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Colleen Loo - One of the best experts on this subject based on the ideXlab platform.
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royal australian and new zealand college of psychiatrists professional practice guidelines for the administration of Electroconvulsive Therapy
Australian and New Zealand Journal of Psychiatry, 2019Co-Authors: Alan Weiss, Colleen Loo, Salam Hussain, Shanthi Sarma, John Tiller, Susan WaiteAbstract:Objectives:To provide guidance for the optimal administration of Electroconvulsive Therapy, in particular maintaining the high efficacy of Electroconvulsive Therapy while minimising cognitive side-...
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chronic catatonic schizophrenia treated successfully with right unilateral ultrabrief pulse Electroconvulsive Therapy case report
Journal of Ect, 2013Co-Authors: Denise Cupina, Sachin Patil, Colleen LooAbstract:AbstractCatatonia is a syndrome with prominent motor and behavioral symptoms commonly seen in acutely ill psychiatric patients. Catatonic symptoms have been considered as positive predictors of response to Electroconvulsive Therapy (ECT); however, few studies so far have addressed the role of ECT tr
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EMBC - Comparison of three right-unilateral Electroconvulsive Therapy montages
Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Inte, 2013Co-Authors: Siwei Bai, Colleen Loo, Nigel H. Lovell, Socrates DokosAbstract:The efficacy and cognitive outcomes of Electroconvulsive Therapy (ECT) on psychiatric disorders have been shown to depend on variations in electrode montages. Conventionally, the right-unilateral (RUL) montage was temporoparietal, originally proposed by d'Elia. Although it was reported to have better cognitive outcomes than the bitemporal montage, it is still associated with substantial memory side effects. Two other RUL montages utilizing a frontal electrode, also proposed by d'Elia, may be more beneficial. In order to investigate this, a high resolution finite element human head model was generated from MRI scans and implemented with tissue heterogeneity. The model was used to compare the effects of three different d'Elia RUL montages. The results suggest that the two alternative placements are likely to result in lesser memory side effects, and may have useful efficacy.
Tom K. Birkenhäger - One of the best experts on this subject based on the ideXlab platform.
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Beta-blocking agents during Electroconvulsive Therapy: a review
BJA: British Journal of Anaesthesia, 2014Co-Authors: E. Boere, Tom K. Birkenhäger, Theo H. N. Groenland, W.w. Van Den BroekAbstract:Electroconvulsive Therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'Electroconvulsive Therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary.
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efficacy of Electroconvulsive Therapy in bipolar versus unipolar major depression a meta analysis
Bipolar Disorders, 2012Co-Authors: Bram Dierckx, Walter W Van Den Broek, Willemijn T Heijnen, Tom K. BirkenhägerAbstract:Dierckx B, Heijnen WT, van den Broek WW, Birkenhager TK. Efficacy of Electroconvulsive Therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord 2012: 14: 146–150. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: Bipolar major depression differs considerably from unipolar major depression with regard to the efficacy of treatment with antidepressants. In bipolar depression, response to treatment with antidepressants is disappointing. Whether response to Electroconvulsive Therapy (ECT) differs between bipolar and unipolar depression remains unclear. Therefore, this systematic review investigates the relative efficacy of ECT in both forms of depression. Methods: Relevant cohort studies were identified from a systematic search of the PubMed electronic database. Six studies were included in this meta-analysis. Results: In this meta-analysis, the overall remission rate was 50.9% (n = 402/790) for patients with unipolar depression and 53.2% (n = 168/316) for patients with bipolar major depression. A pooled odds ratio (OR) and confidence interval (CI) were calculated using random-effects meta-analysis with the Mantel–Haenzel method. This analysis shows similar efficacy of ECT in patients with unipolar and bipolar depression (OR = 1.08, 95% CI: 0.75–1.57). Conclusion: ECT appears to be equally effective for both bipolar and unipolar depression and the remission rates are encouraging, especially for bipolar depression.
