Impacto de la Terapia Electroconvulsiva en el Funcionamiento de la Memoria en Pacientes con Depresión

Introducción: La seguridad de la terapia electroconvulsiva ha mejorado mucho en las últimas décadas, lo que hace que los efectos potencialmente adversos en la memoria y otras funciones neurocognitivas sean el principal aspecto clínico de preocupación en el presente. En Colombia, la población general y los profesionales de la salud (incluso algunos psiquiatras) parecen tener opiniones mayoritariamente negativas sobre el tratamiento electroconvulsivo, pero quizá esto podría reconsiderarse si se brinda más información; por lo tanto, el objetivo del presente estudio es evaluar los cambios en la memoria y la gravedad de los síntomas en un grupo de pacientes con depresión grave antes y después de la terapia electroconvulsiva. Métodos: Se incluyó a 23 pacientes con edades comprendidas entre los 23 y los 70 anos del Servicio de Terapia Electroconvulsiva de la Clínica San Juan de Dios (Manizales, Colombia) para evaluar el efecto de esta terapia en la memoria de pacientes con depresión grave. Los síntomas depresivos y la memoria se evaluaron con la escala de depresión de Hamilton (HAMD) y la prueba de aprendizaje auditivo verbal de Rey (RAVLT) respectivamente. Se evaluó a los participantes antes de la sesión inicial de la serie de terapia electroconvulsiva (0-1 día) y 2 días después de su último tratamiento. Resultados: La terapia electroconvulsiva resultó en una mejora significativa en la puntuación de depresión. No hubo diferencias significativas en las puntuaciones de las 5 pruebas de aprendizaje, recuerdo retardado, aprendizaje y olvido desde antes del tratamiento hasta después de este. Se encontraron diferencias significativas antes y después del tratamiento en la prueba de reconocimiento retardado. Conclusiones: Los problemas de memoria pueden evaluarse y caracterizarse de manera práctica tras la terapia electroconvulsiva. La evaluación cognitiva antes y después de la terapia electroconvulsiva es un procedimiento viable y útil. En general, el rendimiento de la memoria no empeora después de la terapia electroconvulsiva en pacientes con depresión. Solo el reconocimiento retardado se ve afectado unos días después, particularmente en pacientes con bajo nivel educativo y colocación de electrodos bitemporales (BT).

Introduction: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Historia de la terapia electroconvulsiva: ¿cuándo empezó a utilizarse anestesia para este procedimiento? / History of electroconvulsive therapy: when did anesthesia begin to be used for this procedure?

Resumen: La terapia electroconvulsiva consiste en la aplicación de corriente eléctrica a través de electrodos colocados en regiones frontotemporales (bilateral) o unilateral, con el objetivo de inducir una crisis convulsiva, controlada y monitorizada, que se realiza bajo anestesia general con la presencia de un equipo multidisciplinario. En este trabajo, se hace una reseña de la historia de la aplicación de anestésicos y relajantes musculares que se han utilizado para este tratamiento y de cómo el anestesiólogo se ha posicionado como un elemento fundamental para la aplicación del mismo.

Abstract: Electroconvulsive therapy consists of the application of electric current, through electrodes placed in frontotemporal regions (bilateral) or unilateral, with the aim of inducing a seizure, controlled and monitored, and performed under general anesthesia, with the presence of a multidisciplinary team. This paper reviews the history of the application of anesthetics and muscle relaxants, which have been used for this treatment and how the anesthesiologist has positioned himself as a fundamental element for its application.

Effect of ECT2 Gene on Proliferation of Cervical Cancer Cells and Its Mechanism / 肿瘤防治研究

