A successful treatment of drug-resistant depression with electroconvulsive therapy

A woman aged 56 had been treated at the age of 23 for a psychotic depression with vital characteristics in the context of a bipolar disorder. The treatment included electroconvulsive therapy (ECT). From the age of 47, she suffered relapses; drug treatment proved inadequate. For the last 3 years, ECT was administered, which resulted in a good condition. ECT is an effective treatment in patients with depression resistant to medication. However, in spite of continuation pharmacotherapy, the proportion of patients relapsing within 6 months after successful ECT is large. For these patients, continuation ECT may be an efficacious method.     

Use of EEG in electroconvulsive therapy

BACKGROUND: From the point of view of time we can divide the use of EEG in the electroconvulsive therapy into 1) screening before starting the treatment, 2) the EEG correlates of the ECT: recording of the paroxysm, immediate postparoxysmal recording, interparoxysmal recording during a series of ECT, and persistent changes after finishing the series of ECT. METHODS AND RESULTS: EEG screening has shown that the patients with abnormal EEG do not respond well to ECT. In the recording of the paroxysm EEG correlates with therapeutic effect of ECT are looked for--particularly the length of the paroxysm on the EEG, intensity and pattern of the paroxysmal activity, and the suppression of the EEG curve in the terminal part of the paroxysm. The suppression models are in the focus of interest also in the immediate postparoxysmal recording. In the interparoxysmal recordings during a series of ECT the associations of the generalised slowing in the range of the theta and delta activity with the therapeutic effect were looked for, particularly in the past. Persistent changes after finishing the ECT are usually examined especially to look if ECT does not cause persistent abnormalities of the EEG recording which would be an evidence for brain damage or for epileptic kindling. The results in this direction have been negative so far.     

Implant-supported overdenture therapy: a retrospective study

All patients (n = 46) treated with implant-supported overdentures at the Department of Prosthetic Dentistry, Dental and Medical Health Centre, Halmstad, Sweden, from 1986 to 1993 were studied. The clinical examination was completed in 1994. The material was divided into two subgroups: Group A had been initially treatment planned for an implant-supported overdenture, and Group B had been planned for fixed prostheses but because of loss of implants before loading, treatment with a fixed prosthesis was not possible. The authors present their experience and patient reactions to overdenture therapy in two defined groups of patients. The implant failure rate before loading for Group A (n = 12) was 15% (six implants out of 39), and the rate before loading for Group B (n = 29) was 43.6% (68 implants out of 156). After prosthodontic treatment in Group A, the implant success rate after loading was 87.9%, and the overdenture stability was 84.6%. In group B, 17 implants placed in the maxillae were lost after overdenture therapy, which resulted in an implant success rate of 79.3%. A total of eight overdentures, all of which had been placed in the maxillae, were lost, resulting in an overdenture stability of 73.3%. In this study "change of retentive clips" was the predominant prosthodontic complication related to the overdentures, especially in Group B. Most of these complications (62%) occurred in patients with clinical signs of bruxism. Patient reactions to treatment with an overdenture were positive regarding esthetics for both groups. More negative views were recorded in Group B than in Group A in response to function and retention of the overdenture.     

Trimipramine and maprotiline plasma levels during combined treatment with moclobemide in therapy-resistant depression

In an open pilot study of 21 therapy-resistant depressive inpatients, plasma levels of antidepressants were determined during treatment with a combination of moclobemide/ trimipramine (n = 15) and moclobemide/maprotiline (n = 6). After combined administration of trimipramine and moclobemide (MCB), a significant increase in the plasma level of trimipramine (39%) was observed. After combination of maprotiline with moclobemide, maprotiline levels were increased (25%, n.s.). The results show that moclobemide, as an inhibitor of isoenzymes of the cytochrome P 450 oxidase, can cause increases in the plasma levels of tricyclic and tetracyclic antidepressants. No correlation between the serum level of the antidepressants and treatment outcome was found in this open study.     

Incidence of asystole in electroconvulsive therapy in elderly patients

We hypothesize that selective brain cooling (SBC) can occur in hyperthermic humans despite the fact that humans have no carotid rete, a vascular structure that facilitates countercurrent heat exchange and that is located at the base of the skull in some mammals. We postulate that an increase in emissary and angular ocular venous flows contributes to SBC. The efficiency of SBC is increased by evaporation of sweat on the head and by ventilation through the nose. A body position that increases the intravenous pressure gradient across the skull increases emissary flows and hence enhances the efficiency of SBC. The validity of using tympanic temperature as an index of brain temperature is also postulated.     

