Biomedical subjects

Keith G Rasmussen

Publications and source records attributed to Keith G Rasmussen.

26 records · Page 2Linked to original sources

PubMed2003

Long-term maintenance ECT: a retrospective review of efficacy and cognitive outcome.

Continuation and maintenance electroconvulsive therapy (ECT) are used to prevent relapse of depression after a successful course of index ECT. Such a course of treatment is typically extended for as long as a year. However, some patients seem to require longer courses of maintenance ECT. Little is known about the outcomes of long-term use (> 1 year) of maintenance ECT. We reviewed our maintenance ECT practice for the year 2000 and found that 43 patients had been receiving maintenance ECT for more than a year. This retrospective study reviews the outcomes of these patients. All patients had depression associated with either unipolar or bipolar disorder or schizoaffective disorder. These patients had multiple medication or psychotherapy trials or both and multiple hospitalizations before receiving maintenance ECT. Effects on depressive symptoms, level of functioning, health care use, frequency of hospitalizations, and cognition are discussed. We conclude that extended maintenance ECT is efficacious and well tolerated and reduces hospital use for a population of chronically depressed patients refractory to medication.

Adult↗

PubMed2003

Decisional capacity of severely depressed patients requiring electroconvulsive therapy.

OBJECTIVE: The decisional capacity of severely depressed people frequently comes into question. The ability to improve this decisional capacity through educational efforts alone is not known. Our study aimed to determine the decisional capacity of severely depressed people requiring electroconvulsive therapy (ECT), and whether educational interventions improve their ability to provide informed consent for ECT. MATERIALS AND METHODS: Forty subjects with severe depression were recruited. Using the MacArthur Competence Assessment Tool for Treatment instrument, decisional capacity was assessed at baseline and reassessed after education. All of the subjects received standard education. Additionally, half were blindly randomized to receive an experimental educational intervention. RESULT: SAt baseline, there was no statistical difference in the decisional capacity between the standard and experimental intervention groups. After educational interventions, all four areas of decisional capacity improved for both groups (understanding p < 0.001, reasoning p < 0.001, appreciation p = 0.031, choice p = 0.006). However, there was no measurable additional improvement in scores for those randomized to receive additional education. CONCLUSION: Our findings indicate that this group of severely depressed people had good decisional capacities to give informed consent. Education improved their decisional capacity. There is an endpoint beyond which additional educational intervention does not result in measurable improvement in decisional capacity.

Adult↗

PubMed2003

Electroconvulsive therapy for patients with major depression and probable Lewy body dementia.

Patients with dementia and depression are commonly encountered in ECT practice. A large body of case reports and case series in demented patients attests to the utility of ECT in treating concomitant depression in this population. However, there are no reported cases of patients with suspected Lewy Body dementia and depression treated with ECT. We describe our experience in treating seven such patients. All of them enjoyed substantial relief from depression with ECT, which they tolerated well. It is concluded that ECT can be effective in treating depression associated with probable Lewy Body dementia.

Aged↗

PubMed2003

Clinical applications of recent research on electroconvulsive therapy.

Electroconvulsive therapy (ECT) has been in use since the late 1930s to treat a variety of severe mental illnesses, most notably major depression. Current research efforts focus on patient selection, memory impairment, and high posttreatment relapse rates. Psychopathological factors such as psychosis and severe psychomotor retardation predict favorable response to ECT in depression. Technical variables that affect memory include electrode placement, stimulus intensity, and treatment frequency. Strategies to reduce posttreatment relapse rates include maintenance ECT and aggressive medication combinations. In this article, I review recent research that bears on these aspects of ECT practice. Additionally, I review some findings on the neurobiological effects of ECT.

Electroconvulsive Therapy↗

PubMed2002

Electroconvulsive therapy in the management of chronic pain.

Electroconvulsive therapy (ECT) is used predominantly to treat major depressive illness but has also been used for chronic pain. ECT causes a variety of neurochemical and neurophysiologic effects, some of which may interact with the pathophysiologic mechanisms in complex pain states. An extensive literature on the use of ECT in pain patients identifies subgroups for whom ECT may result in substantial pain relief. In this article, we review the literature on the use of ECT in pain patients, suggest possible neurobiologic bases for the efficacy of ECT in such patients, and conclude with our recommendations for current clinical practice.

Chronic Disease↗

PubMed2002

Electroconvulsive therapy in the medically ill.

ECT is often a necessary treatment for severe psychiatric disorders in patients with medical or neurologic comorbidity. Although the available data consist largely of cases and case series, ECT is effective in treating psychopathology despite the comorbidity. With appropriate precautions and monitoring during and after ECT, complications can be minimized.

Chronic Disease↗

PubMed2002

Safety, efficacy, and effects on glycemic control of electroconvulsive therapy in insulin-requiring type 2 diabetic patients.

OBJECTIVE: To determine the safety, efficacy, and effects on glycemic control of electroconvulsive therapy (ECT) in insulin-requiring type 2 diabetic patients. METHODS: Chart review was conducted of 19 patients with insulin-requiring type 2 diabetes mellitus who underwent ECT at Mayo Clinic (Rochester, Minnesota) between 1993 and 2000. None of the patients received oral hypoglycemic drugs. Daily fasting blood glucose concentrations and daily insulin requirements were determined. For each patient, the daily insulin requirements before the first ECT treatment were compared with insulin requirements after the last ECT treatment. In addition, the insulin requirements 1 day before and 1 day after each ECT treatment (n = 143) were compared. Charts were reviewed for activity, appetite, and weight changes. RESULTS: The average change in daily insulin requirements 1 day before the initiation of ECT compared with 1 day after the completion of ECT was not statistically significant. Changes in dietary or activity levels correlated with fluctuations in insulin requirements in selected individuals. There were no significant changes in acute glycemic control associated with ECT. CONCLUSIONS: Our findings refute previous reports of dangerous hyperglycemia or improved glycemic control due to ECT in insulin-requiring type 2 diabetes, and suggest that ECT is safe and efficacious in these patients.

Adult↗

PubMed2002

Electroconvulsive therapy and newer modalities for the treatment of medication-refractory mental illness.

Severe mental illnesses often remain chronic and refractory to medication, leading to substantial morbidity and mortality. For more than 60 years, electroconvulsive therapy has been the only nonpharmacological psychiatric procedure available to treat severe or medication-refractory major depressive disorder and other psychiatric conditions. Memory dysfunction remains the most serious adverse effect, and current research focuses on attempts to ameliorate this complication. Transcranial magnetic stimulation and vagus nerve stimulation, 2 new neuropsychiatric technologies, are emerging as possible additions to our therapeutic armamentarium. Besides providing therapeutic benefits, these 3 methods may help elucidate the pathophysiology of psychiatric illness.

Drug Resistance↗