization of the shock and plume spectral data and the electron temperature and density measurements obtained during the BowShock I and II rocket flights which have been submitted to the AEDC Data Center, has verified the presence of CO Cameron band emission during the Antares engine burn and for an extended period of time in the post-burn plume, and have adapted 3-D radiation entrapment codes developed by the University of Pittsburgh to study aurora and other atmospheric phenomena that involve significant spatial effects to investigate the vacuum ultraviolet (VUV) and extreme ultraviolet (EUV) envelope surrounding the re-entry that create an extensive plasma cloud by photoionization.

  6. SUPERDIFFUSIVE SHOCK ACCELERATION

    Energy Technology Data Exchange (ETDEWEB)

    Perri, S.; Zimbardo, G. [Dipartimento di Fisica, Universita della Calabria, Ponte P. Bucci Cubo 31C, I-87036 Rende (Italy)

    2012-05-10

    The theory of diffusive shock acceleration is extended to the case of superdiffusive transport, i.e., when the mean square deviation grows proportionally to t{sup {alpha}}, with {alpha} > 1. Superdiffusion can be described by a statistical process called Levy random walk, in which the propagator is not a Gaussian but it exhibits power-law tails. By using the propagator appropriate for Levy random walk, it is found that the indices of energy spectra of particles are harder than those obtained where a normal diffusion is envisaged, with the spectral index decreasing with the increase of {alpha}. A new scaling for the acceleration time is also found, allowing substantially shorter times than in the case of normal diffusion. Within this framework we can explain a number of observations of flat spectra in various astrophysical and heliospheric contexts, for instance, for the Crab Nebula and the termination shock of the solar wind.

  7. 异丙酚预先给药对抑郁大鼠电休克后海马Glu和GABA水平的影响%Effects of propofol pretreatment on the levels of glutamate and gamma-aminobutyric acid in hippocampus of mentally depressed rats after electro-convulsive therapy

    Institute of Scientific and Technical Information of China (English)

    刘永峰; 闵苏; 董军; 魏珂; 曹俊; 黎平

    2009-01-01

    Objective To investigate the effects of propofol pretreatment on the levels of glutamate (Glu) and gamma-aminobytyric acid (GABA) in hippocampus of mentally depressed rats after electro-convulsive therapy.Methods Thirty male 2-3 month old SD rats weighing 200-250 g were randomly divided into 5 groups ( n = 6each) : group Ⅰ control (C) ; group Ⅱ mental depression (D) ; group Ⅲ propofol (P) ; group Ⅳ electric shock (E) and groupV propofol + electric shock (PE). Mental depression was induced by subjecting the animals to different kinds of stresses every day for 21 consecutive days in group Ⅱ - Ⅴ. After mental depression had been induced, the animals received intraperitoneal (IP) propofol 100 mg/kg in group P, electric shock in group E and propefol 100 mg/kg + electric shock in group PE respectively once every 2 days × 6 times. The anxiety-related behavior was assessed by open-field test and scored (the higher the score the better) on the day before induction of mental depression was started (To ,baseline), on the 1st day after mental depression had been induced (T1) and on the 2nd day after treatment (T2). The learning ability and memory were evaluated by Morris water maze at T1 and T2. The animals were killed after the last test and their brains were removed and bilateral hippocampi were isolated for determination of glutamate and GABA contents by high performance liquid chromatography (HPLC).Results The behavior scores and learning ability and memory were significandy decreased in group Ⅱ-Ⅴ as compared with the control group (P0.05);与E组比较,PE组学习记忆功能增强,Glu含量升高,GABA含量降低,Glu/GABA比值升高(P<0.05).结论 异丙酚预先给药改善电休克治疗后学习记忆功能的机制可能与异丙酚调节Glu和GABA功能状态的平衡有关.

