Seizure threshold in ECT: I. Initial seizure threshold.

Seizure threshold determination is of crucial importance in optimizing electrical stimulus dosage during administering electroconvulsive therapy (ECT). We measured initial seizure threshold by means of Srinakharinwirot University titration schedule in 150 psychotic patients. Initial seizure threshold was approximately 104 millicoulombs on average, but varied widely (12-fold) across patients. Motor seizure duration was inversely related to initial seizure threshold. Seizure threshold could be strongly predicted by age. The results may have important clinical implications for stimulus dosing strategy in ECT.

Effects of twice- versus thrice-weekly electroconvulsive therapy in schizophrenia.

Electroconvulsive therapy (ECT) has been used to treat a variety of psychiatric disorders since 1938. In clinical practice, a schedule of administration varies greatly and definitive guidelines are not available. The disparity of treatment schedules may influence the rate of response and the duration of morbidity and hospital stay, as well as cognitive adverse effects. The authors conducted a retrospective, comparative study of twice-weekly versus thrice-weekly ECT schedules in ECT-responder schizophrenic patients. Forty-three patients received acute treatment with bilateral ECT and flupenthixol (12-24 mg/d). Outcome measures were the Brief Psychiatric Rating Scale, Global Assessment of Functioning, and the Mini-Mental-State Exam. The thrice-weekly ECT patient group (N = 21) had shorter duration of morbidity and more rapid response than the twice-weekly ECT patient group (N = 22). Twice-weekly ECT treatment is as equally effective as thrice-weekly schedule regarding the degree of improvement. There were no significant differences in the degree of improvement and the cognitive impairment at the end of the study.