Objective To study the effect of epithelial cell transformation sequence 2 (ECT2) on the proliferation of cervical cancer cells and its mechanism. Methods We transfected cervical cancer cells HeLa (HeLa-ECT2) with the lentivirus overexpressing ECT2 and the cells SiHa (SiHa-siRNA) and C33a (C33a-siRNA) with the interfering plasmid. MTT assay was performed to detect cell proliferation ability. Flow cytometry was conducted to detect the cell cycle of each group. The IPA database was searched for the interacting proteins of ETC2, and immunofluorescence subcellular localization verified the effect between the two. qPCR and Western blot were carried out to detect the expression of Rac1, Cdc42, CDK1, and Cyclin B1 mRNA and protein in each group of cells. Results ECT2 may interact with CDK1. After ECT2 expression was upregulated, the G2/M phase of HeLa-ECT2 cells accelerated the transformation to G1 phase, cell proliferation ability was enhanced, and the expression levels of Rac1, Cdc42, CDK1, and cyclin B1 mRNA and protein all increased (P < 0.001); the knockdown of ECT2 expression would reverse the effect (P < 0.05). Conclusion ECT2 accelerates G2 phase of cervical cancer cells to G1 phase and promotes cell proliferation by co-localizing with CDK1 through the downstream Cdc42/Rac1 signaling pathway.

Actitudes sexuales de acuerdo con el nivel de severidad del trauma craneoencefálico / Sexual attitudes according to the level of severity of the cranioencephalic trauma

El objetivo de esta investigación fue analizar la actitud hacia la sexualidad en pacientes con antecedentes de trauma craneoencefálico (TCE), de acuerdo al nivel de severidad presentado. Método: se llevó a cabo un estudio de tipo descriptivo en una muestra de 126 personas, con edades comprendidas entre los 18 y 49 años, con antecedente de trauma craneoencefálico leve, moderado y severo, a quienes se les aplicó la Escala de Actitudes hacia la Sexualidad Ampliada (ATSS) y una encuesta de actitudes hacia la sexualidad. Resultados: se encontró que la mayoría de los participantes manifestaron haber sufrido cambios en su sexualidad tras el TCE, caracterizados por la disminución de la frecuencia de las relaciones y el deseo sexual, sin embargo, evidencian una actitud positiva frente a la sexualidad. Conclusiones: si bien la sexualidad es considerada importante por los participantes del estudio, no se evidenció una conducta tendiente a la erotofilia. No se encontraron diferencias significativas respecto al nivel de severidad del trauma craneoencefálico

The objective of this research was to analyze the attitude towards sexuality in patients with a history of cranioencephalic trauma (TCE), according to the level of severity presented. Method: a descriptive study was carried out in a sample of 126 people, aged between 18 and 49 years, with a history of mild, moderate, and severe head trauma, to whom the Scale of Attitudes towards Extended Sexuality -ATSS and a Survey of Attitudes towards Sexuality were applied. Results: it was found that most of the participants reported having suffered changes in their sexuality after TCE, characterized by a decrease in the frequency of relationships and sexual desire, however, they show a positive attitude towards sexuality. Conclusions: although sexuality is considered important by the study participants, there was no evidence of behavior tending to erotophilia. No significant differences were found regarding the level of severity of cranioencephalic trauma

A retrospective analysis of stimulus characteristics, clinical profile and cognition of patients receiving maintenance electroconvulsive therapy

Background: Maintenance electroconvulsive therapy (M-ECT) has been in use for a long time, yet there is dearth of literature regarding stimulus characteristics and cognitive changes with M-ECT, particularly in the Indian context. To assess stimulus characteristics, clinical profile and cognitive changes in patients receiving maintenance electroconvulsive therapy. Methodology: Records of patients receiving M-ECT in one year were checked and their diagnosis, stimulus characteristics (duration of current, seizure duration, number of ECTs and total charge delivered) and serial MMSE scores (at baseline, after 1 month and final MMSE) were noted. Stimulus characteristics were correlated with sociodemographic details and cognitive changes. A comparison between psychotic and non- psychotic disorders was also made. Results: In a total of 50 patients on M-ECT, total charge delivered was found to be significantly higher in females (P=0.02) and seizure duration was longer in males (P=0.04). Stimulus characteristics between psychotic and non-psychotic disorder did not differ (P > 0.05). MMSE score showed improvement with M- ECT (P = 0.01) and this was most significant between baseline and final MMSE (P < 0.05). Cognitive change negatively correlated with number of ECT (r = - 0.29, P = 0.04). Final MMSE score correlated only with baseline MMSE score (r = 0.47, P < 0.01). Conclusion: Stimulus characteristics vary with gender, but not age and diagnosis. Cognition improves with M-ECT and depends upon number of ECT and pre-ECT cognition

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.

