Ultraviolet dosage and decontamination efficacy were widely variable across 14 UV devices after testing a dried enveloped ribonucleic acid virus surrogate for SARS-CoV-2.

Aims: The dosages and efficacy of 14 ultraviolet (UV) decontamination technologies were measured against a SARS-CoV-2 surrogate virus that was dried onto different materials for laboratory and field testing. Methods and results: A live enveloped, ribonucleic acid (RNA) virus surrogate for SARS-CoV-2 was dried on stainless steel 304 (SS304), Navy Top Coat-painted SS304 (NTC), cardboard, polyurethane, polymethyl methacrylate (PMMA), and acrylonitrile butadiene styrene (ABS) materials at > 8.0 log10 plaque-forming units (PFU) per test coupon. The coupons were then exposed to UV radiation during both laboratory and field testing. Commercial and prototype UV-emitting devices were measured for efficacy: four handheld devices, three room/surface-disinfecting machines, five air disinfection devices, and two larger custom-made machines. UV device dosages ranged from 0.01 to 729 mJ cm-2. The antiviral efficacy among the different UV devices ranged from no decontamination up to nearly achieving sterilization. Importantly, cardboard required far greater dosage than SS304. Conclusion: Enormous variability in dosage and efficacy was measured among the different UV devices. Porous materials limit the utility of UV decontamination. Significance and impact of the study: UV devices have wide variability in dosages, efficacy, hazards, and UV output over time, indicating that each UV device needs independent technical measurement and assessment for product development prior to and during use.

In schizophrenia, are lack of capacity and lack of insight more usefully understood as anosognosia?

OBJECTIVE: To argue that lack of capacity, lack of insight and anosognosia represent different facets of an interconnected, underlying process. METHODS: Electronic and manual literature search. RESULTS: There is demographic, clinical, neurocognitive and possible neuroanatomical overlap between lack of capacity, lack of insight and anosognosia. CONCLUSION: The use of different terms may reflect the background of the authors and their investigative methodologies rather than unrelated phenomena. Anosognosia is preferred as it progresses research and usefully informs clinical and legal practice.

Anosognosia and schizophrenia - a reminder.

OBJECTIVE: To remind the clinical and legal practitioner that anosognosia is a recognised facet of schizophrenia with implications for capacity assessment and for relating effectively with people who experience it. CONCLUSIONS: The term anosognosia emphasises that, in schizophrenia, lack of capacity is the result of a neurological deficit. Under-appreciation of this may place that person at risk of a preventable harm.

On unearned privilege in clinical practice.

OBJECTIVE: To explore what it might mean to be a white psychiatrist working in a white culture. CONCLUSIONS: Inequalities and power imbalances are maintained by person-blaming and the invisibility of structural inequality. Opportunities to recognise the effects of being privileged and working within a medical culture that compounds such inequality may be squandered without curiosity and action.

On being paternalistic.

OBJECTIVE: What does 'being paternalistic' mean? CONCLUSION: Being paternalistic embodies a complex set of ideas that are currently viewed pejoratively, but which retain at its core, the goal of doing something good.

Coercive care and human rights; a complex juxtaposition - part 2.

OBJECTIVE: To examine capacity assessment, coercive care and principles by which a seemingly reasonable request for the discontinuation of treatment may be considered. CONCLUSIONS: A clinical and socio-legal case may be made for 'coercive care'.

Coercive care and human rights; a complex juxtaposition - part 1.

OBJECTIVE: To explore the clinical implications associated with the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD), and coercive practice. CONCLUSIONS: Both human rights and clinical perspectives are necessary in the management of the mentally ill.

Clinically, what ought we to believe?

OBJECTIVE:: To question the status of the randomised controlled trial (RCT) in the hierarchy of evidence. CONCLUSIONS:: The RCT provides important and clinically relevant information, particularly in psychopharmacology. However, and as with other methodologies, RCTs too are flawed and automatic abdication to their conclusions, especially in complex social interventions, is unwise. A clinical example with conflicting and polarising views, each with their evidence base, is described alongside a suggested clinical strategy for resolving differences of opinion.

