Impact of propofol and etomidate on seizure activity during electroconvulsive therapy in patients with schizophrenia.
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Anesthetics, Intravenous↗
Biomedical subjects
Gábor Gazdag
Publications and source records attributed to Gábor Gazdag.
The augmentation of clozapine treatment with electroconvulsive therapy.
OBJECTIVES: The assessment, in terms of safety and efficacy, of augmenting clozapine monotherapy, as well as combined psychopharmacotherapy involving clozapine, with electroconvulsive therapy (ECT). METHOD: Reviewed were the charts of patients who received clozapine-ECT treatment in the Department of Psychiatry and Psychotherapy of Semmelweis University between November 1999 and December 2003. RESULTS: During the studied period there were altogether 43 patients treated with the combination of clozapine and electroconvulsive therapy. In the schizoaffective group, the values for post-electroconvulsive therapy CGI were significantly lower than either in the catatonic (Z=-3.72, p<0.01) or in the hebephrenic (Z=-3.17, p<0.01) group. Among the groups created on the basis of the number of augmentation strategies utilized, the clozapine+3 group consisted of patients significantly older than the clozapine+ 1 group (Z=2.45, p=0.01). In the clozapine monotherapy group, the values for post-electroconvulsive therapy CGI were significantly lower than in any of the groups that had received a combination of augmentations (monotherapy-1 augmentation: Z=-3.01, p<0.01; monotherapy-2 augmentation: Z=-2.89, p<0.01; monotherapy-3 augmentation: Z=-2.41, p=0.01). CONCLUSIONS: According to our examinations, the augmentation of clozapine treatment with electroconvulsive therapy should be tried primarily on schizoaffective patients, in case the clozapine monotherapy is ineffective. The simultaneous use of different augmentation strategies is expected to increase only the side effects not the efficacy of the treatment.
Adult↗
[The beginnings of modern biological psychiatry in Hungary: the atropine coma. A historical overview].
In the authors' opinion modern biological psychiatry in Hungary started with the investigations into the biological mechanism of atropine coma therapy. Atropine coma was used in the period between 1950 and 1975 mainly in the treatment of various psychoses and obsessive compulsive disorder. In a previous communication the method, indications and adverse effects of atropine coma were outlined and the professional and broader social reasons for its eventual disappearance were discussed. In this paper the therapeutic effectiveness and research into the biological mode of action of atropine coma are summarized. Although thousands of patients received atropine coma therapy in the United States and in several Central-Eastern European countries including Hungary, this therapeutic modality is hardly ever features even in papers on the history of psychiatry. This is all the more surprising because initial therapeutic results with atropine coma were favourable and it seemed to be a more safe and efficient treatment than the more widely used insulin coma.
Atropine↗
[Neuropsychiatric symptoms caused by mefloquine (report of several cases)].
INTRODUCTION: The number of Hungarian citizens travelling to countries infected with malaria is increasing year by year. Mefloquine is the most effective medicine in the prophylaxis and treatment of malaria. However, neuropsychiatric side-effects can more often be seen with the use of mefloquine compared to other anti-malaria drugs. AIMS: To assess the neuropsychiatric side-effects with mefloquine prophylaxis; to screen those patients who are possibly affected by the side-effects and to explore factors that forecast the possible side-effects. METHOD: The retrospective analysis of patients, who in the past 2 years, have had mefloquine prophylaxis and then turned up at Semmelweis University, Department of Psychiatry and Psychotherapy and at Szent László Hospital, Outpatient Department of Psychiatry and Addictology because of neuropsychiatric symptoms. RESULTS: Out of the 6 cases presented, whose neuropsychiatric symptoms ranged from slight dizziness, malaise through panic attacks and depression to psychosis, the preceeding psychiatric condition was positive in 4 cases. Even the most serious psychiatric symptoms disappeared within a few days using temporary drug-treatment. In those cases in whom the side-effects were more serious, a positive psychiatric history or a more sensitive personality differing from the average was established. CONCLUSIONS: Because of the low number of cases it is not possible to draw a general conclusion. After analysis of the data the authors assume, that besides the psychiatric history, the premorbid personality can also be a factor that forecasts the possible neuropsychiatric side-effects caused by mefloquine prophylaxis.
Adult↗
Hungarian medical students' knowledge about and attitudes toward electroconvulsive therapy.