揈xtant of the living dead� a case report on Cotard抯 syndrome and its treatment aspects from a tertiary care hospital in India

Cotard抯 syndrome has always borne a historical construct, being linked to pure psychosis, affective disorders as well as organic disorders like Parkinson抯, temporal lobe epilepsy, migraine, and cerebral infarction. Emphasis has remained on the psychopathology, involving beliefs of negation, damnation, guilt, and denouncing of body organs. Treatment aspects has been focused on less frequently; moreover, sparsely from India. We present a case of bipolar affective disorder, current episode severe depression with psychotic symptoms (Cotard抯 syndrome) with special focus on treatment.

Expression of ECT2 gene in human pancreatic ductal adenocarcinoma and its effect on tumor biological characteristics / 中国肿瘤生物治疗杂志

@# Objective: To investigate the expression of ECT2 (epithelial Transforming sequence 2) gene in human pancreatic ductal adenocarcinoma (PDAC) and its effect on the proliferation and apoptosis of pancreatic cancer cells. Methods: Carcinoma tissues and corresponding para-carcinoma tissues from 35 PDAC patients at Changhai Hospital Affiliated to Naval Medical University from July 2018 to March 2019 were collected for this study. The differentially expressed genes in pancreatic cancer were screened out by using Gene Expression Omnibus (GEO) Database. Then, the related gene expression in PDAC and its relation with patients’survival were analyzed by The Cancer Genome Atlas (TCGA) database. QPCR and immunohistochemistry were used to verify the mRNAand protein expressions of ECT2 in human PDAC samples. To explore the effect of ECT2 on the biological behaviors of pancreatic cancer cells, si-RNA was used to silence the ECT2 gene in pancreatic cancer PANC-1 cells, and CCK-8 proliferation assay and Flow cytometry were used to detect the proliferation and apoptosis rate of PANC-1 cells after ECT2 silence. Finally, the expressions of apoptosis-related proteins were detected by WB. Results: The differentially expressed gene-ECT2, was screened out by analyzing the gene expression profiles of human pancreatic cancer in GEO database. TCGA database analysis showed that ECT2 was highly expressed in pancreatic cancer tissues (t=4.005, P<0.05) and significantly correlated with patients’survival (P< 0.01). Moreover, it is also verified that ECT2 was highly expressed in PDAC tissues at mRNA (1.01±0.06 vs 4.25±0.12; t=24.09， P<0.01) and protein level. After ECT2 silence in PANC-1 cells, the proliferation rate was decreased (P<0.01), while the Tamoxifeninduced apoptosis rate was increased (P<0.01), and the expressions of apoptosis-related proteins (BAX and Bcl-2) were also affected. Conclusion: ECT2 is highly expressed in human pancreatic ductal adenocarcinoma and is related with patients’survival. ECT2 promotes the proliferation and apoptosis resistance of pancreatic cancer cells, providing the basis for exploring ECT2 as a new target for the prognostic judgment and treatment of pancreatic cancer.

Electroconvulsive practice in Singapore: a cross-sectional national survey

INTRODUCTION@#The use of electroconvulsive therapy (ECT) in Singapore dates back to 1947. However, there is little local information on the clinical practice of ECT and its standards. We aimed to conduct a comprehensive national survey of ECT practice in Singapore.@*METHODS@#A cross-sectional structured questionnaire assessing the types of ECT (e.g. electrode placement, stimulus parameters), indications, anaesthetic technique, dosing methods, monitoring of outcomes and credentialing was sent in 2015 to all ECT centres in Singapore via email to collect qualitative and quantitative data regarding ECT.@*RESULTS@#Data was obtained from all ECT centres (n = 6), which represented that ECT was available in 23.1% of all hospitals and 50.0% of all psychiatric specialist centres. The rate of ECT was 5.89 treatments per 10,000 residents per year, and each patient received an average of 5.4 ECT per course. Only 7.0% of ECT was administered for continuation/maintenance ECT. The most common indication for ECT was depression in 5 (83.3%) out of six centres, with schizophrenia being the second most common. In 5 (83.3%) out of six centres, ECT was brief (0.5 ms) bitemporal ECT with age-based dosing, and 93.0% of the sessions were conducted in an inpatient setting. All ECT was conducted under general anaesthesia, with propofol (66.7%) being the most common type of anaesthetic used.@*CONCLUSION@#The practice of ECT in Singapore was highly uniform. The rates and indications for ECT were consistent with those of other developed countries, with greater use of ECT for schizophrenia. Future advances for ECT in Singapore include the use of individualised dosing based on empirical seizure threshold titration, expanded electrode placements and increased utilisation of continuation/maintenance ECT.

