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PubMed2003

Propofol alone, sevoflurane alone, and combined propofol-sevoflurane anaesthesia in electroconvulsive therapy.

Electroconvulsive therapy is an effective treatment for severe and medication-resistant depression. There have been no reports describing how a volatile anaesthetic affects haemodynamic responses, seizure duration, and recovery characteristics during electroconvulsive therapy. We carried out a repeated-measure crossover study to compare the effects on haemodynamic responses, seizure duration, and recovery characteristics of the following types of anaesthesia in electroconvulsive therapy: propofol alone, sevoflurane alone, and propofol combined with sevoflurane. We recruited 50 patients requiring electroconvulsive therapy for depression. For anaesthesia induction, 1.5 mg/kg propofol (condition P), 5% sevoflurane in oxygen following a vital capacity rapid inhalation induction (condition S), or 1.5 mg/kg propofol followed by 5% sevoflurane in oxygen (condition PS) was administered. Succinylcholine 1.5 mg/kg was then given. Electrical stimulation was administered after fasciculation. Measurements were obtained before anaesthesia induction (baseline), prior to succinylcholine administration, prior to electroconvulsive therapy, and at the peak after electroconvulsive therapy. After electroconvulsive therapy, peak heart rate and peak mean arterial pressure were highest in condition S. Whereas recovery time was longest in condition PS, motor seizure duration was significantly shorter than in either condition P or S. Electroencephalographic seizure duration was significantly shorter in condition PS than in condition P and significantly shorter in condition S than in condition P. Sevoflurane anaesthesia alone is most disadvantageous in terms of haemodynamics. Propofol-sevoflurane anaesthesia is advantageous in terms of haemodynamics, but disadvantageous in terms of seizure duration and recovery time. Propofol alone is most advantageous in terms of seizure duration.

Adult↗

PubMed2002

The effects of intravenous lignocaine on haemodynamics and seizure duration during electroconvulsive therapy.

Electroconvulsive therapy (ECT) is commonly associated with acute hyperdynamic cardiovascular responses, and we hypothesize that intravenous lignocaine can blunt this response. We have measured the effect of lignocaine 1.5 mg/kg i.v. on heart rate and mean arterial pressure during electroconvulsive therapy. Furthermore, we also assessed seizure duration using both the cuff method and two-lead electroencephalography. We studied 25 patients using a randomized, double-blind, placebo-controlled crossover study design. Patients in the control group were given intravenous saline 0.075 ml/kg, and those in the lignocaine group were given intravenous lignocaine 2% 1.5 mg/kg, and this treatment was conducted one minute before intravenous propofol 1.5 mg/kg to induce unconsciousness. Succinylcholine 1.5 mg/kg was then administered intravenously and electrical stimulation was administered after fasciculation. Measurements were taken at the baseline, prior to succinycholine, prior to electroconvulsive therapy and at the peak response after electroconvulsive therapy. Intravenous lignocaine significantly reduced the increases in heart rate after electroconvulsive therapy, as compared with the placebo. The use of intravenous lignocaine was, however, associated with a remarkably shortened seizure duration. Due to the reduction in seizure duration, routine administration of intravenous lignocaine may not be advisable since it may interfere with the psychotherapeutic efficacy of electroconvulsive therapy. However, intravenous lignocaine medication for electroconvulsive therapy is potentially useful for reducing tachycardia in high-risk patients and reducing the severity of propofol injection pain in comparison with a placebo.

Adult↗

PubMed1991

Electroconvulsive therapy.

Electroconvulsive therapy treatment for severely depressed adults is increasing because it economically and rapidly reduces symptoms in most patients. Improved administration and unilateral electrode placement have decreased complications. However, concern exists about cognitive and other adverse effects of electroconvulsive therapy. Nurses are in a critical position to educate patients about electroconvulsive therapy, to be advocates for patients' rights, and to monitor responses to treatment. Because both depression and electroconvulsive therapy may impair cognitive functioning, nurses should renegotiate patients' consent during electroconvulsive therapy. Nurses who know, research, and evaluate memory and confusion can effectively observe and diminish the side effects of electroconvulsive therapy.

