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Sample records for repeated electroconvulsive shock

  1. 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...... all rats received a lidocaine challenge (LC) in the form of an intraperitoneal (IP) injection of lidocaine (65 mg/kg). After the injection the animals were observed for occurrence of motor seizures. A total of 67% (10/15), 47% (7/15), and 0% (0/18) of the daily, weekly, and sham groups, respectively......, had motor seizures in response to the LC. In the second experiment five groups of rats received an ECS daily for 0, 1, 6, 18, and 36 days, respectively. Eighteen weeks after the last ECS all rats received an LC and 0% (0/15), 13% (2/15), 20% (3/15), 53% (8/15), and 58% (7/12), respectively, developed...

  2. Regional GABA concentration and [3H]-diazepam binding in rat brain following repeated electroconvulsive shock

    International Nuclear Information System (INIS)

    Bowdler, J.M.; Green, A.R.; Minchin, M.C.W.; Nutt, D.J.

    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 [ 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. (Author)

  3. 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......-containing (SSergic) neurons have been found to undergo degeneration. To assess the potential loss of SSergic hilar neurons after repeated ECS, 10 rats were given 110 ECS, one per day, 5 days a week. One day after the last ECS the rats were anesthesized, perfused, the brains cut on a vibratome and prepared...... for nonradioactive in situ hybridization for somatostatin along with five control rats. Like rats given 10-36 ECS in earlier studies, the ECS-treated rats displayed a markedly increased neuronal hybridization labeling when compared with control rats. The total number of dentate hilar SSergic neurons of each rat...

  4. Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study

    NARCIS (Netherlands)

    Aten, J.J.; Oudega, M.L.; van Exel, E.; Stek, M.L.; van Waarde, J.A.

    2015-01-01

    In electroconvulsive therapy (ECT), a dose titration method (DTM) was suggested to be more individualized and therefore more accurate than formula-based dosing methods. A repeated DTM (every sixth session and dose adjustment accordingly) was compared to an age-based method (ABM) regarding treatment

  5. RAT HIPPOCAMPAL LACTATE EFFLUX DURING ELECTROCONVULSIVE SHOCK OR STRESS IS DIFFERENTLY DEPENDENT ON ENTORHINAL CORTEX AND ADRENAL INTEGRITY

    NARCIS (Netherlands)

    KRUGERS, HJ; JAARSMA, D; KORF, J

    The role of the entorhinal cortex and the adrenal gland in rat hippocampal lactate formation was assessed during and after a short-lasting immobilization stress and electroconvulsive shock (ECS). Extracellular lactate was measured on-line using microdialysis and enzyme reactions (a technique named

  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. Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study.

    Science.gov (United States)

    Aten, Jan Jaap; Oudega, Mardien; van Exel, Eric; Stek, Max L; van Waarde, Jeroen A

    2015-06-01

    In electroconvulsive therapy (ECT), a dose titration method (DTM) was suggested to be more individualized and therefore more accurate than formula-based dosing methods. A repeated DTM (every sixth session and dose adjustment accordingly) was compared to an age-based method (ABM) regarding treatment characteristics, clinical outcome, and cognitive functioning after ECT. Thirty-nine unipolar depressed patients dosed using repeated DTM and 40 matched patients treated with ABM were compared. Montgomery-Åsberg Depression Rating Scale (MADRS) and Mini-Mental State Examination (MMSE) were assessed at baseline and at the end of the index course, as well as the total number of ECT sessions. Both groups were similar regarding age, sex, psychotic features, mean baseline MADRS, and median baseline MMSE. At the end of the index course, the two methods showed equal outcome (mean end MADRS, 11.6 ± 8.3 in DTM and 9.5 ± 7.6 in ABM (P = 0.26); median end MMSE, 28 (25-29) and 28 (25-29.8), respectively (P = 0.81). However, the median number of all ECT sessions differed 16 (11-22) in DTM versus 12 (10-14.8) in ABM; P = 0.02]. Using regression analysis, dosing method and age were independently associated with the total number of ECT sessions, with less sessions needed in ABM (P = 0.02) and in older patients (P = 0.001). In this comparative cohort study, ABM and DTM showed equal outcome for depression and cognition. However, the median ECT course duration in repeated DTM appeared longer. Additionally, higher age was associated with shorter ECT courses regardless of the dosing method. Further prospective studies are needed to confirm these findings.

  9. Chronic treatment with repetitive transcranial magnetic stimulation inhibits seizure induction by electroconvulsive shock in rats.

    Science.gov (United States)

    Fleischmann, A; Hirschmann, S; Dolberg, O T; Dannon, P N; Grunhaus, L

    1999-03-15

    Studies in laboratory animals suggest that repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive shock (ECS) increase seizure inhibition acutely. This study was designed to explore whether chronic rTMS would also have seizure inhibition properties. To this purpose we administered rTMS (Magstim Rapid) and sham rTMS twice daily (2.5 T, 4-sec train duration, 20 Hz) to two groups of 10 rats for 16 days. The rTMS coil was a 50-mm figure-8 coil held directly over the rat's head. Raters were blind to experimental groups. On days 11, 17, and 21 (5 days after the last rTMS) ECS was administered with a Siemens convulsator using three electrical charge levels. Variables examined were the presence or absence of seizures and seizure length (measured from the initiation of the tonic contraction until the end of the limb movement). At day 11 rTMS had no effect on seizures, and both rTMS and sham rTMS animals convulsed equally. At day 17, however, rTMS-treated animals convulsed significantly less (both at presence/absence of seizures, and at seizure length) than sham rTMS animals. At day 21 the effects of rTMS had disappeared. These findings suggest that rTMS administered chronically leads to changes in seizure threshold similar to those reported for ECS and ECT; however, these effects were short-lived.

  10. Propofol prevents electroconvulsive-shock-induced memory impairment through regulation of hippocampal synaptic plasticity in a rat model of depression

    Directory of Open Access Journals (Sweden)

    Luo J

    2014-09-01

    Full Text Available Jie Luo, Su Min, Ke Wei, Jun Cao, Bin Wang, Ping Li, Jun Dong, Yuanyuan Liu Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China Background: Although a rapid and efficient psychiatric treatment, electroconvulsive therapy (ECT induces memory impairment. Modified ECT requires anesthesia for safety purposes. Although traditionally found to exert amnesic effects in general anesthesia, which is an inherent part of modified ECT, some anesthetics have been found to protect against ECT-induced cognitive impairment. However, the mechanisms remain unclear. We investigated the effects of propofol (2,6-diisopropylphenol on memory in depressed rats undergoing electroconvulsive shock (ECS, the analog of ECT in animals, under anesthesia as well as its mechanisms.Methods: Chronic unpredictable mild stresses were adopted to reproduce depression in a rodent model. Rats underwent ECS (or sham ECS with anesthesia with propofol or normal saline. Behavior was assessed in sucrose preference, open field and Morris water maze tests. Hippocampal long-term potentiation (LTP was measured using electrophysiological techniques. PSD-95, CREB, and p-CREB protein expression was assayed with western blotting.Results: Depression induced memory damage, and downregulated LTP, PSD-95, CREB, and p-CREB; these effects were exacerbated in depressed rats by ECS; propofol did not reverse the depression-induced changes, but when administered in modified ECS, propofol improved memory and reversed the downregulation of LTP and the proteins. Conclusion: These findings suggest that propofol prevents ECS-induced memory impairment, and modified ECS under anesthesia with propofol improves memory in depressed rats, possibly by reversing the excessive changes in hippocampal synaptic plasticity. These observations provide a novel insight into potential targets for optimizing the clinical use of ECT for psychiatric

  11. Propofol alleviates electroconvulsive shock-induced memory impairment by modulating proBDNF/mBDNF ratio in depressive rats.

    Science.gov (United States)

    Zhang, Fan; Luo, Jie; Min, Su; Ren, Li; Qin, Peipei

    2016-07-01

    This study investigated the effects of propofol and electroconvulsive shock (ECS), the analogue of electroconvulsive therapy (ECT) in animals, on tissue plasminogen activator (tPA) and its inhibitor (PAI-1) as well as the precursor of brain-derived neurotrophic factor (proBDNF)/mature BDNF (mBDNF) ratio in depressive rats. ECT is an effective treatment for depression, but can cause cognitive deficit. Some studies have indicated that propofol can ameliorate cognitive decline induced by ECT, but the underlying molecular mechanism is still unclear. Recent evidence has found that mBDNF and its precursor proBDNF are related to depression and cognitive function; they elicit opposite effects on cellular functions. Chronic unpredicted mild stress is widely used to induce depressive behaviors in rodents. This study found that the depression resulted in an increased expression of PAI-1 and upregulation of the proBDNF/mBDNF ratio, together with a decreased level of tPA, long-term potentiation (LTP) impairment, and cognitive decline. The proBDNF/mBDNF ratio was further upregulated after the ECS treatment in depressive rats, resulting in the deterioration of cognitive function and hippocampal LTP. Propofol alone did not reverse the changes in depressive rats, but when co-administered with ECS, it improved the cognitive function, alleviated the impairment of LTP, downregulated the proBDNF/mBDNF ratio, and increased the tPA expression. The results of this study suggest that propofol ameliorates cognitive decline induced by ECT, which was partly by modulating the proBDNF/mBDNF ratio and reversing the excessive changes in hippocampal synaptic plasticity, providing a new evidence for involving the proBDNF/mBDNF system in the progression and treatment of depression. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. 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

    of epileptic activity and depression, including the piriform cortex, hippocampal dentate gyrus, and amygdala. Likewise, GalR2 gene expression was up-regulated in both the central and the medial amygdala, whereas GalR1 gene expression showed a modest down-regulation in the medial amygdala. [(125) I......]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...

  13. [MK-801 or DNQX reduces electroconvulsive shock-induced impairment of learning-memory and hyperphosphorylation of Tau in rats].

    Science.gov (United States)

    Liu, Chao; Min, Su; Wei, Ke; Liu, Dong; Dong, Jun; Luo, Jie; Liu, Xiao-Bin

    2012-08-25

    This study explored the effect of the excitatory amino acid receptor antagonists on the impairment of learning-memory and the hyperphosphorylation of Tau protein induced by electroconvulsive shock (ECT) in depressed rats, in order to provide experimental evidence for the study on neuropsychological mechanisms improving learning and memory impairment and the clinical intervention treatment. The analysis of variance of factorial design set up two intervention factors which were the electroconvulsive shock (two level: no disposition; a course of ECT) and the excitatory amino acid receptor antagonists (three level: iv saline; iv NMDA receptor antagonist MK-801; iv AMPA receptor antagonist DNQX). Forty-eight adult Wistar-Kyoto (WKY) rats (an animal model for depressive behavior) were randomly divided into six experimental groups (n = 8 in each group): saline (iv 2 mL saline through the tail veins of WKY rats ); MK-801 (iv 2 mL 5 mg/kg MK-801 through the tail veins of WKY rats) ; DNQX (iv 2 mL 5 mg/kg DNQX through the tail veins of WKY rats ); saline + ECT (iv 2 mL saline through the tail veins of WKY rats and giving a course of ECT); MK-801 + ECT (iv 2 mL 5 mg/kg MK-801 through the tail veins of WKY rats and giving a course of ECT); DNQX + ECT (iv 2 mL 5 mg/kg DNQX through the tail veins of WKY rats and giving a course of ECT). The Morris water maze test started within 1 day after the finish of the course of ECT to evaluate learning and memory. The hippocampus was removed from rats within 1 day after the finish of Morris water maze test. The content of glutamate in the hippocampus of rats was detected by high performance liquid chromatography. The contents of Tau protein which included Tau5 (total Tau protein), p-PHF1(Ser396/404), p-AT8(Ser199/202) and p-12E8(Ser262) in the hippocampus of rats were detected by immunohistochemistry staining (SP) and Western blot. The results showed that ECT and the glutamate ionic receptor blockers (NMDA receptor antagonist MK-801 and

  14. 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)

    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 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

  15. Opiate-like electroencephalographic and behavioral effects of electroconvulsive shock in rats.

    Science.gov (United States)

    Tortella, F C; Cowan, A; Belenky, G L; Holaday, J W

    1981-12-03

    Rats were studied (a) after a single transauricular electroshock (acute ECS) and (b) following 10 consecutive once-daily shocks (chronic ECS). ECS produced a generalized convulsion marked by a polyspike EEG seizure. The seizure was followed by a period of postictal depression (PID) characterized by EEG high-voltage synchrony, EMG quietening, and an associated stuporous behavior in the rat. Acute ECS produced a maximal of 33 +/- 8 (S.E.) percent above control in the EEG voltage output during postictus, with the PID lasting 2680 +/- 658 sec. Chronic ECS resulted in a significant enhancement of these acute responses. Pretreating rats with naloxone (0.3-10 mg/kg s.c.) antagonized the postictal effects of acute ECS, but not of chronic ECS. These naloxone-sensitive postictal EEG and behavioral changes appear to reflect a release of endogenous opioid peptides during ictus, a finding consistent with the hypothesis that electroshock activates opioid systems.

  16. Evaluation of New Methodology for Health Hazard Assessment of Repeated Shock in Military Tactical Ground Vehicles

    National Research Council Canada - National Science Library

    Alem, Nabih; Hiltz, Ernest; Breaux-Sims, Arlene; Bumgardner, Bradley

    2004-01-01

    .... The research culminated with the development of a new HHA method for repeated jolt that is tailored for TGVs but is valid for most vehicles where the seated occupant is exposed to repeated (multiple) low-level shocks (jolt...

  17. 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

  18. 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.

    Directory of Open Access Journals (Sweden)

    Erin M van Buel

    Full Text Available 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

  19. 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

  20. Diffusion of intracerebrally injected [1-14C]arachidonic acid and [2-3H]glycerol in the mouse brain. Effects of ischemia and electroconvulsive shock

    International Nuclear Information System (INIS)

    Pediconi, M.F.; Rodriguez de Turco, E.B.; Bazan, N.G.

    1982-01-01

    [2- 3 H]Glycerol and [1- 14 C]arachidonic acid were injected into the region of the frontal horn of the left ventricle of mice and were distributed rapidly throughout the brain. After 10 sec, most of the radioactive fatty acid was found in the hemisphere near the injection site; after 10 min, it was recovered in similar proportions in the cerebellum and brain stem. [2- 3 H]Glycerol showed a heterogeneous distribution, with most of the label remaining in the left hemisphere even after 10 min. On a fresh weight basis, cerebrum, cerebellum, and brain stem were found to contain similar amounts of labeled glycerol. However, the amount of [1- 14 C]arachidonate in cerebrum was only 50% of that recovered from cerebellum or brain stem. Brain ischemia or a single electroconvulsive shock reduced the spread of the label, producing an accumulation of radioactivity in the injected hemisphere, except for an increase in [2- 3 H]glycerol in the brain stem during ischemia. Despite the significant decrease in available precursor in the cerebellum and brain stem after electroshock, the amount of label incorporated into lipids was not altered in these areas and only slightly diminished in the cerebrum

  1. Mitochondria are critical for BDNF-mediated Synaptic and Vascular plasticity of Hippocampus following Repeated Electroconvulsive Seizures

    DEFF Research Database (Denmark)

    Chen, Fenghua; Ardalan, Maryam; Elfving, Betina

    2018-01-01

    for the clinical efficacy obtained from a rapid antidepressant response. Here, we investigated the relationship between, synaptic changes and concomitant non-neuronal changes in microvasculature and mitochondria, and it relationship to Brain-derived neurotrophic factor (BDNF) level changes after repeated...... of synapses and mitochondria, and the length of microvessels in the hippocampus. The BDNF protein levels were quantified with immunohistochemistry. Results: In untreated controls, a lower number of synapses and mitochondria were accompanied by shorter microvessels of the hippocampus in "depressive" phenotype...... (FSL) compared to the "non-depressed" phenotype (FRL). ECS administration significantly increased the number of synapses and mitochondria, and length of microvessels both in FSL-ECS and FRL-ECS rats. In addition, the amount of BDNF protein was significantly increased in FSL and FRL rats after ECS...

  2. LIPID PEROXIDATION AND BIOCHEMICAL PROFILE IN PRE AND POST ELECTROCONVULSIVE THERAPY IN PSYCHIATRIC PATIENTS

    OpenAIRE

    Narasimha Rao Babji; Santhisree

    2014-01-01

    OBJECTIVE: Electroconvulsive therapy (ECT) is an important treatment for a variety of neuropsychiatric disorders. The invasiveness of the procedure and major adverse effects of memory loss and confusion are limiting variables in the use of ECT. Free radical molecules are released during a shock seizure. The effect of electroconvulsive therapy on lipid peroxidation and on enzymes is not well studied. In the present study Malondialdehyde (MDA), Aspartate transaminase (AST), Alan...

  3. MRI T2 relaxometry of brain regions and cognitive dysfunction following electroconvulsive therapy

    OpenAIRE

    Kunigiri, Girish; Jayakumar, P. N.; Janakiramaiah, N.; Gangadhar, B. N.

    2007-01-01

    Background: Although electroconvulsive therapy (ECT) causes no structural brain damage, recent studies reported altered brain perfusion acutely following ECT. This is in keeping with brain edema which was noted in animal experiments following electroconvulsive shock. Aim: This study examined alteration in magnetic resonance imaging (MRI) T2 relaxation time, a measure of brain edema, and its relation to therapeutic efficacy, orientation and memory impairment with ECT. Materials and Methods: Fi...

  4. 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)

  5. 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.

  6. Electroconvulsive therapy for schizophrenia.

    Science.gov (United States)

    Tharyan, P; Adams, C E

    2005-04-18

    Electroconvulsive therapy (ECT) involves the induction of a seizure for therapeutic purposes by the administration of a variable frequency electrical stimulus shock via electrodes applied to the scalp. The effects of its use in people with schizophrenia are unclear. To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning for people with schizophrenia, and to determine whether variations in the practical administration of ECT influences outcome. We undertook electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), MEDLINE (1966-2004), PsycLIT (1974-1996),SCISEARCH (1996) and the Cochrane Schizophrenia Group's Register (July 2004). We also inspected the references of all identified studies and contacted relevant authors. We included all randomised controlled clinical trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics and different schedules and methods of administration of ECT for people with schizophrenia, schizoaffective disorder or chronic mental disorder. Working independently, we selected and critically appraised studies, extracted data and analysed on an intention-to-treat basis. Where possible and appropriate we calculated risk ratios (RR) and their 95% confidence intervals (CI) with the number needed to treat (NNT). For continuous data Weighted Mean Differences (WMD) were calculated. We presented scale data for only those tools that had attained pre-specified levels of quality. We also undertook tests for heterogeneity and publication bias. This review includes 26 trials with 50 reports. When ECT is compared with placebo or sham ECT, more people improved in the real ECT group (n=392, 10 RCTs, RR 0.76 random CI 0.59 to 0.98, NNT 6 CI 4 to 12) and though data were heterogeneous (chi-square 17.49 df=9 P=0.04), its impact on variability of data was not

  7. 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.

  8. Cyclic elastic analysis of a PWR nozzle subjected to a repeated thermal shock

    International Nuclear Information System (INIS)

    Locci, J.M.; Prost, J.P.

    1979-01-01

    In the primary piping system of a PWR nuclear power plant, some nozzles are subjected to strong thermal shocks due to sudden thermal variations in the internal water flow. The thermal gradients are sufficiently high to induce general elastic plastic behaviour. The design of these nozzles using the simplified elastic plastic analysis given in the ASME III Code NB-3200 generally leads to a very high usage factor. The aim of this work is to show by giving an example that a complete cyclic elastic plastic analysis makes it possible to considerably reduce the usage factor. (orig.)

  9. Habituation of the cold shock response is inhibited by repeated anxiety: Implications for safety behaviour on accidental cold water immersions.

    Science.gov (United States)

    Barwood, Martin J; Corbett, Jo; Tipton, Mike; Wagstaff, Christopher; Massey, Heather

    2017-05-15

    Accidental cold-water immersion (CWI) triggers the life-threatening cold shock response (CSR) which is a precursor to sudden death on immersion. One practical means of reducing the CSR is to induce an habituation by undergoing repeated short CWIs. Habituation of the CSR is known to be partially reversed by the concomitant experience of acute anxiety, raising the possibility that repeated anxiety could prevent CSR habituation; we tested this hypothesis. Sixteen participants (12 male, 4 female) completed seven, seven-minute immersions in to cold water (15°C). Immersion one acted as a control (CON1). During immersions two to five, which would ordinarily induce an habituation, anxiety levels were repeatedly increased (CWI-ANX rep ) by deception and a demanding mathematical task. Immersions six and seven were counter-balanced with another high anxiety condition (CWI-ANX rep ) or a further control (CON2). Anxiety (20cm visual analogue scale) and cardiorespiratory responses (cardiac frequency [f c ], respiratory frequency [f R ], tidal volume [V T ], minute ventilation [V̇ E ]) were measured. Comparisons were made between experimental immersions (CON1, final CWI-ANX rep , CON2), across habituation immersions and with data from a previous study. Anxiety levels were sustained at a similar level throughout the experimental and habituation immersions (mean [SD] CON1: 7.0 [4.0] cm; CON2: 5.8 [5.2] cm cf CWI-ANX rep : 7.3 [5.5] cm; p>0.05). This culminated in failure of the CSR to habituate even when anxiety levels were not manipulated (i.e. CON2). These data were different (pCSR consequently habituated. Repeated anxiety prevented CSR habituation. A protective strategy that includes inducing habituation for those at risk should include techniques to lower anxiety associated with the immersion event or habituation may not be beneficial in the emergency scenario. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Electroconvulsive therapy and memory.

    Science.gov (United States)

    Harper, R G; Wiens, A N

    1975-10-01

    Recent research on the effects of electroconvulsive therapy (ECT) on memory is critically reviewed. Despite some inconsistent findings, unilateral nondominant ECT appears to affect verbal memory less than bilateral ECT. Adequate research on multiple monitored ECT is lacking. With few exceptions, the research methodologies for assessing memory have been inadequate. Many studies have confounded learning with retention, and only very recently has long term memory been adequately studied. Standardized assessment procedures for short term and long term memory are needed, in addition to more sophisticated assessment of memory processes, the duration of memory loss, and qualitative aspects of memories.

  11. 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....

  12. 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....

  13. Neuroimaging and electroconvulsive therapy

    DEFF Research Database (Denmark)

    Bolwig, Tom G

    2014-01-01

    BACKGROUND: Since the 1970s, a number of neuroimaging studies of electroconvulsive therapy (ECT) have been conducted to elucidate the working action of this highly efficacious treatment modality. The technologies used are single photon emission tomography, positron emission tomography, magnetic...... in localized cortical and subcortical areas of the brain and have revealed differences in neurophysiology and metabolism between the hyperactive ictal state and the restorative interictal/postictal periods. Recent magnetic resonance imaging studies seem to pave way for new insights into ECT's effects...... on increased connectivity in the brain during depression. CONCLUSION: The existing data reveal considerable variations among studies and therefore do not yet allow the formulation of a unified hypothesis for the mechanism of ECT. The rapid developments in imaging technology, however, hold promises for further...

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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

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

    DEFF Research Database (Denmark)

    Hageman, I; Nielsen, M; Wörtwein, Gitta

    2008-01-01

    whether repeated electroconvulsive stimulations (ECSs) could influence such changes in stressed rats. Furthermore, we investigated whether ECSs per se could influence neuronal branching and total length of the CA3 hippocampal neuronal dendritic tree in normal rats. Rats were stressed using the 21-day 6 h...

  20. MicroRNA expression in rat brain exposed to repeated inescapable shock: differential alterations in learned helplessness vs. non-learned helplessness.

    Science.gov (United States)

    Smalheiser, Neil R; Lugli, Giovanni; Rizavi, Hooriyah S; Zhang, Hui; Torvik, Vetle I; Pandey, Ghanshyam N; Davis, John M; Dwivedi, Yogesh

    2011-11-01

    MicroRNA (miRNA) expression was measured within frontal cortex of male Holtzman rats subjected to repeated inescapable shocks at days 1 and 7, tested for learned helplessness (LH) at days 2 and 8, and sacrificed at day 15. We compared rats that did vs. did not exhibit LH, as well as rats that were placed in the apparatus and tested for avoidance but not given shocks (tested controls, TC). Non-learned helpless (NLH) rats showed a robust adaptive miRNA response to inescapable shock whereas LH rats showed a markedly blunted response. One set of 12 miRNAs showed particularly large, significant down-regulation in NLH rats relative to tested controls (mir-96, 141, 182, 183, 183*, 298, 200a, 200a*, 200b, 200b*, 200c, 429). These were encoded at a few shared polycistronic loci, suggesting that the down-regulation was coordinately controlled at the level of transcription. Most of these miRNAs are enriched in synaptic fractions. Moreover, almost all of these share 5'-seed motifs with other members of the same set, suggesting that they will hit similar or overlapping sets of target mRNAs. Finally, half of this set is predicted to hit Creb1 as a target. We also identified a core miRNA co-expression module consisting of 36 miRNAs that are highly correlated with each other across individuals of the LH group (but not in the NLH or TC groups). Thus, miRNAs participate in the alterations of gene expression networks that underlie the normal (NLH) as well as aberrant (LH) response to repeated shocks.

  1. 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.

  2. Development of the embryonic heat shock response and the impact of repeated thermal stress in early stage lake whitefish (Coregonus clupeaformis) embryos.

    Science.gov (United States)

    Whitehouse, Lindy M; McDougall, Chance S; Stefanovic, Daniel I; Boreham, Douglas R; Somers, Christopher M; Wilson, Joanna Y; Manzon, Richard G

    2017-10-01

    Lake whitefish (Coregonus clupeaformis) embryos were exposed to thermal stress (TS) at different developmental stages to determine when the heat shock response (HSR) can be initiated and if it is altered by exposure to repeated TS. First, embryos were subject to one of three different TS temperatures (6, 9, or 12°C above control) at 4 points in development (21, 38, 60 and 70 days post-fertilisation (dpf)) for 2h followed by a 2h recovery to understand the ontogeny of the HSR. A second experiment explored the effects of repeated TS on the HSR in embryos from 15 to 75 dpf. Embryos were subjected to one of two TS regimes; +6°C TS for 1h every 6 days or +9°C TS for 1h every 6 days. Following a 2h recovery, a subset of embryos was sampled. Our results show that embryos could initiate a HSR via upregulation of heat shock protein 70 (hsp70) mRNA at all developmental ages studied, but that this response varied with age and was only observed with a TS of +9 or +12°C. In comparison, when embryos received multiple TS treatments, hsp70 was not induced in response to the 1h TS and 2h recovery, and a downregulation was observed at 39 dpf. Downregulation of hsp47 and hsp90α mRNA was also observed in early age embryos. Collectively, these data suggest that embryos are capable of initiating a HSR at early age and throughout embryogenesis, but that repeated TS can alter the HSR, and may result in either reduced responsiveness or a downregulation of inducible hsps. Our findings warrant further investigation into both the short- and long-term effects of repeated TS on lake whitefish development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Spatial memory impairment in Morris water maze after electroconvulsive seizures.

    Science.gov (United States)

    Svensson, Maria; Hallin, Thord; Broms, Jonas; Ekstrand, Joakim; Tingström, Anders

    2017-02-01

    Electroconvulsive therapy (ECT) is one of the most efficient treatments for severe major depression, but some patients suffer from retrograde memory loss after treatment. Electroconvulsive seizures (ECS), an animal model of ECT, have repeatedly been shown to increase hippocampal neurogenesis, and multiple ECS treatments cause retrograde amnesia in hippocampus-dependent memory tasks. Since recent studies propose that addition of newborn hippocampal neurons might degrade existing memories, we investigated whether the memory impairment after multiple ECS treatments is a cumulative effect of repeated treatments, or if it is the result of a delayed effect after a single ECS. We used the hippocampus-dependent memory task Morris water maze (MWM) to evaluate spatial memory. Rats were exposed to an 8-day training paradigm before receiving either a single ECS or sham treatment and tested in the MWM 24 h, 72 h, or 7 days after this treatment, or multiple (four) ECS or sham treatments and tested 7 days after the first treatment. A single ECS treatment was not sufficient to cause retrograde amnesia whereas multiple ECS treatments strongly disrupted spatial memory in the MWM. The retrograde amnesia after multiple ECS is a cumulative effect of repeated treatments rather than a delayed effect after a single ECS.

  4. [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.

  5. 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...

  6. Electroconvulsive therapy in a patient with moyamoya syndrome.

    Science.gov (United States)

    Ghignone, Erica; Rosenthal, Lisa; Lloyd, Robert Brett; Mouli, Samdeep; Dinwiddie, Stephen

    2015-03-01

    We report on a 30-year-old woman diagnosed with moyamoya syndrome resulting from sickle cell disease who developed catatonia and was successfully treated with electroconvulsive therapy (ECT). Neuroimaging revealed severe tandem narrowing of the left internal carotid artery with diminished cerebral blood flow, moderate narrowing of the right supraclinoid aspect of the right internal carotid artery, and associated numerous lenticulostriate collaterals bilaterally, consistent with moyamoya. The patient presented with mutism; posturing; immobility; stupor; withdrawal; refusal to eat, drink, or speak; and staring, supporting a diagnosis of catatonia. It initially responded to a lorazepam challenge; however, a complicated hospital course and deterioration of the patient's condition, including septic shock, delirium, and continued catatonic symptoms, led to the pursuit of ECT to treat her symptoms. We discuss the risks involved with the administration of ECT in a patient with fragile cerebral vasculature and the successful treatment of catatonia in this patient without resultant stroke or cerebral hemorrhage.

  7. 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...

  8. 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

  9. 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.

  10. 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

  11. Electroconvulsive Therapy Practice in New Zealand.

    Science.gov (United States)

    Fisher, Mark Wilkinson; Morrison, John; Jones, Paul Anthony

    2017-06-01

    The aim of this study was to describe the contemporary practice of electroconvulsive therapy (ECT) in New Zealand. A 53-item questionnaire was sent to all services providing ECT as of December 2015. Electroconvulsive therapy was provided by 16 services covering 15 district health boards funded by the New Zealand government. No private facilities provided ECT. All services providing ECT responded to an online survey questionnaire. Rates of ECT utilization were low relative to similar countries. Survey results indicated ECT was practiced to an overall good standard. Several resource and logistical issues potentially contributing to low ECT utilization were identified. Electroconvulsive therapy in New Zealand is provided using modern equipment and practices. However, overall rates of utilization remain low, perhaps as a result of controversy surrounding ECT and some resourcing issues.

  12. 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.

  13. 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.

  14. Regulation of the galanin system in the brainstem and hypothalamus by electroconvulsive stimulation in mice

    DEFF Research Database (Denmark)

    Christiansen, S H

    2011-01-01

    Induction of seizures by electroconvulsive stimulation (ECS) is amongst the most efficacious treatments for major depression. However, the working mechanism by which ECS exerts its antidepressant effects remains elusive. The galanin system is regulated by ECS in seizure-prone brain regions and ha...... in brain regions involved in monoaminergic neurotransmission and stress modulation thus indicating a possible role of the galanin system in the therapeutic effects of ECS.......Induction of seizures by electroconvulsive stimulation (ECS) is amongst the most efficacious treatments for major depression. However, the working mechanism by which ECS exerts its antidepressant effects remains elusive. The galanin system is regulated by ECS in seizure-prone brain regions and has...... been shown to modulate depression-like behaviour. To further explore its potential role in the antidepressant effects of ECS the galanin system was investigated by in situ hybridisation and [(125)I]-galanin receptor binding during repeated ECS in the locus coeruleus, dorsal raphe and discrete nuclei...

  15. Contribution of a natural polymorphism, protein kinase G, modulates electroconvulsive seizure recovery in D. melanogaster.

    Science.gov (United States)

    Kelly, Stephanie P; Risley, Monica G; Miranda, Leonor E; Dawson-Scully, Ken

    2018-05-24

    Drosophila melanogaster is a well-characterized model for neurological disorders and is widely used for investigating causes of altered neuronal excitability leading to seizure-like behavior. One method used to analyze behavioral output of neuronal perturbance is recording the time to locomotor recovery from an electroconvulsive shock. Based on this behavior, we sought to quantify seizure susceptibility in larval D. melanogaster with differences in the enzymatic activity levels of a major protein, cGMP-dependent protein kinase (PKG). PKG, encoded by foraging , has two natural allelic variants and has previously been implicated in several important physiological characteristics including: foraging patterns, learning and memory, and environmental stress tolerance. The well-established NO/cGMP/PKG signaling pathway found in the fly, which potentially targets downstream K + channel(s), which ultimately impacts membrane excitability; leading to our hypothesis: altering PKG enzymatic activity modulates time to recovery from an electroconvulsive seizure. Our results show that by both genetically and pharmacologically increasing PKG enzymatic activity, we can decrease the locomotor recovery time from an electroconvulsive seizure in larval D. melanogaster . © 2018. Published by The Company of Biologists Ltd.

  16. Electroconvulsive therapy practice in Ukraine.

    Science.gov (United States)

    Olekseev, Aleksey; Ungvari, Gabor S; Gazdag, Gábor

    2014-09-01

    Patterns of electroconvulsive therapy (ECT) use have recently been extensively surveyed in Central-Eastern Europe. However, data from post-USSR countries are limited. This study aimed to survey ECT practice in Ukraine. All psychiatric services in Ukraine were identified and contacted to obtain information on the use of ECT in 2011 using a 22-item questionnaire. Of the 146 psychiatric inpatient facilities, only 5 confirmed that they performed ECT in 2011. Three other services also performed ECT but refused to provide further information. In the only private psychiatric institute where ECT was offered, 14.28% of inpatients received this treatment in 2011, whereas the corresponding figure in the 6 public psychiatric facilities was a mere 0.4%. Three centers used unmodified ECT, and only 2 centers had equipment that monitored electroencephalogram. In 7 services, in line with international recommendations, affective disorders were the first indications for ECT in Ukraine, whereas uncommon indications such as anorexia or Parkinsonism were also reported. This was the first survey of ECT practice conducted in Ukraine. The provision of ECT in only 8 centers is clearly insufficient for a large country such as Ukraine, which is reflected in the low rate of inpatients treated with ECT. The very limited availability of this effective treatment modality should be addressed by the Ukrainian health authorities.

  17. [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.

  18. 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.

  19. Electroconvulsive therapy after maxillofacial metallic implants.

    Science.gov (United States)

    Freeman, G Mark; Perry, Matthew T; Manatt, George S; Cristancho, Pilar

    2014-03-01

    A growing body of literature suggests that electroconvulsive therapy (ECT) can be safely utilized in patients with craniofacial metallic implants. Here we provide radiographic images and the clinical course of a 49-year-old woman with both maxillary and mandibular metallic implants who safely received ECT.

  20. 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

  1. 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 (TcPCO 2 ) was measured throughout all sessions. Ventilation parameters, hemodynamic measures, seizure characteristics, and side effects were also explored. PHV resulted in lower TcPCO 2 after hyperventilation (p=.008) and over the whole session (p=.035). The lowest TcPCO 2 was achieved after voluntary hyperventilation. Changes in TcPCO 2 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' TcPCO 2 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, CO 2 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.

  2. Acute and repeated ECS treatment increases CRF, POMC and PENK gene expression in selected regions of the rat hypothalamus.

    Science.gov (United States)

    Garcia-Garcia, L; Llewellyn-Jones, V; Fernandez Fernandez, I; Fuentes, J A; Manzanares, J

    1998-01-05

    The purpose of this study was to investigate the effects of acute and repeated electroconvulsive shock (ECS) on corticotropin releasing factor (CRF), proopiomelanocortin (POMC) and proenkephalin (PENK) gene expression in selected regions of the brain and pituitary of the rat. Acute ECS increased CRF gene expression in the paraventricular nucleus (PVN) by 20%, an effect that was further enhanced to 38% when rats received repeated ECS treatment. Acute and repeated ECS increased POMC gene expression in the arcuate nucleus (ARC) by 49-59% but failed to alter these mRNA levels in the anterior lobe (AL) of the pituitary gland. PENK gene expression was increased by 35% in the nucleus accumbens (NA) and by 180% the ventromedial nucleus (VMN) after acute or repeated ECS treatment but no significant changes were found in the PVN or striatum (ST). Taken together, these results indicate a differential CRF and opioid gene expression regulation after acute or repeated ECS treatment that may be relevant to their therapeutic or side effects in depression.

  3. 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

  4. 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.

  5. Concurrent Electroconvulsive Therapy and Bupropion Treatment.

    Science.gov (United States)

    Takala, Christopher R; Leung, Jonathan G; Murphy, Lauren L; Geske, Jennifer R; Palmer, Brian A

    2017-09-01

    Bupropion is associated with a dose-dependent increased risk of seizures. Use of concomitant bupropion and electroconvulsive therapy (ECT) remains controversial because of an increased risk of prolonged seizures. This is the first systematic evaluation of the effect of bupropion on ECT. A case group (n = 119), patients treated with concomitant ECT and bupropion, was compared with an age and gender frequency-matched control group (n = 261), treated with only ECT. Electroconvulsive therapy treatment data including seizure length, number of treatments, and concurrent medications were extracted. Longitudinal mixed models examined ECT versus ECT + bupropion group differences over the course of treatments measured by seizure duration (electroencephalogram [EEG] and motor). Multivariable models examined the total number of treatments and first and last seizure duration. All models considered group differences with ECT treatment measures adjusted for age, gender, benzodiazepine treatment, lead placement, and setting. Electroconvulsive therapy treatment with bupropion led to shorter motor seizure duration (0.047) and EEG seizure duration (P = 0.001). The number of ECT treatments (7.3 vs 7.0 treatments; P = 0.23), respectively, or the probability of a prolonged seizure (P = 0.15) was not significantly different. Benzodiazepine use was significantly more common in control subjects (P = 0.01). This is a retrospective analysis limited in part by unavailable variables (seizure threshold, nature of EEG and motor seizure monitoring, type of ECT device, dosing and formulation of bupropion, and duration of the current depressive illness). This study revealed a significantly shorter duration in seizure length with ECT + concomitant bupropion, but not in the number of required treatments in those treated compared with ECT without bupropion. There remains a critical need to reevaluate the efficacy of concomitant use of psychotropic medications + ECT.

  6. Neurally mediated syncope in electroconvulsive therapy maintenance.

    Science.gov (United States)

    Arbaizar, Beatriz; Llorca, Javier

    2012-03-01

    Electroconvulsive therapy (ECT) is especially necessary to revert some types of depressive disease; nevertheless, it has some widely recognized adverse effects, such as short-term memory loss. Moreover, some articles have reported its potential association with falls; this literature is, however, scanty and mainly consists of case reports. We present the case of a man who has a diagnosis of neurally mediated syncope at the age of 79 years, during the maintenance ECT. The patient had a significant increase in syncope frequency in the period he was treated with ECT, followed by a dramatic decrease when ECT was discontinued.