Attitudes Toward Electroconvulsive Therapy Compared With Cardioversion.

AIM: The aim of this study was to examine the patient preference for electroconvulsive therapy and for cardioversion. The latter was regarded as a proxy control group because each patient had also experienced a life-threatening illness for which there were both pharmacological and electrical options available. METHODS: A retrospective, semistructured, telephone survey of patients from a public, rural Australian hospital who had received either electroconvulsive therapy or cardioversion was undertaken. RESULTS: Thirty-eight elderly patients were interviewed. Patients agreed that they would rather not have had their respective electrical treatments. However, both groups also rated their treatment as effective and agreed that they would have their treatment again. CONCLUSIONS: Despite understandable hesitancies, patients can choose treatments because they are helpful.

Does electrode placement predict time to rehospitalization?

We sought to determine whether electrode placement influenced time to rehospitalization. A retrospective review of an elderly, depressed population that had received bitemporal, bifrontal or 6 x RUL ECT was examined to determine time to rehospitalization. Bitemporal ECT was associated with a statistically significant reduction in the number of (P = 0.026) and time to (P = 0.025), rehospitalization. Bitemporal ECT may be a preferred electrode placement, not only because of its demonstrated effectiveness across a range of diagnoses, but for its previously undocumented capacity to delay rehospitalization.

Bifrontal electroconvulsive therapy in the elderly: a 2-year retrospective.

OBJECTIVES: We sought to examine the clinical effect of bifrontal (BF) electroconvulsive therapy (ECT) in depressed patients aged 65 years and older. METHODS: A retrospective chart review of all patients who received BF ECT for a depressive disorder between January 2000 and December 2002 was made. RESULTS: Fourteen patients, with a mean age of 73.9 years, received BF ECT. Nine had unipolar and 5 had bipolar depression. Twelve patients (86%) responded unequivocally after a mean of 8.5 treatments. Five (35%) experienced cognitive side effects. Ninety-two percent of patients were discharged on lithium (0.6 mmol/L) with 86% also receiving antidepressants or antipsychotics. Only 1 patient relapsed, the remainder remaining well at follow-up after a mean of 18.7 months. CONCLUSION: BF ECT was found to be clinically effective and associated with cognitive side effects in elderly patients who were experiencing a depressive episode of either unipolar or bipolar origin.

Right unilateral electroconvulsive therapy at six times seizure threshold.

OBJECTIVE: To examine the clinical practice of right unilateral electroconvulsive therapy (ECT) administered at six times seizure threshold (6 x RUL ECT). METHOD: A retrospective review of all patients who received 6 x RUL ECT between July 2000 and June 2002. RESULTS: Twenty-one patients across a range of ages and diagnostic groups received D'Elia unilateral ECT at a seizure dosage at or above 388.8 milliCoumbs (mC). In order to sustain predetermined criteria for seizure adequacy, energy was increased in 71% of patients. Final seizure lengths of 45 s electroencephalographic (EEG) activity, 28 s motor activity (cuffed) and a post-ictal suppression index (PSI) of 83% were recorded. Eighty percent of patients responded after a mean of 7.0 treatments. Cognitive side-effects were noted in 21% of patients. Fifty-two percent relapsed on average 6.3 months after the last treatment despite continuation pharmacotherapy. CONCLUSIONS: 6 x RUL ECT was found to be clinically effective, associated with cognitive side-effects and relapse. The debate over electrode placement is likely to continue.

Right unilateral ECT at 6x seizure threshold: is it effective in the psychoses?

