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Biomedical subjects

W V McCall

Publications and source records attributed to W V McCall.

At least 55 records · Page 3Linked to original sources
PubMed1995

ECT administration to a hyperthyroid patient.

There are few reported convincing cases of hyperthyroid depressed patients receiving electroconvulsive therapy (ECT). We describe a depressed 66-year-old woman with catatonic depression diagnosed with new-onset hyperthyroidism due to Grave's disease. After commencing propylthiouracil, her Grave's disease was partially treated, but her depression was no better. She subsequently received a course of seven ECT with resolution of her depression and no adverse sequelae.

Aged↗
PubMed1995

Fatal pulmonary embolism in the catatonic syndrome: two case reports and a literature review.

BACKGROUND: Catatonia is associated with excess early mortality when it is unrecognized or inadequately treated. The characteristics of the lethal catatonia subtype are now well described, but the excess mortality of the remaining patients with catatonic syndrome, particularly from pulmonary embolism, appears to be inadequately recognized. The fatal risk of the catatonic syndrome is reviewed. METHOD: Two new case reports of sudden death from pulmonary embolism in catatonic syndrome are presented. The world literature on morbidity, mortality, and pulmonary embolism in catatonia was reviewed by a search of MEDLINE and PsychInfo from 1966 to the present. Additional older references were discovered by screening bibliographies from articles produced by the searches. RESULTS: Twenty cases of autopsy-confirmed pulmonary embolism were found in patients with catatonic syndrome. Catatonic patients were more likely to die of pulmonary embolism and die earlier than patients with other types of schizophrenia. Death from pulmonary embolism did not occur until after the second week of catatonic symptoms and often occurred without warning. CONCLUSION: Risk of a fatal pulmonary embolism is inherent in persistent catatonic symptoms and may explain the observed excess early mortality. Prompt resolution of the catatonic syndrome with benzodiazepines, barbiturates, or electroconvulsive therapy is the best way to reduce risk of pulmonary embolism. The prophylactic value of physical therapy or anticoagulation merits further investigation. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of acute pulmonary embolism warrants early and vigorous intervention in catatonic patients.

Adult↗
PubMed1995

Can we teach psychiatric residents to rate seizure regularity?

Despite recent advances in electroconvulsive therapy, clinicians still lack a reliable marker of treatment adequacy. Electroencephalographic (EEG) seizure morphology has been proposed as such a marker. However, the reliability of seizure ratings has not been assessed. We present the results of a study that examined how readily psychiatric residents could be taught to rate seizure morphology using a seizure regularity scale. We found that trainees could reliably rate seizure regularity and were particularly adept at discerning highly regular seizures from irregular ones. We believe that establishing reliable human scoring for electroconvulsive therapy seizure regularity justifies the position that human inspection of the ictal EEG should always complement computer analyses of seizure morphology.

Adult↗
PubMed1994

Multifactorial obstructive sleep apnea in a patient with Chiari malformation.

We report a patient with severe obstructive sleep apnea (OSA) associated with a unique combination of syringobulbia-myelia, Chiari malformation type I (CM), absent hypoxic ventilatory drive, vocal cord paralysis, post-menopausal status, obesity, and acute respiratory failure necessitating mechanical ventilation. The remote onset of OSA five years after surgery underscores the need for long-term follow-up of patients with syringobulbia-myelia and CM and the importance of addressing multiple interacting neurologic, metabolic, and mechanical predispositions to sleep-disordered breathing.

Arnold-Chiari Malformation↗
PubMed1994

Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice.

The objective assessment of patients with a presumptive diagnosis of obstructive sleep apnea (OSA) has primarily used attended polysomnographic study. Recent technologic advances and issues of availability, convenience and cost have led to a rapid increase in the use of portable recording devices. However, limited scientific information has been published regarding the evaluation of the efficacy, accuracy, validity, utility, cost effectiveness and limitations of this portable equipment. Attaining a clear assessment of the role of portable devices is complicated by the multiplicity of recording systems and the variability of clinical settings in which they have been analyzed. This paper reviews the current knowledge base regarding portable recording in the assessment of OSA, including technical considerations, validation studies, potential advantages and disadvantages, issues of safety, current clinical usage and areas most in need of further study.

Ambulatory Care↗
PubMed1994

Electrocardiographic and cardiovascular effects of subconvulsive stimulation during titrated right unilateral ECT.