  7. Somatic symptom disorder treated with electroconvulsive therapy.

    Science.gov (United States)

    Borisovskaya, Anna; Augsburger, Jay Alan

    2017-05-01

    Somatic symptom disorder (SSD) is a challenging condition to treat with chronic pain, a common and disabling symptom. We present a patient who received electroconvulsive therapy (ECT) for SSD with significant improvement in pain and gastrointestinal symptoms. We also present a brief literature review of similar cases treated with ECT. Preliminary evidence suggests that ECT should be considered for treatment of SSD comorbid with major depressive disorder, when standard treatments fail. Further research is needed to clarify whether ECT can be used for SSD without associated depression.

  8. Neuropsychological effects and attitudes in patients following electroconvulsive therapy.

    Science.gov (United States)

    Feliu, Miriam; Edwards, Christopher L; Sudhakar, Shiv; McDougald, Camela; Raynor, Renee; Johnson, Stephanie; Byrd, Goldie; Whitfield, Keith; Jonassaint, Charles; Romero, Heather; Edwards, Lekisha; Wellington, Chante'; Hill, LaBarron K; Sollers, James; Logue, Patrick E

    2008-06-01

    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 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 memory (p recall (p visual designs (p memory functioning, and post-ECT self-reports may not be reliable.

  9. 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

  10. Retrograde amnesia after electroconvulsive therapy: a temporary effect?

    NARCIS (Netherlands)

    Meeter, M.; Murre, J.M.J.; Janssen, S.M.J.; Birkenhager, T.; van den Broek, W.W.

    2011-01-01

    Objective: Although electroconvulsive therapy (ECT) is generally considered effective against depression, it remains controversial because of its association with retrograde memory loss. Here, we assessed memory after ECT in circumstances most likely to yield strong retrograde amnesia. Method: A

  11. Effects of maintenance electroconvulsive therapy on cognitive functions

    NARCIS (Netherlands)

    Vothknecht, S.; Kho, K. H.; van Schaick, H. W.; Zwinderman, A. H.; Middelkoop, H.; Blansjaar, B. A.

    2003-01-01

    Background: This study examined cognitive side effects of maintenance electroconvulsive (ECT) in comparison with maintenance pharmacotherapy after index ECT. Method: Clinical outcome data and neuropsychological measurements were compared in 11 maintenance ECT patients and 13 control patients treated

  12. Electroconvulsive therapy: Promoting awareness among primary care physicians.

    Science.gov (United States)

    Sicher, Sarah; Gedzior, Joanna

    2016-04-01

    This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers. © The Author(s) 2016.

  13. Pre-treatment amygdala volume predicts electroconvulsive therapy response

    NARCIS (Netherlands)

    ten Doesschate, Freek; van Eijndhoven, Philip; Tendolkar, Indira; van Wingen, Guido A.; van Waarde, Jeroen A.

    2014-01-01

    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

  14. Differential effects of acute and repeated electrically and chemically induced seizures on ( sup 3 H)Nimodipine and ( sup 125 I)omega-conotoxin GVIA binding in rat brain

    Energy Technology Data Exchange (ETDEWEB)

    Gleiter, C.H.; Cain, C.J.; Weiss, S.R.; Post, R.M.; Marangos, P.J. (National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD (USA))

    1989-07-01

    ({sup 3}H)Nimodipine and high-affinity ({sup 125}I)omega-conotoxin GVIA (CgTX) binding were investigated in membranes from rat cerebral cortex, cerebellum, and hippocampus after electrically and chemically induced seizures. Animals were decapitated 30 min after a single electroconvulsive shock (ECS) or lidocaine-induced seizure and 24 h after the last of 10 once-daily ECS or six once-daily lidocaine-induced seizures. After a single ECS, ({sup 3}H)nimodipine and ({sup 125}I)CgTX binding sites decreased in cerebral cortex (by 10% and 17%, respectively). A downregulation of ({sup 3}H)nimodipine binding sites in hippocampus occurred after single and repeated lidocaine-induced seizures (by 24% and 11%, respectively), whereas ({sup 125}I)CgTX binding remained unaltered. An earlier report on changes in ({sup 3}H)nitrendipine binding after chronic ECS in cortex and hippocampus was not confirmed.

  15. Pregnancy and Electroconvulsive Therapy: A Multidisciplinary Approach.

    Science.gov (United States)

    Ray-Griffith, Shona L; Coker, Jessica L; Rabie, Nader; Eads, Lou Ann; Golden, Kimberly J; Stowe, Zachary N

    2016-06-01

    To scrutinize a series of pregnant women treated with electroconvulsive therapy (ECT) at a tertiary treatment center and combine these data with a literature review to refine the treatment guidelines for ECT during pregnancy. A retrospective chart review of mentally ill pregnant patients treated with ECT since the establishment of a formal women's mental health program. A total of 8 pregnant women treated with ECT were identified from January 2012 to August 2014. Information was extracted from the medical records of a total of 30 ECT treatments across this group. Subjects received an average of 3.75 ECT treatments (range, 1-7). All women were diagnosed as having a mood disorder (either unipolar or bipolar), and 5 of the 8 women had suicidal ideation. The treatment team for ECT was consistent across all treatments. Two women experienced significant complications after the initial treatment: 1) an acute episode of complete heart block; and 2) acute onset of mania after ECT. Obstetrical complications included 2 women with preterm delivery-one secondary to premature rupture of membranes. No other complications or adverse outcomes were recorded. The 5 women with suicidal ideation had symptom resolution, and significant symptom improvement was noted in 6 of the 8 women. Electroconvulsive therapy is a safe and effective treatment during pregnancy and of particular benefit in the acute treatment of suicidal ideation.

  16. Ten tandem repeats of β-hCG 109-118 enhance immunogenicity and anti-tumor effects of β-hCG C-terminal peptide carried by mycobacterial heat-shock protein HSP65

    International Nuclear Information System (INIS)

    Zhang Yankai; Yan Rong; He Yi; Liu Wentao; Cao Rongyue; Yan Ming; Li Taiming; Liu Jingjing; Wu Jie

    2006-01-01

    The β-subunit of human chorionic gonadotropin (β-hCG) is secreted by many kinds of tumors and it has been used as an ideal target antigen to develop vaccines against tumors. In view of the low immunogenicity of this self-peptide,we designed a method based on isocaudamer technique to repeat tandemly the 10-residue sequence X of β-hCG (109-118), then 10 tandemly repeated copies of the 10-residue sequence combined with β-hCG C-terminal 37 peptides were fused to mycobacterial heat-shock protein 65 to construct a fusion protein HSP65-X10-βhCGCTP37 as an immunogen. In this study, we examined the effect of the tandem repeats of this 10-residue sequence in eliciting an immune by comparing the immunogenicity and anti-tumor effects of the two immunogens, HSP65-X10-βhCGCTP37 and HSP65-βhCGCTP37 (without the 10 tandem repeats). Immunization of mice with the fusion protein HSP65-X10-βhCGCTP37 elicited much higher levels of specific anti-β-hCG antibodies and more effectively inhibited the growth of Lewis lung carcinoma (LLC) in vivo than with HSP65-βhCGCTP37, which should suggest that HSP65-X10-βhCGCTP37 may be an effective protein vaccine for the treatment of β-hCG-dependent tumors and multiple tandem repeats of a certain epitope are an efficient method to overcome the low immunogenicity of self-peptide antigens

  17. 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.

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

    DEFF Research Database (Denmark)

    K, Henningsen,; Woldbye, David Paul Drucker; Wiborg, Ove

    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...

  19. 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....

  20. 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

    report on its anatomical effects. We discerned no histological lesions in the brains of higher mammals subjected to electroconvulsive shock (ECS) or MST, under conditions that model closely those used in humans. We sought to extend these findings by determining whether these interventions affected...... the number of neurons or glia in the frontal cortex or hippocampus. Twenty-four animals received 6 weeks of ECS, MST, or anesthesia alone, 4 days per week. After perfusion fixation, numbers of neurons and glia in frontal cortex and hippocampus were determined by unbiased stereological methods. We found...... no effect of either intervention on volumes or total number or numerical density of neurons or glia in hippocampus, frontal cortex, or subregions of these structures. Induction of seizures in a rigorous model of human ECT and MST therapy does not cause a change in the number of neurons or glia...

  1. Aminophylline increases seizure length during electroconvulsive therapy.

    Science.gov (United States)

    Stern, L; Dannon, P N; Hirschmann, S; Schriber, S; Amytal, D; Dolberg, O T; Grunhaus, L

    1999-12-01

    Electroconvulsive therapy (ECT) is considered to be one of the most effective treatments for patients with major depression and persistent psychosis. Seizure characteristics probably determine the therapeutic effect of ECT; as a consequence, short seizures are accepted as one of the factors of poor outcome. During most ECT courses seizure threshold increases and seizure duration decreases. Methylxanthine preparations, caffeine, and theophylline have been used to prolong seizure duration. The use of aminophylline, more readily available than caffeine, has not been well documented. The objective of this study was to test the effects of aminophylline on seizure length. Fourteen drug-free patients with diagnoses of affective disorder or psychotic episode receiving ECT participated in this study. Seizure length was assessed clinically and per EEG. Statistical comparisons were done using paired t tests. A significant increase (p < 0.04) in seizure length was achieved and maintained on three subsequent treatments with aminophylline. No adverse events were noted from the addition of aminophylline.

  2. The origins of electroconvulsive therapy in denmark.

    Science.gov (United States)

    Kragh, Jesper Vaczy

    2009-12-01

    In recent years, the history of electroconvulsive therapy (ECT) has received renewed attention from historical researchers, who have published thorough monographs and articles on the subject of ECT. In these studies, however, one of the important events in the history of ECT has been overlooked: the lectures by Cerletti and Bini at the Third International Neurological Congress in Copenhagen. The lectures at the congress were the first presentation of ECT before a large international audience and became the impetus to the first Danish ECT trials. The first part of this article outlines the events of the neurological congress in 1939 and provides a translation of the paper presented by Bini at the congress. In the last part of the article, the history of ECT in Denmark is summarized.

  3. 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.

  4. Cognitive and Neurophysiological Recovery Following Electroconvulsive Therapy: A Study Protocol

    Directory of Open Access Journals (Sweden)

    Ben J. A. Palanca

    2018-05-01

    Full Text Available Electroconvulsive therapy (ECT employs the elective induction of generalizes seizures as a potent treatment for severe psychiatric illness. As such, ECT provides an opportunity to rigorously study the recovery of consciousness, reconstitution of cognition, and electroencephalographic (EEG activity following seizures. Fifteen patients with major depressive disorder refractory to pharmacologic therapy will be enrolled (Clinicaltrials.gov, NCT02761330. Adequate seizure duration will be confirmed following right unilateral ECT under etomidate anesthesia. Patients will then undergo randomization for the order in which they will receive three sequential treatments: etomidate + ECT, ketamine + ECT, and ketamine + sham ECT. Sessions will be repeated in the same sequence for a total of six treatments. Before each session, sensorimotor speed, working memory, and executive function will be assessed through a standardized cognitive test battery. After each treatment, the return of purposeful responsiveness to verbal command will be determined. At this point, serial cognitive assessments will begin using the same standardized test battery. The presence of delirium and changes in depression severity will also be ascertained. Sixty-four channel EEG will be acquired throughout baseline, ictal, and postictal epochs. Mixed-effects models will correlate the trajectories of cognitive recovery, clinical outcomes, and EEG metrics over time. This innovative research design will answer whether: (1 time to return of responsiveness will be prolonged with ketamine + ECT compared with ketamine + sham ECT; (2 time of restoration to baseline function in each cognitive domain will take longer after ketamine + ECT than after ketamine + sham ECT; (3 postictal delirium is associated with delayed restoration of baseline function in all cognitive domains; and (4 the sequence of reconstitution of cognitive domains following the three treatments in this study is similar to that

  5. Pulseless electrical activity during electroconvulsive therapy: a case report

    Directory of Open Access Journals (Sweden)

    Kalava Arun

    2012-05-01

    Full Text Available Abstract Background Arrhythmias resulting in cardiac arrest during electroconvulsive therapy have been reported. Most reported cases of cardiac arrest had asystole as the initial rhythm. Pulseless electrical activity as an initial rhythm of cardiac arrest during electroconvulsive therapy has never been reported. Also, thromboembolism after inflation of pneumatic tourniquet during lower limb surgery has been reported but never following tourniquet inflation during an electroconvulsive therapy. Case presentation We report a case involving an 81- year- old female who presented to us for an electroconvulsive therapy for severe depression and developed pulseless electrical activity immediately after electroconvulsive therapy. She was successfully resuscitated and was later found to have bilateral pulmonary emboli with a complete occlusion of the right lower lobe pulmonary artery. The source of embolus was from her left lower extremity deep venous thrombus, which we believe, got dislodged intraoperatively after inflation of pneumatic tourniquet. Our patient not only survived the massive pulmonary embolus, but also showed significant improvement in her mental status compared to her pre-admission level at the time of discharge to a sub-acute rehabilitation centre. Conclusion We recommend that patients who are elderly and at high risk of thromboembolism should selectively undergo a preoperative doppler ultrasound for deep venous thrombosis. Also, selective application of tourniquet in the upper limb, to monitor for seizure activity, would reduce the incidence of pulmonary thrombo-embolism as embolic events are significantly less from deep venous thromboses of upper extremities when compared to lower extremities.

  6. Electroconvulsive Therapy in Schizophrenia in China: A National Survey.

    Science.gov (United States)

    Li, Qian; Su, Yun-Ai; Xiang, Yu-Tao; Shu, Liang; Yu, Xin; Ungvari, Gabor S; Seiner, Stephen J; Chiu, Helen F K; Ning, Yu-Ping; Wang, Gao-Hua; Zhang, Ke-Rang; Li, Tao; Sun, Li-Zhong; Shi, Jian-Guo; Chen, Xian-Sheng; Mei, Qi-Yi; Li, Ke-Qing; Si, Tian-Mei

    2017-06-01

    Little is known about electroconvulsive therapy (ECT) use in the treatment of schizophrenia in China. This study examined the frequency of ECT use, its trend between 2006 and 2012, and its independent demographic and clinical correlates in a nationwide survey in China. A total of 5162 inpatients in 45 Chinese psychiatric hospitals/centers were interviewed (2696 in 2006 and 2466 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Electroconvulsive therapy was used in 6.1% of the whole sample; 4.7% in 2006 and 7.7% in 2012 (P Electroconvulsive therapy for schizophrenia has increased between 2006 and 2012 in China. Its percentage was higher than the figures reported in most other countries. Reasons for the substantial variations in the frequency of ECT across different provinces in China require further investigations.

  7. 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.

  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. 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.

  10. Electroconvulsive therapy-induced Wolff-Parkinson-White syndrome: a case report.

    Science.gov (United States)

    Enomoto, Shingo; Yoshino, Aihide; Takase, Bonpei; Kuwahara, Tatsuro; Tatsuzawa, Yasutaka; Nomura, Soichiro

    2013-01-01

    Wolff-Parkinson-White (WPW) syndrome is characterized by premature ventricular excitation due to the presence of an abnormal accessory pathway. Electrocardiography (ECG) of patients with WPW syndrome portrays a short PR interval and a wide QRS interval with a delta wave. Herein, we report the case of a patient with schizophrenia who developed a wide QRS interval with a delta wave immediately following electroconvulsive therapy (ECT). Initially, the delta wave disappeared within 2 days after ECT. However, the duration of the delta wave increased exponentially to 4 months when ECT was repeated. Although the patient's cardiocirculatory dynamics remained normal, we continued to monitor her ECG until the delta wave disappeared because WPW syndrome can lead to serious arrhythmia. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. 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.

  12. 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

  13. Electroconvulsive therapy for lycanthropy and Cotard syndrome: a case report.

    Science.gov (United States)

    Grover, Sandeep; Shah, Ruchita; Ghosh, Abhishek

    2010-12-01

    We present a case of psychotic depression presenting with lycanthropy (being converted to a pig) and Cotard syndrome simultaneously and treated with electroconvulsive therapy. A 37-year-old female patient developed psychotic depression after a stressor (a possibility of having a malignancy). As her depression worsened, she developed delusional belief of self being metamorphosed to a pig and her children also being metamorphosed into pig. In addition, she had the delusional belief that her own body and body of her children was rotting away. She was treated with electroconvulsive therapy along with venlafaxine and olanzapine, with which she improved completely.

  14. Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses.

    Science.gov (United States)

    Elias, Alby; Phutane, Vivek H; Clarke, Sandy; Prudic, Joan

    2018-05-01

    Acute course of electroconvulsive therapy is effective in inducing remission from depression, but recurrence rate is unacceptably high following termination of electroconvulsive therapy despite continued pharmacotherapy. Continuation electroconvulsive therapy and maintenance electroconvulsive therapy have been studied for their efficacy in preventing relapse and recurrence of depression. The purpose of this meta-analysis was to examine the efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy in preventing relapse and recurrence of depression in comparison to antidepressant pharmacotherapy alone. We searched MEDLINE, Embase, PsycINFO, clinicaltrials.gov and Cochrane register of controlled trials from the database inception to December 2016 without restriction on language or publication status for randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. Two independent Cochrane reviewers extracted the data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. The risk of bias was assessed using four domains of the Cochrane Collaboration Risk of Bias Tool. Outcomes were pooled using random effect model. The primary outcome was relapse or recurrence of depression. Five studies involving 436 patients were included in the meta-analysis. Analysis of the pooled data showed that continuation electroconvulsive therapy and maintenance electroconvulsive therapy, both with pharmacotherapy, were associated with significantly fewer relapses and recurrences than pharmacotherapy alone at 6 months and 1 year after a successful acute course of electroconvulsive therapy (risk ratio = 0.64, 95% confidence interval = [0.41, 0.98], p = 0.04, risk ratio = 0.46, 95% confidence interval = [0.21, 0.98], p = 0.05, respectively). There was insufficient data to perform a meta-analysis of stand

  15. 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

  16. Electroconvulsive therapy's mechanism of action: neuroendocrine hypotheses.

    Science.gov (United States)

    Haskett, Roger F

    2014-06-01

    Despite a range of etiological theories since the introduction of electroconvulsive therapy (ECT) more than 75 years ago, its mechanism of action remains poorly understood. The neuroendocrine hypothesis is based on the seizure-related release of hypothalamic hormones into the blood and cerebrospinal fluid and evidence of endocrine dysfunction in many patients with severe mood disorder. The specific effect of ECT was hypothesized to result from the transverse passage of current through the brain with direct stimulation of axial structures including the diencephalon. The prompt release of adrenocorticotropic hormone, cortisol, and prolactin into blood followed ECT with a return to pretreatment baseline levels in several hours. The elevated levels of hormones were absorbed by the cerebrospinal fluid, providing contact with brain cells and central nervous system structures. An apparently specific pattern of ECT-induced hormone changes, limited to prolactin and cortisol, suggested that ECT released a substance with dopaminergic antagonist and antipsychotic properties. As hypothalamic dysfunction is a key finding in endogenomorphic depression and the abnormal endocrine and physiological functions usually normalize with recovery, this led to a search for biological markers that would supplement clinical assessment of diagnosis and treatment response. One of these, the overnight dexamethasone suppression test found that 40% to 50% of melancholic depressed patients had abnormal results, whereas 90% of control patients suppressed normally. This was followed by a period of uncritical overenthusiasm followed by wholesale rejection of the clinical neuroendocrine strategies. Several key methodological issues received inadequate attention, and there have been calls to revisit this topic.

  17. [Use of electroconvulsive therapy in the adolescent].

    Science.gov (United States)

    Cohen, D; Dubos, P F; Basquin, M

    1997-01-01

    Despite the progress of pharmocotherapy, electroconvulsive therapy (ECT) is still used in a majority of countries to treat severe intractable mental disorders of the youth, yet few studies have been conducted to assess its use for individuals under 20-year-old. Efficacy, indications, side effects, technical characteristics and outcome are uncertain. A review of the 96 cases reported in the literature shows that: 1) its average frequency in adolescent psychiatric practice is similar throughout western nations and can be estimated around one ECT every year per million people; 2) intractable mood disorders, both manic and depressive episodes, are its main indications, since ECT treated more than 90% of the 66 cases reported; ECT can also offer an interesting alternative in some schizoaffective and schizophrenic episodes, in particular catatonic ones; 3) tolerance appears to be good, although secondary effects may occur. The most serious ones are infrequent spontaneous seizures and more common memory loss. Although no prospective studies are available on the evolution of cognitive side effects, they seem to disappear within a few weeks.

  18. 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.

  19. A case of Todd's Palsy following unilateral electroconvulsive therapy

    Science.gov (United States)

    Bell, Christine; Lepping, Peter; Clifford, John; Gardner-Thorpe, Catherine

    2012-01-01

    This case describes a woman undergoing unilateral electroconvulsive therapy (ECT) who developed a Todd's Palsy following the treatment, and which resolved when converted to bilateral ECT. We go on to hypothesize that this rare side effect may be an indication of the need to switch laterality during a course of ECT. PMID:22988330

  20. Achieving Competency in Electroconvulsive Therapy: A Model Curriculum

    Science.gov (United States)

    Dolenc, Tamara J.; Philbrick, Kemuel L.

    2007-01-01

    Objective: This article illustrates a model electroconvulsive therapy (ECT) curriculum with specific parameters of both practice-based learning and medical knowledge. Method: The authors review the recommendations of the APA Task Force on ECT as they relate to training in ECT in psychiatry residency programs, and discuss diverse educational…

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

    African Journals Online (AJOL)

    ... in pharmacotherapy, electroconvulsive therapy is an effective treatment strategy in ... Behavioral Sciences Research Center, Noor University Hospital,. Ostandari Street .... side effects of ECT such as cognitive impairment to the degree that the .... adolescents with mood disorders: patients' and parents' attitude. Psychiatry ...

  2. Patient with intractable delirium successfully treated with electroconvulsive therapy

    DEFF Research Database (Denmark)

    Lindgren, Eske; Hageman, Ida

    2014-01-01

    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...

  3. 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.

  4. 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…

  5. Thiopental is better than propofol for electroconvulsive therapy.

    Science.gov (United States)

    Nuzzi, Massimiliano; Delmonte, Dario; Barbini, Barbara; Pasin, Laura; Sottocorna, Ornella; Casiraghi, Giuseppina Maria; Colombo, Cristina; Landoni, Giovanni; Zangrillo, Alberto

    2018-01-16

    electroconvulsive therapy is a psychiatric procedure requiring general anesthesia. The choice of the hypnotic agent is important because the success of the intervention is associated to the occurrence and duration of motor convulsion. However, all available anesthetic agents have anti-convulsant activity. We compared the effect of thiopental and propofol on seizures. We designed a retrospective study at Mood Disorders Unit of a teaching Hospital. Fifty-six consecutive patients undergoing electroconvulsive therapy were enrolled. Patients received fentanyl followed by either thiopental or propofol. We evaluated the incidence and the duration of seizure after electric stimulus at the first session of electroconvulsive therapy for each patient. Adverse perioperative effects were recorded. Patients were 60±12.1 years old and 64% was female. There was a statistically significant higher number of patients who had motor convulsion activity in the thiopental group when compared to the propofol group (25 vs 13, p=0.023). Seizure duration was statistically significant longer in the thiopental group than in the propofol group (35 sec vs 11 sec, p=0.046). No hemodynamic instability, oxygen desaturation episodes, prolonged recovery time from anesthesia and adverse effects related to anesthesia were recorded. Thiopental induction has a favourable effect on seizure when compared to propofol in patients undergoing electroconvulsive therapy.

  6. Electroconvulsive Therapy: A Primer for Mental Health Counselors.

    Science.gov (United States)

    Leinbaugh, Tracy C.

    2001-01-01

    Electroconvulsive therapy is the treatment of choice for severe depressive episodes. Although little definitive research exists to explain its effectiveness, since its development in 1938 it has proven effective for the treatment of depression with psychotic features and suicidal ideation. Explains the procedure and discusses implications for the…

  7. Multifactorial Determinants of the Neurocognitive Effects of Electroconvulsive Therapy

    OpenAIRE

    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 af...

  8. Does Electroconvulsive therapy aggravate the rise in potassium and ...

    African Journals Online (AJOL)

    Background: Potassium and creatine kinase levels increase after the administration of suxamethonium. This rise may be exaggerated by the combination of suxamethonium fasciculation and the modified tonic/clonic convulsion induced by electroconvulsive therapy. This study compared the magnitude of increase in ...

  9. SUCCESSFUL TREATMENT OF OBSESSIVE-COMPULSIVE DISORDER WITH ELECTROCONVULSIVE THERAPY

    OpenAIRE

    Kishimoto, Toshifumi; Ikawa, Genro

    1995-01-01

    Two men with obsessive-compulsive disorder showed abnormal behaviors including agitation and aggression without evidence of depression. They responded to electroconvulsive therapy (ECT) following failure of drug treatments. Further investigation of the utility of ECT in treating drug refractory obsessive-compulsive disorder is indicated.

  10. The use of electroconvulsive therapy in the treatment of psychiatric ...

    African Journals Online (AJOL)

    Out of 1816 patients admitted to Umzimkulu Hospital between 1976 and 1982, 378 (20,8%) received electroconvulsive therapy (ECT) in combination with drugs. The use of ECT at this hospital is described and comparisons are made between ECT and non-ECT patients using length of stay in hospital as the criterion ...

  11. Update on electroconvulsive therapy dosing strategies : review article

    African Journals Online (AJOL)

    Electroconvulsive Therapy (ECT) remains a controversial treatment modality, with a wide range of clinical practice and application. Recently significant advances in the technique of application of ECT have been made. These new approaches incorporate a variety of advances in ECT dosing strategies and techniques, ...

  12. 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

  13. A meta-analysis of electroconvulsive therapy efficacy in depression

    NARCIS (Netherlands)

    Kho, King Han; van Vreeswijk, Michiel Floris; Simpson, Steve; Zwinderman, Aeilko H.

    2003-01-01

    Recently published controlled studies comparing electroconvulsive therapy (ECT) with other treatments for depression offer the opportunity to perform a meta-analysis of ECT in depression. Fifteen studies were identified which fulfilled the inclusion criteria. From these controlled trials, 20 effect

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

    African Journals Online (AJOL)

    Objective: To evaluate the effectiveness of electroconvulsive therapy in the treatment of Bipolar I Disorder patients with a single manic episode. Method: In a retrospective study, we reviewed medical records of inpatients who had been admitted to treat a single manic episode of Bipolar I Disorder at Noor University Hospital, ...

  15. 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.

  16. Caffeine Sodium Benzoate for Electroconvulsive Therapy Augmentation.

    Science.gov (United States)

    Bozymski, Kevin M; Potter, Teresa G; Venkatachalam, Vasu; Pandurangi, Ananda K; Crouse, Ericka L

    2018-05-15

    Because of an ongoing manufacturer shortage of injectable caffeine sodium benzoate (CSB), patients at our health system were given CSB compounded in-house to increase seizure response during electroconvulsive therapy (ECT). Therefore, we aimed to evaluate its effectiveness and safety as an ECT augmentation agent. Medical records of patients who received compounded CSB at Virginia Commonwealth University Health System were reviewed to identify adults receiving it as part of an index ECT treatment course between June 2012 and December 2016. The primary outcome was change in electroencephalogram seizure duration from pre-caffeine session to initial caffeine session. Data were also collected on demographics, motor seizure duration, maximum heart rate, mean arterial pressure, and concurrent medication use for these sessions and the last caffeine session. Seven-one patients were included in the study, predominantly white females with a mean age of 58.6 years. The most common indication for ECT was major depressive disorder resistant to pharmacotherapy (71.8%), followed by catatonia associated with another mental disorder (19.7%). Electroencephalogram seizure duration increased by 24.1 seconds on average with first CSB use (P < 0.0001), allowing 24 more patients overall to achieve goal of at least 30 seconds (P < 0.0001). No clinically significant changes in maximum heart rate or mean arterial pressure were observed, nor did any patients require an abortive agent for prolonged seizure. Five patients (7%) discontinued CSB prematurely: 4 related to adverse effects and 1 secondary to ineffectiveness. We confirm results of prior studies of the utility of CSB and add that compounded CSB is effective for ECT augmentation, maintaining effectiveness throughout the index course with minimal safety concerns.

  17. Improvement of cycloid psychosis following electroconvulsive therapy.

    Science.gov (United States)

    Holm, Jonas; Brus, Ole; Båve, Ullvi; Landen, Mikael; Lundberg, Johan; Nordanskog, Pia; von Knorring, Lars; Nordenskjöld, Axel

    2017-08-01

    The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness. The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome. Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n = 42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test. The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p < 0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p = 0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p = 0.31). None of the other investigated potential predictors was statistically significantly associated with outcome. ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies. The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.

  18. Subjective Memory Immediately Following Electroconvulsive Therapy.

    Science.gov (United States)

    Brus, Ole; Nordanskog, Pia; Båve, Ullvi; Cao, Yang; Hammar, Åsa; Landén, Mikael; Lundberg, Johan; Nordenskjöld, Axel

    2017-06-01

    The aims of the present study were to describe the short-term rate of subjective memory worsening (SMW) and identify factors of importance for SMW in a large clinical sample treated for depression with electroconvulsive therapy (ECT). This register-based study included 1212 patients from the Swedish National Quality Register for ECT. Subjective memory worsening was defined as a 2-point worsening on the memory item of the Comprehensive Psychopathological Rating Scale from before to within 1 week after treatment. Associations between patient characteristics and treatment factors were examined using logistic regression. Subjective memory worsening was experienced in 26%. It was more common in women than in men (31% vs 18%; P < 0.001) and more common in patients aged 18 to 39 years than in patients 65 years or older (32% vs 22%; P = 0.008). Patients with less subjective memory disturbances before ECT had a greater risk of SMW. Patients in remission after ECT had a lower risk of SMW. A brief pulse width stimulus gave higher risk of SMW compared with ultrabrief pulse (odds ratio, 1.61; 95% confidence interval, 1.05-2.47). Subjective memory worsening is reported by a minority of patients. However, young women are at risk of experiencing SMW. Ultrabrief pulse width stimulus could be considered for patients treated with unilateral electrode placement who experience SMW. Each patient should be monitored with regard to symptoms and adverse effects, and treatment should be adjusted on an individual basis to maximize the clinical effect and with efforts to minimize the cognitive adverse effects.

  19. 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

  20. 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.

  1. 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.

  2. The hippocampus in patients treated with electroconvulsive therapy: a proton magnetic resonance spectroscopic imaging study.

    Science.gov (United States)

    Ende, G; Braus, D F; Walter, S; Weber-Fahr, W; Henn, F A

    2000-10-01

    We monitored the effect of electroconvulsive therapy (ECT) on the nuclear magnetic resonance-detectable metabolites N-acetylaspartate, creatine and phosphocreatine, and choline-containing compounds in the hippocampus by means of hydrogen 1 magnetic resonance spectroscopic imaging. We hypothesized that if ECT-induced memory deterioration was associated with neuronal loss in the hippocampus, the N-acetylaspartate signal would decrease after ECT and any increased membrane turnover would result in an increase in the signal from choline-containing compounds. Seventeen patients received complete courses of ECT, during which repeated proton magnetic resonance spectroscopic imaging studies of the hippocampal region were performed. Individual changes during the course of ECT were compared with values obtained in 24 healthy control subjects and 6 patients remitted from major depression without ECT. No changes in the hippocampal N-acetylaspartate signals were detected after ECT. A significant mean increase of 16% of the signal from choline-containing compounds after 5 or more ECT treatments was observed. Despite the mostly unilateral ECT application (14 of 17 patients), the increase in the choline-containing compound signal was observed bilaterally. Lactate or elevated lipid signals were not detected. All patients showed clinical amelioration of depression after ECT. Electroconvulsive therapy is not likely to induce hippocampal atrophy or cell death, which would be reflected by a decrease in the N-acetylaspartate signal. Compared with an age-matched control group, the choline-containing compounds signal in patients with a major depressive episode was significantly lower than normal, before ECT and normalized during ECT.

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

    DEFF Research Database (Denmark)

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

    2018-01-01

    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 for exist......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...... the shortest seizures, etomidate and ketamine the longest. Etomidate and ketamine+propofol 1 : 1 seems to yield the seizures with best quality. Seizure quality is improved when induction of ECT is delayed until the effect of the anaesthetic has waned - possibly monitored with BIS values. Manual...

  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. Neuropsychological effects and attitudes in patients following electroconvulsive therapy

    OpenAIRE

    Feliu, Miriam; Edwards, Christopher L; Sudhakar, Shiv; McDougald, Camela; Raynor, Renee; Johnson, Stephanie; Byrd, Goldie; Whitfield, Keith; Jonassaint, Charles; Romero, Heather; Edwards, Lekisha; Wellington, Chante?; Hill, LaBarron K; Sollers, James; Logue, Patrick E

    2008-01-01

    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...

  7. ELECTROCONVULSIVE THERAPY EXPERIENCES AT NARA MEDICAL UNIVERSITY HOSPITAL

    OpenAIRE

    Kishimoto, Toshifumi; Ueda, Atsushi; Noriyama, Yoshinobu; Nagai, Toshiya; Hirayama, Tomohide; Kirita, Ikuhiro; Hata, Kazuya; Ikawa, Genro

    1995-01-01

    We surveyed the clinical electroconvulsive therapy (ECT) treatment expe- riences between 1987 and 1992 at Nara Medical University Hospital. ECT is restrictedly applied to severely ill patients who have no response to other somatic therapies. For 5 years, 43 cases were treated with ECT, of which 27 suffered from depressive disorders, 3 from schizophrenia, 3 from somatoform disorders, and 10 from anxiety disorders. ECT was selected by psychiatrists for severe depressive states after failure of ...

  8. On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

    OpenAIRE

    Nordanskog, Pia

    2015-01-01

    Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive. The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically ...

  9. Knowledge, experience & attitudes concerning electroconvulsive therapy among patients & their relatives

    OpenAIRE

    Rajagopal, R.; Chakrabarti, S.; Grover, S.; Khehra, N.

    2012-01-01

    Background & objectives: Electroconvulsive therapy (ECT) is used frequently in developing countries, but investigations of patients’ awareness and perception of ECT are rare. The present study thus attempted a comprehensive examination of knowledge, experience and attitudes concerning ECT among patients treated with brief-pulse, bilateral, modified ECT, and their relatives. Methods: Of the 153 recipients of ECT, 77 patients and relatives were eventually assessed using questionnaires designed ...

  10. Electroconvulsive therapy stimulus titration: Not all it seems.

    Science.gov (United States)

    Rosenman, Stephen J

    2018-05-01

    To examine the provenance and implications of seizure threshold titration in electroconvulsive therapy. Titration of seizure threshold has become a virtual standard for electroconvulsive therapy. It is justified as individualisation and optimisation of the balance between efficacy and unwanted effects. Present day threshold estimation is significantly different from the 1960 studies of Cronholm and Ottosson that are its usual justification. The present form of threshold estimation is unstable and too uncertain for valid optimisation or individualisation of dose. Threshold stimulation (lowest dose that produces a seizure) has proven therapeutically ineffective, and the multiples applied to threshold to attain efficacy have never been properly investigated or standardised. The therapeutic outcomes of threshold estimation (or its multiples) have not been separated from simple dose effects. Threshold estimation does not optimise dose due to its own uncertainties and the different short-term and long-term cognitive and memory effects. Potential harms of titration have not been examined. Seizure threshold titration in electroconvulsive therapy is not a proven technique of dose optimisation. It is widely held and practiced; its benefit and harmlessness assumed but unproven. It is a prematurely settled answer to an unsettled question that discourages further enquiry. It is an example of how practices, assumed scientific, enter medicine by obscure paths.

  11. Deployment Repeatability

    Science.gov (United States)

    2016-04-01

    evaluating the deployment repeatability builds upon the testing or analysis of deployment kinematics (Chapter 6) and adds repetition. Introduction...material yield or failure during a test. For the purposes of this chapter, zero shift will refer to permanent changes in the structure, while reversible ...the content of other chapters in this book: Gravity Compensation (Chapter 4) and Deployment Kinematics and Dynamics (Chapter 6). Repeating the

  12. Pick-up ion energization at the termination shock

    Energy Technology Data Exchange (ETDEWEB)

    Gary, S Peter [Los Alamos National Laboratory; Winske, Dan [Los Alamos National Laboratory; Wu, Pin [BOSTON UNIV.; Schwadron, N A [BOSTON UNIV.

    2009-01-01

    One-dimensional hybrid simulations are used to investigate how pickup ions are energized at the perpendicular termination shock. Contrary to previous models based on pickup ion energy gain by repeated crossings of the shock front (shock surfing) or due to a reforming shock front, the present simulations show that pickup ion energy gain involves a gyro-phasedependent interaction with the inhomogeneous motional electric field at the shock. The process operates at all relative concentrations of pickup ion density.

  13. 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.

  14. 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.

  15. Labetalol does not lengthen asystole during electroconvulsive therapy.

    Science.gov (United States)

    Dannon, P N; Iancu, I; Hirschmann, S; Ross, P; Dolberg, O T; Grunhaus, L

    1998-12-01

    Labetalol, a combined alpha- and beta-adrenergic blocker is often used to attenuate the transient increases in heart rate and blood pressure that accompany electroconvulsive therapy (ECT). It has been suggested that labetalol should not be administered during ECT without the protection provided by anticholinergic medications, because of its potential severe bradycardic effects. We present our experience with 32 patients from all age groups who received labetalol without anticholinergic treatment during ECT. None of the patients demonstrated adverse bradycardic effects. We conclude that administration of labetalol during ECT does not routinely require premedication with anticholinergic drugs and does not lengthen asystole.

  16. Electroconvulsive therapy in patients taking monoamine oxidase inhibitors.

    Science.gov (United States)

    Dolenc, Tamara J; Habl, Samar S; Barnes, Roxann D; Rasmussen, Keith G

    2004-12-01

    Concerns have been expressed regarding the use of general anesthesia for electroconvulsive therapy (ECT) in patients taking monoamine oxidase inhibitors (MAOIs). We review the published literature and present 4 new cases and conclude that there is no evidence of a dangerous interaction between ECT and MAOI use. In general, a cautious approach would be to discontinue MAOIs before ECT if the medication has not been helpful; however, there is no need for a washout interval before starting ECT. Furthermore, if there is otherwise a reason for continuing the MAOI, it can be continued during index ECT or initiated during maintenance ECT.

  17. 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. © 2013 Elsevier B.V. All rights reserved.

