Effect of electroconvulsive therapy on brain functional network in major depressive disorder / 生物医学工程学杂志

Electroconvulsive therapy (ECT) is an interventional technique capable of highly effective neuromodulation in major depressive disorder (MDD), but its antidepressant mechanism remains unclear. By recording the resting-state electroencephalogram (RS-EEG) of 19 MDD patients before and after ECT, we analyzed the modulation effect of ECT on the resting-state brain functional network of MDD patients from multiple perspectives: estimating spontaneous EEG activity power spectral density (PSD) using Welch algorithm; constructing brain functional network based on imaginary part coherence (iCoh) and calculate functional connectivity; using minimum spanning tree theory to explore the topological characteristics of brain functional network. The results show that PSD, functional connectivity, and topology in multiple frequency bands were significantly changed after ECT in MDD patients. The results of this study reveal that ECT changes the brain activity of MDD patients, which provides an important reference in the clinical treatment and mechanism analysis of MDD.

Posibles mecanismos de acción de la terapia electroconvulsiva en esquizofrenia: revisión de la evidencia disponible en investigación con seres humanos / A review about the putative mechanisms of action of electroconvulsive therapy in schizophrenia in human research

Electroconvulsive therapy (ECT) has multiple uses in psychiatry, but its mechanisms of action (MA) in patients with schizophrenia (PS) are poorly understood. We synthesize and discuss the available evidence in this regard. We conducted a search for primary human studies and systematic reviews searching MA of ECT in PS published in PubMed/Medline, SciELO, PsycInfo, and the Cochrane Library, including 24 articles. Genetic findings are scarce and inconsistent. At the molecular level, the dopaminergic and GABAergic role stands out. The increase in brain derived neurotrophic factor (BDNF) after ECT, is a predictor of positive clinical outcomes, while the change in N-acetyl aspartate levels would demonstrate a neuroprotective role for ECT. This intervention would improve inflammatory and oxidative parameters, thereby resulting in a symptomatic improvement. ECT is associated with an increase in functional connectivity in the thalamus, right putamen, prefrontal cortex and left precuneus, structures that play a role in the neural default mode network. A decrease in connectivity between the thalamus and the sensory cortex and an enhanced functional connectivity of the right thalamus to right putamen along with a clinical improvement have been reported after ECT. Moreover a volumetric increase in hippocampus and insula has been reported after ECT. These changes could be associated with the biochemical pathophysiology of schizophrenia. Most of the included studies are observational or quasi-experimental, with small sample sizes. However, they show simultaneous changes at different neurobiological levels, with a pathophysiological and clinical correlation. We propose that the research on ECT should be carried out from neurobiological dimensions, but with a clinical perspective.

Eletroconvulsoterapia: Caracterização dos Pacientes Atendidos em Hospitais no Sul Catarinense / Electroconvulsive therapy: characterization of patients attended in hospitals in the south of Santa Catarina

Introdução: A eletroconvulsoterapia surge em 1938 para tratamento de psicoses graves, desenvolvida por Ugo Cerletti e Lucio Bini. As indicações para o uso da eletroconvulsoterapia são as mais variadas, entre elas podemos citar: depressão refratária aos antidepressivos, transtorno afetivo bipolar, esquizofrenia, psicoses, doença de Parkinson e epilepsia. O procedimento é realizado em ambiente adequado com equipe especializada, incluindo um psiquiatra, um anestesista e um enfermeiro. O procedimento deve ser feito sob anestesia, bloqueadores neuromusculares e medicações coadjuvantes usadas de forma individualizada. O presente estudo objetivou caracterizar o perfil sociodemográfico e clínico dos pacientes submetidos à ECT em dois hospitais situados no município de Tubarão, em Santa Catarina. Métodos: A presente pesquisa trata-se de um estudo epidemiológico com delineamento transversal. A população em estudo consiste em todos os pacientes submetidos à eletroconvulsoterapia no Hospital Nossa Senhora da Conceição e no Hospital e Maternidade Socimed, ambos localizados na cidade de Tubarão/SC. Desta maneira, obteve-se uma população de 82 pacientes. A coleta de dados ocorreu através de prontuários em um período de janeiro de 2013 até março de 2020. Resultados: Foi encontrada uma prevalência de 47,56% quanto ao diagnóstico para indicação da ECT em transtorno depressivo, em que 69,51% usavam algum antidepressivo e uma mediana de nove (9) sessões de eletroconvulsoterapia (P25: 6; P75:11) e variação de uma até 25 sessões. Conclusão: Foi possível caracterizar os pacientes submetidos à eletroconvulsoterapia em um período de 8 anos, com foco no perfil sociodemográfico e clínico dos pacientes.

