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Resumen El artículo analiza la implementación de los tratamientos biológicos de shock en el Instituto de Psiquiatría de Rosario, Argentina, durante el período de entreguerras. El objetivo es destacar el impacto que un fenómeno global, referido al fortalecimiento de la disciplina y el surgimiento de nuevas terapias, tuvo en un espacio de atención psiquiátrica argentino. Así, se analizará la relevancia que tuvieron las limitaciones presupuestarias, la experimentación de alternativas y la presencia de expertos internacionales en la incorporación de las novedades terapéuticas. Se sostiene que las estrategias desplegadas por el Instituto para implementarlos exponen los matices locales de un fenómeno global, así como su aporte a la experimentación de los tratamientos.
Abstract This article analyses the implementation of biological shock treatments in the Psychiatric Institute of Rosario, Argentina, during the interwar period. The aim is to illuminate the impact that a global phenomenon, referred to the strengthening of the discipline and the emergence of new therapies, had on an Argentinean psychiatric care space. Thus, it will analyse the relevance that budgetary limitations, the experimentation of alternatives and the presence of international experts had in the incorporation of therapeutic novelties. It is argued that the strategies deployed by the Institute to implement them expose the local nuances of a global phenomenon, as well as its contribution to the experimentation of treatments.
Subject(s)
Psychiatric Somatic Therapies , Internationality , Electroconvulsive Therapy , Extracorporeal Shockwave Therapy , Argentina , History, 20th CenturyABSTRACT
OBJECTIVE: By recording the treatment events of implantable cardioverter defibrillator(ICD) in patients with ejection fraction reduced heart failure(HFrEF), to analyze the difference in primary and secondary prevention patients. METHODS: A single center retrospective study was conducted. HFrEF patients with ICD or cardiac resynchronization therapy with cardioverter defibrillator(CRT-D) implanted in Peking Union Medical College Hospital from January 2006 to December 2017 were enrolled in our study. Basic clinical data was collected and ICD treatment events were recorded during follow-up. The appropriate treatment events were identified according to electrocardiogram recorded by ICD. The ICD treatment events of primary and secondary prevention patients were analyzed. RESULTS: 1) A total of 145 patients with HFrEF implanted with ICD or CRT-D were enrolled, 103 primary prevention patients and 42 secondary prevention patients. Primary prevention patients had longer left ventricular end-systolic diameter(LVESD) and lower left ventricular ejection fraction(LVEF) than secondary prevention patients. 2) Multivariate competitive risk regression analysis showed that secondary prevention patients and male patients had higher risk of receiving appropriate treatment and appropriate shock therapy. 3) K-M curve and Log-Rank test showed that there was no significant difference in the risk of inappropriate treatment between primary and secondary prevention patients. The main cause of inappropriate treatment was atrial flutter or atrial fibrillation. CONCLUSION: 1) Primary prevention patients have lower risk of receiving appropriate treatment and appropriate shock therapy than secondary prevention patients; 2) There is no significant difference between primary and secondary prevention patients in the risk of inappropriate treatment. The main cause of inappropriate treatment events is atrial flutter or atrial fibrillation.
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Objective To investigate the clinical application of modified electroconvulsive therapy (MECT),and provide the references for more standardized and rational use of MECT.Methods A retrospective study was performed by stratified random sampling method.The clinical data of 1 330 psychiatric inpatients from January 2006 to December 2015 in Henan Psychiatric Hospital were analyzed retrospectively,and the clinical application of MECT was investigated,including the proportion of psychiatric inpatients receiving MECT,the situation of combined use of MECT and antipsychotic drugs,and the routine examination results before and after MECT.Results The proportion of receiving MECT in schizophrenic patients was the highest,it is 11.36％ (81/713),the second was depressive episode (5.61％,12/214),followed by dissociative conversion disorder (5.56％,2/36),bipolar disorder (5.34％,7/131),organic mental disorder (3.23 ％,1/31) and other mental disorders (2.93％,6/205).There were significant differences in the distribution of various mental disorders between the non electroshock group and the electroshock group (x2 =21.728,P ＜ 0.05).The proportion of the patients without electric shock and the patients with single drug,two drugs,triple therapy or quadruple therapy was 0.92％,17.43 ％,56.88％,21.10％ and 3.67％,respectively.The proportion of the patients with two or more antipsychotic drugs was 81.65％ in the electroshock group.The antipsychotics were olanzapine (28.44％),clozapine (27.52％),quetiapine (26.61％) and risperidone (24.77 ％) according to the drugs used frequently in the electroshock group.The results of routine blood test were compared among the time points of before treatment,the 1st,2nd,3 rd week of MECT and 1 week after MECT in the shock group,which showed that there was significant difference in white blood cell count (F =2.570,P ＜ 0.05);but there was no significant difference in the levels of platelet,hemoglobin and red blood cell (P ＞ 0.05);the level of white blood cell returned to normal within two weeks in 93.33％ patients with increased white blood count.The myocardial enzymes and liver function tests were not perfect during the treatment of MECT and after treatment.There was no long-term systematic evaluation of cognitive function and quality of life in patients with electroconvulsive shock.Conclusions The probability of using MECT in the patients with schizophrenia is more than that in the patients with depression.MECT is used in combination with two or more antipsychotic drugs.MECT may cause a short increase in white blood cells,but the white blood cell level in most patients can recover to normal levels after symptomatic treatment.The clinical data for treatment and prognosis in patients with MECT are inadequate,so it is necessary to improve the medical record.
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OBJECTIVE:To observe the efficacy and safety of breviscapine combined with double shock in the treatment of lu-pus encephalopathy. METHODS:70 patients with lupus encephalopathy were randomly divided into control group and observation group. Control group was treated with Methylprednisolone sodium succinate for injection 500 mg for continuous 3 d,iv,once a day,Cyclophosphamide for injection 1.0 g in the 4th day,iv,and Methylprednisolone sodium succinate for injection 80 mg was used for maintaining treatment in the 5th day for continuous 15 d,once a day. Observation group was treated with Breviscapine for injection 50 mg for continuous 20 d based on the treatment of control group,iv,once a day. The SLE activity(SLEDAI) score, IL-1β,IL-6,IL-8 and IFN-γ were observed,cases of neurological and psychological symptoms,the fatality rate and incidence of adverse reactions were recorded. RESULTS:After treatment,the SLEDAI,IL-1β,IL-6,IL-8 and IFN-γ in 2 groups were signifi-cantly lower than before,and observation group was lower than control group(P0.05). CONCLU-SIONS:Breviscapine combined with double shock has good efficacy and safety in the treatment of lupus encephalopathy,it can re-duce the SLEDAI score,improve neurological and psychological symptoms.