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Wu Y, Li Y, Liang W, Bai L, Yu J, Li K, Zhang Y, Guo Y, Liu Z, Wang J, Zhang C, Wang X, Xu J, Liu L, Li J, Yang F. The safety and efficacy of sequential intramuscular/oral ziprasidone treatment of acute episode in patients with schizophrenia: a multicenter, open-labeled study. BMC Psychiatry 2023; 23:166. [PMID: 36922763 PMCID: PMC10015911 DOI: 10.1186/s12888-023-04588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 02/03/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Ziprasidone mesylate injection is an atypical antipsychotic drug which is recently approved in China. In combination with its oral formulation, sequential therapy with ziprasidone brings new interventions to patients with agitation in the acute phase of schizophrenia. The purpose of this 7-day multicenter study conducted in China was to evaluate the efficacy and safety of ziprasidone sequential treatment through intramuscular/oral routes in agitated patients with schizophrenia. METHODS A total of 95 patients were enrolled from three centers in this study. The study duration was 7 days. In the first 3 days, subjects were administered an intramuscular injection of ziprasidone 10-40 mg daily and started sequentially with oral ziprasidone 40-80 mg at dinner (or lunch) from the day of the last intramuscular injection. In the following 4 days, according to the severity of the symptoms and the drug response, 120-160 mg of ziprasidone was orally administered daily. In total, six visits were scheduled to assess the Positive and Negative Syndrome Scale (PANSS), the Behavioral Activity Rating Scale (BARS), the Clinical Global Impression of Severity (CGI-S), and Improvement (CGI-I) scores throughout the procedure. Lastly, adverse events were recorded during treatment. RESULTS Out of the 95 patients that were enrolled, 83 cases were effectively completed. Visits 3, 4, 6, PANSS, and PANSS-excited component (PANSS-EC) subscale points, and Visit 2-Visit 6 viewpoints, BARS scale points, and baseline scores denote a progressive downward trend (P < 0.001). In this study, 62 adverse events were reported. The most common adverse events were extrapyramidal symptoms (EPS) (23 cases) and excessive sedation(10 cases), and 13 cases of prolonged QTc interval were reported. CONCLUSIONS Ziprasidone IM demonstrated significant and rapid reduction in agitation, and sequential oral formulation keep stability and continuation of the treatment can further ensure efficacy. Ziprasidone sequential therapy may provide a new approach to acute agitation in schizophrenic patients. TRIAL REGISTRATION The Chinese Clinical Trials Registry; URL: https://www.chictr.org.cn : ChiCTR-OIC-16007970.
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Affiliation(s)
- Yaxue Wu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Yanli Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Weiye Liang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Luyuan Bai
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Jianjin Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Keqing Li
- The Mental Health Center of Hebei Province, Baoding, People's Republic of China
| | - Yunshu Zhang
- The Sixth People's Hospital of Hebei Province, Baoding, People's Republic of China
| | - Yanmei Guo
- The Sixth People's Hospital of Hebei Province, Baoding, People's Republic of China
| | - Zenglong Liu
- The Sixth People's Hospital of Hebei Province, Baoding, People's Republic of China
| | - Jian Wang
- The Sixth People's Hospital of Hebei Province, Baoding, People's Republic of China
| | - Congpei Zhang
- Harbin First Specialized Hospital, Harbin, People's Republic of China
| | - Xijin Wang
- Harbin First Specialized Hospital, Harbin, People's Republic of China
| | - Jia Xu
- Harbin First Specialized Hospital, Harbin, People's Republic of China
| | - Liping Liu
- Harbin First Specialized Hospital, Harbin, People's Republic of China
| | - Juan Li
- Beijing Geriatric Hospital, Beijing, People's Republic of China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China.
