ECT

To investigate if repetitive transcranial magnetic stimulation (rTMS) was as effective as electroconvulsive therapy (ECT) in treating major depressive episodes and to perform a cost-effectiveness analysis. A single-blind pragmatic multicentre randomised controlled trial (RCT) with 6 months of follow-up to test equivalence of rTMS with ECT. The South London and Maudsley NHS Trust and Pembury Hospital in the Invicta Mental Health Trust in Kent. Right-handed adult patients referred for ECT for treatment of a major depressive episode (DSM-IV) were assessed. During the 2.5-year trial period, 260 patients were referred for ECT, of whom 46 entered the trial. The main reason for not entering the trial was not consenting to ECT while being formally treated under the UK Mental Health Act 1983. Patients were randomised to receive a 15-day course of rTMS of the left dorsolateral prefrontal cortex (n = 24) or a course of ECT (n = 22). Patients were assessed before randomisation, at end of treatm...

The existence of pediatric applications of electroconvulsive therapy (ECT) in the 1940s in Italy has been neglected by international literature. However, 2 case reports by Ferdinando Accornero and Mario Anderson, both assistants of Ugo Cerletti at the Sapienza Clinic for Nervous and Mental Diseases, should be brought to the attention of historians of ECT. The work presented therein began in Rome in September 1940, approximately at the same time of the first reported ECT administration on a child in Bristol, United Kingdom. The 2 reports described applications on 19 children and adolescents during 3 different sessions (1940–1941, 1944–1947, and 1947–1949), with a 3-year-long interruption due to the circumstances of World War II. Unfortunately, this research appeared belatedly in 2 articles from 1948 and 1950, respectively, in an Italian journal with limited distribution, when more extensive research contributions on pediatric ECT had already received international exposure. The Italian reports may cast light on the progress made by the early generation of ECT researchers in the 1940s toward the refinement of ECT techniques and the subsequent identification of diagnostic indicators for ECT among children.

In the 1940s, regressive and intensive methods were developed to increase the therapeutic effects of electroconvulsive therapy. The diagnostic indications, methods of application, effectiveness, complications, and mortality of these techniques are briefly discussed here. An attempt is also made to evaluate the risks and benefits of these methods from a historical perspective.

Mit über 2.500 bilateralen Investitionsschutzverträgen (BIT) hat sich seit den 60er Jahren des vergangenen Jahrhunderts ein regelrechter Hype im internationalen Investitionsschutzrecht entwickelt. Mit 74 bi- oder multilateralen Investitionsschutzabkommen stellt Russland einen der wichtigsten Staaten für ausländische Direktinvestitionen dar. Aufgrund der Vielfältigkeit bei der Formulierung der einzelnen Schutzbereiche stellen sich für die Investoren jedoch zahlreiche rechtliche Fragen, die in diesem Beitrag beleuchtet werden sollen.

The debate about ECT in Ireland in recent times has been vibrant and
often  polarised.  The  uniqueness  of  the  Irish  situation  is  that  the  psychiatric  profession is protected by legislation whereby ECT treatment can be authorized by two consultant psychiatrists without the consent of the patient. This paper will consider if ECT is ever ethically justified, and if so, under what circumstances. The proposal is to investigate  ECT  from an ethical perspective with  reference  to the  UNESCO
Universal Declaration on Bioethics and Human Rights.
The enquiry will begin with an historical context to the origin and development of ECT as a treatment for severe mental  illness.  The  application  of  various  ethical  principles  will  be  considered  in conjunction with the relevant literature before arriving at a conclusion.

ABSTRACT: We report a case of pulmonary edema after electroconvulsive therapy (ECT) in an 88-year-old man with controlled hypertension and treatment-refractory depression. Despite this unexpected episode of pulmonary edema, the patient was able to complete this course of ECT without further complications. Because the pulmonary edema was thought to be due to extremely elevated blood pressures, nitroglycerine and esmolol were used during subsequent treatments, and electrode placement was changed to bilateral to speed recovery.

Electroconvulsive therapy (ECT) is a neurostimulation therapeutic intervention that is highly effective and frequently used to treat certain psychiatric conditions, particularly major depressive disorder. Despite its high efficacy, a major limitation of ECT is the significant rate at which patients relapse after treatment. Providing additional ECT treatments after completion of a short-term course of ECT, referred to as continuation ECT (C-ECT), is a strategy used to reduce the risk of relapse. Specifically, C-ECT involves the administration of additional ECT treatments during the 6-month period after remission. This article summarizes the available literature regarding C-ECT including indication for use, patient selection, treatment guidelines/parameters, and safety. The efficacy of C-ECT is also discussed, with a focus on major depressive disorder and schizophrenia. On the basis of the current literature, indications for use and patient selection for C-ECT are predominately simila...

