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  1 / 9053 MEDLINE  
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[PMID]:28463343
[Au] Autor:Correll CU; Yu X; Xiang Y; Kane JM; Masand P
[Ti] Título:Biological treatment of acute agitation or aggression with schizophrenia or bipolar disorder in the inpatient setting.
[So] Source:Ann Clin Psychiatry;29(2):92-107, 2017 05.
[Is] ISSN:1547-3325
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Schizophrenia and bipolar disorders are chronic illnesses that commonly present with symptoms of acute agitation and aggression. These symptoms must be managed rapidly to prevent potential harm to the patient and others, including their caregivers, peers, and health care workers. A number of treatment options are available to clinicians to manage acute agitation and aggression, including non-pharmacologic behavioral and environmental de-escalation strategies, as well as biological treatment options such as pharmacologic agents and electroconvulsive therapy. We summarize the available biological treatment options for patients with schizophrenia or bipolar disorder presenting with acute agitation or aggression in the inpatient setting, focusing on antipsychotics. METHODS: The following searches were used in PubMed to obtain the most relevant advances in treating schizophrenia or bipolar disorder with acute agitation and aggression: (agitation, agitated, aggression, aggressive, hostile, hostility, violent, or violence) and (schizophr*, psychosis, psychot*, psychos*, mania, manic, or bipolar) and (*pharmacologic, antipsychotic*, neuroleptic*, antiepileptic*, anti-seizure*, mood stabilizer*, lithium, benzodiazepine*, beta blocker, beta-blocker, alpha2, alpha-2, *histamine*, electroconvulsive, ECT, shock, or transcranial). Individual searches were performed for each drug class. The studies were limited to peer-reviewed, English-language, and human studies. Most were placebo-controlled randomized controlled trials (RCTs) or meta-analyses. RESULTS: Among pharmacologic agents, antipsychotics, benzodiazepines, anticonvulsants, and lithium have been studied in randomized trials. Some typical and, more recently, atypical antipsychotics are available as both oral and short-acting intramuscular (IM) formulations, with 1 typical antipsychotic also available as an inhalable formulation. CONCLUSIONS: Among the pharmacologic agents studied in RCTs, atypical antipsychotics have the best evidence to support efficacy both in oral and short-acting IM formulations, as well as in one instance in an inhalable formulation.
[Mh] Termos MeSH primário: Transtorno Bipolar
Agitação Psicomotora/terapia
Psicotrópicos/farmacologia
Esquizofrenia/terapia
[Mh] Termos MeSH secundário: Agressão/efeitos dos fármacos
Agressão/psicologia
Transtorno Bipolar/psicologia
Transtorno Bipolar/terapia
Eletroconvulsoterapia/métodos
Serviços de Emergência Psiquiátrica/métodos
Seres Humanos
Agitação Psicomotora/psicologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Psicologia do Esquizofrênico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Psychotropic Drugs)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


  2 / 9053 MEDLINE  
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[PMID]:27771245
[Au] Autor:Dols A; Bouckaert F; Sienaert P; Rhebergen D; Vansteelandt K; Ten Kate M; de Winter FL; Comijs HC; Emsell L; Oudega ML; van Exel E; Schouws S; Obbels J; Wattjes M; Barkhof F; Eikelenboom P; Vandenbulcke M; Stek ML
[Ad] Endereço:Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: a.dols@ggzingeest.nl.
[Ti] Título:Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy.
[So] Source:Am J Geriatr Psychiatry;25(2):178-189, 2017 Feb.
