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G Petrides

Publications and source records attributed to G Petrides.

At least 19 recordsLinked to original sources
PubMed2001

ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE.

OBJECTIVE: To compare the relative efficacy of electroconvulsive therapy (ECT) in psychotic and nonpsychotic patients with unipolar major depression. METHODS: The outcome of an acute ECT course in 253 patients with nonpsychotic (n = 176) and psychotic (n = 77) unipolar major depression was assessed in the first phase of an ongoing National Institute of Mental Health-supported four-hospital collaborative study of continuation treatments after successful ECT courses. ECT was administered with bilateral electrode placement at 50% above the titrated seizure threshold. The remission criteria were rigorous: a score <or=10 on the 24-item Hamilton Rating Scale for Depression (HRSD) after 2 consecutive treatments, and a decrease of at least 60% from baseline. RESULTS: The overall remission rate was 87% for study completers. Among these, patients with psychotic depression had a remission rate of 95% and those with nonpsychotic depression, 83%. Improvement in symptomatology, measured by the HRSD, was more robust and appeared sooner in the psychotic patients compared with the nonpsychotic patients. CONCLUSION: Bilateral ECT is effective in relieving severe major depression. Remission rates are higher and occur earlier in psychotic depressed patients than in nonpsychotic depressed patients. These data support the argument that psychotic depression is a distinguishable nosological entity that warrants separate treatment algorithms.

Adult↗
PubMed2001

The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report.

As part of a C.O.R.E., multi-site longitudinal study comparing continuation electroconvulsive therapy (ECT) vs. continuation pharmacotherapy, the authors determined the response of 253 patients with major depression to acute-phase, bilateral ECT by use of the 24-item Hamilton Rating Scale for Depression. Remission rates for three age-groups, > or =65 years; 46-64 years; and < or =45 years, were 90 percent, 89.8 percent, and 70 percent, respectively. Age, as a continuous variable, positively influenced response to treatment. Bilateral, dose-titrated ECT is a highly effective acute treatment for major depression, and older age confers a greater likelihood of achieving remission.

Age Factors↗
PubMed1997

Catatonia and other motor syndromes in a chronically hospitalized psychiatric population.

BACKGROUND: To determine the motor characteristics of chronic catatonia, catatonia and other motor disorders were systematically rated in a long-term hospitalized sample. METHOD: Chronically hospitalized psychiatric inpatients (N = 42) with a clinical diagnosis of catatonic schizophrenia (295.2X) were rated for catatonia with a novel 23-item catatonia rating scale, and for parkinsonism, dyskinesia and akathisia using standard rating scales with scale-based criteria for case definition. RESULTS: Catatonia was the sole motor syndrome in nine cases (21%), co-existed with parkinsonism in five (12%), tardive dyskinesia in four (10%), and both parkinsonism and tardive dyskinesia in 10 (24%). There was no correlation between total scores across the four rating scales. 'Rigidity' was the sole catatonic sign which overlapped with other scales. The symptom profile of catatonia in this chronic sample was similar to previous reports based on acutely ill patients. CONCLUSION: Catatonia is distinguishable from other motor disorders in chronic psychiatric patients using the 23-item catatonia rating scale. The features of chronic catatonia are described, and the distribution of catatonic signs is similar for chronic and acute catatonia.

Adult↗
PubMed1997

Synergism of lorazepam and electroconvulsive therapy in the treatment of catatonia.

Electroconvulsive therapy (ECT) and lorazepam are effective treatments for catatonia. ECT combined with benzodiazepines has been associated with reduced efficacy and efficiency and therefore is not recommended in the routine practice of ECT. We report 5 prospectively identified cases of catatonia treated either sequentially or concurrently with lorazepam and ECT. In each case, the combination of lorazepam with ECT was superior to monotherapy. This apparent synergism, its possible mechanisms, and its implications for treating catatonia are discussed.

Adolescent↗
PubMed1996

Trimethaphan (Arfonad) control of hypertension and tachycardia during electroconvulsive therapy: a double-blind study.

STUDY OBJECTIVE: To ascertain the optimal dose of trimethaphan camsylate administered by intravenous (i.v.) bolus injection for the control of hypertension and tachycardia during electroconvulsive therapy (ECT). DESIGN: Prospective, double blind, within-subject study. SETTING: Treating room of the psychiatric unit of the University Hospital at Stony Brook, NY. SUBJECTS: Patients undergoing ECT for major psychiatric illnesses. MEASUREMENTS AND MAIN RESULTS: Fifteen ASA status I or II patients received in a random sequence placebo, or 5, 10, or 15 mg boluses of trimethaphan during their second to fifth treatments. Blood pressure (BP) and heart rate (HR) were recorded every 30 seconds by automated oscillometric recorder. Recordings taken before administration, during seizure, 5, and 20 minutes after seizure were examined. All doses ameliorated BP (systolic, diastolic, and mean), HR, and rate pressure product (RPP) increases during the seizure, compared with placebo. The group that received 15 mg exhibited smaller increases in RPP, i.e., 67.7% increase compared with 155.4%, 110.9%, and 98.7% increases for the placebo, 5, and 10 mg, respectively. The 10 mg and 15 mg doses caused a faster return to baseline than did the 5 mg dose or placebo. No rebound hypertension, prolonged hypotension, arrhythmias, or other side effects were noted. Trimethaphan did not alter seizure duration. CONCLUSIONS: Trimethaphan is safe, practical, and effective in the management of the hyperdynamic response to ECT. An i.v. bolus injection of 15 mg is more effective than 10 mg or 5 mg.

Adult↗
PubMed1996

Case study: electroconvulsive therapy in adolescents.

