Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience

OBJECTIVE: The most common indication for electroconvulsive therapy (ECT) is major depression. It is less recognized that ECT is effective also in the treatment of acute mania. This article aims to provide a comprehensive and critical review of the literature on the use of ECT for manic patients. METHOD: All published papers in the English language on the use of ECT in acute mania that could be found were reviewed with regard to efficacy, frequency and number of treatments, bilateral versus unilateral electrode placement, predictors of antimanic response, stability of therapeutic response, cognitive consequences, and other relevant issues. RESULTS: The evidence indicates that ECT is associated with remission or marked clinical improvement in 80% of manic patients and that it is an effective treatment for patients whose manic episodes have responded poorly to pharmacotherapy. Manic patients do not require a high frequency or prolonged course of treatments to respond to ECT. The seizure threshold appears to be lower in manic patients than in depressed patients. The issues of relapse following response to ECT, cognitive consequences of ECT, and the relative merits of unilateral versus bilateral ECT in manic patients require further study. CONCLUSIONS: ECT is an effective and safe treatment for acute mania. Remission of mania following ECT reflects a primary therapeutic effect rather than a secondary consequence of an ECT-induced organic brain syndrome.     

Exceptionally high seizure threshold: ECT device limitations

Numerous studies have confirmed the distinct biological behavior of two subsets of prostate cancer diagnosed incidentally after either transurethral resection (TURP) or open prostatectomy for presumed benign prostatic hyperplasia (BPH). Focal, low-grade lesions are associated with a low risk for clinical progression and are designated as stage T1a or A1. These cases have traditionally been managed conservatively with close clinical observation. In contrast, multifocal, high-volume, or high-grade tumors are associated with a more aggressive clinical course and are designated as stage T1b or A2. Early definitive intervention is usually advocated for these latter patients. Therefore, accurate pathological assignment to either stage T1a or T1b is crucial for selection of appropriate management options. A variety of methods for staging patients with incidentally detected prostate cancer have been proposed, including detailed histological analysis, repeat TURP or transurethral biopsy, serial prostate-specific antigen (PSA) analysis, and imaging with either transrectal ultrasound (TRUS) or magnetic resonance (MRI) techniques. This article critically examines the clinical utility of these staging modalities for patients with incidentally detected prostate cancer.     

Theophylline and ECT

STUDY OBJECTIVES: To evaluate the success rate of the spinal needle exiting through the spinal needle orifice in two commonly available single-lumen, dual-orifice combined spinal-epidural (CSE) needle kits, and to study the effects of the epidural needle bevel orientation and the modified insertion technique on its success rate. DESIGN: Prospective, randomized study. SETTING: Laboratory. EQUIPMENT: Two types of single-lumen, dual-orifice CSE needle kits: CSE-Q kit and CSE-S kit. INTERVENTION: 20 anesthesiologists and nurse-anesthetists were assigned to select randomly from the two types of CSE kits (CSE-Q and CSE-S). The epidural needle was then placed into a foam device simulating a patient's back and the associated spinal needle was inserted through the epidural needle with the epidural needle bevel oriented randomly upward, downward, left, and right, respectively. The procedures were performed before and after the modified technique was used. The modified technique consisted of (1) aligning the orifice/bevel of the spinal needle in the same direction as the epidural needle bevel, and (2) gently bending the hub of the spinal needle in the direction of the epidural needle bevel while advancing the spinal needle. MEASUREMENTS AND MAIN RESULTS: Success rate of the spinal needle exiting through the spinal needle orifice was measured. Data were collected from 1600 attempts. The modified technique improved the success rate of spinal needle exiting through the spinal needle orifice from 67% to 94 % for the CSE-Q kit and 50% to 81% for the CSE-S kit. Upward orientation of the epidural needle bevel further improved the success rate to 96% and 91% for CSE-Q and CSE-S kits, respectively. CONCLUSIONS: The spinal needle did not always exit through the spinal needle orifice in the CSE kits tested. CSE-Q kits performed better than CSE-S kits. Under the study conditions, the modified technique and the upward orientation of epidural needle bevel significantly improved the success rate of the spinal needle exiting through the appropriate spinal needle orifice.     

A model of hysterical and hypnotic blindness: Cognition, motivation, and awareness.