  8. The Shock and Vibration Bulletin. Part 1. Invited Papers, Submarine Shock Testing, Shock Analysis, Shock Testing

    Science.gov (United States)

    1973-06-01

    P. White, Jr., Rochester Applied Science Associates, Inc., Rochester, New York MATHEMATICAL MODEL OF A TYPICAL FLOATING SHOCK PLATFORM SUBJECTED TO...our offer. standardization projects as well as in the This asrect of cuantitive railroad technology various technical societies. This multi...Analysis of a Gravity phenomena which my education had kept care- Dam," using gelatin models . The stimulation fully hidden from me until that time. It’s

  9. Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Galasso Olimpio

    2012-06-01

    Full Text Available Abstract Background There is evidence supporting the use of extracorporeal shock wave therapy (ESWT in calcific tendinopathy of the rotator cuff, but the best current evidence does not support its use in non-calcifying tendinopathy. We conducted a randomized placebo-controlled trial to investigate the efficacy and safety of low energy ESWT for non-calcifying tendinopathy of the rotator cuff. Methods 20 patients with non-calcifying supraspinatus tendinopathy (NCST were randomized to an active or a sham treatment group. Physical, blood, roentgenographic, and MRI examinations of the shoulder were conducted to verify that patients met the inclusion and exclusion criteria. These examinations were repeated six and twelve weeks after treatments. Effectiveness was determined by comparison of the mean improvement in the Constant and Murley score (CMS between the treatment and the placebo groups at three months. Safety was assessed by analyzing the number and severity of adverse events. Results All the patients completed the investigation protocol. At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values. Significantly higher total CMS, and significantly higher scores for CMS pain and ROM were observed in the ESWT group when compared to the placebo. No serious adverse events were noted after ESWT. Conclusions Patients suffering from NCST may benefit from low energy ESWT, at least in short-term. The application protocol of ESWT is likely to play a key-role in a successful treatment. Future investigations should be undertaken on the long-term effects of this technique for the treatment of NCST. Trial registration Current Controlled Trials ISRCTN41236511

  10. Shock breakout theory

    CERN Document Server

    Waxman, Eli

    2016-01-01

    The earliest supernova (SN) emission is produced when the optical depth of the plasma lying ahead of the shock, which ejects the envelope, drops below c/v, where v is the shock velocity. This "breakout" may occur when the shock reaches the edge of the star, producing a bright X-ray/UV flash on time scales of seconds to a fraction of an hour, followed by UV/optical "cooling" emission from the expanding cooling envelope on a day time-scale. If the optical depth of circumstellar material (CSM) ejected from the progenitor star prior to the explosion is larger than c/v, the breakout will take place at larger radii, within the CSM, extending its duration to days time scale. The properties of the early, breakout and cooling, emission carry unique signatures of the structure of the progenitor star (e.g. its radius and surface composition) and of its mass-loss history. The recent progress of wide-field transient surveys enable SN detections on a day time scale, and are being used to set unique constraints on the proge...

  11. Characterization of shocked beryllium

    Directory of Open Access Journals (Sweden)

    Papin P.A.

    2012-08-01

    Full Text Available While numerous studies have investigated the low-strain-rate constitutive response of beryllium, the combined influence of high strain rate and temperature on the mechanical behavior and microstructure of beryllium has received limited attention over the last 40 years. In the current work, high strain rate tests were conducted using both explosive drive and a gas gun to accelerate the material. Prior studies have focused on tensile loading behavior, or limited conditions of dynamic strain rate and/or temperature. Two constitutive strength (plasticity models, the Preston-Tonks-Wallace (PTW and Mechanical Threshold Stress (MTS models, were calibrated using common quasi-static and Hopkinson bar data. However, simulations with the two models give noticeably different results when compared with the measured experimental wave profiles. The experimental results indicate that, even if fractured by the initial shock loading, the Be remains sufficiently intact to support a shear stress following partial release and subsequent shock re-loading. Additional “arrested” drive shots were designed and tested to minimize the reflected tensile pulse in the sample. These tests were done to both validate the model and to put large shock induced compressive loads into the beryllium sample.

