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Rev. méd. Minas Gerais ; 31: 31204, 2021.
Article in Portuguese | LILACS | ID: biblio-1291274


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.

Humans , Electroconvulsive Therapy , COVID-19 , Respiratory Tract Infections , Adaptation, Psychological , Coronavirus , Adaptation , Pandemics , Noninvasive Ventilation
Rev. ANACEM (Impresa) ; 14(1): 58-67, 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1123594


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.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Schizophrenia/therapy , Electroconvulsive Therapy/statistics & numerical data , Transcranial Magnetic Stimulation , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Randomized Controlled Trial
Article in English | WPRIM | ID: wpr-763569


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.

Anesthesia , Electroconvulsive Therapy , Electronic Health Records , Humans , Propofol , Retrospective Studies , Seizures
Psychiatry Investigation ; : 704-712, 2019.
Article in English | WPRIM | ID: wpr-760977


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.

Anesthesia , Diagnostic and Statistical Manual of Mental Disorders , Electroconvulsive Therapy , Electronic Health Records , Humans , Male , Psychotic Disorders , Schizophrenia , Seizures , Sodium , Thiopental
Psychiatry Investigation ; : 479-483, 2019.
Article in English | WPRIM | ID: wpr-760963


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.

Antidepressive Agents , Chronobiology Disorders , Circadian Rhythm , Depression , Depressive Disorder , Electroconvulsive Therapy , Humans , Ketamine , Mood Disorders , Sleep Deprivation
Psychiatry Investigation ; : 464-468, 2019.
Article in English | WPRIM | ID: wpr-760945


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.

Anxiety , Atropine , Cognition , Cognition Disorders , Depression , Depressive Disorder, Major , Electric Stimulation Therapy , Electroconvulsive Therapy , Follow-Up Studies , Humans
Article in English | WPRIM | ID: wpr-763562


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.

Antipsychotic Agents , Bipolar Disorder , Clozapine , Dopamine , Electroconvulsive Therapy , Humans , Recurrence , Schizophrenia , Serotonin , Suicide
Rev. bras. anestesiol ; 68(6): 564-570, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-977391


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−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−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.

Humans , Male , Female , Adult , Aged , Propofol/administration & dosage , Electroconvulsive Therapy , Hypnotics and Sedatives/administration & dosage , Seizures , Time Factors , Blood Chemical Analysis , Body Weight , Retrospective Studies , Consciousness Monitors , Middle Aged
Psiquiatr. salud ment ; 35(1/2): 105-113, ene.-jun. 2018.
Article in Spanish | LILACS | ID: biblio-998494


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.

Humans , Male , Adult , Psychomotor Agitation/etiology , Psychomotor Agitation/therapy , Schizophrenia/complications , Patient Isolation , Antipsychotic Agents/therapeutic use , Clozapine/therapeutic use , Electroconvulsive Therapy
Med. U.P.B ; 37(1): 25-35, ene. 2018.
Article in English | LILACS, COLNAL | ID: biblio-878937


Objetivo: la terapia electroconvulsiva (TEC) se ha considerado un tratamiento seguro y eficaz para episodios de depresión mayor, para episodios maníacos y otros trastornos psiquiátricos serios. El estudio describe los efectos cognitivos de la TEC en pacientes referidos para tratamiento a una clínica privada. Metodología: estudio descriptivo del tipo de serie de casos. En cada participante se realizó una evaluación basal antes del inicio de la TEC y otras dos (una a la semana y otra a los seis meses) después de terminado el ciclo de tratamientos, para describir el efecto de la TEC frontotemporal bilateral en la función neurocognitiva mediante el cambio, desde el estado basal hasta la evaluación final en los dominios de memoria, velocidad psicomotora, tiempo de reacción, atención compleja y flexibilidad cognoscitiva, así como en la función cognoscitiva global; y determinar su seguridad por el reporte de eventos adversos. La evaluación cognitiva se realizó con una batería de pruebas neuropsicológicas y la severidad de la enfermedad psiquiátrica se evaluó con la escala Clinical Global Impression Severity (CGI-S). Se incluyeron seis pacientes remitidos para tratamiento durante el periodo de seis meses. Resultados: no se observaron diferencias estadísticamente significativas entre las medianas de las evaluaciones de CGI-S, ni de la función cognitiva global, así como de ninguno de los dominios evaluados. Conclusiones: la TEC no produjo cambios en las funciones cognitivas analizadas en los seis pacientes estudiados.