Obsessive-compulsive disorder and depression. A retrospective study on course and interaction

In a retrospective study 62 patients, who fulfilled the ICD-8/9 criteria for obsessive-compulsive disorder (OCD), were followed up. Besides an assessment of the cross-sectional symptomatology of OCD and depression, the long-term course of OCD and its relationship to depression were investigated. Five courses of OCD could be differentiated: continuous and unchanging (27.4%); continuous with deterioration (9.7%); continuous with improvement (24.4%); episodic with partial remission (24.2%), and episodic with full remission (11.3%). There was no difference between primary or secondary depression on the prognosis of OCD, and there was also no difference between the continuous or episodic course with regard to primary or secondary depression. Our results may be biased by the fact that we selected a sample of OCD and not primarily major depressive patients.     

Relationship of seizure duration to antidepressant efficacy in electroconvulsive therapy

BACKGROUND: Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery. The marked difference in average wholesale cost between these two drug therapies (aprotinin, $1,080 vs. epsilon-aminocaproic acid, $11) has generated significant controversy regarding their relative efficacies and costs. METHODS: In a multicenter, randomized, prospective, blinded trial, patients having repeated cardiac surgery received either a high-dose regimen of aprotinin (total dose, 6 x 10(6) kallikrein inactivator units) or epsilon-aminocaproic acid (total dose, 270 mg/kg). RESULTS: Two hundred four patients were studied. Overall (data are median [25th-75th percentiles]), aprotinin-treated patients had less postoperative thoracic drainage (511 ml [383-805 ml] vs. 655 ml [464-1,045 ml]; P = 0.016) and received fewer platelet transfusions (0 [range, 0-1] vs. 1 [range, 0-2]; P = 0.036). The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients (44% vs. 26%; P = 0.012). No differences, however, were seen in allogeneic erythrocyte transfusions or in the time required for chest closure. Overall, direct and indirect bleeding-related costs were greater in aprotinin- than in epsilon-aminocaproic acid-treated patients ($1,813 [$1,476-2,605] vs. $1,088 [range, $511-2,057]; P = 0.0001). This difference in cost per case varied in magnitude among sites but not in direction. CONCLUSIONS: Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions. Epsilon-aminocaproic acid, however, was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery. A cost-benefit analysis using the lower cost of half-dose aprotinin ($540) still resulted in a significant cost advantage using epsilon-aminocaproic therapy (P = 0.022).     

Obsessive-compulsive disorder responsive to electroconvulsive therapy in an elderly woman

An elderly woman with a long history of obsessive-compulsive disorder (OCD) was treated with electroconvulsive therapy (ECT) after intractable depression developed. OCD had been well established for many years before onset of the depressive symptoms. After ECT, there was resolution of both OCD and depression. The patient eventually had relapse and was treated with maintenance ECT.     

Mortality in depressed patients treated with electroconvulsive therapy and antidepressants

The treatments of 519 depressed patients hospitalized from 1959 to 1969 were compared in a three-year follow-up study with particular reference to mortality. The electroconvulsive therapy (ECT) group had a significantly lower mortality than the inadequate antidepressant treatment group (P less than .05) and the group that received neither ECT nor antidepressants (P less than .025). Although the adequate antidepressant treatment group had a low mortality, statistically significant differences between this and other treatment groups could not be documented. Nonsuicidal deaths (P less than .005), and particularly myocardial infarctions (P less than .01), were significantly more frequent in the inadequately treated group compared to the adequately treated group. The superiority of adequate treatment is especially striking among men and among the older age groups. The results underscore the importance of adequate treatment of depression, especially in the older man.     

Dexamethasone adjunctive therapy for bacterial meningitis in children: a retrospective study in Brazil

Contribution of a case report of megacalycosis in a nine and a half-year old male child, in whom the disorder was diagnosed by our team when he was only four. The intense colic pains experienced by the child together with the isotopic renogram non responsive to seguril typical of obstruction, raised the diagnosis of superimposed stenosis of the pyeloureteral attachment. As a result, an Anderson-Hynes pyeloplasty was performed. Post-operative status after four years is absolutely normal from both a clinical and scintiscan point of view.     

