RESUMO
In cases of malignant catatonia, prompt administration of electroconvulsive therapy (ECT) can decrease mortality, whereas delays to initiating ECT have resulted in adverse outcomes, including death. We present a clinical vignette of malignant catatonia that required court-ordered ECT, followed by a discussion of practical and legal obstacles to expediting emergent ECT when patients cannot provide consent. We review particularly exacting mandates for involuntary ECT from three states: California, Texas, and New York. As compared to standard practice for other clinical interventions when a patient lacks decision-making capacity, ECT is highly regulated; in some cases, these regulations can interfere with life-saving treatment.
Assuntos
Catatonia/terapia , Eletroconvulsoterapia/legislação & jurisprudência , Eletroconvulsoterapia/normas , Adulto , HumanosRESUMO
OBJECTIVES: : To evaluate the efficacy and safety of electroconvulsive therapy (ECT) in bipolar disorder (BPD). METHODS: : Clinical trials on the treatment of BPD with ECT were systematically reviewed. A comprehensive search of MEDLINE, PsycINFO, and ISI Web of Science databases was conducted in March 2010. RESULTS: : A total of 51 articles met our selection criteria. Only 3 controlled or comparative prospective trials addressed the treatment of mania with ECT. In these studies, which had small samples, ECT was superior to simulated ECT, lithium, or the combination of lithium and haloperidol. We did not find any controlled or comparative prospective trial on the efficacy of ECT in bipolar depression. In the 4 retrospective studies that compared ECT with antidepressants, no difference was observed between them. In 9 of 10 trials that compared bipolar with unipolar depressed patients, ECT was equally efficacious for both groups of patients. Of the 6 studies of patients with BPD that performed a comparison between pre-ECT versus post-ECT, only 1 study showed a worsening in cognition after the treatment. CONCLUSIONS: : There are no studies with adequate methodology on the treatment of BPD with ECT. The lack of scientific evidence contrasts with broad anecdotal clinical experience that suggests that ECT is an important tool in the treatment of BPD, especially in more severe or refractory cases. The marked stigma associated with ECT and the lack of large financial support may account for the paucity of ECT research.
Assuntos
Transtorno Bipolar/terapia , Eletroconvulsoterapia , Eletroconvulsoterapia/normas , Humanos , SegurançaRESUMO
OBJECTIVE: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice. METHOD: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients' perception, mechanism of action, technique and cognitive impairment. RESULTS: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment. CONCLUSION: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes.
Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/normas , Eletroconvulsoterapia/efeitos adversos , Humanos , Metanálise como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Objetivo: A eficácia da eletroconvulsoterapia em tratar sintomas depressivos está estabelecida por meio de inúmeros estudos desenvolvidos durante as últimas décadas. A eletroconvulsoterapia é o tratamento biológico mais efetivo para depressão atualmente disponível. O objetivo deste estudo foi demonstrar o papel da eletroconvulsoterapia no tratamento da depressão e destacar aspectos atuais relativos à sua prática. Método: Foram revisados na literatura estudos de eficácia, remissão de sintomas, fatores preditores de resposta, assim como aspectos atuais acerca da qualidade de vida, percepção dos pacientes, mecanismo de ação, técnica e prejuízo cognitivos. Resultados: Os principais achados desta revisão foram: 1) a eletroconvulsoterapia é mais efetiva do que qualquer medicação antidepressiva; 2) a remissão da depressão com a eletroconvulsoterapia varia, em geral, de 50 a 80%; 3) Ainda é controverso o efeito da eletroconvulsoterapia nos níveis de fator neurotrófico derivado do cérebro (acho que aqui pode colocar entre parenteses o BNDF); 4) a eletroconvulsoterapia tem efeito positivo na melhora da qualidade de vida; 5) os pacientes submetidos à eletroconvulsoterapia, em geral, têm uma percepção positiva do tratamento. Conclusão: A eletroconvulsoterapia permanece sendo um tratamento altamente eficaz em pacientes com depressão resistente. Com o avanço da sua técnica, a eletroconvulsoterapia tornou-se um procedimento aindamais seguro e útil tanto para a fase aguda, quanto para a prevenção de novos episódios depressivos.
Objective: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerablestudies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of lectroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice. Method: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients perception, mechanism of action, technique and cognitive impairment. Results: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment. Conclusion: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes.