Objective: Electroconvulsive therapy (ECT) has been considered a safe and effective treatment for depression, manic episodes, and other serious psychiatric conditions. Its main reported side effect has been cognitive impairment. This study describes the cognitive effects of ECT in psychiatric patients referred for treatment at a private clinic. Methodology: Descriptive case series study. A baseline assessment conducted before starting ECT, and another two (at one week and at six months) after completing the treatment cycle were used to describe the effects of frontotemporal bilateral ECT on neurocognitive function in terms of the change from the baseline to the final assessment in the domains of memory, psychomotor speed, reaction time, complex attention, and cognitive flexibility, as well as global cognitive function, as well as to determine ECT's safety by reporting adverse events. Cognitive assessment was conducted with a neuropsychological test battery and severity of psychiatric illness with the Clinical Global Impression-Severity scale (CGI-S). Six patients referred for treatment during six months were included. Results: No statistically significant differences were observed between the medians of the evaluations of CGI-S scale, global cognitive function or any of the domains evaluated. Conclusions: ECT did not produce changes in the cognitive functions assessed in the six studied patients.

Objetivo: a terapia eletroconvulsiva (TEC) se há considerado um tratamento seguro e eficaz para episódios de depressão maior, para episódios maníacos e outros transtornos psiquiátricos sérios. O estudo descreve os efeitos cognitivos da TEC em pacientes referidos para tratamento a uma clínica privada. Metodologia: estudo descritivo do tipo de série de casos. Em cada participante se realizou uma avaliação basal antes do início da TEC e outras dois (uma em uma semana e outra aos seis meses) depois de terminado o ciclo de tratamentos, para descrever o efeito da TEC frontotemporal bilateral na função neurocognitiva mediante a mudança, desde o estado basal até a avaliação final nos domínios de memória, velocidade psicomotora, tempo de reação, atenção complexa e flexibilidade cognoscitiva, assim como na função cognoscitiva global; e determinar sua segurança pelo reporte de eventos adversos. A avaliação cognitiva se realizou com uma bateria de provas neuropsicológicas e a severidade da doença psiquiátrica se avaliou com a escala Clinical Global Impression Severity (CGI-S). Se incluíram seis pacientes remitidos para tratamento durante o período de seis meses. Resultados: não se observaram diferencias estatisticamente significativas entre as média das avaliações de CGI-S, nem da função cognitiva global, assim como de nenhum dos domínios avaliados. Conclusões: a TEC não produziu mudanças nas funções cognitivas analisadas nos seis pacientes estudados.

Electroconvulsive Therapy , Cognition , Depression , Cognitive Dysfunction , Neuropsychological Tests
Psychiatry Investigation ; : 829-835, 2018.
Article in English | WPRIM | ID: wpr-716458


OBJECTIVE: This study aimed to investigate the effectiveness and tolerability of the combination of electroconvulsive therapy (ECT) in patients with clozapine-treated schizophrenia. METHODS: Patients with clozapine-treated schizophrenia during five years of pre-determined period were recruited from Electronic Medical Record. Clinical effects of acute ECT on psychotic symptoms were investigated. We also tried to identify predictive variables requiring maintenance treatment of ECT. RESULTS: Fourteen patients received ECT and clozapine and sixteen were treated with clozapine alone. In the ECT group, which could be refined as clozapine-resistance, PANSS total score was significantly reduced by 19.0±9.9 points, corresponding to a reduction rate of 18.5±8.3%. The clinical remission defined as 20% PANSS reduction criteria was achieved at 42.9%. The subscale factors were significantly reduced, among which the negative symptom was the least. There was no difference in demographic and clinical information between patients receiving and not receiving maintenance ECT, and not all patients seemed to need maintenance ECT if clozapine is continued. CONCLUSION: Combination of ECT and clozapine in patients with clozapine-resistant schizophrenia resulted in a rapid and substantial reduction of psychotic symptoms. Further studies are needed to improve the effectiveness and tolerability of ECT.

Clozapine , Electroconvulsive Therapy , Electronic Health Records , Humans , Schizophrenia
Article in English | WPRIM | ID: wpr-716367


OBJECTIVE: Continuation-maintenance electroconvulsive therapy (C/M-ECT) is used to prevent relapse or recurrence in patients with severe mental illnesses. We aimed to investigate the effect of C/M-ECT on reducing hospital re-admissions in patients with treatment-resistant schizophrenia. METHODS: We applied a mirror-image design by retrospectively examining re-hospitalization rates of 18 patients with schizophrenia spectrum disorders. We compared the numbers of psychiatric admissions during the actual period over which C/M-ECT was administered with the same period prior to the beginning of C/M-ECT. RESULTS: The number of psychiatric admissions was reduced significantly during C/M-ECT (0.33±0.77) compared with that of the same period prior to C/M-ECT (2.67±1.33) (Wilcoxon signed rank Z=−3.663; p < 0.001). CONCLUSION: This finding shows that C/M-ECT augmentation could successfully reduce the re-hospitalization rates in patients with treatment-resistant schizophrenia.

