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Biomedical subjects

Conrad M. Swartz

Publications and source records attributed to Conrad M. Swartz.

At least 19 recordsLinked to original sources
PubMed1993

Age Effect on Electroconvulsive Therapy Seizure Resistance.

To specifically examine the expectation that seizure induction is more difficult in older patients, we studied a consecutive series of 21 men receiving a course of brief-pulse, square-wave, bilateral electroconvulsive therapy (ECT). Each subject received a 144-mC stimulus over 1 s (800-mA, 1.5-ms pulses at 60 Hz) at the second, third, or fourth ECT session, randomly selected. Nine subjects showed no convulsion. Subjects who showed seizure (age 37.7 +/- 13.2 years) were younger (t = 4.178, df = 19, p = 0.00025, one-tailed) than those who did not (age 57.6 +/- 6.1 years). These observations indicate that seizure resistance to bilateral brief-pulse ECT increases strongly with age in men.

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PubMed1993

Anesthesia for ECT.

This article reviews the use of sedatives and narcosis agents, muscle relaxants, and ventilation that are specific to ECT anesthesia rather than surgical anesthesia. Particular focus is given to interference with a seizure by pretreatment sedation and anesthetic narcosis; dosage of succinylcholine and alternatives to succinylcholine; emergence agitation; and the effects of ventilation on seizure quality.

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PubMed1992

Propofol Anesthesia in ECT.

Multiple independent investigators have reported that propofol anesthesia during electroconvulsive therapy (ECT) is associated with substantially shorter ECT seizure duration than barbiturate anesthesia, which evidences seizure obstruction by propofol. Seizure length after propofol narcosis is often below the 20-30 s range accepted as minimally adequate. Seizure-induced elevations of prolactin, adrenocorticotropic hormone, and cortisol are similarly lower after propofol. Together with a recent report that average course length with propofol exceeds 16 sessions, this report indicates that propofol is undesirable for routine ECT anesthesia, and also illustrates how aspects of ECT anesthesia that affect the psychiatric or behavioral outcome require the collaboration of a psychiatrist.

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PubMed1991

Electroconvulsive Therapy-Induced Prolactin Release as an Epiphenomenon.

Electroconvulsive therapy (ECT)-induced prolactin release has been described by many investigators with the expectation that it reflects brain chemistry and thereby the neurochemical pathology of depression or the therapeutic impact of the ECT seizure, analogous to a blood drug level. Neuroendocrine evidence is reviewed to construct plausible mechanisms for ECT-induced prolactin release dependent on three sequential steps outside the brain: posterior pituitary change, transport to anterior pituitary, and prolactin release from anterior pituitary. These mechanisms also explain the prolactin elevations induced by suckling and by estradiol exposure. One mechanism posits seizure-induced interruption of the dopamine flux from posterior to anterior pituitary and consequent decrease of tonic inhibition on prolactin release. The other mechanism depends on a short-chain peptide prolactin-releasing factor. The substantial likelihood of strong posterior pituitary control of ECT-induced prolactin release suggests that it reflects brain chemistry only dimly.

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PubMed1989

Comparison of Atropine with Glycopyrrolate for Use in ECT.

The occurrence of undesirable events during the postictal electroconvulsive therapy (ECT) period was retrospectively compared between 29 patients who had received glycopyrrolate premedication 0.002 mg/lb i.v. and 25 patients who had received atropine 1.0 mg i.m. A separate comparison was made for 14 patients who had received ECTs with each of these premedications. A total of 952 ECTs were reviewed. In both comparisons supraventricular tachycardia was more common with atropine (p <.0001 with each), after approximately 13% of ECTs. Otherwise, postictal events with the two agents were indistinguishable; specifically, bradycardia and nausea were not more frequent with glycopyrrolate.

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PubMed1989

Safety and ECT Stimulus Electrodes: I. Heat Liberation at the Electrode-Skin Interface.

Calculations reveal that the electroconvulsive therapy (ECT) stimulus cannot cause burn injury to brain tissue, but poor electrode-skin contact is a risk for skin burn. This article reviews factors that influence skin temperature, including electrical charge, skin impedance, topographic conformity between electrode and skin, electrode surface area, and thermal diffusivity of electrode material.

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PubMed1989

Safety and ECT Stimulus Electrodes: II. Clinical Procedures.

The accidental risks and problems associated with the stimulus in electroconvulsive therapy (ECT) include skin burn, inadvertent exposure to the stimulus, short-circuit of the stimulus with ineffectual delivery, and accidental mislocation. These problems and aspects of their prevention are reviewed.

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PubMed1988

Serotonin and Electroconvulsive Shock-Induced Prolactin Release.

Baseline and post-electroconvulsive shock (ECS) prolactin levels were determined in serum samples from 13 rabbits, with and without pretreatment with the serotonin-2 (5-HT(2)) receptor blocker ketanserin. Without ketanserin, ECS did not raise serum prolactin levels over baseline. After ketanserin, baseline serum prolactin levels were 50% lower and post-ECS prolactin levels were twice this new baseline level and close to post-ECS prolactin levels without ketanserin. These observations suggest that serotonergic neurotransmission potentiates stress-induced prolactin secretion, but contributes little to ECS-induced prolactin release.

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PubMed1986

Double Electroconvulsive Therapy for Resistant Depression.

A case is described of psychotic depression that worsened during a course of three bilateral ECTs per week, but responded to administration of two bilateral ECTs three times per week. For some patients, ECTs may need to be given more than three times per week to obtain remission.

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PubMed1986

An Auditory Representation of ECT-Induced Seizures.

Seizure monitoring using an auditory representation of the electroencephalogram (EEG) was tested in 82 consecutive electroconvulsive treatments (ECTs). It was found to have high interrater and intrarater reliability and high validity against the paper EEG standard.

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PubMed1986

Differences Between First and Second Electroconvulsive Treatments Given in the Same Session.

For the first and second of two bilateral ECTs given under the same anesthesia, judgments were made of the durations of four seizure-induced phenomena: tonic-clonic motor activity, paroxysmal EEG activity, EEG spike waves, and tachycardia. A total of 36 pairs of treatments were given to 14 patients. Pearson correlation coefficients between each of six possible pairs of these four measures were higher for the first ECTs than for the second ECTs (p < 0.05 to p < 0.001). These results suggest that the seizure associated with the second ECT under the same anesthesia is physiologically different from that of the first ECT and is less well generalized through the brain.

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