1,720,973 research outputs found
Electroconvulsive therapy: what should be done when the needs exceed the treatment capacities?—A medical ethics guidance
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Effectiveness of maintenance electroconvulsive therapy—Evidence from modifications due to the COVID‐19 pandemic
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Effects of Anesthesia Changes During Maintenance ECT: A Longitudinal Comparison of Seizure Quality Under Anesthesia Using Propofol/Esketamine Versus Methohexital
No full textAbstract Introduction The effectiveness of ECT relies on the induction of a generalized cerebral seizure. Among others, seizure quality (SQ) is potentially influenced by the anesthetic drug used. Commonly used anesthetics comprise barbiturates, etomidate, propofol, and esketamine, with different characteristics and impacts on seizure parameters. So far, no studies have compared the influence of methohexital vs. a combination of propofol/esketamine on established SQ parameters. Methods This retrospective longitudinal study compared eight established SQ parameters (PSI, ASEI, MSC, midictal amplitude, motor and electroencephalography (EEG) seizure duration, concordance, PHR) before and after the change from propofol/esketamine to methohexital in 34 patients under maintenance ECT. Each patient contributed four measurements, two before and two after the anesthesia change. Anesthesia dose, stimulus dose, electrode placement, and concomitant medication remained unchanged throughout the analyzed treatments. Results Under methohexital (M=88.97 mg), ASEI (p=0.039 to 0.013) and midictal amplitude (p=0.022 to<0.001) were significantly lower, whereas seizure duration (motor and EEG) was significantly longer when compared to propofol/esketamine (M=64.26 mg/51.18 mg; p=0.012 to<0.001). PSI, MSC, seizure concordance, and PHR were not affected by the anesthetic used. Discussion Although to what extent these parameters correlate with the therapeutic effectiveness remains ambiguous, a decision for or against a particular anesthetic could be considered if a specific SQ parameter needs optimization. However, no general superiority for one specific substance or combination was found in this study. In the next step, anesthetic effects on treatment response and tolerability should be focused on
Versorgungsaspekte der Elektrokonvulsionstherapie: Analyse der externen Zuweisungen an ein universitäres Zentrum
No full textBACKGROUND: The application of ECT in Germany varies widely depending on regional availability. This shortfall in ECT supply is partly compensated via referrals to hospitals with ECT services, yet restricted by limited resources in these clinics. OBJECTIVE: External referrals for ECT were investigated at the University Medical Center Göttingen. We analyzed the referring institutions, patient characteristics, pharmacotherapy according to current guidelines before indications for ECT, and clinical outcome in cases of treatment with ECT. MATERIAL AND METHODS: All external referrals were systematically recorded and retrospectively evaluated for the time span of 1 year. Besides descriptive presentation of the data, pharmacological pretreatment was compared with the current guideline recommendations. We used overall clinical impression (CGI-I) to determine the treatment response post-ECT. RESULTS: External referrals were made for N = 52 patients, 82.7% of whom were from the inpatient setting and from a distance of up to 300 km. The most common diagnoses were unipolar depression (57.7%), followed by schizophrenia spectrum (36.5%). Prior to referral, at least one guideline-based pretreatment was given in the majority of cases. ECT was performed in 18 patients in our hospital, of whom 72.7% showed a good to very good response. CONCLUSION: Both numbers and radius of external referrals indicate a high unmet need for ECT and thus limited access to this evidence-based and guideline-recommended therapy. As treatment close to home should be the goal, more hospitals are needed to establish (or expand) ECT services; however, even with considerable delays which are often associated with external referrals, the response rate is good across all diagnoses
P.239 Electroconvulsive therapy and the brain: no increase of neurofilament light chain in the treatment course
No full textInfluence of depressed patients' expectations prior to electroconvulsive therapy on its effectiveness and tolerability (Exp-ECT): a prospective study
No full textElectroconvulsive therapy (ECT) is the most effective therapy for severe depressive disorders. Though there are known clinical predictors of response (e.g., higher age, presence of psychotic symptoms), there is a lack of knowledge concerning the impact of patients' expectations on treatment outcome and tolerability in terms of possible placebo/nocebo effects. In 31 patients with unipolar or bipolar depressive disorder, we used a questionnaire to investigate the patients' expectations of ECT effectiveness and tolerability prior to and in the course of the treatment. Additionally, the questionnaire was used after the ECT course for a final assessment. Depressive symptoms and putative side-effects were measured at each time point. General linear models were used to analyze the course of depressive symptoms and patients' expectation of ECT effectiveness and tolerability. ECT significantly reduced depressive symptoms with large effect sizes. Patients' rating of ECT effectiveness decreased in parallel: While responders' rating of ECT effectiveness remained stable on a high level, non-responders' rating decreased significantly. Group difference was significant after, but not prior to and during the treatment. Regarding tolerability, there was a (temporary) significant increase in the severity of self-rated symptoms such as headache and memory impairment. In contrast, patients' expectation and assessment of ECT tolerability remained unchanged, and their expectations prior to ECT had no impact on the occurrence of side-effects. These findings contradict the presence of relevant placebo/nocebo effects in the context of ECT when investigating a population of mostly chronic or treatment resistant patients with moderate to severe depressive disorder
Overlooking the obvious? Influence of electrolyte concentrations on seizure quality parameters in electroconvulsive therapy
No full textSex attracts - neural correlates of sexual preference under cognitive demand
No full textNeurofunctional correlates of sexual arousal are of interest in basic research as well as in clinical science. In forensic psychiatry, it is important to use designs which are potentially robust against susceptibility to manipulation or deception. We tested a new design to measure neurofunctional correlates of sexual preference. Twenty-two healthy heterosexual men had to solve a mental rotation task while sexually preferred or non-preferred distractors were presented simultaneously. With this challenging active task, subjects’ possibility to manipulate their response to the sexual stimuli should be lower than in easier tasks and in passive designs. Participants needed more time to solve the mental rotation task when distractors of women and girls were presented compared to distractors of men and boys. FMRI-results showed a network of three brain regions which specifically responded to sexually preferred distractors. Female and adult distractors evoked stronger responses than male and child distractors in regions comprising parahippocampal/fusiform gyrus and amygdala/basal ganglia/thalamus, respectively. Women distractors elicited stronger responses in the inferior parietal lobe compared to all other distractors. Specifically, sexually preferred distractors elicited a weaker downregulation than other distractors. We suppose a different emotion regulation with respect to the sexual relevance of the distractors. To our knowledge, this study is the first to show neurofunctional correlates of sexual preference under cognitive demand. Further studies should examine whether this design is more robust against susceptibility to manipulation than others, in order to be applied as a measurement of sexual preference in forensic patients
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