Prolactin Levels Before And After Electroconvulsive Therapy And Its Corelation With Clinical Improvement In Psychopathalogy

BACKGROUND: It is a well-known fact that prolactin increases after Electroconvulsive Therapy (ECT), but in later studies it was found that the amount of prolactin rise after each ECT gradually declines on successive ECT. Many studies have found that there is a correlation between this prolactin drop and improvement in psychopathology. But the results found were inconsistent and only limited to depression. AIM: To see the serum prolactin changes during a course of ECT in patients suffering from BPAD mania and to assess whether any correlation exists between these changes and improvement in psychopathology. METHORD: 20 inpatients meeting diagnostic criteria for BPAD mania as per ICD-10 who were planned to receive ECT were taken as cases and 20 BPAD mania patients not receiving ECT were taken as controls. Blood for prolactin and psychopathology on YMRS assessed three times in each case. First at baseline, second after 1st ECT and third after last ECT. Similarly controls were assessed at baseline and after three weeks for prolactin and psychopathology. RESULTS: In patients who received ECT, serum prolactin levels were significantly raised after 1st ECT (mean 78.65) compared to baseline (mean 54.02). Prolactin level significantly decreased after a course of ECT (mean 67.22). There was no significant correlation between prolactin changes and in YMRS score. CONCLUSION: There is no significant correlation between prolactin changes during a course of ECT and improvement in psychopathology in BPAD mania patients suggesting the prolactin rise may be an epiphenomenon to ECT rather than reflection of therapeutic process.

Efficacy of electroconvulsive therapy augmentation for partial response to clozapine: a pilot randomized ECT – sham controlled trial

Abstract Background Thirty percent of schizophrenia patients are treatment-resistant. Objective This is a single-blinded sham-controlled trial to assess the efficacy of electroconvulsive therapy (ECT) as augmentation strategy in patients with clozapine-resistant schizophrenia. Methods Twenty three subjects were randomly assigned to 12 sessions of ECT (N = 13) or placebo (Sham ECT) (N = 10). The primary outcome was improvement on psychotic symptoms as measured by the mean reduction of the PANSS positive subscale. The assessments were performed by blind raters. Results At baseline both groups were similar, except for negative and total symptoms of the PANSS, which were higher in the Sham group. At the endpoint both groups had a significant decrease from basal score. In the ECT group the PANSS total score decreased 8.78%, from 81.23 to 74.75 (p = 0.042), while the positive subscale had a mean reduction of 19% (19.31 to 16.17, p = 0.006). In the Sham group, the mean reduction of PANSS total score was 15.27% (96.80 to 87.43; p = 0.036), and the PANSS positive subscale decreased 27.81% (22.90 to 19.14, p = 0.008). The CGI score in ECT group decreased 23.0% (5.23 to 4.17; p = 0.001) and decreased 24.31% in the Sham ECT group (5.80 to 4.86; p = 0.004). Discussion In this pilot study, we found no difference between the groups.

Radiologic features of intestinal duplications in children / 实用放射学杂志

Objective To analyze the radiologic features of intestinal duplications in children and improve the diagnostic rate of this disease presurgical resection.Methods The clinical presentation and imaging data of eight cases confirmed surgically and patho-logically with intestinal duplications were retrospectively analyzed,as well as reviewed based on literature review.Results 8 cases were given ultrasonography,7 of them had positive performance.7 csaes were given CT scan and 6 of them had positive performance. 6 cases had ECT examination and 4 of them were positive.Their positive rates were 87.5%,85.7%,66.7% respectively.The posi-tive rates were all 100% combining ultrasonography with CT or CT with ECT.Conclusion Ultrasonography,CT and ECT is helpful to diagnose of intestinal duplications in children,their results are the no-specificity.Choosing a suitable imaging examination is useful to offer a pre-operative diagnosis.