  18. The Treatment of Clozapine-Withdrawal Delirium with Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    Anish Modak

    2017-01-01

    Full Text Available Clozapine, a commonly used atypical antipsychotic, can precipitate a severe withdrawal syndrome. In this report, we describe a case of delirium with catatonic features emerging after the immediate cessation of clozapine subsequent to concerns of developing neuroleptic malignant syndrome. After multiple treatments were found to be inefficacious, electroconvulsive therapy (ECT was initiated, resulting in significant improvement. A literature search revealed six previous cases of clozapine-withdrawal syndromes of varied symptomatology treated with ECT. To our knowledge, the present case represents the first reported clozapine-withdrawal delirium treated successfully with ECT.

  19. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression.

    Science.gov (United States)

    Nordanskog, P; Larsson, M R; Larsson, E-M; Johanson, A

    2014-04-01

    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. 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. 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. The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome. © 2013 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

  20. Anterograde Amnesia during Electroconvulsive Therapy: A Prospective Pilot-Study in Patients with Major Depressive Disorder.

    Directory of Open Access Journals (Sweden)

    Elvira Boere

    Full Text Available Electroconvulsive therapy (ECT is considered an effective treatment for major depression with melancholic features. However, neurocognitive side-effects such as anterograde amnesia still regularly occur. The present study aims to evaluate the severity and course of anterograde amnesia in severely depressed patients undergoing ECT. In a prospective naturalistic study, anterograde memory function was assessed among inpatients who underwent ECT (n = 11. Subjects met DSM-IV criteria for major depressive disorder. Recruitment took place between March 2010-March 2011 and March 2012-March 2013. Controls treated with antidepressants (n = 9 were matched for age, gender and depression severity. Primary outcome measure was immediate recall; secondary outcome measures were delayed recall, recognition, and visual association. Differences were tested using repeated measures ANOVA and paired t-tests. Correlations with hypothesized covariates were calculated. In patients with major depressive disorder, ECT had a significant effect on delayed memory function (p<0.01 with large effect sizes. Findings on immediate recall were less consistent. Four weeks after treatment discontinuation, these memory functions had recovered. Age was identified as a very important covariate. The main limitations of our study are its naturalistic design, possibly compromising internal validity, and its small sample size. However, if these findings can be reproduced in a more comprehensive study group, then the possible induction of anterograde amnesia is not a justifiable reason for clinicians to disregard ECT as a treatment option.

  1. Repeating Marx

    DEFF Research Database (Denmark)

    Fuchs, Christian; Monticelli, Lara

    2018-01-01

    This introduction sets out the context of the special issue “Karl Marx @ 200: Debating Capitalism & Perspectives for the Future of Radical Theory”, which was published on the occasion of Marx’s bicentenary on 5 May 2018. First, we give a brief overview of contemporary capitalism’s development...... and its crises. Second, we argue that it is important to repeat Marx today. Third, we reflect on lessons learned from 200 years of struggles for alternatives to capitalism. Fourth, we give an overview of the contributions in this special issue. Taken together, the contributions in this special issue show...... that Marx’s theory and politics remain key inspirations for understanding exploitation and domination in 21st-century society and for struggles that aim to overcome these phenomena and establishing a just and fair society. We need to repeat Marx today....

  2. Shock absorber

    International Nuclear Information System (INIS)

    Nemeth, J.D.

    1981-01-01

    A shock absorber for the support of piping and components in a nuclear power plant is described. It combines a high degree of stiffness under sudden shocks, e.g. seismic disturbances, with the ability to allow for thermal expansion without resistance when so required. (JIW)

  3. 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

  4. Deployment Repeatability

    Science.gov (United States)

    2016-08-31

    large cohort of trials to spot unusual cases. However, deployment repeatability is inherently a nonlinear phenomenon, which makes modeling difficult...and GEMS tip position were both tracked during ground testing by a laser target tracking system. Earlier SAILMAST testing in 2005 [8] used...recalls the strategy used by SRTM, where a constellation of lights was installed at the tip of the boom and a modified star tracker was used to track tip

  5. Volume of the human hippocampus and clinical response following electroconvulsive therapy

    DEFF Research Database (Denmark)

    Oltedal, Leif; Narr, Katherine L.; Abbott, Christopher

    2018-01-01

    Background: Hippocampal enlargements are commonly reported following electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. Methods...

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

    NARCIS (Netherlands)

    Kroes, Marijn C. W.; Tendolkar, Indira; van Wingen, Guido A.; van Waarde, Jeroen A.; Strange, Bryan A.; Fernández, Guillén

    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

  7. Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia--an open label study

    NARCIS (Netherlands)

    Kho, K. H.; Blansjaar, B. A.; de Vries, S.; Babuskova, D.; Zwinderman, A. H.; Linszen, D. H.

    2004-01-01

    OBJECTIVE: This open label study describes the efficacy of electroconvulsive therapy (ECT) as adjunctive treatment in clozapine nonresponders suffering from schizophrenia. METHOD: The results of clozapine and ECT treatment in 11 clozapine nonresponders suffering from schizophrenia are reported in

  8. Electroconvulsive seizures (ECS) do not prevent LPS-induced behavioral alterations and microglial activation

    NARCIS (Netherlands)

    van Buel, E. M.; Bosker, F. J.; van Drunen, J.; Strijker, J.; Douwenga, W.; Klein, H. C.; Eisel, U. L. M.

    2015-01-01

    Background: Long-term neuroimmune activation is a common finding in major depressive disorder (MDD). Literature suggests a dual effect of electroconvulsive therapy (ECT), a highly effective treatment strategy for MDD, on neuroimmune parameters: while ECT acutely increases inflammatory parameters,

  9. White Matter Hyperintensities and Cognitive Impairment During Electroconvulsive Therapy in Severely Depressed Elderly Patients

    NARCIS (Netherlands)

    Oudega, M.L.; van Exel, E.; Wattjes, M.P.; Comijs, H.C.; Scheltens, P.; Barkhof, F.; Eikelenboom, P.; Craen, A.J.M.; Beekman, A.T.F.; Stek, M.L.

    2014-01-01

    Objective: Transient cognitive impairment during electroconvulsive therapy (ECT) can be a reason to discontinue ECT in depressed elderly patients. We hypothesized that both white matter hyperintensities and medial temporal lobe atrophy contribute to transient cognitive impairment during ECT.

  10. 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...

  11. demystifying the shock of shocking

    African Journals Online (AJOL)

    (with a pulse), atrial fibrillation and atrial flutter. The energy dose in cardioversion is less (0.5. - 2 J/kg) than in defibrillation (2 - 4 J/kg). In cardioversion the shock is discharged synchronously with the native R wave of the patient. Without synchronisation,. VF can be induced if a shock is delivered during the refractory period ...

  12. 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.

  13. 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.

  14. Toxoplasmosis infection and cognitive deficit after electroconvulsive treatment (ECT), is there a connection?

    OpenAIRE

    Berg, John Erik

    2012-01-01

    Electroconvulsive treatment (ECT) has developed over 70 years to a modern, effective way of lifting depressive moods. Memory loss and visual acuity after electroconvulsive treatment is the only remaining relevant criticism of the treatment modality when considering the overall rate of remission from this treatment compared to all other treatment modalities. A depressive state impedes memory, and memory improves on several qualities of cognition after treatment. However, the comparison of a pe...

  15. Catatonia in dementia managed with electroconvulsive therapy: A case report and review of the evidence

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2017-01-01

    Full Text Available There is limited literature on catatonia as a presenting manifestation of dementia. Further, whenever catatonia occurs in patients with dementia, it often responds to lorazepam. There is limited literature on use of electroconvulsive therapy for management of catatonia among patients with dementia. In this report, we present a case of catatonia occurring during dementia of Lewy body which did not respond to lorazepam but responded to use of electroconvulsive therapy.

  16. ELECTROCONVULSIVE THERAPY EFFECTS ON COGNITION AND MEMORY AND NURSE’S ROLE

    OpenAIRE

    Stergiopoulou, Antonia

    2016-01-01

    Background: Electroconvulsive therapy (ECT) is brain stimulation with a short controlled series of electrical pulses co-administered with intravenous anesthesia. Aims: The aim of this review is the evaluation of electroconvulsive effect as a first and second choice psychiatric treatment associated with memory impairment effects. Method: A literature review search took place between 1989 to 2014, concerning aspects and reports of ECT. Results: Specifically 27 studies were selected and in nine ...

  17. Hypovolemic shock

    Science.gov (United States)

    ... the person's position unless they are in immediate danger. Do not give fluids by mouth. If person ... the patient with shock. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  18. 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; Wörtwein, Gitta

    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...

  19. Shock absorber

    International Nuclear Information System (INIS)

    Housman, J.J.

    1978-01-01

    A shock absorber is described for use in a hostile environment at the end of a blind passage for absorbing impact loads. The shock absorber includes at least one element which occupies the passage and which is comprised of a porous brittle material which is substantially non-degradable in the hostile environment. A void volume is provided in the element to enable the element to absorb a predetermined level of energy upon being crushed due to impact loading

  20. 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

  1. Oral Health in Electroconvulsive Therapy: A Neglected Topic.

    Science.gov (United States)

    Muzyka, Brian C; Glass, Magdalena; Glass, Oliver M

    2017-03-01

    Psychiatric medications may have serious and untoward adverse effects such as blurred vision, restlessness, agranulocytosis, muscle rigidity, and tremors. When compared to medications, electroconvulsive therapy (ECT) is becoming a more acceptable treatment due to its efficacy, tolerability, and minimal adverse effect profile. Oral trauma can be an ECT-related adverse effect. We reviewed the published literature on oral health and dental protection in patients undergoing ECT, and found that there are deficits in all guidelines on dental protection during ECT. Dental assessment and treatment before and after ECT is warranted. Given the increased risk of poor oral health in psychiatric patients, and the continued evolution of ECT as a mainstay treatment, it is important that studies be conducted to determine the optimal method of oral protection. If adequate care can be ensured, the risks of ECT-induced oral trauma will be minimized.

  2. New-onset dissociative disorder after electroconvulsive therapy.

    Science.gov (United States)

    Zaidner, Eduardo; Sewell, R Andrew; Murray, Evan; Schiller, Allen; Price, Bruce H; Cunningham, Miles G

    2010-09-01

    Electroconvulsive therapy (ECT) is an exceptionally effective treatment for a number of psychiatric conditions; however, a common adverse effect is temporary cognitive impairment, especially memory loss. The dissociative disorders also involve disturbances of memory, as well as consciousness and personal identity, but are rarely iatrogenic. We report a case in which dissociative symptoms developed after ECT. A 51-year-old woman with hypothyroidism, migraine headaches, bipolar disorder, and anorexia by history was admitted for worsening depression with suicidal ideation. After a course of 7 right-sided ECT treatments, she experienced remarkable personality change, claiming that it was 1976 and behaving as though she was 30 years younger. Neuropsychological tests were normal, and her memory and former personality spontaneously returned 2 weeks later. This case illustrates that such events may be seen in patients with certain psychiatric profiles, and further studies are needed to determine the risk factors for the occurrence of dissociative episodes after ECT.

  3. The influence of cognitive reserve on memory following electroconvulsive therapy.

    Science.gov (United States)

    Legendre, Susan A; Stern, Robert A; Solomon, David A; Furman, Martin J; Smith, Kristin E

    2003-01-01

    Cognitive reserve (CR) theory proposes that certain genetic and nonacquired variables, such as larger head size and greater neuronal density, and some life experiences, such as higher educational and occupational attainment, provide a buffer against brain dysfunction in the face of acquired central nervous system (CNS) dysfunction. This study examined CR in the pseudoexperimental paradigm of electroconvulsive therapy (ECT). Subjects included fifty (N = 50) depressed patients treated with bilateral ECT. Subjects were placed in high (n = 27) or low (n = 23) CR groups based on years of education and occupational attainment. At baseline, no significant differences were observed between the groups in the amount of information forgotten on a verbal memory measure (Randt stories) after a 30-minute delay. Following three ECT treatments, however, the high CR group forgot significantly less information after a 30-minute delay, as compared to the low CR group (p memory loss in ECT.

  4. Electroconvulsive therapy and memory loss: a personal journey.

    Science.gov (United States)

    Donahue, A B

    2000-06-01

    The cause for the significant gap between research and anecdotal evidence regarding the extent of some memory loss after electroconvulsive therapy (ECT) has never been adequately explained. A patient's development of awareness and self-education about her severe side effects from ECT raises questions regarding many current assumptions about memory loss. ECT-specific studies, which conclude that side effects are short term and narrow in scope, have serious limitations, including the fact that they do not take into account broader scientific knowledge about memory function. Because of the potential for devastating and permanent memory loss with ECT, informed consent needs significant enhancement until advancing research on both improved techniques and on better predictive knowledge regarding memory loss progresses to making a greater impact on clinical applications. Follow-up care and education in coping skills need to be a regular part of ECT practice when patients do experience severe effects.

  5. The Use of Electroconvulsive Therapy in Atypical Psychotic Presentations

    Science.gov (United States)

    Vasu, Devi

    2007-01-01

    Convulsive therapy and its progeny, electroconvulsive therapy (ECT), were originally used for the treatment of catatonic schizophrenia, and there is little doubt that ECT remains an effective intervention for the treatment of schizophrenia. However, current practice tends to favor the use of ECT in severe or treatment refractory affective disorders, and its use in schizophrenia and other nonaffective (atypical) psychotic disorders has become controversial. Case reports have suggested a role for ECT in two specific atypical psychotic disorders: Cotard's syndrome and cycloid psychosis. In this article, we review the atypical psychotic disorders and report a series of five case examples that signify the role of ECT in atypical psychotic presentations, particularly when the symptoms resemble those found in Cotard's syndrome and cycloid psychosis. PMID:20428309

  6. [Successful electroconvulsive therapy of Cotard syndrome with bitemporal hypoperfusion].

    Science.gov (United States)

    Lohmann, T; Nishimura, K; Sabri, O; Klosterkötter, J

    1996-05-01

    A case study is presented to illustrate a rare condition described by Cotard as "délire de négation". The central symptom is a nihilistic delusion with denial of one's own existence of oneself and that of the external world. In the present case, the syndrome became manifest as an escalation of a recurrent depressive disorder late in life. After initial resistance to therapy, the syndrome was successfully treated with electroconvulsive therapy. For the first time, we report the regional cerebral blood flow measured by 99mTc-HMPAO-SPECT before and after therapy. Before treatment, significant bitemporal hypoperfusion relative to the cerebellum was found, which was no longer demonstrable on remission.

  7. 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

  8. 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

  9. 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

  10. Glycopyrrolate prevents extreme bradycardia and cerebral deoxygenation during electroconvulsive therapy

    DEFF Research Database (Denmark)

    Rasmussen, Peter; Andersson, John-Erik; Koch, Palle

    2007-01-01

    The stimulation phase of electroconvulsive therapy (ECT) induces bradycardia. We evaluated the effect of this bradycardia on cerebral perfusion and oxygenation by administration of the anticholinergic drug glycopyrrolate (Glp). Cerebral perfusion was estimated by transcranial ultrasound......) during the stimulation phase of ECT (P cerebral artery V(mean) decreased 43% (9%-71%; P ....8) to 0.0 (-4.2 to 0.8) microM (P stimulation phase of ECT, maintaining HR at 78 (40-94) beats min(-1), MCA V(mean) at 53 (37-77) cm s(-1), and O(2)Hb at 5.6 (10.6-38.5) microM (P cerebral perfusion...

  11. Electroconvulsive Therapy in Functional Hallucination: Scope and Challenges

    Directory of Open Access Journals (Sweden)

    Sulochana Joshi

    2017-01-01

    Full Text Available Functional hallucinations are hallucinations triggered by a stimulus in the same modality and cooccur with it. They are rare in occurrence; however, their rarity has no significance as psychopathology till date. Also, very little is known about the treatment of such hallucinations. Electroconvulsive therapy (ECT has been tested for several psychiatric illnesses and has a few relative contraindications; however, it has not previously been used in treating functional hallucinations. We report on a female patient with paranoid schizophrenia who experienced functional hallucinations continuously despite the use of adequate risperidone, which controlled other symptoms. She was treated with ECT which resolved the functional hallucinations. The case highlights the need to ponder on the significance of the phenomenon as well as treatment of this psychopathology by ECT. It also underscores ECT as a treatment option for this kind of hallucination.

  12. Electroconvulsive therapy for obsessive-compulsive disorder: a systematic review.

    Science.gov (United States)

    Fontenelle, Leonardo F; Coutinho, Evandro S F; Lins-Martins, Natália M; Fitzgerald, Paul B; Fujiwara, Hironobo; Yücel, Murat

    2015-07-01

    Surgical therapies for treatment-refractory obsessive-compulsive disorder (OCD), such as deep brain stimulation or psychosurgery, remain unattainable for many patients. Despite the long-held view that electroconvulsive therapy (ECT) is an ineffective treatment for OCD, there is no systematic review to support or refute this claim, which is the basis of the current review. A systematic search of MEDLINE, Web of Science, Scopus, and LILACS databases was conducted on December 22, 2013, using the terms obsessive-compulsive disorder and electroconvulsive therapy. Reference lists, specific journals, and clinical trial registries were also scrutinized. No date or language limitation was imposed on the search. After irrelevant and redundant records from the 500 identified titles were excluded, the 50 articles reporting the acute treatment effects of ECT in OCD and related constructs (involving a total of 279 patients) were analyzed for this study. The relevant sociodemographic, clinical, and outcome data of individual cases were extracted. Data from individual cases were used to compare the characteristics of responders versus nonresponders to ECT. Most selected records were case reports/series; there were no randomized controlled trials. A positive response was reported in 60.4% of the 265 cases in which individual responses to ECT were available. ECT responders exhibited a significantly later onset of OCD symptoms (P = .003), were more frequently nondepressed (P = .009), more commonly reported being treated with ECT for severe OCD (P = .01), and received a fewer number of ECT sessions (P = .03). ECT responders were also less frequently previously treated with adequate trials of serotonin reuptake inhibitors (P = .05) and cognitive-behavioral therapy (P = .005). Although 60% of the reported cases reviewed exhibited some form of a positive response to ECT, it cannot be stated that this provides evidence that ECT is indeed effective for OCD. © Copyright 2015 Physicians

  13. 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.

  14. 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.

  15. Diaphragmless shock wave generators for industrial applications of shock waves

    Science.gov (United States)

    Hariharan, M. S.; Janardhanraj, S.; Saravanan, S.; Jagadeesh, G.

    2011-06-01

    The prime focus of this study is to design a 50 mm internal diameter diaphragmless shock tube that can be used in an industrial facility for repeated loading of shock waves. The instantaneous rise in pressure and temperature of a medium can be used in a variety of industrial applications. We designed, fabricated and tested three different shock wave generators of which one system employs a highly elastic rubber membrane and the other systems use a fast acting pneumatic valve instead of conventional metal diaphragms. The valve opening speed is obtained with the help of a high speed camera. For shock generation systems with a pneumatic cylinder, it ranges from 0.325 to 1.15 m/s while it is around 8.3 m/s for the rubber membrane. Experiments are conducted using the three diaphragmless systems and the results obtained are analyzed carefully to obtain a relation between the opening speed of the valve and the amount of gas that is actually utilized in the generation of the shock wave for each system. The rubber membrane is not suitable for industrial applications because it needs to be replaced regularly and cannot withstand high driver pressures. The maximum shock Mach number obtained using the new diaphragmless system that uses the pneumatic valve is 2.125 ± 0.2%. This system shows much promise for automation in an industrial environment.

  16. Toxic shock syndrome

    Science.gov (United States)

    Staphylococcal toxic shock syndrome; Toxic shock-like syndrome; TSLS ... Toxic shock syndrome is caused by a toxin produced by some types of staphylococcus bacteria. A similar problem, called toxic shock- ...

  17. A Case of Treatment- resistant Depression and Body Dysmorphic Disorder: The Role of Electroconvulsive Therapy Revisited.

    Science.gov (United States)

    Mahato, Ram S; San Gabriel, Maria Chona P; Longshore, Carrol T; Schnur, David B

    2016-01-01

    Body dysmorphic disorder is a common, often disabling condition, and is frequently comorbid with major depressive disorder. Selective serotonin reuptake inhibitors constitute first line set of somatic interventions but the management of refractory patients remains challenging. Electroconvulsive therapy, an often highly beneficial treatment for medication resistant-depression, is not considered an effective therapeutic alternative for treatment refractory body dysmorphic disorder. Here we present a 50-year-old woman with body dysmorphic disorder and comorbid major depressive disorder who remained incapacitated and suicidal despite several trials with selective serotonin reuptake inhibitors and antipsychotic medication. Depressive and dysmorphic symptoms appeared to resolve with electroconvulsive therapy, and remission was sustained for two months. Electroconvulsive therapy has an important place in the management of treatment- resistant depression associated with body dysmorphic disorder, and, in select cases, may be effective for dysmorphic symptoms as well.

  18. Maintenance electroconvulsive therapy for depression with catatonia in a young woman with Down syndrome.

    Science.gov (United States)

    Torr, Jennifer; D'Abrera, Juan Carlos

    2014-12-01

    To describe and discuss the use of maintenance electroconvulsive therapy (ECT) in a young woman with Down syndrome and depression with catatonia. Clinical case report. A 23-year-old woman with Down syndrome (mosaic type) and a 4-year history of depressed mood triggered by adverse life events presented with mutism, psychomotor retardation, and compromised oral intake. Multiple trials of antidepressant medications were either ineffective or complicated by adverse reactions. She improved rapidly with a course of bilateral ECT but required maintenance ECT to sustain recovery. A series of premorbid, morbid, and post-treatment drawings by the young woman highlight the efficacy of treatment. Electroconvulsive therapy was found to be a safe and effective treatment for life-threatening mental illness in a young woman with Down syndrome who had failed multiple trials of antidepressant medications. This case highlights the importance of considering catatonia as a diagnosis in persons with Down syndrome and the effectiveness of electroconvulsive treatment.

  19. 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.

  20. Effects of electroconvulsive seizures on depression-related behavior, memory and neurochemical changes in Wistar and Wistar-Kyoto rats.

    Science.gov (United States)

    Kyeremanteng, C; MacKay, J C; James, J S; Kent, P; Cayer, C; Anisman, H; Merali, Z

    2014-10-03

    Investigations in healthy outbred rat strains have shown a potential role for brain-derived neurotrophic factor (BDNF) and the hypothalamic-pituitary-adrenal (HPA) axis in the antidepressant and memory side effects of electroconvulsive therapy (ECT, or ECS in animals). The Wistar-Kyoto (WKY) rat strain is used as a genetic model of depression yet no studies to date have directly compared the impact of ECS on the WKY strain to its healthy outbred control (Wistar). The objective of this study is to examine behavioral (antidepressant and retrograde memory) and neurochemical (BDNF and HPA axis) changes immediately (1day) and at a longer delay (7days) after repeated ECS (5 daily administrations) in WKY and Wistar rats. Male Wistar and WKY rats received 5days of repeated ECS or sham treatment and were assessed 1 and 7days later for 1) depression-like behavior and mobility; 2) retrograde memory; and 3) brain BDNF protein, brain corticotropin-releasing factor (CRF) and plasma corticosterone levels. Both strains showed the expected antidepressant response and retrograde memory impairments at 1day following ECS, which were sustained at 7days. In addition, at 1day after ECS, Wistar and WKY rats showed similar elevations in brain BDNF and extra-hypothalamic CRF and no change in plasma corticosterone. At 7days after ECS, Wistar rats showed sustained elevations of brain BDNF and CRF, whereas WKY rats showed a normalization of brain BDNF, despite sustained elevations of brain CRF. The model of 5 daily ECS was effective at eliciting behavioral and neurochemical changes in both strains. A temporal association was observed between brain CRF levels, but not BDNF, and measures of antidepressant effectiveness of ECS and retrograde memory impairments suggesting that extra-hypothalamic CRF may be a potential important contributor to these behavioral effects after repeated ECS/ECT. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Public attitudes towards electroconvulsive therapy in the Chuvash Republic.

    Science.gov (United States)

    Golenkov, Andrei; Ungvari, Gabor S; Gazdag, Gábor

    2012-05-01

    Public attitudes towards a given medical procedure can have a significant influence on the employment of that method. Electroconvulsive therapy (ECT) is a medical procedure that has received an exceptionally ambiguous public reception since its inception. To survey the level of information about and attitudes towards ECT in a general population sample of the Chuvash Republic of the Russian Federation. A randomly selected cohort of 5,373 people was contacted by telephone. The respondents were asked three closed and three open questions. The response rate was 74.7%. Only 35.2% of those interviewed said they knew anything about ECT. Health professionals and younger respondents were better informed. The two main sources of information about ECT were foreign films and the mass media. The main indication of ECT was thought to be schizophrenia. The majority (63.3%) of the respondents had negative opinions and emotions about ECT. Limited information about and generally negative attitudes towards ECT were found in the general population of the Chuvash Republic. Gender, age, education level, employment in the health industry, and information source were found to be the determining factors in the knowledge of and attitudes towards ECT.

  2. 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

  3. Retrograde amnesia after electroconvulsive therapy: a temporary effect?

    Science.gov (United States)

    Meeter, Martijn; Murre, Jaap M J; Janssen, Steve M J; Birkenhager, Tom; van den Broek, W W

    2011-07-01

    Although electroconvulsive therapy (ECT) is generally considered effective against depression, it remains controversial because of its association with retrograde memory loss. Here, we assessed memory after ECT in circumstances most likely to yield strong retrograde amnesia. A cohort of patients undergoing ECT for major depression was tested before and after ECT, and again at 3-months follow-up. Included were 21 patients scheduled to undergo bilateral ECT for severe major depression and 135 controls matched for gender, age, education, and media consumption. Two memory tests were used: a verbal learning test to assess anterograde memory function, and a remote memory test that assessed memory for news during the course of one year. Before ECT the patients' scores were lower than those of controls. They were lower again after treatment, suggesting retrograde amnesia. At follow-up, however, memory for events before treatment had returned to the pre-ECT level. Memory for events in the months after treatment was as good as that of controls. The sample size in this study was not large. Moreover, memory impairment did not correlate with level of depression, which may be due to restriction of range. Our results are consistent with the possibility that ECT as currently practiced does not cause significant lasting retrograde amnesia, but that amnesia is mostly temporary and related to the period of impairment immediately following ECT. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. 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

  5. Electroconvulsive therapy regulates emotional memory bias of depressed patients.

    Science.gov (United States)

    Bai, Tongjian; Xie, Wen; Wei, Qiang; Chen, Yang; Mu, Jingjing; Tian, Yanghua; Wang, Kai

    2017-11-01

    Emotional memory bias is considered to be an important base of the etiology of depression and can be reversed by antidepressants via enhancing the memory for positive stimuli. Another antidepressant treatment, electroconvulsive therapy (ECT), has rapid antidepressant effect and frequently causes short-term memory impairment. However, it is unclear about the short-term effect of ECT on memory bias. In this study, the incidental memory task with emotional pictures were applied to evaluate the emotional memory of twenty depressed patients at pre- and post-ECT (three days after ECT) compared to twenty healthy controls. The depressive symptoms were evaluated using the Hamilton rating scale of depression (HRSD). Before ECT, patients showed decreased recognition memory for positive pictures compared to controls and remembered negative pictures more easily than positive pictures in the recognition task. In patients, the main effect of session (pre-ECT and post-ECT) was significant for both recognition and recall memory with reduced memory performance. The interaction between valence (positive, neutral and negative) and session was significant for recognition memory, indicating that negative memory was impaired more severely than positive memory. Our study indicates that ECT relieves depressive symptoms and regulates emotional memory through more severe impairment on memory for negative stimuli. Copyright © 2017. Published by Elsevier B.V.

  6. [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.

  7. State of the art: nursing knowledge and electroconvulsive therapy.

    Science.gov (United States)

    Froimson, L; Creed, P; Mathew, L

    1995-09-01

    Nursing services attempting to develop standards for their own facilities will find limited literature specific to nursing and electroconvulsive therapy (ECT) in American publications. From 1966 to December 1994, there were only 19 publications in American nursing journals that provide a specific focus on nursing and ECT. Only one of these articles reported research findings. Twenty-seven citations in Convulsive Therapy included nurse contributors. While the APA Task Force on the Practice of ECT has addressed educational needs of nursing and technical elements of the procedure, there do not currently exist specific standards for nursing practice in ECT. Concerns salient to nursing that have generated articles by nurses include instruction of patients, support to patients and families, safety of patients, assessment of clinical status, informed consent, and nurses' and patients' attitudes about ECT. Nurses are encouraged to join their physician-colleagues in developing and disseminating the information needed for the field of nursing to contribute its own expertise to the care of patients receiving ECT.

  8. A systematic review of left unilateral electroconvulsive therapy.

    Science.gov (United States)

    Kellner, C H; Farber, K G; Chen, X R; Mehrotra, A; Zipursky, G D N

    2017-08-01

    To systematically review the published clinical trials, case series, and case reports on left unilateral (LUL) electrode placement for clinical electroconvulsive therapy (ECT). PubMed, Ovid Medline, and the Cochrane Library were searched for articles concerning LUL ECT. Number of patients, efficacy, and cognitive outcomes were extracted from the papers that met our inclusion criteria. A total of 52 articles were included in this review, consisting of 33 clinical trials, seven case series, and 12 case reports. Overall, the efficacy of LUL electrode placement for the treatment of depression and psychosis is similar to that of right unilateral (RUL) and bilateral (BL) electrode placements. Patients receiving LUL ECT tend to experience more verbal memory impairment than patients receiving RUL ECT, but less verbal impairment than patients receiving BL ECT. In contrast, patients receiving LUL ECT tended to experience the least visual and nonverbal memory impairment, compared to patients receiving RUL or BL ECT. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. 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

  10. 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

  11. 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

  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. 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.

  14. Electroconvulsive therapy in the elderly: Anesthetic considerations and Psychotropic interactions

    Directory of Open Access Journals (Sweden)

    Harsh Garekar

    2017-01-01

    Full Text Available Electroconvulsive therapy (ECT has been found to be a rapid and effective treatment strategy for psychiatric and neurological conditions in the elderly, but the administration of ECT in the elderly can be challenging due to a high risk of adverse events. The increased risk can be attributed to a declined physiological reserve, the presence of physical comorbidities, and the use of multiple drugs, which interact with the electrical stimulus and the anesthetic medications used during the ECT procedure. The selection of appropriate induction agents and muscle relaxants should be guided by patient's clinical status and the psychotropic drugs being used. Modifications in the doses of psychotropic drugs also need to be carried out before ECT to reduce cardiovascular and neurological side effects. Modification in the conduct of anesthesia can also aid in augmenting seizures and in preventing common side effects of ECT. A vital step in preventing adverse events in the elderly is carrying out a thorough pre.ECT evaluation. Despite these challenges, ECT can be carried out safely in elderly patients with severe comorbidities, provided clinical ECT, and anesthetic parameters are adequately optimized.

  15. 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.

  16. Serum lipid profile changes after successful treatment with electroconvulsive therapy in major depression: A prospective pilot trial.

    Science.gov (United States)

    Aksay, Suna Su; Bumb, Jan Malte; Janke, Christoph; Biemann, Ronald; Borucki, Katrin; Lederbogen, Florian; Deuschle, Michael; Sartorius, Alexander; Kranaster, Laura

    2016-01-01

    Cholesterol is reduced in depressed patients, however, these patients have a higher risk for cardiovascular diseases. Electroconvulsive therapy (ECT) is a highly effective treatment option for specific forms of depression. Like for other non-pharmacological therapies targeting depression such as psychotherapy or sleep deprivation, there is a lack of evidence about the effects on peripheral lipid parameters. Our objective was to study the impact of ECT as a non-pharmacological treatment on the peripheral lipid pattern in depressive patients. Peripheral lipid profile composition before and after a course of ECT was analysed in 27 non-fasting inpatients at a university psychiatric hospital with DSM-IV major depressive episode. For the impact of ECT treatment on each lipid parameter a multivariate repeated measurement regression analysis was performed and computed separately for every dependent variable. Total Cholesterol and the cholesterol subtypes HDL and LDL were increased after the treatment compared to baseline. Apolipoprotein A1 was also increased after ECT, whereas apolipoprotein B was not. Indices for the prediction of cardiovascular diseases were unchanged after successful treatment by ECT. The reduction of depressive psychopathology negatively correlated with increases of HDL cholesterol and apolipoprotein A1. Subjects received several antidepressants and other psychotropic medication before and during the ECT. In our preliminary pilot study ECT as a non-pharmacological, effective treatment of depression led to distinct effects on the peripheral lipid pattern. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Patients' perspectives on electroconvulsive therapy: a reevaluation of the review by Rose et al on memory loss after electroconvulsive therapy.

    Science.gov (United States)

    Bergsholm, Per

    2012-03-01

    In 2003, based on a review of 7 studies, Rose et al concluded that at least one third of patients report significant memory loss 6 months or more after electroconvulsive therapy (ECT). However, few details on the included studies were given. The present study evaluates factors that may have influenced the results. The 7 studies were scrutinized as to the 6-month assessment criterion, whether the data represent ECT-treated patients in general, specification and significance of the memory loss, stimulus type, and electrode placement. In 3 studies, the 6-month inclusion criterion was not met, including 1 study with 98% satisfied patients and 1 study with only 37% valid response rate. Two other studies selected individuals from user/advocacy groups generally biased against ECT and were probably overlapping. The significance of memory problems was not mentioned in any of the studies. Two studies reported that 30% and 55% of patients treated with bilateral ECT in the 1970s felt they had persistent memory gaps around the time of treatment, but the long-obsolete sine wave stimulus type was used. The results mostly concerned bilateral ECT, whereas unilateral ECT seemed to cause little complaints. Data used by Rose et al are severely flawed, making their results inconclusive and misleading.

  18. Treatment of Adults With Treatment-Resistant Depression: Electroconvulsive Therapy Plus Antidepressant or Electroconvulsive Therapy Alone? Evidence From an Indirect Comparison Meta-Analysis

    OpenAIRE

    Song, Guo-Min; Tian, Xu; Shuai, Ting; Yi, Li-Juan; Zeng, Zi; Liu, Shuang; Zhou, Jian-Guo; Wang, Yan

    2015-01-01

    Abstract Electroconvulsive therapy (ECT) and antidepressant are the effective treatment alternatives for patients with treatment-resistant depression (TRD); however, the effects and safety of the ECT plus antidepressant relative to ECT alone remain controversial. We decide to assess the potential of ECT plus antidepressant compared with ECT alone by undertaking an indirect comparison meta-analysis. Databases from PubMed, ISI Web of Science, CENTRAL, Clinicaltrials.gov, EMBASE, CBM (China Biom...

  19. Shock Prevention

    Science.gov (United States)

    1978-01-01

    The electrician pictured is installing a General Electric Ground Fault Interrupter (GFI), a device which provides protection against electrical shock in the home or in industrial facilities. Shocks due to defective wiring in home appliances or other electrical equipment can cause severe burns, even death. As a result, the National Electrical Code now requires GFIs in all new homes constructed. This particular type of GFI employs a sensing element which derives from technology acquired in space projects by SCI Systems, Inc., Huntsville, Alabama, producer of sensors for GE and other manufacturers of GFI equipment. The sensor is based on the company's experience in developing miniaturized circuitry for space telemetry and other spacecraft electrical systems; this experience enabled SCI to package interruptor circuitry in the extremely limited space available and to produce sensory devices at practicable cost. The tiny sensor measures the strength of the electrical current and detects current differentials that indicate a fault in the functioning of an electrical system. The sensing element then triggers a signal to a disconnect mechanism in the GFI, which cuts off the current in the faulty circuit.

  20. Electroconvulsive therapy in a pediatric patient with malignant catatonia and paraneoplastic limbic encephalitis.

    Science.gov (United States)

    Lee, Andrew; Glick, David B; Dinwiddie, Stephen H

    2006-12-01

    Paraneoplastic limbic encephalitis is a rare disorder that can cause memory loss, confusion, personality change, cognitive dysfunction, and psychosis. We present a case of an 11-year-old girl who was successfully treated with electroconvulsive therapy for a catatonic state associated with paraneoplastic limbic encephalitis caused by an ovarian teratoma.

  1. Prediction of electroconvulsive therapy response and remission in major depression: Meta-analysis

    NARCIS (Netherlands)

    Van Diermen, L. (Linda); Van Den Ameele, S. (Seline); A.M. Kamperman (Astrid); Sabbe, B.C.G. (Bernard C.G.); Vermeulen, T. (Tom); Schrijvers, D. (Didier); T.K. Birkenhäger (Tom)

    2018-01-01

    textabstractElectroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate

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

    OpenAIRE

    Paul, Sean; Goetz, Jennifer; Bennett, Jeffrey; Korah, Tessy

    2013-01-01

    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.

  3. 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.

  4. 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...

  5. 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

  6. 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.

  7. 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...

  8. The Optical Fractionator Technique to Estimate Cell Numbers in a Rat Model of Electroconvulsive Therapy

    DEFF Research Database (Denmark)

    Olesen, Mikkel Vestergaard; Needham, Esther Kjær; Pakkenberg, Bente

    2017-01-01

    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...

  9. 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

  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

    2018-01-01

    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 esta......, the baseline binding capacity of D1 receptors predicts the magnitude of increased binding, up to a maximum binding capacity....

  11. 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.

  12. 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.

  13. Tics as signs of catatonia: electroconvulsive therapy response in 2 men.

    Science.gov (United States)

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

    2010-12-01

    Tics have rarely been described in catatonia although tics are sudden and nonrhythmic variants of stereotypic or repetitive movement abnormalities that are considered cardinal symptoms of catatonia. We describe 2 men with tics and self-injurious behavior, who met criteria for catatonia. One patient met criteria for autism. We reported 2 new cases and performed a literature review using PubMed to identify other cases of tics that were treated with electroconvulsive therapy. Tics along with other catatonic symptoms and self-injurious behavior responded to electroconvulsive therapy in 2 men. Eight other patients with tics that were treated with electroconvulsive therapy were found in the literature. Catatonia was recognized in 4 of the 8 patients. Two patients met criteria for autism. Tics, with or without self-injurious behavior, may be signs of catatonia. Patients with tics or Tourette syndrome warrant assessment for catatonia. If catatonia is present, electroconvulsive therapy provides a safe but rarely used alternative to pharmacotherapy, psychosurgery, or invasive brain stimulation in the treatment of tics and Tourette syndrome. © 2010 Lippincott Williams & Wilkins, Inc.