Biological parameters in major depression: effects of paroxetine, viloxazine, moclobemide, and electroconvulsive therapy. Relation to early clinical outcome

Mammography, whilst remaining the first line imaging investigation of suspected primary breast cancer, can be difficult to interpret in patients with fibrous or dense breasts. Radionuclide imaging of the breast (scintimammography) has been suggested as an additional test. The aim of this study was to perform prospectively a comparison of the two techniques in a population with suspected breast cancer. Seventy such patients, mean age 54 years (range 57 years, 28-85) with 74 suspicious breast lesions were studied. They were imaged 5-10 min after intravenous injection of 740 MBq of Tc-99m sestamibi. Prone lateral and anterior supine views with and without markers were performed. All patients had histological confirmation of the nature of the breast lesions by limited incisional biopsy or definitive wide local excision, or cytological confirmation on fine needle aspiration. All patients had X-ray mammography. There were 53 malignant breast tumours and 21 benign lesions. Scintimammography correctly diagnosed 47 breast cancers, and yielded true-negative results in 12 benign breast lesions. There were six cases of false-negative results and nine false-positive results. Four scans were reported as equivocal. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89%, 52%, 84% and 67%, respectively. X-ray mammography diagnosed correctly 37 malignant tumours, and in 12 benign lesions the results were true negatives. Ten studies were reported as equivocal. The sensitivity, specificity, PPV and NPV were 70%, 57%, 80% and 43%, respectively. The accuracy of Tc-99m sestamibi scintimammography was better than X-ray mammography though this was not significant (McNemar's test). Fewer equivocal results were obtained with scintimammography. Scintimammography may therefore have a role in the diagnosis of primary breast cancer when X-ray mammography is equivocal or unhelpful.     

History of electroconvulsive therapy in the United States in the last decades

Despite its acknowledged efficacy and safety in the treatment of patients with severe affective and psychotic illnesses, as well as extensive efforts at professional and public education, electroconvulsive therapy is a neglected treatment, its use in the U.S. being mainly restricted to academic and private hospitals. Widespread use between 1935 and 1960, a rapid decline following the introduction of psychoactive drugs, and a slow resurgence in clinical interest since 1975 characterizes its history. The use of ECT has been encouraged by repeated favorable evaluations and by new procedures which improve both its efficacy and its safety. The experience in the United States provides a lesson for other nations where its use is inhibited.     

Emotional processing in experiential therapy: Why "the only way out is through."

The purpose of this study was to examine observable moment-by-moment steps in emotional processing as they occurred within productive sessions of experiential therapy. Global distress was identified as an unprocessed emotion with high arousal and low meaningfulness. The investigation consisted of 2 studies as part of a task analysis that examined clients processing distress in live video-recorded therapy sessions. Clients in both studies were adults in experiential therapy for depression and ongoing interpersonal problems. Study 1 was the discovery-oriented phase of task analysis, which intensively examined 6 examples of global distress. The qualitative findings produced a model showing: global distress, fear, shame, and aggressive anger as undifferentiated and insufficiently processed emotions; the articulation of needs and negative self-evaluations as a pivotal step in change; and assertive anger, self-soothing, hurt, and grief as states of advanced processing. Study 2 tested the model using a sample of 34 clients in global distress. A multivariate analysis of variance showed that the model of emotional processing predicted positive in-session effects, and bootstrapping analyses were used to demonstrate that distinct emotions emerged moment by moment in predicted sequential patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The safety and efficacy of electroconvulsive therapy in patients over age 75

OBJECTIVES: To examine the safety and efficacy of electroconvulsive therapy (ECT) in patients over the age of 75 years. METHOD: Retrospective study of all patients over 75 years treated with ECT in three hospitals between 1995 and 1997. RESULTS: Ninety-three ECT courses were administered during the study period. Ten patients (10.8%) suffered complications following ECT. The most common adverse events were prolonged confusion and hypomania, all of which resolved within 2 weeks of the cessation of treatment. Eighty-five per cent of patients made a marked or moderate response to treatment. CONCLUSIONS: ECT is a relatively safe and effective procedure in patients over age 75.