RESUMO
OBJECTIVE: The authors compared the clinical and cognitive effects of bifrontal electrode placement with standard bitemporal electrode placement in the treatment of patients with major depression. METHOD: Forty-eight patients with unipolar or bipolar depression were treated with a course of bifrontal or bitemporal ECT. The Hamilton Rating Scale for Depression and the standardized Mini-Mental State were administered at baseline and repeated during the course of treatment. RESULTS: Forty-seven of the 48 patients who completed the course of treatment met remission criteria by the 12th treatment. There were no differences between the patients given bifrontal ECT and those given bitemporal ECT in the number of treatments required to reach remission criteria. The standardized Mini-Mental State scores of the patients given bitemporal ECT worsened more after treatment than did those of the patients given bifrontal ECT. CONCLUSIONS: Bifrontal electrode placement was as efficacious as bitemporal placement and resulted in less cognitive impairment. A study of the two placements with more cognitive measures is indicated.
Assuntos
Transtorno Depressivo/terapia , Eletroconvulsoterapia/métodos , Lobo Frontal/fisiologia , Lateralidade Funcional/fisiologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do TratamentoRESUMO
There is substantial comorbidity between schizophrenia and substance abuse. Although evidence indicates that the course of schizophrenia is complicated by substance abuse, patients perceive benefits from drugs of abuse. Treatment of these patients should be provided in settings with a high degree of psychiatric expertise.
Assuntos
Esquizofrenia/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Comorbidade , Humanos , Escalas de Graduação Psiquiátrica , Psicologia do EsquizofrênicoAssuntos
Agressão/psicologia , Transtorno Depressivo/tratamento farmacológico , Fluoxetina/efeitos adversos , Suicídio/psicologia , Recusa do Paciente ao Tratamento/psicologia , Transtorno Depressivo/psicologia , Feminino , Fluoxetina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Recidiva , Isolamento Social/psicologia , TelevisãoRESUMO
The authors anticipate that an increasing number of AIDS victims will be admitted to psychiatric inpatient units. The turmoil caused by the first AIDS patient admitted to the authors' psychiatric unit is described. The authors then discuss staff difficulties from the perspective of the forces unique to this inpatient unit and from the perspective of the group defenses that such a patient mobilizes in any setting. Recommendations are made for a flexible yet authoritarian leadership style when coordinating care for a patient who provokes so much staff anxiety.