  14. Cognitive Effects of Electroconvulsive Therapy in Patients with Major Depressive, Bipolar and Schizophrenia Disorders

    Directory of Open Access Journals (Sweden)

    N Fouladi

    2011-10-01

    Full Text Available Background & Aim: Electroconvulsive therapy (ECT is a highly effective treatment for affective and schizophrenic disorders. The main objective of this study was to examine the cognitive effects of ECT in patients with major depressive, bipolar and schizophrenia disorders. Methods: In this study we administered a battery of cognitive tasks on 90 patients with major depressive, bipolar and schizophrenia disorders, one day before and after the termination of ECT. The effects were measured by a set of computerized cognitive tests including: auditory reaction time, visual reaction time, verbal memory, Benton visual memory, Wisconsin card sort and motor function. The collected data were analyzed using One-way ANOVA and dependent t-test. Results: The results showed that depressive patients had poorer verbal memory and motor function after the termination of ECT compared to pretest, but their executive function was improved (p<0.05. After the termination of ECT the verbal and visual memory and executive function was significantly improved in patients with bipolar and schizophrenia disorders but their motor function was significantly reduced (p<0.05. Conclusion: Results of this study showed improvement for most cognitive functions in patients after electroconvulsive therapy. Findings of this study may help patients and their families to overcome their fear of electroconvulsive therapy. The results also can aware patients regarding the cognitive effects of electroconvulsive therapy.

  15. 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

  16. Anterograde amnesia during electroconvulsive therapy: A prospective pilot-study in patients with major depressive disorder

    NARCIS (Netherlands)

    I.A. Boere (Ingrid); A.M. Kamperman (Astrid); Van't Hoog, A.E. (Arianne E.); W.W. van den Broek (Walter); T.K. Birkenhäger (Tom)

    2016-01-01

    textabstractElectroconvulsive therapy (ECT) is considered an effective treatment for major depression with melancholic features. However, neurocognitive side-effects such as anterograde amnesia still regularly occur. The present study aims to evaluate the severity and course of anterograde amnesia

  17. Electroconvulsive therapy for treating schizophrenia: a chart review of patients from two catchment areas

    DEFF Research Database (Denmark)

    Kristensen, Diana; Bauer, Jeanett; Pedersen, Ida Hageman

    2011-01-01

    To examine disease and treatment characteristics of patients with schizophrenia treated with electroconvulsive therapy (ECT). We examined charts from 79 patients diagnosed with schizophrenia (n = 55), persistent delusional disorders (n = 7), and schizoaffective disorders (n = 17) between 2003...

  18. 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

    DEFF Research Database (Denmark)

    Miskowiak, Kamilla W; Kessing, Lars V; Ott, Caroline V

    2017-01-01

    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...... 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....

  19. 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

  20. Cognitive impairment and electroconvulsive therapy in geriatric depression, what could be the role of rivastigmine? A case series

    NARCIS (Netherlands)

    van Schaik, Audrey Monica; Rhebergen, Didi; Henstra, Marieke Jantien; Kadouch, Daniel J.; van Exel, Eric; Stek, Maximilianus Lourentius

    2015-01-01

    Electroconvulsive therapy (ECT), albeit highly effective in treating depression, is frequently associated with cognitive impairment, either temporary or more persistent. Especially in older patients, who generally respond even better, serious cognitive impairment during the course of ECT may lead to

  1. The subjective experience of patients who received electroconvulsive therapy.

    Science.gov (United States)

    Koopowitz, Leslie Frank; Chur-Hansen, Anna; Reid, Sally; Blashki, Miriam

    2003-02-01

    Despite the vast amount of scientific literature available on electroconvulsive therapy (ECT), there is little qualitative focus upon the patients' subjective experience of this procedure. Using an exploratory descriptive methodology, this study aims to provide a more unique insight into what certain patients actually think of ECT. Semistructured interviews were conducted to explore eight patients' opinions and experiences of ECT. Interviews were subjected to analysis by a five-step framework approach that identified prominent themes in relation to five broad questions and in conjunction with issues raised by the subjects themselves. Eleven major themes were identified. Four of these were chosen for discussion, not only as the most prevalent themes (in terms of how frequently they were mentioned by the subjects), but also as the most striking (in regards to the intensity of emotions evoked, or their influence on their perception of ECT as a future treatment option). The four themes are fear of ECT, attribution of cognitive decline and memory loss to ECT, positive ECT experiences, and patients' suggestions. Using such a qualitative approach, the depth of the information obtained has revealed new perspectives on how patients perceive the experience of ECT. Fears reported by patients present an opportunity to address specific areas of the procedure that generate the most angst. These were closely associated with recommendations that many patients proposed throughout the interviews. Patients' perceptions of the cognitive effects of ECT do not necessarily correspond with those commonly reported in the literature on ECT. Positive experiences with ECT were more complex than simply its efficacy. There is a need for future research in order to explore and address patients' experiences of ECT.

  2. 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

  3. High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy (ECT)

    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

    2017-01-01

    Background While electroconvulsive therapy (ECT) is widely regarded as a life-saving and safe procedure, evidence regarding its effects on myocardial cell injury are sparse. The objective of this investigation was to determine incidence and magnitude of new cardiac troponin elevation after ECT using a novel high-sensitivity cardiac troponin I (hscTnI) assay. Methods This was a prospective cohort study in adult patients undergoing ECT in a single academic center (up to three ECT treatments per patient). The primary outcome was new hscTnI elevation after ECT, defined as an increase of hscTnI >100% after ECT compared to baseline with at least one value above the limit of quantification (10 ng/L). 12-lead ECG and hscTnI values were obtained prior to and 15–30 minutes after ECT; in a subset of patients an additional 2-hour hscTnI value was obtained. Results The final study population was 100 patients and a total of 245 ECT treatment sessions. Eight patients (8/100, 8%) experienced new hscTnI elevation after ECT with a cumulative incidence of 3.7% (9/245 treatments; one patient had two hscTnI elevations), two of whom had a non-ST-elevation myocardial infarction (incidence 2/245, 0.8%). Median hscTnI concentrations did not increase significantly after ECT. Tachycardia and/or elevated systolic blood pressure developed after approximately two thirds of ECT treatments. Conclusions ECT appears safe from a cardiac standpoint in a large majority of patients. A small subset of patients with pre-existing cardiovascular risk factors, however, may develop new cardiac troponin elevation after ECT, the clinical relevance of which is unclear in the absence of signs of myocardial ischemia. PMID:28166110

  4. Common Use of Electroconvulsive Therapy for Chinese Adolescent Psychiatric Patients.

    Science.gov (United States)

    Zhang, Qing-E; Wang, Zhi-Min; Sha, Sha; Ng, Chee H; Seiner, Stephen J; Welch, Charles A; Lok, Grace K I; Chow, Ines H I; Wang, Fei; Li, Lu; Xiang, Yu-Tao

    2016-12-01

    Little is known about the use of electroconvulsive therapy (ECT) for adolescent psychiatric patients in China. This study examined the frequency of ECT and the demographic and clinical correlates of adolescent psychiatric patients hospitalized in a tertiary psychiatric hospital in China. This was a retrospective chart review of 954 inpatients aged between 13 and 17 years treated over a period of 8 years (2007-2013). Sociodemographic and clinical data were collected from the electronic chart management system for discharged patients. The rate of ECT use was 42.6% in the whole sample (46.5% for patients with schizophrenia, 41.8% for major depressive disorder, 57.8% for bipolar disorders, and 23.9% for other diagnoses). Use of ECT was independently and positively associated with older age, high aggression risk at time of admission, and use of antipsychotics and antidepressants. Compared with patients with schizophrenia, those with other psychiatric diagnoses were less likely to receive ECT. The above significant correlates explained 32% of the variance of ECT use (P < 0.001). Limitations of this study included the lack of data regarding the efficacy and side effects of ECT. Furthermore, the high rate of ECT applied only to 1 setting which limits the ability to extrapolate the implications of the results to other populations. The use of ECT was exceedingly high in adolescent patients treated in a tertiary clinical centre in China. It is unlikely that such a high rate of ECT use is found across China or that such practice reflects standard of care for psychiatrically ill adolescents. The underlying reasons for the high use of ECT at this center warrant urgent investigations.

  5. 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

  6. Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

    Science.gov (United States)

    Hollingsworth, Jessa; Baliko, Beverly; McKinney, Selina; Rosenquist, Peter

    2018-04-17

    The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest

  7. 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.

  8. The Efficacy of Acute Electroconvulsive Therapy in Atypical Depression

    Science.gov (United States)

    Husain, Mustafa M.; McClintock, Shawn M.; Rush, A. John; Knapp, Rebecca G.; Fink, Max; Rummans, Teresa A.; Rasmussen, Keith; Claassen, Cynthia; Petrides, Georgios; Biggs, Melanie M.; Mueller, Martina; Sampson, Shirlene; Bailine, Samuel H.; Lisanby, Sarah H.; Kellner, Charles H.

    2013-01-01

    Objective This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT). Method Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D24) and the 30-item Inventory of Depressive Symptomatology–Self-Report (IDS-SR30). Remission was defined as at least a 60% decrease from baseline in HAM-D24 score and a total score of 10 or below on the last 2 consecutive HAM-D24 ratings. The randomized controlled trial was performed from 1997 to 2004. Results The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D24. Conclusion Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features. PMID:18278988

  9. The ''injection problem'' for quasiparallel shocks

    International Nuclear Information System (INIS)

    Zank, G. P.; Rice, W. K. M.; le Roux, J. A.; Cairns, I. H.; Webb, G. M.

    2001-01-01

    For a particle to be accelerated diffusively at a shock by the first-order Fermi acceleration mechanism, the particle must be sufficiently energetic that it can scatter across all the micro- and macrostructure of the shock, experiencing compression between the converging upstream and downstream states. This is the well-known ''injection problem.'' Here the interaction of ions with the ramp of a quasiparallel shock is investigated. Some ions incident on the shock experience specular reflection, caused either by the cross-shock electrostatic potential or by mirroring as the magnetic field is bent and compressed through the ramp. Scattering of reflected ions by self-generated and pre-existing turbulence in the region upstream of the shock then acts to trap backstreaming ions and return them to the ramp, where some experience further reflections. Such repeated reflections and scattering energize a subpopulation of ions up to energies sufficiently large that they can be diffusively shock accelerated. Two ion distributions are considered: pickup ions which are assumed to be described by a shell distribution, are thermal solar wind ions which may be described by a kappa distribution. Injection efficiencies are found analytically to be very high for pickup ions and much lower for thermal solar wind ions, suggesting that this injection mechanism, stochastic reflected ion or SRI acceleration, is a natural precursor for the acceleration of the anomalous cosmic ray component at a quasiparallel shock. While significantly less efficient, SRI acceleration is also viable for thermal solar wind ions described by a kappa distribution

  10. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study.

    Science.gov (United States)

    Grunhaus, L; Dannon, P N; Schreiber, S; Dolberg, O H; Amiaz, R; Ziv, R; Lefkifker, E

    2000-02-15

    Repetitive transcranial magnetic stimulation (rTMS), a new method for the stimulation of the central nervous system, is being proposed as a potential new treatment in patients with major depressive disorder (MDD). We tested the hypothesis that rTMS would be as effective as electroconvulsive therapy (ECT) in patients with MDD. Forty patients with MDD referred for ECT were randomly assigned to either ECT or rTMS. Repetitive transcranial magnetic stimulation was performed at 90% power of the motor threshold. The stimulation frequency was 10 Hz for either 2 sec (first eight patients) or 6 sec (final 12 patients) for 20 trains. Patients were treated for up to 20 treatment days. Electroconvulsive therapy was performed according to standard protocols. Overall patients responded best to ECT (chi(2) = 3.8, p <.05). Patients with MDD and psychosis responded significantly better to ECT (chi(2) = 9.2, p <. 01), whereas MDD patients without psychosis responded similarly to both treatments (chi(2) = 0.0, ns). The analysis of variance with repeated measures of clinical variables for the whole sample revealed significant treatment effects for both groups; however, interaction between group and treatment was seen only for the Global Assessment of Function and the Sleep assessment. When the psychosis-nonpsychosis grouping was considered, patients with psychosis responded dramatically better to ECT in all assessments, whereas those without psychosis responded similarly to both treatments. Overall ECT was a more potent treatment for patients with MDD, this being particularly evident in patients with MDD and psychosis; however, in patients with MDD without psychosis the effects of rTMS were similar to those of ECT. The results we report are encouraging and support an important role for rTMS in the treatment of severe MDD; however, additional blinded studies are needed to precisely define this role.

  11. Electro-Convulsive Therapy (ECT): an Egyptian perspective

    African Journals Online (AJOL)

    Adele

    that has stood the test of time for over six decades like ECT. ... safety of ECT in the treatment of psychiatric disorders as well as determining its ... which needs to be changed since shock and convulsion are absent when giving modified ECT.

  12. 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...

  13. Geometrical shock dynamics for magnetohydrodynamic fast shocks

    KAUST Repository

    Mostert, W.; Pullin, D. I.; Samtaney, Ravi; Wheatley, V.

    2016-01-01

    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

  14. 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

  15. 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...... 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......U-positive neurons showed time-dependent attrition of ∼40% from day 1 to 3 months, with no further decline between 3 and 12 months. ECS did not affect the number of pre-existing dentate granule neurons or the volume of the dentate granule cell layer, suggesting no damaging effect of the treatment. Finally, we found...

  16. Toxoplasmosis Infection and Cognitive Deficit after Electroconvulsive Treatment (ECT), Is There a Connection?

    Science.gov (United States)

    E Berg, John

    2012-01-01

    Electroconvulsive treatment (ECT) has developed over 70 years to a modern, effective way of lifting depressive moods. Memory loss and visual acuity after electroconvulsive treatment is the only remaining relevant criticism of the treatment modality when considering the overall rate of remission from this treatment compared to all other treatment modalities. A depressive state impedes memory, and memory improves on several qualities of cognition after treatment. However, the comparison of a person's memory ability from the months before depression started to the level after a course of ECT is never performed, for obvious reasons. Some infectious diseases are known to influence memory negatively through effects on the dopamine receptors. More specifically, former toxoplasmosis infection may be a factor. Preliminary data on titres of toxoplasma IgG may indicate a connection to the development of long-standing memory problems after ECT.

  17. Cotard's syndrome with schizophreniform disorder can be successfully treated with electroconvulsive therapy: case report

    Science.gov (United States)

    Caliyurt, Okan; Vardar, Erdal; Tuglu, Cengiz

    2004-01-01

    We report a case of Cotard's syndrome associated with psychotic symptoms. A 27-year-old man was admitted to hospital with the diagnosis of schizophreniform disorder. His presenting symptoms, which had started 1 month before hospital admission, were somatic delusions of gastrointestinal and cardiovascular malfunction and the absence of a stomach, which resulted in a decrease in weight from 75 kg to 63 kg in 1 month. Cranial computed tomographic images showed dilatation of the lateral and third ventricles, whereas magnetic resonance imaging revealed central atrophy and lateral ventricle dilatation. Single- photon emission computed tomography demonstrated left temporal, left frontal and left parietal hypoperfusion. The patient did not respond to antipsychotic therapies, but he was successfully treated with electroconvulsive therapy. This report emphasizes that Cotard's syndrome may be accompanied by lesions of the left hemisphere and that electroconvulsive therapy could be the first-line therapy in such patients with psychotic disorder. PMID:15069468

  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. 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...... of newly formed neurons in the hippocampal subgranular zone. Also estimated were the total number of neurons and the volume of the granule cell layer in adult rats subjected to chronic restraint stress and electroconvulsive stimulation either alone or in combination. We found that chronic restraint stress...

  20. 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 CO 2 and increased O 2 saturation significantly (Pelectroconvulsive therapy procedure without adding costs. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. 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.

  2. Amlodipine and the Successful Management of Post-Electroconvulsive Therapy Agitation

    OpenAIRE

    Shahriari, Ali; Khooshideh, Maryam; Sheikh, Mahdi

    2016-01-01

    Electroconvulsive therapy (ECT) is a highly effective nonpharmacologic treatment for the management of depression and some other psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness, irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to serious and severe forms requiring prompt medical intervention to protect the patient and the medical staff. In seve...

  3. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

    OpenAIRE

    Mosam Phirke; Harshal Sathe; Nilesh Shah; Sushma Sonavane; Anup Bharati; Avinash DeSousa

    2015-01-01

    Background: Electroconvulsive therapy (ECT) is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014...

  4. Studies on cellular changes and amnesia in a rat model of electroconvulsive therapy

    OpenAIRE

    Jansson, Linda

    2011-01-01

    Electroconvulsive therapy (ECT) is a well-established treatment for severe depressive disorder, but its clinical use has been limited by concerns about side effects such as memory disturbances. Despite over 70 years in clinical use, the exact mechanisms of action behind the therapeutic or adverse effects are not fully understood. Enhanced brain plasticity, including neurogenesis, angiogenesis and synaptic reorganization, has been suggested to underlie the therapeutic effects of ECT. In the cu...

  5. Prediction of electroconvulsive therapy response and remission in major depression : meta-analysis

    OpenAIRE

    Diermen, van, Linda; Ameele, van den, Seline; Kamperman, Astrid M.; Sabbe, Bernard G.C.; Vermeulen, Tom; Schrijvers, Didier; Birkenhager, Tom K.

    2018-01-01

    Abstract: Background Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. Method A meta-analysis was conducted according to t...

  6. Rocuronium-sugammadex use for electroconvulsive therapy in a hemodialysis patient: a case report

    OpenAIRE

    Kurita, Shigeaki; Moriwaki, Katsuyuki; Shiroyama, Kazuhisa; Sanuki, Mikako; Toyota, Yukari; Takebayashi, Minoru

    2016-01-01

    Background Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. Case presentation In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions fo...

  7. 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....

  8. Early effects of modern electroconvulsive therapy on subjective memory in patients with mania or depression

    OpenAIRE

    Bag, Sevda; Canbek, Ozge; Atagun, Ilhan Murat; Kutlar, Tarik Mehmet

    2016-01-01

    Context: Although electroconvulsive therapy (ECT) is considered a very effective tool for the treatment of psychiatric diseases, memory disturbances are among the most important adverse effects. Aims: This study aimed to assess prospectively early subjective memory complaints in depressive and manic patients due to bilateral, brief-pulse ECT, at different stages of the treatment, compare the associations between psychiatric diagnosis, sociodemographic characteristics, and ECT characteristics....

  9. 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.

  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. CAN MELATONIN BE EFFECTIVELY USED TO DIMINISH SIDE EFFECTS OF VARIOUS PSYCHOTROPIC DRUGS AND ELECTROCONVULSIVE THERAPY?

    Directory of Open Access Journals (Sweden)

    Roman Aleksandrovich Bekker

    2017-10-01

    Full Text Available Purpose. To study and summarize the existing evidence base for the use of melatonin as a mean to counteract or diminish the side effects of various psychotropic drugs and electroconvulsive therapy, and to provide the reader with relevant conclusions. Methodology. The authors have searched for the scientific literature regarding the use of melatonin as a mean to counteract or diminish the side effects of various psychotropic drugs and electroconvulsive therapy, using the PubMed and Google Scholar as a search tool. Then the authors thoroughly reviewed the data they found. The resulting review is presented in this article. Results. The data we have obtained from this review of the literature indicate that melatonin can be effectively used both in monotherapy and in combination with other therapeutic means in order to reduce several different side effects of psychotropic drugs and electroconvulsive therapy. Melatonin also deserves further study in this regard. The evidence base for its use in this manner is very variable in quality for different side effects. For now, the greatest evidence base exists regarding the potential effectiveness of melatonin in the prevention and treatment of drug-induced insomnia, memory and cognitive impairment, akathisia, tardive dyskinesias, and metabolic syndrome. Practical implications. The results we have obtained can be widely applied in psychiatry, neurology and addiction medicine, as well as in all those areas of general medicine, which make use of psychotropic drugs.

  12. Possible Association between Serum Matrix Metalloproteinase-9 (MMP-9) Levels and Relapse in Depressed Patients following Electroconvulsive Therapy (ECT).

    Science.gov (United States)

    Shibasaki, Chiyo; Itagaki, Kei; Abe, Hiromi; Kajitani, Naoto; Okada-Tsuchioka, Mami; Takebayashi, Minoru

    2018-03-01

    Matrix metalloproteinases are involved in neuroinflammatory processes, which could underlie depression. Serum levels of MMP-9 and MMP-2 in depressed patients are significantly altered following electroconvulsive therapy, but an association between altered matrix metalloproteinases after successful ECT and possible relapse has yet to be investigated. Serum was obtained twice, before and immediately after a course of electroconvulsive therapy, from 38 depressed patients. Serum was also collected, once, from two groups of age- and gender-matched healthy controls, 40 volunteers in each group. Possible associations between levels of matrix metalloproteinases and relapse during a 1-year follow-up period were analyzed. Excluding patients who did not respond to electroconvulsive therapy and patients lost to follow-up, data from 28 patients were evaluated. Eighteen of the patients (64.3%) relapsed within 1 year. In the group that did not relapse, serum levels of MMP-9 were significantly decreased after a course of electroconvulsive therapy, but not in the group that relapsed. No association between MMP-2 and relapse was observed. The degree of change in serum MMP-9 change could be associated with relapse following electroconvulsive therapy in depressed patients. © The Author 2017. Published by Oxford University Press on behalf of CINP.

  13. Miniature shock tube for laser driven shocks.

    Science.gov (United States)

    Busquet, Michel; Barroso, Patrice; Melse, Thierry; Bauduin, Daniel

    2010-02-01

    We describe in this paper the design of a miniature shock tube (smaller than 1 cm(3)) that can be placed in a vacuum vessel and allows transverse optical probing and longitudinal backside extreme ultraviolet emission spectroscopy in the 100-500 A range. Typical application is the study of laser launched radiative shocks, in the framework of what is called "laboratory astrophysics."

  14. Are Credit Shocks Supply or Demand Shocks?

    OpenAIRE

    Bijapur, Mohan

    2013-01-01

    This paper provides new insights into the relationship between the supply of credit and the macroeconomy. We present evidence that credit shocks constitute shocks to aggregate supply in that they have a permanent effect on output and cause inflation to rise in the short term. Our results also suggest that the effects on aggregate supply have grown stronger in recent decades.

  15. Shock absorbing structure

    International Nuclear Information System (INIS)

    Kojima, Naoki; Matsushita, Kazuo.

    1992-01-01

    Small pieces of shock absorbers are filled in a space of a shock absorbing vessel which is divided into a plurality of sections by partitioning members. These sections function to prevent excess deformation or replacement of the fillers upon occurrence of falling accident. Since the shock absorbing small pieces in the shock absorbing vessel are filled irregularly, shock absorbing characteristics such as compression strength is not varied depending on the direction, but they exhibit excellent shock absorbing performance. They surely absorb shocks exerted on a transportation vessel upon falling or the like. If existing artificial fillers such as pole rings made of metal or ceramic and cut pieces such as alumium extrusion molding products are used as the shock absorbing pieces, they have excellent fire-proofness and cold resistance since the small pieces are inflammable and do not contain water. (T.M.)

  16. Melting under shock compression

    International Nuclear Information System (INIS)

    Bennett, B.I.

    1980-10-01

    A simple model, using experimentally measured shock and particle velocities, is applied to the Lindemann melting formula to predict the density, temperature, and pressure at which a material will melt when shocked from room temperature and zero pressure initial conditions

  17. 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.

  18. Relativistic Shock Acceleration

    International Nuclear Information System (INIS)

    Duffy, P.; Downes, T.P.; Gallant, Y.A.; Kirk, J.G.

    1999-01-01

    In this paper we briefly review the basic theory of shock waves in relativistic hydrodynamics and magneto-hydrodynamics, emphasising some astrophysically interesting cases. We then present an overview of the theory of particle acceleration at such shocks describing the methods used to calculate the spectral indices of energetic particles. Recent results on acceleration at ultra-relativistic shocks are discussed. (author)

  19. Response to Electroconvulsive Therapy in Patients With Autism Spectrum Disorder and Intractable Challenging Behaviors Associated With Symptoms of Catatonia.

    Science.gov (United States)

    Sajith, Sreedharan Geetha; Liew, Siew Fai; Tor, Phern Chern

    2017-03-01

    There are several reports of electroconvulsive therapy (ECT) used in autism spectrum disorder (ASD) in the context of catatonic symptoms. We describe response to ECT in two adults with ASD and intellectual disability with intractable aggression and self-injurious behaviors associated with catatonic symptoms who had not responded to standard interventions. Unilateral ECT at a frequency of 3 times a week was given followed by weekly maintenance ECT. Patients' catatonic symptoms included episodes of agitation and echophenomena. Electroconvulsive therapy resulted in significant improvement in their behavior problems but 1 patient relapsed when the ECT was discontinued or frequency of treatment reduced. The second patient required 2 courses of ECT before improvement which was maintained on weekly ECT. Electroconvulsive therapy could be a potentially beneficial intervention in patients with ASD and severe challenging behaviors associated with catatonic symptoms including agitated or excited forms of catatonia.

  20. 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.

  1. Alfven shock trains

    International Nuclear Information System (INIS)

    Malkov, M.A.; Kennel, C.F.; Wu, C.C.; Pellat, R.; Shapiro, V.D.

    1991-01-01

    The Cohen--Kulsrud--Burgers equation (CKB) is used to consider the nonlinear evolution of resistive, quasiparallel Alfven waves subject to a long-wavelength, plane-polarized, monochromatic instability. The instability saturates by nonlinear steepening, which proceeds until the periodic waveform develops an interior scale length comparable to the dissipation length; a fast or an intermediate shock then forms. The result is a periodic train of Alfven shocks of one or the other type. For propagation strictly parallel to the magnetic field, there will be two shocks per instability wavelength. Numerical integration of the time-dependent CKB equation shows that an initial, small-amplitude growing wave asymptotes to a stable, periodic stationary wave whose analytic solution specifies how the type of shock embedded in the shock train, and the amplitude and speed of the shock train, depend on the strength and phase of the instability. Waveforms observed upstream of the Earth's bowshock and cometary shocks resemble those calculated here

  2. 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.

  3. System Shock: The Archetype of Operational Shock

    Science.gov (United States)

    2017-05-25

    the battle space. They can also facilitate a much greater understanding of the variables involved in each party’s decision - making process. However...system shock nests within current US Army Unified Land Operations doctrine. In order to test the utility of system shock theory to Gray Zone...23 Neil E. Harrison, “Thinking about the World We Make ” in Chaos Theory in the Social Sciences: Foundations and Applications

  4. Revisiting the TALE repeat.

    Science.gov (United States)

    Deng, Dong; Yan, Chuangye; Wu, Jianping; Pan, Xiaojing; Yan, Nieng

    2014-04-01

    Transcription activator-like (TAL) effectors specifically bind to double stranded (ds) DNA through a central domain of tandem repeats. Each TAL effector (TALE) repeat comprises 33-35 amino acids and recognizes one specific DNA base through a highly variable residue at a fixed position in the repeat. Structural studies have revealed the molecular basis of DNA recognition by TALE repeats. Examination of the overall structure reveals that the basic building block of TALE protein, namely a helical hairpin, is one-helix shifted from the previously defined TALE motif. Here we wish to suggest a structure-based re-demarcation of the TALE repeat which starts with the residues that bind to the DNA backbone phosphate and concludes with the base-recognition hyper-variable residue. This new numbering system is consistent with the α-solenoid superfamily to which TALE belongs, and reflects the structural integrity of TAL effectors. In addition, it confers integral number of TALE repeats that matches the number of bound DNA bases. We then present fifteen crystal structures of engineered dHax3 variants in complex with target DNA molecules, which elucidate the structural basis for the recognition of bases adenine (A) and guanine (G) by reported or uncharacterized TALE codes. Finally, we analyzed the sequence-structure correlation of the amino acid residues within a TALE repeat. The structural analyses reported here may advance the mechanistic understanding of TALE proteins and facilitate the design of TALEN with improved affinity and specificity.

  5. Reconfigurable multiport EPON repeater

    Science.gov (United States)

    Oishi, Masayuki; Inohara, Ryo; Agata, Akira; Horiuchi, Yukio

    2009-11-01

    An extended reach EPON repeater is one of the solutions to effectively expand FTTH service areas. In this paper, we propose a reconfigurable multi-port EPON repeater for effective accommodation of multiple ODNs with a single OLT line card. The proposed repeater, which has multi-ports in both OLT and ODN sides, consists of TRs, BTRs with the CDR function and a reconfigurable electrical matrix switch, can accommodate multiple ODNs to a single OLT line card by controlling the connection of the matrix switch. Although conventional EPON repeaters require full OLT line cards to accommodate subscribers from the initial installation stage, the proposed repeater can dramatically reduce the number of required line cards especially when the number of subscribers is less than a half of the maximum registerable users per OLT. Numerical calculation results show that the extended reach EPON system with the proposed EPON repeater can save 17.5% of the initial installation cost compared with a conventional repeater, and can be less expensive than conventional systems up to the maximum subscribers especially when the percentage of ODNs in lightly-populated areas is higher.

  6. The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats A repetição de ondas de choque extracorpóreas e a lesão do parênquima renal em ratos normais e diabéticos

    Directory of Open Access Journals (Sweden)

    Vicente Massaji Kira

    2007-08-01

    Full Text Available PURPOSE: To assess the effect of repeated extracorporeal shock waves (ESW on renal parenchyma of normal and diabetic rats. METHODS: 40 normal rats (A and 40 diabetic rats (B were assigned for ESW (Direx Tripter X1® - 14 KVA as follow: A1/B1 and A3/B3 no ESW; A2/B2 one ESW (2,000 SW; A4/B4 two ESW (4,000 SW in an elapsed 14 days. All the animals were sacrificed 3 days after the ESW and samples of renal parenchyma were histological prepared, stained by H&E. For each animal the frequency of hemorrhage focus (HF in the subcapasular, interstitial and glomerulus area was calculated (porcentage on 20 randomly histological sections. RESULTS: No one HF was identified in all normal or diabetic animals without ESW (A1, A3 and B1, B3. In the normal rats the HF frequency was similar to one ESW (subcapsular =15%; interstitial =20% and glomerular =10% or repetead ESW (subcapsular =25%; interstitial =20%; glomerular=10%. In diabetic rats the occurence of HF with repetead ESW was more frequent (subcapsular =40%; interstitial =30% and glomerular =10% than with a single ESW (subcapsular =25%; interstitial =15% and glomerular =15%. CONCLUSION: A single ESW or a repeated ESW caused a mild and similar damage on renal cortex of normal rats. In diabetic rats the repetead ESW may result in an accumulated damage, especially with focus of hemorrhage in subcapsular and interstitial tissue and glomerulus edema.RESUMO OBJETIVO: Avaliar o efeito de repetidas ondas de choque extracorpóreas (OCE sobre o parênquima renal de ratos normais e diabéticos. MÉTODOS: 40 ratos normais e 40 ratos diabéticos foram distribuídos para aplicação de OCE (Direx Tripter X1® - 14 KVA como segue: A1/B1 e A3/B3 sem OCE; A2/B2 uma sessão de OCE (2000 OC; A4/B4 duas sessões de OC (4000 OC num intervalo de 14 dias. Todos os animais foram sacrificados no 3º. dia após a aplicação da OCE e amostras de parênquima renal foram histologicamente preparados e corados em H&E. Para cada animal

  7. Quantum repeated games revisited

    International Nuclear Information System (INIS)

    Frąckiewicz, Piotr

    2012-01-01

    We present a scheme for playing quantum repeated 2 × 2 games based on Marinatto and Weber’s approach to quantum games. As a potential application, we study the twice repeated Prisoner’s Dilemma game. We show that results not available in the classical game can be obtained when the game is played in the quantum way. Before we present our idea, we comment on the previous scheme of playing quantum repeated games proposed by Iqbal and Toor. We point out the drawbacks that make their results unacceptable. (paper)

  8. Electroconvulsive therapy modulates plasma pigment epithelium-derived factor in depression: a proteomics study.

    Science.gov (United States)

    Ryan, K M; Glaviano, A; O'Donovan, S M; Kolshus, E; Dunne, R; Kavanagh, A; Jelovac, A; Noone, M; Tucker, G M; Dunn, M J; McLoughlin, D M

    2017-03-28

    Electroconvulsive therapy (ECT) is the most effective treatment for severe depression, yet its mechanism of action is not fully understood. Peripheral blood proteomic analyses may offer insights into the molecular mechanisms of ECT. Patients with a major depressive episode were recruited as part of the EFFECT-Dep trial (enhancing the effectiveness of electroconvulsive therapy in severe depression; ISRCTN23577151) along with healthy controls. As a discovery-phase study, patient plasma pre-/post-ECT (n=30) was analyzed using 2-dimensional difference in gel electrophoresis and mass spectrometry. Identified proteins were selected for confirmation studies using immunodetection methods. Samples from a separate group of patients (pre-/post-ECT; n=57) and matched healthy controls (n=43) were then used to validate confirmed changes. Target protein mRNA levels were also assessed in rat brain and blood following electroconvulsive stimulation (ECS), the animal model of ECT. We found that ECT significantly altered 121 protein spots with 36 proteins identified by mass spectrometry. Confirmation studies identified a post-ECT increase (P<0.01) in the antiangiogenic and neuroprotective mediator pigment epithelium-derived factor (PEDF). Validation work showed an increase (P<0.001) in plasma PEDF in depressed patients compared with the controls that was further increased post-ECT (P=0.03). PEDF levels were not associated with mood scores. Chronic, but not acute, ECS increased PEDF mRNA in rat hippocampus (P=0.02) and dentate gyrus (P=0.03). This study identified alterations in blood levels of PEDF in depressed patients and further alterations following ECT, as well as in an animal model of ECT. These findings implicate PEDF in the biological response to ECT for depression.

  9. Overgeneral memory predicts stability of short-term outcome of electroconvulsive therapy for depression.

    Science.gov (United States)

    Raes, Filip; Sienaert, Pascal; Demyttenaere, Koen; Peuskens, Joseph; Williams, J Mark G; Hermans, Dirk

    2008-03-01

    To investigate the predictive value of overgeneral memory (OGM) for outcome of electroconvulsive therapy (ECT) for depression. The Autobiographical Memory Test was used to measure OGM in 25 patients with depression before ECT. The Hamilton Rating Scale for Depression (HRSD) was administered weekly to 1 week posttreatment. Overgeneral memory did not predict HRSD scores from the last ECT treatment, but did predict HRSD change scores from the last treatment to 1-week follow-up: patients high in OGM experienced a relatively greater increase in HRSD scores after the last treatment. Results further extend the status of OGM as a predictor of an unfavorable course of depression to a previously unstudied ECT population.

  10. 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....

  11. 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.

  12. Treatment of post-electroconvulsive therapy headache with topical methyl salicylate.

    Science.gov (United States)

    Logan, Christopher J; Stewart, Jonathan T

    2012-06-01

    Headache after administration of electroconvulsive therapy (ECT) is common, affecting approximately half of patients treated. Post-ECT headache is typically treated with acetaminophen or nonsteroidal anti-inflammatory drugs but occasionally requires agents such as sumatriptan, opioids, or β-blockers. We report on a patient whose severe post-ECT headaches responded completely to methyl salicylate ointment, applied to the area of his temporalis and masseter muscles. Topical methyl salicylate is generally well tolerated and may be a viable option for some patients with post-ECT headache.

  13. Preventive Effect of Liothyronine on Electroconvulsive Therapy-Induced Memory Deficit in Patients with Major Depressive Disorder: A Double-Blind Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Arash Mohagheghi

    2015-01-01

    Full Text Available Introduction and Objective. Despite the effectiveness of electroconvulsive therapy (ECT in treating major depressive disorder (MDD, its cognitive side effects make it less popular. This study investigated the impact of liothyronine on ECT-induced memory deficit in patients with MDD. Methodology. This is a double-blind clinical trial, in which 60 patients with MDD who were referred for ECT were selected. The diagnosis was based on the criteria of DSM-IV-TR. Patients were divided randomly into two groups to receive either liothyronine (50 mcg every morning or placebo. After the assessment with Wechsler Memory Scale-Revised (WMS-R before first session of ECT, posttests were repeated again, two months after the completion of ECT. Findings. By controlling the pretest scores, the mean scores of the experimental group were higher than the control group in delayed recall, verbal memory, visual memory, general memory, and attention/concentration scales (P<0.05. Conclusion. Liothyronine may prevent ECT-induced memory impairment in patients with MDD. This study has been registered in IRCT under IRCT201401122660N2.

  14. Repeat migration and disappointment.

    Science.gov (United States)

    Grant, E K; Vanderkamp, J

    1986-01-01

    This article investigates the determinants of repeat migration among the 44 regions of Canada, using information from a large micro-database which spans the period 1968 to 1971. The explanation of repeat migration probabilities is a difficult task, and this attempt is only partly successful. May of the explanatory variables are not significant, and the overall explanatory power of the equations is not high. In the area of personal characteristics, the variables related to age, sex, and marital status are generally significant and with expected signs. The distance variable has a strongly positive effect on onward move probabilities. Variables related to prior migration experience have an important impact that differs between return and onward probabilities. In particular, the occurrence of prior moves has a striking effect on the probability of onward migration. The variable representing disappointment, or relative success of the initial move, plays a significant role in explaining repeat migration probabilities. The disappointment variable represents the ratio of actural versus expected wage income in the year after the initial move, and its effect on both repeat migration probabilities is always negative and almost always highly significant. The repeat probabilities diminish after a year's stay in the destination region, but disappointment in the most recent year still has a bearing on the delayed repeat probabilities. While the quantitative impact of the disappointment variable is not large, it is difficult to draw comparisons since similar estimates are not available elsewhere.

  15. Shock timing technique for the National Ignition Facility

    International Nuclear Information System (INIS)

    Munro, David H.; Celliers, Peter M.; Collins, Gilbert W.; Gold, David M.; Silva, Luiz B. da; Haan, Steven W.; Cauble, Robert C.; Hammel, Bruce A.; Hsing, Warren W.

    2001-01-01

    Among the final shots at the Nova laser [Campbell et al., Rev. Sci. Instrum. 57, 2101 (1986)] was a series testing the VISAR (velocity interferometry system for any reflector) technique that will be the primary diagnostic for timing the shocks in a NIF (National Ignition Facility) ignition capsule. At Nova, the VISAR technique worked over the range of shock strengths and with the precision required for the NIF shock timing job--shock velocities in liquid D 2 from 12 to 65 μm/ns with better than 2% accuracy. VISAR images showed stronger shocks overtaking weaker ones, which is the basis of the plan for setting the pulse shape for the NIF ignition campaign. The technique is so precise that VISAR measurements may also play a role in certifying beam-to-beam and shot-to-shot repeatability of NIF laser pulses

  16. Episodic memory following deep brain stimulation of the ventral anterior limb of the internal capsule and electroconvulsive therapy

    NARCIS (Netherlands)

    Bergfeld, Isidoor O; Mantione, Mariska; Hoogendoorn, Mechteld L C; Horst, Ferdinand; Notten, Peter; Schuurman, P Richard; Denys, D.