Introduction: Electroconvulsive therapy (ECT) emerged in 1938 to treat severe psychoses, developed by Ugo Cerletti and Lucio Bini. The indications for the use of electroconvulsive therapy are the most varied: depression refractory to antidepressants, bipolar affective disorder, schizophrenia, psychoses, Parkinson's disease, and epilepsy. The procedure occurs in an appropriate environment with a specialized team, including a psychiatrist, an anesthesiologist, and a nurse. It must be done under anesthesia, neuromuscular blockers, and adjunctive medications used on an individualized basis. This study aimed to characterize the sociodemographic and clinical profile of patients undergoing ECT in two hospitals located in Tubarão, Santa Catarina. Methods: This research is an epidemiological study with a cross-sectional design. The study population consisted of all patients undergoing electroconvulsive therapy in the Hospital Nossa Senhora da Conceição and the Hospital (HNSC) and Socimed Maternity Hospital (Maternidade Socimed), both located in the city of Tubarão/SC. Thus, the study obtained a population of 82 patients. Data collection occurred through medical records from January 2013 to March 2020. Results: A prevalence of 47.56% was found regarding the diagnosis for the indication of ECT in depressive disorder, in which 69.51% used some antidepressant and a median of nine (9) sessions of electroconvulsive therapy (P25: 6; P75:11) and a variation of one to 25 sessions. Conclusion: It was possible to characterize the patients submitted to electroconvulsive therapy over eight years, focusing on patients' sociodemographic and clinical profiles.

Terapias globales, psiquiatras locales: la circulación de tratamientos de shock y su implementación en Rosario, Argentina, 1936-1944 / Global therapies, local psychiatrists: shock treatment circulation and its implementation in Rosario, Argentina, 1936-1944

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.

Effects of electroconvulsive therapy on cognition and quality of life in schizophrenia

INTRODUCTION@#The effects of electroconvulsive therapy (ECT) on quality of life (QoL), and its relationship with symptom and cognitive change remains unclear. We aim to examine the association of QoL changes with psychiatric symptom and cognitive changes among patients with schizophrenia who underwent ECT.@*METHODS@#This is a retrospective cohort study of 132 patients who received ECT from July 2017 to December 2019. Sociodemographic and clinical characteristics were obtained from medical records. Changes in QoL, psychiatric symptoms and cognition function were examined after 6 sessions of ECT. Generalised linear regression was used to examine the associations of Brief Psychiatric Rating Scale (BPRS) scores and Montreal Cognitive Assessment (MoCA) scores with QoL as measured by EQ-5D scores.@*RESULTS@#The mean (standard error) improvements after ECT were statistically significant for the assessment scales of EQ-5D utility score: 0.77 (0.02) to 0.89 (0.02), P<0.001; EuroQol-5-Dimension (EQ-5D) visual analogue scale score: 66.82 (2.61) to 73.05 (1.93), P=0.012; and EQ-5D subdomain scores. Both improvement in BPRS (adjusted β coefficient -0.446, 95% confidence interval [CI] -0.840 to -0.052) and MoCA (adjusted β 12.068, 95% CI 0.865 to 12.271) scores were significantly associated with improvement in EQ-5D utility scores after adjustment for sociodemographic and clinical characteristics. Improvement of BPRS scores (psychiatric symptoms) was significantly associated with improvement of the patients' mental health that was assessed by EQ-5D subdomain scores of pain (adjusted β coefficient 0.012, 95% CI 0.004 to 0.021) and anxiety (adjusted β coefficient 0.013, 95% CI 0.002 to 0.024). Improvement of MoCA scores (cognitive function) was significantly associated with patients' physical health as assessed by EQ-5D subdomain score of usual activity (adjusted β coefficient -0.349, 95% CI -0.607 to -0.09).@*CONCLUSION@#ECT was associated with an overall improvement of QoL among patients with schizophrenia. The improvement of psychiatric symptoms was found to be significantly associated with better mental health while the improvement of cognitive function was associated with better physical health.