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Chiu NM, Tseng EYL. Management for A Depressive Patient with Femoral Neck Fracture by Electroconvulsive Therapy during COVID-19 Pandemic: A Case Report and Literature Review. Int J Environ Res Public Health 2023; 20:4004. [PMID: 36901014 PMCID: PMC10002147 DOI: 10.3390/ijerph20054004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for refractory major depressive disorder with suicidal ideation. The most common adverse medical events are transient retrograde amnesia, falls and pneumonia. Hip fractures, associated with high-energy trauma by convulsions, were occasionally reported in western countries, in the period before the COVID-19 pandemic. Strict COVID-19 regulations influenced the course and further investigation of the treatment of post-ECT complications. A 33-year-old man, previously diagnosed with major depressive disorder, had a history of nine successful sessions of ECT treatment for depression five years ago. He was hospitalized again for 12 sessions of ECT for recurrent depression. Unfortunately, an ECT-induced right hip-neck fracture was noted after the ninth session of ECT, in March 2021. After receiving close reduction and internal fixation of the right femoral neck fracture, with three screws, his original daily function was restored. His treatment was regularly followed up at the outpatient clinic for 20 months; he achieved partial remission with three combined antidepressants. This case of ECT-induced right hip-neck fracture informed psychiatric staff to be aware of this rare adverse complication and ensure its appropriate management, especially during the COVID-19 pandemic.
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Affiliation(s)
- Nien-Mu Chiu
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8753); Fax: +886-77-32-6817
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Hajigholam Saryazdi H, Honarmand A, Nazemroaya B, Naderi Afshar P. A Comparative Study of the Effect of Low-Dose Epinephrine and Ketamine on Rapid-Sequence Endotracheal Intubation by the Priming Dose Method of Cisatracurium in Patients under General Anesthesia. Adv Biomed Res 2023; 12:13. [PMID: 36926434 PMCID: PMC10012019 DOI: 10.4103/abr.abr_398_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/05/2023] Open
Abstract
Background Low-dose ephedrine and ketamine may accelerate the onset time of action of neuromuscular blocking agents. We studied the effect of ephedrine and ketamine and cisatracurium priming on endotracheal intubation conditions and the onset time of action of cisatracurium. Materials and Methods The study was a double-blind clinical trial performed on American Society of Anesthesiologists (ASA) class 1 and 2 patients, who were candidates for general anesthesia. In total, 120 patients were entered into the study and were divided into 4 groups, E, K, E + K, and N. The first group was given 70 mcg/kg ephedrine (E group), the second group was given 0.5 ml/kg ketamine (K group), the third group was given the same amount of ketamine plus ephedrine (E + K group), and the fourth group was given the same volume of normal saline (control group); a single dose of 0.1 mg/kg cisatracurium was given, and intubating conditions were evaluated at 60 seconds after cisatracurium administration. Results The mean Cooper score based on the response to laryngoscopy, the position of the vocal cords, and the movement of the diaphragm of patients in the control group with a mean of 2.53 ± 1.07 was significantly lower than in the three groups of E, K, and E + K with the means of 4.47. 1.17, 4.53 ± 1.14, and 7.63 ± 1.42, respectively (P value < 0.001). In the (E + K) group, it was significantly higher than in the two other drugs alone (P value < 0.001). The two groups of E and K alone were not significantly different from each other (P value = 0.997). The means of hemodynamic parameters were not significantly different in any of the groups (P value > 0.05). Conclusion According to the results of the present study, the use of low-dose ephedrine and ketamine alone can improve intubation conditions. In addition, the combined use of these drugs not only had any Positive effect on patients' hemodynamic parameters but also greatly improved intubation conditions.