Diagnostic Value of ECT plus Serum ALP, Calcium Detection in Lung Cancer Patients with Bone Metastases / 沈阳医学院学报

Objective:To retrospectivey analyze of serum alkaline phosphatase (ALP), calcium levels in lung cancer patients undergoing bone scan (ECT) in order to evaluate their clinical values in diagnosis of bone metastases. Methods:The results of blood ALP, calcium (Ca2+) and ECT findings from 81 cases of lung cancer patients with bone metastases and 43 cases without bone metastases were collected,the levels of ALP,calcium were compared between the two groups. Lung cancer patients were performed a grading classification for the bone metastasis,serum ALP,calcium levels were analysed. The clinical values of serum ALP,calcium in monitoring bone metastasis were evaluated through receiver operating characteristic (ROC) curve. Results:(1) The serum levels of ALP,calcium in lung cancer patients with bone metastases were higher than those in patients without bone metastases (P<0.01) . (2) Grade Ⅲ patients had a significantly higher blood ALP level than grade Ⅰ, grade Ⅱ patients (P=0.003), whereas serum calcium levels were higher in gradeⅠpatients than that in gradeⅡ,Ⅲpatients,but there was no significant difference (P>0.05) . (3) The area under the curve (AUC) of blood ALP, calcium in lung cancer patients were 0.715, 0.769, respectively, when detection was combined, the sensitivity increased to 70.4%, and specificity remained at a high level. Conclusion:ECT combined with blood ALP, calcium has a diagnostic value in the detection of bone metastases in lung cancer patients, and can be used as a screening and monitoring methods.

Selection of appropriate subjects for public hospitals social evaluation and component architecture / 中华医院管理杂志

Objective To identify appropriate subjects for public hospitals social evaluation which fit and match the public hospital social evaluation index system.Methods The methods of literature review,expert consulting and comprehensive evaluation were used.SWOT analysis,appropriateness ranking and classification were made to such six evaluation subj ects as civil servants,medical workers, professional organizations,patients and their family,the public at large and mass media representatives. Results For the support dimension,the top three appropriate evaluation subj ects are professional social organizations,the public at large and medical workers in turn.For the process dimension,the top three subj ects are social professional organizations,civil servants and the public at large.For the result dimension,the top three are professional organizations,the public at large and civil servants.Conclusions Diversified evaluation subj ects independently represented and guided by non-government third-party professional organizations seem a better solution for China′s present specifics.Such a mechanism is authorized by the government,involving patients and their family,the public and social observers,and mass media representatives,supported and coordinated by government departments and public hospitals.

Variation of plasma cortisol levels in patients with depression after treatment with bilateral electroconvulsive therapy / Variação de cortisol plasmático em pacientes deprimidos após tratamento com eletroconvulsoterapia bilateral

Introduction: More than 60 years after the introduction of modern psychopharmacology, electroconvulsive therapy (ECT) continues to be an essential therapeutic modality in the treatment of mental disorders, but its mechanism of action remains unclear. Hormones play an essential role in the development and expression of a series of behavioral changes. One aspect of the influence of hormones on behavior is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs and ECT. Objective: We measured blood levels of the hormone cortisol in patients with unipolar depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and compared results with levels found in healthy adults. Method: Blood cortisol levels were measured before the beginning of treatment with ECT, at the seventh session, and at the last session, at treatment completion. Depression symptoms were assessed using the Beck Depression Inventory (BDI). Results: Cortisol levels remained stable in both men and women between the seventh and the last sessions of ECT; values ranged from 0.686±9.6330 g/dL for women, and there was a mean decrease of 5.825±6.0780 g/dL (p = 0.024). Mean number of ECT sessions was 12. After the seventh and the last ECT sessions, patients with depression and individuals in the control group had similar cortisol levels, whereas BDI scores remained different. Conclusion: Cortisol levels decreased during ECT treatment. ECT seems to act as a regulator of the hypothalamic-pituitaryadrenal axis. .