Reflexões acerca das implicações éticas e legais da realização da Eletroconvulsoterapia / Reflections on the ethical and legal implications of performing Electroconvulsive Therapy / Reflexiones sobre las implicaciones éticas y legales de realizar Terapia Electroconvulsiva

A Electroconvulsoterapia (ECT), também conhecida por eletrochoque, é um tratamento psiquiátrico, no qual são provocadas alterações na atividade elétrica do cérebro, induzidas por meio de passagem de corrente elétrica sob efeito de anestesia geral, com a finalidade de induzir uma crise convulsiva que dura em torno de 30 segundos. O tratamento é feito em sessões, e o número de aplicações é definido pelo psiquiatra.1

ECT no contexto da pandemia COVID-19: readequar é necessário / Electroconvulsive therapy in terms of the COVID-19 pandemic: adaptation is needed

Introdução: A pandemia pelo COVID-19 representa um desafio para os serviços de saúde, impactando, inclusive, na realização da eletroconvulsoterapia (ECT), um procedimento essencial. Objetivo: O objetivo deste trabalho é revisar artigos que relatam a adaptação de serviços de ECT ao cenário de pandemia por COVID-19 e propor adequações visando sua manutenção. Métodos: Foi realizada uma revisão narrativa a partir dos resultados encontrados nos bancos de dados do PubMed e do PubMed Central até 27 de maio de 2020. Os termos utilizados na pesquisa foram: "ECT" AND "COVID-19", "ECT" AND "Coronavirus", "electroconvulsive therapy" AND "COVID-19", "electroconvulsive therapy" AND "coronavirus". Foram encontrados 23 artigos no PubMed Central e 8 artigos no PubMed. Onze deles foram selecionados para a revisão de acordo com a relevância. Resultados: Os artigos demonstram uma redução significativa de ECT durante a pandemia. Dentre os motivos, estão: a teórica eletividade da ECT, escassez de relaxantes musculares, receio da transmissão do vírus principalmente por meio da ventilação não invasiva e receio de que profissionais de saúde necessitem de ser realocados para a linha de frente de assistência aos pacientes infectados. Discussão: Discutimos neste artigo as adaptações necessárias para a manutenção dos serviços de ECT: revisão de indicação de ECT, organização do serviço antes, durante e depois do procedimento, inclusive logística e transporte, screening da equipe e pacientes, revisão no uso de equipamentos de proteção individual e o manejo de vias aéreas, avaliar teleconsultas para acompanhamento entre as sessões, além de fiscalização se as adaptações estão sendo seguidas.

Introduction: The COVID-19 pandemic is a challenge for health services and has affected the electroconvulsive therapy (ECT) services performed as an essential procedure. The aim of this study was to the review articles that reported on the adaptation of ECT services to the COVID-19 pandemic scenario and to propose some adjustments to help in maintaining this service. Objective: A narrative review was performed based on the literature review of the PubMed and PubMed Central databases by searching articles published up to May 27, 2020. The search terms used were as follows: "ECT" AND "COVID-19," "ECT" AND "Coronavirus," "electroconvulsive therapy" AND "COVID-19," and "electroconvulsive therapy" AND "coronavirus". Overall, 23 articles were found in PubMed Central and eight in PubMed. Further, 11 of these were selected. Methods: These articles showed that ECT procedures have significantly reduced during the pandemic. The reasons for this are as follows: theoretical electivity of ECT; scarcity of muscle relaxants; fear of transmission of the virus, particularly via noninvasive ventilation; and fear that health professionals need to be relocated to the front-line care for the infected patients. Discussion: In this article, we discussed the adaptations required to maintain ECT services. These adaptations are as follows: review of the indication for ECT; organization of the service before, during, and after the procedure including logistics and transportation; screening of staff and patients; review of the use of personal protection equipment and respiratory airway management; evaluation of teleconsultations for monitoring patients between sessions; and monitoring to ensure that the adaptations are being followed.