Reviews clinical and experimental analyses of hysterical conversion reactions of blindness. A model is offered to account for the visually controlled behavior of the psychogenically blind. The model attributes a central role to motivational factors in determining selective nonawareness of cognition. A case study of hypnotic blindness is presented that illustrates the utility of the model. The model has implications for interpretations of other hypnotic phenomena and for views concerning the relations between cognition and awareness. (79 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Voice recognition and the ontological status of self-deception.

W. Douglas and K. Gibbins (see record 1983-29703-001) argued that the present authors' (see record 1979-26213-001) demonstration that errors in self–other recognition are often instances of self-deception was inadequate. In their study, they found that both self–other and acquaintance–other recognition errors met 2 of the 4 criteria the present authors had offered as necessary and sufficient for ascribing self-deception. They presented no evidence that either type of recognition error was not an instance of self-deception. The original basis of the authors' demonstration is described, and the logical fallacy in Douglas and Gibbins's argument is pointed out. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dichotic-listening measures of brain laterality in mania.

Dichotic syllable and complex tone tests were used to compare performance asymmetries in 35 manic patients with 26 normal controls and to determine whether there were changes in laterality with remission of the manic state. Relationships of performance asymmetries to treatment outcome and symptom features were also examined. Compared with normal controls, manic patients showed overall poorer accuracy, particularly for complex tones presented to the left ear, and they failed to show the normal left-ear (right-hemisphere) advantage for complex tones. Abnormal laterality for complex tones was present in patients who later responded to treatment but not in nonresponders. In the euthymic state, patients showed improved left-ear accuracy for complex tones and more normal perceptual asymmetry. These findings suggest that mania is associated with a decrement in right-hemisphere processing of complex tonal information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relations between observer-rating and self-report of depressive symptomatology.

Sources of discrepancy between the Hamilton Rating Scale for Depression (HRSD) and the Beck Depression Inventory (BDI) were investigated in 114 depressed inpatients treated with ECT. Three previously reported observations were found to occur within the same sample: (1) There was only a moderate baseline correlation between the measures; (2) this correlation improved markedly at later assessment; (3) the HRSD had a greater effect size for change. The modest baseline correlation was largely due to patients who rated themselves as substantially less depressed than clinicians had rated them. Improvement in the correlation with repeated assessment was due to the representation of clinical responders. The larger effect size with the HRSD was mainly attributable to a small subgroup that showed marked deterioration on the BDI, a phenomenon not observed with clinical evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-deception, other-deception, and self-reported psychopathology.

Administered inventories designed to assess self-reported psychopathology, other-deception (lying), and self-deception to a group of 250 undergraduates. The inventories included the Beck Depression Inventory, the Neuroticism and Lie scales of the Eysenck Personality Inventory, the Manifest Symptom Questionnaire, the Other-Deception Questionnaire, and the Self-Deception Questionnaire. Substantial negative correlations were found between self-deception and psychopathology scores, and the relationships between the self-deception and psychopathology scores were stronger than those between the other-deception and psychopathology measures. Findings support the view that self-deception significantly contributes to the invalidity of self-report inventories and more so than does other-deception. The possibility is raised that self-deception is a moderating variable contributing to the lack of agreement between clinical and actuarial forms of assessment. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autobiographical memory and mood: Effects of electroconvulsive therapy.

An Autobiographical Memory Interview (AMI) was administered to 75 depressed inpatients and 16 nondepressed controls. Patients were randomized to 1 of 4 forms of electroconvulsive therapy (ECT) that varied in electrode placement and stimulus intensity. Short-term retrograde amnesia was assessed during the week following the randomized phase. Bilateral ECT produced more marked deficits than right unilateral ECT. At a 2-mo follow-up, persistent amnesic deficits were related to having received a second ECT course and, to a lesser extent, bilateral ECT during the randomized phase. The magnitude of clinical improvement was not associated with amnesia scores at either time point. There were no differential amnesic effects as a function of the affective valence of memories. It appears that retrograde amnesia for autobiographical information after ECT and mood congruence effects on recall are independent phenomena. The magnitude and persistence of retrograde amnesia is related to how ECT is performed and not to changes in clinical state or the affective valence of memories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)