[Is] ISSN:1545-7214
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The clinical profile of late-life depression (LLD) is frequently associated with cognitive impairment, aging-related brain changes, and somatic comorbidity. This two-site naturalistic longitudinal study aimed to explore differences in clinical and brain characteristics and response to electroconvulsive therapy (ECT) in early- (EOD) versus late-onset (LOD) late-life depression (respectively onset <55 and ≥55 years). METHODS: Between January 2011 and December 2013, 110 patients aged 55 years and older with ECT-treated unipolar depression were included in The Mood Disorders in Elderly treated with ECT study. Clinical profile and somatic health were assessed. Magnetic resonance imaging (MRI) scans were performed before the first ECT and visually rated. RESULTS: Response rate was 78.2% and similar between the two sites but significantly higher in LOD compared with EOD (86.9 versus 67.3%). Clinical, somatic, and brain characteristics were not different between EOD and LOD. Response to ECT was associated with late age at onset and presence of psychotic symptoms and not with structural MRI characteristics. In EOD only, the odds for a higher response were associated with a shorter index episode. CONCLUSION: The clinical profile, somatic comorbidities, and brain characteristics in LLD were similar in EOD and LOD. Nevertheless, patients with LOD showed a superior response to ECT compared with patients with EOD. Our results indicate that ECT is very effective in LLD, even in vascular burdened patients.
[Mh] Termos MeSH primário: Idade de Início
Encéfalo/patologia
Transtorno Depressivo/diagnóstico por imagem
Transtorno Depressivo/terapia
Eletroconvulsoterapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Bélgica
Feminino
Seres Humanos
Modelos Logísticos
Estudos Longitudinais
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Análise Multivariada
Países Baixos
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  3 / 9053 MEDLINE  
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[PMID]:29228982
[Au] Autor:Rask O; Suneson K; Holmström E; Bäckström B; Johansson BA
[Ad] Endereço:Department of Clinical Sciences, Division of Pediatrics, Lund University, Lund, Sweden. olof.rask@med.lu.se.
[Ti] Título:Electroconvulsive therapy for manic state with mixed and psychotic features in a teenager with bipolar disorder and comorbid episodic obsessive-compulsive disorder: a case report.
[So] Source:J Med Case Rep;11(1):345, 2017 Dec 12.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Comorbidity of bipolar disorder and obsessive-compulsive disorder is common in adolescence. Obsessive-compulsive disorder symptoms may be episodic and secondary to alterations in mood, and display specific features. Management of pediatric bipolar disorder-obsessive-compulsive disorder is challenging, as pharmacotherapy of obsessive-compulsive disorder may induce or exacerbate manic episodes and there is limited evidence of treatment efficacy. Electroconvulsive therapy is sparsely used in children and adolescents, but is documented to be a safe and efficacious intervention in adults with bipolar disorder. In view of the severity of symptoms in juvenile mania, studies on treatment strategies are warranted. We report a case of an adolescent with bipolar disorder-obsessive-compulsive disorder who was successfully treated with electroconvulsive therapy during an episode of severe mania. CASE PRESENTATION: A 16-year-old girl of Middle East origin first presented to us with depressed mood, irritability, and increased obsessive-compulsive disorder symptoms, which were initially interpreted in the context of acute stress secondary to migration. She had been diagnosed with bipolar disorder and obsessive-compulsive disorder in her previous home country, but had difficulties in accounting for earlier psychiatric history. During hospitalization her mood switched to a manic state with mixed and psychotic features, at times showing aggression toward others. Interruption in her lithium treatment for a short period and possibly the introduction of an atypical antipsychotic could in part have been triggering factors. After 8 weeks of in-patient care and psychotropic drug trials, electroconvulsive therapy was initiated and administered every second or third day for 4 weeks, with marked positive response. No apparent side effects were reported. CONCLUSIONS: This case demonstrates the need for a detailed medical history, taking special note of periodicity and character of obsessive-compulsive disorder symptoms, in adolescents with mood disorders. When treating culturally diverse patients, extra consideration should be taken. Special concerns in the pharmacological treatment to avoid the patient's condition from worsening must be addressed, including giving priority to mood stabilization before obsessive-compulsive disorder symptoms. There are potential benefits in considering electroconvulsive therapy in young patients with severe mania where first-line treatment options have failed.
