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Biomedical subjects

C E Coffey

Publications and source records attributed to C E Coffey.

At least 55 records · Page 3Linked to original sources
PubMed1991

Practical issues in the use of electroconvulsive therapy (ECT).

ECT is a safe and effective treatment for affective disorders and certain types of schizophrenia. It is also useful as a form of continuation/maintenance therapy in otherwise resistant cases. The referral of a patient for ECT is based on a careful risk-benefit analysis of all viable treatment options. The administration of ECT in the present era is a refined, technically sophisticated procedure which should be performed only by practitioners with established competency to do so. With proper understanding of risk factors and treatment technique, modifications of the ECT procedure can now frequently be made to minimize adverse effects and to maximize therapeutic response.

Electroconvulsive Therapy↗
PubMed1990

Cardiovascular response to unilateral electroconvulsive therapy.

Few studies have examined the cardiovascular response to pulse unilateral electroconvulsive therapy (ECT) performed using modern techniques. In this study of 30 patients (mean age 62 years) with major depression, we determined the effects of pulse unilateral ECT on cardiac work load using the rate-pressure product (RPP), a product of pulse and systolic blood pressure. The mean RPP across all ECT treatments increased by an average of 96% from pre-ECT baseline, with the maximal RPP occurring typically during the seizure. The amount of increase in RPP did not differ significantly over the course of treatments. The increase in RPP was significantly and inversely related to baseline RPP, such that subjects with the highest baseline RPPs actually had smaller increases in RPP during the ECT treatments. The mean percent change in RPP was not associated with age, sex, presence of cardiovascular disease, ECT stimulus charge, EEG seizure duration, or amnestic side effects. There was a trend (p = 0.06), however, for the mean increase in RPP to be greater in responders (100% increase, n = 25) than in nonresponders (76% increase, n = 5). The potential relationship of clinical outcome to the increase in RPP suggests that both factors may be manifestations of the physiological intensity of the ECT-induced seizure.

Adult↗
PubMed1990

Caffeine augmentation of ECT.

In a randomized, double-blind, placebo-controlled pilot study of 40 depressed inpatients, the authors compared two techniques for maintaining seizure duration during pulse unilateral ECT: pretreatment with intravenous caffeine versus electrical stimulus intensity dosing. Both techniques effectively maintained seizure duration, but with caffeine this was accomplished without any increase in mean stimulus intensity over the course of ECT. There were no differences between the two techniques in therapeutic outcome or cognitive side effects from ECT, and caffeine pretreatment was well tolerated. The authors discuss the clinical and research implications of these findings with respect to strategies for maintaining seizure duration during ECT.

Adult↗
PubMed1990

Brain magnetic resonance imaging findings in ECT-induced delirium.

A prolonged (interictal) but reversible delirium was induced by electroconvulsive therapy (ECT) in 10 of 87 (11%) elderly depressed patients. Brain magnetic resonance imaging (MRI) revealed several structural abnormalities, particularly basal ganglia and moderate to severe subcortical white-matter lesions, in the patients who developed delirium. These findings are consistent with several lines of data that have implicated the basal ganglia and subcortical white matter in the development of delirium from other causes and suggest that lesions in these areas may predispose one to developing an interictal delirium during a course of ECT.

Aged↗
PubMed1990

Electroconvulsive therapy: an update.

Electroconvulsive therapy (ECT) is a safe, rapidly acting, and very effective form of treatment for severe affective illness. In recent years the limitations of available psychopharmacotherapies and the pressures of cost containment appear to be encouraging the increasing use of ECT. The authors provide an overview of electroconvulsive therapy as a treatment modality, focusing on indications, contraindications, adverse effects, and contemporary ECT technique, including recent modifications in electrode placement, stimulus wave form, and dosage intensity. They urge that adequate training be provided for medical and nursing personnel who administer ECT and that facilities monitor practitioners' competence by specific privileging.

Bipolar Disorder↗
PubMed1990

Caffeine-modified electroconvulsive therapy in depressed patients with medical illness.