  12. Radiative effects in radiative shocks in shock tubes

    Science.gov (United States)

    Drake, R. P.; Doss, F. W.; McClarren, R. G.; Adams, M. L.; Amato, N.; Bingham, D.; Chou, C. C.; DiStefano, C.; Fidkowski, K.; Fryxell, B.; Gombosi, T. I.; Grosskopf, M. J.; Holloway, J. P.; van der Holst, B.; Huntington, C. M.; Karni, S.; Krauland, C. M.; Kuranz, C. C.; Larsen, E.; van Leer, B.; Mallick, B.; Marion, D.; Martin, W.; Morel, J. E.; Myra, E. S.; Nair, V.; Powell, K. G.; Rauchwerger, L.; Roe, P.; Rutter, E.; Sokolov, I. V.; Stout, Q.; Torralva, B. R.; Toth, G.; Thornton, K.; Visco, A. J.

    2011-09-01

    Using modern high-energy-density facilities it is straightforward to produce radiative shock waves in which the transfer of energy by radiation controls the hydrodynamic structure of the system. Some of these experiments use shock tubes. This paper discusses such experiments, with an emphasis on the simple physical relations that determine the primary features of such shocks and on the details and impact of radiative energy transfer in such systems. Notable aspects include the creation of high-density shocked layers, the flow of radiative energy toward regions of higher energy density, and the creation of secondary shocks by ablation of the tube walls ahead of the primary shock front. Simulations of one such experimental system are also shown.

  13. Fundamentals of collisionless shocks for astrophysical application, 2. Relativistic shocks

    CERN Document Server

    Bykov, A M

    2011-01-01

    We review recent progress on collisionless relativistic shocks. Kinetic instability theory is briefed including its predictions and limitations. The main focus is on numerical experiments in (i) pair and (ii) electron-nucleon plasmas. The main results are: (i) confirmation of shock evolution in non-magnetised relativistic plasma in 3D due to either the lepton-Weibel instability or the ion-Weibel instability; (ii) sensitive dependence on upstream magnetisation ; (iii) the sensitive dependence of particle dynamics on the upstream magnetic inclination angle $\\thetabn$, where particles of $\\thetabn>34^\\circ$ cannot escape upstream, leading to the distinction between `sub-luminal' and `super-luminal' shocks; (iv) particles in ultra-relativistic shocks can hardly overturn the shock and escape to upstream; they may oscillate around the shock ramp for a long time, so to speak `surfing it' and thereby becoming accelerated by a kind of SDA; (v) these particles form a power law tail on the downstream distribution; their...

  14. Shock wave treatment in medicine

    Indian Academy of Sciences (India)

    S K Shrivastava; Kailash

    2005-03-01

    Extracorporeal shock wave therapy in orthopedics and traumatology is still a young therapy method. Since the last few years the development of shock wave therapy has progressed rapidly. Shock waves have changed the treatment of urolithiasis substantially. Today shock waves are the first choice to treat kidney and urethral stones. Urology has long been the only medical field for shock waves in medicine. Meanwhile shock waves have been used in orthopedics and traumatology to treat insertion tendinitis, avascular necrosis of the head of femur and other necrotic bone alterations. Another field of shock wave application is the treatment of tendons, ligaments and bones on horses in veterinary medicine. In the present paper we discuss the basic theory and application of shock waves and its history in medicine. The idea behind using shock wave therapy for orthopedic diseases is the stimulation of healing in tendons, surrounding tissue and bones. This is a completely different approach compared to urology where shock waves are used for disintegration.

  15. Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental

    Directory of Open Access Journals (Sweden)