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Affiliation(s)
- Hamid Hajigholam Saryazdi
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Nazemroaya
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Al-Zahra Hospital, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pouyan Naderi Afshar
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in people with depression. Cochrane Database of Systematic Reviews 2022. [DOI: 10.1002/14651858.cd015164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Adverse effects of electroconvulsive therapy. Hippokratia 2021. [DOI: 10.1002/14651858.cd014995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in bipolar disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd015172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for acute affective episodes in people with bipolar disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd014996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Kronsell A, Nordenskjöld A, Bell M, Amin R, Mittendorfer-Rutz E, Tiger M. The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: nationwide register-based cohort study. BJPsych Open 2021; 7:e71. [PMID: 33752777 PMCID: PMC8058839 DOI: 10.1192/bjo.2021.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). ECT treatment effect relies on induced generalised seizures. Most anaesthetics raise the seizure threshold and shorten seizure duration. There are no conclusive studies on the effect of anaesthetic dose on response and remission rates with ECT for MDD. AIMS We aimed to examine the effect of different dose intervals of anaesthetics on response and remission after ECT for MDD. METHOD We conducted a nationwide cohort study, using data from Swedish registers. Low-, medium- and high-dose intervals, adjusted for age and gender, were constructed for each anaesthetic drug. Response and remission were measured with the Clinical Global Impression - Severity and Improvement scales (CGI-I and CGI-S), and a self-rated version of the Montgomery-Åsberg Depression Rating Scale (MADRS-S). Logistic regression models were used to calculate adjusted odds ratios for response and remission rates. RESULTS The study included 7917 patients who received ECT for MDD during 2012-2018. Patients were given either thiopental (64.1%) or propofol (35.9%). Low-dose intervals of anaesthetics were associated with increased rates of response (CGI-I: odds ratio 1.22, 95% CI 1.07-1.40, P = 0.004; MADRS-S: odds ratio 1.31, 95% CI 1.09-1.56, P = 0.004) and remission (CGI-S: odds ratio 1.37, 95% CI 1.17-1.60, P ≤ 0.001; MADRS-S: odds ratio 1.31, 95% CI 1.10-1.54, P = 0.002). CONCLUSIONS We found improved treatment outcomes with low- compared with high-dose anaesthetic during ECT for MDD. To enhance treatment effect, deep anaesthesia during ECT for MDD should be avoided.
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Affiliation(s)
- Alexander Kronsell
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Max Bell
- Department of Anaesthesiology, Surgical Services and Intensive Care, Karolinska University Hospital, Sweden; and Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
| | - Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Mikael Tiger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and Stockholm Health Care Services, Region Stockholm, Sweden
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for depression. Hippokratia 2021. [DOI: 10.1002/14651858.cd013843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Abstract
OBJECTIVES Image of electroconvulsive therapy (ECT) in TV shows and movies have been studied before. However, there is no study about image of ECT on YouTube as one of the most commonly used social media platforms for disseminating health information. Our study aims to study the image of ECT in YouTube videos. METHODS Key word "Electroconvulsive therapy and ECT" were used to search on Youtube.com and only videos over 50,000 view counts and in English were selected. Above videos were reviewed by an ECT physician and were classified into neutral, negative, and positive groups based on the image of ECT. RESULTS There were 41 YouTube videos selected based on the criteria as stated above, among which 14 were unrelated with ECT treatment, 8 were neutral, 9 were positive, and 10 were reflecting negative image about ECT. There was no significant difference among view counts of the positive, negative and neutral videos (χ = 2.746, P = 0.253). Furthermore, the most viewed 3 videos showed negative image of ECT. Additionally, only 6 videos showed the modified ECT and one showed both modified and nonmodified ECT. CONCLUSIONS This is the first study conducted on image of ECT in YouTube videos. We found the stigma against ECT may persist in digital video platforms, such as YouTube.