Adult↗

PubMed1990

Normalization of blunted lymphocyte beta-adrenergic responsivity in melancholic inpatients by a course of electroconvulsive therapy.

Electroconvulsive therapy has been reported to desensitize brain beta-adrenergic receptors in rodents, but this effect has not been studied in man. We examined the effect of a course of electroconvulsive therapy on lymphocyte beta-adrenergic responsivity in 19 inpatients with melancholia. Before treatment, beta-adrenergic cyclic adenosine monophosphate response to isoproterenol was significantly blunted in the patients compared with controls. Following a course of electroconvulsive therapy, beta-adrenergic responsivity increased such that patients no longer differed from controls. Thus, blunted lymphocyte beta-adrenergic responsivity is a state-dependent effect of melancholia that can be corrected by a therapeutic course of electroconvulsive therapy. The effect of electroconvulsive therapy on this beta-adrenergic system is in the opposite direction to that reported for rodent forebrain, where electroconvulsive therapy causes desensitization, and may reflect differences between peripheral and central effects, species differences, or disease effects.

Cyclic AMP↗

PubMed2006

Carbon dioxide exhalation temporarily increases during electroconvulsive therapy.

Electroconvulsive therapy induces hypermetabolism and elevates oxygen and energy demands, while more carbon dioxide is produced than usual. The purpose of the present study was to determine the elevated carbon dioxide exhalation and the adequate ventilation volume during electroconvulsive therapy. Carbon dioxide exhalation during an electrically induced seizure was continuously monitored by capnography and spirography in 15 patients with endogenous depression. A laryngeal mask airway was used to measure the airway gas flow. Data were collected during a total of 80 electroconvulsive therapy trials. The carbon dioxide exhalation at 1 min after electrical stimulation was higher than the control value (2.8 +/- 0.4 versus 2.3 +/- 0.3 ml.min(-1).kg(-1), mean +/- SD; P < 0.05). The ventilation volume was increased for 3 min after the electrical stimulation to maintain the end-tidal carbon dioxide partial pressure at 35-40 mmHg. The results showed that increasing the ventilation volume by approximately 20% may be necessary to compensate for the increased carbon dioxide exhalation during electroconvulsive therapy.

Adult↗

PubMed2000

Electroconvulsive therapy for schizophrenia.

BACKGROUND: Electroconvulsive therapy (ECT) involves the induction of a seizure (fit) for therapeutic purposes by the administration of a low frequency electrical stimulus shock via electrodes applied to the scalp. At present it is used for those with schizophrenia but its effects are unclear. OBJECTIVES: To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning in those with schizophrenia. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), Medline (1966-1996), PsycLIT (1974-1996) and SCISEARCH (1996) were undertaken. The references of all identified studies were investigated. SELECTION CRITERIA: All randomised controlled trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics for people with schizophrenia, schizoaffective disorder or chronic mental disorder. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and analysed the data on an intention to treat basis. MAIN RESULTS: Less people with schizophrenia treated with ECT showed no improvement in general functioning when compared to those given placebo in the short term (OR 0.48 CI 99% 0.26-0.90). This effect, however, does not last. However, ECT is less effective than antipsychotic drug treatment for those with schizophrenia. Limited evidence exists to suggest that combining antipsychotic drugs and ECT increases the rate and extent of clinical improvement, in the short term, in one out of every five to six people. The evidence for the efficacy of ECT in the medium to long term is equivocal. Electroconvulsive therapy is also more effective than the now obsolete insulin coma treatment. REVIEWER'S CONCLUSIONS: There is some evidence to support the use of ECT for those with schizophrenia for short term relief of symptoms. Electroconvulsive therapy may be advocated as an adjunct to antipsychotic medication for those with schizophrenia who show a limited response to medication alone but the evidence for this is not strong. In fact in spite of more than five decades of widespread clinical use, the administration of ECT to those with schizophrenia lacks a strong research base.

Electroconvulsive Therapy↗

PubMed1985

Consensus conference. Electroconvulsive therapy.

Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure. In the United States in the 1940s and 1950s, the treatment was often administered to the most severely disturbed patients residing in large mental institutions. As often occurs with new therapies, ECT was used for a variety of disorders, frequently in high doses and for long periods. Many of these efforts proved ineffective, and some even harmful. Moreover, its use as a means of managing unruly patients, for whom other treatments were not then available, contributed to the perception of ECT as an abusive instrument of behavioral control for patients in mental institutions for the chronically ill. With the introduction of effective psychopharmacologic medications and the development of judicial and regulatory restrictions, the use of ECT has waned. The treatment is now used primarily in general hospital psychiatric units and in psychiatric hospitals. A National Institute of Mental Health hospital survey estimated that 33,384 patients admitted to hospital psychiatric services during 1980 were treated with ECT, representing approximately 2.4% of all psychiatric admissions. Although ECT has been in use for more than 45 years, there is continuing controversy concerning the mental disorders for which ECT is indicated, its efficacy in their treatment, the optimal methods of administration, possible complications, and the extent of its usage in various settings. These issues have contributed to concerns about the potential for misuse and abuse of ECT and to desires to ensure the protection of patients' rights. At the same time, there is concern that the curtailment of ECT use in response to public opinion and regulation may deprive certain patients of a potentially effective treatment. In recent decades, researchers intensified efforts to establish the effectiveness of ECT and its indications, understand its mechanism of action, clarify the extent of adverse effects, and determine optimum treatment technique. Despite recent research effort yielding substantial information, permitting professional and public evaluation of the safety and efficacy of ECT, the investigation of ECT has not generally been in the mainstream of mental health research. To help resolve questions surrounding these issues, the National Institutes of Health in conjunction with the National Institute of Mental Health convened a Consensus Development Conference on Electroconvulsive Therapy from June 10 to 12, 1985.(ABSTRACT TRUNCATED AT 400 WORDS)

Bipolar Disorder↗

PubMed1991

Heterogeneity in the beta-endorphin immunoreactivity response to electroconvulsive therapy.

Electroconvulsive therapy is accompanied by an activation of the hypothalamic-pituitary-adrenal axis, resulting in a release of beta-endorphin from the anterior pituitary corticotrophs of humans. As a group, patients in our study demonstrated similar plasma beta-endorphin immunoreactivity response to their initial and final treatments. However, approximately half of the patients demonstrated greater beta-endorphin immunoreactivity release with their first seizure compared with their last seizure, and half of the patients demonstrated the opposite pattern. This difference was not explained by age, sex, unilateral vs bilateral treatments, sine wave vs brief pulse, or psychotropic or anticholinergic medication. Patients with constant seizure duration during the first and final treatments demonstrated a greater release of beta-endorphin immunoreactivity with the final treatment compared with the first treatment. Individuals with decreasing seizure duration during the course of the electroconvulsive therapy demonstrated a decreased beta-endorphin immunoreactivity response during their final treatment.

Adult↗

PubMed1982

Factors influencing prolactin release induced by electroconvulsive therapy.

Electroconvulsions have been reported to induce rapid elevations of serum prolactin (PRL) levels. To further evaluate factors involved in the hormonal release an extended study was performed. Blood samples for determination of PRL were withdrawn from depressed patients 5 min before and 15 min after administration of electroconvulsions. Significant elevations of PRL levels were found in 35 of 37 patients. Increase in PRl levels was significantly correlated to duration of seizures but not to duration of the electric stimulation. The hormonal response to electroconvulsions was diminished with age. Patients on lithium medication had significantly more pronounced rises of PRL levels than patients treated with other psychotropic drugs and otherwise untreated patients. The results indicate that the elevation in PRL levels is a biochemical marker of the seizure activity during electroconvulsive therapy.

Adolescent↗

PubMed1992

Failed and short seizures associated with prior electroconvulsive therapy.

Electroconvulsive therapy (ECT) has not been associated with many long-lasting effects that are associated with the treatments itself. The impact of having prior ECT to determine if the increased seizure threshold that is noticed during the treatment course is long-lasting was studied. If so, more failed and short seizures should occur among those patients who have had prior electroconvulsive treatments. A review of the treatments of 114 males and 220 females indicated a strong association of prior ECT with failed as well as short seizures for men but not for women.

Adult↗

PubMedDate not supplied

Contemporary practice of electroconvulsive therapy.

