The Evolution of Electroconvulsive Therapy
Barry M. Maletzky, C. Conrad Carter, James L. Fling in Multiple-Monitored Electroconvulsive Therapy, 2019
As previously discussed, CNS malignant tumors could be considered a relative contraindication, as could a number of chronic medical conditions, such as advanced arteriosclerotic disease of the coronary vessels or severe, chronic, obstructive pulmonary disease. It is an old adage but a true one that the risks of most treatments need to be balanced against the anticipated benefits. What may not be so obvious in computing this equation is the risk of the condition creating the need for ECT. Convulsive therapy is indicated primarily for the severe depressions, illnesses that carry a high mortality rate.7 Although it was long assumed that these severe depressions caused severe morbidity, they were thought to carry only a slightly increased mortality rate, chiefly due to suicide. One recent large study has presented data which graphically indicate that the risk of cardiac disease and death is much greater in those who are endogenously depressed than in a matched, nondepressed sample.7 To some extent, therefore, these conditions are fatal and must be treated definitely and with as much dispatch as we now treat other medical illnesses which carry dire prognoses. ECT should not be prescribed with abandon, nor should its use be withheld lightly.
Depression in the Older Woman
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
Electroconvulsive therapy is the passing of an electrical current through the brain to induce seizure activity under general anesthesia. In those with severe melancholic depression who are not eating, are catatonic, delusional, have previously responded to ECT or are unable to participate in any other treatments, it is the preferred option. In a hospital setting, 6 to 9 sessions are usually required and the response rate approaches 90%. The side effect risks include those of a general anaesthetic and a seizure as well as amnestic syndromes, delirium, and possible permanent cognitive impairment. The extent of possible permanent cognitive changes characteristics of patients at higher risk for such side effects, and the lowered risk of unilateral ECT in this regard are still matters of debate.
Psychotropic Use during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
High-voltage electrical shock is used to treat some psychiatric disorders, although it may also occur in accidental electrocution. The mechanism of action of electroconvulsive therapy is unknown. However, it is clearly understood that the seizure produced by electroconvulsive therapy is necessary for therapeutic efficacy (Ottosson, 1962a, 1962b). Electroconvulsive therapy was used safely in the treatment of depression in a pregnant woman following expanded clinical guidelines that included the presence of an obstetrician during treatment, endotracheal intubation, low-voltage, non-dominant therapy with electrocardiographic and electroencephalogram monitoring, Doppler ultrasonography of fetal heart rate, tocodynamometer recording of uterine tone, arterial blood gases during and after treatment, glycopyrrolate (anticholinergic of choice) use during anesthesia, and weekly non-stress tests (Wise et al., 1984). The frequency of birth defects among the newborns of 318 women who received electroconvulsive therapy during gestation has not increased (Impastato et al., 1964).
Does lunar synodic cycle affect the rates of psychiatric hospitalizations and sentinel events?
Published in Chronobiology International, 2021
Apurva Mittal, Swarna Buddha Nayok, Ravindra Neelakanathappa Munoli, Samir Kumar Praharaj, Podila Sathya Venkata Narasimha Sharma
Decisions about the application of restraints were taken by the resident doctors in consultation with the treating doctors. This was done only after failed attempts of verbal de-escalation. Need for physical restraint was reevaluated every 15 min by the resident and was continued only if deemed necessary. Parenteral chemical restraints were preferred if patient was violent or severely agitated. Parenteral chemical restraints included the administration of lorazepam (2–4 mg/dose), haloperidol (5–10 mg/dose), and promethazine (25–50 mg/dose). Oral chemical restraints included clonazepam (up to 1 mg), lorazepam (up to 4 mg), zolpidem (up to 10 mg), and quetiapine (up to 25 mg). Restraints of any kind were mandatorily documented by the nursing staff and duly signed by the resident doctor. Restraints were considered only after the initial optimized management failed. This included pharmacotherapy, electro-convulsive therapy, and psychotherapy. As soon as restraints were applied, the treating team revised the management procedure to avoid further need of restraints.
Catatonia revived: a unique syndrome updated
Published in International Review of Psychiatry, 2020
Charles Mormando, Andrew Francis
Convulsive therapy has a historical tradition and modern support as a treatment for catatonia. In the 1930s, the use of both chemically induced and electroconvulsive seizures was described. Since then, clinical experience and case series have shown that ECT produces remission of catatonia even when other treatments (e.g. amobarbital or lorazepam) have failed (Bush et al., 1996b; Petrides et al., 2004). ECT can be considered first-line treatment in clinically severe and/or life-threatening cases (profound stupor or excitability leading to dehydration and exhaustion, autonomic instability, fever, etc.) However, a recent meta-analysis (Leroy et al., 2018) failed to demonstrate the usual statistical criteria for efficacy or effectiveness of ECT in the treatment of catatonia. This bespeaks to the difficulty in constructing quality randomized controlled trials rather than a true lack of effectiveness. An additional advantage of ECT is benefit for the associated affective or psychotic disorder. Clinical case reports suggest that ECT and lorazepam may be synergistic (Petrides, Divadeenam, Bush, & Francis, 1997).
Recovery of patients with severe depression in inpatient rural psychiatry: a descriptive clinical study
Published in Nordic Journal of Psychiatry, 2020
Snaebjorn Omar Gudjonsson, Eydis Kristin Sveinbjarnardottir, Ragnheidur Harpa Arnardottir
This study was conducted at a 10-bed inpatient acute psychiatric unit at Akureyri Hospital, Iceland, which serves a rural population of around 50,000 inhabitants. The focus at the unit is acute care with an emphasis on collaborative interdisciplinary teamwork. The treatment theoretical framework is based on the Model of Care by Glick et al. [27], which emphasises evidence-based quality protocols during admission and three phases of treatment: assessment, implementation, and resolution phase. Treatment includes pharmacology, psychotherapy, and other traditional psychological support therapies, and in fewer instances electroconvulsive therapy (ECT). Psychoeducation, activity motivation, physical activity and support are given daily during hospitalisation. DASS-42 is routinely used at admission and discharge. Family support interventions had not been specially implemented at the unit at the time of the study and HRQoL was not a part of the routine assessment.
Related Knowledge Centers
- Catatonia
- Convulsion
- Fetus
- Major Depressive Disorder
- Mania
- General Anaesthesia
- Psychiatry
- Seizure
- Mental Disorder
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