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ECT for Catatonia from Hypoxic-Ischemic Brain Injury

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Out on PubMed, from clinicians at NYU, is this case report:Successful Use of Electroconvulsive Therapy for Catatonia After Hypoxic-Ischemic Brain Injury.Kim K, Anbarasan D, Caravella RA, Nally E, Ying P, Gurin L.Psychosomatics. 2020 Sep 2:S0033-3182(20)30243-7. doi: 10.1016/j.psym.2020.08.009. Online ahead of print.PMID: 33023757 A small portion of the text of the case report is excerpted below (the pdf is not available without permission):


This is an interesting and well-written case report. The theoretical discussion about the medical/neuropsychiatric contexts in which catatonia may appear is thoughtful. What is distressing is the tentative and ineffectual ECT that was initially prescribed for the patient, and the obsessional, repetitive exaggeration of the risks of cognitive adverse effects in the text, thinking that also seemed to drive the clinical decisions. Mature clinical decision-making involves carefully balancing risks and benefits, but also understanding the seriousness of a p…

Systematic Review of Dose Titration in ECT

Out on Pubmed, from researchers in Montreal, Quebec, Canada is this systematic review:The clinical relevance of dose titration in electroconvulsive therapy: A systematic review of the literature.Landry M, Lafrenière S, Patry S, Potvin S, Lemasson M.Psychiatry Res. 2020 Oct 3;294:113497. doi: 10.1016/j.psychres.2020.113497. Online ahead of print.PMID: 33039882 The abstract is copied below:
Electroconvulsive therapy is a highly effective treatment of several psychiatric disorders. The debate regarding which charge dosing method offers the most favorable risk-benefit ratio remains. Our objective was to review the comparative evidence regarding efficacy and tolerability of dose titration (DT) vs other charge dosing methods, such as the age-based method (ABM) and the fixed dose method. Our secondary objective was to examine which populations would most benefit from DT. We conducted a systematic review of the literature in March 2020. Studies comparing DT to another charge dosing method were …

Propofol-Ketamine Combination: Negative Results From a Small Study

Out on Pubmed, from researchers in France and Canada, is this study:The Combination of Propofol and Ketamine Does Not Enhance Clinical Responses to Electroconvulsive Therapy in Major Depression-The Results From the KEOpS Study.Brunelin J, Iceta S, Plaze M, Gaillard R, Simon L, Suaud-Chagny MF, Galvao F, Poulet E.Front Pharmacol. 2020 Sep 15;11:562137. doi: 10.3389/fphar.2020.562137. eCollection 2020.PMID: 33041803 The abstract is copied below:
Objective: We investigated the clinical effects of the combination of ketamine and propofol as anesthetic agents during electroconvulsive therapy (ECT) in patients with uni- or bipolar major depressive episodes. We hypothesized that ketamine may confer short- and long- term advantages in improving depressive symptoms at the early stages of ECT.

Methods: In a randomized placebo-controlled trial, remission rates after 4 and 8 weeks of ECT were compared between patients who were randomly allocated to receive either the combination of ketamine (0.5 mg/…

Attitudes About ECT in Hungary

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Out on PubMed, from researchers in Hungary, is this article:[The public's attitudes towards electroconvulsive therapy in Hungary].Asztalos M, Könye P, Gazdag G.Ideggyogy Sz. 2020 Sep 30;73(9-10):311-316. doi: 10.18071/isz.73.0311.PMID: 33035417 The abstract is copied below:
Background and purpose: This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public's attitude towards ECT, and no such study has been published from Hungary.

Methods: Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers.

Results: The result showed a significan…

Classics in ECT: Very Early Use of Anesthesia (1946)

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The pdf is here.This is a fascinating report of the early use of barbiturate anesthesia for ECT. It has both archaic and modern features, and is very well written. Note the reference to trying to use the initial phase of barbiturate hypnosis to obtain "psychogenic material" through "narcoanalysis," as in an amytal interview. Also, the discussion of maintenance ECT is surprisingly au courant.

Classics in ECT- Fred Frankel's Discussion of Special Section on ECT, American Journal of Psychiatry ,1977

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The pdf is here.This is Dr. Frankel's (Chair of the 1978 APA Task Force on ECT) thoughtful discussion of the five articles that comprise the Special Section on ECT in the September, 1977 issue of the American Journal of Psychiatry. Particularly good reading is his scathing rebuke of the anti-ECT neurologist, John Friedberg. The critiques of the other four papers are also definitely worth reading (20 minutes).(Please see also blog post of October 9, 2010)

ECT for NMS-Case Report from Portugal

Out on PubMed, from clinicians in Lisbon, Portugal, is this case report:Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report.Maia A, Cotovio G, Barahona-Corrêa B, Oliveira-Maia AJ.Acta Med Port. 2020 Sep 30. doi: 10.20344/amp.13019. Online ahead of print.PMID: 32997617 From the text: CASE REPORT
A 66-year-old man with prior diagnosis of schizophrenia was admitted to an ICU due to respiratory infection and septic shock syndrome, evolving rapidly to stupor and respiratory failure, and requiring sustained sedation for orotracheal intubation. At admission, all psychiatric medication was discontinued, and a course of empirical antibiotic treatment was started. Three days later, upon improvement of respiratory function and laboratory parameters, propofol was interrupted and the patient was extubated. However, leukocytosis and mild elevations of lactate dehydrogenase and liver transaminases persisted, despite normal creatine kinase levels. In the …