Nonconvulsive Status Epilepticus after the Ninth Electroconvulsive Therapy.
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Biomedical subjects
Publications and source records attributed to B. N. Gangadhar.
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Dopamine (DA) autoreceptor and postsynaptic receptor changes following repeated electroconvulsive shocks (ECS) were investigated in rats using the indices of low- and high-dose apomorphine-induced motility responses. Repeated ECS produced no changes in the DA autoreceptors; however, enhanced postsynaptic receptor-mediated responses were observed, suggesting increased sensitivity of the DA postsynaptic receptors.
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Thirty-two endogenous depressed patients (RDC) were treated with electroconvulsive therapy. Four patients (12.5%) developed a transient manic reaction; in two cases, this reaction occurred in mid-depression. Mania is not a generally recognized side effect of ECT; we detail the clinical characteristics, but fail to define clinical predictors of vulnerability.
Endogenous depression is known to be associated with good outcome following electroconvulsive therapy (ECT). In a double-blind, prospective study, we applied three clinical predictive indices and one diagnostic index to a cohort of 29 endogenous depressed patients, to obtain better predictors of outcome following ECT. The Newcastle Prognostic Index identified ECT responders with high specificity but low sensitivity; other indices, such as those described by Hobson (1953) and by Mendels (1967), were neither sensitive nor specific in predictive standards. If ECT-treated depressed patients are pre-selected for endogenous symptomatology, fresh clinical predictive indices need to be developed.
In a double-blind prospective study, 29 endogenously depressed patients (RDC) were randomized into sinusoidal wave (SW) and brief-pulse (BP) electroconvulsive therapy (ECT) groups. Bilateral modified treatments were administered on alternate days, three per week, and the treatment variables of current dosage and seizure duration were monitored for each treatment. Significantly more patients responded to SW than to BP ECT, but a comparable number of treatments was required to produce this response in the two groups. There was no difference in clinical or treatment variables between the SW and the BP groups, nor between ECT responders and nonresponders, with the exception that the SW-treated patients received larger doses of current per treatment than did the BP patients. For endogenous depression treated with ECT, we conclude that cumulative seizure duration may not be a parameter of significance, that overall rate of recovery in ECT responders is independent of stimulus waveform, and that some depressives may respond to SW but not to BP ECT. We suggest that the antidepressant effect of the ECT seizure may be characterized by a therapeutic window in current requirements; alternatively, a putative response threshold (again in terms of current requirement) may exist, which is higher in some patients than in others.
An open trial of electroconvulsive therapy was conducted in nine subjects who met DSM-III criteria for obsessive-compulsive disorder. There was an initial reduction in symptomatology that lasted from 1 to 4 months. Subjects who had less obsessive-compulsive (anankastic) personality traits responded better. There was also the post hoc observation that subjects who were agitated did better. We observed correlations between depression and interference scores, but not with symptom scores, suggesting that ECT has anti-obsessional activity.