Electroconvulsive Therapy in Incapable Patients Refusing Treatment: Prevalence, Effectiveness, and Associated Factors.

OBJECTIVES: Severe psychiatric disorders may be accompanied by life-threatening conditions, lack of insight, and treatment refusal. Involuntary treatment may be indicated in patients who lack capacity to consent and refuse treatment. In this context, there is a lack of systematic data regarding the use of electroconvulsive therapy (ECT) in Germany. METHODS: A questionnaire with 25 items comprising quantitative and qualitative data was sent to all psychiatric hospitals in Germany that perform ECT. Cases of ECT treatment in incapable patients refusing therapy were identified retrospectively in a 12-month period. RESULTS: Fifty-three hospitals completed the questionnaire, and 15 cases of ECT in incapable and refusing patients were reported. A marked clinical response was observed in 14 patients. Capacity to consent was restored in 11 patients. In contrast to this particularly good effectiveness, psychiatrists' attitudes revealed a widespread lack of experience as well as reservations and uncertainties regarding the use of ECT against the patient's wishes. CONCLUSIONS: In line with other recent publications, our data suggest a very good benefit-to-risk ratio for ECT in incapable patients refusing the treatment, while at the same time the provision of ECT in such patients is rare in Germany. In light of the scarcity of treatment alternatives and the possible consequences of a refusal to perform ECT in life-threatening conditions, a general rejection of involuntary ECT does not seem ethically appropriate.

Semantic congruency and the (reversed) Colavita effect in children and adults.

When presented with auditory, visual, or bimodal audiovisual stimuli in a discrimination task, adults tend to ignore the auditory component in bimodal stimuli and respond to the visual component only (i.e., Colavita visual dominance effect). The same is true for older children, whereas young children are dominated by the auditory component of bimodal audiovisual stimuli. This suggests a change of sensory dominance during childhood. The aim of the current study was to investigate, in three experimental conditions, whether children and adults show sensory dominance when presented with complex semantic stimuli and whether this dominance can be modulated by stimulus characteristics such as semantic (in)congruency, frequency of bimodal trials, and color information. Semantic (in)congruency did not affect the magnitude of the auditory dominance effect in 6-year-olds or the visual dominance effect in adults, but it was a modulating factor of the visual dominance in 9-year-olds (Conditions 1 and 2). Furthermore, the absence of color information (Condition 3) did not affect auditory dominance in 6-year-olds and hardly affected visual dominance in adults, whereas the visual dominance in 9-year-olds disappeared. Our results suggest that (a) sensory dominance in children and adults is not restricted to simple lights and sounds, as used in previous research, but can be extended to semantically meaningful stimuli and that (b) sensory dominance is more robust in 6-year-olds and adults than in 9-year-olds, implying a transitional stage around this age.

Impact of continuous low level heatwrap therapy in acute low back pain patients: subjective and objective measurements.

OBJECTIVES: Muscular pain is usually associated with increased muscle tension resulting in a vicious tension-pain-cycle, leading to increased alertness and stress. However, this has not been broadly evaluated using objective methods, for example, looking at neurophysiologic changes. The focus of this study was, therefore, to combine objective [spontaneous electroencephalogram (EEG) as a surrogate of alertness and stress] with subjective parameters (self-assessed pain affected variables) to investigate the effect of continuous low-level heat therapy in low back pain (LBP)-patients. METHODS: This investigation was a randomized, active controlled, parallel-designed study. Thirty patients were randomly assigned to one of 2 groups: the control group, in which patients were provided with oral analgesics (nonsteroidal anti-inflammatory drug) and instructed to use it if needed, and the treatment group, in which patients in addition to oral analgesics as rescue medication were provided with a heatwrap therapy. The objective parameters were assessed by measuring the power of frequency bands in the spontaneous EEG. The subjective parameters (sleep pattern, well-being, pain intensity, etc.) were assessed by a Pain, Sleep, and Stress Questionnaire. RESULTS: In the EEG-recordings, the heatwrap therapy group showed decreased power in Beta-1 and Beta-2 frequency bands compared with the control group, indicating a reduction in arousal. Also, in comparison to the control group, the heatwrap therapy group reported significantly reduced LBP, everyday situations being less stressful, a better night's sleep, and a decreased number of daytime naps. DISCUSSION: In addition to classic psychophysical assessment of pain-related parameters and sleep quality, performance in daily life, we were able to obtain objective measures (EEG) that suggest an acute therapeutic relaxation on the basis of the central nervous system effects accompanying the reported significant pain relief. We believe that this was due to a reduced nociceptive information load in LBP-patients after the use of the heatwrap therapy.

Anesthesia affects olfaction and chemosensory event-related potentials.

OBJECTIVE: Olfactory and trigeminal systems interact and contribute to the perception of odorants. This study was aimed at investigating the effect of local anesthesia on olfaction. METHODS: One percent of tetracaine on a cotton swab was applied intranasally at three different locations in 20 volunteers and 4% of lidocaine was applied to the olfactory cleft in a head-down position. Before and after anesthesia, self-assessment, psychometric testing and olfactory event-related potentials [OERPs, using H(2)S and phenyl ethyl alcohol (PEA)], and chemosomatosensory event-related potentials (CSSERPs, using CO(2)) were examined. RESULTS: Anesthesia at all four locations significantly lowered the perceived self-assessment of olfaction, while using the cotton swab only anesthesia in the middle meatus elevated threshold (P = 0.020), lowered discrimination (P = 0.015), and prolonged OERP (PEA, P = 0.008; H(2)S, P = 0.016), as well as CSSERPs latencies (CO(2), P = 0.020). However, complete temporary anosmia was only achieved after applying 4% lidocaine into the olfactory cleft. CONCLUSIONS: Intranasal anesthesia applied with a swab reduced self-assessment of olfaction but was unable to produce anosmia. Psychometric test results were concordant with changes in chemosensory event-related potentials. SIGNIFICANCE: Temporary anosmia is technically difficult to achieve but could be demonstrated for the first time using local anesthesia. Even though anesthesia influences self-assessment, measurable olfactory function can remain unchanged.

Test-retest reliability of chemosensory evoked potentials.

This study investigated the test-retest reliability of chemosensory event-related potentials in humans. Olfactory event-related potentials and chemosomatosensory event-related potentials were evaluated in 20 healthy, normosmic subjects. Phenyl ethyl alcohol (PEA, 40% v/v) and H(2)S (4 ppm) served as olfactory stimuli whereas CO(2) (60% v/v) was the chemosomatosensory stimulus. Fifteen stimuli of each compound were applied to each nostril. Identical stimulation sequences were used during three test sessions. Sessions 1 and 2 were separated by a mean of 6.8 days; sessions 2 and 3 by 12.5 days. Electroencephalographic recordings were made from Fz, Cz, Pz, C3, and C4. Amplitudes and latencies of P1, N1, P2, N2, and P3 were measured. Pearson's correlation coefficient was calculated to test the test-retest reliability, and the general linear model examined the differences. Most correlations ranged between 0.4 < r < 0.75. Latencies correlated significantly better (P = 0.008) between sessions than amplitudes, even though with CO(2) stimulus amplitudes correlated significantly better than with PEA (P = 0.006) or H(2)S (P = 0.003). No differences arose between measurements from different nostrils for any stimulus. Chemosensory event-related potentials show good test-retest reliability. Carbon dioxide amplitudes exhibit better signal-to-noise ratios than PEA or H(2)S amplitudes. Chemosensory event-related potentials are a clinically valuable objective and are reproducible.