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Abstract
Objective: Ministry of Health of Turkey issued a legislation to use only modified electroconvulsive therapy (ECT) in 2005, and this study aimed to assess satisfaction and attitude of bipolar patients regarding modified and unmodified electroconvulsive therapy.Methods: A total of 100 patients (50 treated with modified electroconvulsive therapy (M-ECT) and 50 treated with unmodified ECT (UM-ECT) with a diagnosis of Bipolar Disorder (depressive or manic episode) were invited to participate in this study. Patients with euthymic mood were included. Satisfaction and attitude towards ECT were evaluated with a structured attitude questionnaire, and M-ECT and UM-ECT patients, and their subgroups (depressive vs. manic) were compared.Results: No significant differences were found between M-ECT and UM-ECT groups regarding age, sex, marital status and occupation. The majority of all patients (78%) were satisfied from treatment with ECT and with the outcome (88%), without significant differences between modified and unmodified groups. Forgetfulness (70%) and headaches (57%) occurred in all groups, with the only significant difference in forgetfulness being reported by more manic patients treated with UM-ECT. Depressive and manic patients treated with UM-ECT reported concerns of brain damage and physical harm significantly more frequently. While 86% of patients treated with M-ECT consented to a future treatment, this was significantly less in patients treated with UM-ECT (50%).Conclusions: Bipolar patients report a high degree of satisfaction treated either with modified or unmodified ECT but there was a significant difference in perception of adverse effects and willingness for receiving ECT in future.
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Affiliation(s)
- Özge Canbek Atay
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, ECT Center, Istanbul, Turkey
| | - Sevda Bag
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Haluk Usta
- Department of Psychiatry, Erenkoy Teaching Hospital for Psychiatry and Neurology, Istanbul, Turkey
| | - Esin Çetinkaya
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, ECT Center, Istanbul, Turkey
| | - Medaim Yanik
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, ECT Center, Istanbul, Turkey
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Duffy RM, Gulati G, Paralikar V, Kasar N, Goyal N, Desousa A, Kelly BD. A Focus Group Study of Indian Psychiatrists' Views on Electroconvulsive Therapy under India's Mental Healthcare Act 2017: 'The Ground Reality is Different'. Indian J Psychol Med 2019; 41:507-515. [PMID: 31772436 PMCID: PMC6875845 DOI: 10.4103/ijpsym.ijpsym_247_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND India's Mental Healthcare Act, 2017 (MHCA) greatly restricts the use of electroconvulsive therapy (ECT) in minors and bans unmodified ECT. Indian psychiatrists have raised concerns that these measures may deprive certain patients of life-saving treatment. This study describes the perspectives of Indian psychiatrists on how ECT is dealt with in the legislation. METHODS We conducted nine focus groups in three Indian states. We explored the positive and negative implications of the MHCA and discussed its implementation, especially in relation to ECT. RESULTS Many of the themes and concerns commonly discussed in relation to ECT in other jurisdictions are readily apparent among Indian psychiatrists, although perspectives on specific issues remain heterogeneous. The one area of near-universal agreement is Indian psychiatrists' affirmation of the effectiveness of ECT. We identified three main areas of current concern: the MHCA's ban on unmodified ECT, ECT in minors, and ECT in the acute phase. Two broad additional themes also emerged: resource limitations and the impact of nonmedical models of mental health. We identified a need for greater education about the MHCA among all stakeholders. CONCLUSION Core concerns about ECT in India's new legislation relate, in part, to medical decisions apparently being taken out of the hands of psychiatrists and change being driven by theoretical perspectives that do not reflect "ground realities." Although the MHCA offers significant opportunities, failure to resource its ambitious changes will greatly limit the use of ECT in India.