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antidepressant pharmacoTherapy failure and response to subsequent Electroconvulsive Therapy a meta analysis
Journal of Clinical Psychopharmacology, 2010Co-Authors: Willemijn T Heijnen, Tom K. Birkenhäger, Andre I Wierdsma, Walter W Van Den BroekAbstract:Failure to respond to antidepressants probably is the most common indication for Electroconvulsive Therapy (ECT). The literature seems to be divided as to whether medication resistance has a negative influence on the efficacy of subsequent ECT. Therefore, we performed a systematic review to investigate the effect of previous pharmacoTherapy failure on the efficacy of ECT. Relevant cohort studies were identified from systematic search of the PubMed electronic database. Seven studies were included in this meta-analysis: the overall remission rate amounts to 48.0% (281/585) for patients with and 64.9% (242/373) for patients without previous pharmacoTherapy failure. An exact analysis with the Mantel-Haenszel method (fixed effect model) shows a reduced efficacy of ECT in patients that received previous pharmacoTherapy (OR, 0.52; 95% confidence interval [CI], 0.39-0.69). In conclusion, the efficacy of ECT is significantly superior in patients without previous pharmacoTherapy failure as compared with medication-resistant patients. Because this finding is based on observational studies, it might be caused by a confounding factor, for example, the presence of psychotic features or the duration of the index episode. Electroconvulsive Therapy seems to be an effective treatment for severely depressed patients as well as for patients with previous pharmacoTherapy failure.
Keith G. Rasmussen - One of the best experts on this subject based on the ideXlab platform.
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Electroconvulsive Therapy is equally effective in unipolar and bipolar depression
Acta Psychiatrica Scandinavica, 2009Co-Authors: Samuel H Bailine, Keith G. Rasmussen, Max Fink, Rebecca G Knapp, Georgios Petrides, Mustafa M Husain, Shirlene Sampson, Martina Mueller, Shawn M Mcclintock, Kristen G. TobiasAbstract:Bailine S, Fink M, Knapp R, Petrides G, Husain MM, Rasmussen K, Sampson S, Mueller M, McClintock SM, Tobias KG, Kellner CH. Electroconvulsive Therapy is equally effective in unipolar and bipolar depression. Objective: To determine the relative efficacy of Electroconvulsive Therapy (ECT) in the treatment of bipolar (BP) and unipolar (UP) depressive illness and clarify its role in BP depression. Method: Patients referred for ECT with both UP and BP depressions. [classified by Structured Clinical Interview for DSM (SCID-I) criteria for history of mania] were included in a multi-site collaborative, double-masked, randomized controlled trial of three electrode placements – right unilateral, bifrontal or bitemporal – in a permutated block randomization scheme. Results: Of 220 patients, 170 patients (77.3%) were classified as UP and 50 (22.7%) as BP depression in the intent-to-treat sample. The remission and response rates and numbers of ECT for both groups were equivalent. Conclusion: Both UP and BP depressions remit with ECT. Polarity is not a factor in the response rate. In this sample ECT did not precipitate mania in depressed patients. Treatment algorithms for UP and BP depression warrant re-evaluation.
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Remifentanil/Thiopental combination and seizure length in Electroconvulsive Therapy.
Journal of Ect, 2009Co-Authors: Keith G. Rasmussen, Mark W. Imig, Ranji VargheseAbstract:: In an effort to see if use of high-potency opioid combined with lower-than-usual dose barbiturate results in longer seizure length in Electroconvulsive Therapy, we retrospectively examined data from 56 patients. For each case, 1 seizure with thiopental alone and 1 with thiopental combined with remifentanil were compared. Longer mean electroencephalographic seizure length with the combination slightly missed statistical significance, whereas motor seizure duration was not statistically significantly different between the 2 strategies. We conclude that if thiopental is used for anesthetic induction in Electroconvulsive Therapy in the dose range described herein, modest dose reduction and combination with remifentanil does not reliably prolong seizure duration.
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Correlates of myalgia in Electroconvulsive Therapy.
Journal of Ect, 2008Co-Authors: Keith G. Rasmussen, Kristin N. Petersen, Jessica L. Sticka, La Chelle J. Wieme, Jason H. Zosel, Marie E. S. Marienau, Debra A. Ryan, Darrel R Schroeder, Susanna R. Stevens, W. Michael HootenAbstract:Myalgias are common in patients treated with Electroconvulsive Therapy (ECT). The mechanism of this side effect is unknown. Two commonly postulated etiologies are the motor activity during the convulsion and the fasciculations induced by succinylcholine. If the former phenomenon accounts for most of themyalgias, then the appropriate strategy will be to increase the succinylcholine dose at subsequent treatments. If, on the other hand, the latter phenomenon is more important in inducing myalgias, then the appropriate strategy may be to decrease succinylcholine dosages (on the theory that lower doses result in less fasciculating). On the other hand, if neither of these factors accounts for myalgias, then succinylcholine dose adjustments may be irrelevant to myalgias in the ECT situation. In this study, we assessed the degree of convulsive movements during the seizure as well as strength of fasciculations caused by succinylcholine to see which, if either, correlates with ultimate complaints of myalgias. The results indicated that neither of these factors, nor dose of succinylcholine, correlated with myalgias. We conclude that dose adjustments to succinylcholine are unlikely to affect complaints of myalgias in ECT patients.