Intervención del Comité de bioética a propósito de un caso de indicación a un paciente de terapia electroconvulsiva / Intervention of the bioethics committee in the purpose of a case of indication to a patient for electroconvulsive therapy

[RESUMEN]: Describe el caso de un paciente que presenta un cuadro psicótico con alucinaciones auditivas, soliloquios, estupor y perplejidad. Tenía alteraciones motoras que limitaban su desempeño, deambulaba y se alimentaba con dificultad; se realizó interconsulta con el servicio de Salud Mental y lo evaluó el psiquiatra en entrevista conjunta con un psicólogo. Se solicitó la Intervención del Comité de Bioética. Y luego del análisis de la evidencia se realiza la recomendación respecto al tema consultado: Aplicación de Terapia Electroconvulsiva en un paciente con esquizofrenia fundamentado en el análisis de evidencia científica.

[ABSTRACT]: Patients with Covid 19, caused by the severe aIt describes the case of a patient who presents a psychotic picture with auditory hallucinations, soliloquies, stupor and perplexity. He had motor alterations that limited his performance, he wandered and fed with diffi culty; Consultation with the Mental Health service was carried out and it was evaluated by the psychiatrist in a joint interview with a psychologist. The Intervention of the Bioethics Committee was requested. And after the analysis of the evidence, the recommendation is made regarding the topic consulted: Application of Electroconvulsive Therapy in a patient with schizophrenia based on the analysis of scientific evidence.

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more "precision-oriented" practice.

Terapia Electroconvulsiva y Estimulación Magnética Transcraneal Repetitiva en pacientes con esquizofrenia: una revisión sistemática / Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in patients with schizophrenia: a systematic review

Cuando la esquizofrenia no responde satisfactoriamente a tratamiento farmacológico, alcanzar una terapia efectiva para el paciente es una tarea bastante frustrante para el médico psiquiatra. Es en este contexto que la terapia electroconvulsiva y la estimulación magnética transcraneal repetitiva han tomado fuerza en la investigación clínica, a pesar de los grandes cuestionamientos sobre su efectividad y mala reputación. Se realizó una revisión sistemática de la literatura en las principales bases de datos disponibles. Concluyendo que ambas terapias demuestran ser herramientas útiles en el tratamiento de la esquizofrenia resistente a tratamiento farmacológico, así como también complementarias a los antipsicóticos

When schizophrenia does not respond satisfactorily to pharmacological treatment, achieving effective therapy for the patient is quite a frustrating task for the psychiatrist. It is in this context that electroconvulsive therapy and repetitive transcranial magnetic stimulation have gained strength in clinical research, despite huge questions about its success and bad reputation. A systematic review of the literature was conducted in the main available databases. Concluding that both specific therapies will be useful tools in the treatment of schizophrenia resistant to pharmacological treatment, as well as complementary to antipsychotics.

Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electroconvulsive Therapy?

OBJECTIVE: To evaluate the effects of 2 different dose regimens of propofol (low dose: 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group. CONCLUSION: Higher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.

Efficacy of Asenapine in Schizophrenia Resistant to Clozapine Combined with Electroconvulsive Therapy: A Case Report

Schizophrenic patients resistant to antipsychotics are diagnosed as having treatment-refractory schizophrenia, and they are treated with clozapine. However, clozapine is sometimes combined with electroconvulsive therapy (ECT) if clozapine monotherapy fails. In this report, a severe treatment-refractory schizophrenic patient who did not respond to clozapine even with ECT, but who recovered with asenapine monotherapy, is presented. Asenapine, considered a serotonin spectrum dopamine modulator, is a new atypical antipsychotic with unique pharmacological features that is used not only for schizophrenia, but also for bipolar disorder. The unique features of asenapine may be effective for some treatment-refractory schizophrenic patients.

