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Biomedical subjects

D P Devanand

Publications and source records attributed to D P Devanand.

At least 91 records · Page 5Linked to original sources
PubMed1992

Use of increased anesthetic dose prior to electroconvulsive therapy to prevent postictal excitement.

The authors report on three patients who developed severe postictal excitement at several consecutive electroconvulsive therapy (ECT) treatments. In all three cases, an increase in the anesthetic (or equivalent medication) dosage prior to ECT prevented the emergence of postictal excitement at subsequent treatments. This strategy, among others, should be considered in the management of patients who repeatedly manifest this phenomenon during a course of ECT.

Aged↗
PubMed1992

Effects of major depression on estimates of intelligence.

This study examined whether patients with major depressive disorder manifest deficits in intelligence during affective episodes and following clinical improvement. WAIS-R scores were contrasted in 100 patients in an episode of major depression with 50 normal controls, matched to the patient sample in terms of demographic variables and estimates of premorbid IQ. The groups were equivalent in verbal IQ, but, in line with previous studies, the depressed patients had a pronounced deficit in performance IQ. A patient subsample was administered the WAIS-R under unlimited time conditions to determine whether the time constraints of performance IQ subtests contributed to the magnitude of the verbal-performance IQ discrepancy. This discrepancy was only slightly reduced with untimed scoring. Subgroups of depressed patients were retested with the WAIS-R within one week (n = 26) or two months (n = 33) following treatment with electroconvulsive therapy. In both subsamples, IQ scores were improved at posttreatment testing relative to pretreatment, but with little change in the verbal-performance IQ discrepancy. These and related findings suggested that a performance IQ deficit is characteristic of depressed patients regardless of affective state.

Adult↗
PubMed1992

Behavioral syndromes in Alzheimer's disease.

The Behavioral Syndromes Scale for Dementia (BSSD) is a new instrument that showed strong internal consistency and interrater reliability in an outpatient sample of 106 patients with probable Alzheimer's disease. Factor analysis provided support for a priori symptom groupings, particularly the syndromes of disinhibition and apathy-indifference. Dependency (87%), denial of illness (63%), and motor agitation (55%) were common, while sexual disinhibition (2.9%) and self-destructive behaviors (2.9%) were rare. Virtually all symptoms were predominantly minimal to mild in severity. Patients with longer illness duration were more apathetic. Disinhibited behaviors and apathy-indifference increased with greater severity of dementia. Catastrophic reactions, aggression, and agitation were associated with greater functional impairment. There was great heterogeneity in symptom presentation. In Alzheimer's disease, several behavioral changes might be direct manifestations of underlying brain pathology, rather than being solely secondary to cognitive impairment.

Activities of Daily Living↗
PubMed1992

Low dose oral haloperidol and blood levels in Alzheimer's disease: a preliminary study.

Nineteen patients with probable Alzheimer's disease who manifested psychosis or behavioral disturbance received 0.5 to 5 mg per day of oral haloperidol, with blood levels drawn on a stable daily dose. Oral dose correlated strongly with haloperidol blood levels assessed by radioimmunoassay (r = 0.82, p = .0001). The stronger correlation observed between oral dose and blood level compared with most studies in schizophrenia may be related to the fact that virtually all the Alzheimer's patients were neuroleptic naive, without the alterations in absorption and metabolism known to occur in schizophrenics receiving long-term neuroleptic treatment. Compared with oral dose, blood levels showed stronger relations to changes in symptoms and to changes in severity of extrapyramidal side effects. These preliminary data suggest that the utility of monitoring haloperidol blood levels in patients with Alzheimer's disease merits further investigation.

Aged↗
PubMed1991

Serial dexamethasone suppression tests and plasma dexamethasone levels. Effects of clinical response to electroconvulsive therapy in major depression.