The American Psychiatric Association Task Force on ECT has recommended that electroconvulsive therapy (ECT) stimuli be dosed at "moderately suprathreshold" intensities. Empiric estimation of the convulsive threshold by stimulus dose titration may expose the patient to subconvulsive stimuli, and subconvulsive stimuli have been reported by some to carry serious cardiovascular risk. This study examines the electrocardiographic (ECG) and cardiovascular effects of subconvulsive stimuli. Forty consecutive inpatients (29 women, 11 men; mean age 68 years) with major depression received subconvulsive stimuli during titrated, right unilateral (RUL) ECT. Successively larger stimuli were administered until a convulsion began. The effects of subconvulsive stimuli on the ECG, heart rate (HR), and blood pressure (BP) were assessed with multivariate repeated measures analysis. Subconvulsive stimuli prolonged the R-R interval and decreased HR compared with baseline values immediately before the subconvulsive stimulus, but the changes were of questionable clinical significance. BP was not changed. In conclusion, subconvulsive stimuli are well tolerated in the context of titrated RUL ECT. If stimulus dose titration proves to be useful in optimizing efficacy with fewer cognitive side effects, then cardiovascular considerations should not be an obstacle in the application of stimulus dose titration in most patients.

Aged↗
PubMed1994

Effects of caffeine pretreatment on measures of seizure impact.

Caffeine lengthens electroconvulsive therapy (ECT) seizures but has not been demonstrated to lower seizure threshold, nor to directly improve treatment outcome. We examined the effects of caffeine upon three recently proposed physiologic measures of seizure quality or impact: electroencephalography voltage suppression ratios, seizure regularity, and heart rate. None of these measures differed significantly in depressed inpatients randomly pretreated with either i.v. caffeine or saline on successive treatments during a course of right unilateral ECT. Newly defined measures of seizure impact may help identify ECT seizures of differing clinical efficacy, but these measures did not discriminate our caffeine and placebo conditions.

Aged↗
PubMed1993

The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an intraindividual crossover study.

Recent evidence suggests that electroconvulsive therapy (ECT) efficacy depends upon both electrode placement and the degree to which stimulus dosage exceeds seizure threshold (T), and not simply on surpassing a minimum seizure duration as has been assumed. In light of these findings and studies reporting ictal electroencephalogram (EEG) differences between bilateral and unilateral ECT, we performed this 19-subject intraindividual crossover study of the effects of dose and electrode placement on the ictal EEG. We found ictal EEG evidence of greater seizure intensity with bilateral than unilateral ECT and with higher dosage (2.25 T) compared with barely suprathreshold stimuli. Seizure duration was not longer with bilateral than unilateral ECT and actually decreased with increased dose. A number of ictal EEG variables separated the unilateral 2.25 T and unilateral T conditions, which reportedly differ in efficacy, and therefore, these EEG measures show promise as markers of treatment adequacy.

Adult↗
PubMed1993

Convulsive threshold differences in right unilateral and bilateral ECT.

UNLABELLED: This study examines how the convulsive threshold in electroconvulsive therapy (ECT) varies with electrode placement (bilateral [BL] versus right unilateral [RUL]), age, gender, weight, and the nasion-inion measurements of the head. METHOD: Twenty-eight subjects underwent stimulus dose titration to determine the convulsive threshold. Titration was accomplished for each subject with both electrode placements during the first and second ECT in a balanced design. Head measurements were made prior to the first ECT. Results indicated that the convulsive threshold was higher for BL than RUL, higher for men than women, increased with age, and increased with an increasing nasion-inion measurement in women but not in men. We concluded that the convulsive threshold varies according to the choice of electrode placement, gender, and age as has been reported by others. We additionally report that the convulsive threshold increases with increasing head size as reflected in the nasion-inion distance.

Adult↗
PubMed1993

Aerobic fitness, acute exercise and sleep in older men.

In the current study 12 aerobically fit and 12 sedentary older men underwent two nocturnal polysomnographic (PSG) studies. A control PSG was conducted following a day without aerobic activity, whereas a postexercise PSG study was conducted following an afternoon session of exhaustive aerobic exercise. In addition to deriving usual sleep parameters, a computer scoring program was used to count the number of individual electroencephalographic (EEG) slow waves in each PSG tracing. Multivariate and univariate analyses showed that the fit subjects had shorter sleep onset latencies, less wake time after onset, fewer discrete sleep episodes, fewer sleep stage shifts during the initial portion of the night, less stage 1 sleep, a higher sleep efficiency and more total slow waves during both PSGs than did the sedentary subjects. Although no main effects were found for the acute exercise challenge, post hoc analyses showed that high levels of body heating during exercise predicted increased sleep fragmentation for both fit and sedentary subjects. These findings provide initial support for the contention that exercise and fitness may have significant effects on the sleep of older men. However, results also suggest that high levels of body heating resulting from a single exercise challenge may have adverse effects. Implications of the study are discussed and suggestions for future research are provided.

