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Joyce G. Small

Publications and source records attributed to Joyce G. Small.

6 recordsLinked to original sources
PubMed1988

Clinical, Neuropsychological, and EEG Evidence for Mechanisms of Action of ECT.

Clinical, neuropsychological, and electroencephalogram (EEG) data from 150 ECT-treated patients with affective disorders were analyzed to bear upon current hypotheses about neurophysiological mechanisms of action of electroconvulsive therapy (ECT). Comparisons of responders and nonresponders revealed little or no evidence to support kindling, sensitization, diencephalic stimulation, or anticonvulsant theories. Neuropsychological test data supported right hemispheric dysfunctions in affective illness which resolved more in ECT responders than in nonresponders. There were more impairments in dominant and bilateral hemispheric functions after successful than after unsuccessful ECT. The amount of EEG slowing and paroxysmal activity was not related to therapeutic response. Transient left-sided EEG slowing was associated with positive ECT response whereas right-sided EEG changes were not. The data support the hypothesis that in patients with affective disorders, ECT restores hemispheric equilibrium with enhancement of right brain functions and dampening of the left.

Journal Article↗
PubMed1987

Uni- Versus Bilateral ECT in the Treatment of Mania.

Recent reports have challenged the assumption that unilateral and bilateral electroconvulsive therapy (ECT) are equally effective in all cases. In a prospective study, hospitalized manic patients were randomly assigned to treatment with either lithium or ECT. The first six patients received nondominant unilateral treatment but failed to respond. However, they rapidly remitted when switched to bilateral ECT. Accordingly, the next 11 manic patients to receive ECT were assigned to bilateral treatment. They were compared with the first six patients on weekly ratings of mania and other psychopathology. Both ECT groups improved but therapeutic responses were delayed until after switchover to bilateral treatment in the patients who began with unilateral ECT. We conclude that patients in the manic state should receive bilateral rather than unilateral ECT.

Journal Article↗
PubMed1986

Does Electroconvulsive Therapy Prevent Suicide?

To examine the issue of whether or not electroconvulsive therapy (ECT) protects against suicidal death, we followed a complete population of 1,494 adult hospitalized psychiatric patients for 5-7 years. During that time there were 76 deaths, of which 16 or 21% were by suicide. Cause of death was not significantly related to age, gender, or research diagnosis. Patients who committed suicide were more apt to have received ECT than those who died from other causes, but this difference was not significant. A control group of living patients matched for age, sex, and diagnosis had very similar exposures to ECT, which further indicates that ECT does not influence long-term survival. These findings combined with a close examination of the literature do not support the commonly held belief that ECT exerts long-range protective effects against suicide.

Journal Article↗
PubMed1985

Efficacy of Electroconvulsive Therapy in Schizophrenia, Mania, and Other Disorders. I. Schizophrenia.

Clinical studies are reviewed comparing the efficacy of ECT and sham ECT, ECT and neuroleptic drugs, and the effects of electrode placement in the therapy of patients with schizophrenia. The efficacy of ECT is greater in acutely ill patients, and combined with neuroleptics it elicits a better short-term outcome than drug treatment alone. No differential effects of electrode placement are noted. The need for more sophisticated evaluations is emphasized.

Journal Article↗