Serial 1-mg dexamethasone suppression tests with concurrent plasma dexamethasone assessments were conducted in 58 patients with endogenous depression treated with electroconvulsive therapy (ECT). Plasma cortisol levels decreased significantly from pretreatment to immediately posttreatment, and they declined further during the first week after the ECT course, when patients remained drug free. Plasma dexamethasone levels showed an opposite pattern of progressive increases over these three time points. The progressive changes in plasma dexamethasone and cortisol levels seen during the week after ECT indicate that alterations in the bioavailability of dexamethasone and in hypothalamic-pituitary-adrenal axis function may be incomplete immediately after the ECT course. This may partly account for previous inconsistencies in serial dexamethasone suppression test findings with this treatment modality. The major finding was that clinical response was associated with increased plasma dexamethasone levels, whereas changes in cortisol levels were independent of clinical outcome. With ECT, changes in plasma dexamethasone levels may be more related to changes in clinical state than changes in postdexamethasone cortisol levels. The extent to which clinical recovery with other treatments in depression is associated with altered bioavailability of dexamethasone and perhaps other compounds is unknown and in need of investigation.

Age Factors↗
PubMed1991

Absence of cognitive impairment after more than 100 lifetime ECT treatments.

The cognitive function scores and subjective memory complaints of eight patients who had each received more than 100 treatments with bilateral modified since wave ECT were equivalent to those of matched patients who had never received ECT. The results suggest that patients given many ECT treatments over several courses do not manifest measurable cognitive impairment at long-term follow-up.

Adult↗
PubMed1991

Stimulus intensity, seizure threshold, and seizure duration: impact on the efficacy and safety of electroconvulsive therapy.

There has been considerable uncertainty in the clinical community on how stimulus dose, seizure threshold, and seizure duration relate to the efficacy and side effects of electroconvulsive therapy (ECT). This article reviews the evidence bearing on these issues. Recent evidence contradicts a number of long-standing views about how to optimize ECT administration. Among these recent observations are findings that (1) generalized seizures that are "adequate" by conventional duration criteria may be produced reliably, yet lack therapeutic properties; (2) the degree to which stimulus intensity exceeds seizure threshold is critical in determining the efficacy of unilateral ECT and also the speed of response with both unilateral and bilateral ECT; (3) the degree to which electrical dose exceeds seizure threshold, not the absolute dose administered, determines dosing effects on clinical outcome and on the magnitude of cognitive deficits; (4) there is marked variability among patients in their seizure thresholds that is related reliably to patient characteristics (sex, age) and treatment factors (electrode placement); and (5) seizure duration alone should not serve as a marker of the adequacy of treatment--there are complex relations between stimulus dosing and seizure duration, with the likelihood that substantially suprathreshold stimulation may result in shorter durations particularly early in the treatment course.

Adult↗
PubMed1991

Electroconvulsive therapy in the treatment-resistant patient.

In medication-resistant patients with major depressive disorder, the response rate with bilateral electroconvulsive therapy (ECT) drops to 50% from the expected range of 80% to 90%. Relapse rates following ECT are high in medication-resistant depressed patients and are clustered in the first 4 months following clinical response. Medication resistance during the index episode predicts a high rate of relapse, whereas those patients who have not received an adequate medication trial prior to ECT are less likely to relapse. If a patient who fails an antidepressant trial then responds to a course of ECT, alternative pharmacologic strategies or maintenance ECT should be considered to decrease the likelihood of relapse. Patients who do not respond to a traditional course of bilateral ECT may respond subsequently to longer courses of bilateral ECT at markedly suprathreshold stimulus intensity, or may respond to a different class of antidepressant medication from that which they failed previously.

Antidepressive Agents↗
PubMed1990

Regional cerebral blood flow in mood disorders. I. Comparison of major depressives and normal controls at rest.