    2017-01-01

    BACKGROUND: Electroconvulsive Therapy (ECT) and Deep Brain Stimulation (DBS) are effective treatments for patients with treatment-resistant depression (TRD). However, a common side effect of ECT is autobiographical memory loss (e.g., personal experiences), whereas the impact of DBS on

  17. Episodic memory following deep brain stimulation of the ventral anterior limb of the internal capsule and electroconvulsive therapy

    NARCIS (Netherlands)

    Bergfeld, Isidoor O.; Mantione, Mariska; Hoogendoorn, Mechteld L. C.; Horst, Ferdinand; Notten, Peter; Schuurman, P. Richard; Denys, Damiaan

    2017-01-01

    Background: Electroconvulsive Therapy (ECT) and Deep Brain Stimulation (DBS) are effective treatments for patients with treatment-resistant depression (TRD). However, a common side effect of ECT is autobiographical memory loss (e.g., personal experiences), whereas the impact of DBS on

  18. Decreased cognitive functioning after electroconvulsive therapy is related to increased hippocampal volume : Exploring the role of brain plasticity

    NARCIS (Netherlands)

    van Oostrom, Iris; van Eijndhoven, Philip; Butterbrod, E.; van Beek, Maria H; Janzing, Joost; Donders, Rogier; Schene, Aart; Tendolkar, Indira

    2018-01-01

    Objective:Electroconvulsive therapy (ECT) is still the most effective treatment of severe and therapy-refractory major depressive disorder. Cognitive side effects are the major disadvantage of ECT. Cognitive deficits are generally temporary in nature and may be mediated by the hippocampus. Recent

  19. 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

    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...

  20. Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study

    NARCIS (Netherlands)

    Verwijk, E.; Comijs, H.C.; Kok, R.M.; Spaans, H.P.; Tielkes, C.E.M.; Scherder, E.J.A.; Stek, M.L.

    2014-01-01

    Background: It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning

  1. Shock Analysis Method for Systematic Performance Evaluation of Component Embedded in Handheld Electronic Devices

    Directory of Open Access Journals (Sweden)

    C.S. Chin

    2006-01-01

    Full Text Available It is important to identify the robustness of product (or embedded component inside the product against shock due to free drop. With the increasing mobile and fast-paced lifestyle of the average consumer, much is required of the products; such as consumers expect mobile products to continue to operate after drop impact. Since free drop test is commonly used to evaluate the robustness of small component embedded in MP3 player, it is difficult to produce a repeatable shock reading due to highly uncontrolled orientation during the impact on ground. Hence attention has been focus on shock table testing, which produces a higher repeatable result. But it failed to demonstrate the actual shock with the presence of rotational movement due to free drop and also it suffers from a similar limitation of repeatability. From drop to drop, shock tables can vary about ± 5% in velocity change but suitable for making a consistent tracking the product improvement.

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

    NARCIS (Netherlands)

    Kho, K.H.; van Vreeswijk, M.F.; Murre, J.M.J.

    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

  3. 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

  4. The effect of electroconvulsive therapy on autobiographical memory: a systematic review.

    Science.gov (United States)

    Fraser, Louisa M; O'Carroll, Ronan E; Ebmeier, Klaus P

    2008-03-01

    In the last 20 years, an increasing number of articles have been published about effects of electroconvulsive therapy (ECT) on memory. Here, we review autobiographical memory studies in particular because there have been conflicting reports about the extent and persistence of ECT effects and the period before treatment from which memories are most likely to be affected. Five psychological and medical databases (MEDLINE, PubMed, PsychINFO, ScienceDirect, and Web of Knowledge) were searched from 1980 to 2007, yielding 15 studies of ECT and autobiographical memory. Evidence suggests that autobiographical memory impairment does occur as a result of ECT. Objective measures found memory loss to be relatively short term (6 months post-ECT). Electroconvulsive therapy predominantly affects memory of prior personal events that are near the treatment (within 6 months). Autobiographical memory loss is reduced by using brief pulse ECT rather than sine wave-unilateral positioning of electrodes rather than bilateral-and by titrating electrical current relative to the patient's own seizure threshold. Further research is required to determine memory loss associated with ECT, controlling for the direct effects of the depressive state.

  5. Electroconvulsive Therapy (ECT) and Race: A Report of ECT Use and Sociodemographic Trends in Texas.

    Science.gov (United States)

    Williams, Julie; Chiu, Lawrence; Livingston, Robin

    2017-06-01

    Minimal research on race and other sociodemographic disparities in patients receiving electroconvulsive therapy (ECT) exists. One previously noted national trend reveals whites receiving ECT disproportionately more than other races. The aim of this study is to determine whether a county ECT program demonstrates similar disparities observed at the state and national levels. This study examined 21 years of ECT data, between 1993 and 2014, provided by the Texas Department of State Health Services, focusing on race, sex, age, and payer source and 2.5 years of the same variables from a Harris County hospital ECT program. In addition, population demographic data for Harris County and the state of Texas during the same period were obtained from the Department of State Health Services Web site. Despite an overall decrease in the population of whites countywide and statewide, whites continue to use more ECT than African Americans, Latinos, and Asians in both Harris County and Texas. However, the rates of ECT use in minorities increased overall. Both countywide and statewide, ECT was used more than twice as often in women than men. Statewide, elderly patients (>65 years old) saw decreases in ECT use, and there was an increase in private third-party payer source. Electroconvulsive therapy remains underused among African Americans, Latinos, and Asians. Hypotheses and areas for future study include cultural beliefs, stigma, patient and provider knowledge of ECT, and access to care. Despite this, the general use of ECT in Texas has increased overall, and minority use is slowly on the rise.

  6. 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.

  7. A Survey of the Practice of Electroconvulsive Therapy in South Africa.

    Science.gov (United States)

    Benson-Martin, Janine J; Milligan, Peter D

    2015-12-01

    The aim of this study was to describe the contemporary practice of electroconvulsive therapy (ECT) in South Africa. A 36-item questionnaire was sent to all hospitals that practiced ECT in a 12-month period between 2011 and 2012. Forty-two institutions had an ECT machine on site, but 13 institutions reported nonuse. Electroconvulsive therapy services were available in only 6 of the 9 provinces. Questionnaires were sent to the 29 active sites. Twenty-four units (82.8%) responded, and of these, 20 institutions (68.9%) responded to question on the number of patients treated with ECT. Pre-ECT procedures commonly involved informed consent, a physical examination, and basic blood investigations. Bilateral, unilateral, and bifrontal electrode placements were used, whereas dose titration methods and seizure monitoring were used by most respondents. The number of persons treated with ECT per 10,000 persons per year was 0.22, whereas the number of ECT procedures performed per 10,000 persons per year was 1.19. The most common indication for ECT was depression, with most patients being between the ages of 18 and 59 years. The characteristics and rate of ECT utilization in South Africa have been determined and generally emulated international guidelines and trends. However, accessibility to services and aspects such as training and accreditation could be improved.

  8. 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.

  9. Hydraulic shock absorbers

    International Nuclear Information System (INIS)

    Thatcher, G.; Davidson, D. F.

    1984-01-01

    A hydraulic shock absorber of the dash pot kind for use with electrically conducting liquid such as sodium, has magnet means for electro magnetically braking a stream of liquid discharged from the cylinder. The shock absorber finds use in a liquid metal cooled nuclear reactor for arresting control rods

  10. Our Favorite Film Shocks

    DEFF Research Database (Denmark)

    Willerslev, Rane; Suhr, Christian

    2014-01-01

    The modern medium of film has long been hailed for its capacity for producing shocks of an entertaining, thought-provoking, or even politically emancipative nature. But what is a shock, how and when does it occur, how long does it last, and are there particular techniques for producing cinematic...

  11. 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

  12. The Pentapeptide Repeat Proteins

    OpenAIRE

    Vetting, Matthew W.; Hegde, Subray S.; Fajardo, J. Eduardo; Fiser, Andras; Roderick, Steven L.; Takiff, Howard E.; Blanchard, John S.

    2006-01-01

    The Pentapeptide Repeat Protein (PRP) family has over 500 members in the prokaryotic and eukaryotic kingdoms. These proteins are composed of, or contain domains composed of, tandemly repeated amino acid sequences with a consensus sequence of [S,T,A,V][D,N][L,F]-[S,T,R][G]. The biochemical function of the vast majority of PRP family members is unknown. The three-dimensional structure of the first member of the PRP family was determined for the fluoroquinolone resistance protein (MfpA) from Myc...

  13. Effects of repeated extracorporeal shock wave in urinary biochemical markers of rats Avaliação dos fatores bioquímicos urinários de risco para nefrolitíase em ratos submetidos à aplicação repetida de ondas de choque eletro-hidráulicas

    Directory of Open Access Journals (Sweden)

    Márcio Carvalho

    2009-12-01

    Full Text Available PURPOSE: To access the effect of repeated extracorporeal shock wave (ESW on urinary biochemical markers METHODS: 20 rats were assigned for ESW (Direx Tripter X1® - 14 KV to one of two groups: G1 (n=10 one ESW; G2 (n=10 two ESWs within a 14-day interval. Within the twenty-four hour period before and after the application of shock waves, the animals were placed in metabolic cages for 24 hour urine collection. The ph, creatinine, sodium, potassium, chlorides, calcium, magnesium, phosphorus, oxalates, alkaline phosphatase and citrates were measured. Twenty-four hours after the material was collected for urinary determination, the animals underwent nephrectomy of the kidney submitted to the ESW applications and were, then, sacrificed. The kidneys were processed for hispatological examination. RESULTS: Small variations in the biochemical markers were found in both groups, with no significant differences between the values obtained either prior to or following the ESW applications, except for citrate and alkaline phosphatase. Citraturia decreased significantly in group 2, following the second ESWL application (24.8 ± 3.0 mg/day after the first ESWL vs. 15.3 ± 2.2 mg/day after the second ESWL; p OBJETIVO: Avaliar os efeitos renais das ondas de choque eletro-hidráulicas (OCEH, utilizando como parâmetros marcadores bioquímicos urinários. MÉTODOS: Foram utilizados 20 ratos machos, EPM - Wistar, distribuídos aleatoriamente em dois grupos: G1 (n=10 Animais submetidos a uma sessão de OCEH. G2 (n=10 Animais submetidos a duas sessões de OCEH separadas por um intervalo de 14 dias. Para coleta da urina os animais foram mantidos em gaiolas metabólicas 24 horas antes e depois da aplicação das OCEH. Foram medidos o pH, a creatinina, sódio, potássio, cloretos, cálcio, magnésio, fósforo, oxalato, fosfatase alcalina e citrato. Vinte e quatro horas após a coleta da urina os animais foram submetidos à nefrectomia do rim envolvido no experimento e, em

  14. Repeated Causal Decision Making

    Science.gov (United States)

    Hagmayer, York; Meder, Bjorn

    2013-01-01

    Many of our decisions refer to actions that have a causal impact on the external environment. Such actions may not only allow for the mere learning of expected values or utilities but also for acquiring knowledge about the causal structure of our world. We used a repeated decision-making paradigm to examine what kind of knowledge people acquire in…

  15. simple sequence repeat (SSR)

    African Journals Online (AJOL)

    In the present study, 78 mapped simple sequence repeat (SSR) markers representing 11 linkage groups of adzuki bean were evaluated for transferability to mungbean and related Vigna spp. 41 markers amplified characteristic bands in at least one Vigna species. The transferability percentage across the genotypes ranged ...

  16. Collisionless shock waves

    International Nuclear Information System (INIS)

    Sagdeev, R.Z.; Kennel, C.F.

    1991-01-01

    Collisionless shocks cannot occur naturally on the earth, because nearly all matter here consists of electrically neutral atoms and molecules. In space, however, high temperatures and ultraviolet radiation from hot stars decompose atoms into their constituent nuclei and electrons, producing a soup of electrically charged particles known as a plasma. Plasma physicists proposed that the collective electrical and magnetic properties of plasmas could produce interactions that take the place of collisions and permit shocks to form. In 1964 the theoretical work found its first experimental confirmation. Norman F. Ness and his colleagues at the Goddard Space Flight Center, using data collected from the iMP-1 spacecraft, detected clear signs that a collisionless shock exists where the solar wind encounters the earth's magnetic field. More recent research has demonstrated that collisionless shocks appear in a dazzling array of astronomical settings. For example, shocks have been found in the solar wind upstream (sunward) of all the planet and comets that have been visited by spacecraft. Violent flares on the sun generate shocks that propagate to the far reaches of the solar system; tremendous galactic outbursts create disruptions in the intergalactic medium that are trillions of times larger. In addition, many astrophysicists think that shocks from supernova explosions in our galaxy accelerate cosmic rays, a class of extraordinarily energetic elementary particles and atomic nuclei that rain down on the earth from all directions

  17. Pediatric Toxic Shock Syndrome

    Directory of Open Access Journals (Sweden)

    Jennifer Yee

    2017-09-01

    Full Text Available Audience: This scenario was developed to educate emergency medicine residents on the diagnosis and management of a pediatric patient with toxic shock syndrome. The case is also appropriate for teaching of medical students and advanced practice providers, as well as a review of the principles of crisis resource management, teamwork, and communication. Introduction: Toxic shock syndrome is a low-frequency, high-acuity scenario requiring timely identification and aggressive management. If patients suffering from this condition are managed incorrectly, they may progress into multi-organ dysfunction and potentially death. Toxic shock syndrome has been associated with Streptococcus and Staphylococcus aureus (Staph. Approximately half of Staph cases are associated with menstruation, which was first described in the 1970s-1980s and was associated with the use of absorbent tampons.1 Group A Streptococcus may cause complications such as necrotizing fasciitis and gangrenous myositis.2 Pediatric patients may present critically ill from toxic shock syndrome. Providers need to perform a thorough history and physical exam to discern the source of infection. Management requires aggressive care with antibiotics and IV fluids. Objectives: By the end of this simulation session, the learner will be able to: 1 Recognize toxic shock syndrome. 2 Review the importance of a thorough physical exam. 3 Discuss management of toxic shock syndrome, including supportive care and the difference in antibiotic choices for streptococcal and staphylococcal toxic shock syndrome. 4 Appropriately disposition a patient suffering from toxic shock syndrome. 5 Communicate effectively with team members and nursing staff during a resuscitation of a critically ill patient. Method: This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on toxic shock syndrome.

  18. Shocks near Jamming

    Science.gov (United States)

    Gómez, Leopoldo R.; Turner, Ari M.; van Hecke, Martin; Vitelli, Vincenzo

    2012-02-01

    Nonlinear sound is an extreme phenomenon typically observed in solids after violent explosions. But granular media are different. Right when they jam, these fragile and disordered solids exhibit a vanishing rigidity and sound speed, so that even tiny mechanical perturbations form supersonic shocks. Here, we perform simulations in which two-dimensional jammed granular packings are dynamically compressed and demonstrate that the elementary excitations are strongly nonlinear shocks, rather than ordinary phonons. We capture the full dependence of the shock speed on pressure and impact intensity by a surprisingly simple analytical model.

  19. Mechanical shock absorber

    International Nuclear Information System (INIS)

    Vrillon, Bernard.

    1973-01-01

    The mechanical shock absorber described is made of a constant thickness plate pierced with circular holes regularly distributed in such a manner that for all the directions along which the strain is applied during the shock, the same section of the substance forming the plate is achieved. The shock absorber is made in a metal standing up to extensive deformation before breaking, selected from a group comprising mild steels and austenitic stainless steels. This apparatus is used for handling pots of fast neutron reactor fuel elements [fr

  20. Shock formation of HCO+

    International Nuclear Information System (INIS)

    Elitzur, M.

    1983-01-01

    It is shown that shocks propagating in dense molecular regions will lead to a decrease in HCO + relative abundance, in agreement with previous results by Iglesias and Silk. The shock enhancement of HCO + detected in the supernova remnant IC 443 by Dickenson et al. is due to enhanced ionization in the shocked material. This is the result of the material penetrating the remnant cavity where it becomes exposed to the trapped cosmic rays. A similar enhancement appears to have been detected by Wootten in W28 and is explained by the same model

  1. 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

  2. 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

  3. Shock Isolation Elements Testing for High Input Loadings. Volume II. Foam Shock Isolation Elements.

    Science.gov (United States)

    SHOCK ABSORBERS ), (*GUIDED MISSILE SILOS, SHOCK ABSORBERS ), (*EXPANDED PLASTICS, (*SHOCK(MECHANICS), REDUCTION), TEST METHODS, SHOCK WAVES, STRAIN(MECHANICS), LOADS(FORCES), MATHEMATICAL MODELS, NUCLEAR EXPLOSIONS, HARDENING.

  4. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    DEFF Research Database (Denmark)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald

    2013-01-01

    intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

  5. 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)

  6. Life shocks and homelessness.

    Science.gov (United States)

    Curtis, Marah A; Corman, Hope; Noonan, Kelly; Reichman, Nancy E

    2013-12-01

    We exploited an exogenous health shock-namely, the birth of a child with a severe health condition-to investigate the effect of a life shock on homelessness in large cities in the United States as well as the interactive effects of the shock with housing market characteristics. We considered a traditional measure of homelessness, two measures of housing instability thought to be precursors to homelessness, and a combined measure that approximates the broadened conceptualization of homelessness under the 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act (2010). We found that the shock substantially increases the likelihood of family homelessness, particularly in cities with high housing costs. The findings are consistent with the economic theory of homelessness, which posits that homelessness results from a conjunction of adverse circumstances in which housing markets and individual characteristics collide.

  7. Unlimited Relativistic Shock Surfing Acceleration

    International Nuclear Information System (INIS)

    Ucer, D.; Shapiro, V. D.

    2001-01-01

    Nonrelativistic shock surfing acceleration at quasiperpendicular shocks is usually considered to be a preacceleration mechanism for slow pickup ions to initiate diffusive shock acceleration. In shock surfing, the particle accelerates along the shock front under the action of the convective electric field of the plasma flow. However, the particle also gains kinetic energy normal to the shock and eventually escapes downstream. We consider the case when ions are accelerated to relativistic velocities. In this case, the ions are likely to be trapped for infinitely long times, because the energy of bounce oscillations tends to decrease during acceleration. This suggests the possibility of unlimited acceleration by shock surfing

  8. Technology shocks matter

    OpenAIRE

    Jonas D. M. Fisher

    2002-01-01

    This paper uses the neoclassical growth model to identify the effects of technological change on the US business cycle. In the model there are two sources of technological change: neutral, which effects the production of all goods homogeneously, and investment-specific. Investment-specific shocks are the unique source of the secular trend in the real price of investment goods, while shocks to both kinds of technology are the only factors which affect labor productivity in the long run. Consis...

  9. The Heliospheric Termination Shock

    Science.gov (United States)

    Jokipii, J. R.

    2013-06-01

    The heliospheric termination shock is a vast, spheroidal shock wave marking the transition from the supersonic solar wind to the slower flow in the heliosheath, in response to the pressure of the interstellar medium. It is one of the most-important boundaries in the outer heliosphere. It affects energetic particles strongly and for this reason is a significant factor in the effects of the Sun on Galactic cosmic rays. This paper summarizes the general properties and overall large-scale structure and motions of the termination shock. Observations over the past several years, both in situ and remote, have dramatically revised our understanding of the shock. The consensus now is that the shock is quite blunt, is with the front, blunt side canted at an angle to the flow direction of the local interstellar plasma relative to the Sun, and is dynamical and turbulent. Much of this new understanding has come from remote observations of energetic charged particles interacting with the shock, radio waves and radiation backscattered from interstellar neutral atoms. The observations and the implications are discussed.

  10. Bio-heat transfer model of electroconvulsive therapy: Effect of biological properties on induced temperature variation.

    Science.gov (United States)

    de Oliveira, Marilia M; Wen, Paul; Ahfock, Tony

    2016-08-01

    A realistic human head model consisting of six tissue layers was modelled to investigate the behavior of temperature profile and magnitude when applying electroconvulsive therapy stimulation and different biological properties. The thermo-electrical model was constructed with the use of bio-heat transfer equation and Laplace equation. Three different electrode montages were analyzed as well as the influence of blood perfusion, metabolic heat and electric and thermal conductivity in the scalp. Also, the effect of including the fat layer was investigated. The results showed that temperature increase is inversely proportional to electrical and thermal conductivity increase. Furthermore, the inclusion of blood perfusion slightly drops the peak temperature. Finally, the inclusion of fat is highly recommended in order to acquire more realistic results from the thermo-electrical models.

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

    Science.gov (United States)

    Dols, Annemieke; Rhebergen, Didi; Eikelenboom, Piet; Stek, Max L.

    2012-01-01

    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. PMID:24765410

  12. 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.

  13. Ketamine appears associated with better word recall than etomidate after a course of 6 electroconvulsive therapies.

    Science.gov (United States)

    McDaniel, William W; Sahota, Anupinder K; Vyas, Barin V; Laguerta, Nena; Hategan, Liana; Oswald, Jessica

    2006-06-01

    Ten patients treated with electroconvulsive therapy (ECT) for depressive illness received anesthesia with either etomidate or ketamine. Three patients received both etomidate and ketamine anesthesia for ECT during separate episodes of depression. Patients anesthetized with ketamine for ECT had significantly less impairment of short-term memory function than did patients who received ECT with etomidate anesthesia. All patients who received both anesthetics for ECT during 2 different episodes had less memory loss during ECT with ketamine than with etomidate. These results show the importance of studying the effects of all anesthetic agents used during ECT on cognitive functions. The results imply that the effect of ECT on memory may be largely caused by effects mediated by glutamate at N-methyl-d-aspartate receptors and suggest that N-methyl-d-aspartate antagonists may offer protection from memory dysfunction during ECT.

  14. Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up.

    Science.gov (United States)

    Squire, L R; Slater, P C; Miller, P L

    1981-01-01

    Memory for past events was assessed in 43 patients who had been prescribed bilateral electroconvulsive therapy (ECT) for relief of depressive illness. Four memory tests of personal or public events were administered before ECT, shortly after the fifth treatment, one week after completion of treatment, and about seven months later. The results indicated that ECT can initially disrupt recall of events that occurred many years previously, but recovery of these memories was virtually complete by seven months after treatment. It was also clear that persisting memory loss for information acquired only a few days before treatment can occur. For information acquired one to two years prior to treatment, recovery was substantial, but the results suggested that some memory problems might persist for events that occurred during this time period.

  15. Falls associated with electroconvulsive therapy among the geriatric population: a case report.

    Science.gov (United States)

    Rao, Sanjay S; Daly, John W; Sewell, Daniel D

    2008-06-01

    Electroconvulsive therapy (ECT) is the treatment of choice in many older individuals with depression and a few other conditions. Like all medical treatments, this intervention has certain possible risks, which include undesirable reactions associated with general anesthesia and those attributed specifically to ECT itself, such as short-term memory loss. The potential association of falls with ECT has not been well studied. Our recent literature search revealed that information on this topic consists mainly of chart reviews and case reports. We present a case of an older woman with a history of recurrent major depressive disorder that required intervention with ECT. She suffered 2 falls during her course of ECT. This case adds to the growing body of anecdotal evidence supporting an association of falls with ECT and highlights the need for more scientifically rigorous data to clarify whether this apparent association is real and/or causally related.

  16. Rivastigmine treatment for the prevention of electroconvulsive therapy-induced memory deficits in patients with schizophrenia.

    Science.gov (United States)

    Stryjer, Rafael; Ophir, Dana; Bar, Faina; Spivak, Baruch; Weizman, Abraham; Strous, Rael D

    2012-01-01

    Electroconvulsive therapy (ECT) is an effective strategy in some treatment-resistant patients with schizophrenia. However, ECT is associated with cognitive adverse effects, most notably, memory loss. This study examined the effects of rivastigmine, a selective central nervous system acetylcholinesterase inhibitor, with benefits on cognition in Alzheimer disease, on memory performance in patients with schizophrenia treated with ECT. Thirty inpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision schizophrenia treated with ECT were coadministered rivastigmine (3-4.5 mg/d) or placebo in a prospective, randomized, double-blind, placebo-controlled trial (maximum period of 4 weeks). Over the ECT course, scores on the cognitive subscale of the Alzheimer's Disease Assessment in subjects receiving placebo showed no significant change, whereas subjects receiving rivastigmine displayed decreased cognitive subscale of the Alzheimer's Disease Assessment scores, indicating cognitive improvement (P ECT and indicate possible beneficial effects of rivastigmine coadministration in minimizing some of these ECT-induced cognitive impairments.

  17. Lack of effect of naloxone on prolactin and seizures in electroconvulsive therapy.

    Science.gov (United States)

    Sperling, M R; Melmed, S; McAllister, T; Price, T R

    1989-01-01

    Both opiate agonist and antagonist injection have been reported to modulate prolactin secretion, alter brain excitability and produce seizures, and modify the postictal state. We studied the effects of administration of high-dose naloxone, an opiate antagonist, on postictal prolactin levels, seizure duration, and postictal behavior, using patients undergoing electroconvulsive therapy (ECT) as a seizure model. Seven patients had 8 mg naloxone injected prior to one ECT treatment and saline injected prior to another treatment, with the order of injection randomized. Before ECT and 15 min after ECT, prolactin levels were drawn, and no blunting of the expected postictal prolactin elevation by naloxone injection was observed. We found no evidence that endogenous opiates trigger prolactin secretion during seizures. Seizure duration was also similar in saline and naloxone groups, and naloxone did not reverse postictal depression, as has been reported in an animal model.

  18. Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators.

    Science.gov (United States)

    Dolenc, Tamara J; Barnes, Roxann D; Hayes, David L; Rasmussen, Keith G

    2004-09-01

    Electroconvulsive therapy (ECT) is used to treat major depressive illness, especially in elderly and medically frail patients. Not uncommonly, these patients have cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Only a few case reports in the literature describe the use of ECT in such patients. Herein we review our ECT experience treating 26 pacemaker patients and 3 ICD patients. All patients obtained significant antidepressant benefits with ETC. Only one serious cardiac event occurred, a case of supraventricular tachycardia (SVT) requiring a stay on the cardiac intensive care unit. The SVT resolved and the patient went on to receive further uncomplicated ECT treatments. We conclude from this experience that with proper pre-ECT cardiac and pacemaker/defibrillator assessment, ECT can be safely and effectively administered to patients with an implanted cardiac device.

  19. 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

    with bipolar and schizoaffective disorders received the treatment in 2000 compared with 1976. CONCLUSIONS: Unipolar affective disorders, long duration of admissions, and no history of previous admissions are strong predictors of receiving first ECT. Despite a decrease in available inpatient beds, the treatment......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...... utilization. METHODS: A register-based case-control study. The sample included 2010 cases treated with ECT between 1976 and 2000 and 148,284 controls. RESULTS: Predictors for receiving first ECT were unipolar affective disorders, long admissions, and no previous admissions. Significantly fewer patients...

  20. The use of electroconvulsive therapy in atypical psychotic presentations: a case review.

    Science.gov (United States)

    Montgomery, John H; Vasu, Devi

    2007-10-01

    Convulsive therapy and its progeny, electroconvulsive therapy (ECT), were originally used for the treatment of catatonic schizophrenia, and there is little doubt that ECT remains an effective intervention for the treatment of schizophrenia. However, current practice tends to favor the use of ECT in severe or treatment refractory affective disorders, and its use in schizophrenia and other nonaffective (atypical) psychotic disorders has become controversial.CASE REPORTS HAVE SUGGESTED A ROLE FOR ECT IN TWO SPECIFIC ATYPICAL PSYCHOTIC DISORDERS: Cotard's syndrome and cycloid psychosis. In this article, we review the atypical psychotic disorders and report a series of five case examples that signify the role of ECT in atypical psychotic presentations, particularly when the symptoms resemble those found in Cotard's syndrome and cycloid psychosis.

  1. 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...... convincing evidence of benefits. It is concluded that there is insufficient support, at present, for the hypothesis that the hypertensive surge during ECT and the resultant blood-brain barrier breach contribute meaningfully to ECT-induced cognitive deficits. Future research should address the subset....... These changes may impair neuronal functioning and contribute to the mechanisms underlying ECT-induced cognitive deficits. Some but not all clinical data on the subject suggest that blood pressure changes during ECT correlate with indices of cognitive impairment. In animal models, pharmacological manipulations...

  2. Body temperature change during anesthesia for electroconvulsive therapy: implications for quality incentives in anesthesiology.

    Science.gov (United States)

    Modell, Jerome H; Gravenstein, Nikolaus; Morey, Timothy E

    2008-11-01

    The American Society of Anesthesiologists has announced that perioperative normothermia is a "Quality Incentive in Anesthesiology." We examined whether we could meet this quality incentive in a simple population: patients undergoing anesthesia for electroconvulsive therapy (ECT). We compared infrared-measured ear temperature before anesthesia to temperature upon delivery of patients to the postanesthesia care unit (PACU) after 101 consecutive brief anesthetics to facilitate ECT. For 35 procedures, the patients had an infrared ear thermometer temperature of measures were substandard. Also, current methods of measuring temperature may be inadequate to ascertain if patients are hypothermic after surgery. As the avoidance of hypothermia is a meritorious goal, anesthesia departments need to ensure that their temperature monitoring equipment is adequate to ensure accurate measurement of postanesthetic temperature if this variable is to be used as a quality incentive.

  3. Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion

    Directory of Open Access Journals (Sweden)

    Quintí Foguet-Boreu

    2018-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depressive disorder with psychotic features. During her third hospital admission, symptoms of autonomic instability, hyperpyrexia, severe extrapyramidal side effects, and delirium appeared, suggesting NMS due to concomitant treatment with risperidone and quetiapine, among other drugs. Despite several consecutive pharmacological treatments (lorazepam, bromocriptine and amantadine and prompt initiation of electroconvulsive therapy (ECT, clinical improvement was observed only after combining bupropion with ECT. The symptoms that had motivated the admission gradually remitted and the patient was discharged home. Bupropion increases dopaminergic activity in both the nucleus accumbens and the prefrontal cortex. Therefore, from a physiopathological standpoint, bupropion has a potential role in treating NMS. However, there is scarce evidence supporting this approach and therefore future cases should be carefully considered.

  4. Knowledge and Attitudes of Patients and Their Relatives Toward Electroconvulsive Therapy in China.

    Science.gov (United States)

    Li, Yang; An, Feng-Rong; Zhu, Hui; Chiu, Helen F K; Ungvari, Gabor S; H Ng, Chee; Lai, Kelly Y C; Xiang, Yu-Tao

    2016-10-01

    To examine the knowledge and attitudes of patients and their relatives as well as patients' subjective experience with electroconvulsive therapy (ECT) in China. Up to 420 responders including patients receiving ECT (n = 210) and their relatives (n = 210) were assessed with self-reported questionnaires. Patients and their relatives did not receive adequate information before ECT, particularly about the mode of its delivery, risks, and adverse effects. The most common adverse effect of ECT reported by patients was memory impairment. Both patients and their relatives had positive attitudes toward ECT and appeared satisfied with its therapeutic effects. Mental health professionals need to address the inadequate information on ECT provided to patients and their relatives prior to the treatment. © 2015 Wiley Periodicals, Inc.

  5. 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

  6. 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

  7. Delirium during the course of electroconvulsive therapy in a patient on lithium carbonate treatment.

    Science.gov (United States)

    Sadananda, Suneetha Karkada; Narayanaswamy, Janardhanan C; Srinivasaraju, Ravindra; Math, Suresh Bada

    2013-01-01

    The safety of concurrent mood stabilizers during the course of electroconvulsive therapy (ECT) is yet to be clearly established. Delirium with concurrent administration of ECT and lithium carbonate is described in this case report. A 30-year-old male with a past history of significant head injury developed delirium during the course of bitemporal ECT. The clinical picture and the details of the cognitive impairment have been discussed in the report with a focus on relationship between the lithium carbonate administration and the concurrent ECT. Patients with preexisting organic brain damage could be prone to develop the cognitive adverse effect while on a combination of lithium and ECT. Possible interactions between lithium and ECT need further systematic evaluation. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. 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...... utilization. METHODS: A register-based case-control study. The sample included 2010 cases treated with ECT between 1976 and 2000 and 148,284 controls. RESULTS: Predictors for receiving first ECT were unipolar affective disorders, long admissions, and no previous admissions. Significantly fewer patients...... with bipolar and schizoaffective disorders received the treatment in 2000 compared with 1976. CONCLUSIONS: Unipolar affective disorders, long duration of admissions, and no history of previous admissions are strong predictors of receiving first ECT. Despite a decrease in available inpatient beds, the treatment...

  9. 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.

  10. Recurrent Aspiration in a Patient With Gastric Band Undergoing Electroconvulsive Therapy.

    Science.gov (United States)

    Lubit, Elana B; Fetterman, Tammy Cohen; Ying, Patrick

    2016-06-01

    We report a case of a 33-year-old woman with depression and suicidal ideation, treated successfully with electroconvulsive therapy (ECT) in the past. Since her previous course of ECT, she underwent gastric banding, a bariatric surgical procedure associated with increased risk of gastric regurgitation. Despite increasingly stringent measures to minimize the risk of regurgitation and aspiration during ECT, she had several episodes of regurgitation, the last of which precipitated an acute illness consistent with aspiration pneumonitis. We took additional precautions after each event, until she had no further episodes of regurgitation. We discuss the risk posed by the gastric band, the measures we implemented to minimize that risk, and our recommendations for assessment and management of post-gastric banding patients who present for ECT.

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

    Science.gov (United States)

    Semkovska, Maria; Keane, Deborah; Babalola, Oyemi; McLoughlin, Declan M

    2011-06-01

    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. Copyright © 2010

  12. Evaluation of serum indexes and electrophysiological characteristics after ziprasidone combined with modified electroconvulsive therapy for schizophrenian

    Directory of Open Access Journals (Sweden)

    Hong-Bo Cao

    2017-06-01

    Full Text Available Objective: To study the effect of ziprasidone combined with modified electroconvulsive therapy (MECT on serum indexes and electrophysiological characteristics of schizophrenia. Methods: A total of 44 patients with schizophrenia treated in our hospital between May 2014 and July 2016 were selected and randomly divided into MECT group and control group, MECT group received ziprasidone combined with MECT therapy and control group received ziprasidone therapy. Before treatment as well as 1 month, 2 months and 3 months after treatment, serum nerve cytokine levels and inflammatory factor levels as well as nerve electrophysiology parameters were detected. Results: 1 month, 2 months and 3 months after treatment, serum BDNF, GDNF and NGF levels of both groups were significantly higher than those before treatment, IL-1β, IL-6, IL-17 and TNF-α levels were significantly lower than those before treatment, P300 and N2-P3 latency were significantly shorter than those before treatment, and P300 and N2-P3 amplitude were significantly higher than those before treatment; serum BDNF, GDNF and NGF levels of MECT group were significantly higher than those of control group, IL-1β, IL-6, IL-17 and TNF-α levels were significantly lower than those of control group, P300 and N2-P3 latency were significantly shorter than those of control group, and P300 and N2-P3 amplitude were significantly higher than those of control group. Conclusion: Ziprasidone combined with modified electroconvulsive therapy can improve neuron function, reduce neuron damage and adjust nerve electrophysiology function.

  13. [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.

  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. 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.

  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. 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.

  18. 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.

  19. 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....

  20. Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental

    OpenAIRE

    Dannon, Pinhas; Zahavi,Guy

    2014-01-01

    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 seiz...

  1. Lithium and brain plasticity - studies on glial cell changes and electroconvulsive treatment-induced amnesia in rats

    OpenAIRE

    Orre, Karin

    2013-01-01

    Depression and bipolar disorder, collectively known as mood disorders, are devastating, common and often chronic illnesses. Imaging studies of patients with mood disorders have demonstrated structural changes in several brain regions implicated in mood regulation. Furthermore, bipolar disorder is associated with white matter abnormalities and post mortem analysis of brain tissue from patients with mood disorders have shown glial cell pathology. Electroconvulsive therapy (ECT) and pharmacologi...

  2. The safety of electroconvulsive therapy and lithium in combination: a case series and review of the literature.

    Science.gov (United States)

    Dolenc, Tamara J; Rasmussen, Keith G

    2005-09-01

    Early reports cautioned against the combination of lithium and electroconvulsive therapy (ECT), citing risk of excessive cognitive disturbance, prolonged apnea, and spontaneous seizures. However, recent case series with larger numbers of patients indicate that the combination may be used safely and with optimal efficacy in certain clinical circumstances. In this report, we describe 12 patients in whom the combination of lithium and ECT was deemed safe. We also provide a comprehensive review of published literature and provide detailed recommendations for clinical practice.

  3. Evaluation of nonmemory cognitive parameters in psychiatric patients? pre- and post-electroconvulsive therapy: An observational study

    OpenAIRE

    Prakash, Jyoti; Srivastava, Kalpana; Manandhar, Pradeep; Saha, Amitabh

    2015-01-01

    Introduction: Possibility of cognitive side effects has made electroconvulsive therapy (ECT) questionable. Variable deficits have been debated in memory cognition. Pattern of changes in nonmemory cognition pre- and post-ECT is not clear. Methodology: Forty patients undergoing ECT were studied on nonmemory cognitive parameters before ECT, after a course of ECT, and after 4 weeks of last. ECT. Results: Nonmemory cognition improved during the course of ECT and over 4 weeks of ECT. Co...

  4. I'm shocked: informed consent in ECT and the phenomenological-self.

    Science.gov (United States)

    Seniuk, Patrick

    2018-02-13

    This paper argues that phenomenological insights regarding selfhood are relevant to the informed consent process in the treatment of depression using electro-convulsive therapy (ECT). One of the most significant side-effects associated with ECT is retrograde amnesia. Unfortunately, the current informed consent model does not adequately appreciate the full extent in which memory loss disturbs lived-experience. Through the philosophy of Merleau-Ponty, it is possible to appreciate the way in which memory loss affects a person's self-experience, with emphasis given to one's pre-reflective and embodied, relationship with things in the world. This paper aims to demonstrate that proper informed consent should acknowledge the extent to which repeated ECT treatments affect a patient's sense self.

  5. Memory loss after electroconvulsive treatment--may the sudden alleviation of depression-inducing memories explain patient despair?