A survey using self-administered questionnaires was conducted among fifth-year medical students beginning their psychiatry clerkships to assess their attitude toward and their basic knowledge of electroconvulsive therapy (ECT). The questionnaire, consisting of 28 questions, was completed by 127 students. Ten rated their own knowledge on ECT as mediocre, the rest of them as minimal. A total of 67% of the students would not consent to undergoing ECT themselves, not even if they had severe depression with psychotic features. ECT was believed to be used to bring violent patients under control by 35% of the students, was believed to be painful by 54%, and to be even dangerous by 50%. A total of 61% of the participants believed that ECT should only be used as a last resort, 35% found ECT outmoded, 32% thought that ECT causes permanent brain damage, and 14% would ban its use. Among the students refusing to be treated with ECT, the proportion of women was higher, and their attitude toward ECT was significantly more negative (P = 0.031) than that of those who would consent to ECT. The answers that psychiatrists often misuse ECT, that ECT is an outmoded therapy causing brain damage, and that the use of which should be forbidden were given more frequently by those who refused to be treated with ECT. Also, the attitude of those describing themselves as more knowledgeable about psychiatry was found to be significantly (P = 0.005) more negative than the attitude of those with minimal psychiatric knowledge. The frequent occurrence of incorrect beliefs about and negative attitudes toward ECT support the necessity of covering ECT in the medical school curriculum more thoroughly and in more detail.
Adult↗
Atropine coma: a historical note.
Insulin coma and various types of convulsive therapies were the major biologic treatment modalities in psychiatry before the psychopharmacological era. Except for electroconvulsive therapy (ECT), these methods disappeared from the psychiatric armamentarium after the introduction of psychotropic drugs. Atropine coma therapy (ACT) was one variety of nonconvulsive coma therapy used from the 1950s in a few state mental hospitals in the United States and in several Middle- and Eastern European countries until the late 1970s. In ACT, a coma of 6-10 hours' duration was induced with doses of parenteral atropine sulfate that were hundreds of times greater than the therapeutic dose administered in internal medicine. Although ACT was given to thousands of patients with a variety of diagnoses for nearly 3 decades, it is rarely mentioned, even in papers on the history of psychiatry. The method, indications, contraindications and adverse effects of ACT are summarized together with patients' personal accounts. Hypotheses concerning its mode of action are briefly mentioned. The reasons why ACT never gained wider acceptance are explored in the context of both contemporary psychiatric practice and the broader sociocultural climate of the era.
Atropine↗
[Gerontopsychiatric problems in a consultation-liaison practice].
UNLABELLED: The most effective way for the diagnosing and the treatment of psychopathological symptoms appearing in non-psychiatric hospitalized patients is the utilization of consultation-liaison psychiatry. With the increasing number of the elderly patients, number of appearing gerontopsychiatric problems in consultation work is also growing. AIM: We have studied among the patients of a consultation-liaison service the problems which led to the psychiatric consultations, the diagnoses which were set up, the concomitant somatic disorders and the treatment recommendations. METHOD: We have retrospectively studied the data of the patients in the consultation-liaison service of St. László Hospital. RESULTS: 77% of the consultations were asked from internal medicine. Most frequent reason of the requests were the presence of any psychiatric symptom, but unexplained somatic complains were also common. Gerontopsychiatric problems were most frequently associated to cardiovascular disorders. Demencia and delirium were the most frequent diagnoses. The rate of affective disorders was higher than reported in the literature. CONCLUSIONS: Consultations were most frequently asked for non-compliance in patients with demencia, and for unexplained somatic complain in affective disorders. Most frequent reason of psychiatric referrals was symptoms of delirium. Authors try to explain these results in accordance with the literature.
Aged↗
The impact of neuroleptic medication on seizure threshold and duration in electroconvulsive therapy.
