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Background: Electro-convulsive therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. This study was undertaken with the aim of exploring the clinical and demographic profile of patients treated with ECT from a tertiary care psychiatry hospital in north India.Methods: It was a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Institute of mental health and neurosciences Kashmir during a period of one year (March 2017 to February 2018).Results: A total of 70 patients received ECT during the course of one year. About 72.85% of the patients belonged to 20-39 years age group. Female patients constituted more than half of the subjects (55.71%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (35.71%), followed by bipolar affective disorder (28.57%), depressive disorder (28.57%), schizoaffective disorder (4.28%) and substance induced mood/psychotic disorders (2.85%). A significant majority of subjects (57.13%) received about 7-9 ECT sessions. No any major complications were noted during ECT treatment.Conclusions: This study suggests that ECT, use as a treatment modality is common in adults between 20 to 39 years of age and females with Schizophrenia being the most common indications.
ABSTRACT
Electroconvulsive therapy (ECT) is a standard procedure in the modern psychiatric armamentarium. It involves, application of electric stimulus for a brief time in psychiatric patients to induce generalized seizure. ECT is utilized for treating various severe, treatment-resistant or refractory psychiatric disorders, schizophrenia and major depressive disorder (MDD). During ECT, severe disturbances can be noted in the cerebrovascular and cardiovascular system. Various anaesthetic drugs used in modified ECT can prevent these disturbances. We wanted to compare induction time, alteration of hemodynamics, seizure duration, and recovery time by using intravenous etomidate and intravenous propofol for induction of anaesthesia in modified electroconvulsive therapy.METHODSSixty patients were included in this prospective and comparative study. Patients of age group of 18–60 years of either sex, who had been posted for ECT therapy were randomly divided into two groups. Group E received Inj. Etomidate at 0.2 mg/Kg IV and Group P received Inj. Propofol 1% at 1.5 mg/Kg for induction of anaesthesia. Patients were monitored for various haemodynamic parameters such as heart rate, blood pressure at basal, after induction, and 1 min, 2 min, 3 min, 5 min, 10 min and 20 min following ECT. Induction time, seizure duration, quality of anaesthesia and recovery time from anaesthesia were also noted.RESULTSInduction of anaesthesia is faster with propofol (40.30 ± 3.65 sec) than with etomidate (48.63 ± 3.29 sec). Longer seizure duration was found with etomidate (58.90 ± 11.91 sec) induction in comparison to propofol (22.16 ± 5.48 sec) induction. Propofol group had more stable hemodynamic parameters compared to etomidate group following ECT. Propofol group (7 ± 1.43 min) achieved consciousness earlier than those of etomidate group (8.60 ± 1.16 min) following induction.CONCLUSIONSPropofol had the advantage of smooth induction, stable hemodynamic parameters, and rapid recovery as compared to etomidate. However, it was associated with shorter seizure duration. Etomidate had longer seizure duration which results in better clinical outcomes over propofol. However, it was associated with greater incidence of myoclonic jerks during induction.
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Objective To observe the effects of ketamine on the patients with depression re-ceiving modified electric conulsive therapy (MECT).Methods Sixty patients with depression were randomly divided into ketamine group and propofol group (n =30 each group).Atropine 0.5-1.0 mg, propofol 1.0 mg/kg or ketamine 0.8 mg/kg i.v.were given before MECT,Scoline 0.7-1.0 mg/kg i. v.was given after the eyelash reflex disappeared.Hamilton Depression Rating Scale (HAMD)was completed after the 2 nd ,4 th and 6 th MECT,the time of convulsion,twitch index,energy percentage, respiratory recovery time and adverse reactions were recorded.Results The total score of HAMD was significantly decreased with the increasing times of MECT in both groups,compared with propo-fol group,ketamine group's HAMD total score decreased faster,especially after the 4th MECT,the score decreased significantly in ketamine group (P <0.05).The time of convulsion,twitch index,en-ergy percentage, respiratory recovery time, adverse reactions all had no statistical significance between the two groups.Conclusion Compered with propofol,ketamine,as an anesthetic of MECT, can effectively lower the score of HAMD.
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Objective To observe the effect of mivacurium,succinylcholine and atracurium in modified electric convulsive therapy (MECT).Methods Sixty ASA Ⅰ or Ⅱ patients with schizo-phrenia aged from 18 to 60 years old were randomly divided into 3 groups :mivacurium group (group A,n=20),succinylcholine group (group B,n=20),atracurium group (group C,n=20).The on-set time of muscle relaxation,the recovery time of spontaneous breathing after MECT,the awake time,as well as the changes of 5 min MAP,HR and SpO2 before and after MECT were observed re-spectively.Results The onset time of muscle relaxation and the recovery time of spontaneous breath-ing in group B were shorter than those in groups A and C (P <0.05).The onset time of muscle re-laxation and the recovery time of spontaneous breathing in group A were shorter than those in group C (P <0.05).Conclusion Mivacurium is a better alternative medicine in MECT in the situation of no succinylcholine or succnylcholine contraindication.
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Spine fractures occur less than 1% after electro-convulsive therapy(ECT). We report a rare case of thoracic compression fracture due to seizure after ECT. The patient was a 37-year-old female who suffered from major depression disorder. She received ECT six times in total. She complained of back pain after fifth ECT. There was no history of trauma. On thoracic CT and MRI, compression fracture of T4 body was clearly shown, but cord injury was not evident. After one month of bed rest, her back pain was improved. We discuss the mechanism of vertebral fracture after ECT with literature review.
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Adult , Female , Humans , Back Pain , Bed Rest , Depression , Fractures, Compression , Magnetic Resonance Imaging , Seizures , SpineABSTRACT
Objective To determine the dose of ropivacaine leading to convulsion and the convulsant action of midazolam. Methods Twenty healthy adult rabbits weighing 2.5-3.5kg were randomly divided into two groups with ten animals in each group: ropivacaine group(R) and midazolam-ropivacaine group(MR). Middle artery of ear was cannulated for MAP, HR monitoring and blood sampling for blood gas analysis and determination of plasma lactate and ropivacaine concentrations. Edge vein of ear was cannulated for administration of drugs. In both groups animals received intravenous infusion of 0.75% ropivacaine at a rate of 0.5m1/min until convulsion occurred. In MR group midazolam 0.8 mg/kg was given intravenously before ropivacaine.Results The dose of ropivacaine leading to convulsion was 4.86mg/kg for R group and 12.26mg/kg for MR group. Plasma ropivacaine concentration was 11 .52pg/ml in group Rand 16.77pg/ml in MR group. Convulsion lasted for 7.25 mm(R group) and 8.59mm(MR group) . Plasma lactate concentration increased significantly during convulsion in R group but remained unchanged in MR group. Blood pH decreased significantly during convulsion in R group but there was little change in PaCO2 and PaO2. Blood pH, PaO2 and PaCO2 did not change significantly during convulsion in MR group. There was no significant change in MAP and HR during convulsion in R group. In MR group MAP and HR decreased by 31 % and 35% respectively during convulsion and returned to baseline value gradually after ropivacaine infusion was stopped. All animals survived the experiment in both groups. Conclusions Ropivacaine is less cardiovascular toxic. Pretreatment with 0 . 8mg/kg midazolam greatly increases the dose of ropivacaine leading to convulsion. Midazolam can effectively prevent and treat CNS toxicity of ropivacaine.