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Pape A, Kittel-Schneider S. [Practice of anaesthesia for electroconvulsive therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:422-435. [PMID: 37582353 DOI: 10.1055/a-1925-6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Electroconvulsive therapy (ECT) is an established therapeutic method for the treatment of severe mental disorders refractory to pharmaco- and psychotherapy. ECT is a first-line treatment option in delusional disorders, severe depression with acute suicidal tendency or life-threatening catatonia. Usually, ECT is performed as a treatment series. Under short-term anaesthesia and muscle relaxation, tonic-clonic seizures are induced using an external stimulation electrode. Convulsion can be exerted by uni- or bipolar stimulation using an electric charge up to 1000 millicoulomb (mC) with an amperage of 900 mA. Muscular relaxation is necessary to prevent injuries caused by uncontrolled movements during convulsion. During paralysis, consciousness is blocked by general anaesthesia, although ECT is associated with antegrade amnesia for seizure induction and the seizure itself. In the context of ECT, the ideal hypnotic should be characterised by rapid onset, short duration of action and negligible anticonvulsive effects (i.e., least possible impact on seizure quality and duration). As mutual awareness of psychiatric and anaesthesiologic techniques is essential for safe and effective conduction of ECT, this article presents ECT both from the psychiatrist's and the anaesthesiologist's perspective.
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Ahmad I, Sandberg M, Brus O, Ekman CJ, Hammar Å, Landén M, Lundberg J, Nordanskog P, von Knorring L, Nordenskjöld A. Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy. Nord J Psychiatry 2022; 76:96-103. [PMID: 34346852 DOI: 10.1080/08039488.2021.1939416] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. AIM This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. MATERIALS AND METHODS From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery Åsberg Depression Rating Scale between the Q-ECT and the patient record. RESULTS A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. CONCLUSIONS We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.
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Affiliation(s)
- Irma Ahmad
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Ole Brus
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Carl Johan Ekman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Pia Nordanskog
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Psychiatry, Region Östergötland, Linköping, Sweden
| | - Lars von Knorring
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
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Giné Servén E, Martinez Ramirez M, Boix Quintana E, Petrizan Aleman A, Barón Fernández FJ, Fernández Corcuera P, Serra Buil M, Cañete Crespillo J. Emerging cycloid psychosis episodes during COVID-19 pandemic: a case series. Nord J Psychiatry 2021; 75:465-471. [PMID: 33630694 DOI: 10.1080/08039488.2021.1885061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Cycloid psychosis (CP) is a clinical entity characterized by sudden onset of psychotic polymorphic symptomatology and fluctuant course. It has a reported rate of psychosocial precipitating factors ranging 30-65%. The aim of the study was to describe all cases of CP, admitted in our Psychiatry ward, during the first two months of the COVID-19 pandemic. METHOD In this retrospective and observational study, we reported a sample of eight patients who were treated as inpatients in the psychiatric ward of our hospital during the first two months of COVID-19 pandemic (mid-March to mid-May 2020) and compared it with previous years. All our patients fulfilled all four Perris & Brockington criteria for CP. We reported the sociodemographic, clinical and biological parameters. RESULTS In our sample, all of the patients had maladaptive personality traits; the major external stressing factor was COVID-19; all our patients had short prodromal symptomatology, short Duration of Untreated Psychosis (DUP) and high score at the Positive Scale at Positive and Negative Syndrome Scale (PANSS-P) at hospital admission with the majority showing psychotic symptoms related to the actual COVID-19 pandemic. The predominant treatment during admission was olanzapine and a short time to full remission of psychotic symptoms was observed in all patients. CONCLUSION We found an increase in the admission of patients with CP during the first two months of the actual pandemic. Stress caused by the COVID-19 situation has possibly incremented the frequency of stress-related disorders and it has also influenced its clinical presentation.
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Affiliation(s)
- Eloi Giné Servén
- Psychiatry Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | | | - Ester Boix Quintana
- Psychiatry Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | | | | | | | - Maria Serra Buil
- Psychiatry Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
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