Electroconvulsive Therapy , Hospitalization , Humans , Recurrence , Retrospective Studies , Schizophrenia
Psychiatry Investigation ; : 717-726, 2018.
Article in English | WPRIM | ID: wpr-715599


OBJECTIVE: Electroconvulsive therapy (ECT) is the most effective treatment for mood disorders. Accumulating evidence has suggested the important role of circadian genes in mood disorders. However, the effects of ECT on circadian genes have not been systemically investigated. METHODS: We examined the expression and daily oscillation of major circadian genes in the rat frontal cortex after electroconvulsive seizure (ECS). RESULTS: Firstly, mRNA and protein level were investigated at 24 hr after single ECS (E1X) and repeated ECS treatements for 10 days (E10X), which showed more remarkable changes after E10X than E1X. mRNA expression of Rorα, Bmal1, Clock, Per1, and Cry1 was decreased, while Rev-erbα expression was increased at 24 hr after E10X compared to sham. The proteins showed similar pattern of changes. Next, the effects on oscillation and rhythm properties (mesor, amplitude, and acrophase) were examined, which also showed more prominent changes after E10X than E1X. After E10X, mesor of Rorα, Bmal1, and Cry1 was reduced, and that of Rev-erbα was increased. Five genes, Rev-erbα, Bmal1, Per1, Per2, and Cry2, showed earlier acrophase after E10X. CONCLUSION: The findings suggest that repeated ECS induces reduced expression and phase advance of major circadian genes in the in vivo rat frontal cortex.

Animals , Circadian Rhythm , Electroconvulsive Therapy , Frontal Lobe , Mood Disorders , Rats , RNA, Messenger , Seizures
Rev. bras. enferm ; 71(supl.6): 2743-2750, 2018.
Article in English | LILACS, BDENF | ID: biblio-977664


ABSTRACT Objective: to describe the nursing care performed by the nursing team to the person with mental disorder submitted to ECT and to analyze the implications of the Psychiatric Reform in this care. Method: socio-historical study, which uses the Thematic Oral History method. Results: the nursing team is present in a continuous way in the monitoring of people submitted to ECT, performing care before, during and after the same, as well as visualizing the evolution of the technique and also of nursing care itself, however, does not recognize the Psychiatric Reform as agent for this change. Final considerations: the Brazilian Psychiatric Reform triggered a process of humanization of nursing knowledge, influencing the care of the person with mental disorder submitted to ECT, with this, care practices also changed, a law was approved, regulating its practice, and its application was decreasing.

RESUMEN Objetivo: describir el cuidado de Enfermería realizado por el equipo de Enfermería a la persona con trastorno mental sometido a la TEC y analizar las implicaciones de la Reforma Psiquiátrica en ese cuidado. Método: estudio socio-histórico, que utiliza el método de la Historia Oral Temática. Resultados: el equipo de Enfermería se hace presente de forma continua en el acompañamiento de las personas sometidas a la TEC, realizando cuidados antes, durante y después de la realización de la misma, así como visualiza la evolución de la técnica y también del cuidado de Enfermería en sí, sin embargo, no reconoce la Reforma Psiquiátrica como agente formador de este cambio. Consideraciones finales: la Reforma Psiquiátrica brasileña desencadenó un proceso de humanización del saber de Enfermería, influenciando en el cuidado a la persona con trastorno mental sometido a la TEC, con eso, las prácticas asistenciales también sufrieron alteración, una ley fue aprobada, regulando su práctica, y su aplicación fue decreciente.

RESUMO Objetivo: descrever o cuidado de Enfermagem realizado pela equipe de Enfermagem à pessoa com transtorno mental submetida à ECT e analisar as implicações da Reforma Psiquiátrica nesse cuidado. Método: estudo sócio-histórico, que utiliza o método da História Oral Temática. Resultados: a equipe de Enfermagem se faz presente de forma contínua no acompanhamento das pessoas submetidas à ECT, realizando cuidados antes, durante e após a realização da mesma, bem como visualiza a evolução da técnica e também do cuidado de Enfermagem em si, contudo, não reconhece a Reforma Psiquiátrica como agente formador desta mudança. Considerações finais: a Reforma Psiquiátrica brasileira desencadeou um processo de humanização do saber de Enfermagem, influenciando no cuidado à pessoa com transtorno mental submetida à ECT, com isso, as práticas assistenciais também sofreram alteração, uma lei foi aprovada, regulamentando a sua prática, e sua aplicação foi diminuindo.