    Science.gov (United States)

    Berg, John E

    2011-12-01

    Electroconvulsive treatment (ECT) has developed over 70 years to a modern, effective way of lifting depressive moods. Memory loss after electroconvulsive treatment is the only remaining relevant criticism of the treatment modality when considering the overall rate of remission from this treatment compared to all other treatment modalities. A depressive state impedes memory. After treatment memory improves on several qualities of cognition. However, comparing a person's memory ability from the months before depression started to the level after a course of ECT is never done, of obvious reasons. There are great clinical difficulties explaining who would develop memory problems, regardless of stimulation techniques, age or sex of the patient. The memory loss seen in some patients undergoing electroconvulsive treatment (ECT) is not explained by the treatment alone. After ECT unpleasant memories are disclosed rapidly and the patient may unconsciously try to defend herself by extending memory repression to other areas of memory. This may be unrelated to treatment modality, number of sessions or severity of depression. Psychological factors may partly explain why some patients unfold memory problems when the depression is rapidly lifted, rather than the treatment modality itself. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. 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.

  7. Electroconvulsive Therapy in Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of the Literature.

    Science.gov (United States)

    Coffey, M Justin; Cooper, Joseph J

    2016-12-01

    There is a growing scientific literature describing the neuropsychiatric symptoms of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, including the use of electroconvulsive therapy (ECT) to treat those symptoms. We sought to consolidate this literature into a review that highlights its relevance to ECT practitioners. We performed a PubMed search using the terms electroconvulsive therapy and encephalitis, autoimmune encephalitis, or anti-NMDA receptor encephalitis. We reviewed all relevant studies in detail, cross-referenced all bibliographies, and collected key clinical information related to the practice of ECT. We identified 6 studies offering patient-level descriptions of the use of ECT in patients with anti-NMDA receptor encephalitis. In all cases ECT was used to target symptoms of catatonia. Electroconvulsive therapy was delivered safely and effectively irrespective of the timing of diagnosis, tumor removal, or immunotherapy. There are no controlled data on the use of ECT in anti-NMDA receptor encephalitis. Further investigation is needed to determine whether ECT has a disease-modifying effect on this form of autoimmune encephalitis.

  8. Particle magnetic moment conservation and resonance in a pure magnetohydrodynamic shock and field inclination influence on diffusive shock acceleration

    International Nuclear Information System (INIS)

    Lieu, R.; Quenby, J.J.

    1990-01-01

    Computational and analytical methods have been used in a study of particle acceleration by MHD shocks. Numerical simulations of single-particle trajectories indicate that magnetic moment is conserved quite accurately for an encounter with a near-perpendicular shock, and for all pitch angles except the very small ones. Acceleration is most effective for particles which are reflected by the shock at small pitch angles. If future encounters with the shock are possible, large acceleration will be repeated only for relativistic plasma flow velocities. Results for the pure MHD shock are then considered within the context of a diffusion model (hence a diffusive MHD shock). The microscopic approach is employed whereby one follows the history of a test particle and explicitly takes into account the possibility of reflection by the shock. Exact analytical solutions are currently available to order V/c, where V is the plasma flow speed, and are found to be in complete agreement with diffusion theory. More specifically, the presence of electromagnetic effects leads to a shortening of acceleration time scale but does not change the steady state spectrum of energetic particles. 7 refs

  9. Repeatability of Cryogenic Multilayer Insulation

    Science.gov (United States)

    Johnson, W. L.; Vanderlaan, M.; Wood, J. J.; Rhys, N. O.; Guo, W.; Van Sciver, S.; Chato, D. J.

    2017-12-01

    Due to the variety of requirements across aerospace platforms, and one off projects, the repeatability of cryogenic multilayer insulation (MLI) has never been fully established. The objective of this test program is to provide a more basic understanding of the thermal performance repeatability of MLI systems that are applicable to large scale tanks. There are several different types of repeatability that can be accounted for: these include repeatability between identical blankets, repeatability of installation of the same blanket, and repeatability of a test apparatus. The focus of the work in this report is on the first two types of repeatability. Statistically, repeatability can mean many different things. In simplest form, it refers to the range of performance that a population exhibits and the average of the population. However, as more and more identical components are made (i.e. the population of concern grows), the simple range morphs into a standard deviation from an average performance. Initial repeatability testing on MLI blankets has been completed at Florida State University. Repeatability of five Glenn Research Center (GRC) provided coupons with 25 layers was shown to be +/- 8.4% whereas repeatability of repeatedly installing a single coupon was shown to be +/- 8.0%. A second group of 10 coupons has been fabricated by Yetispace and tested by Florida State University, the repeatability between coupons has been shown to be +/- 15-25%. Based on detailed statistical analysis, the data has been shown to be statistically significant.

  10. Shocks in fragile matter

    Science.gov (United States)

    Vitelli, Vincenzo

    2012-02-01

    Non-linear sound is an extreme phenomenon typically observed in solids after violent explosions. But granular media are different. Right when they unjam, these fragile and disordered solids exhibit vanishing elastic moduli and sound speed, so that even tiny mechanical perturbations form supersonic shocks. Here, we perform simulations in which two-dimensional jammed granular packings are continuously compressed, and demonstrate that the resulting excitations are strongly nonlinear shocks, rather than linear waves. We capture the full dependence of the shock speed on pressure and compression speed by a surprisingly simple analytical model. We also treat shear shocks within a simplified viscoelastic model of nearly-isostatic random networks comprised of harmonic springs. In this case, anharmonicity does not originate locally from nonlinear interactions between particles, as in granular media; instead, it emerges from the global architecture of the network. As a result, the diverging width of the shear shocks bears a nonlinear signature of the diverging isostatic length associated with the loss of rigidity in these floppy networks.

  11. 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...

  12. Life Shocks and Homelessness

    Science.gov (United States)

    Corman, Hope; Noonan, Kelly; Reichman, Nancy E.

    2014-01-01

    We exploited an exogenous health shock—namely, the birth of a child with a severe health condition—to investigate the effect of a life shock on homelessness in large cities in the United States as well as the interactive effects of the shock with housing market characteristics. We considered a traditional measure of homelessness, two measures of housing instability thought to be precursors to homelessness, and a combined measure that approximates the broadened conceptualization of homelessness under the 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act (2010). We found that the shock substantially increases the likelihood of family homelessness, particularly in cities with high housing costs. The findings are consistent with the economic theory of homelessness, which posits that homelessness results from a conjunction of adverse circumstances in which housing markets and individual characteristics collide. PMID:23868747

  13. Health Shocks and Retirement:

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Larsen, Mona

    We investigate the effect of an acute health shock on retirement among elderly male workers in Denmark, 1991-1999, and in particular whether various welfare state programs and institutions impinge on the retirement effect. The results show that an acute health event increases the retirement chances...... significant. For the most part, the retirement effect following a health shock seems to be immune to the availability of a multitude of government programs for older workers in Denmark....... 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...

  14. 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.

  15. Repeat Customer Success in Extension

    Science.gov (United States)

    Bess, Melissa M.; Traub, Sarah M.

    2013-01-01

    Four multi-session research-based programs were offered by two Extension specialist in one rural Missouri county. Eleven participants who came to multiple Extension programs could be called "repeat customers." Based on the total number of participants for all four programs, 25% could be deemed as repeat customers. Repeat customers had…

  16. 78 FR 65594 - Vehicular Repeaters

    Science.gov (United States)

    2013-11-01

    ... coordinators estimate the effect on coordination fees? Does the supposed benefit that mobile repeater stations... allow the licensing and operation of vehicular repeater systems and other mobile repeaters by public... email: [email protected] or phone: 202-418- 0530 or TTY: 202-418-0432. For detailed instructions for...

  17. Electric foot shock stress adaptation: Does it exist or not?

    Science.gov (United States)

    Bali, Anjana; Jaggi, Amteshwar Singh

    2015-06-01

    Stress adaptation is a protective phenomenon against repeated stress exposure and is characterized by a decreased responsiveness to a repeated stress stimulus. The adaptation is associated with a complex cascade of events, including the changes in behavior, neurotransmitter and gene expression levels. The non-adaptation or maladaptation to stress may underlie the affective disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). Electric foot shock is a complex stressor, which includes both physical and emotional components. Unlike immobilization, restraint and cold immersion stress, the phenomenon of stress adaptation is not very well defined in response to electric foot shock. A number of preclinical studies have reported the development of adaptation to electric foot shock stress. However, evidence also reveals the non-adaptive behavior in response to foot shocks. The distinct adaptive/non-adaptive responses may be possibly influenced by the type, intensity, and duration of the stress. The present review discusses the existence or non-existence of adaptation to electric foot shock stress along with possible mechanism. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. 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...... is the exception rather than the rule. Instead, incremental ‘crisis routines’ based on existing policy instruments are overwhelmingly used to deal with economic hardship. We discuss these findings in the light of the psychological ‘threat-rigidity’ effect and reflect on their consequences for theories...

  19. Shock absorber in Ignalina NPP

    International Nuclear Information System (INIS)

    Bulavas, A.; Muralis, J.

    1996-09-01

    Theoretical calculation and experimental analysis of models of shock absorber in Ignalina NPP is presented. The results obtained from the investigation with model of shock absorber coincide with the theoretical calculation. (author). 2 figs., 3 refs

  20. Shock Response of Boron Carbide

    National Research Council Canada - National Science Library

    Dandekar, D. P. (Dattatraya Purushottam)

    2001-01-01

    .... The present work was undertaken to determine tensile/spall strength of boron carbide under plane shock wave loading and to analyze all available shock compression data on boron carbide materials...

  1. Fascinating World of Shock Waves

    Indian Academy of Sciences (India)

    Srimath

    travelling at supersonic speeds (more than the sound speed at ... actual earth- quake, travel at supersonic speeds. .... The time scale of the shock wave is also important ..... real lithotripsy where a shock wave is used shatter the kidney stones!

  2. INTERFERENCE OF UNIDIRECTIONAL SHOCK WAVES

    Directory of Open Access Journals (Sweden)

    P. V. Bulat

    2015-05-01

    Full Text Available Subject of study.We consider interference of unidirectional shock waves or, as they are called, catching up shock waves. The scope of work is to give a classification of the shock-wave structures that arise in this type of interaction of shock waves, and the area of their existence. Intersection of unidirectional shock waves results in arising of a shock-wave structure at the intersection point, which contains the main shock wave, tangential discontinuity and one more reflected gas-dynamic discontinuity of unknown beforehand type. The problem of determining the type of reflected discontinuity is the main problem that one has to solve in the study of catching shock waves interference. Main results.The paper presents the pictures of shock-wave structures arising at the interaction of catching up shock waves. The areas with a regular and irregular unidirectional interaction of shocks are described. Characteristic shock-wave structures are of greatest interest, where reflected gas-dynamic discontinuity degenerates into discontinuous characteristics. Such structures have a number of extreme properties. We have found the areas of existence for such shock-wave structures. There are also areas in which the steady-state solution is not available. The latter has determined revival of interest for the theoretical study of the problem, because the facts of sudden shock-wave structure destruction inside the air intake of supersonic aircrafts at high Mach numbers have been discovered. Practical significance.The theory of interference for unidirectional shock waves and design procedure are usable in the design of supersonic air intakes. It is also relevant for application possibility investigation of catching up oblique shock waves to create overcompressed detonation in perspective detonation air-jet and rocket engines.

  3. Electroconvulsive therapy

    Science.gov (United States)

    ... Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. ... (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  4. Shock tube Multiphase Experiments

    Science.gov (United States)

    Middlebrooks, John; Allen, Roy; Paudel, Manoj; Young, Calvin; Musick, Ben; McFarland, Jacob

    2017-11-01

    Shock driven multiphase instabilities (SDMI) are unique physical phenomena that have far-reaching practical applications in engineering and science. The instability is present in high energy explosions, scramjet combustors, and supernovae events. The SDMI arises when a multiphase interface is impulsively accelerated by the passage of a shockwave. It is similar in development to the Richtmyer-Meshkov (RM) instability however, particle-to-gas coupling is the driving mechanism of the SDMI. As particle effects such as lag and phase change become more prominent, the SDMI's development begins to significantly deviate from the RM instability. We have developed an experiment for studying the SDMI in our shock tube facility. In our experiments, a multiphase interface is created using a laminar jet and flowed into the shock tube where it is accelerated by the passage of a planar shockwave. The interface development is captured using CCD cameras synchronized with planar laser illumination. This talk will give an overview of new experiments conducted to examine the development of a shocked cylindrical multiphase interface. The effects of Atwood number, particle size, and a second acceleration (reshock) of the interface will be discussed.

  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. Shock-induced electrical activity in polymeric solids. A mechanically induced bond scission model

    International Nuclear Information System (INIS)

    Graham, R.A.

    1979-01-01

    When polymeric solids are subjected to high-pressure shock loading, two anomalous electrical phenomena, shock-induced conduction and shock-induced polarization, are observed. The present paper proposes a model of mechanically induced bond scission within the shock front to account for the effects. An experimental study of shock-induced polarization in poly(pyromellitimide) (Vespel SP-1) is reported for shock compressions from 17 to 23% (pressures from 2.5 to 5.4 GPa). Poly(pyromellitimide) is found to be a strong generator of such polarization and the polarization is found to reflect an irreversible or highly hysteretic process. The present measurements are combined with prior measurements to establish a correlation between monomer structure and strength of shock-induced polarization; feeble signals are observed in the simpler monomer repeat units of poly(tetrafluoroethylene) and polyethylene while the strongest signals are observed in more complex monomers of poly(methyl methacrylate) and poly(pyromellitimide). It is also noted that there is an apparent correlation between shock-induced conduction and shock-induced polarization. Such shock-induced electrical activity is also found to be well correlated with the propensity for mechanical bond scission observed in experiments carried out in conventional mechanochemical studies. The bond scission model can account for characteristics observed for electrical activity in shock-loaded polymers and their correlation to monomer structure. Localization of elastic energy within the monomer repeat unit or along the main chain leads to the different propensities for bond scission and resulting shock-induced electrical activity

  7. STEREO interplanetary shocks and foreshocks

    International Nuclear Information System (INIS)

    Blanco-Cano, X.; Kajdič, P.; Aguilar-Rodríguez, E.; Russell, C. T.; Jian, L. K.; Luhmann, J. G.

    2013-01-01

    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 θ Bn ∼20-86°. 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 ∼1 AU and have been producing suprathermal particles for a shorter time.

  8. 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.

  9. Repeated causal decision making.

    Science.gov (United States)

    Hagmayer, York; Meder, Björn

    2013-01-01

    Many of our decisions refer to actions that have a causal impact on the external environment. Such actions may not only allow for the mere learning of expected values or utilities but also for acquiring knowledge about the causal structure of our world. We used a repeated decision-making paradigm to examine what kind of knowledge people acquire in such situations and how they use their knowledge to adapt to changes in the decision context. Our studies show that decision makers' behavior is strongly contingent on their causal beliefs and that people exploit their causal knowledge to assess the consequences of changes in the decision problem. A high consistency between hypotheses about causal structure, causally expected values, and actual choices was observed. The experiments show that (a) existing causal hypotheses guide the interpretation of decision feedback, (b) consequences of decisions are used to revise existing causal beliefs, and (c) decision makers use the experienced feedback to induce a causal model of the choice situation even when they have no initial causal hypotheses, which (d) enables them to adapt their choices to changes of the decision problem. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  10. 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

  11. Shock Dynamics in Stellar Outbursts. I. Shock Formation

    Energy Technology Data Exchange (ETDEWEB)

    Ro, Stephen; Matzner, Christopher D., E-mail: ro@astro.utoronto.ca [Department of Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, ON M5S 3H4 (Canada)

    2017-05-20

    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.

  12. Grain destruction in interstellar shocks

    International Nuclear Information System (INIS)

    Seab, C.G.; Shull, J.M.

    1984-01-01

    One of the principal methods for removing grains from the Interstellar Medium is to destroy them in shock waves. Previous theoretical studies of shock destruction have generally assumed only a single size and type of grain; most do not account for the effect of the grain destruction on the structure of the shock. Earlier calculations have been improved in three ways: first, by using a ''complete'' grain model including a distribution of sizes and types of grains; second, by using a self-consistent shock structure that incorporates the changing elemental depletions as the grains are destroyed; and third, by calculating the shock-processed ultraviolet extinction curves for comparison with observations. (author)

  13. 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...

  14. Expansion of protein domain repeats.

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    Asa K Björklund

    2006-08-01

    Full Text Available Many proteins, especially in eukaryotes, contain tandem repeats of several domains from the same family. These repeats have a variety of binding properties and are involved in protein-protein interactions as well as binding to other ligands such as DNA and RNA. The rapid expansion of protein domain repeats is assumed to have evolved through internal tandem duplications. However, the exact mechanisms behind these tandem duplications are not well-understood. Here, we have studied the evolution, function, protein structure, gene structure, and phylogenetic distribution of domain repeats. For this purpose we have assigned Pfam-A domain families to 24 proteomes with more sensitive domain assignments in the repeat regions. These assignments confirmed previous findings that eukaryotes, and in particular vertebrates, contain a much higher fraction of proteins with repeats compared with prokaryotes. The internal sequence similarity in each protein revealed that the domain repeats are often expanded through duplications of several domains at a time, while the duplication of one domain is less common. Many of the repeats appear to have been duplicated in the middle of the repeat region. This is in strong contrast to the evolution of other proteins that mainly works through additions of single domains at either terminus. Further, we found that some domain families show distinct duplication patterns, e.g., nebulin domains have mainly been expanded with a unit of seven domains at a time, while duplications of other domain families involve varying numbers of domains. Finally, no common mechanism for the expansion of all repeats could be detected. We found that the duplication patterns show no dependence on the size of the domains. Further, repeat expansion in some families can possibly be explained by shuffling of exons. However, exon shuffling could not have created all repeats.

  15. S -ketamine compared to etomidate during electroconvulsive therapy in major depression.

    Science.gov (United States)

    Zavorotnyy, Maxim; Kluge, Ina; Ahrens, Kathrin; Wohltmann, Thomas; Köhnlein, Benjamin; Dietsche, Patricia; Dannlowski, Udo; Kircher, Tilo; Konrad, Carsten

    2017-12-01

    Objective of the study was to compare two commonly used anesthetic drugs, S-ketamine and etomidate, regarding their influence on seizure characteristics, safety aspects, and outcome of electroconvulsive therapy (ECT) in major depression. Treatment data of 60 patients who underwent a total number of 13 ECTs (median) because of the severe or treatment-resistant major depressive disorder (DSM-IV) were analyzed. Etomidate, mean dosage (SD) = 0.25 (0.04) mg/kg, was used for anesthesia in 29 participants; 31 patients received S-ketamine, mean dosage (SD) = 0.96 (0.26) mg/kg. Right unilateral brief pulse ECTs were performed. The number of ECTs was individually adjusted to clinical needs, mean (SD) = 13.0 (4.3). Seizure characteristics, adverse events, and the clinical global impression (CGI) scores were compared between the both groups during ECT series. In the S-ketamine group, a lower initial seizure threshold (p = 0.014), stimulation charge (p ketamine might hold a potential to become a clinically favorable anesthetic agent during ECT. However, the current findings should be interpreted with caution, and further prospective randomized clinical trials are required. Also, specific adverse effects profile of S-ketamine, especially with regard to the cardiovascular risk, needs to be taken into account.

  16. Heat transfer due to electroconvulsive therapy: Influence of anisotropic thermal and electrical skull conductivity.

    Science.gov (United States)

    Menezes de Oliveira, Marilia; Wen, Peng; Ahfock, Tony

    2016-09-01

    This paper focuses on electroconvulsive therapy (ECT) and head models to investigate temperature profiles arising when anisotropic thermal and electrical conductivities are considered in the skull layer. The aim was to numerically investigate the threshold for which this therapy operates safely to the brain, from the thermal point of view. A six-layer spherical head model consisting of scalp, fat, skull, cerebro-spinal fluid, grey matter and white matter was developed. Later on, a realistic human head model was also implemented. These models were built up using the packages from COMSOL Inc. and Simpleware Ltd. In these models, three of the most common electrode montages used in ECT were applied. Anisotropic conductivities were derived using volume constraint and included in both spherical and realistic head models. The bio-heat transferring problem governed by Laplace equation was solved numerically. The results show that both the tensor eigenvalues of electrical conductivity and the electrode montage affect the maximum temperature, but thermal anisotropy does not have a significant influence. Temperature increases occur mainly in the scalp and fat, and no harm is caused to the brain by the current applied during ECT. The work assures the thermal safety of ECT and also provides a numerical method to investigate other non-invasive therapies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

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    Mosam Phirke

    2015-01-01

    Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

  19. 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.

    2015-01-01

    Objective 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. Methods Twenty-three participants admitted to McLean Hospital (Belmont, MA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI), 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 (CMAI)-short form, Neuropsychiatric Inventory (NPI)-Nursing Home Version, Cornell Scale for Depression in Dementia (CSDD), and the Clinical Global Impression Scale (CGI) at baseline, during, and after the ECT course. Results Regression analyses revealed a significant decrease from baseline to discharge on the CMAI (F(4, 8) =13.3; p=0.006) and NPI (F(4, 31)= 14.6; pagitated/aggressive” at baseline to “borderline agitated/aggressive” at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants due to recurrence of agitation and for three participants due to adverse events. Conclusions ECT may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. PMID:24838521

  20. Amlodipine and the Successful Management of Post-Electroconvulsive Therapy Agitation.

    Science.gov (United States)

    Shahriari, Ali; Khooshideh, Maryam; Sheikh, Mahdi

    2016-01-01

    Electroconvulsive therapy (ECT) is a highly effective nonpharmacologic treatment for the management of depression and some other psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness, irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to serious and severe forms requiring prompt medical intervention to protect the patient and the medical staff. In severe agitation medical management may be necessary which consists of using sedative agents, either benzodiazepines or propofol. The side-effects of these sedative agents, especially in the elderly population, necessitate finding ways that could help the prevention of the occurrence of agitation after ECT treatments. We report a 68-year-old female with major depression who was referred for ECT. She experienced severe post-ECT agitation requiring medical intervention after all ECT treatments. Administering of oral amlodipine (5 mg) one hour before ECT treatment successfully prevented the occurrence of post-ECT agitation in this patient. We briefly discuss the possible underlying mechanisms and pathophysiology of amlodipine in the prevention of post-ECT agitation.

  1. Amlodipine and the Successful Management of Post-Electroconvulsive Therapy Agitation

    Directory of Open Access Journals (Sweden)

    Ali Shahriari

    2016-01-01

    Full Text Available Electroconvulsive therapy (ECT is a highly effective nonpharmacologic treatment for the management of depression and some other psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness, irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to serious and severe forms requiring prompt medical intervention to protect the patient and the medical staff. In severe agitation medical management may be necessary which consists of using sedative agents, either benzodiazepines or propofol. The side-effects of these sedative agents, especially in the elderly population, necessitate finding ways that could help the prevention of the occurrence of agitation after ECT treatments. We report a 68-year-old female with major depression who was referred for ECT. She experienced severe post-ECT agitation requiring medical intervention after all ECT treatments. Administering of oral amlodipine (5 mg one hour before ECT treatment successfully prevented the occurrence of post-ECT agitation in this patient. We briefly discuss the possible underlying mechanisms and pathophysiology of amlodipine in the prevention of post-ECT agitation.

  2. Nitrous oxide (laughing gas) inhalation as an alternative to electroconvulsive therapy.

    Science.gov (United States)

    Milne, Brian

    2010-05-01

    Electroconvulsive therapy (ECT) is used widely in the treatment of psychiatric conditions; however, its use is not without controversy with some recommending a moratorium on its clinical use. Complications and side effects of ECT include memory loss, injury, problems originating from sympathetic stimulation such as arrhythmias and myocardial ischemia and the risk of general anesthesia. Nitrous oxide (laughing gas) could potentially substitute for ECT as it shares some similar effects, has potential beneficial properties for these psychiatric patients and is relatively safe and easy to administer. Nitrous oxide induces laughter which has been described as nature's epileptoid catharsis which one might surmise would be beneficial for depression. It also produces a central sympathetic stimulation similar to ECT and causes release of endogenous opioid peptides, which are potential candidates for the development of antidepressant drugs. Nitrous oxide is also associated with seizure like activity itself. Administration of nitrous oxide as a substitute for ECT is eminently feasible and could be given in a series of treatments similar to ECT therapy.

  3. Measuring retrograde autobiographical amnesia following electroconvulsive therapy: historical perspective and current issues.

    Science.gov (United States)

    Semkovska, Maria; McLoughlin, Declan M

    2013-06-01

    Retrograde amnesia following electroconvulsive therapy (ECT) is a major concern for both patients and clinicians. In contemporary ECT research, retrograde autobiographical amnesia (RAA) is commonly measured with instruments assessing autobiographical memory (AM) consistency over time. However, normal AM recall loses in consistency with the passage of time, and time has a differential effect on stability of personal memories. In addition, experiencing depression is associated with a decreased ability to recall specific AMs, and this difficulty may persist in the euthymic phase of recurrent depression. Despite these scientific facts, relatively few attempts have been made to accurately measure the specific effect of ECT on AM independent of both normal and mood-associated forgetting over time. This major gap in our knowledge prevents us at present from objectively quantifying the nature and extent of RAA associated with ECT. In turn, this hinders our identifying and implementing strategies for prevention or remediation of AM deficits. The present article aims to provide an up-to-date review and historical perspective of this major methodological conundrum for ECT research, highlight current issues in retrograde amnesia assessment following ECT, and propose directions for future studies. In conclusion, we suggest methods to reliably and specifically measure the extent and progression over time of ECT-associated RAA independently from persistent depressive symptoms' contribution and normal loss in AM consistency over time.

  4. Comparison of clinical efficacy and side effects for bitemporal and bifrontal electrode placement in electroconvulsive therapy.

    Science.gov (United States)

    Bakewell, Catherine J; Russo, Joan; Tanner, Craig; Avery, David H; Neumaier, John F

    2004-09-01

    Bifrontal (BF) placement of electrodes in electroconvulsive therapy (ECT) has become a popular alternative to bitemporal (BT) placement. This study compares the clinical efficacy, side effects, and rehospitalization rates of BT and BF electrode placement in a community hospital setting. Charts from 76 patients receiving ECT treatments at Harborview Medical Center from 1994 to 2000 were reviewed to extract data on the characteristics of the course of ECT, clinical response, total headaches, narcotic and nonsteroidal anti-inflammatory drug doses, as well as documentation of confusion, disorientation, memory loss, and treatment emergent need for assistance with activities of daily living. The BT patients experienced more clinical improvement during their stay (a 7-point greater change in Psychiatric Symptom Assessment Scale score, P < 0.05) and were significantly less likely to be rehospitalized within a 1-year time frame (odds ratio = 4.9, P = <0.05), even after controlling for relevant covariates. Although the two patient groups had equal rates of headache and analgesic administration, the BT placement caused significantly more cognitive impairment. This study suggests that BT electrode placement offers better efficacy but modestly greater cognitive impairment than BF electrode placement.

  5. Comparing bilateral to unilateral electroconvulsive therapy in a randomized study with EEG monitoring.

    Science.gov (United States)

    Horne, R L; Pettinati, H M; Sugerman, A A; Varga, E

    1985-11-01

    In a double-blind study, 48 DSM-III depressed patients were randomly assigned to either the bilateral or nondominant unilateral electroconvulsive therapy (ECT) group. Seizure length was monitored by electroencephalography (EEG). When seizures were less than 25 s, ECT was immediately readministered. When length of seizure and pretreatment depression scores were controlled between the two groups, there were no differences in treatment effectiveness, as measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory, or in the number of treatments required. This was true after five ECT treatments as well as after completing all ECT treatments. Thus, when ECT is monitored via EEG to assure the presence of an adequate seizure, bilateral and nondominant unilateral placement yield equivalent responses. If ECT had not been readministered immediately following a missed seizure, unilateral patients would have had significantly more missed seizures. Significant difficulties in both short- and long-term memory were found 24 hours after the fifth ECT in bilateral but not in nondominant unilateral patients. No apparent memory loss could be documented in nondominant unilateral ECT.

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

    Science.gov (United States)

    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.

  7. Rocuronium-sugammadex use for electroconvulsive therapy in a hemodialysis patient: a case report.

    Science.gov (United States)

    Kurita, Shigeaki; Moriwaki, Katsuyuki; Shiroyama, Kazuhisa; Sanuki, Mikako; Toyota, Yukari; Takebayashi, Minoru

    2016-01-01

    Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions for severe major depression. In the initial eight sessions, we tested the feasibility of rocuronium-sugammadex use for ECT. During the series of four ECT sessions, we measured plasma concentrations for the sum of sugammadex and sugammadex-rocuronium complex and observed whether possible residual sugammadex affected muscle relaxation during subsequent sessions of ECT. The results showed the feasibility of rocuronium-sugammadex use as muscle relaxants for ECT in patients undergoing hemodialysis. However, an accumulation of sugammadex did occur even after two sessions of hemodialysis, and residual sugammadex decreased the effect of the rocuronium given in the subsequent ECT sessions. Rocuronium-sugammadex was successfully utilized as muscle relaxants for ECT in this patient. Our experience in this case may indicate that if succinylcholine is contraindicated, rocuronium-sugammadex can be an alternative method for muscle relaxation during ECT in patients undergoing hemodialysis. When this rocuronium-sugammadex procedure is used, the effect of residual sugammadex after hemodialysis on the subsequently administered rocuronium should be considered.

  8. Knowledge of and attitudes toward electroconvulsive therapy among medical students, psychology students, and the general public.

    Science.gov (United States)

    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.

  9. Neuroversion: using electroconvulsive therapy as a bridge to deep brain stimulation implantation.

    Science.gov (United States)

    Williams, Nolan R; Sahlem, Greg; Pannu, Jaspreet; Takacs, Istvan; Short, Baron; Revuelta, Gonzalo; George, Mark S

    2017-02-01

    Parkinson's disease (PD) is a movement disorder with significant neuropsychiatric comorbidities. Electroconvulsive therapy (ECT) is effective in treating these neuropsychiatric symptoms; however, clinicians are reluctant to use ECT in patients with deep brain stimulation (DBS) implantations for fear of damaging the device, as well as potential cognitive side effects. Right unilateral ultra-brief pulse (RUL UBP) ECT has a more favorable cognitive side-effect profile yet has never been reported in PD patients with DBS implants. We present a case series of three patients with a history of PD that all presented with psychiatric decompensation immediately prior to planned DBS surgery. All three patients had DBS electrode(s) in place at the time and an acute course of ECT was utilized in a novel method to "bridge" these individuals to neurosurgery. The patients all experienced symptom resolution (psychosis and/or depression and/or anxiety) without apparent cognitive side effects. This case series not only illustrates that right unilateral ultra-brief pulse can be utilized in patients with DBS electrodes but also illustrates that this intervention can be utilized as a neuromodulatory "bridge", where nonoperative surgical candidates with unstable psychiatric symptoms can be converted to operative candidates in a manner similar to electrical cardioversion.

  10. Effects of Electroconvulsive Therapy on Thyroid Function Parameters in Depressed Patients

    Directory of Open Access Journals (Sweden)

    M Akbari

    2008-10-01

    Full Text Available Introduction: A considerable portion of patients with depressive disorders do not respond properly to medical treatment and need Electroconvulsive therapy (ECT. On the other hand, as some beneficial effects of ECT are attributed to increase in thyroid hormones, levothyronin is used as an adjuvant prior to ECT. The aim of this study was to evaluate thyroid function changes after ECT. Methods: This was an out come study done on depressed patients attending the psychiatric clinic who were resistant to medical therapy and therefore candidates for ECT. Blood samples were drawn before the first and the last ECT and serum levels of T3, T4, T3RU and TSH were measured. Results: Thirty-one patients (19 males and 12 females were enrolled the study. Serum levels of T3 and T3RU significantly increased by ECT (p-values of 0.0001 and 0.029, respectively. T3 increased in all 31 patients and this was true for both genders and all age groups and also for various durations of depression, but T4 and TSH levels decreased significantly (p-values of 0.025 and 0.0001, respectively. Conclusion: Our findings showed that some effects of ECT may be primarily due to increased T3 levels and other parameters change accordingly. These findings need to be confirmed by further studies

  11. Routine Cross-Sectional Head Imaging Before Electroconvulsive Therapy: A Tertiary Center Experience.

    Science.gov (United States)

    Sajedi, Payam I; Mitchell, Jason; Herskovits, Edward H; Raghavan, Prashant

    2016-04-01

    Electroconvulsive therapy (ECT) is generally contraindicated in patients with intracranial mass lesions or in the presence of increased intracranial pressure. The purpose of this study was to determine the prevalence of incidental abnormalities on routine cross-sectional head imaging, including CT and MRI, that would preclude subsequent ECT. This retrospective study involved a review of the electronic medical records of 105 patients (totaling 108 imaging studies) between April 27, 2007, and March 20, 2015, referred for cranial CT or MRI with the primary indication of pre-ECT evaluation. The probability of occurrence of imaging findings that would preclude ECT was computed. A cost analysis was also performed on the practice of routine pre-ECT imaging. Of the 105 patients who presented with the primary indication of ECT clearance (totaling 108 scans), 1 scan (0.93%) revealed findings that precluded ECT. None of the studies demonstrated findings that indicated increased intracranial pressure. A cost analysis revealed that at least $18,662.70 and 521.97 relative value units must be expended to identify one patient with intracranial pathology precluding ECT. The findings of this study demonstrate an extremely low prevalence of findings that preclude ECT on routine cross-sectional head imaging. The costs incurred in identifying a potential contraindication are high. The authors suggest that the performance of pre-ECT neuroimaging be driven by the clinical examination. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Improvement in verbal memory performance in depressed in-patients after treatment with electroconvulsive therapy.

    Science.gov (United States)

    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. Unilateral ultra-brief pulse electroconvulsive therapy for depression in Parkinson's disease.

    Science.gov (United States)

    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.

  14. Electroconvulsive therapy and its relationships with clinical characteristics and quality of life in Chinese psychiatric patients.

    Science.gov (United States)

    An, Feng-Rong; Zhang, Ling; Zhang, Qing-E; Ungvari, Gabor S; Ng, Chee H; Chiu, Helen F K; Wu, Ping-Ping; Jin, Xin; Li, Lu; Lok, Grace K I; Xiang, Yu-Tao

    2016-12-30

    Little is known about the pattern of electroconvulsive therapy (ECT) use in the clinical population in China. This study examined the percentage of ECT use and its association with clinical characteristics and quality of life (QOL) in a psychiatric center in China that caters for a population of 20 million. A total sample of 1364 inpatients was consecutively recruited for the study. Demographic and clinical data including the use of ECT were collected. Psychopathology, activity of daily living and QOL were measured using standardized instruments. The percentage of ECT use was 52.1% in the whole sample; 53.4% in major depression, 57.8% in bipolar disorder, 57.0% in schizophrenia and 32.4% in other diagnoses. There was no significant difference between the ECT and non-ECT groups in any domain of QOL. Multivariate analyses revealed that ECT was independently associated with the diagnoses of major depression, bipolar disorder and schizophrenia, physical restraint, severe aggression, better activity of daily living skills, more frequent use of antipsychotics and less frequent use of benzodiazepines. The percentage of ECT use was much greater in a major psychiatric center in China than those reported from other parts of the world. Use of ECT had no influence on the short-term QOL. Further investigations are warranted to explore the reasons for the high percentage of ECT use. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Pattern of electroconvulsive therapy use in Spain: Proposals for an optimal practice and equitable access.

    Science.gov (United States)

    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.

  16. 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.

  17. 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.

  18. 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’stherapy. 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

  19. Effectiveness of electroconvulsive therapy in patients with treatment resistant schizophrenia: A retrospective study.

    Science.gov (United States)

    Grover, Sandeep; Chakrabarti, Subho; Hazari, Nandita; Avasthi, Ajit

    2017-03-01

    This study aimed to evaluate the effectiveness of electroconvulsive therapy (ECT) among patients with treatment resistant schizophrenia (TRS). Records of patients who had received ECT were reviewed to identify patients with TRS who were administered ECT in combination with clozapine. Socio-demographic, clinical data and ECT details were extracted. The most common diagnosis was of paranoid schizophrenia (49%) followed by undifferentiated schizophrenia (36%). A-fifth (22%) of the patients were judged to have poor response to clozapine. The mean number of ECTs given were 13.97 (SD-7.67) and mean clozapine dose was 287.5mgs/day (SD-100.1). About two-thirds (63%) of the patients showed >30% reduction in scores on different symptom-rating scales with combined use of clozapine and ECT. Among clozapine non-responders, approximately 69% responded to the combination. Post-ECT rise in blood pressure was the most common side effect (16.9%) followed by prolonged seizures (7%). Long-term follow-up data was available for 47 out of the 59 patients. More than two-third (N=34; 72%) followed-up for an average of 30 months (SD 32.3; range: 1-120), maintained well with continued clozapine treatment. To conclude, results of this study further endorse the effectiveness, safety and long-term benefits of the clozapine-ECT combination in TRS and clozapine-refractory schizophrenia. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. I had no other option: Women, electroconvulsive therapy, and informed consent.

    Science.gov (United States)

    Clarke, Karen-Ann; Barnes, Margaret; Ross, Dyann

    2018-06-01

    Electroconvulsive therapy (ECT) is a controversial procedure used in the management of depression. Whilst it may be administered under mental health legislation, it is usually given to people who voluntarily consent. At the practice level, the consent process for ECT requires a detailed explanation of the procedure. The person consenting must have capacity to make this decision, and consent must be given freely and without coercion. Research using a feminist narrative approach unexpectedly highlighted the issue of potential coercion in the context of explaining the procedure. In-depth interviews were used to understand seven women's accounts of deciding to receive ECT. A thematic analysis of their narratives uncovered a shared concern with how they consented to the treatment. Four subthemes were identified that related to the way in which they provided their consent: (i) 'Not enough information'; (ii) 'I had no other choice'; (iii) 'Just go along with it'; and (iv) 'Lacking capacity'. A consent process that includes elements of passive coercion and a lack of timely and appropriate information influences the way some women make decisions. These factors can disempower women at the point of decision-making. A practice shift is needed where women are enabled to have control over decisions. Further, there is a need to adhere more rigorously to noncoercive practice when obtaining consent. © 2017 Australian College of Mental Health Nurses Inc.

  2. Electroconvulsive therapy and risk of dementia in patients with affective disorders

    DEFF Research Database (Denmark)

    Osler, Merete; Rozing, Maarten Pieter; Christensen, Gunhild Tidemann

    2018-01-01

    included in the study, 5901 (3·5%) patients had at least one ECT. During the median follow-up of 4·9 years (IQR 2·4-7·8) and 872 874 person years, the number of patients who developed dementia was 111 (0·1%) of 99 045 patients aged 10-49 years, 965 (2·7%) of 35 945 aged 50-69 years, and 4128 (12·5%) of 33...... 025 aged 70-108 years. 217 (3·6%) of the 5901 patients treated with ECT developed dementia, whereas of 162 114 patients not treated with ECT 4987 (3·1%) developed dementia. The corresponding incidences were 70·4 cases per 10 000 person-years (95% CI 61·6-80·5) and 59·2 per 10 000 person-years (57......BACKGROUND: Electroconvulsive therapy (ECT) is the most effective treatment for severe episodes of mood disorders. Temporary memory loss is a common side-effect, but ongoing discussions exist regarding potential long-term adverse cognitive outcomes. Only a few studies have examined the frequency...