    Zahavi GS

    2014-02-01

    Full Text Available Guy Sender Zahavi,1 Pinhas Dannon1,2 1Sackler School of Medicine, Tel Aviv University, Israel; 2Brain Stimulation Unit at Beer Yaakov-Ness Ziona Mental Health Center, Israel Objectives: Electroconvulsive therapy (ECT is considered to be one of the most effective treatments in psychiatry. Currently, three medications for anesthesia are used routinely during ECT: propofol, etomidate, and thiopental. The objective of this study was to evaluate the effects of the anesthetics used in ECT on seizure threshold and duration, hemodynamics, recovery from ECT, and immediate side effects. Methods: Our study is a retrospective cohort study, in which a comparison was made between three groups of patients who underwent ECT and were anesthetized with propofol, etomidate, or thiopental. The main effect compared was treatment dose and seizure duration. All patients were chosen as responders to ECT. Results: Data were gathered about 91 patients (39 were anesthetized with thiopental, 29 with etomidate, and 23 with propofol. Patients in the thiopental group received a lower electrical dose compared to the propofol and etomidate group (mean of 459 mC compared to 807 mC and 701 mC, respectively, P<0.001. Motor seizure duration was longer in the thiopental group compared to propofol and etomidate (mean of 40 seconds compared to 21 seconds and 23 seconds, respectively, P=0.018. Seizure duration recorded by electroencephalography was similar in the thiopental and etomidate groups and lower in the propofol group (mean of 57 seconds in both groups compared to 45 seconds, respectively, P=0.038. Conclusion: Patients who were anesthetized with thiopental received a lower electrical treatment dose without an unwanted decrease in seizure duration. Thiopental might be the anesthetic of choice when it is congruent with other medical considerations. Keywords: anesthesia, ECT, seizure

  16. The clonic phase of seizures in patients treated with electroconvulsive therapy is related to age and stimulus intensity

    Directory of Open Access Journals (Sweden)

    Chih-Chieh eTseng

    2013-12-01

    Full Text Available Background: Electroconvulsive therapy (ECT is effective in the treatment of major depressive disorder and schizophrenia in patients who are drug-naïve or less-receptive to antipsychotic drugs. Several studies have discussed the correlation between patient characteristics, input current volume and seizure duration. According to the present principle of ECT guidelines, the therapeutic effect of ECT mostly correlates with seizure duration. As the tonic phase is different from the clonic phase with respect to brain function and activity, it is informative to analyse both the tonic and clonic phases. Thus, this study sought to clarify the relationship between the features of the two phases, and to re-examine and refine guidelines regarding ECT treatment.Method: ECT-course data from 44 schizophrenia patients were recollected, including the number of treatments that they had received, their gender, age, and the association of these characteristics with motor seizure duration was analysed. A two-factor correlation was employed to test the relationship between each of the two factors.Result: The meta-analysis results indicate that seizure duration and age are significantly correlated. Older patients had relatively short seizure durations after ECT-treatment. Notably, a negative correlation was only found between age and the clonic phase of the seizure, not between age and the tonic phase. Furthermore, this study also found an inverse relationship between ECT-intensity and the clonic phase, but not between ECT-intensity and the tonic phase.Conclusion: This study demonstrated that age and ECT-intensity are negatively correlated with seizure duration, particularly in the clonic phase. The present observations are not fully consistent with the basic guidelines of the APA-ECT practical manual. Accordingly, the predictions regarding the therapeutic effect of ECT can be based on both the seizure duration and the clonic phase.

  17. Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Choudhary Maria

    2007-06-01

    Full Text Available Abstract Background Electroconvulsive therapy (ECT is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients. Methods This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan. Results We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009. The most common source of awareness was electronic and print media (38%, followed by relatives (24% and doctors (23%. Physical injuries (42% and neurological (12% and cognitive disturbances (11% were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%. Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001 and efficacy (p = 0.0001. Conclusion We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.

  18. Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Wei Zheng

    Full Text Available This meta-analysis of randomized controlled trials (RCTs examined the efficacy and safety of the combination of electroconvulsive therapy (ECT and antipsychotic medication (except for clozapine versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS. Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD, risk ratio (RR ±95% confidence intervals (CIs, number needed to treat (NNT, and number needed to harm (NNH were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1 symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I(2 = 62%, separating the two groups as early as weeks 1-2 with an SMD of -0.58 (p<0.00001; I(2 = 0%; (2 study-defined response (RR = 1.48, p<0.0001 with an NNT of 6 (CI = 4-9 and remission rate (RR = 2.18, p = 0.0002 with an NNT of 8 (CI = 6-16; (3 PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009. Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3 studies. The ECT-antipsychotic combination caused more headache (p = 0.02 with an NNH of 6 (CI = 4-11 and memory impairment (p = 0.001 with an NNH of 3 (CI = 2-5. The use of ECT to augment antipsychotic treatment (clozapine excepted can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache.