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Affiliation(s)
- Richard M Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
| | - Gautam Gulati
- Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland
| | | | - Niket Kasar
- Department of Psychiatry, KEM Hospital Research Centre, Pune, India
| | - Nishant Goyal
- Department of Psychiatry, Academic Section, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Avinash Desousa
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, India
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
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Duffy RM, Kelly BD. India's Mental Healthcare Act, 2017: Content, context, controversy. Int J Law Psychiatry 2019; 62:169-178. [PMID: 30122262 DOI: 10.1016/j.ijlp.2018.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 05/13/2023]
Abstract
India's new mental health legislation, the Mental Healthcare Act, 2017, was commenced on 29 May 2018 and seeks explicitly to comply with the United Nations Convention on the Rights of Persons with Disabilities. It grants a legally binding right to mental healthcare to over 1.3 billion people, one sixth of the planet's population. Key measures include (a) new definitions of 'mental illness' and 'mental health establishment'; (b) revised consideration of 'capacity' in relation to mental healthcare (c) 'advance directives' to permit persons with mental illness to direct future care; (d) 'nominated representatives', who need not be family members; (e) the right to mental healthcare and broad social rights for the mentally ill; (f) establishment of governmental authorities to oversee services; (g) Mental Health Review Boards to review admissions and other matters; (h) revised procedures for 'independent admission' (voluntary admission), 'supported admission' (admission and treatment without patient consent), and 'admission of minor'; (i) revised rules governing treatment, restraint and research; and (j) de facto decriminalization of suicide. Key challenges relate to resourcing both mental health services and the new structures proposed in the legislation, the appropriateness of apparently increasingly legalized approaches to care (especially the implications of potentially lengthy judicial proceedings), and possible paradoxical effects resulting in barriers to care (e.g. revised licensing requirements for general hospital psychiatry units). There is ongoing controversy about specific measures (e.g. the ban on electro-convulsive therapy without muscle relaxants and anaesthesia), reflecting a need for continued engagement with stakeholders including patients, families, the Indian Psychiatric Society and non-governmental organisations. Despite these challenges, the new legislation offers substantial potential benefits not only to India but, by example, to other countries that seek to align their laws with the United Nations' Convention on the Rights of Persons with Disabilities and improve the position of the mentally ill.
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Affiliation(s)
- Richard M Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
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Choi BS, Kim JM, Lee HY. A Young Woman Who Suffered a Fractured Vertebra During Electroconvulsive Therapy. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20181010-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lewis O, Callard F. The World Psychiatric Association’s “Bill of Rights”: A curious contribution to human rights. International Journal of Mental Health 2017. [DOI: 10.1080/00207411.2017.1278963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Narayanan A, Lal C, Al-Sinawi H. General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy: Retrospective analysis of 504 sessions over a five-year period at a tertiary care hospital in Oman. Sultan Qaboos Univ Med J 2017; 17:e43-e49. [PMID: 28417028 DOI: 10.18295/squmj.2016.17.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/25/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. METHODS This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. RESULTS A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). CONCLUSION All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined.
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Affiliation(s)
- Aravind Narayanan
- Department of Anaesthesia & Intensive Care Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | - Chandar Lal
- Department of Anaesthesia & Intensive Care Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamed Al-Sinawi
- Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Aksay SS, Bumb JM, Remennik D, Thiel M, Kranaster L, Sartorius A, Janke C. Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia. Neuropsychiatr Dis Treat 2017; 13:1389-1394. [PMID: 28579785 PMCID: PMC5449135 DOI: 10.2147/ndt.s134751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Postictal agitation (PIA) represents one of the most common complications during a modified electroconvulsive therapy (ECT) course. Its clinical management can be challenging especially in cases with poor response to benzodiazepines. Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist acting predominantly in the locus coeruleus, exerts sedative effects without causing relevant respiratory depression. To the best of our knowledge, this is the first study that aimed to assess the impact of dexmedetomidine use with S-ketamine anesthesia on PIA reduction in ECT. PATIENTS AND METHODS We retrospectively analyzed 7 patients who underwent 178 ECT sessions with S-ketamine anesthesia between June 2011 and July 2015 at the Central Institute of Mental Health Mannheim. In 101 sessions, the patients received dexmedetomidine in combination with S-ketamine anesthesia. The decision for dexmedetomidine use was based on individual clinical presentation (patients with positive PIA history). A multivariate repeated measurement logistic regression analysis was conducted to investigate the effect of dexmedetomidine use on the occurrence of PIA. We hypothesized that the use of dexmedetomidine reduced the incidence of PIA also in combination with S-ketamine anesthesia. RESULTS The prevalence of PIA in ECT sessions with dexmedetomidine administration was lower (mean per patient, 34% vs 62%). In the multivariate logistic regression analysis, the use of dexmedetomidine predicted the non-occurrence of PIA in a highly significant manner (P=0.001, z=-3.83, odds ratio =0.011-0.303). CONCLUSION Adjunctive use of dexmedetomidine to S-ketamine anesthesia in ECT seems to be a promising tool for the management of intractable PIA syndrome.