Electroconvulsive therapy (ECT) is an effective and important treatment for severe depressive illness and for other depressive illnesses that have not responded to drug treatment. Practical guidelines based on recent research findings are presented here to maximize the efficacy and minimize the adverse effects of ECT.

Clinical Protocols↗

PubMed2000

Side effects of electroconvulsive therapy.

Electroconvulsive therapy is extremely effective and is the fastest acting antidepressant treatment now available, although not necessarily limited to use with depression. Despite years of experience with this technique and its unparalleled successes, patients continue to be affected by mostly transient, but sometimes impairing side effects from memory problems and cardiovascular changes associated with ECT treatments. Nausea, headache, muscle aches, and other side effects that have been referenced in the literature and clinical experience will also be discussed in this review. Helpful literature with recommendations on minimizing the risks of these side effects and improving the tolerability of the electroconvulsive treatments will also be presented.

Major Depressive Disorder↗

PubMed1994

Electroconvulsive therapy.

Electroconvulsive therapy (ECT) has evolved into a useful treatment alternative for a select psychiatric patient population. With thorough knowledge of ECT and judicious candidate selection, positive therapeutic responses can be achieved with minimal risk of complications. ECT, in its state-of-the-art application, offers certain severely-ill psychiatric patients a treatment option that can provide immediate results.

Electroconvulsive Therapy↗

PubMed1989

Electroconvulsive therapy.

Electroconvulsive therapy (ECT), introduced in 1938 by Cerletti, has been of value in the treatment of depression in spite of the use of stimuli which were usually standardized and the wide variation in the inter-electrode impedance and in the resistivity of the tissues traversed. Accurate measurement of the peak current and the peak voltage in a large number of treatments has shown the need for a considerable choice of constant current values. The lack of measurements accounts for much of the variability in the clinical results.

Animals↗

PubMed1981

A survey of attitudes on the use of electroconvulsive therapy.

Electroconvulsive therapy in recent years has received extensive coverage in the mass media, much of it negative. However, little can be found in either the professional literature or the popular press on the attitudes of professionals, patients, and the general public toward ECT. A questionnaire study of 587 individuals drawn from these three categories shows an over-all favorable response to the use of ECT, despite the presence of significant differences in response among members of each category. The implications of the findings for current practice and research are discussed.

Attitude of Health Personnel↗

PubMed2004

Diffuse T-wave inversions associated with electroconvulsive therapy.

Electroconvulsive therapy (ECT) can lead to ST depression and arrhythmias in patients with coronary artery disease, most likely secondary to increased myocardial oxygen demand. This report describes a case of ECT-associated, global T-wave inversions in a patient with chronic atrial fibrillation treated with digoxin. Laboratory evaluation and echocardiography were normal. These T-wave changes may result from increased sympathetic activity associated with ECT. Prospective studies suggest that this finding may be seen in up to 4% of patients undergoing ECT.

Aged↗

PubMed2003

Clinical applications of recent research on electroconvulsive therapy.

Electroconvulsive therapy (ECT) has been in use since the late 1930s to treat a variety of severe mental illnesses, most notably major depression. Current research efforts focus on patient selection, memory impairment, and high posttreatment relapse rates. Psychopathological factors such as psychosis and severe psychomotor retardation predict favorable response to ECT in depression. Technical variables that affect memory include electrode placement, stimulus intensity, and treatment frequency. Strategies to reduce posttreatment relapse rates include maintenance ECT and aggressive medication combinations. In this article, I review recent research that bears on these aspects of ECT practice. Additionally, I review some findings on the neurobiological effects of ECT.

Electroconvulsive Therapy↗

PubMed1978

The use of electroconvulsive therapy.

Electroconvulsive therapy is a treatment procedure in psychiatry which has frequently come under considerable critical scrutiny. This paper describes its use mainly in a postgraduate institute of psychiatry and, for comparative purposes, two other types of psychiatric facilities in Toronto. The treatment is given conservatively, varying to hospital, and is prescribed for 11 percent of patients at a postgraduate institute. However, it is used largely for those with depressive disorders as recommended in standard textbooks. Diagnosis and age are the key variables affecting ECT prescription. It is suggested that ECT practice is effective by and large and now efforts should concentrate on making it efficient.

Adult↗