OBJECTIVE: To date, right unilateral electroconvulsive therapy administered at 6x seizure threshold (6x RUL-ECT) has been described in relation to unipolar depression alone. For clinicians who have developed an experience and confidence in bilateral ECT, the effectiveness of 6x RUL-ECT in other psychiatric disorders, particularly those who are severely ill, has remained untested and therefore unknown. This article describes the results of 6x RUL-ECT in a select series of patients with a nondepressive psychotic illness. METHOD: Six patients with psychotic disorders of nondepressive origin were selected from a recent 2-year retrospective review of 6x RUL-ECT practice. The clinical presentation, ECT parameters, and responses were recorded. RESULTS: Four patients with severe psychotic disorders, two of whom met broad criteria for catatonia, responded to an index course of 6x RUL-ECT. One psychogeriatric patient who had protracted inpatient mania continues to benefit from outpatient maintenance 6x RUL-ECT over 18 months. Two elderly males, in whom seizures were difficult to elicit and maintain, responded poorly. CONCLUSION: 6x RUL-ECT was effective in 4 patients with nondepressive, psychotic disorders. While clinically viable and although memory was not assessed, it is uncertain what advantage 6x RUL-ECT confers over a bilateral electrode placement. The real focus should remain on clinical responsivity.

ECT in the Asia Pacific region: what do we know?

OBJECTIVE: To review and describe the practice of ECT in the Asia Pacific region in the year 2000. METHOD: A survey of 34 defined countries within the Asia Pacific region was made prior to the 1st Asia Pacific ECT Conference held in Melbourne, Australia, 2001. RESULTS: Contact addresses for 23 of 34 countries (70%) were found with responses from 12 different countries (35%). Individual responses were received from less than 1% of the total mail out for the conference. The percentage of inpatients who received ECT was consistently less than or equal to 9%, except for Nepal where it was 25.6%. Except for Kiribati and the Solomon Islands, all devices delivered brief pulse, square wave currents. All of the 12 countries surveyed used anesthesia, preferred bilateral electrode placement and reported a response rate of at least 86%. Adverse events were uncommon, memory being the most commonly reported side effect. Community attitudes were generally negative. CONCLUSION: Despite the difficulties in attempting to generalize about this huge and diverse region, a number of seemingly universal findings appeared in accord with the world literature. These included the widespread use of ECT, its effectiveness and its relative safety despite equally widespread community reluctance.

ECT use delayed in the presence of comorbid mental retardation: a review of clinical and ethical issues.

The objective is to develop a clinically and ethically supportive literature for the use of electroconvulsive therapy (ECT) in patients with mental retardation who are concurrently experiencing a significant psychiatric illness. A review of both the clinical and ethical literature using traditional, manual library methods and the Medline and Psychlit databases was undertaken. In addition, a record of all patients who had undergone ECT at our facility between 1995 and 2000 was examined for patients with comorbid mental retardation. We found that the use of ECT for people who have both a psychiatric illness and comorbid mental retardation was significantly delayed. However, a rapid response to index, continuation, and maintenance ECT was also noted. Further, this response occurred with routine ECT administered irrespective of age, gender, diagnosis, stimulus parameters, electrode placement, or number of treatments. In addition, the successful use of right-sided unilateral ECT at six times the initial seizure threshold was reported in a patient who had previously responded to bilateral ECT. A cogent ethical justification was developed with the use of the rule of double effect. We concluded that for patients who have mental retardation and who subsequently develop a psychiatric illness, ECT is delayed and left as a treatment of last choice. Although the literature is sparse and uncontrolled, a cogent clinical and ethical justification may help negotiate these and other delays.

Australian and US responses to electroconvulsive therapy dosage selection.

OBJECTIVE: The practice of electroconvulsive therapy (ECT) varies considerably across sites with a lack of certainty as to what constitutes seizure adequacy. The aim of this study was to trial a method to explore decision making and to describe any differences between Australian and US practitioners. METHOD: Two hundred and thirty-six consultant psychiatrists from Australia and US were asked what dosage of electrical energy they would prescribe after reading a standardized clinical vignette in which an unremarked upon change in seizure tracings followed the first two treatments. RESULTS: Considerable variability in the dosage was found with 17.3% decreasing, 46.8% maintaining and 30% increasing charge. Involvement in administration of ECT was unrelated to this decision. CONCLUSION: Standardized vignettes may be a useful method to assess clinicians' responses in dosage selection.