scholarly journals A comparison of stimulus dosing methods for electroconvulsive therapy

2000 ◽  
Vol 24 (5) ◽  
pp. 184-187 ◽  
Author(s):  
J. Laidlaw ◽  
P. Bentham ◽  
G. Khan ◽  
V. Staples ◽  
A. Dhariwal ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Initial Treatment ◽  
Fixed Dose ◽  
Dose Titration ◽  
Titration Method ◽  
Dose Prediction ◽  
Dose Method ◽  
Treatment Dose ◽  
A Prospective Study ◽  
Therapy Treatment

Aims and MethodsA prospective study comparing initial electroconvulsive therapy treatment doses determined by empirical dose titration with estimates derived from two simple dose prediction methods and a fixed-dose regimen (275 mC).ResultsThirty-three patients had seizure thresholds between 25 mC and 403 mC. The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC). Estimates were within acceptable limits in 33% of cases for the age method, 64% for the half-age method and 40% for the fixed-dose method.Clinical ImplicationsEither dose prediction or dose titration methods may be more appropriate in different clinical situations. The half-age method appears to be a more accurate predictor of optimum initial treatment dose.

Value of the initial stimulus dose in right unilateral and bifrontal electroconvulsive therapy

1999 ◽  
Vol 29 (6) ◽  
pp. 1417-1423 ◽  
Author(s):  
P. HEIKMAN ◽  
A. TUUNAINEN ◽  
K. KUOPPASALMI
Keyword(s):  
Electroconvulsive Therapy ◽  
Threshold Level ◽  
Seizure Threshold ◽  
Dose Titration ◽  
High Dose ◽  
Titration Method ◽  
Initial Stimulus ◽  
Dose Method ◽  
High Stimulus ◽  
The Individual

Background. The outcome of electroconvulsive therapy (ECT) is affected by the placement and dose of the stimulus. In general, the ECT dose can be selected either by the dose-titration method (on which the measured seizure threshold level is based), or the method of predetermined dose (e.g. the age-based dosing and the fixed high dose method).Methods. Seizure thresholds were measured in 50 patients with right unilateral (RUL) and in 30 patients with experimental bifrontal (BF) ECT stimulus. The ECT dose (mC) of the age-based dosing was calculated by multiplying the age (years) by 5·0 (age method) or 2·5 (half-age method). The fixed high dose was set to 378 mC.Results. The seizure thresholds had only a moderate correlation with the age of the patients. The methods based on the predetermined dose would have led us to give patients with the lowest seizure thresholds in the RUL ECT group very high stimulus doses, up to 12 (age method) or 15 (fixed high dose method) times the individual seizure threshold. In contrast, the RUL ECT patients with the highest seizure thresholds would have received low stimulus doses down to 1·5 times (half-age method) the initial seizure threshold. In the BF ECT group the-age based dose would have been similarly dependent on the initial seizure threshold level.Conclusion. The use of the dose-titration method is recommended, because it is the only method that allows for the individual selection of ECT stimulus dose relative to the seizure threshold.

scholarly journals Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

2016 ◽  
Vol 28 (6) ◽  
pp. 1051-1052
Author(s):  
Craig D'Cunha ◽  
Christos Plakiotis ◽  
Daniel W. O'Connor
Keyword(s):  
Side Effects ◽  
Older People ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Seizure Duration ◽  
New Learning ◽  
Prescription Rates ◽  
Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

scholarly journals Audit of compliance with WHO surgical safety checklist (modified for electroconvulsive therapy including NPSA advice)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S64-S64
Author(s):  
Faisal Alam ◽  
Rizwan Ashraf ◽  
Kyaw Sein ◽  
Terri Feeney
Keyword(s):  
Patient Safety ◽  
Electroconvulsive Therapy ◽  
Time Pressure ◽  
Clinical Situation ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
National Patient ◽  
Service Standards ◽  
Therapy Treatment

AimsThis audit aims to evaluate the compliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment in ECT clinic at Greater Manchester Mental Health Bolton Directorate. The audit is based on WHO surgical safety checklist modified for ECT including National Patient Safety Agency advice. The goal is to improve the compliance and in turn improve clinical outcomes.BackgroundThe WHO surgical safety checklist (modified for Electroconvulsive therapy including NPSA advice) is devised to promote patient safety, improve teamwork, reduce errors/adverse events and improve overall quality of care. An audit was completed regarding the compliance with the safety checklist at the Bolton ECT clinic and to assess how this could be improved.MethodFollowing approval from the clinical audit department, GMMH NHS Foundation Trust, 20 checklists from randomly selected patient ECT files were included in this audit. We looked at whether the checklists were completed, signed and dated. Our current WHO surgical safety checklist is as per the Electroconvulsive therapy accreditation service standards.ResultA total of 20 WHO surgical safety checklists were reviewed. 95% of the checklists (19/20) were completed by the duty Psychiatrist. 1 form was not completed. 25% (5/20) were not signed rendering them invalid. A total of 75% checklists were complete and valid. Checklists were present in all the case notes.ConclusionCompliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment can be challenging due to various reasons ranging from time pressure to difficult clinical situation. This audit has highlighted that the overall compliance with the set standards (100% completion) was not achieved. A repeat audit will be important to further improve the compliance and overall clinical outcome.

