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Andreas Conca

Publications and source records attributed to Andreas Conca.

11 recordsLinked to original sources
PubMed2006

Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): a short-term randomised controlled trial in pharmaco-resistant major depression.

BACKGROUND: In most studies right unilateral electroconvulsive therapy (ECT) has been shown to cause fewer cognitive side effects but less antidepressant efficacy compared with bi(fronto)temporal ECT at certain intensities. AIMS: To compare the short-term efficacy and side effects of right unilateral ECT and bifrontal ECT. METHODS: In a double-blind randomised controlled clinical trial, 92 patients diagnosed with pharmaco-resistant major depression received either six right unilateral ECT treatments (250% stimulus intensity of titrated threshold) or six bifrontal ECT (150% of threshold) treatments over a 3-week period. Concomitant psychotropic medications were continued during ECT treatments. The severity of depression and cognitive status was assessed prior to the first ECT and one day after the sixth ECT using the 21-item Hamilton Depression Rating Scale and the modified Mini Mental State Examination. RESULTS: Eight patients did not complete the course of the study due to minor side effects or withdrawal of consent. The mean Hamilton Depression score decreased from 27 to 17 points in both groups of 46 patients, resulting in 12 responders (primary endpoint defined as a decrease >50%) in each patient group (95% confidence interval for the odds ratio from 0.35 to 2.8). There was no reduction in the modified Mini Mental State score (mean score 86 of 100 points). CONCLUSIONS: Both bifrontal and right unilateral electrode placements in ECT were reasonably safe and moderately efficacious in reducing symptoms of pharmaco-resistant major depression.

Adult↗
PubMed2006

[Adverse cognitive effects and ECT].

Electroconvulsive therapy (ECT) is a rapidly acting and highly effective treatment for severe and life threatening conditions seen in affective and schizophrenic diseases. Notwithstanding its therapeutic benefits, ECT remains controversial because of seizure induction, cognitive side effects, memory dysfunction and effects on cerebral physiology. These factors have raised the concern that ECT produces structural and functional brain damages. This issue continues to have a major impact on the acceptance of ECT as a therapeutic modality, both within the medical community and in public opinion. A close look at incidence, type, severity, neurofunctional and -anatomical correlates, aetiology and therapeutic approaches of the adverse cognitive effects attributed to ECT may contribute to rational and objective handling of this topic. The final chapter deals with the issue of whether ECT causes brain damage.

Amnesia, Retrograde↗
PubMed2006

[Psychiatric care in South Tyrol -- an example of coordination].

The Tyrol's division after the two World Wars cut the South Tyrol off from every relevant aspect of psychiatric care. First attempts towards a community psychiatric system weren't sufficiently sustained by politicians. Only in the 90 ty's was the association of relatives of mentally ill people able to sensitize public and politicians to the need for an adequate psychiatric care system. Since 1996 an excellent psychiatric plan has been in existence, 80 % of which has to date been able to be put into practice. Since 1997 mentally ill people have founded their own self-help-organization and influenced the planning process.

Austria↗
PubMed2004

No deterioration of cognitive performance in an aggressive unilateral and bilateral antidepressant rTMS add-on trial.

BACKGROUND: Cognitive functions were assessed before and following a course of repetitive transcranial magnetic stimulation (rTMS) in patients with depression participating in a sham-controlled, randomized trial of rTMS as adjunct to antidepressant treatment. METHOD: Forty-one medicated inpatients with a DSM-IV diagnosis of a depressive episode were consecutively randomly assigned to 1 of 3 groups comparing 2 active rTMS conditions with sham stimulation. The rTMS was applied either at high frequency over the left dorsolateral-prefrontal cortex (DLPFC) (10 sessions x 10 trains x 10 seconds 20 Hz at 100% motor threshold [MT], 90-second intertrain interval) or in a combined high- and low-frequency manner to the left and right DLPFC, respectively (10 sessions x 1 train x 10 minutes at 120% MT). Thirty-eight patients completed a neuropsychological test battery at baseline and following day 14. The cognitive assessment focused on motor skills, attention, executive functions, learning, and memory. Data were collected from November 1999 to August 2002. RESULTS: Active treatment groups did not differ with respect to assessed cognitive measures and thus were pooled. A comparison of short-term changes (baseline-day 14) in neuropsychological performance revealed a more favorable time course of the actively treated patients for encoding in the verbal memory test compared with the sham-stimulated patients. CONCLUSIONS: Unilateral rTMS as well as bilateral combined rTMS revealed no detrimental effects on cognition, as compared with the sham group. Moreover, neither the add-on design nor the used aggressive parameters had a negative impact on cognitive measures in comparison with sham. Repetitive transcranial magnetic stimulation might have mild beneficial cognitive effects partly independent of its antidepressant efficacy.

Adult↗
PubMed2003

Simultaneous pattern of rCBF and rCMRGlu in continuation ECT: case reports.