  3. Are morphological changes necessary to mediate the therapeutic effects of electroconvulsive therapy?

    Science.gov (United States)

    Nickl-Jockschat, Thomas; Palomero Gallagher, Nicola; Kumar, Vinod; Hoffstaedter, Felix; Brügmann, Elisabeth; Habel, Ute; Eickhoff, Simon B; Grözinger, Michael

    2016-04-01

    The neurotrophic hypothesis has become the favorite model to explain the antidepressant properties of electroconvulsive therapy (ECT). It is based on the assumption that a restoration of previously defective neural networks drives therapeutic effects. Recent data in rather young patients suggest that neurotrophic effects of ECT might be detectable by diffusion tensor imaging. We here aimed to investigate whether the therapeutic response to ECT necessarily goes along with mesoscopic effects in gray matter (GM) or white matter (WM) in our patients in advanced age. Patients (n = 21, 15 males and 7 females) suffering from major depressive disorder were treated with ECT. Before the start of treatment and after the completion of the index series, they underwent magnetic resonance imaging, including a diffusion-weighed sequence. We used voxel-based morphometry to assess GM changes and tract-based spatial statistics and an SPM-based whole-brain analysis to detect WM changes in the course of treatment. Patients significantly improved clinically during the course of ECT. This was, however, not accompanied by GM or WM changes. This result challenges the notion that mesoscopic brain structure changes are an obligatory prerequisite for the antidepressant effects of ECT.

  4. Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital

    Directory of Open Access Journals (Sweden)

    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.

  5. Antidepressant and neurocognitive effects of isoflurane anesthesia versus electroconvulsive therapy in refractory depression.

    Directory of Open Access Journals (Sweden)

    Howard R Weeks

    Full Text Available Many patients have serious depression that is nonresponsive to medications, but refuse electroconvulsive therapy (ECT. Early research suggested that isoflurane anesthesia may be an effective alternative to ECT. Subsequent studies altered drug, dose or number of treatments, and failed to replicate this success, halting research on isoflurane's antidepressant effects for a decade. Our aim was to re-examine whether isoflurane has antidepressant effects comparable to ECT, with less adverse effects on cognition.Patients with medication-refractory depression received an average of 10 treatments of bifrontal ECT (n = 20 or isoflurane (n = 8 over 3 weeks. Depression severity (Hamilton Rating Scale for Depression-24 and neurocognitive responses (anterograde and retrograde memory, processing speed and verbal fluency were assessed at Pretreatment, Post all treatments and 4-week Follow-up.Both treatments produced significant reductions in depression scores at Post-treatment and 4-week Follow-up; however, ECT had modestly better antidepressant effect at follow-up in severity-matched patients. Immediately Post-treatment, ECT (but not isoflurane patients showed declines in memory, fluency, and processing speed. At Follow-up, only autobiographical memory remained below Pretreatment level for ECT patients, but isoflurane patients had greater test-retest neurocognitive score improvement.Our data reconfirm that isoflurane has an antidepressant effect approaching ECT with less adverse neurocognitive effects, and reinforce the need for a larger clinical trial.

  6. Clinically insubstantial cognitive side effects of bitemporal electroconvulsive therapy at 0.5 msec pulse width.

    Science.gov (United States)

    Warnell, Ronald L; Swartz, Conrad M; Thomson, Alice

    2011-11-01

    We measured cognitive side effects from bitemporal electroconvulsive therapy (ECT) using stimuli of 0.5 msec pulse width 900 milliamperes (mA). Mini-Mental State Exam (MMSE) and 21-item Hamilton Rating Scale for Depression (HRSD-21) were rated within 36 hours before and 36 hours after a series of 6 bitemporal ECT sessions on 15 patients age ≥45. MMSE remained high after ECT (pre-ECT mean 29, standard deviation [SD] 1.60, post-ECT mean 28.53, SD 1.36) with no significant change. The mean HRSD-21 fell from 27.5 to 16.3. Post-ECT MMSE was significantly and markedly higher than in previous studies of bitemporal ECT; all had used ECT stimuli of pulse width at least 1 msec. With stimuli of 0.5 msec pulse width and 900 mA, 6 bitemporal ECTs did not decrease MMSE score. This result leaves no opportunity for further decrease in basic cognitive side effects, and complements published reports of stronger physiological effects with stimuli of 0.5 msec pulse width and 900 mA. ECT stimuli of 0.5 msec pulse width and 900 mA are more desirable than wider pulse widths. Six bitemporal ECT sessions using these stimuli generally will not have more cognitive side effects than treatments with other placements, allowing maintenance of full efficacy with clinically insubstantial side effects.

  7. Adjustable Shock Absorbers

    OpenAIRE

    Adamiec, Radek

    2012-01-01

    Bakalářská práce obsahuje přehled používaných tlumičů osobních automobilů, závodních automobilů a motocyklů. Jsou zde popsány systémy t lumením, konstrukce tlumičů a vidlic používaných u motocyklů. Dále je zde přehled prvků používaných u podvozků automobilů. This bachelor´s thesis contains the survey of the shock absorbers of passenger cars, racing cars and motorcycles. Are described damping systems, the design used shock absorbers and forks for motorcycles. Then there is the list of the e...

  8. Radiative relativistic shock adiabate

    International Nuclear Information System (INIS)

    Tsintsadze, L.N.; Nishikawa, K.

    1997-01-01

    The influences of thermal radiation on the state equation of shock waves, derived in the previous paper [L. N. Tsintsadze, Phys. Plasmas 2, 4462 (1995)], are studied and a series of relations of thermodynamic quantities that hold for shock waves are derived. It is shown that the presence of radiation can strongly change the compressibility of the plasma. It is well known that for polytropic gases the compressibility cannot change more than four times the initial value in the case of nonrelativistic temperatures. The numerical calculations show that there are no such restrictions, when the radiation energy exceeds the kinetic energy of the plasma. The ultrarelativistic temperature range is also covered in our numerical calculations. Also studied are the influences of the radiation on the PT and the TV diagrams. A significant modification due to radiation is found in every case studied. copyright 1997 American Institute of Physics

  9. POSTURAL SHOCK IN PREGNANCY

    Science.gov (United States)

    Wilkening, Ralph L.; Knauer, John; Larson, Roger K.

    1955-01-01

    Signs and symptoms of shock may be produced in some patients in late pregnancy by putting them in the dorsal recumbent posture. Change from this position will relieve the condition. The features of the supine hypotensive syndrome can be duplicated by applying pressure to the abdomen with the patient in a lateral position. The postural variations of venous pressure, blood pressure, and pulse appear to be due to obstruction of venous return from the lower portion of the body caused by the large uterus of late pregnancy compressing the vena cava. When shock is observed in a woman in late pregnancy, she should be turned to a lateral position before more active measures of treatment are begun. ImagesFigure 1. PMID:14351983

  10. 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.

  11. Shock Isolation Elements Testing for High Input Loadings. Volume III. Mechanical Shock Isolation Elements.

    Science.gov (United States)

    SHOCK ABSORBERS ), (*GUIDED MISSILE SILOS, SHOCK ABSORBERS ), (*SPRINGS, (*SHOCK(MECHANICS), REDUCTION), TORSION BARS, ELASTOMERS, DAMPING, EQUATIONS OF MOTION, MODEL TESTS, TEST METHODS, NUCLEAR EXPLOSIONS, HARDENING.

  12. Shock resistance testing

    International Nuclear Information System (INIS)

    Pouard, M.

    1984-03-01

    In the framework of mechanical tests and to answer the different requests for tests, the T.C.R (Transport Conditionnement et Retraitement) laboratory got test facilities. These installations allow to carry out tests of resistance to shocks, mainly at the safety level of components of nuclear power plants, mockups of transport casks for fuel elements and transport containers for radioactive materials. They include a tower and a catapult. This paper give a decription of the facilities and explain their operation way [fr

  13. On Modeling Risk Shocks

    OpenAIRE

    Dorofeenko, Victor; Lee, Gabriel; Salyer, Kevin; Strobel, Johannes

    2016-01-01

    Within the context of a financial accelerator model, we model time-varying uncertainty (i.e. risk shocks) through the use of a mixture Normal model with time variation in the weights applied to the underlying distributions characterizing entrepreneur productivity. Specifically, we model capital producers (i.e. the entrepreneurs) as either low-risk (relatively small second moment for productivity) and high-risk (relatively large second moment for productivity) and the fraction of both types is...

  14. The Shock Doctrine

    OpenAIRE

    Dionysios K. Solomos; Dimitrios N. Koumparoulis

    2011-01-01

    Naomi Klein attempts to redefine the economic history discovering the historical continuities and to reveal the neoliberal theory which functions via the utilization of specific “tools”. The state of shock is the key for the opponents of Chicago School and Milton Friedman in order for them to establish neoliberal policies and to promote the deregulated capitalism which includes less welfare state, less public sector, less regulation, weakened labor unions, privatizations and laissez-faire. Th...

  15. Electroconvulsive therapy in patients with skull defects or metallic implants: a review of the literature and case report.

    Science.gov (United States)

    Amanullah, Shabbir; Delva, Nicholas; McRae, Harold; Campbell, Laura A; Cole, Julie

    2012-01-01

    Head injury is often associated with psychiatric morbidity. While it is well understood that the loss of critical areas of the brain may play a role in cognitive dysfunction and change in personality, head injury can also have profound effects on mood and cognition. The role of medications in the treatment of mood disorders associated with brain injury is well documented, and there is also evidence favoring the use of electroconvulsive therapy (ECT) in this context. However, data are limited on the use of ECT in patients with skull defects or metallic head implants. First, a review of the literature on use of ECT in patients with metallic head implants is provided. Electronic databases and online sites, including PubMed, Cochrane Library of Systematic Reviews, and UpToDate, were used to search for relevant articles and case reports on the use of ECT in patients with and without metallic implants in the head (1964 to 2009). The search terms electroconvulsive, electroconvulsive therapy, ECT, electroshock therapy, EST, head injury, brain injury, metallic plates, metallic implants, skull prosthesis, and depression were used interchangeably. The search produced 7 articles discussing exclusively the use of ECT in patients with a metallic skull plate. Second, the case of the successful and safe use of ECT in an individual with a previous history of brain trauma and metallic plate implantation is described. Most cases of head injury are managed by neurologists and rehabilitation consultants; the more severe cases of depression and other mood disorders tend to be referred for specialist psychiatric care. With greater degrees of deficit following head injury, management becomes more complicated. Our patient showed positive results with ECT, including improvement in depressive features and resolution of suicidal ideas/plans. ECT is an effective and safe alternative in patients with a history of brain trauma and metallic plate implantation who subsequently develop treatment

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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...... of the important epigenetic marks associated with gene activation. We show increased H4Ac at the c-Fos promoter at 1 h post-ECS. Surprisingly, we also observed a significant increase in DNA methylation of the Arc gene promoter at 24 h post-ECS. DNA methylation, which is responsible for gene silencing, is a rather...

  1. Electroconvulsive therapy in geriatric patients: A literature review and program report from Virginia Commonwealth University, Richmond, Virginia, USA

    Directory of Open Access Journals (Sweden)

    Andrew D Snyder

    2017-01-01

    Full Text Available Electroconvulsive therapy (ECT is an effective therapeutic intervention in the elderly patients with major depression, especially those with psychosis, suicidality, catatonia, nutritional compromise, and resistance to medications. Response rates can be as high as 80%. We present an extensive review of the relevant literature, provide a description of the ECT program at Virginia Commonwealth University in Richmond, Virginia, USA, and present results of our experience with ECT in fifty elderly patients. The treatments were safe, well tolerated, and produced high response rates, variably between 68% and 84%. Patients in the long-term maintenance ECT program continue to show sustained benefits from ECT.

  2. Evaluation of nonmemory cognitive parameters in psychiatric patients' pre- and post-electroconvulsive therapy: An observational study

    Directory of Open Access Journals (Sweden)

    Jyoti Prakash

    2015-01-01

    Full Text Available Introduction: Possibility of cognitive side effects has made electroconvulsive therapy (ECT questionable. Variable deficits have been debated in memory cognition. Pattern of changes in nonmemory cognition pre- and post-ECT is not clear. Methodology: Forty patients undergoing ECT were studied on nonmemory cognitive parameters before ECT, after a course of ECT, and after 4 weeks of last. ECT. Results: Nonmemory cognition improved during the course of ECT and over 4 weeks of ECT. Conclusions: ECT does not affect the nonmemory cognition adversely.

  3. The influence of the anesthesia-to-stimulation time interval on seizure quality parameters in electroconvulsive therapy

    DEFF Research Database (Denmark)

    Jorgensen, A; Christensen, S J; Jensen, A E K

    2018-01-01

    BACKGROUND: Electroconvulsive therapy (ECT) continues to be the most efficacious treatment for severe depression and other life-threatening acute psychiatric conditions. Treatment efficacy is dependent upon the induced seizure quality, which may be influenced by a range of treatment related factors....... Recently, the time interval from anesthesia to the electrical stimulation (ASTI) has been suggested to be an important determinant of seizure quality. METHODS: We measured ASTI in 73 ECT sessions given to 22 individual patients, and analyzed its influence on five seizure quality parameters (EEG seizure...

  4. Selfsimilar time dependent shock structures

    International Nuclear Information System (INIS)

    Beck, R.; Drury, L.O.

    1985-01-01

    Diffusive shock acceleration as an astrophysical mechanism for accelerating charged particles has the advantage of being highly efficient. This means however that the theory is of necessity nonlinear; the reaction of the accelerated particles on the shock structure and the acceleration process must be self-consistently included in any attempt to develop a complete theory of diffusive shock acceleration. Considerable effort has been invested in attempting, at least partially, to do this and it has become clear that in general either the maximum particle energy must be restricted by introducing additional loss processes into the problem or the acceleration must be treated as a time dependent problem (Drury, 1984). It is concluded that stationary modified shock structures can only exist for strong shocks if additional loss processes limit the maximum energy a particle can attain. This is certainly possible and if it occurs the energy loss from the shock will lead to much greater shock compressions. It is however equally possible that no such processes exist and we must then ask what sort of nonstationary shock structure develops. The same argument which excludes stationary structures also rules out periodic solutions and indeed any solution where the width of the shock remains bounded. It follows that the width of the shock must increase secularly with time and it is natural to examine the possibility of selfsimilar time dependent solutions

  5. Selfsimilar time dependent shock structures

    Science.gov (United States)

    Beck, R.; Drury, L. O.

    1985-01-01

    Diffusive shock acceleration as an astrophysical mechanism for accelerating charged particles has the advantage of being highly efficient. This means however that the theory is of necessity nonlinear; the reaction of the accelerated particles on the shock structure and the acceleration process must be self-consistently included in any attempt to develop a complete theory of diffusive shock acceleration. Considerable effort has been invested in attempting, at least partially, to do this and it has become clear that in general either the maximum particle energy must be restricted by introducing additional loss processes into the problem or the acceleration must be treated as a time dependent problem (Drury, 1984). It is concluded that stationary modified shock structures can only exist for strong shocks if additional loss processes limit the maximum energy a particle can attain. This is certainly possible and if it occurs the energy loss from the shock will lead to much greater shock compressions. It is however equally possible that no such processes exist and we must then ask what sort of nonstationary shock structure develops. The ame argument which excludes stationary structures also rules out periodic solutions and indeed any solution where the width of the shock remains bounded. It follows that the width of the shock must increase secularly with time and it is natural to examine the possibility of selfsimilar time dependent solutions.

  6. Film repeats in radiology department

    International Nuclear Information System (INIS)

    Suwan, A. Z.; Al-Shakharah, A. I

    1997-01-01

    During a one year period, 4910 radiographs of 55780 films were repeated. The objective of our study was to analyse and to classify the causes in order to minimize the repeats, cut the expenses and to provide optimal radiographs for accurate diagnosis. Analysis of the different factors revealed that, 43.6% of film repeats in our service were due to faults in exposure factors, centering comprises 15.9% of the repeats, while too much collimation was responsible for 7.6% of these repeats. All of which can be decreased by awareness and programmed training of technicians. Film blurring caused by patient motion was also responsible for 4.9% for radiographs reexamination, which can be minimized by detailed explanation to the patient and providing the necessary privacy. Fogging of X-Ray films by improper storage or inadequate handling or processing faults were responsible for 14.5% in repeats in our study. Methods and criteria for proper storage and handling of films were discussed. Recommendation for using modern day-light and laser processor has been high lighted. Artefacts are noticeably high in our cases, due to spinal dresses and frequent usage of precious metals for c osmotic purposes in this part of the world. The repeated films comprise 8.8% of all films We conclude that, the main factor responsible for repeats of up to 81.6% of cases was the technologists, thus emphasizing the importance of adequate training of the technologists. (authors). 15 refs., 9 figs., 1 table

  7. Nifty Nines and Repeating Decimals

    Science.gov (United States)

    Brown, Scott A.

    2016-01-01

    The traditional technique for converting repeating decimals to common fractions can be found in nearly every algebra textbook that has been published, as well as in many precalculus texts. However, students generally encounter repeating decimal numerals earlier than high school when they study rational numbers in prealgebra classes. Therefore, how…

  8. Repeated Prescribed Burning in Aspen

    Science.gov (United States)

    Donald A. Perala

    1974-01-01

    Infrequent burning weather, low flammability of the aspen-hardwood association, and prolific sprouting and seeding of shrubs and hardwoods made repeated dormant season burning a poor tool to convert good site aspen to conifers. Repeat fall burns for wildlife habitat maintenance is workable if species composition changes are not important.

  9. Tailored Buckling Microlattices as Reusable Light-Weight Shock Absorbers.

    Science.gov (United States)

    Frenzel, Tobias; Findeisen, Claudio; Kadic, Muamer; Gumbsch, Peter; Wegener, Martin

    2016-07-01

    Structures and materials absorbing mechanical (shock) energy commonly exploit either viscoelasticity or destructive modifications. Based on a class of uniaxial light-weight geometrically nonlinear mechanical microlattices and using buckling of inner elements, either a sequence of snap-ins followed by irreversible hysteretic - yet repeatable - self-recovery or multistability is achieved, enabling programmable behavior. Proof-of-principle experiments on three-dimensional polymer microstructures are presented. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  10. Tevatron serial data repeater system

    International Nuclear Information System (INIS)

    Ducar, R.J.

    1981-01-01

    A ten megabit per second serial data repeater system has been developed for the 6.28km Tevatron accelerator. The repeaters are positioned at each of the thirty service buildings and accommodate control and abort system communications as well as distribution of the Tevatron time and energy clocks. The repeaters are transparent to the particular protocol of the transmissions. Serial data are encoded locally as unipolar two volt signals employing the self-clocking Manchester Bi-Phase code. The repeaters modulate the local signals to low-power bursts of 50 MHz rf carrier for the 260m transmission between service buildings. The repeaters also demodulate the transmission and restructure the data for local utilization. The employment of frequency discrimination techniques yields high immunity to the characteristic noise spectrum

  11. All-photonic quantum repeaters

    Science.gov (United States)

    Azuma, Koji; Tamaki, Kiyoshi; Lo, Hoi-Kwong

    2015-01-01

    Quantum communication holds promise for unconditionally secure transmission of secret messages and faithful transfer of unknown quantum states. Photons appear to be the medium of choice for quantum communication. Owing to photon losses, robust quantum communication over long lossy channels requires quantum repeaters. It is widely believed that a necessary and highly demanding requirement for quantum repeaters is the existence of matter quantum memories. Here we show that such a requirement is, in fact, unnecessary by introducing the concept of all-photonic quantum repeaters based on flying qubits. In particular, we present a protocol based on photonic cluster-state machine guns and a loss-tolerant measurement equipped with local high-speed active feedforwards. We show that, with such all-photonic quantum repeaters, the communication efficiency scales polynomially with the channel distance. Our result paves a new route towards quantum repeaters with efficient single-photon sources rather than matter quantum memories. PMID:25873153

  12. Repeatability of visual acuity measurement.

    Science.gov (United States)

    Raasch, T W; Bailey, I L; Bullimore, M A

    1998-05-01

    This study investigates features of visual acuity chart design and acuity testing scoring methods which affect the validity and repeatability of visual acuity measurements. Visual acuity was measured using the Sloan and British Standard letter series, and Landolt rings. Identifiability of the different letters as a function of size was estimated, and expressed in the form of frequency-of-seeing curves. These functions were then used to simulate acuity measurements with a variety of chart designs and scoring criteria. Systematic relationships exist between chart design parameters and acuity score, and acuity score repeatability. In particular, an important feature of a chart, that largely determines the repeatability of visual acuity measurement, is the amount of size change attributed to each letter. The methods used to score visual acuity performance also affect repeatability. It is possible to evaluate acuity score validity and repeatability using the statistical principles discussed here.

  13. 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...

  14. Efficacy and cognitive side effects after brief pulse and ultrabrief pulse right unilateral electroconvulsive therapy for major depression: a randomized, double-blind, controlled study

    NARCIS (Netherlands)

    Spaans, H.P.; Verwijk, E.; Comijs, H.C.; Kok, R.M.; Sienaert, P.; Bouckaert, F.; Fannes, K.; Vandepoel, K.; Scherder, E.J.A.; Stek, M.L.; Kho, K.H.

    2013-01-01

    Objective: To compare the efficacy and cognitive side effects of high-dose unilateral brief pulse electroconvulsive therapy (ECT) with those of high-dose unilateral ultrabrief pulse ECT in the treatment of major depression. Method: From April 2007 until March 2011, we conducted a prospective,

  15. Relapse and long-term cognitive performance after brief pulse or ultrabrief pulse right unilateral electroconvulsive therapy: A multicenter naturalistic follow up

    NARCIS (Netherlands)

    Verwijk, E.; Spaans, H.P.; Comijs, H.C.; Kho, K.H.; Sienaert, P.; Bouckaert, F.; Obbels, J.; Scherder, E.J.A.; Stek, M.L.; Kok, R.M.

    2015-01-01

    Background Superior cognitive functioning for electroconvulsive therapy (ECT) with right unilateral (RUL) ultrabrief pulse (UBP) stimulation compared to RUL brief pulse (BP) stimulation is not clearly established and long-term data is needed. Methods We conducted a prospective naturalistic follow-up

  16. Risk shocks and housing markets

    OpenAIRE

    Dorofeenko, Viktor; Lee, Gabriel S.; Salyer, Kevin D.

    2010-01-01

    Abstract: This paper analyzes the role of uncertainty in a multi-sector housing model with financial frictions. We include time varying uncertainty (i.e. risk shocks) in the technology shocks that affect housing production. The analysis demonstratesthat risk shocks to the housing production sector are a quantitatively important impulse mechanism for the business cycle. Also, we demonstrate that bankruptcy costs act as an endogenous markup factor in housing prices; as a consequence, the volati...

  17. Thermal shock behaviour of mullite-bonded porous silicon carbide ceramics with yttria addition

    International Nuclear Information System (INIS)

    Ding Shuqiang; Zeng Yuping; Jiang Dongliang

    2007-01-01

    Thermal shock resistance of mullite (3Al 2 O 3 · 2SiO 2 )-bonded porous silicon carbide (SiC) ceramics with 3.0 wt% yttria (Y 2 O 3 ) addition was evaluated by a water-quenching technique. The thermal shock damage was investigated as a function of the quenching temperature, quenching cycles and specimen thickness. The residual flexural strength of the quenched specimens decreases with increasing quenching temperature and specimen thickness due to the larger thermal stress caused by thermal shock. However, quenching cycles at the temperature difference of 1200 deg. C have no effect on the residual strength since the same thermal stress was produced in repeated thermal shock processes. The good thermal shock damage resistance of the specimens is contributed mainly by the low strength and moderate elastic modulus. Moreover, the pores prevent the continuous propagation of cracks and alleviate further damage

  18. Health shocks and risk aversion.

    Science.gov (United States)

    Decker, Simon; Schmitz, Hendrik

    2016-12-01

    We empirically assess whether a health shock influences individual risk aversion. We use grip strength data to obtain an objective health shock indicator. In order to account for the non-random nature of our data regression-adjusted matching is employed. Risk preferences are traditionally assumed to be constant. However, we find that a health shock increases individual risk aversion. The finding is robust to a series of sensitivity analyses and persists for at least four years after the shock. Income changes do not seem to be the driving mechanism. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Shock in the emergency department

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren

    2016-01-01

    BACKGROUND: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED. METHODS: Population...... failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death. RESULTS: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100...

  20. Shock compression of diamond crystal

    OpenAIRE

    Kondo, Ken-ichi; Ahrens, Thomas J.

    1983-01-01

    Two shock wave experiments employing inclined mirrors have been carried out to determine the Hugoniot elastic limit (HEL), final shock state at 191 and 217 GPa, and the post-shock state of diamond crystal, which is shock-compressed along the intermediate direction between the and crystallographic axes. The HEL wave has a velocity of 19.9 ± 0.3 mm/µsec and an amplitude of 63 ± 28 GPa. An alternate interpretation of the inclined wedge mirror streak record suggests a ramp precursor wave and th...

  1. [Case report: electroconvulsive therapy in a 33-year-old man with hysterical quadriplegia].

    Science.gov (United States)

    Gaillard, A; Gaillard, R; Mouaffak, F; Radtchenko, A; Lôo, H

    2012-02-01

    Conversion disorder refers to the occurrence of neurological-like symptoms or deficits that are neither intentionally produced nor simulated. While it cannot be explained by an organic disease, it is often related to psychological events. We report the case of a 33-year-old patient with a fluctuating hysterical tetraplegia, which had started three years earlier. After the failure or the exhaustion of several biological (psychotropic medication, transcranial magnetic stimulation) and psychotherapeutic strategies, treatment with electroconvulsive therapy (ECT) was conducted. A total of thirty-five ECT sessions were performed. Whereas the patient's clinical state was initially characterized by a complete quadriplegia and an uncontrollable muscular hypertonia, we noted that the ECT sessions were associated with a slow, though remarkable, progress. At first, the sessions were followed by moments of altered consciousness during which the patient would be relaxed and could make simple movements. Secondarily, not only was our patient able to consciously move his four limbs, but he was also able to walk. However, those improvements remained partial and fluctuating, sometimes allowing the symptom to return temporarily secondary to frustrations or annoyances. Finally, our patient relapsed. Nevertheless, his clinical state presently remains better than that in which we first knew him. The treatment of conversion disorders has been the subject of few studies and predominantly remains symptomatic. Its main goals are: to lessen secondary gains impact by adopting a neutral behaviour towards the symptom and by encouraging physical rehabilitation; to lower the symptom by allowing the patient to understand the normal functioning of the diseased organ, and; to help the patient to deal with stressful situations. There is no evidence that hypnosis is superior to medical and other psychotherapeutic approaches. Pharmacological treatments may be helpful in the case of anxiety, impulsivity

  2. A Shocking Solar Nebula?

    OpenAIRE

    Liffman, Kurt

    2009-01-01

    It has been suggested that shock waves in the solar nebula formed the high temperature materials observed in meteorites and comets. It is shown that the temperatures at the inner rim of the solar nebula could have been high enough over a sufficient length of time to produce chondrules, CAIs, refractory dust grains and other high-temperature materials observed in comets and meteorites. The solar bipolar jet flow may have produced an enrichment of 16O in the solar nebula over time and the chond...

  3. Myths of "shock therapy".

    Science.gov (United States)

    Fink, M

    1977-09-01

    The author discusses the myths of the ECT process--that shock and the convulsion are essential, memory loss and brain damage are inescapable, and little is known of the process--and assesses the fallacies in these ideas. Present views of the ECT process suggest that its mode of action in depression may best be described as a prolonged form of diencephalic stimulation, particularly useful to affect the hypothalamic dysfunctions that characterize depressive illness. The author emphasizes the need for further study of this treatment modality and for self-regulation by the profession.

  4. 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

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

    Science.gov (United States)

    Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice

    2010-09-01

    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. We report a case of a 45-year-old man with a 5-year history of MCS who had to quit his job to live a solitary life without his wife and children because of the condition. The patient had no history of psychiatric illness and no signs of clinical depression at treatment start. Over a 3-week period, he underwent a course of 8 ECTs, giving a remarkable effect on symptom severity and social functional level. After a partial symptom relapse, maintenance treatment was started with 1 ECT every second week. No memory impairment or other complications of ECT were reported at the 4-month follow-up. In this case, a substantial, positive effect on symptom severity and social disability related to MCS was obtained by an initial ECT course and maintenance treatment. Electroconvulsive therapy should be considered an option in severe and socially disabling MCS, but more studies are needed to evaluate if ECT can be recommended as a treatment in MCS.

  6. [Computer modelling of electroconvulsive treatment and transcranial magnetic stimulation--an explanation of poor efficacy of the magnetic method].

    Science.gov (United States)

    Zyss, Tomasz; Krawczyk, Andrzej; Zieba, Andrzej; Dudek, Dominika; Hese, Robert T; Drzymała, Paweł; Wiak, Sławomir; Sawicki, Bartosz; Starzyński, Jacek; Szmurło, Robert; Wincenciak, Stanisław

    2010-01-01

    With help of informatics technology it is possible to simulate various physiological processes in virtual models of biological structures. In a created realistic model of the human head we made some comparative investigations over physical phenomena accompanying the electroconvulsive treatment ECT and transcranial magnetic stimulation TMS--two methods with confirmed (ECT) or presumable (TMS) antidepressant efficacy. The present investigations are a continuation of the earlier conducted study in the simple spherical model of the head. Investigations confirmed, that magnetic stimulation TMS generates a considerably weaker current flow in the brain than it is present in electroconvulsive technique. Applying of such weak stimulation in modus,,at haphazard", i.e. on the brain area which does not need to be metabolically disturbed in this patient--cannot cause an antidepressant effect at all. The results of the investigations explain not only the safety of the magnetic method, but the weak effectiveness of this method. The authors propose some methods for improvement of TMS efficacy.

  7. Episodic Visual Learning/Memory and Attentional Flexibility in Patients With Major Depressive Disorder After Clinically Effective Electroconvulsive Therapy.

    Science.gov (United States)

    Kalogerakou, Stamatina; Oulis, Panagiotis; Anyfandi, Eleni; Konstantakopoulos, George; Papakosta, Vasiliki-Maria; Kontis, Dimitrios; Theochari, Eirini; Angelopoulos, Elias; Zervas, Ioannis M; Mellon, Robert C; Papageorgiou, Charalambos C; Tsaltas, Eleftheria

    2015-12-01

    This study is a follow-up of a previous one reporting that the neuropsychological profile of pharmacoresistant patients with major depressive disorder referred for electroconvulsive therapy (ECT, ECT group) contrasted with that of their pharmacorespondent counterparts (NECT group). The NECT group exhibited severe visuospatial memory and minor executive deficits; the ECT group presented the reverse pattern. In that same ECT group, the current follow-up study examined the effects of clinically effective ECT on both cognitive domains 2 months later. Fifteen ECT patients were administered Hamilton Depression (HAMD-24), Hamilton Anxiety (HAMA), Mini-Mental State Examination Scales and 5 tests of Cambridge Neuropsychological Test Automated Battery at intake (pre-ECT), end of ECT course (post-ECT), and 2 months thereafter (follow-up). Electroconvulsive therapy was effective in relieving clinical depression. After a post-ECT decline, the patients exhibited significant improvement in both Cambridge Neuropsychological Test Automated Battery, paired associate learning, and Stockings of Cambridge. By contrast, their major pre-ECT deficit in intra/extradimensional set shifting remained virtually unaffected. Our findings suggest that attentional flexibility deficits may constitute a neuropsychological trait-like feature of pharmacoresistant, ECT-referred major depressive disorder patients. However, this deficit does not seem generalized, given patient improvement in episodic visual learning/memory and some indication of improvement in spatial planning after ECT.

  8. Increased BDNF levels after electroconvulsive therapy in patients with major depressive disorder: A meta-analysis study.

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    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.

  9. Successful switch from bilateral brief pulse to right unilateral ultrabrief pulse electroconvulsive therapy after failure to induce seizures

    Directory of Open Access Journals (Sweden)

    Kawashima H

    2018-02-01

    Full Text Available Hirotsugu Kawashima,1 Yuko Kobayashi,1 Taro Suwa,2 Toshiya Murai,2 Ryuichi Yoshioka1 1Department of Psychiatry, Toyooka Hospital, Toyooka, Hyogo, Japan; 2Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan Abstract: Inducing adequate therapeutic seizures during electroconvulsive therapy (ECT is sometimes difficult due to a high seizure threshold, even at the maximum stimulus charge. Previous studies have demonstrated that seizure threshold is lower in patients treated with right unilateral ultrabrief pulse (RUL-UBP ECT than in those treated with bilateral or brief pulse (BL-BP ECT. Therefore, switching to RUL-UBP ECT may be beneficial for patients in whom seizure induction is difficult with conventional ECT. In the present report, we discuss the case of a patient suffering from catatonic schizophrenia in whom BL-BP ECT failed to induce seizures at the maximum charge. However, RUL-UBP ECT successfully elicited therapeutic seizures and enabled the patient to achieve complete remission. This case illustrates that, along with other augmentation strategies, RUL-UBP ECT represents an alternative for seizure induction in clinical practice. Keywords: electroconvulsive therapy, augmentation, ultrabrief pulse, electrode placement, seizure threshold

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

    Science.gov (United States)

    Iancu, Iulian; Pick, Nimrod; Seener-Lorsh, Orit; Dannon, Pinhas

    2015-01-01

    While electroconvulsive therapy (ECT) has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M)-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning. We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years) with schizophrenia (n=16) or schizoaffective disorder (n=4) who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised. Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment). We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant. C/M-ECT is safe and effective for 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.

  11. Cognitive training to improve memory in individuals undergoing electroconvulsive therapy: Negative findings.

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    Choi, Jimmy; Wang, Yuanjia; Feng, Tianshu; Prudic, Joan

    2017-09-01

    Although electroconvulsive therapy (ECT) remains the most effective treatment for severe depression, some patients report persistent memory problems following ECT that impact their quality of life and their willingness to consent to further ECT. While cognitive training has been shown to improve memory performance in various conditions, this approach has never been applied to help patients regain their memory after ECT. In a double-blind study, we tested the efficacy of a new cognitive training program called Memory Training for ECT (Mem-ECT), specifically designed to target anterograde and retrograde memory that can be compromised following ECT. Fifty-nine patients with treatment-resistant depression scheduled to undergo ultra-brief right unilateral ECT were randomly assigned to either: (a) Mem-ECT, (b) active control comprised of nonspecific mental stimulation, or (c) treatment as usual. Participants were evaluated within one week prior to the start of ECT and then again within 2 weeks following the last ECT session. All three groups improved in global function, quality of life, depression, and self-reported memory abilities without significant group differences. While there was a decline in verbal delayed recall and mental status, there was no decline in general retrograde memory or autobiographical memory in any of the groups, with no significant memory or clinical benefit for the Mem-ECT or active control conditions compared to treatment as usual. While we report negative findings, these results continue to promote the much needed discussion on developing effective strategies to minimize the adverse memory side effects of ECT, in hopes it will make ECT a better and more easily tolerated treatment for patients with severe depression who need this therapeutic option. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Electroconvulsive Therapy for Agitation in Schizophrenia: Metaanalysis of Randomized Controlled Trials.

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    Gu, Xiaojing; Zheng, Wei; Guo, Tong; Ungvari, Gabor S; Chiu, Helen F K; Cao, Xiaolan; D'Arcy, Carl; Meng, Xiangfei; Ning, Yuping; Xiang, Yutao

    2017-02-25

    Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I 2 =0%, p =0.004) and its excitement sub-score (WMD=-1.97, p agitation related outcomes in schizophrenia patients. However, ECT alone or ECT-APs combination were associated with significant reduction in the PANSS total score. High-quality RCTs are needed to confirm the current interpretations.

  13. A dissociation between anterograde and retrograde amnesia after treatment with electroconvulsive therapy: a naturalistic investigation.

    Science.gov (United States)

    O'Connor, Margaret; Lebowitz, Brian K; Ly, Jenny; Panizzon, Matthew S; Elkin-Frankston, Seth; Dey, Sangeeta; Bloomingdale, Kerry; Thall, Mark; Pearlman, Chester

    2008-06-01

    The aim of the present study is to investigate the cumulative effects of a clinically determined course of electroconvulsive therapy (ECT) on anterograde and retrograde amnesia. In this study, mood and memory were examined in the context of a protocol driven by therapeutic response, rather than by preordained research criteria. Twenty-two patients with major depressive disorder and 18 nondepressed controls were taught a series of faces and names before the initiation of ECT, and their retention of this information was examined after the end of treatment. Anterograde (ie, new learning) and retrograde memory (ie, recall of information learned before ECT) were assessed. Eleven ECT patients underwent unilateral (UL) stimulation, and 11 had a combination of UL and bilateral stimulation. Major depressive disorder patients and nondepressed controls participants were matched according to baseline memory abilities. Unilateral and unilateral/bilateral (UB) ECT patients were matched according to baseline depression and memory abilities. Treatment with ECT resulted in a dissociation between anterograde and retrograde memory; after treatment, major depressive disorder patients demonstrated significant retrograde amnesia, whereas there was no change in their anterograde memory. Unilateral and UB ECT patients performed equally well on tasks of anterograde memory. Contrary to our expectation, UB ECT was not associated with greater retrograde memory loss than was UL ECT treatment. However, a trend toward a group difference was present on 1 memory measure. Results of the study suggest that a clinical course of ECT is associated with isolated impairment for information learned before treatment (ie, retrograde memory), whereas there was no effect of ECT on posttreatment learning abilities (ie, anterograde memory).

  14. Persistent genital arousal disorder (PGAD): case report of long-term symptomatic management with electroconvulsive therapy.