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QTc dispersion in patients referred for Electroconvulsive Therapy.
The journal of ECT, 2008Co-Authors: M. Leann Dodd, Tamara J. Dolenc, Victor M. Karpyak, Keith G. RasmussenAbstract:Objective: To determine the presence of possible risk factors for arrhythmias during Electroconvulsive Therapy (ECT) by assessing QTc dispersion on the baseline electrocardiogram. Method: The pre-ECT electrocardiogram on 105 patients was examined, and QTc dispersion was calculated. This was correlated with presence or absence of cardiac conditions and various psychotropic medications being used by the patients. Results: Neither age nor sex was associated with QTc dispersion. Presence of cardiac illness also was not associated with prolongation of QTc dispersion. None of the psychotropic medication classes, including atypical antipsychotics, were associated with prolongation of QTc dispersion either. Conclusion: In patients referred for ECT, baseline QTc dispersion does not correlate with presence of cardiac illness or concomitant psychotropic usage.
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the safety of Electroconvulsive Therapy and lithium in combination a case series and review of the literature
Journal of Ect, 2005Co-Authors: Tamara J. Dolenc, Keith G. RasmussenAbstract:Abstract:Early reports cautioned against the combination of lithium and Electroconvulsive Therapy (ECT), citing risk of excessive cognitive disturbance, prolonged apnea, and spontaneous seizures. However, recent case series with larger numbers of patients indicate that the combination may be used sa
Ala Nozari - One of the best experts on this subject based on the ideXlab platform.
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minimum effective doses of succinylcholine and rocuronium during Electroconvulsive Therapy a prospective randomized crossover trial
Anesthesia & Analgesia, 2016Co-Authors: Hooman Mirzakhani, Charles A. Welch, Henkjan Guchelaar, Cristina Cusin, Mary E Doran, Teresa Macdonald, Edward A Bittner, Matthias Eikermann, Ala NozariAbstract:BACKGROUND:Neuromuscular blockade is required to control excessive muscle contractions during Electroconvulsive Therapy (ECT). In a crossover, assessor-blinded, prospective randomized study, we studied the minimum effective dose (MED) of succinylcholine and rocuronium for ECT. The MED was the lowest
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neuromuscular blocking agents for Electroconvulsive Therapy a systematic review
Acta Anaesthesiologica Scandinavica, 2012Co-Authors: Hooman Mirzakhani, Charles A. Welch, Matthias Eikermann, Ala NozariAbstract:Electroconvulsive Therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. The clinical indications for ECT as an effective therapeutic modality have been considerably expanded since its introduction. Anaesthesia and neuromuscular blocking agents (NMBAs) are required to ensure patients’ safety during ECT. The optimal dose of muscle relaxant for ECT reduces muscle contractions without inducing complete paralysis. Slight residual motor convulsive activity is helpful in ascertaining that a seizure has occurred, while total paralysis prolongs the procedure unnecessarily. Suxamethonium is commonly used, but nondepolarising NMBAs are indicated in patients with certain comorbidities. In this review, we summarise current concepts of NMBA management for ECT.
Joy M Settembrino - One of the best experts on this subject based on the ideXlab platform.
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effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of Electroconvulsive Therapy
The New England Journal of Medicine, 1993Co-Authors: Harold A Sackeim, Joan Prudic, D P Devanand, Judith E Kiersky, Linda Fitzsimons, Bobba J Moody, Martin C Mcelhiney, Eliza Coleman, Joy M SettembrinoAbstract:Background The efficacy of Electroconvulsive Therapy in major depression is established, but the importance of the electrical dosage and electrode placement in relation to efficacy and side effects is uncertain. Methods In a double-blind study, we randomly assigned 96 depressed patients to receive right unilateral or bilateral Electroconvulsive Therapy at either a low electrical dose (just above the seizure threshold) or a high dose (2.5 times the threshold). Symptoms of depression and cognitive functioning were assessed before, during, immediately after, and two months after Therapy. Patients who responded to treatment were followed for one year to assess the rate of relapse. Results The response rate for low-dose unilateral Electroconvulsive Therapy was 17 percent, as compared with 43 percent for high-dose unilateral Therapy (P = 0.054), 65 percent for low-dose bilateral Therapy (P = 0.001), and 63 percent for high-dose bilateral Therapy (P = 0.001). Regardless of electrode placement, high dosage result...