The clinical relevance of dose titration in electroconvulsive therapy: A systematic review of the literature

2020 ◽  
Vol 294 ◽  
pp. 113497 ◽  
Author(s):  
Marilyne Landry ◽  
Simon Lafrenière ◽  
Simon Patry ◽  
Stéphane Potvin ◽  
Morgane Lemasson
Keyword(s):  
Systematic Review ◽  
Electroconvulsive Therapy ◽  
Clinical Relevance ◽  
Dose Titration ◽  
Review Of The Literature

scholarly journals Recovery after ECT: comparison of propofol, etomidate and thiopental

2008 ◽  
Vol 30 (2) ◽  
pp. 149-151 ◽  
Author(s):  
Moacyr A Rosa ◽  
Marina O Rosa ◽  
Iara M T Belegarde ◽  
Celso R Bueno ◽  
Felipe Fregni
Keyword(s):  
Electroconvulsive Therapy ◽  
Electric Charge ◽  
Seizure Threshold ◽  
Recovery Profile ◽  
Different Types ◽  
The Mean ◽  
Hypnotic Drugs ◽  
To Receive ◽  
Mean Time ◽  
Therapy Treatment

OBJECTIVES: To compare post anesthetic time for patient recovery after electroconvulsive therapy, as measured by the post anesthetic Recovery Score of Aldrete and Kroulik, using three different types of hypnotic drugs (propofol, etomidate and thiopental). METHOD: Thirty patients were randomized to receive one of the three drugs (n = 10 in each group), during a course of electroconvulsive therapy treatment. Patients and raters were blinded to which drug was received. Main treatment characteristics were recorded (as total electric charge received seizure threshold, number of treatments, and the mean time for recovery) along the whole treatment. RESULTS: Thiopental and propofol were associated with a significance increase in charge needed to induce a seizure (p < 0.0001) when compared to etomidate, as well as a significant decrease of time for recovery (p = 0.042). CONCLUSIONS: These findings suggest that, although there seems to be no difference in the clinical outcome across these three drugs, propofol offers the best recovery profile. However, it makes a higher mean electric charge necessary.

Are recent statin recommendations to employ fixed doses and abandon targets effective for treatment of hypercholesterolaemia? Investigation based on number needed to treat

2016 ◽  
Vol 24 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Handrean Soran ◽  
Safwaan Adam ◽  
Paul N Durrington
Keyword(s):  
Secondary Prevention ◽  
Moderate Intensity ◽  
Fixed Dose ◽  
Dose Titration ◽  
Number Needed To Treat ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Cholesterol Lowering ◽  
Cholesterol Levels ◽  
Lowering Therapy

Background Assessed by number needed to treat (NNT) to prevent one event, it was previously shown that for those at similar atherosclerotic cardiovascular disease (CVD) risk, the benefit accruing from treating people with higher cholesterol levels with statins is greater than for those with lower levels. Method By estimating NNT from both the absolute atherosclerotic cardiovascular risk and the pre-treatment low density lipoprotein cholesterol (LDL-C) concentration, recent recommendations for fixed dose high and moderate intensity statin treatment in the primary and secondary prevention of CVD were compared with cholesterol-lowering therapy aimed at a target LDL-C. Results We report that the USA and UK recommendations to employ a fixed dose of atorvastatin 20 mg daily for primary prevention will produce good results in people with low cholesterol levels, but are a disadvantage for those with higher levels who benefit more from a therapeutic target and statin dose titration and, where necessary, adjunctive cholesterol-lowering therapy to achieve this target. The higher dose of atorvastatin 80 mg daily with no target recommended for secondary prevention is generally more effective than aiming for a LDL-C goal except in people with particularly high cholesterol. Conclusion For optimum clinical effectiveness, initial LDL-C concentration must be considered in deciding whether a target will allow a greater decrease in LDL-C and thus a lower NNT than a fixed dose regimen. Individual variation in the LDL-C response to statins also makes post-treatment cholesterol measurement essential.

Managing the Patient with Multidrug-Resistant HIV

2017 ◽  
Author(s):  
Ye Thu ◽  
Naiel Nassar
Keyword(s):  
Hiv Infection ◽  
Treatment Guidelines ◽  
Virologic Failure ◽  
Multidrug Resistant ◽  
Fixed Dose ◽  
Combination Product ◽  
The Past ◽  
Antiretroviral Medication ◽  
Dose Combination ◽  
Therapy Treatment

During approximately the past 15 years, HIV infection has been transformed into a chronic manageable disease primarily due to the effectiveness of antiretroviral therapy. Treatment guidelines emphasize the need for at least two or preferably three fully active medications in the salvage regimens of patients experiencing virologic failure. The new regimen should be started with as little interruption as possible because the structured interruption of treatment in patient with multidrug-resistant HIV infection is associated with greater progression of the disease. The new pharmacokinetic enhancer, cobicistat, is available as a fixed-dose combination product with antiretroviral medication that allows the treatment to be simplified and reduces the pill burden.

Sign in / Sign up

Export Citation Format

Share Document