ABSTRACT
OBJECTIVE: Greater ECT stimulus efficiency allows for a lower stimulus dose and should diminish the side effects of ECT. METHOD: Four different ECT stimuli of identical charge (average mC=2.5 times age) with pulse widths of 0.5 msec and 1 msec and frequencies of 30 Hz and 60 Hz, respectively, were compared for efficiency. The stimuli were applied in a balanced order to each of 24 subjects. Asymmetric bilateral electrode placement was used. RESULTS: Peak heart rates were higher with the 0.5-msec pulse width than the 1-msec pulse width. Seizure induction was more successful with the 0. 5-msec pulse width than the 1-msec pulse width. Stimulus frequency had no effect on heart rate or seizure induction. CONCLUSIONS: The pulse width of 0.5 msec is more efficient than the 1-msec pulse width. The "half-age" dose for the first bilateral ECT treatment is usually successful for subsequent ECTs when the 0.5-msec pulse width is used.
Subject(s)
Electroconvulsive Therapy/methods , Adult , Age Factors , Aged , Depressive Disorder/therapy , Electric Stimulation , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/statistics & numerical data , Electrodes , Female , Functional Laterality , Heart Rate/physiology , Humans , Male , Middle AgedABSTRACT
The authors compared falls, cardiovascular factors, confusion, gastrointestinal, pulmonary, and metabolic side effects for "old-old" (>75 years) patient groups treated with either electroconvulsive therapy (ECT) or pharmacotherapy. A subset of a pharmacotherapy patient group was selected to match for age, sex, and diagnosis in a case-control design. Side effects were recorded from each selected patient's medical record and compared between groups. Patients receiving ECT showed fewer cardiovascular and gastrointestinal side effects. Patients receiving ECT had longer lengths of stay and more favorable outcomes. Overall, there was a tendency for ECT to result in fewer side effects and better treatment outcomes. ECT appears to be relatively safe and more effective than pharmacotherapy for major depressive disorders in old-old patients.
Subject(s)
Antidepressive Agents/adverse effects , Depressive Disorder/therapy , Electroconvulsive Therapy/adverse effects , Aged , Aged, 80 and over , Antidepressive Agents/therapeutic use , Case-Control Studies , Confusion/etiology , Depressive Disorder/drug therapy , Female , Humans , Length of Stay , Male , Retrospective Studies , Treatment OutcomeABSTRACT
Changes in the heart rate during electroconvulsive therapy (ECT) reflect seizure activity at a deeper brain site than shown by electroencephalography and motoric activity. Accordingly, such changes may provide additional information that is helpful in the evaluation of treatment quality. One basic measurement of heart rate change is the duration of ECT-induced tachycardia. In a prospective study, the electrocardiographic ECT records of 24 patients were rated for the abruptness of the endpoint of the seizure-induced elevation in heart rate; 19 showed abrupt endpoints and 5 showed gradual endpoints. The baseline heart rate of patients with abrupt endpoints (88 SD [standard deviation] 10 beats/min) was significantly lower (p = 0.00001) than those with gradual endpoints (118 SD 12 beats/min). A threshold occurred at a baseline heart rate of 100 beats/min, with abrupt endpoints below and gradual endpoints above. The data suggest that patients with low baseline heart rates might be likely to show bradyarrhythmia during the treatment, and corresponding precautions might be considered.
Subject(s)
Depressive Disorder/therapy , Electrocardiography , Electroconvulsive Therapy , Electroencephalography , Heart Rate/physiology , Adult , Aged , Depressive Disorder/physiopathology , Dominance, Cerebral/physiology , Female , Frontal Lobe/physiopathology , Humans , Male , Middle Aged , Temporal Lobe/physiopathologyABSTRACT
The asymmetric bilateral stimulus electrode placement described by Swartz was used to treat four patients, ages 60, 75, 75, and 80 years, who had previously received electroconvulsive therapy with other placements. After the course, each showed full remission with no overt cognitive dysfunction and no decrement in mini-mental state score. Three patients had shown substantial confusion during previous treatments, one with bifrontotemporal brief pulse and two with sine wave, at least one of whom received unilateral treatment. Remission was maintained at followup 2-4 months later. These cases further suggest that this new placement is clinically useful.
Subject(s)
Affective Symptoms/therapy , Electroconvulsive Therapy/methods , Aged , Aged, 80 and over , Depression/therapy , Electrodes , Female , Humans , Male , Middle AgedABSTRACT
The effect of divalent and monovalent cations on the hydrolysis of BzIleGlu(OR)GlyArgpNA(S-2222) was compared to the rate of inactivation of factor Xa by dansyl-GluGlyArg-chloromethylketone(DERG-CK). At substrate concentrations below Km, an approximate four-fold increase in amidase activity was observed in the presence of manganese ions while a three-fold increase was observed with calcium ions. The presence of magnesium ions resulted in a two-fold increase in amidase activity. Similar increases in the rate of inactivation of factor Xa by DERG-CK were observed. Na+ ions had a marked enhancing effect of both factor Xa amidase activity and inactivation by DERG-CK. Kinetic parameters for the hydrolysis of S-2222 by factor Xa were obtained in the presence and absence of Ca++ and Na+. Vmax values increased in the presence of either Ca++ or Na+. Km values increased in the presence of Ca++ while there was a modest decrease in Km in the presence of Na+. It is suggested that the enhanced activity of factor Xa is a reflection of changes in the reactivity of active site residues.