Introdução: Mais de 60 anos após a introdução da moderna psicofarmacologia, a eletroconvulsoterapia (ECT) continua essencial para o tratamento de distúrbios mentais, mas seu mecanismo de ação ainda não é totalmente conhecido. Certos hormônios têm um papel fundamental no desenvolvimento e expressão de uma série de alterações comportamentais. Um aspecto da influência dos hormônios nos comportamentos é sua contribuição potencial para a patofisiologia dos distúrbios psiquiátricos e o mecanismo de ação de psicotrópicos e da ECT. Objetivo: Os níveis do hormônio cortisol no sangue foram medidos em pacientes com depressão unipolar classificados de acordo com a 4ª edição do Manual Estatístico e Diagnóstico de Transtornos Mentais (DSM-IV), e os resultados foram comparados com os níveis encontrados em adultos saudáveis. Métodos: Os níveis de cortisol no sangue foram medidos antes do início do tratamento com ECT, na sétima e na última sessão, após a conclusão do tratamento. Os sintomas de depressão foram avaliados usando o Inventário de Depressão de Beck (BDI). Resultados: Os níveis de cortisol permaneceram estáveis tanto nos pacientes masculinos quanto femininos entre a sétima e a última sessão de ECT; os valores variaram 0,686±9,6330 g/ dL entre as pacientes femininas, e houve uma diminuição de 5,825±6,0780 g/dL (p = 0,024). O número médio de sessões de ECT foi 12. Após a sétima e a última sessão de ECT, os níveis de cortisol nos pacientes com depressão e nos indivíduos no grupo controle foram semelhantes, enquanto os resultados da escala BDI permaneceram diferentes. Conclusão: Os níveis de cortisol diminuíram durante o tratamento com ECT. A ECT parece atuar como reguladora do eixo hipotalâmico-hipofisário-adrenal. .

Analysis of patient radiation dose from nuclear medicine examinations / 中华放射医学与防护杂志

Objective To measure and analyze the radiation dose for patients undergoing nuclear medicine examination,and to characterize radiation exposure of patients by using the estimated effective dose.Methods Patients undergoing nuclear medicine examinations were classified and the radiation doses from radiopharmaceuticals to patients were measured and calculated.Meanwhile,radiation exposure from computed tomography (CT) procedure was calculated on the basis of CT protocols and patients' information.The effective doses to patient from both the radiopharmaceutical and CT scan radiation were calculated and the factors influencing patient radiation doses were analyzed.Results For the patients undergoing positron emission tomography-computed tomography (PET-CT) examination,the average effective doses from positron radiopharmaceutical 18F-fluorodeoxyglucose (18F-FDG),18F-fluoro-l-thymidine (18 F-FLT),11C-choline,11 C-methylmethionine (11 C-MET) and 11 C-acetate (11 C-Ac) were (5.06 ± 0.73),(4.74±1.29),(1.71 ±0.05),(3.18±0.69) and (1.08±0.19) mSv,respectively.CTscan caused average effective dose was (8.80 ± 0.58) mSv.If a full diagnostic CT investigation was performed,the effective dose might be up to 27 mSv.Whereas for emission computed tomography (ECT) examinations,the average effective dose to the patients irradiated by single photon radiopharmaceutical 99Tcm-methylenediphosphonate (99Tcm-MDP),99Tcm-macroaggregated albumin (99Tcm-MAA),99Tcm-diethylentriaminpentaacetic acid (99 Tcm-DTPA),99Tcm-methoxyisobutyl isonitrile (99 Tcm-MIBI) and 99Tcm-pyrophosphate (99Tcm-PYP) were (4.63 ± 0.01),(1.71 ± 0.01),(1.18 ± 0.01),(7.19 ± 0.03) and (4.18 ± 0.01) mSv,respectively.Conclusions Radiopharmaceutical irradiation caused effective dose to the patients undergoing nuclear medicine examinations is from 1.08 to 7.19 mSv,while CT scan cause average effective dose is 8.80 mSv in PET-CT examination.

Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia / Avaliação da eficácia da eletroconvulsoterapia contínua para esquizofrenia resistente ao tratamento

Background: Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective: The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods: In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion: Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse...

