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Biomedical subjects

L B Guttmacher

Publications and source records attributed to L B Guttmacher.

16 recordsLinked to original sources
PubMed1998

ECT in the presence of intracranial aneurysm.

Two patients with known intracranial aneurysms (ICA) received electroconvulsive therapy (ECT). The first patient received ECT 4 years after the clipping of a right middle cerebral artery aneurysm. Treatment with esmolol failed to completely prevent an increase in blood pressure, but she did well nonetheless. The second patient underwent clipping of a basilar artery aneurysm 11 years before ECT. At the time of ECT, angiography showed a right paraophthalmic artery aneurysm. He received esmolol before each ECT, and, like the first patient, still had significant peri-ictal increases in his blood pressure, but otherwise tolerated the procedure well. Our experience and previously published literature indicate that even with pretreatment, patients often sustain significant increases in their blood pressure. However, this has not been accompanied by any morbidity. Possible guidelines for the management of ICA in association with ECT are discussed.

Adrenergic beta-Agonists↗
PubMed1997

Effect of methohexitone and propofol with or without alfentanil on seizure duration and recovery in electroconvulsive therapy.

We have studied the effects of methohexitone and propofol with and without alfentanil on seizure duration and recovery in this observer-blinded, prospective, randomized, crossover study involving 24 patients undergoing electroconvulsive therapy (ECT). Each patient had four treatment sessions, and received the following four i.v. regimens in random order: methohexitone 0.75 mg kg-1, methohexitone 0.50 mg kg-1 and alfentanil 10 micrograms kg-1, propofol 0.75 mg kg-1, propofol 0.50 mg kg-1 and alfentanil 10 micrograms kg-1. Additional methohexitone or propofol was given as needed in 10-20-mg increments until loss of consciousness. Suxamethonium 1.0 mg kg-1 i.v. was given for muscular paralysis. Mean motor and EEG seizure durations were longer with methohexitone-alfentanil (44.7 (SD 15.0) and 70.5 (29.7) s) than with methohexitone (37.6 (12.6) and 52.6 (15.3) s) and similarly, seizures were longer with propofol-alfentanil (36.8 (15.2) and 54.5 (20.9) s) than with propofol alone (27.2 (11.9) and 39.2 (3.9) s). Seizures were longest with methohexitone-alfentanil and shortest with propofol. Recovery time was statistically shorter in patients receiving propofol compared with methohexitone-alfentanil and methohexitone alone. Alfentanil with a reduced dose of methohexitone or propofol provided unconsciousness and increased seizure duration in patients undergoing ECT. We conclude that the combination of methohexitone with alfentanil is a good regimen for ECT, especially for patients with short seizure duration.

Adult↗
PubMed1996

Facilitating effective residency education on short-term inpatient units.

This paper examines the impact of shorter inpatient lengths of stay on residency education, and adaptations in training and supervision that facilitate effective learning experiences on a short-term inpatient unit. The caseloads of three PGY II psychiatric residents at the University of Rochester's Strong Memorial Hospital during three months of their inpatient rotations from 1979-80, 1986-87, and 1994-1995 are examined. Findings illustrate the changes occurring as inpatient units have moved to a shorter length of stay. The challenges and opportunities that face residents and supervisors in short-term inpatient settings today are examined. The discussion focuses on potential adaptations in the supervision of residents and organization of training experiences to insure that educational objectives are attained as length of stay decreases. Educational objectives especially relevant to short-term inpatient units are reviewed. Opportunities for continuity of teaching and training experiences offered by combining inpatient and partial hospital programs are highlighted.

Adult↗
PubMed1988

Amnesia for the McCollough effect following unilateral electroconvulsive therapy: implications for laterality.

The hemispheric lateralization of retrograde amnesia following unilateral electroconvulsive therapy (ECT) was measured by a novel nonverbal probe, the McCollough effect, which allowed equal and exclusive access to each hemisphere. Alternating exposure to perpendicular gratings of complementary colors (e.g., red vertical stripes alternated with green horizontal stripes) will cause subsequently presented black and white gratings to appear colored hours or even days later (the McCollough effect). Three of the patients examined (3 of 10) lost the effect in just the half visual field contralateral to the treatment side when unilateral nondominant ECT was interposed between the induction of the effect and the its test. Six patients lost the effect bilaterally following unilateral ECT. One patient retained a bilateral aftereffect. This patient had by far the shortest seizure (18 sec). Nine of 10 comparison patients, also suffering from major depression but without ECT intervening between induction and test, showed good bilateral retention of the McCollough effect. The remaining comparison patients showed no retention. These results imply that despite bilateral cortical spread of seizure activity, unilateral nondominant ECT has effects that are most pronounced over the stimulated hemisphere.

Adult↗
PubMed1988

Electroconvulsive therapy in one child and three adolescents.

Four patients aged 12 to 15 years who received ECT are reported. Despite the presentation of signs and symptoms consistent with positive response to electroconvulsive therapy (ECT) in adults, only one of the four patients responded favorably, and three patients had seizures lasting longer than 4 minutes. The patient who did respond to ECT did not experience a prolonged seizure, and he was also the only prepubescent patient. The authors present a tentative hypothesis that correlates youth with prolonged seizures and refractoriness to ECT.

Adolescent↗
PubMed1984

Epidemiologic considerations in electroconvulsive therapy.

Data from the Monroe County (New York) Psychiatric Case Register were grouped for 1961 through 1965, 1966 through 1970, and 1971 through 1975 for comparisons of incidence, prevalence, mortality, and length of stay associated with electroconvulsive therapy (ECT). While incidence of first ECT series declined substantially from 1961 through 1965 to 1971 through 1975 in most age-sex groups, significant declines in prevalence of admissions involving ECT occurred only among young female patients. Both prevalence and incidence analyses showed increasing specificity over time of ECT use in cases of depression. Demographic characteristics associated with ECT were accounted for by diagnostic correlates. Mortality effects associated with use of ECT were not pronounced, though a lower rate of accidental and circulatory deaths in the ECT group was noted. Lengths of hospital stay for patients receiving ECT were generally longer than for other depression hospitalizations, both for first ECT and later ECT series.

Actuarial Analysis↗
PubMed1983

D-amphetamine in obsessive-compulsive disorder.

In a double-blind crossover study, single doses of d-amphetamine and placebo were administered to 12 patients with severe chronic obsessive-compulsive disorder (OCD). Improvement of obsessional symptoms was significant on clinical ratings and was correlated with improved performance on an attention task. Changes were also significant for self-rated measures of activation and altered reality. The behavior response to amphetamine was not statistically correlated with subsequent improvement during a 6-week clomipramine trial, although the direction of change was the same during both treatments for every patient studied.

Adolescent↗
PubMed1982

The dexamethasone suppression test in patients with primary obsessive-compulsive disorder.

The dexamethasone suppression test (DST) was administered to 16 obsessive-compulsive disorder (OCD) patients. Six of these patients (37.5%) had an abnormal DST response. There was a trend for patients with the DST abnormality to have higher depression rating scale scores and a higher incidence of family history of affective illness compared to DST suppressors. Although 7 of the 16 OCD patients met DSM-III criteria for major depressive disorder, in every case the affective symptoms were secondary to the primary obsessional illness. The relationship of the DST to the specificity of psychiatric diagnoses is discussed.

Adolescent↗