Hyperventilation and electroconvulsive therapy: A literature review

BACKGROUND

Hyperventilation has been proposed as an augmentation strategy in electroconvulsive therapy (ECT) in accordance with its proconvulsant effect.

OBJECTIVE

This study reviews the existing literature on the application of hyperventilation in ECT, its efficacy, and tolerance.

METHODS

A systematic search was performed in PubMed and EMBASE databases. Search terms ('electroconvulsive therapy' and 'hyperventilation', 'ventilation', 'hyperoxygenation', 'hyperoxia', 'hypocapnia') were used to retrieve works from 1966 to June 2016. Works that described hyperventilation manoeuvres in ECT settings and their clinical repercussion were included in the review.

RESULTS

A total of 17 observational and experimental studies were selected. An important heterogeneity in study designs, samples and ECT conditions, was detected. Findings support a positive influence of hyperventilation on seizure duration, which is the main study variable across different works. Effects of hyperventilation on seizure threshold and quality parameters have been less thoroughly studied. Systematic recording of clinical outcomes and adverse effects of hyperventilation is uncommon.

CONCLUSIONS

The literature suggests that hyperventilation may be an effective and safe technique to enhance ECT, but many aspects remain to be studied. Further investigations, especially controlled clinical trials, are necessary and should result in a specific and reliable hyperventilation protocol for ECT settings.

Treatment guidelines for Attention Deficit and Hyperactivity Disorder: A critical review

A series of clinical guidelines for Attention Deficit and Hyperactivity Disorder throughout life have been published in recent years. The aim is to provide a synthesis of the best available scientific knowledge and facilitate clinical work as well as to make a critical review of the latest clinical guidelines based on treatment and recommendations. Searches of the following databases were performed: MEDLINE/ PubMed/ Index Medicus, PsycINFO/ PsyLIT and the Science Citation Index at Web of Science (ISI). The indexed MeSH terms “ADHD,” “guideline,” “therapeutics” were used for the search, and a total of 10 articles and 9 guides were selected. The guidelines indicate that the diagnosis of ADHD is made by clinical assessment and must be performed by a health professional with training and experience in the disorder. Multimodal treatment is ideal for the integral management of ADHD. Pharmacotherapy remains the first choice treatment for ADHD throughout life, particularly stimulant medication and among them, highlighting treatment with methylphenidate and all guidelines agree that psychological therapy increases the effectiveness of treatment as co-adjuncts to pharmacotherapy.

[Differential perception of gender violence by Romanian immigrants resident in the metropolitan area of Madrid]

INTRODUCTION

Battered women have poorer health. Immigrant women have a higher risk of suffering abuse by their partner, with the most frequent type being psychological abuse. A large percentage of the population living in the health district of Coslada are of Romanian origin, therefore we designed a study aimed at determining whether there are differences between Spanish and Romanian women regarding the perception of different types of violence, expecting to find significant differences.

MATERIAL AND METHODS

A total of 93 people (61.26% Romanian) were included in the study, and who were given a questionnaire with sociodemographic variables, family APGAR, and a questionnaire on perceptions of behaviors related to gender violence. Descriptive statistics and a hierarchical multiple regression analysis was performed on the results.

RESULTS AND CONCLUSIONS

Nearly 30% of women from Romania and 10% of Spanish respondents were considering or had considered being victims of abuse. According to the data, the Romanian-born women in the sample identified easier those behaviours involving physical or sexual violence easier; while, like Spanish women had more difficulty recognizing psychological violence.

Estimation of a multiattribute utility function for the Spanish version of the TooL questionnaire

OBJECTIVES

To estimate and assess the psychometric properties of a multiattribute utility function (MAUF) for the Spanish version of the Tolerability and Quality of Life (TooL questionnaire).

METHODS

Balanced data on 243 patients diagnosed with schizophrenia or bipolar disorder were gathered. In addition to the demographic and clinical variables and the usual generic health-related quality of life (HRQoL) questionnaires (EuroQol-5D [EQ-5D] and Short Form-6D [SF-6D]), instruments considered included the Spanish versions of the Positive and Negative Symptoms of Schizophrenia Scale (PANSS), Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Udvalg for Kliniske Undersogelser (UKU), and Clinical Global Impression Severity (CGIS) scale. MAUF parameters estimation involved a number of visual analogue scale (VAS) and time trade-off (TTO) ratings that proved difficult to be performed by the patients. After checking for inconsistencies in patient responses, the original sample was reduced to a still balanced subsample of 70 individuals. A multiplicative-form MAUF was estimated following the standard methodology.

RESULTS

Good convergent validity was demonstrated because utility estimates from the MAUF presented strong correlations with utilities from the generic HRQoL instruments included: SF-6D (0.66, P < 0.01), EQ-5D (0.69, P < 0.01), and moderate correlations with the rest of instruments considered: PANSS (-0.27, P = 0.10), YMRS (-0.30, P = 0.08), MADRS (-0.48, P < 0.01), UKU (-0.35, P < 0.01). Criterion validity was also met because differences in mean utilities by clinical severity were found (P < 0.01). Utilities from the MAUF covered a wider range of health states [0.04,1.00] than those from the SF-6D [0.53,1.00] and EQ-5D [0.23,0.96].

CONCLUSIONS

Utilities from the MAUF showed good psychometric properties, serving as a complement to generic health utilities. If misapplied, however, utilities from this instrument might favor the positive evaluation of drugs showing fewer associated side effects.

[Nutritional aspects of attention-deficit/hyperactive disorder]

INTRODUCTION

Attention-deficit/hyperactive disorder (ADHD) has received in the past years a lot of attention from the paediatrician's specialties. Even though the studies of its etiopathology have advanced, mainly the ones related with genetics and neuroimaging, the final cause today is still unclear.

DEVELOPMENT

It has been related to many factors such as diet, like some allergies to additives, toxicity to heavy metals and other toxic substances from the environment, due to low protein diets with a high carbohydrate content, unbalanced minerals, essential fatty acids and phospholipid deficit, amino acid deficits, thyroid disorders, and vitamin B complex disorders and phytochemicals. The way our lifestyle has changed in general and the diet in particular nowadays is being considered as a hypothesis for many disorders and health problems, but what about ADHD? One of the changes that we want to emphasize is related to vegetable fat and oils that dominate human consumption and the reduction income of fatty acids from the omega-3 family, including alpha-linolenic acid, eicosapentaenoic acid and docosapentaenoic acid. The fact is even worse when the amount of omega-6 increases and the ratio between both changes.

CONCLUSIONS

It is a fact that these kinds of nutrients play an important role in the nervous system development. In this paper the essential fatty acids in neuropsychiatric disorders in general, ADHD in particular, is reviewed.

[Update on attention-deficit/hyperactive disorder treatment]

INTRODUCTION

Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient's every day life. AIM. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment.

DEVELOPMENT

As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal.

CONCLUSIONS

The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient's family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders' patients.