Age Factors↗
PubMed1993

A reappraisal of the role of caffeine in ECT.

Caffeine lengthens ECT seizures, perhaps by lowering the convulsive threshold. The authors assessed the impact of caffeine on the convulsive threshold and seizure duration. The convulsive threshold and seizure durations of 12 inpatients receiving right unilateral ECT were determined with and without caffeine pretreatment. Caffeine did not change the convulsive threshold, but it did lengthen seizure duration. Caffeine's lengthening of seizure duration without affecting the convulsive threshold is an uncertain benefit in right unilateral ECT.

Brain↗
PubMed1993

Relationship of nasal continuous positive airway pressure to periodic limb movement disorder in a patient without sleep apnea.

The treatment of sleep apnea with nasal continuous positive airway pressure (CPAP) occasionally has been associated with the appearance of periodic limb movement (PLM) disorder, but it has not been clear whether CPAP induces PLM, or whether the PLM is simply disguised until apnea is treated. We report the emergence of PLM after the inadvertent application of CPAP in a patient without sleep apnea.

Adult↗
PubMed1992

Controlled investigation of the amobarbital interview for catatonic mutism.

OBJECTIVE: Clinical reports over the last 60 years suggest that the amobarbital interview is effective in relieving catatonic symptoms. This has never been substantiated with methodologically sound trials. The authors postulated that a randomized blind comparison of intravenous amobarbital and saline would demonstrate the superiority of amobarbital in relieving catatonic mutism. METHOD: The subjects were 20 inpatients with catatonic mutism. They were randomly assigned to either saline (N = 10) or a 5% amobarbital solution (N = 10), and the infusions were administered intravenously at a rate of 1 cc/min or less over 10 minutes by a blinded physician. A second blinded physician administered a semistructured interview during the infusion to control for the effect of suggestion. A third blinded physician rated patient responsiveness, reactivity, and arousal. Any patient who was unresponsive to the initial infusion was crossed over to the other infusion. Interviews were videotaped for determination of interrater reliability. RESULTS: In the initial infusions, six of 10 patients responded to amobarbital and zero of 10 responded to saline. Four of the saline nonresponders responded when given amobarbital. Response was evident by the 4th minute of the amobarbital infusion. Interrater reliability was high. The responders and nonresponders differed significantly in the variance of the weight-adjusted amobarbital dose, and the responders tended to be older and female. CONCLUSIONS: Intravenous amobarbital is superior to saline in relieving catatonic mutism, although only 50% of these patients responded. The nonresponders were distinguished from the responders by a greater variance in the weight-adjusted dose of amobarbital.

Adult↗
PubMed1992

The addition of intravenous caffeine during an amobarbital interview.

Although the amobarbital interview is an effective means of temporarily relieving catatonic mutism, some catatonic patients simply fall asleep during an amobarbital interview. We are examining the feasibility of administering intravenous caffeine benzoate during an amobarbital interview to prevent patients from falling asleep. This paper describes an open trial of the administration of 500 mg caffeine benzoate during amobarbital interviews with ten patients. The procedure was well tolerated, but further studies are needed to determine whether or not caffeine is an advantage over amobarbital alone.

Adult↗
PubMed1992

Ambulatory polysomnography: technical aspects and normative values.

Ambulatory polysomnographic (APSG) assessment of sleep disorders is now possible, but the technique of APSG is sufficiently different from in-laboratory PSG that normative data from in-laboratory PSG may not apply to APSG. This paper reviews the technical aspects of APSG and presents normative APSG data from 20 older healthy males. Subjects underwent medical and psychiatric screening before completing APSG in their homes. Total sleep time and the rapid-eye-movement sleep latency (RL) were both shorter than those reported by others using traditional in-laboratory techniques. The shorter total sleep may be related to behaviors at home that impinge upon sleep. The shorter RL may be related to differences in calculation methods. Periodic limb movements were common in our subjects but did not contribute to sleep disturbance. We conclude that APSG is sufficiently different from traditional PSG as to warrant collection of a large normative data base.

Ambulatory Care↗