Search PubMed⌕ Search

Biomedical subjects

Richard Abrams

Publications and source records attributed to Richard Abrams.

At least 19 recordsLinked to original sources
PubMed2002

Stimulus titration and ECT dosing.

The seizure threshold to electroconvulsive therapy (ECT) is defined entirely by the duration of the induced seizure, is multidetermined, and varies enormously with a wide variety of patient and treatment factors, including especially the parameters of the ECT stimulus. No consistent relationship has ever been detected between the clinical antidepressant response to ECT and either the threshold or the duration of the induced seizure. The stimulus titration method for determining the seizure threshold (titration-threshold dosing) was the central research tool used to reverse years of dogma by proving that the induced seizure of ECT is not alone sufficient to explain the therapeutic properties of ECT, and that the interaction between dosage and treatment electrode placement is critical in this regard. In clinical use, however, titration-threshold dosing has proven less than fully effective in optimizing the stimulus dose for ECT-better results are consistently obtained with age-based or fixed high-dose methods. The lack of a direct correlation between either seizure threshold or duration and clinical ECT response is an irremediable flaw of the titration-threshold method as clinically applied. New approaches are now called for in which ECT stimulus dosage is set and adjusted ("titrated") according to the clinical antidepressant response of the patient or to measurable correlates thereof: maximum sustained electroencephalogram (EEG) ictal power, EEG postictal suppression, induced interictal EEG delta activity, peak heart rate, maximum sustained EEG coherence, and postictal EEG coherence reduction, all of which have been found by various investigators to be related to the clinical antidepressant response to ECT.

Depression↗
PubMed1991

Prediction of ECT Response in Melancholia.

None of 15 individual Hamilton depression scale items obtained at baseline, or five depression factors derived therefrom, significantly predicted an adjusted posttreatment Hamilton depression score after six unilateral or bilateral ECTs in a sample of 47 melancholic men. Excluding patients with nonmelancholic syndromes from ECT samples attenuates the previously reported predictive value of individual or grouped clinical psychopathological features of depression.

Journal Article↗
PubMed1991

Seizure Generalization and Unilateral Electroconvulsive Therapy.

The author responds to Ottosson's exposition of the variables that determine the relative efficacies of unilateral and bilateral ECT. To Ottosson's prescription for maximizing the therapeutic impact of unilateral ECT, he adds the administration of a markedly suprathreshold brief pulse stimulus train of.5 to 1.5 ms pulse width and >/=2 s duration.

Journal Article↗
PubMed1989

Lateralized Hemispheric Mechanisms and the Antidepressant Effects of Right and Left Unilateral ECT.

This article critically reviews the six controlled studies of the antidepressant effects of right unilateral versus left unilateral ECT (R-ECT, L-ECT), contrasting them with results recently obtained in double-blind, random assignment comparison of the two methods, using a square-wave stimulus, widely spaced temporoparietal electrode placement, and markedly supra-threshold stimulus charge. The author challenges the prevalent belief in a therapeutic advantage of R-ECT versus L-ECT, proposing instead the contrary case for a therapeutic advantage of L-ECT, based on the interaction of a hypothesized interhemispheric seizure threshold difference and a maximally efficient method of stimulus delivery.

Journal Article↗
PubMed1988

Serotonin and Electroconvulsive Shock-Induced Prolactin Release.

Baseline and post-electroconvulsive shock (ECS) prolactin levels were determined in serum samples from 13 rabbits, with and without pretreatment with the serotonin-2 (5-HT(2)) receptor blocker ketanserin. Without ketanserin, ECS did not raise serum prolactin levels over baseline. After ketanserin, baseline serum prolactin levels were 50% lower and post-ECS prolactin levels were twice this new baseline level and close to post-ECS prolactin levels without ketanserin. These observations suggest that serotonergic neurotransmission potentiates stress-induced prolactin secretion, but contributes little to ECS-induced prolactin release.

Journal Article↗
PubMed1987

Postictal Delirium (and Recovery From Melancholia) After Left-Unilateral ECT.

Postictal delirium was observed after left-unilateral ECT in a fully dextral man whose melancholia entirely remitted with seven treatments. These findings suggest that it is premature to attribute either the syndrome of postictal delirium or the beneficial effects of ECT in melancholia primarily to right hemisphere mechanisms.

Journal Article↗