Assuntos
Humanos , Fator Neurotrófico Derivado do Encéfalo/sangue , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/normas , Eletroconvulsoterapia/efeitos adversos , Metanálise como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
The use of right unilateral electrode placement for electroconvulsive therapy (ECT) is one of the most important developments on the technique because it is considered to spare cognition. Nevertheless, the best way to determine the charge to be given to the individual patient is still controversial. We present an open study on the use of right unilateral ECT using the technique of method of limits and giving treatments with 6 times the seizure threshold. Of 30 patients, there was a response/remission rate of 53.33%, as measured by the Hamilton Depression Rating Scale, after a mean of 8 sessions. Half of the nonresponders (n = 7) received subsequent bilateral ECT, with improvement on 4. The data suggest that it is a good practice to start the treatment with unilateral ECT and, if no response is achieved, to switch to bilateral placement.
Assuntos
Transtorno Depressivo Maior/terapia , Terapia por Estimulação Elétrica , Eletroconvulsoterapia/métodos , Adulto , Anestésicos/uso terapêutico , Eletroconvulsoterapia/normas , Eletrodos/normas , Feminino , Lateralidade Funcional , Humanos , Masculino , Titulometria , Resultado do TratamentoRESUMO
O presente trabalho revisa alguns aspectos relacionados a prática do procedimento de eletroconvulsoterapia. Este estudo surgiu frente a necessidade de implementaçäo de critérios para uma rotina deste procedimento no Hospital de Clínicas de Porto Alegre. Säo discutidos as indicaçöes, contraindicaçöes, avaliaçäo do paciente, frequência das sessöes e ECT de manutençäo, em busca de uma otimizaçäo deste procedimento
Assuntos
Humanos , Eletroconvulsoterapia/normasRESUMO
Con el propósito de recabar información utilizable en la cooperación técnica en temas vinculados con la atención psiquiátrica, la OPS/OMS llevó a cabo en América Latina y el Caribe de habla inglesa y holandesa una encuesta postal sobre el uso del electrochoque (ECH). En América Latina los informantes fueron las divisiones/departamentos de salud mental de los ministérios nacionales, mientras que en el Caribe la información fue suministrada por los responsables de los programas o los directores de los hospitales psiquiátricos. Los resultados de la encuesta mostraron que el uso del ECH difiere entre las dos citadas regiones, es generalizado en América Latina y sólo parcial en el Caribe. Su uso varía también al interior de los países así como en el curso del tiempo. La mitad de los países latinoamericanos informaron contar con normas técnicas de aplicación. La utilización de la anestesia y los relajantes musculares aún no ha sido adoptada por la totalidad de las instituciones psiquiátricas de América Latina ni tampoco es universal la obtención del consentimiento informado. La divulgación de los resultados obtenidos, sumados a las políticas de atención psiquiátrica actualmente vigentes, permitirán promover acciones que ayuden a neutralizar los estereotipos negativos que despierta esta intervención y a aumentar el nivel de consenso entre los profesionales que la aplicam.
Assuntos
Humanos , Eletroconvulsoterapia , Anestesia/estatística & dados numéricos , Bioética , Região do Caribe , Eletroconvulsoterapia/normas , Consentimento Livre e Esclarecido , América Latina , Fármacos Neuromusculares/uso terapêuticoRESUMO
Con el propósito de recabar información utilizable en la cooperación técnica en temas vinculados con la atención psiquiátrica, la OPS/OMS llevó a cabo en América Latina y el Caribe de habla inglesa y holandesa una encuesta postal sobre el uso del electrochoque (ECH). En América Latina los informantes fueron las divisiones/departamentos de salud mental de los ministérios nacionales, mientras que en el Caribe la información fue suministrada por los responsables de los programas o los directores de los hospitales psiquiátricos. Los resultados de la encuesta mostraron que el uso del ECH difiere entre las dos citadas regiones, es generalizado en América Latina y sólo parcial en el Caribe. Su uso varía también al interior de los países así como en el curso del tiempo. La mitad de los países latinoamericanos informaron contar con normas técnicas de aplicación. La utilización de la anestesia y los relajantes musculares aún no ha sido adoptada por la totalidad de las instituciones psiquiátricas de América Latina ni tampoco es universal la obtención del consentimiento informado. La divulgación de los resultados obtenidos, sumados a las políticas de atención psiquiátrica actualmente vigentes, permitirán promover acciones que ayuden a neutralizar los estereotipos negativos que despierta esta intervención y a aumentar el nivel de consenso entre los profesionales que la aplicam. (AU)