Search PubMed⌕ Search

Biomedical subjects

C M Swartz

Publications and source records attributed to C M Swartz.

At least 37 records · Page 2Linked to original sources
PubMed1997

Neuroendocrine effects of electroconvulsive therapy (ECT).

Reliable observation of ECT-induced hormone release requires that other processes that affect hormone levels remain constant and not obscure it. This article reviews principles and pitfalls in making such observations. Clinical applicability and limitations of measurements of prolactin, cortisol, oxytocin, vasopressin, and other hormones are described. Applications include elucidation of ECT physiology and seizure quality, comparison of ECT techniques, and description of illness severity. Accounting for each of these different effects can be needed to characterize any of them. An important but unrealized application of neuroendocrine measurement is prediction of the stability of individual ECT response.

Antipsychotic Agents↗
PubMed1996

Obstruction of ECT seizure by submaximal hyperventilation: a case report.

Extreme obstruction of ECT seizure induction occurred in an elderly female with a low cardiac ejection fraction after a 20 to 25 s interval between the last ventilation and the electrical stimulus. Stimuli of 378 and 504 mC induced no motoric or EEG activity after an initial stimulus of 227 mC produced just 1 s of motoric seizure activity. After prolonged hyperventilation and immediate stimulation a seizure resulted with 33 s of motoric activity. This case suggests that patients with a low cardiac output might be particularly sensitive to the quality of ventilation.

Aged↗
PubMed1996

Disconnection of electroencephalographic, motoric, and cardiac evidence of ECT seizure.

Three electroconvulsive therapy (ECT) stimuli of increasing dosage were applied sequentially under one anesthesia to each of two patients. With each, the first produced intense electroencephalogram (EEG) seizure activity with a sharp endpoint but no motoric activity and little heart rate elevation. The second produced 15-21 s of tonic-clonic activity with negligible seizure activity on the EEG monitor and little heart rate increase. The third produced typical motoric, EEG, and heart rate signs of seizure. These observations indicate that the signs of high EEG amplitude, sharp EEG endpoint, distinct postictal suppression, and tonic-clonic activity can appear in seizures of questionable quality and weak generalization through the brain. Consequently, none of these characteristics by themselves indicate good quality or seizure generalization, and ECT monitoring is incomplete without considering all of them along with peak heart rate.

Adult↗
PubMed1995

Generalization, duration, and low-frequency electroencephalographic persistence of bilateral electroconvulsive therapy seizure.

Measurements were made at the beginning and end of a course of bifrontotemporal brief-pulse ECT for 28 males to both determine how well seizure generalization is maintained along the course of electroconvulsive therapy (ECT) and examine correspondence between low-frequency EEG activity and other seizure durations. Durations of spike electroencephalographic (EEG) paroxysmal activity, heart rate elevation, and Ionic-clonic activity decreased about 30% along the course, p < 0.0001, yet correlated highly at both times, I = 0.69 to 0.88, p < 0.0005, as did their changes: these correlations demonstrate high-seizure generalization and its maintenance. EEG low-frequency persistence, the difference between total and spike EEG paroxysmal durations, doubled along the course (p = 0.041), but showed no association with any other seizure duration measure. This absence of association suggests that low-frequency activity and other seizure duration measures describe separate phenomena and should be expressed separately, rather than combined as the (traditional) total EEG paroxysmal duration.

Adult↗
PubMed1995

Tardive psychopathology.

Tardive psychopathology (TP) corresponds to mental changes from chronic neuroleptic exposure, as tardive dyskinesia corresponds to induced movement disorders. TP was prospectively identified in 4 inpatients. Each took neuroleptics more than 3 years, showed good premorbid adjustment or initiative, and met criteria for chronic schizophrenia. Each also had obsessions or compulsions, and apathetic dysphoria, symptoms not previously attributed to TP. Following neuroleptic termination with introduction of lithium and sertraline, each showed atypically rapid disappearance of this psychopathology. The incidence of these features is over 47% (p < 0.05). Some cases of apparent neuroleptic-resistant schizophrenia may be TP.

Adult↗
PubMed1995

Clozapine treatment of euphoric mania.

Four patients with treatment-resistant euphoric mania characterized by elevated mood, hyperactivity, and rapid speech, refractory to standard treatments and anticonvulsants, showed dramatic improvement in symptoms when treated with clozapine. All developed enhanced functioning and new insight into previous psychopathology. This degree of improvement suggests that clozapine can be considered in the treatment of not only schizophrenia, schizoaffective disorder, and dysphoric mania but also classic euphoric mania unresponsive to traditional treatments.