Although pretreatment with intravenous caffeine is an effective technique for increasing seizure duration during a course of electroconvulsive therapy (ECT), little has been published regarding the use of this technique in patients with severe medical illness. The authors describe nine depressed inpatients with major cardiovascular or other medical disease or both whose ECT seizure durations declined despite maximal settings on the ECT device. In all cases, caffeine pretreatment lengthened seizures, and clinical improvement followed. The caffeine-modified ECT treatments were well tolerated and were associated with no clinically significant adverse cardiovascular effects.

Aged↗
PubMed1989

Regional cerebral blood flow correlates of a dichotic listening task.

This investigation was designed to test the hypothesis that ear advantage on a dichotic listening (DL) task of pitch discrimination reflects asymmetries in the metabolic activities of the temporal lobes. Fourteen normal subjects, with either a left-ear advantage (LEA) (n = 9) or a right-ear advantage (REA) (n = 5) on the DL task, underwent measurements of regional cerebral blood flow (rCBF) during a resting baseline condition and during performance on the DL task. For both groups, the DL task was associated with selective and significant increases in rCBF to the contralateral posterior temporal lobe. Our finding of selective rCBF activation with dichotic stimulation may have potential implications for an understanding of the functional organization of the cerebral hemispheres.

Acoustic Stimulation↗
PubMed1989

White matter hyperintensity on magnetic resonance imaging: clinical and neuroanatomic correlates in the depressed elderly.

In a prospective study of depressed elderly patients referred for electroconvulsive therapy (ECT), subcortical white matter hyperintensity (WMH) was seen in all 51 patients 60 years or older who received magnetic resonance imaging (MRI) prior to treatment. In over half of the patients the WMH was formally rated as at least moderately severe, and it was commonly associated with other structural brain changes. The majority (80%) of patients had late-age-onset depression, suggesting that structural brain changes may interact with aging to facilitate the emergency of depression in late life.

Aged↗
PubMed1989

Brain iron in progressive supranuclear palsy: clinical, magnetic resonance imaging, and neuropathological findings.

A patient with progressive supranuclear palsy demonstrated a region-specific decrease in T2 signal during high-field-strength brain magnetic resonance imaging. At autopsy the T2-signal hypointensity was found to correspond topographically to increased deposition of ferric iron. The potential clinical, radiologic, and pathophysiologic implications of these findings are discussed.

Brain↗
PubMed1988

Leukoencephalopathy in elderly depressed patients referred for ECT.

Using brain magnetic resonance imaging (MRI) and high-resolution computed tomography (CT), we identified changes in the subcortical white matter in 44 of 67 elderly depressed inpatients (66%) referred for electroconvulsive therapy (ECT). This "leukoencephalopathy" was frequently associated with other structural brain changes, including cortical atrophy, lateral ventricular enlargement, and lacunar infarctions of the basal ganglia and thalamus. Many (58%) of the patients had developed late-onset depressive disorders, and the majority (86%) had been refractory to and/or intolerant of antidepressant drug therapy. Nevertheless, all but 1 of the 44 patients subsequently responded to a course of ECT, which in general was well tolerated. Although the precise etiology of the leukoencephalopathy remains unclear, clinical data suggest that it may result from arteriosclerotic disease of the medullary arteries that supply the subcortical brain regions. Several lines of evidence suggest that leukoencephalopathy may have implications for the pathophysiology of depressive illness, at least in some elderly patients.

Aged↗
PubMed1988

Effects of ECT on brain structure: a pilot prospective magnetic resonance imaging study.

The authors describe a pilot prospective investigation of the effects of ECT on brain structure using magnetic resonance imaging (MRI). In nine patients with major depression, a course of ECT produced no acute changes in brain structure according to blind raters' assessments of cortical atrophy and global comparison of pre- and post-ECT studies. There were also no significant changes in the ventricle-brain ratios. Pre-ECT brain abnormalities were common in these patients yet were also unaffected by ECT. Future MRI studies of ECT should include more subjects and should address long-term changes and subtle brain abnormalities.

Adult↗