History, 20th Century , Electroconvulsive Therapy/history , Mental Disorders/therapy , Nursing Care/methods , Brazil , Health Care Reform/history , Health Care Reform/methods , History of Nursing
REVISA (Online) ; 7(3): 235-247, 2018.
Article in Portuguese | LILACS | ID: biblio-1097563


Analisou as implicações éticas e legais da realização da ECT; Evidenciar as divergências de concepções entre os grupos que apoiam a ECT entre os que a condenam; destacar evidências sobre a eficácia do tratamento e identificar a participação da enfermagem em sua aplicação. Metodologia: Trata-se de uma pesquisa bibliográfica, realizada no período de 2001 a 2017 com 12 publicações obtidas nas bases de dados das Bibliotecas Virtuais BDENF, BVS, MEDLINE e SCIELO. Resultados: É um tratamento reconhecido pelo Conselho Federal de Medicina e Associação Brasileira de Psiquiatria, sua aplicabilidade requer que se cumpram exigências estabelecidas no protocolo de execução deste tratamento. Aspectos éticos, não foram claramente tratados pelos estudos. A ECT tem uma história de abusos que não é negada nem por seus próprios defensores, porém, quando prescrita de forma adequada, há eficácia com o tratamento. O papel da enfermagem na aplicação do tratamento é pouco relatado, e está mais relacionada aos cuidados pré e pós desenvolvimento da técnica. Considerações: Há um estigma do uso do eletrochoque que ainda predomina na sociedade em geral. Mais que uma prática técnica, a ECT necessita ser discutida como um tratamento que gera rejeições e que traz um marco histórico de punições e dor social. Se hoje ela tem sua relevância e se tornou uma aplicação criteriosa e ética, é necessário que estas questões sejam respeitosamente enfrentadas e discutidas na sociedade.

Electroconvulsive Therapy
Article in English | WPRIM | ID: wpr-739458


OBJECTIVE: In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS: AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION: The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.

Adult , Aged , Antipsychotic Agents , Biological Therapy , Consensus , Depression , Depression, Postpartum , Depressive Disorder , Depressive Disorder, Major , Drug Therapy , Electroconvulsive Therapy , Female , Humans , Mood Disorders , Pregnant Women , Premenstrual Dysphoric Disorder , Transcranial Magnetic Stimulation
S. Afr. j. psychiatry (Online) ; 24: 1-5, 2018. ilus
Article in English | AIM | ID: biblio-1270861


Background: Catatonia is a psychomotor dysregulation syndrome seen in several illnesses. Uncertainties exist regarding its prevalence and causes. While some research shows a strong association with mood disorders, other data show catatonia to be strongly associated with schizophrenia. Data from low- and middle-income countries are required. Aim: To determine the clinical and demographic profile of patients with catatonia that received electroconvulsive therapy (ECT) between 01 January 2012 and 31 December 2014. Setting: The study was conducted at Elizabeth Donkin Psychiatric Hospital in Port Elizabeth, Eastern Cape. The hospital has mostly patients admitted under the Mental Health Care Act 17 of 2002 as Involuntary Mental Health Care Users. Method: A retrospective chart review was conducted. Using the hospital ECT database, all files of patients who received ECT for catatonia were identified. Demographics, psychiatric and medical diagnoses, signs of catatonia and other data were abstracted from these files. Results: Forty-two patients received ECT for catatonia, of whom 34 (80.95%) were diagnosed with a psychotic illness. Schizophrenia was the most common diagnosis (n = 19; 45.24%), followed by psychotic disorder owing to a general medical condition (n = 8; 19.05). Human immunodeficiency deficiency virus was the cause in 75.00% of the patients whose medical conditions caused catatonia. Seven (16.67%) patients had mood disorders, with bipolar I disorder accounting for 6 (14.29%) of these. Conclusion: Psychotic disorders were more frequent than mood disorders in the sample. Schizophrenia was the most common diagnosis, followed by psychotic disorder owing to a general medical condition

Catatonia/prevention & control , Electroconvulsive Therapy , Patients , Schizophrenia , South Africa