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    Korda, Joanna B; Pfaus, James G; Kellner, Charles H; Goldstein, Irwin

    2009-10-01

    This is the second case report of a woman with bipolar disorder type I who noted the onset of persistent genital arousal disorder (PGAD) symptoms after abrupt cessation of paroxetine. With the worsening of PGAD symptoms, she developed severe depression and suicidal thoughts, resulting in her undergoing electroconvulsive therapy (ECT) as management. To describe a case of PGAD and develop hypotheses to explain the beneficial actions of ECT on PGAD based on 4 years of ECT administration. Patient self-report after obtaining consent, as well as literature review. After the fourth ECT, the patient's PGAD symptoms abated serendipitously. She was placed on ECT on demand for the treatment of her PGAD. With each ECT treatment, PGAD symptoms immediately disappeared, relapsing slowly over time until the next ECT was administered. The patient has, thus far, received a total of 30 treatments of ECT. Side effects continue to be minimal and include brief short-term memory loss, headache, and muscle aches. ECT is known to induce cerebral excitatory and inhibitory neurotransmitter changes after acute and chronic administration. Sexual arousal is stimulated by the action of hypothalamic and limbic dopamine, noradrenaline, melanocortin, and oxytocin, and inhibited by serotonin, cerebral opioids, and endocannabinoids. Based on the patient's bipolar disorder, the mechanism of action of ECT and the observation of ECT effectiveness on her PGAD, we hypothesize the following: (i) bipolar disorder led to central hyperactive dopamine release, an important component in the pathophysiology of her PGAD; (ii) central serotonin deficiency after selective serotonin-reuptake inhibitor (SSRI) withdrawal resulted in a lack of inhibition of sexual excitement; (iii) ECT resulted in lowering of the hyperstimulated central dopamine release; and (iv) ECT led to an increase in sexual inhibition by stimulating serotonin activity. Further research in the central control of sexual arousal is needed.

  15. The effect of propofol-remifentanil anesthesia on selected seizure quality indices in electroconvulsive therapy.

    Science.gov (United States)

    Dinwiddie, Stephen H; Glick, David B; Goldman, Morris B

    2012-07-01

    Use of a short-acting opiate to potentiate anesthetic induction agents has been shown to increase seizure duration in electroconvulsive therapy (ECT), but little is known of the effect of this combination on indices of seizure quality. To determine whether anesthetic modality affects commonly provided indices of seizure quality. Twenty-five subjects were given propofol 2 mg/kg body weight for their first ECT session, at which time seizure threshold was titrated. Subjects thereafter alternated between that anesthetic regimen or propofol 0.5 mg/kg plus remifentanil 1 mcg/kg. Linear mixed models with random subject effect, adjusting for electrode placement, electrical charge, and number of treatments, were fit to estimate effect of anesthesia on seizure duration and several standard seizure quality indices (average seizure energy, time to peak electroencephalography (EEG) power, maximum sustained power, interhemispheric coherence, early and midictal EEG amplitude, and maximum sustained interhemispheric EEG coherence). Propofol-remifentanil anesthesia significantly lengthened seizure duration and was associated with longer time to reach maximal EEG power and coherence as well as maximal degree of interhemispheric EEG coherence. No effect was seen on early ictal amplitude or average seizure energy index. Propofol-remifentanil anesthesia prolongs seizure duration and has a significant effect on some, but not all, measures of seizure quality. This effect may be of some benefit in cases where adequate seizures are otherwise difficult to elicit. Varying anesthetic technique may allow more precise investigation of the relationships between and relative impacts of commonly used seizure quality indices on clinical outcomes and ECT-related cognitive side effects. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. 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.

  17. Seizure threshold and the half-age method in bilateral electroconvulsive therapy in Japanese patients.

    Science.gov (United States)

    Yasuda, Kazuyuki; Kobayashi, Kaoru; Yamaguchi, Masayasu; Tanaka, Koichi; Fujii, Tomokazu; Kitahara, Yuichi; Tamaoki, Toshio; Matsushita, Yutaka; Nunomura, Akihiko; Motohashi, Nobutaka

    2015-01-01

    Seizure threshold (ST) in electroconvulsive therapy (ECT) has not been reported previously in Japanese patients. We investigated ST in bilateral ECT in Japanese patients using the dose-titration method. The associations between demographic and clinical characteristics and ST were analyzed to identify the predictors of ST. Finally, the validity of the half-age method for the stimulus dose was evaluated. Fifty-four Japanese patients with mood disorder, schizophrenia, and other psychotic disorders received an acute course of bilateral ECT using a brief-pulse device. ST was determined at the first session using a fixed titration schedule. ST was correlated with age, sex, body mass index, history of previous ECT, and psychotropic drugs on multiple regression analysis. Furthermore, the rate of accomplished seizures was calculated using the half-age method. Mean ST was 136 mC. ST was influenced by age, sex, history of previous ECT, and medication with benzodiazepines. The accomplished seizure rate using the half-age method was 72%, which was significantly lower in men and subjects on benzodiazepines. ST in Japanese patients was equal to or slightly higher than that previously reported in other ethnic groups, which might be attributable, at least in part, to high prevalence of and large-dose benzodiazepine prescription. Higher age, male gender, no history of ECT, and benzodiazepines were related to higher ST. The half-age method was especially useful in female patients and subjects without benzodiazepine medication. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  18. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

    International Nuclear Information System (INIS)

    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

  19. Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression.

    Science.gov (United States)

    Liang, Chih-Sung; Chung, Chi-Hsiang; Ho, Pei-Shen; Tsai, Chia-Kuang; Chien, Wu-Chien

    2017-12-11

    Electroconvulsive therapy (ECT) has long been believed to reduce suicidal tendencies in patients with affective disorders; however, ECT recipients, who constitute the most severely ill and suicidal patients, are not eligible to participate in head-to-head randomized controlled trials. Large-scale studies are required to investigate the anti-suicidal effects of ECT vs psychopharmacotherapy. A nationwide retrospective cohort study design was used. Data were obtained from the Taiwan National Health Insurance Research Database. Inpatients with unipolar disorder or bipolar disorder who received ECT (n = 487) were observed from 1 January 2000 to 31 December 2013 for suicide events. The non-ECT control cohort consisted of inpatients with psychopharmacotherapy randomly matched (ratio, 1:4) by age, sex, and diagnosis. After potential confounds had been accounted for, the adjusted hazard ratio (HR) was 0.803, indicating that ECT recipients showed a 19.7% lower risk of suicide than control individuals. The stratum-specific adjusted HR was 0.79 in patients with unipolar disorder (P = .041) and 0.923 in patients with bipolar disorder (P = .254). Upon further stratification of the patients with bipolar disorder by their affective states, the adjusted HR was 0.805 (P = .046) for bipolar depression, 1.048 for bipolar mania (P = .538), and 0.976 for mixed bipolar state (P = .126). Compared with psychopharmacotherapy, ECT exerted superior anti-suicidal effects in patients with unipolar disorder and bipolar depression; however, there was a lack of superior anti-suicidal effects of ECT in the treatment of patients with bipolar mania and mixed state. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Maintenance Electroconvulsive Therapy in Severe Bipolar Disorder: A Retrospective Chart Review.

    Science.gov (United States)

    Santos Pina, Laura; Bouckaert, Filip; Obbels, Jasmien; Wampers, Martien; Simons, Wim; Wyckaert, Sabien; Sienaert, Pascal

    2016-03-01

    The aim of this study was to evaluate the effectiveness of continuation and maintenance electroconvulsive therapy (C/M-ECT) in patients with bipolar or schizoaffective disorder. We reviewed the charts of all patients diagnosed with a bipolar or schizoaffective disorder treated with C/M-ECT from August 2009 until December 2013. We gathered demographic data and treatment variables (electrode placement, stimulus dose, and concomitant use of medication; number of C/M-ECT sessions; and number of new ECT courses). Primary outcome measure was the number of hospitalization days during C/M-ECT as compared with an equal period before starting the index course. Twenty women (64.5%) and 11 men (35.5%) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition bipolar disorder (n = 22, 71%) or schizoaffective disorder (n = 9, 29%) received C/M-ECT. The mean (SD) age was 51.23 (14.86; range, 28-74) years. Before the start of the index ECT, patients had a mean of 290 hospitalization days (248.4 days, full hospitalization; 41.6 days, partial hospitalization), whereas during C/M-ECT, they had a mean of 214.7 hospitalization days (85.4 days, full hospitalization; 129.3 days, partial hospitalization). The number of readmissions before ECT was 2.13, whereas during C/M-ECT, it decreased to 1.48. Only the decrease in number of full hospitalization days was significant. Most patients (n = 23, 74.19%) needed an acute course of ECT during M-ECT. Maintenance ECT seems to significantly reduce the number of full hospitalization days in patients with severe bipolar or schizoaffective disorder.

  1. Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy.

    Science.gov (United States)

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

    2015-12-01

    We describe the clinical characteristics and short-term outcomes of a sample of inpatients with bipolar disorder with severe catatonic features resistant to pharmacological treatment. The study involved 26 catatonic patients, resistant to a trial of benzodiazepines, and then treated with electroconvulsive therapy (ECT). All patients were evaluated prior to and one week following the ECT course using the Bush-Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI). In our sample, women were over-represented (n = 23, 88.5%), the mean (± standard deviation) age was 49.5 ± 12.5 years, the mean age at onset was 28.1 ± 12.8 years, and the mean number of previous mood episodes was 5.3 ± 2.9. The mean duration of catatonic symptoms was 16.7 ± 11.8 (range: 3-50) weeks, and personal history of previous catatonic episodes was present in 10 patients (38.5%). Seventeen (65.4%) patients showed abnormalities at cerebral computerized tomography and/or magnetic resonance imaging and neurological comorbidities were observed in 15.4% of the sample. Stupor, rigidity, staring, negativism, withdrawal, and mutism were observed in more than 90% of patients. At the end of the ECT course, 21 patients (80.8%) were classified as responders. The BFCRS showed the largest percentage of improvement, with an 82% reduction of the initial score. The number of previous mood episodes was significantly lower and the use of anticholinergic and dopamine-agonist medications was significantly more frequent in non-responders than in responders. Our patients with bipolar disorder had predominantly retarded catatonia, frequent previous catatonic episodes, indicating a recurrent course, and high rates of concomitant brain structure alterations. However, ECT was a very effective treatment for catatonia in this patient group that was resistant to benzodiazepines. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Assessment of Arterial Oxygen Saturation by Pulse Oximetry Before, During and After Electroconvulsive Therapy

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    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. Junior medical students’ knowledge about and attitudes towards electroconvulsive therapy in a South African setting

    Directory of Open Access Journals (Sweden)

    Matthew B. Mausling

    2017-07-01

    Full Text Available Background: Although electroconvulsive therapy (ECT is a safe and effective treatment modality with a long history of use in psychiatry, it remains controversial owing to misconceptions and negative attitudes among the public and medical profession. The aim of this study was to explore the state of knowledge and attitudes towards ECT among a sample of South African medical students. Method: Prior to their theoretical psychiatry module, 131 second-year medical students responded to an anonymous online survey designed to assess the source and extent of their ECT knowledge as well as their attitude towards ECT and psychiatry in general. Results: The Internet (46.6% and TV and/or movies (30.5% were the principal sources of knowledge of ECT while ‘professional publication’ was the least common (0%. The students’ attitudes towards psychiatry were generally positive and nearly one-third (29.8% would consider specialising in the field. Overall, perception towards ECT was mixed, with many respondents approving of its use albeit only as a last resort. Notably, low ECT knowledge scores were associated with more negative attitudes towards this treatment modality and a lower perception of psychiatry as a medical speciality. Conclusion: The findings indicate that for these students, media is the main source of ECT knowledge. While they are generally knowledgeable about ECT, they still harbour some misconceptions and negative attitudes about the treatment. Knowledge appears able to amend these attitudes, thus underlining the importance of integrating accurate information about ECT into the preclinical medical curriculum rather than leaving it to mass media to forge warped perceptions and attitudes for these future clinicians.

  4. Minimum Electric Field Exposure for Seizure Induction with Electroconvulsive Therapy and Magnetic Seizure Therapy.

    Science.gov (United States)

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

    2017-05-01

    Lowering and individualizing the current amplitude in electroconvulsive therapy (ECT) has been proposed as a means to produce stimulation closer to the neural activation threshold and more focal seizure induction, which could potentially reduce cognitive side effects. However, the effect of current amplitude on the electric field (E-field) in the brain has not been previously linked to the current amplitude threshold for seizure induction. We coupled MRI-based E-field models with amplitude titrations of motor threshold (MT) and seizure threshold (ST) in four nonhuman primates (NHPs) to determine the strength, distribution, and focality of stimulation in the brain for four ECT electrode configurations (bilateral, bifrontal, right-unilateral, and frontomedial) and magnetic seizure therapy (MST) with cap coil on vertex. At the amplitude-titrated ST, the stimulated brain subvolume (23-63%) was significantly less than for conventional ECT with high, fixed current (94-99%). The focality of amplitude-titrated right-unilateral ECT (25%) was comparable to cap coil MST (23%), demonstrating that ECT with a low current amplitude and focal electrode placement can induce seizures with E-field as focal as MST, although these electrode and coil configurations affect differently specific brain regions. Individualizing the current amplitude reduced interindividual variation in the stimulation focality by 40-53% for ECT and 26% for MST, supporting amplitude individualization as a means of dosing especially for ECT. There was an overall significant correlation between the measured amplitude-titrated ST and the prediction of the E-field models, supporting a potential role of these models in dosing of ECT and MST. These findings may guide the development of seizure therapy dosing paradigms with improved risk/benefit ratio.

  5. Early effects of modern electroconvulsive therapy on subjective memory in patients with mania or depression

    Science.gov (United States)

    Bag, Sevda; Canbek, Ozge; Atagun, Ilhan Murat; Kutlar, Tarik Mehmet

    2016-01-01

    Context: Although electroconvulsive therapy (ECT) is considered a very effective tool for the treatment of psychiatric diseases, memory disturbances are among the most important adverse effects. Aims: This study aimed to assess prospectively early subjective memory complaints in depressive and manic patients due to bilateral, brief-pulse ECT, at different stages of the treatment, compare the associations between psychiatric diagnosis, sociodemographic characteristics, and ECT characteristics. Settings and Design: This prospective study was done with patients undergoing ECT between November 2008 and April 2009 at a tertiary care psychiatry hospital of 2000 beds. Materials and Methods: A total of 140 patients, scheduled for ECT with a diagnosis of bipolar disorder (depressive or manic episode) or unipolar depression according to Diagnostic and Statistical Manual of Mental Disorders IV diagnostic criteria, were included in the study and invited to complete the Squire Subjective Memory Questionnaire (SSMQ) before ECT, after the first and third sessions and end of ECT treatment. Statistical Analysis: Mean values were compared with the Kruskal–Wallis test and comparison of the longitudinal data was performed with a nonparametric longitudinal data analysis method, F1_LD_F1 design. Results: SSMQ scores of the patients before ECT were zero. SSMQ scores showed a decrease after the first and third ECT sessions and before discharge, showing a memory disturbance after ECT and were significantly less severe in patients with mania in comparison to those with depression. Conclusions: These findings suggest an increasing degree of subjective memory complaints with bilateral brief-pulse ECT parallel to the increasing number of ECT sessions. PMID:27385854

  6. 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

  7. The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

    Science.gov (United States)

    Selva-Sevilla, Carmen; Gonzalez-Moral, Maria Luisa; Tolosa-Perez, Maria Teresa

    2016-01-01

    Background: Clinical practice protocols should consider both the psychological criteria related to a patient’s satisfaction as a consumer of health services and the economic criteria to allocate resources efficiently. An electroconvulsive therapy (ECT) program was implemented in our hospital to treat psychiatric patients. The main objective of this study was to determine the cost associated with the ECT sessions implemented in our hospital between 2008 and 2014. A secondary objective was to calculate the cost of sessions that were considered ineffective, defined as those sessions in which electrical convulsion did not reach the preset threshold duration, in order to identify possible ways of saving money and improving satisfaction among psychiatric patients receiving ECT. Methods: A descriptive analysis of the direct health costs related to ECT from the perspective of the public health system between 2008 and 2014 was performed using a retrospective chart review. All of the costs are in euros (2011) and were discounted at a rate of 3%. Based on the base case, a sensitivity analysis of the changes of those variables showing the greatest uncertainty was performed. Results: Seventy-six patients received 853 sessions of ECT. The cumulative cost of these sessions was €1409528.63, and 92.9% of this cost corresponded to the hospital stay. A total of €420732.57 (29.8%) was inefficiently spent on 269 ineffective sessions. A sensitivity analysis of the economic data showed stable results to changes in the variables of uncertainty. Conclusion: The efficiency of ECT in the context outlined here could be increased by discerning a way to shorten the associated hospital stay and by reducing the number of ineffective sessions performed. PMID:27303347

  8. 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.

  9. 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.

  10. 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

  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. 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

  13. Electroconvulsive therapy in the elderly: Retrospective analysis from an urban general hospital psychiatry unit

    Directory of Open Access Journals (Sweden)

    Dimple D Dadarwala

    2017-01-01

    Full Text Available Introduction: The number of elder patients with severe psychiatric illnesses other than depression is increasing. Electroconvulsive therapy (ECT has a special role in the treatment of late-life depression and other psychiatric conditions in the elderly. Using ECTs in the elderly could be difficult. In an Indian setting, ECT in the geriatric population is used as last resort of treatment which is in contrast to Western countries. There is dearth of data available for the use of ECT in the elderly in India. Methodology: Retrospective data review was carried out to identify patients 55 years or older who had received ECT from January 2014 to June 2016 in tertiary care teaching hospital in a metropolitan city in India. Results: A total of 304 ECTs were administered to 25 elderly aged> 55 years with average of 12 ECTs per patient. Schizophrenia (56% was the most common diagnosis among patients who were considered for ECT, and this was followed by major depression without psychotic features (24% and major depression with psychotic features (8%. The most common indication to start ECT was nonresponsiveness to medications (92%. There was an increase in mean Mini-Mental State Examination (MMSE scores from baseline (23.42 to the end of the sixth (24.60 and last ECT (24.60. Duration of current used during ECT had positive correlation with MMSE. Patients with comorbid medical illness (20% received ECT without any complication. Conclusions: This study adds to scarce database on the use of ECT in old-age patients in India and adds to evidence that ECT is safe and effective treatment in old age with no negative impact on cognition.

  14. Chart review of electroconvulsive therapy practice from a tertiary care geriatric mental health set up

    Directory of Open Access Journals (Sweden)

    Akanksha Sonal

    2017-01-01

    Full Text Available Introduction: Electroconvulsive therapy (ECT is frequently used treatment procedure, and is utilized more often for severe, treatment-resistant, or refractory psychiatric disorders. However, published data on the use of ECT is limited, more so for special population like older adults. Aim: The aim of the study was to explore the clinical, demographic, and diagnostic profiles of older adults, and the parameters of ECT treatment, in a tertiary care Geriatric Mental Health set up. Materials and Methods: Approval to review the case notes was obtained from the Institutional Ethical Committee. The individuals were aged 60 years and above and had received ECT between January 2014 and May 2017. The relevant details pertaining to the aims of the study were recorded in a spreadsheet. Results: Twenty-five courses (absolute number = 191 of ECT were given to 21 patients (mean age = 67.44 ± 9.8 years with mean of 7.64 ± 3.6 ECT per patient. Majority of the patients belonged to age group 60–69 years, and were male (81%. Depression was the most common diagnosis for giving ECT (43% in these individuals, and poor response to pharmacological treatment (81% was the most common indication. The mean duration of the seizure elicited was 28.8 ± 13.2 s, and a therapeutic response was seen in 86% of cases. No major complications were noted during ECT treatment. Conclusion: When used judiciously and with trained staff, ECT is an effective and relatively safe mode of treatment even in older adults.

  15. Gravitational shock waves and extreme magnetomaterial shock waves

    International Nuclear Information System (INIS)

    Lichnerowicz, Andre.

    1975-01-01

    Within an astrophysical context corresponding to high densities, a self-gravitating model is studied, which is the set of an extreme material medium of infinite conductivity and of a magnetic field. Corresponding shock waves generate necessarily, in general, gravitational shock waves [fr

  16. Shock Producers and Shock Absorbers in the Crisis

    OpenAIRE

    Sinn, Hans-Werner

    2009-01-01

    It is not surprising that the U.S. has been by far the world’s largest shock producer in this crisis. The big shock absorbers on the other hand were Japan, Russia and Germany, whose exports shrank more than their imports.

  17. Simulations of Converging Shock Collisions for Shock Ignition

    Science.gov (United States)

    Sauppe, Joshua; Dodd, Evan; Loomis, Eric

    2016-10-01

    Shock ignition (SI) has been proposed as an alternative to achieving high gain in inertial confinement fusion (ICF) targets. A central hot spot below the ignition threshold is created by an initial compression pulse, and a second laser pulse drives a strong converging shock into the fuel. The collision between the rebounding shock from the compression pulse and the converging shock results in amplification of the converging shock and increases the hot spot pressure above the ignition threshold. We investigate shock collision in SI drive schemes for cylindrical targets with a polystyrene foam interior using radiation-hydrodynamics simulations with the RAGE code. The configuration is similar to previous targets fielded on the Omega laser. The CH interior results in a lower convergence ratio and the cylindrical geometry facilitates visualization of the shock transit using an axial X-ray backlighter, both of which are important for comparison to potential experimental measurements. One-dimensional simulations are used to determine shock timing, and the effects of low mode asymmetries in 2D computations are also quantified. LA-UR-16-24773.

  18. Analysis of repeated measures data

    CERN Document Server

    Islam, M Ataharul

    2017-01-01

    This book presents a broad range of statistical techniques to address emerging needs in the field of repeated measures. It also provides a comprehensive overview of extensions of generalized linear models for the bivariate exponential family of distributions, which represent a new development in analysing repeated measures data. The demand for statistical models for correlated outcomes has grown rapidly recently, mainly due to presence of two types of underlying associations: associations between outcomes, and associations between explanatory variables and outcomes. The book systematically addresses key problems arising in the modelling of repeated measures data, bearing in mind those factors that play a major role in estimating the underlying relationships between covariates and outcome variables for correlated outcome data. In addition, it presents new approaches to addressing current challenges in the field of repeated measures and models based on conditional and joint probabilities. Markov models of first...

  19. Repeated DNA sequences in fungi

    Energy Technology Data Exchange (ETDEWEB)

    Dutta, S K

    1974-11-01

    Several fungal species, representatives of all broad groups like basidiomycetes, ascomycetes and phycomycetes, were examined for the nature of repeated DNA sequences by DNA:DNA reassociation studies using hydroxyapatite chromatography. All of the fungal species tested contained 10 to 20 percent repeated DNA sequences. There are approximately 100 to 110 copies of repeated DNA sequences of approximately 4 x 10/sup 7/ daltons piece size of each. Repeated DNA sequence homoduplexes showed on average 5/sup 0/C difference of T/sub e/50 (temperature at which 50 percent duplexes dissociate) values from the corresponding homoduplexes of unfractionated whole DNA. It is suggested that a part of repetitive sequences in fungi constitutes mitochondrial DNA and a part of it constitutes nuclear DNA. (auth)

  20. Erythropoietin as an add-on treatment for cognitive side effects of electroconvulsive therapy: a study protocol for a randomized controlled trial.

    Science.gov (United States)

    Schmidt, Lejla Sjanic; Petersen, Jeff Zarp; Vinberg, Maj; Hageman, Ida; Olsen, Niels Vidiendal; Kessing, Lars Vedel; Jørgensen, Martin Balslev; Miskowiak, Kamilla Woznica

    2018-04-19

    Electroconvulsive therapy (ECT) is the most effective treatment for severe depression, but its use is impeded by its cognitive side effects. Novel treatments that can counteract these side effects may therefore improve current treatment strategies for depression. The present randomized trial investigates (1) whether short-term add-on treatment with erythropoietin (EPO) can reduce the cognitive side -effects of ECT and (2) whether such effects are long-lasting. Further, structural and functional magnetic resonance imaging (MRI) will be used to explore the neural underpinnings of such beneficial effects of EPO. Finally, the trial examines whether potential protective effects of EPO on cognition are accompanied by changes in markers of oxidative stress, inflammation, and neuroplasticity. The trial has a double-blind, randomized, placebo-controlled, parallel group design. Patients with unipolar or bipolar disorder with current moderate to severe depression referred to ECT (N = 52) are randomized to receive four high-dose infusions of EPO (40,000 IU/ml) or placebo (saline). The first EPO/saline infusion is administered within 24 h before the first ECT. The following three infusions are administered at weekly intervals immediately after ECT sessions 1, 4, and 7. Cognition assessments are conducted at baseline, after the final EPO/saline infusion (3 days after eight ECT sessions), and at a 3 months follow-up after ECT treatment completion. The neuronal substrates for potential cognitive benefits of EPO are investigated with structural and functional MRI after the final EPO/saline infusion. The primary outcome is change from baseline to after EPO treatment (3 days after eight ECT sessions) in a cognitive composite score spanning attention, psychomotor speed, and executive functions. With a sample size of N = 52 (n = 26 per group), we have ≥ 80% power to detect a clinically relevant between-group difference in the primary outcome measure at an alpha

  1. Fostering repeat donations in Ghana.

    Science.gov (United States)

    Owusu-Ofori, S; Asenso-Mensah, K; Boateng, P; Sarkodie, F; Allain, J-P

    2010-01-01

    Most African countries are challenged in recruiting and retaining voluntary blood donors by cost and other complexities and in establishing and implementing national blood policies. The availability of replacement donors who are a cheaper source of blood has not enhanced repeat voluntary donor initiatives. An overview of activities for recruiting and retaining voluntary blood donors was carried out. Donor records from mobile sessions were reviewed from 2002 to 2008. A total of 71,701 blood donations; 45,515 (63.5%) being voluntary donations with 11,680 (25%) repeat donations were collected during the study period. Donations from schools and colleges contributed a steady 60% of total voluntary whilst radio station blood drives increased contribution from 10 to 27%. Though Muslim population is less than 20%, blood collection was above the 30-donation cost-effectiveness threshold with a repeat donation trend reaching 60%. In contrast Christian worshippers provided donations. Repeat donation trends amongst school donors and radio blood drives were 20% and 70% respectively. Repeat donations rates have been variable amongst different blood donor groups in Kumasi, Ghana. The impact of community leaders in propagating altruism cannot be overemphasized. Programs aiming at motivating replacement donors to be repeat donors should be developed and assessed. Copyright 2009 The International Association for Biologicals. All rights reserved.

  2. 30th International Symposium on Shock Waves

    CERN Document Server

    Sadot, Oren; Igra, Ozer

    2017-01-01

    These proceedings collect the papers presented at the 30th International Symposium on Shock Waves (ISSW30), which was held in Tel-Aviv Israel from July 19 to July 24, 2015. The Symposium was organized by Ortra Ltd. The ISSW30 focused on the state of knowledge of the following areas: Nozzle Flow, Supersonic and Hypersonic Flows with Shocks, Supersonic Jets, Chemical Kinetics, Chemical Reacting Flows, Detonation, Combustion, Ignition, Shock Wave Reflection and Interaction, Shock Wave Interaction with Obstacles, Shock Wave Interaction with Porous Media, Shock Wave Interaction with Granular Media, Shock Wave Interaction with Dusty Media, Plasma, Magnetohyrdrodynamics, Re-entry to Earth Atmosphere, Shock Waves in Rarefied Gases, Shock Waves in Condensed Matter (Solids and Liquids), Shock Waves in Dense Gases, Shock Wave Focusing, Richtmyer-Meshkov Instability, Shock Boundary Layer Interaction, Multiphase Flow, Blast Waves, Facilities, Flow Visualization, and Numerical Methods. The two volumes serve as a reference ...

  3. Molecular diagnostics of interstellar shocks

    International Nuclear Information System (INIS)

    Hartquist, T.W.; Oppenheimer, M.; Dalgarno, A.

    1980-01-01

    The chemistry of molecules in shocked regions of the interstellar gas is considered and calculations are carried out for a region subjected to a shock at a velocity of 8 km s -1 Substantial enhancements are predicted in the concentrations of the molecules H 2 S, SO, and SiO compared to those anticipated in cold interstellar clouds

  4. Molecular diagnostics of interstellar shocks

    Science.gov (United States)

    Hartquist, T. W.; Dalgarno, A.; Oppenheimer, M.

    1980-02-01

    The chemistry of molecules in shocked regions of the interstellar gas is considered and calculations are carried out for a region subjected to a shock at a velocity of 8 km/sec. Substantial enhancements are predicted in the concentrations of the molecules H2S, SO, and SiO compared to those anticipated in cold interstellar clouds.

  5. How Culture Shock Affects Communication.

    Science.gov (United States)

    Barna, LaRay M.

    The paper defines the term "culture shock" and discusses the changes that this state can make in a person's behavior. Culture shock refers to the emotional and physiological reaction of high activation that is brought about by sudden immersion in a new culture. Because one's own culture shields one from the unknown and reduces the need to make…

  6. Molecular diagnostics of interstellar shocks

    Science.gov (United States)

    Hartquist, T. W.; Dalgarno, A.; Oppenheimer, M.

    1980-01-01

    The chemistry of molecules in shocked regions of the interstellar gas is considered and calculations are carried out for a region subjected to a shock at a velocity of 8 km/sec. Substantial enhancements are predicted in the concentrations of the molecules H2S, SO, and SiO compared to those anticipated in cold interstellar clouds.

  7. Shock wave treatment in medicine

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Biosciences; Volume 30; Issue 2 ... 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 ...

  8. Shock wave treatment in medicine

    Indian Academy of Sciences (India)

    Unknown

    to open surgery, the cost of the ESWT is very reasonable. But nevertheless it is necessary to improve the basic un ... In second group, shock waves are used to measure distances because of the low energy loss over large distances ... pared to a piezoelectric hydrophone. The rise time of an electrohydraulic generated shock ...

  9. Numerical modeling of slow shocks

    International Nuclear Information System (INIS)

    Winske, D.

    1987-01-01

    This paper reviews previous attempt and the present status of efforts to understand the structure of slow shocks by means of time dependent numerical calculations. Studies carried out using MHD or hybrid-kinetic codes have demonstrated qualitative agreement with theory. A number of unresolved issues related to hybrid simulations of the internal shock structure are discussed in some detail. 43 refs., 8 figs

  10. Dynamic shock wave: hammer blow

    International Nuclear Information System (INIS)

    Lackme, Claude

    1978-01-01

    The general properties of shocks, their generation and the conditions of reflexion to an interface are dealt with in turn. By then applying these concepts to a liquid column and its environment (wall, free area, closing devices) the hammer blow is presented as being a relatively weak shock [fr

  11. Geomorphology: the Shock of the Familiar

    Science.gov (United States)

    Dietrich, W. E.

    2008-12-01

    Everyone experiences landscapes and has a sense about how they work: water runs down hill, it erodes and carries sediments, and that's about it, right? Introductory earth science text books are uniformly qualitative about the field, and leave one with little sense of wonder, and certainly not "shock". But four shocks occur if one peels away the first impressions. First, landscapes are surprisingly similar: the same forms are repeated in virtually all environments, including under the ocean and on other planets. Second, we lack theory and mechanistic observations to answer many simple first-order questions, e.g. what controls the width of a river, how does rock type control hillslope form and erosion rate, or, is there a topographic signature of life. Third, there are unexpected connections between surface erosion, deep earth processes, and climate. And fourth, the field itself, despite having been a subject of study for well over 100 years, is currently experiencing a revolution of ideas and discoveries through new tools, observatories, centers, journals, books, contributions of researchers from other disciplines, and from a significant hiring of young researchers in geomorphology. Deep messages await discovery in the simple landforms surrounding us.

  12. Slow shocks and their transition to fast shocks in the inner solar wind

    International Nuclear Information System (INIS)

    Wang, Y.C.

    1987-01-01

    The jump conditions of MHD shocks may be directly calculated as functions of three upstream conditions: the shock Alfven number based on the normal component of the relative shock speed, the shock angle, and the plasma β value. The shock Alfven number is less than 1 for a slow shock and greater than 1 for a fast shock. A traveling, forward shock can be a slow shock in coronal space, where the Alfven speed is of the order of 1000 km/s. The surface of a forward slow shock has a bow-shaped geometry with its nose facing toward the sun. The decrease in the Alfven speed at increasing heliocentric distance causes the shock Alfven number of a forward slow shock to become greater than 1, and the shock eventually evolves from a slow shock into a fast shock. During the transition the shock system consists of a slow shock, a fast shock, and a rotational discontinuity. They intersect along a closed transition line. As the system moves outward from the sun, the area enclosed by the transition line expands, the fast shock grows stronger, and the slow shock becomes weaker. Eventually, the slow shock diminishes, and the entire shock system evolves into a forward fast shock. copyrightAmerican Geophysical Union 1987

  13. Shocking matter to extreme conditions

    International Nuclear Information System (INIS)

    Gupta, Y.M.; Sharma, S.M.

    1997-01-01

    A good understanding of the thermodynamic response of matter at high compression and high energy densities is important to several areas of physics. Shock-wave experiments are uniquely suited for obtaining data at extreme conditions, and a shock-compressed matter can be viewed as a condensed system with or without dissociation or as a strongly coupled plasma. This article reviews work by Da Silva et al. in which irradiances ranging from 5x10 superscript 12 to 2x10 superscript 14 W/cm 2 were used to generate 8- to 10-ns square pulses in liquid deuterium. The authors demonstrated negligible pre-heating of the sample, steady propagation of the shock wave, and direct determination of the shock wave velocity along with particle velocity and density in the shocked state. Da Silva et al. results are compared with models and other experimental information, and the usefulness of the data in other areas is assessed. 11 refs., 1 fig

  14. Electron transport and shock ignition

    Energy Technology Data Exchange (ETDEWEB)

    Bell, A R; Tzoufras, M, E-mail: t.bell1@physics.ox.ac.uk [Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU (United Kingdom)

    2011-04-15

    Inertial fusion energy (IFE) offers one possible route to commercial energy generation. In the proposed 'shock ignition' route to fusion, the target is compressed at a relatively low temperature and then ignited using high intensity laser irradiation which drives a strong converging shock into the centre of the fuel. With a series of idealized calculations we analyse the electron transport of energy into the target, which produces the pressure responsible for driving the shock. We show that transport in shock ignition lies near the boundary between ablative and heat front regimes. Moreover, simulations indicate that non-local effects are significant in the heat front regime and might lead to increased efficiency by driving the shock more effectively and reducing heat losses to the plasma corona.

  15. Oscillating nonlinear acoustic shock waves

    DEFF Research Database (Denmark)

    Gaididei, Yuri; Rasmussen, Anders Rønne; Christiansen, Peter Leth

    2016-01-01

    We investigate oscillating shock waves in a tube using a higher order weakly nonlinear acoustic model. The model includes thermoviscous effects and is non isentropic. The oscillating shock waves are generated at one end of the tube by a sinusoidal driver. Numerical simulations show that at resona......We investigate oscillating shock waves in a tube using a higher order weakly nonlinear acoustic model. The model includes thermoviscous effects and is non isentropic. The oscillating shock waves are generated at one end of the tube by a sinusoidal driver. Numerical simulations show...... polynomial in the space and time variables, we find analytical approximations to the observed single shock waves in an infinitely long tube. Using perturbation theory for the driven acoustic system approximative analytical solutions for the off resonant case are determined....

  16. Shock waves & explosions

    CERN Document Server

    Sachdev, PL

    2004-01-01

    Understanding the causes and effects of explosions is important to experts in a broad range of disciplines, including the military, industrial and environmental research, aeronautic engineering, and applied mathematics. Offering an introductory review of historic research, Shock Waves and Explosions brings analytic and computational methods to a wide audience in a clear and thorough way. Beginning with an overview of the research on combustion and gas dynamics in the 1970s and 1980s, the author brings you up to date by covering modeling techniques and asymptotic and perturbative methods and ending with a chapter on computational methods.Most of the book deals with the mathematical analysis of explosions, but computational results are also included wherever they are available. Historical perspectives are provided on the advent of nonlinear science, as well as on the mathematical study of the blast wave phenomenon, both when visualized as a point explosion and when simulated as the expansion of a high-pressure ...

  17. Analysis of shock implosion

    Energy Technology Data Exchange (ETDEWEB)

    Mishkin, E.A.; Alejaldre, C. (Polytechnic Inst. of New York, Brooklyn (USA))

    1984-06-01

    An imploding shock wave, coming from infinity, moves through an ideal gas with the adiabatic constant ..gamma... To define a single-valued self-similar coefficient over the whole classical interval 1<..gamma..

  18. Effect of environmental temperature on shock absorption properties of running shoes.

    Science.gov (United States)

    Dib, Mansour Y; Smith, Jay; Bernhardt, Kathie A; Kaufman, Kenton R; Miles, Kevin A

    2005-05-01

    To determine the effect of temperature changes on the shock attenuation of 4 running shoe shock absorption systems. Prospective. Motion analysis laboratory. The shock attenuation of 4 different running shoes representing common shock absorption systems (Nike Air Triax, Asics Gel Nimbus IV, Adidas a3 cushioning, Adidas Supernova cushion) was measured at ambient temperatures of -20 degrees C, -10 degrees C, 0 degrees C, +10 degrees C, +20 degrees C, +30 degrees C, +40 degrees C, and +50 degrees C. Repeated-measures analysis of variance was used to determine differences between shoes. Shock attenuation as indicated by peak deceleration (g) measured by a mechanical impactor following ASTM Standard F1614-99. Shock attenuation decreased significantly with reduced temperature for each shoe tested. The Adidas a3 shoe exhibited significantly higher peak decelerations (lower shock attenuation) at cold temperatures compared with the other shoes. Cold ambient temperatures significantly reduce the shock attenuation of commonly used running shoes. These findings have important clinical implications for individuals training in extreme weather environments, particularly those with a history of lower limb overuse injuries.

  19. The cosmic-ray shock structure problem for relativistic shocks

    Science.gov (United States)

    Webb, G. M.

    1985-01-01

    The time asymptotic behaviour of a relativistic (parallel) shock wave significantly modified by the diffusive acceleration of cosmic-rays is investigated by means of relativistic hydrodynamical equations for both the cosmic-rays and thermal gas. The form of the shock structure equation and the dispersion relation for both long and short wavelength waves in the system are obtained. The dependence of the shock acceleration efficiency on the upstream fluid spped, long wavelength Mach number and the ratio N = P sub co/cP sub co+P sub go)(Psub co and P sub go are the upstream cosmic-ray and thermal gas pressures respectively) are studied.

  20. Cosmic-ray shock acceleration in oblique MHD shocks

    Science.gov (United States)

    Webb, G. M.; Drury, L. OC.; Volk, H. J.

    1986-01-01

    A one-dimensional, steady-state hydrodynamical model of cosmic-ray acceleration at oblique MHD shocks is presented. Upstream of the shock the incoming thermal plasma is subject to the adverse pressure gradient of the accelerated particles, the J x B force, as well as the thermal gas pressure gradient. The efficiency of the acceleration of cosmic-rays at the shock as a function of the upstream magnetic field obliquity and upstream plasma beta is investigated. Astrophysical applications of the results are briefly discussed.