INTRODUCTION: In most patients diagnosed with psychotic depression or schizophrenia and treated with electroconvulsive therapy, parallelly administered antipsychotic medication cannot be stopped. Antipsychotic drugs can influence both seizure threshold and seizure activity in different ways. PATIENTS AND METHOD: The present study processes the data of 77 patients treated parallelly with electroconvulsive therapy and antipsychotic drugs. Oral doses of the antipsychotic medication administered the day before the electroconvulsive therapy, stimulus intensity, seizure durations, and impedance were analysed from session to session. RESULTS: One group of antipsychotics (haloperidol, fluphenazine, risperidone, sulpirid) was not found to influence seizure activity: there was no significant difference in EEG and EMG registered seizure duration or in stimulus intensity between the treated and non-treated group. However, significant difference was found between the next treated and non-treated groups in 40% of the sessions in case of olanzapine, in 50% of the sessions in case of clozapine and in 57% of the sessions in case of zuclopenthixol in EEG or EMG registered seizure duration as well as in stimulus intensity. In the third group (quetiapine) there was a significant difference in each session (2nd session: EMG, p=0.02; 5th session: EEG, p=0.05, EMG, p=0.04). Most of the antipsychotics (olanzapine, clozapine, zuclopenthixol) have been shown to possess epileptogenic properties; only quetiapine reduces seizure activity. CONCLUSION: In the clinical use of olanzapine, clozopine and zuclopenthixol seems epileptogenic, whereas in the case of quetiapine seizure reducing properties must be taken into account. Together with the consideration of the accompanying somatic and neurologic disturbances and with the concomitant medications this can influence the treatment of choice.
Adult↗
Attitudes towards electroconvulsive therapy among Hungarian psychiatrists.
Participants of a postgraduate biologic psychiatric course were surveyed about their attitudes toward electroconvulsive therapy (ECT) with a self-administered questionnaire. Among the respondents, 65 persons were specialists in psychiatry, 32% of whom would not consider using ECT even if they were in a psychotic depressive state. According to the bias factor, which has been calculated based on the answers to the 11 questions regarding attitudes, those psychiatrists who worked in inpatient care showed a less negative attitude. Among the items concerning knowledge of ECT, incorrect answers were most frequent to questions about myocardial infarction as a contraindication, and about the identity of the person who had pioneered this treatment. The negative attitude of Hungarian psychiatrists, especially of those who work in outpatient care, may have an important role in the decrease of the application of ECT in the past decade in Hungary.
Attitude of Health Personnel↗
Etomidate versus propofol for electroconvulsive therapy in patients with schizophrenia.
Among drugs used for the anesthesia of electroconvulsive therapy (ECT), propofol reduces seizure duration to a greater degree than etomidate. The perceived difference between the 2 anesthetics is smaller in patients with schizophrenia than in patients who suffer depression. In this study, propofol and etomidate were compared during the ECT of patients with schizophrenia, on the basis of their impact on seizure activity and on seizure-induced hemodynamic reactions. Schizophrenics (n = 34) who were treated with ECT participated in this randomized crossover study. Propofol (1 mg/kg) and etomidate (0.2 mg/kg) were used alternately. The 2 drugs were compared on the basis of EEG- and EMG-registered seizure duration, mean arterial pressure (MAP), pulse frequency, energy index, and postictal suppression. We also analyzed the number of necessary restimulations. In case of anesthesia with etomidate, both EEG- (61.29 +/- 22.4 s, 47.9 +/- 21.3 s P = 0.014) and EMG- (46.3 +/- 23.8 s, 33.6 +/- 15.9 s P = 0.006) registered seizure durations were significantly longer than in case of propofol. When using propofol, the increase in MAP was significantly lower than when etomidate was used (8.1 +/- 10.2 mm Hg, 18.3 +/- 11.2 mm Hg, P = 0.001). There were no significant differences found in the postseizure increase in pulse frequency, in postictal suppression, or in the energy index, nor did the numbers of necessary restimulations differ significantly. Propofol was found to reduce seizure duration to a significantly greater extent than etomidate. At the same time, in electrophysiological parameters that show a correlation with clinical efficacy, there was no significant difference found between the 2 anesthetics. However, the seizure-induced increase in MAP was reduced by propofol to a significantly greater degree than by etomidate.
Adult↗
[Physical and electrophysiological aspects of electroconvulsive therapy--literature review].
Personnel and technical conditions for ECT (electroconvulsive therapy) is legally determined. In this article the author reviews studies focused on the technical questions of ECT. After the comparison of the unilateral and bilateral electrode placement an analysis is given on the physical properties of the stimulus used to elicit seizures. After discussing the questions of dose, wave-form frequency and polarity, the anatomical and physiological factors of impedance are evaluated. The author then discuss gender, age and encephalopathy as factors influencing seizure threshold. The connection between symmetry, regularity, and postictal suppression registered on the EEG and efficacy is observed. The EEG and EMG concordance is supposed to be connected also with the efficacy. In the discussion the author gives recommendations based on the literature.
Age Factors↗