OBJECTIVE: Recognizing the limited experience with electroconvulsive therapy (ECT) in adolescent psychiatric patients, the authors evaluated the efficacy, indications, and benefit of the treatment in this population. METHOD: The records of patients in the ECT rosters at University Hospital at Stony Brook between 1983 and 1993 were reviewed. Thirteen adolescents between the ages of 16 and 18 years who received ECT were identified. ECT followed the institution's standard adult protocol. RESULTS: Ten patients were evaluated as responders, and three as nonresponders. Patients with diagnoses of an affective illness, unspecified psychosis, and catatonia benefited the most. Some improvements were seen in the patients with schizophrenia. Eight patients (62%) were contacted by telephone for follow-up. Five remain asymptomatic 3 years after the treatment, and three relapsed within 12 months despite maintenance pharmacotherapy. CONCLUSION: Within the limitation of record review and partial follow-up, ECT was found to be an effective and useful procedure in the treatment of adolescents with severe psychiatric disorders.

Adolescent↗
PubMed1996

Catatonia. I. Rating scale and standardized examination.

To facilitate the systematic description of catatonic signs, we developed a catatonia rating examination, rating scale and screening instrument. We constructed a 23-item rating scale and a truncated 14-item screening instrument using operationalized definitions of signs ascribed to catatonia in published sources. Inter-rater reliability was tested in 44 simultaneous ratings of 28 cases defined by the presence of > or = 2 signs on the 14-item screen. Inter-rater reliability for total score on the rating scale was 0.93, and mean agreement of items was 88.2% (SD 9.9). Inter-rater reliability for total score on the screening instrument was 0.95, and mean agreement of items was 92.7% (SD 4.9). Diagnostic agreement was high based on criteria for catatonia put forth by other authors. Seven per cent (15/215) of consecutively admitted patients to an academic psychiatric in-patient facility met criteria for catatonia. It is concluded that catatonia is a distinct, moderately prevalent neuropsychiatric syndrome. The rating scale and screening instrument are reliable and valid. Their use facilitates diagnosis, treatment protocols, and cross-study comparisons.

Catatonia↗
PubMed1996

Catatonia. II. Treatment with lorazepam and electroconvulsive therapy.

Case material and retrospective studies support the use of both lorazepam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this study we test their efficacy in an open, prospective protocol, and define a "lorazepam test' with predictive value for treatment. Twenty-eight patients with catatonia were treated systematically with parenteral and/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed. Outcome was monitored quantitatively during the treatment phase with the Bush-Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial intravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demographic variables nor severity of catatonia predicted response to lorazepam. Four patients failing lorazepam responded promptly to ECT. It is concluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to change in clinical status.

Adult↗
PubMed1996

Atrial fibrillation, anticoagulation, and electroconvulsive therapy.

We describe our experience with six patients with atrial fibrillation (AF) during electroconvulsive therapy (ECT). In four, we observed episodic or persistent conversion of AF to normal sinus rhythm (NSR). Four patients, three with cardioversion and one without, received anticoagulation. In published case reports, ECT was successfully performed in three patients with AF without anticoagulation and in three patients with AF who received anticoagulation. In addition, 18 patients received ECT while taking concomitant anticoagulation therapy for reasons other than AF. Despite the potential risk of embolization with AF, we consider ECT may be safely administered to patients with AF. Because of the high incidence of conversion of AF to NSR, anticoagulation therapy with either warfarin or heparin is recommended.

Aged↗
PubMed1996

The "half-age" stimulation strategy for ECT dosing.

Energy levels affect the treatment efficacy and efficiency of electroconvulsive therapy (ECT). United States devices require preselection of energy dosage before stimulating patients, and two strategies have been proposed to determine an effective dosage, i.e., based on the patient's age and measured estimates of seizure threshold. The age method is criticized for overstimulation and an assumed association with increased cognitive effects. Threshold determination strategy is cumbersome and requires multiple stimulations, possibly placing patients at increased cardiovascular risk. In 35 patients, we examined an energy estimate for bilateral electrode placement at half the patient's age in "percent of energy" or joules delivered by the Thymatron and MECTA devices. Each patient required one stimulation in the first treatment to elicit motor seizures averaging 51.7 s. Subsequently, 20 patients were randomly assigned to either threshold titration followed by half-age for the first two treatments or the opposite (AB-BA design). Half-age energy was 7 J (30%) higher than titration estimates, corresponding to 55% energy of the age method. The relation of half-age and titration estimates were confirmed in energy dosing records from two independent centers. Energy dosing by half-age calculation in bilateral ECT is simple, practical, avoids overdosing and repeat stimulation, and is a useful substitute for the more complex strategy based on threshold estimation.

Aging↗
PubMed1994

Continuation ECT: relapse prevention in affective disorders.

Relapse rates after the acute treatment of affective disorders with drugs or electroconvulsive therapy (ECT) are high (often 50-95%), despite preventive pharmacotherapy. In practice, some patients receive continuation and maintenance ECT after successful treatment of the index episode with ECT. We reviewed the charts of patients with affective illnesses who received continuation ECT (C-ECT) in our inpatient service from 1985 to 1991. In 33 courses of C-ECT, mean intertreatment interval was 10.1 days and the average duration of treatment was 10 weeks. One-year follow-up was available for 21 patients. Seven (33%) patients relapsed and needed re-admission within 1 year. The relapse rate for the patients with delusional depression was 42%, lower than the 95% reported for patients with delusional depression maintained on continuation pharmacotherapy before the C-ECT program started in our facility. No single factor examined was a significant predictor of relapse except C-ECT, which exhibited a sustained prophylactic effect for the year after the index episode.

Adult↗