Convulsive therapy
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Reliable, valid, and brief measures of mood state are essential to the evaluation of electroconvulsive therapy (ECT) efficacy. However, existing measures of mood state may be inappropriate for patients with transient cognitive impairment. Stern and colleagues have recently developed a set of Visual Analog Mood Scales (VAMS) for use in neurologically impaired patients. ⋯ Results indicate that the VAMS are as sensitive to the therapeutic effects of ECT as is the more lengthy and verbally demanding HDRS. In addition, the VAMS were highly correlated with the clinician's Clinical Global Improvement rating and the patient's self-report using a modified Center for Epidemiological Studies-Depression scale. The VAMS are brief, reliable scales that are sensitive to the treatment effects of ECT and that are appropriate for patients with transient cognitive impairment.
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Letter Randomized Controlled Trial Clinical Trial
Triazolam and diphenhydramine effects on seizure duration in depressed patients receiving ECT.
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The use of ketamine anesthesia in electroconvulsive therapy (ECT) has been limited by its effects on blood pressure and concerns about untoward psychological reactions. However, because its effect on seizures is presumably less than that of methohexital, ketamine is listed as an alternative method to prolong seizure length. In this case series, 10 patients were given ketamine anesthesia during ECT. ⋯ There were no adverse psychological reactions noted with ketamine, which was generally well tolerated. It is concluded that ketamine anesthesia with the doses used in this series is unlikely to be associated with longer seizures in ECT. However, for theoretical reasons discussed, ketamine may be worth studying further in ECT.
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Electroconvulsive therapy (ECT) is a safe, highly effective, and rapidly acting treatment for certain major psychiatric illnesses, most notably severe mood disorders. Disturbances in mood and behavior as symptoms of delirium may complicate recovery from traumatic brain injury, but virtually no data exist on the role of ECT as a treatment modality in such clinical situations. We describe a patient with severe, unremitting, agitated behavior following a severe closed head injury from a motor vehicle accident. ⋯ As an intervention of "last resort," he then received six brief-pulse, bilateral ECT treatments that resulted in marked lessening of his agitation and improvement in his ability to express his needs and participate in his self-care. Also, following the ECT, he showed a markedly enhanced response to psychopharmacologic agents. These findings may have important clinical implications for treatment of prolonged delirium after traumatic brain injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of electroconvulsive therapy after propofol and methohexital anesthesia.
Fifty-eight patients with major depression were randomly assigned to receive a hypnotic dose of either propofol or methohexital for their complete treatment series of electroconvulsive therapy (ECT). As expected, seizure duration was significantly shorter with propofol than with methohexital anesthesia. ⋯ However, this was independent of the choice of propofol or methohexital as the anesthetic. This study supports previous reports that seizure duration does not influence recovery from depression.