We measured regional cerebral blood flow with the xenon 133 inhalation technique in 41 patients with major depressive disorder and 40 matched, normal controls during an eyes-closed, resting condition. The depressed group had a marked reduction in global cortical blood flow. To examine topographic abnormalities, traditional multivariate analyses were applied, as well as a new scaled subprofile model developed to identify abnormal functional neural networks in clinical samples. Both approaches indicated that the depressed sample had an abnormality in topographic distribution of blood flow, in addition to the global deficit. The scaled subprofile model identified the topographic abnormality as being due to flow reduction in the depressed patients in selective frontal, central, superior temporal, and anterior parietal regions. This pattern may reflect dysfunction in the parallel distributed cortical network involving frontal and temporoparietal polymodal association areas. The extent of this topographic abnormality, as revealed by the scaled subprofile model, was associated with both patient age and severity of depressive symptoms.

Adult↗
PubMed1990

Medication resistance and clinical response to electroconvulsive therapy.

We examined the extent to which medication resistance during an episode of major depression was related to short-term clinical response to bilateral electroconvulsive therapy (ECT). Strength of pharmacological treatment trials was rated in 53 patients who met Research Diagnostic Criteria for major depressive disorder and were subsequently treated with ECT. Patients who had failed to respond to adequate pre-ECT pharmacotherapy were substantially less likely to respond to ECT than patients who had not received adequate pharmacological trials before ECT. Therefore, medication resistance had predictive value with respect to the therapeutic effects of ECT. The clinical and theoretical implications of this finding are discussed.

Aged↗
PubMed1990

The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression.

After clinical response to electroconvulsive therapy (ECT), 58 patients with major depressive disorder were followed for 1 year or until relapse. The rate of relapse was substantially higher in patients who had failed adequate antidepressant medication trials prior to ECT than in patients not determined to be medication resistant. Adequacy of post-ECT pharmacotherapy was only marginally related to likelihood of relapse. The subgroup of patients who appeared to benefit from adequate post-ECT pharmacotherapy were those who did not receive an adequate medication trial prior to ECT. The findings call into question the common practice of administering as continuation pharmacotherapy following ECT the same class of medications that patients had failed with during the acute episode prior to ECT. The findings also indicate that resistance to antidepressant medication is a strong predictor of relapse following response to ECT.

Aged↗
PubMed1990

ECT in a patient with aortic aneurysm.

A patient with a history of corrected Type B dissecting aortic aneurysm and current Type III dissection of the aortic arch was successfully treated with electroconvulsive therapy (ECT) without complications. During ECT, intravenous nitroprusside and esmolol drips with arterial line monitoring were used to control the rise in blood pressure and heart rate. This case provides further evidence that ECT can be administered safely to patients with aortic aneurysm.

Aged↗
PubMed1989

A pilot study of haloperidol treatment of psychosis and behavioral disturbance in Alzheimer's disease.

Nine outpatients meeting research criteria for probable Alzheimer's disease who had psychosis or behavioral disturbance participated in a single-blind, placebo-controlled pilot study. Oral haloperidol in doses of 1 to 5 mg daily improved target symptoms, confirmed by double-blind ratings of videotaped interviews. Patients could not be maintained on more than 4 mg of haloperidol daily due to the severity of extrapyramidal side effects. Modified Mini-Mental State scores worsened while taking haloperidol, with only partial recovery in the final 4-week placebo phase. Severe extrapyramidal side effects and decline in cognitive function may compromise the efficacy of commonly used doses of neuroleptic drugs in patients with Alzheimer's disease.

Activities of Daily Living↗
PubMed1988

The development of mania and organic euphoria during ECT.

Mania that develops in depressed patients who are undergoing ECT is relatively uncommon and may occur more frequently in bipolar patients. The authors' review of three cases illustrates the importance of the clinician distinguishing mania from organic euphoric states that can also develop during ECT. Severity of cognitive impairment and the presence of silly or inappropriate laughter are useful in making this distinction. Capacity to clinically evaluate the persistence of depressive symptoms should determine whether ECT can continue when an organic euphoric state develops.

Adult↗