Contexto: A eletroconvulsoterapia (ECT) tem mostrado ser um tratamento seguro e eficaz para esquizofrenia. No entanto, o número de estudos que avaliam a utilização contínua de ECT em pacientes com esquizofrenia e a resposta parcial ao tratamento farmacológico é limitado. Objetivo: O objetivo deste estudo é avaliar a eficácia da ECT de continuação na prevenção de recaída em pacientes com esquizofrenia resistente ao tratamento. Métodos: Nesta análise retrospectiva, pacientes com esquizofrenia (n = 73) foram alocados em três grupos: pacientes que receberam apenas o tratamento AP (somente AP), pacientes que receberam um curso agudo de ECT durante a hospitalização (aECT+AP) e pacientes que receberam um curso agudo de ECT durante a hospitalização e ECT de continuação (a-cECT+AP). Esses três grupos foram comparados de acordo com a pontuação atribuída na Positive and Negative Syndrome Scale (PANSS) e na Brief Psychiatric Rating Scale (BPRS). Resultados: De acordo com a comparação dos grupos, somente em AP, aECT+AP e a+cECT+AP, em termos de PANSS e BPRS, após descarga no primeiro, terceiro e sexto mês, as pontuações na PANSS no terceiro e sexto mês no grupo a+cECT+AP foram estatística e significativamente menores do que nos outros dois grupos. Conclusões: Embora este estudo mostre limitações causadas pela análise retrospectiva de prontuários, os resultados sugerem que a continuação da ECT em combinação com antipsicóticos é mais eficaz do que somente os antipsicóticos, na prevenção da recaída em pacientes com diagnóstico de esquizofrenia que responderam ao curso agudo de ECT...

Socio demographic, clinical and side effect profile of electroconvulsive therapy use among psychiatric inpatients: a cross sectional study from South East Asia - Kashmir.

Background: Electroconvulsive Therapy (ECT) is a neuromodulative technique, which is effective but underutilized for treatment of psychiatric disorders. The aim of the study was to investigate socio demographic, clinical and side effect profile of electroconvulsive therapy use among psychiatric inpatients. Methods: A cross sectional study was performed for a period of 1 year in postgraduate department of psychiatry (Institute of mental health and neurosciences Kashmir - center of excellence). Patients of pharmacotherapy resistant psychiatric disorders attending the hospital during this period were taken in study. The data was recorded in a specially designed proforma which documented the socio-demographic variables including age, sex, residence, occupation, socioeconomic status was recorded. Chi-square, Fisher exact, and t tests were used to note the statistically significant association. Results: The mean age of the study sample was 39.6 (±11.76) years. Maximum number of patients were in the age group 41-50 years i.e. 16 (28.6%), followed by 31-40 years i.e. 15 (26.8%). The mean number of ECT’s received was 8.22 (±2.073). About 29 (51.8%) patients reported body aches, 24 (42.9%) patients reported forgetfulness, 9 (16%) patients reported headache and only 1 (2%) patient reported agitation. Conclusion: The results indicate that electroconvulsive therapy is used in all psychiatric disorder with fewer side effects in pharmacotherapy resistant psychiatric disorders.

Contralateral intraocular pressure lowering effect of prostaglandin analogues.

Background: Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral eff ects of PGA are limited. Aims: To evaluate if PGA treatment in one eye has an eff ect on the IOP of the untreated fellow eye. Design: Retrospective study. Materials and Methods: Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had offi ce diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and offi ce diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals. Statistical Analysis: IOPs of the fellow eye during the offi ce diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests. Results: Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically signifi cant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was signifi cantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008). Conclusion: Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.

Antidepressant action of ketamine anaesthesia during electroconvulsive therapy in a patient with depression

Background: Managing treatment resistant depression has been a confounding problem for psychiatrists in clinical practice. Glutamate receptor agents are being tried as the next line of antidepressants for the future. Case Description: We describe herewith a case of treatment resistant depression that received ECT with ketamine anaesthesia and showed improvement in a course of 7 ECTs. Discussion : The improvement the patient showed was remarkable and demonstrates the efficacy of ketamine in the management of depression where most drugs have not benefited the patient Conclusion : The role of ketamine in ECT anaesthesia in the management of patients with depression needs to be explored further