Convulsive therapy
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We report a 19-year-old woman who received electroconvulsive therapy (ECT) late in the course of neuroleptic malignant syndrome (NMS). She received at least two sessions with multiple ECT and had a full recovery. We suggest that multiple seizures may optimize ECT treatment in NMS.
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Randomized Controlled Trial Clinical Trial
Effect of esmolol pretreatment on EEG seizure morphology in RUL ECT.
Intravenous beta-blockers are an effective means of controlling heart rate and blood pressure during electroconvulsive therapy (ECT), but have been shown to decrease seizure duration. While the importance of seizure duration to the antidepressant response of ECT grows less certain, there is growing evidence that seizure morphology predicts the antidepressant effect of ECT. This study examined the impact of esmolol pretreatment on seizure morphology. ⋯ Routine administration of intravenous esmolol before ECT may cause a decrease in ictal regularity. Careful consideration should be given to the potential benefits of esmolol versus the deleterious effect on the electrophysiologic process. Esmolol may still be indicated on a case-by-case basis for extreme tachycardia or hypertension associated with ECT, and presumably poses no problem for the therapeutic effect of ECT if given after the seizure is over.
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Randomized Controlled Trial Clinical Trial
The effect of esmolol on ST-segment depression and arrhythmias after electroconvulsive therapy.
Electroconvulsive therapy (ECT) induces sympathetically mediated hemodynamic alterations that can be associated with myocardial ischemia and arrhythmia generation. Esmolol, a short-acting beta-blocker, blunts the hypertension and tachycardia seen with ECT. The purpose of this study is to determine whether esmolol use during ECT reduces the incidence of myocardial ischemia or arrhythmias after ECT. ⋯ There was no difference in the incidence of ECG defined ischemia post-ECT between groups, with 7 of 19 (36.8%) patients in the esmolol group showing ST-segment depression compared with 5 of 19 (26.3%) in the placebo group. There was no difference between groups in arrhythmia detection. This experiment demonstrates that (a) ECT is associated with a significant incidence of ST-segment depression, (b) esmolol blunts the sympathetic discharge during ECT, and (c) esmolol does not reduce the incidence of post-ECT ischemia or arrhythmia.
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Letter Case Reports
Combination midazolam and droperidol for severe post-ECT agitation.
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A retrospective investigation of electroconvulsive therapy (ECT)-treated patients in 1992-94 at the Psychiatric Hospital in Aarhus, Denmark showed that en bloc treatment had been given in 39 cases of 420 patient series. The basic diagnoses (according to ICD-10) were severe depressive disorder, bipolar affective disorder mixed state, manic disorder, acute transient psychotic disorder, schizoaffective disorder, and schizophrenia; all patients were in a severely psychotic condition. ⋯ Patients were subsequently given supplementary treatment for the underlying disease. ECT is an effective treatment for psychoses complicated by acute delirium.