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Affiliation(s)
- Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
| | - Jan Malte Bumb
- Department of Addictive Behavior and Addiction Medicine,Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
| | - Dmitry Remennik
- Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Manfred Thiel
- Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
| | - Christoph Janke
- Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.E-mail:
| | | | | | - Devavrat Harshe
- Department of Psychiatry, D Y Patil Medical College, Kolhapur, Maharashtra, India
| | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Abstract
Electroconvulsive therapy (ECT) is an effective treatment commonly used for depression and other major psychiatric disorders. We discuss potential adverse effects (AEs) associated with ECT and strategies for their prevention and management. Common acute AEs include headache, nausea, myalgia, and confusion; these are self-limiting and are managed symptomatically. Serious but uncommon AEs include cardiovascular, pulmonary, and cerebrovascular events; these may be minimized with screening for risk factors and by physiologic monitoring. Although most cognitive AEs of ECT are short-lasting, troublesome retrograde amnesia may rarely persist. Modifications of and improvements in treatment techniques minimize cognitive and other AEs.
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India.
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India
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Abstract
The Mental Health Care Bill - 2013 has been introduced in Rajya Sabha and is now waiting for enactment. The Bill entails unprecedented measures to be undertaken by the Government ensuring everyone right to access mental health care and treatment from services run or funded by the Government. The Government is to meet the man-power requirement of mental health professionals according to international standard within a period of ten years. Various rights of persons with mental illness have been ensured. All the places where psychiatric patients are admitted and treated including the general hospital psychiatry units (GHPU) are to be registered as mental health establishments. Unmodified ECT has been banned and ECT to minors can be given only after approval from the Mental Health Review Board. This article advocates for exemption of GHPU from the purview of the Bill, taking into consideration impediment created in the treatment of vast majority of psychiatric patients who retain their insight into the illness and seldom require involuntary admissions. It is also advocated to reconsider ban on unmodified ECT and restriction placed on ECT to minor which are very effective treatment methods based on scientific evidence. In our country, family is an important asset in management of mental illness. But requirement of seeking approval from the Board in many of the mental health care decision may discourage the families to be proactive in taking care of their wards. The Board and Mental Health Authorities at the central and the state levels are authorized to take many crucial decisions, but these panels have very few experts in the field of mental health.
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Affiliation(s)
| | - Shivendra Shekhar
- Department of Psychiatry, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India
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Tripathi A, Winek NC, Goel K, D'Agati D, Gallegos J, Jayaram G, Nguyen T, Vaidya P, Zandi P, Trivedi JK, Reti IM. Electroconvulsive therapy pre-treatment with low dose propofol: comparison with unmodified treatment. J Psychiatr Res 2014; 53:173-9. [PMID: 24602447 DOI: 10.1016/j.jpsychires.2014.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/08/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. METHOD We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. RESULTS Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration. CONCLUSION Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
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Affiliation(s)
- Adarsh Tripathi
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Nathan C Winek
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kapil Goel
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Douglas D'Agati
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jesus Gallegos
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetha Jayaram
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thai Nguyen
- Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Punit Vaidya
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Zandi
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jitendra K Trivedi
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Irving M Reti