  19. Effectiveness of thiopentone, propofol and midazolam as an ideal intravenous anaesthetic agent for modified electroconvulsive therapy: A comparative study

    Directory of Open Access Journals (Sweden)

    Pratibha Jain Shah

    2010-01-01

    Full Text Available Modified electroconvulsive therapy (ECT is a safe and most effective treatment modality for major depressive disorders with suicidal tendencies. For this, one must have an ideal intravenous anaesthetic agent for induction which provides rapid onset, short duration of action, attenuates adverse physiological effect of ECT, rapid recovery without adverse shortening of seizure duration and minimum rise in serum potassium. The studies in search of an ideal intravenous anaesthetic agent are limited. Aim is to compare the effect of iv thiopentone, propofol and midazolam on induction time and quality, haemodynamics, Seizure duration, recovery time and changes in serum potassium level. 90 patients of ASA I and II of either sex having major depressive illness were randomly allocated into three groups (n = 30 based on iv induction agent used. Group I, Group II and Group III patients were induced with iv thiopentone 5 mg/kg, propofol 2 mg/kg and midazolam 0.2 mg/kg, respectively. The induction time, quality of induction, haemodynamic changes, seizure duration, recovery time and change in serum potassium level were measured and analyzed by Z test. Induction was quicker in propofol group i.e., 41.03 ± 6.11 sec than in thiopentone (50.6 ± 6.32 sec and midazolam group (77.30 ± 6.67 sec. Seizure duration was significantly shorter in midazolam group compared to propofol and thiopentone groups. Though significant rise in HR, SBP DBP was observed in all the three groups following ECT, but rise was significantly higher in thiopentone group compared to other two groups. Significantly, faster recovery was observed with propofol. Rise in serum potassium after ECT was not significant in any of the groups. Propofol is a safe and suitable intravenous anaesthetic agent for induction of anaesthesia for modified ECT.

  20. Global decrease of serotonin-1A receptor binding after electroconvulsive therapy in major depression measured by PET

    Science.gov (United States)

    Lanzenberger, R; Baldinger, P; Hahn, A; Ungersboeck, J; Mitterhauser, M; Winkler, D; Micskei, Z; Stein, P; Karanikas, G; Wadsak, W; Kasper, S; Frey, R

    2013-01-01

    Electroconvulsive therapy (ECT) is a potent therapy in severe treatment-refractory depression. Although commonly applied in psychiatric clinical routine since decades, the exact neurobiological mechanism regarding its efficacy remains unclear. Results from preclinical and clinical studies emphasize a crucial involvement of the serotonin-1A receptor (5-HT1A) in the mode of action of antidepressant treatment. This includes associations between treatment response and changes in 5-HT1A function and density by antidepressants. Further, alterations of the 5-HT1A receptor are consistently reported in depression. To elucidate the effect of ECT on 5-HT1A receptor binding, 12 subjects with severe treatment-resistant major depression underwent three positron emission tomography (PET) measurements using the highly selective radioligand [carbonyl-11C]WAY100635, twice before (test–retest variability) and once after 10.08±2.35 ECT sessions. Ten patients (∼83%) were responders to ECT. The voxel-wise comparison of the 5-HT1A receptor binding (BPND) before and after ECT revealed a widespread reduction in cortical and subcortical regions (P<0.05 corrected), except for the occipital cortex and the cerebellum. Strongest reductions were found in regions consistently reported to be altered in major depression and involved in emotion regulation, such as the subgenual part of the anterior cingulate cortex (−27.5%), the orbitofrontal cortex (−30.1%), the amygdala (−31.8%), the hippocampus (−30.6%) and the insula (−28.9%). No significant change was found in the raphe nuclei. There was no significant difference in receptor binding in any region comparing the first two PET scans conducted before ECT. This PET study proposes a global involvement of the postsynaptic 5-HT1A receptor binding in the effect of ECT. PMID:22751491