Initial Seizure Threshold in Brief-Pulse Bilateral Electroconvulsive Therapy in Patients with Schizophrenia or Schizoaffective Disorder

OBJECTIVE: The present study aimed to report the initial seizure threshold (IST) of a brief-pulse bilateral electroconvulsive therapy (BP-BL ECT) in Korean patients with schizophrenia/schizoaffective disorder and to identify IST predictors. METHODS: Among 67 patients who received ECT and diagnosed with schizophrenia/schizoaffective disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, we included 56 patients who received 1-millisecond BP-BL ECT after anesthesia with sodium thiopental between March 2012 and June 2018. Demographic and clinical information was gathered from electronic medical records, and a multiple regression analysis was conducted to identify predictors of the IST. RESULTS: The mean age of the patients was 36.9±12.0 years and 30 (53.6%) patients were male. The mean and median IST were 105.9±54.5 and 96 millicoulombs (mC), respectively. The IST was predicted by age, gender, and dose (mg/kg) of sodium thiopental. Other physical and clinical variables were not associated with the IST. CONCLUSION: The present study demonstrated that the IST of 1-ms BP-BL ECT following sodium thiopental anesthesia in Korean patients was comparable to those reported in previous literature. The IST was associated with age, gender, and dose of sodium thiopental.

Is Advancing Circadian Rhythm the Mechanism of Antidepressants?

Antidepressants usually require 2–8 weeks after drug administration to obtain a clinical response. In contrast, three fast-acting antidepressant treatments (sleep deprivation, electroconvulsive therapy, and ketamine) significantly reduced depressive symptoms within hours to days in a subgroup of patients with depressive disorder. This review addresses the mechanisms underlying these fast effects, with specific focus on treatment effects on circadian rhythms. Numerous recent studies have shown that circadian dysregulation may play an important role in the pathogenesis of mood disorders. These studies indicate that a common therapeutic mechanism underlying the three fast antidepressant therapies is related to circadian rhythm. Evidence suggests that depressive disorder is associated with circadian rhythm delay and that the mechanism of the antidepressant effect is a process in which the delayed circadian rhythm is restored to normal by the treatment.

Low-Charge Electrotherapy in Geriatric Major Depressive Disorder Patients: A Case Series

To examine the feasibility of low-charge electrotherapy (LCE) in treating geriatric major depressive disorder (MDD) patients. Bi-temporal LCEs (approximately 25 mC) were performed with an electroconvulsive therapy (ECT) instrument three times per week. We used the Hamilton Depression Scale 17 (HAMD-17) and the Hamilton Anxiety Scale (HAMA) to assess the effects of LCE and the Mini-Mental State Examination (MMSE) to evaluate the cognitive function change before and after LCE. Six visits occurred at the baseline, after LCE sessions 3, 6, and 9, after the last session, and at the end of the one-month follow-up period. Four patients were enrolled in the study. Two patients completed all LCE sessions. Two patients withdrew during the trial, one due to the adverse event of uroschesis potentially caused by atropine and the other due to her own will. All four patients completed the follow-up sessions. The HAMD-17 and HAMA scores were reduced significantly at the last LCE session and the end of the follow-up period compared with the scores at the baseline. As measured by the MMSE, cognitive impairment showed no significant changes at the last LCE session and the end of the follow-up period compared with that at the baseline. In this case series, LCE showed potential as an alternative current-based treatment for treating geriatric MDD patients. Further research is needed to assess the efficiency and safety of LCE.

Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy / Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia

Abstract Background and objectives: Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods: After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results: 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions: Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.