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Peng L, Min S, Wei K, Ziemann‐Gimmel P. Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression. Cochrane Database Syst Rev 2014; 2014:CD009763. [PMID: 24723301 PMCID: PMC6464335 DOI: 10.1002/14651858.cd009763.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is a common mental disorder. It affects millions of people worldwide and is considered by the World Health Organization (WHO) to be one of the leading causes of disability. Electroconvulsive therapy (ECT) is a well-established treatment for severe depression. Intravenous anaesthetic medication is used to minimize subjective unpleasantness and adverse side effects of the induced tonic-clonic seizure. The influence of different anaesthetic medications on the successful reduction of depressive symptoms and adverse effects is unclear. OBJECTIVES This review evaluated the effects of different regimens of intravenous sedatives and hypnotics on anti-depression efficacy, recovery and seizure duration in depressed adults undergoing ECT. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12); MEDLINE via Ovid SP (from 1966 to 31 December 2012); and EMBASE via Ovid SP (from 1966 to 31 December 2012). We handsearched related journals and applied no language restrictions. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cross-over trials evaluating the effects of different intravenous sedatives and hypnotics for ECT. We excluded studies and trials using placebo or inhalational anaesthetics and studies that used no anaesthetic. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When possible, data were pooled and risk ratios (RRs) and mean differences (MDs), each with 95% confidence intervals (CIs), were computed using the Cochrane Review Manager statistical package (RevMan). MAIN RESULTS We included in the review 18 RCTs (599 participants; published between 1994 and 2012). Most of the included trials were at high risk of bias.We analysed the results of studies comparing six different intravenous anaesthetics.Only a few studies comparing propofol with methohexital (four studies) and with thiopental (three studies) could be pooled.No difference was noted in the reduction of depression scores observed in participants treated with propofol compared with methohexital (low-quality evidence). These four studies were not designed to detect differences in depression scores.The duration of electroencephalograph (EEG) and of motor seizures was shorter in the propofol group compared with the methohexital group (low-quality evidence). No difference was seen in EEG seizure duration when propofol was compared with thiopental (low-quality evidence).Time to recovery (following commands) was longer among participants after anaesthesia with thiopental compared with propofol (low-quality evidence).For the remaining comparisons of anaesthetics, only single studies or insufficient data were available. Adverse events were inadequately reported in eligible trials, and none of the included trials reported anaesthesia-related mortality. AUTHORS' CONCLUSIONS Most of the included studies were at high risk of bias, and the quality of evidence was generally low. The studies were not designed to detect clinically relevant differences in depression scores. Anaesthetic agents should be chosen on the basis of adverse effect profile, emergence and how these medications affect seizure duration. If it is difficult to elicit an adequately long seizure, methohexital may be superior to propofol (low-quality evidence). If a patient is slow to recover from anaesthesia, propofol may allow a faster time to follow commands than thiopental (low-quality evidence). A factor of clinical concern that was not addressed by any study was adrenal suppression from etomidate. Optimal dosages of intravenous sedatives or hypnotics have not yet been determined.Larger well-designed randomized studies are needed to determine which intravenous anaesthetic medication leads to the greatest improvement in depression scores with minimal adverse effects.
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Affiliation(s)
- Lihua Peng
- The First Affiliated Hospital, Chongqing Medical UniversityThe Department of Anaesthesia and Pain MedicineNo 1 Youyi Road, Yuan‐jia‐gangYu‐zhong DistrictChongqingChina40016
| | - Su Min
- The First Affiliated Hospital, Chongqing Medical UniversityThe Department of Anaesthesia and Pain MedicineNo 1 Youyi Road, Yuan‐jia‐gangYu‐zhong DistrictChongqingChina40016
| | - Ke Wei
- The First Affiliated Hospital, Chongqing Medical UniversityDepartment of Anaesthesia and Pain Medicine1# Youyi Road, Yuanjiangang CommunityYuzhong DistrictChongqingChina400016
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Affiliation(s)
- James T Antony
- Department of Psychiatry, Jubilee Mission Medical College and Research Institute, Kerala, India
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25
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Affiliation(s)
- Anirudh Kala
- Clinical Director, The Mind Plus, Ludhiana, Punjab, India
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Affiliation(s)
- B N Gangadhar
- National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India E-mail:
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Affiliation(s)
- Charles H Kellner
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA. E-mail:
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
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