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Biomedical subjects

Richard D. Weiner

Publications and source records attributed to Richard D. Weiner.

At least 19 recordsLinked to original sources
PubMed1992

ECT in a State Hospital Setting.

The use of electroconvulsive therapy (ECT) in U.S. state hospitals has markedly decreased in the past 20 years. During this time ECT technique has reached a high level of sophistication. We examine whether ECT still has a place and can be effectively used in a modern state hospital. We conclude that approximately 1% of state hospital patients are candidates for ECT and that patients with major depression, mania, schizoaffective disorder, and schizophrenia may benefit from such treatment. The relative youth and good physical health of state hospital patients referred for ECT reduces the risk of the procedure in this setting. Most of our patients were on civil commitment but retained the capacity to consent to treatment. We discuss the use of inpatient continuation ECT and the treatment of protracted psychotic excitement as issues relevant to state hospitals.

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PubMed1992

Dental Pathology in ECT Patients Prior to Treatment.

Dental complications during electroconvulsive therapy (ECT) are uncommon. Nevertheless, dental complications are often cited in ECT-related malpractice litigation. Choice of dental protection during ECT should be based on dental pathology prior to ECT. We describe the results of formal dental examinations of 82 patients prior to ECT and 82 matched psychiatric controls. Dental pathology was frequent in both groups without intergroup differences. The decision to pursue a formal dental consultation prior to ECT should be based upon questions raised on inspection of the oral cavity by the treating psychiatrist. The type of dental protection during ECT should be chosen according to the patient's pre-ECT dental status.

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PubMed1991

Effects of Labetalol on Hemodynamics and Seizure Duration During ECT.

Beta blockers are commonly used to attenuate the transient increase in heart rate (HR) and blood pressure (BP) that accompany electroconvulsive therapy (ECT). Recent reports have suggested that several beta blockers have anticonvulsant properties and hence could be countertherapeutic with ECT. In a randomized, double-blind controlled study of the dose response effects of intravenous labetalol on ECT hemodynamics and seizure duration, labetalol exhibited dose-dependent reduction in HR and rate pressure product (RPP) at the 5 and 10 mg doses compared to placebo. However, no significant differences between labetalol 5 mg, 10 mg, or placebo were found on BP or seizure duration.

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PubMed1989

Brain Magnetic Resonance Imaging in Elderly Depressed Patients Receiving Electroconvulsive Therapy.

The authors review their experience with brain magnetic resonance (MR) imaging in elderly patients with depression referred for electroconvulsive therapy (ECT). A variety of brain changes were identified on the pre-ECT MR scans of these patients, including cortical atrophy, subcortical encephalomalacia, lateral ventricular enlargement, and lesions of the pons. The authors examine the effects of these preexisting brain changes on the therapeutic outcome and side effects from ECT. Pilot data suggest that these brain findings do not change during a course of ECT. The potential relationship of these brain changes to the development of affective disorder in the elderly is discussed and areas for future research are suggested.

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PubMed1989

Continuation Therapy for Depression Using Outpatient Electroconvulsive Therapy.

This naturalistic study followed the course of 27 patients who received continuation therapy with outpatient electroconvulsive therapy (ECT) after responding well to an index course of ECT for major depression. The continuation outpatient ECT protocol consisted of weekly treatments for the 1st month after remission, followed by a gradual tapering to monthly treatments. All patients were free of psychotropic medications during their continuation course of ECT. Patients who completed the continuation ECT protocol were significantly (p = 0.04) less likely to experience a relapse of depressive symptoms necessitating hospitalization during a 5-month follow-up period than were those who failed to follow the protocol. Indications for use of continuation ECT are discussed and areas for future research are identified.

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PubMed1988

The First ECT Devices.

The earliest electroconvulsive therapy (ECT) equipment was surprisingly advanced in its characteristics. Designed by some of the leading clinical scientists of the day in conjunction with creative engineering entrepreneurs, many devices contained features as advanced as are now in contemporary devices. A review of the development of ECT devices is of historical interest and it offers a fresh glimpse into technical issues that occupy recent interest.

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PubMed1988

Effects of ECT on Polysomnographic Sleep: A Prospective Investigation.

The authors describe a pilot investigation using ambulatory polysomnography (PSG) to assess rapid eye movement (REM) latency in 11 depressed inpatients before and after a course of electroconvulsive therapy (ECT). Prior to beginning ECT, all subjects had REM latencies of 56 minutes or less (mean 22 min). A course of ECT was associated with clinical improvement in every patient and a statistically significant (p < 0.0002) increase of 67% in mean REM latency (37 min). However, individual patients showed marked variability in REM latency both during and after the course of ECT, and 7 of the 11 responders continued to exhibit shortened REM latencies of 34 min or less. Technical considerations related to PSG studies during ECT are reviewed and the clinical and theoretical implications of our findings are discussed.

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