This report presents the simultaneous pattern of cerebral blood flow and cerebral glucose metabolism in two patients with a major depressive disorder who were undergoing continuation ECT. The regional cerebral blood flow and regional cerebral metabolic rate of these patients were imaged using double isotope 18F-FDG and 99mTc-HMPAO single-photon emission computed tomography before acute ECT and after the completion of continuation ECT; bilateral electrode placement (11 and 12 sessions, respectively) was chosen for the acute treatment course whereas unilateral placement was the method chosen during the continuation phase (6 and 7 sessions, respectively). Baseline SPECT scans of our patients, who continued to receive treatment with medication, were normal as compared with controls; however, scans at the end of continuation ECT revealed decreased uptake activities of both isotopes in prefrontal regions on both sides, which might be associated with the therapeutic impact and efficacy. These results are consistent with previous brain imaging studies of acute ECT. Furthermore, marked changes in both basal ganglia regions were found. The pattern of the isotope uptake ratios did not show any similarities to neurodegenerative processes, which might confirm the high safety profile of ECT also during the continuation phase of treatment.

Adult↗
PubMed2002

Combining high and low frequencies in rTMS antidepressive treatment: preliminary results.

The antidepressive potency of repetitive transcranial magnetic stimulation (rTMS) seems to depend on variables such as the stimulation placements, different frequencies, stimulus intensities, coil shape and interstimulus intervals. The aim of this pilot study was to investigate the augmentation properties of rTMS combining low and high frequencies. Thirty six depressed medicated in-patients were recruited and assigned to three different rTMS treatment modalities as an add-on strategy (each n = 12). In group 1 a stimulus intensity of 110% of the motor threshold (MT) was used with a frequency of 10 Hz over the left dorsolatero prefrontal cortex (DLPC). The right DLPC was stimulated in the same session with 110% MT at 1 Hz. In group 2 the patients were stimulated only over the left DLPC with alternating trains of 110% MT at 10 Hz and trains of 110% MT at 1 Hz in the same session. In group 3 the high frequency stimulation over the left DLPC was performed as an internal control group. None of the treatment modalities was superior but different side effects were observed. These preliminary findings suggest that rTMS, at varying frequencies and stimulation placements, evokes different psychoactive effects of clinical relevance.

Depressive Disorder↗
PubMed2002

Effect of chronic repetitive transcranial magnetic stimulation on regional cerebral blood flow and regional cerebral glucose uptake in drug treatment-resistant depressives. A brief report.

Brain imaging studies have shown that repetitive transcranial magnetic stimulation (rTMS) is biologically active. The aim of the present study was to investigate the patterns of the regional cerebral glucose uptake rate (rCMRGlu) and regional (99m)Tc HMPAO uptake rate (regional cerebral blood flow; rCBF) during a series of therapeutic rTMS sessions at low frequency. Four drug-resistant depressed patients underwent 10 rTMS sessions as an add-on measure over 14 days. One day before and 1 day after the TMS series, 511-keV SPECT with simultaneous (18)F-fluorodeoxyglucose and (99m)Tc HMPAO measurements were carried out. All patients showed a good clinical outcome. Statistically significant common changes in rCBF and rCMRGlu patterns were found in the upper frontal regions bilaterally in terms of increased uptake rates and in the left orbitofrontal cortex in terms of decreased uptake rates of both isotopes compared to controls. However, the lateralization patterns of rCBF and rCMRGlu after rTMS treatment revealed marked differences. Thus, although no relevant changes in lateralization of the glucose uptake were observed, a clear right-sided preponderance of rCBF also in areas remote from the stimulation site was described. Therapeutic rTMS seems to influence distinct cortical regions, affecting rCBF and rCMRGlu in a homogeneous manner as well as in different ways, which are probably region dependent and illness related. The role of the stimulation coil placement site should be taken into account.

Adult↗
PubMed2000

Clinical impacts of single transcranial magnetic stimulation (sTMS) as an add-on therapy in severely depressed patients under SSRI treatment.

Research on single and rapid transcranial magnetic stimulation (sTMS/rTMS) indicates an antidepressive efficacy of these methods. In our 4 week study of sTMS, 12 patients affected by severe non-psychotic major depression (DSM-III-R) were enrolled and put on standardized combined antidepressant medication with the serotonin re-uptake inhibitor citalopram, and the serotonin modulating drug, trazodone. They underwent sTMS in a specific method as an add-on therapy. Age, gender, illness and episode duration, episode number, Hamilton Rating Depression Scale-24 (HRDS), Mini-Mental State (MMS), drug levels assessed by HPLC, magnesium and thyroid stimulating hormone (TSH) were recorded. For each patient functional brain imaging was performed by (18)FDG and (99m)Tc HMPAO SPECT at the beginning of the study, as were EEG tracings which also were recorded at the end. Lorazepam was allowed as co-medication. Of the patients, 66.7 per cent (N=8) could be identified as sTMS responders. Possible predictors for sTMS response as add-on therapy may be duration, pattern of improvement in global and in specific single items of the HRDS, lorazepam dosage, functional involvement of basal ganglia and cortical temporal lobe and the initially lower mean frequency and lability of the alpha-activity of EEG. These variables possibly predict the clinical outcome of depressed patients treated by sTMS as an add-on therapy. Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