Catatonia is a motor syndrome with abnormalities in neuroendocrine regulation. Both the motor syndrome and the neuroendocrine abnormalities respond rapidly to electroconvulsive therapy (ECT). This rapid efficacy supports a neuroendocrine hypothesis of the mode of action of ECT and encourages neuroendocrine studies of catatonia.

Amobarbital↗

PubMed1993

Blood Pressure, Memory, and Electroconvulsive Therapy.

Blood pressure changes recorded during electroconvulsive therapy (ECT) in 23 psychiatric in-patients with major depressive disorders correlated with and predicted the degree of anterograde memory changes measured 48-72 h after ECT. The Randt memory test was the principal measure of memory change. A subgroup of older patients with cardiovascular illness received trimethaphan, a ganglionic blocker that impedes a hypertensive surge during the treatment. They did not differ in memory function from a younger subgroup that did not receive trimethaphan. Control of the hypertensive response in the older age group counterbalanced the additional memory dysfunction that was anticipated as a result of advanced age and cardiovascular pathology.

Journal Article↗

PubMed1993

Prolonged Seizures.

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Editorial↗

PubMed1993

Caffeine Pretreatment Enhances Clinical Efficacy and Reduces Cognitive Effects of Electroconvulsive Therapy.

In an open clinical trial, depressed patients received age-dosed, brief-pulse electroconvulsive therapy (ECT) either with or without 500 mg i.v. caffeine sodium benzoate before each treatment. Caffeine-pretreated patients required fewer ECT treatments, and after three to four treatments, their Hamilton Depression Scale (HDS) scores were significantly lower. At the end of the ECT course, both groups reached the same reduction in HDS scores. Of five memory tests, one showed better performance at the end of the ECT course for the caffeine-pretreated compared with the non-caffeine-pretreated patients. The results argue that caffeine-modified ECT differs from unmodified ECT in speed of response and the effects on cognitive tests.

Journal Article↗

PubMed1993

Electroconvulsive Therapy in Children and Adolescents.

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Editorial↗

PubMed1993

Reversible Dementia and Affective Disorder: The Rip Van Winkle Syndrome.

The diagnostic separation of the reversible dementia of an affective disorder from the dementia secondary to structural brain pathology remains a clinical challenge. A 58-year-old woman had been diagnosed as having Alzheimer's dementia for 9 years before antidepressant treatment with electroconvulsive therapy (ECT) resolved the dementia syndrome. The patient has functioned well for 8 years on maintenance treatment with lithium, with ECT given every 7-8 weeks. By the summer of 1993, she had undergone 132 ECT. Until specific and reliable pre-morbid tests for the diagnosis of irreversible dementias of the Alzheimer's and multiinfarct types are developed, antidepressant treatment trials are encouraged in elderly patients with a dementia syndrome. Extensive maintenance ECT schedules are safe.

Journal Article↗

PubMed1993

ECT and Drugs: Concurrent Administration.

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Editorial↗

PubMed1993

Post-ECT Delirium.

A confusional state accompanied by restlessness is a frequent occurrence at the end of an induced seizure in electroconvulsive therapy (ECT). Delirium, which usually lasts <1 h, occurs in up to 12% of patients. It is most frequent during the initial treatments of a series. The occurrence of delirium in one treatment is not a harbinger of its reappearance in later treatments. Usually gentle reassurance is sufficient to help the patient, but some instances warrant the administration of diazepam, midazolam, a barbiturate, or droperidol.

Journal Article↗

PubMed1992