Several guidelines support the role of electroconvulsive therapy as a first line treatment of severe major depressive disorder, especially in psychotic and suicidal patients, or those with catatonia or treatment-resistant depression. Two important guidelines differ in their recommendations regarding indication for electroconvulsive therapy in depressive illness. This article focuses on overview of guidelines and recommendations enriched with relevant literature quotations.

Vertebral compression fractures are a common injury affecting older individuals, predominantly women with osteoporosis. Although compression fractures may be asymptomatic, they frequently result in moderate-to-severe acute and chronic back pain. Fortunately, they are rarely associated with neurological dysfunction. They may occur spontaneously, or result from direct trauma, falls, or seemingly innocuous occurrences such as coughing, sneezing, or rolling over in bed. In the past, thoracic compression fractures
occurred as a side effect of unmodified electroconvulsive therapy (ECT) (Kalinowsky and Hoch, 1952; Fink, 1979). With modern anesthesia techniques
for ECT, compression fractures have virtually been eliminated.

The authors examine the differences in outcome between black and white patients receiving electroconvulsive therapy (ECT) as a part of the Consortium for Research on Electroconvulsive Therapy multisite study. A total of 624 patients were enrolled in an National Institute of Mental Health (NIMH)-funded, randomized, controlled ECT trial comparing the efficacy of continuation ECT versus continuation pharmacotherapy between 1997 and 2004. This analysis focuses on the 32 black and 483 white patients who participated in phase I of the study. The authors compared baseline demographic and clinical variables and acute outcomes of these 2 groups. Compared with whites, far fewer blacks participated in the study. Those who did were less likely to have failed adequate medication trials and were more likely to have psychotic features. Their initial 24-item Hamilton Rating Scale for Depression scores were higher than those of the whites, and they showed a greater reduction in these 24-item Hamilto...

Understanding the contributions of the prefrontal cortex (PFC) to working memory is central to understanding the neu- ral bases of high-level cognition. One question that remains controversial is whether the same areas of the dorsolateral PFC (dlPFC) that participate in the manipulation of information in working memory also contribute to its short-term retention (STR). We evaluated this question by first

The application of eddy current testing for structural integrity assessment of heat exchangers is a well established practice. Service induced multiple defects in heat exchanger tubes produce difficult-to-evaluate complicated impedance plane trajectories during periodic eddy current examinations. Finite element simulations carried out to analyse interactions in a two-defect system are discussed. Probable uncertainty in the interpretation of eddy current trajectories is highlighted. Systematic analysis of the results from these studies will simplify procedures for on-line evaluation of eddy current signals.

Objective: To determine whether the Mini-Mental State Examination (MMSE) could be used to predict short-term impairments in memory functions during a course of Electroconvulsive Therapy (ECT). Method: Patients with severe depression (n=32) were followed up while they were receiving ECTs, and up to a month after that. They were rated independently and blindly on the MMSE for global cognitive dysfunction, the PGI Mem- ory Scale (PGIMS) for memory loss, and the Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depression. Results: MMSE scores dipped during the course of ECT, but picked up in the week and month following cessation of treatment. The PGIMS scores mimicked this pattern, whereas the MADRS scores continued to decline slowly as the patients improved. MMSE scores were highly correlated with memory impairment (PGIMS scores) prior to, during, and up to one month after treatment with ECT. MMSE scores were the strongest predictor of the PGIMS scores at virtually al...

Background: Combined use of electroconvulsive therapy (ECT) and
antipsychotics in acute phases of schizophrenia remains controversial
and inadequately investigated.
Aim: This study tried to examine whether the ECT-antipsychotic
combination was more efficacious than antipsychotic drugs used
alone in the acute phase treatment of schizophrenia, by way of an
open review and an exploratory meta-analysis of the Indian studies
on the subject.
Method: Eleven studies (n = 651) and 4 controlled trials (n = 113) were
selected for the open review and the meta-analysis, respectively. For the
meta-analysis, a standard #2 analysis was undertaken to check for
heterogeneity. Brief Psychiatric Rating Scale scores were used to
estimate treatment effects.
Results: The open review suggested that the ECT-antipsychotic
combination was more efficacious than antipsychotic drugs used
alone in the first few weeks of treatment of schizophrenia. The metaanalysis,
using the Inverse Weighted Variance Model, showed that
the ECT-antipsychotic combination provides an advantage of approximately
5 Brief Psychiatric Rating Scale points over antipsychotic
drugs, in the first 4 to 5 weeks of treatment of schizophrenia
(mean treatment effect, 4.89; 95% confidence intervals, 0.50Y9.38).
Conclusions: The studies reviewed thus indicated that ECTantipsychotic
combinations might be better than antipsychotic
drugs used alone in the first few weeks of treatment of schizophrenia;
the main benefit seemed to be an acceleration of treatment response.
Although the evidence was not conclusive because of several
methodological difficulties, it does suggest that further research is
required to determine the usefulness of the ECT-antipsychotic
combination in the acute treatment of schizophrenia