Adult↗
PubMed1995

Encephalopathy associated with rapid decrease of high levels of lithium.

A case is described in which a highly detailed time course of serum lithium levels and mental status observations was consistent with neurotoxicity from the rapid decrease in high lithium levels rather than from the high lithium levels alone. The highest lithium level observed was 4.89 mEq/L; the patient remained oriented until about 40 h after hospital admission and the serum lithium level fell below 1.65 mEq/L. An EEG taken during the 2-day period of gross disorientation showed focal sharp epileptiform waves and paroxysmal bursts of slowing without full seizure. In view of these and previous complementary observations, and a rationale of similarity between hyperlithemia and hyponatremia, the potential toxicities of dialysis and abrupt lithium dose discontinuation should be considered in patients who develop high lithium levels after taking regular doses.

Adult↗
PubMed1994

Hyperlithemia correction and persistent delirium.

Experience with three patients whose courses are described suggested that delirium and persistent neurologic dysfunction follow rapid correction of hyperlithemia, which develops after regular lithium doses. From all retrievable published reports of adult hospitalization for hyperlithemia, all cases that described cognitive dysfunction after lithium administration for at least 10 days with insubstantial neuroleptic exposure were selected. Lithium was universally discontinued before or on admission. Of the 65 such cases, 50 were at least somewhat responsive on admission; of these, substantial deterioration during hospitalization occurred in 56%. Dialysis was associated with greater incidence of persistent neurologic sequelae (62% vs. 22%, P = .012) and deterioration during hospitalization (85% vs. 46%, P = .016), although cognitive dysfunction on hospital admission was less (P < .001) for patients who were then dialyzed. The greater neurotoxicity after dialysis suggests that while hyperlithemia can be toxic, its rapid correction can be more toxic. Parallels with hyponatremia, including a potential mechanism, suggest that gradual rather than abrupt correction of hyperlithemia might decrease the risk of neurotoxicity.

Aged↗
PubMed1994

Electroconvulsive therapy during high-risk pregnancy.

Pregnancy increases the risk of injury associated with mental illness. The varieties of malnutrition, substance abuse, and aggression that may accompany mental illness can injure the unborn child in more severe ways than the patient herself. Dangers associated with illness-related behavior can outweight the risks of pharmacotherapy, but no psychotropic drug is approved for use during pregnancy. Failure to produce a prompt or lasting remission of psychiatric symptoms also is a significant possibility with medication. The morbidity from continued illness and the incompletely described adverse effects of psychotropic drugs increases the attractiveness of ECT for severely depressed pregnant patients, especially with associated high-risk conditions. This paper discusses physiologic changes occurring during pregnancy and ECT and reviews contemporary monitors of maternal and fetal well-being. Guidelines are suggested for ECT during regular and high-risk pregnancies. The authors conclude that using additional precautions with high-risk pregnant patients permits ECT to be given with relative safety; medical and obstetric risk factors need not prevent its use.

Depressive Disorder↗
PubMed1994

Heart rate differences between right and left unilateral electroconvulsive therapy.

Left and right unilateral electrode placements were alternately applied in electroconvulsive therapy given to 21 men with melancholia. Accompanying heart rate elevations were greater following right unilateral treatment than left unilateral, apparently because of longer persistence of peak rates. This is consistent with right cerebral hemisphere superiority in the control of heart rate activity in neurologically intact humans.

Adult↗
PubMed1994

Asymmetric bilateral right frontotemporal left frontal stimulus electrode placement for electroconvulsive therapy.

The development is described of a new stimulus electrode placement for electroconvulsive therapy (ECT) from expectations that relate the location and volume of induced seizure foci to side effects and efficacy, respectively. These expectations are that cognitive side effects would be minimized by avoiding induction of seizure foci in brain regions associated with neuropsychological function, and that greater efficacy would be associated with a larger volume of seizure foci. These considerations led to placement on the right temple and on the left forehead. This placement was used in an open trial on 10 consecutive female inpatients suffering from mania, depression, or mixed manic-depressive state, 9 of whom showed severe cognitive impairment, psychosis, or both. All patients achieved remission, indicating efficacy as likely above 93.3% as below it, and above 74% (p < 0.05); 6- to 10-week follow-up was essentially unchanged. No cognitive morbidity was observed. Post-ECT mini-mental status score averaged 28.4 out of 30, with an average improvement of 17.3 points, substantially better than reported after bifrontotemporal ECT. These results justify further consideration of this placement.

Adult↗