Resumo Justificativa e objetivos: O propofol é comumente usado como agente hipnótico na terapia eletroconvulsiva, mas apresenta também propriedades anticonvulsivantes. O objetivo principal foi avaliar o efeito da dose de propofol ajustada ao peso na duração da convulsão elétrica. Os objetivos secundários foram avaliar o efeito da dose total de propofol na duração da convulsão elétrica, o efeito da dose tanto total quanto ajustada ao peso nos valores do índice bispectral e a influência da bioquímica do sangue no efeito anticonvulsivante. Métodos: Após aprovação do Comitê de Ética em Pesquisa, foi feita uma revisão retrospectiva dos prontuários de todos os pacientes que fizeram pelo menos uma sessão de eletroconvulsoterapia. Análise de regressão linear múltipla ajustada para potenciais confundidores foi feita para explorar o efeito da dosagem de propofol sobre os valores do índice bispectral e a duração da convulsão; análises de correlação bivariada foram previamente feitas para identificar as variáveis que atendem aos critérios de confusão, especificamente valores de r de Spearman > 0,10. Os resultados da análise de regressão foram expressos como coeficiente B com intervalo de confiança de 95%. Resultados: Setenta e seis pacientes receberam 631 sessões de fase aguda. Propofol mostrou um efeito negativo estatisticamente significativo sobre a duração da convulsão (especificamente uma redução de 4,081 segundos para cada mg.kg−1 de propofol; IC de 95%: -7906 para -0,255, p = 0,037), mas não para os valores do índice bispectral. Anemia leve e hipoalbuminemia foram condições muito raras e o efeito anticonvulsivante não foi influenciado por esses parâmetros. Conclusões: A dose de propofol ajustada ao peso está negativamente relacionada com a duração das crises convulsivas, deve ser cuidadosamente titulada quando usada na terapia eletroconvulsiva.

A propósito de un caso complejo: agitación psicomotora: ¿TEC y clozapina, sala de aislamiento? / About a complex case: psychomotor agitation: TEC and clozapine, isolation room?

Paciente de 25 años. Ingreso a Servicio de Urgencia. Paciente viene solo, desaseado, relata múltiples ideas bizarras, no sistematizadas. Pensamiento laxo, musita, interferido, a ratos discordante. Diagnóstico: Síndrome esquizomorfo. Antecedentes judiciales: Informe cumplimiento condena en Puerto Montt: Lesiones menos graves y Robo con violencia. Persiste amenazante, exaltado. Paranoide. Durante la tarde amenaza con colgase, cortarse o quemar colchón, cuelga sabana de ventana e intenta ahorcarse. Primera sesión de TEC, Cisordinol accutard. Contención física, Sujeciones. Modecate. Cortes en antebrazo, Amenaza con matar otros pacientes, al apagar las luces se sienta en cama de otro paciente en actitud intimidante, lo agrede con lápiz en ojo derecho. Reinicia TEC, Inicia clozapina 25mg/día. Hostil y desafiante ante funcionarios por el encuadre, Baja en recuento de blancos, inicia litio. Algo hostil y querellante con personal, probablemente relacionado con suspensión de TEC (20 sesiones). Clozapina 450mg/día, Litio 600 mg/día. Traslado de paciente para sala de aislamiento, Se retira chapa de aislamiento ­ Sala de observación, Cuidador especial constante, hombre, Mitones, solicitud a UGC apoyo

Patient of 25 years old. Entrance to Emergency Service. Patient comes alone, untidy, reports multiple bizarre ideas, not systematized. Lax thought, mumble, interfered, discordant at times. Diagnosis: Schizomorphic syndrome. Legal background: Condemning Report in Puerto Montt: Less serious injuries and robbery with violence. He persists threatening, exalted. Paranoid. During the afternoon threatens to hang, cut or burn mattress, hangs a blanket in window and tries to hang himself. First session of TEC, Cisordinol accutard. Physical restraint, Supports. Modecate. Cuts in forearm. Threat to kill other patients, when turning off lights sits in bed of another patient in intimidating attitude, strikes him with pencil in right eye. Restart TEC, Starts clozapine 25mg / day. Hostile and challenging with officials because of setting, White cells: Low counting, initiating lithium. Somehow hostile and prosecuting with staff, probably related to ECT suspension (20 sessions). Clozapine 450mg / day, Lithium 600mg / day. Transfer of patient to isolation room, Removal of insulation sheet - Observation room, Special caregiver constant, male, Mittens, request to UGC support.