Electroconvulsive and Neuromodulation Therapies by Conrad M. Swartz MD

By Conrad M. Swartz MD

Electroconvlusive treatment (ECT) is a psychiatric remedy regarding the induction of a seizure throughout the transmission of electrical energy into the mind. within the early eighties, ECT was once changed by means of way more powerful psychopharmacologic medicines as a prime remedy modality. a lot of the decline in use of ECT at the moment was once additionally ascribable to the variety of problems linked to the approach. due to fresh refinements and a stronger realizing of the clinical mechanisms underpinning ECT, this remedy modality has in recent years noticeable a resurgence in use in medical perform. This publication is the recent definitive reference on electroconvulsive and neuromodulation remedy. It comprehensively covers either the medical foundation and scientific perform of ECT, in addition to offering readers with administrative views for the learning and administration of this modality in scientific perform. The more moderen varieties of non-convulsive electric and magnetic mind stimulation treatment also are coated intimately and provided as a separate part.

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1996). This toxicity occurred with high caffeine doses alone, so it is probably the same effect caused by any exposure to amphetamine or methylphenidate and should not prevent IV caffeine when truly needed. Physiological monitoring (and specific signs) I monitor tonic motor activity and peak heart rate during the seizure. If there is no tonic motor activity, total motor duration is less than 18 seconds, or peak heart rate decreases as described in “Stimulus dose method,” I strongly consider increasing stimulus dose.

In 3,000 cases of similar duration from 75 American and European hospitals, Meduna and Friedman (1939) also reported 52% remissions, plus another 20% improved, although in cases of more than 18 months only 10% recovered. As data accumulated, judgments became more sober. From a large survey of New York state hospitals, Ross and Malzberg (1939) found that PTZ produced outcomes starkly inferior to those of insulin, and no better than in an untreated control group. 6% Note: PTZ, pentylenetetrazol. 1).

Risks were minimized by excluding patients with cardiovascular disease. Convulsive treatment sometimes reactivated pulmonary tuberculosis, a leading cause of mortality in squalid mental institutions. The immediate hazard of status epilepticus was exacerbated when practitioners supplemented unsuccessful doses, potentially increasing the convulsant to dangerous levels. , 1946). Toxic sequelae included vomiting, delirium, and psychomotor excitement. Euphoria was common on the following day, and florid symptoms sometimes appeared (Kennedy, 1937).

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