[Mh] Termos MeSH primário: Transtorno Bipolar/terapia
Eletroconvulsoterapia/métodos
Transtorno Obsessivo-Compulsivo/terapia
Refugiados
[Mh] Termos MeSH secundário: Adolescente
Antimaníacos/uso terapêutico
Antipsicóticos/uso terapêutico
Transtorno Bipolar/epidemiologia
Transtorno Bipolar/psicologia
Comorbidade
Feminino
Haloperidol/uso terapêutico
Seres Humanos
Compostos de Lítio/uso terapêutico
Oriente Médio/etnologia
Transtorno Obsessivo-Compulsivo/epidemiologia
Transtorno Obsessivo-Compulsivo/psicologia
Suécia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antimanic Agents); 0 (Antipsychotic Agents); 0 (Lithium Compounds); J6292F8L3D (Haloperidol)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-017-1508-8


  4 / 9053 MEDLINE  
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[PMID]:29310360
[Au] Autor:Moeller S; Kalkwarf N; Lücke C; Ortiz D; Jahn S; Först C; Braun N; Philipsen A; Müller HHO
[Ad] Endereço:Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy-University Hospital.
[Ti] Título:Achieving stable remission with maintenance electroconvulsive therapy in a patient with treatment-resistant schizophrenia: A case report.
[So] Source:Medicine (Baltimore);96(48):e8813, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Up to one third of all schizophrenic patients are classified as having treatment-resistant schizophrenia (TRS). This subgroup faces remarkable medical and psychosocial damages, and pharmacotherapy is often limited due to nonresponse and/or side effects. Maintenance electroconvulsive therapy (M-ECT) might be effective in TRS. PATIENT CONCERNS: We present a case of a 26-year-old male patient with a TRS. DIAGNOSES: He received a treatment series of ECT sessions and a course of 24 M-ECTs. INTERVENTIONS: The entire treatment was tolerated without significant side effects. OUTCOMES: Moreover, the Psychotic Symptom Rating Scale (PSYRATS) scores for both positive and negative symptoms decreased and remained stable over the course of M-ECT. LESSONS: Because of the remarkable improvement in the negative and positive symptom clusters, we propose systematic examinations in the field of M-ECT in TRS patients. These studies should integrate long-term outcome and tolerance measurements, gaining insight into the optimal duration of treatment for this indication.
[Mh] Termos MeSH primário: Eletroconvulsoterapia/métodos
Esquizofrenia/terapia
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Masculino
Escalas de Graduação Psiquiátrica
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008813


  5 / 9053 MEDLINE  
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[PMID]:28910337
[Au] Autor:van Buel EM; Sigrist H; Seifritz E; Fikse L; Bosker FJ; Schoevers RA; Klein HC; Pryce CR; Eisel UL
[Ad] Endereço:Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, Netherlands.
[Ti] Título:Mouse repeated electroconvulsive seizure (ECS) does not reverse social stress effects but does induce behavioral and hippocampal changes relevant to electroconvulsive therapy (ECT) side-effects in the treatment of depression.
[So] Source:PLoS One;12(9):e0184603, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Electroconvulsive therapy (ECT) is an effective treatment for depression, but can have negative side effects including amnesia. The mechanisms of action underlying both the antidepressant and side effects of ECT are not well understood. An equivalent manipulation that is conducted in experimental animals is electroconvulsive seizure (ECS). Rodent studies have provided valuable insights into potential mechanisms underlying the antidepressant and side effects of ECT. However, relatively few studies have investigated the effects of ECS in animal models with a depression-relevant manipulation such as chronic stress. In the present study, mice were first exposed to chronic social stress (CSS) or a control procedure for 15 days followed by ECS or a sham procedure for 10 days. Behavioral effects were investigated using an auditory fear conditioning (learning) and expression (memory) test and a treadmill-running fatigue test. Thereafter, immunohistochemistry was conducted on brain material using the microglial marker Iba-1 and the cholinergic fibre marker ChAT. CSS did not increase fear learning and memory in the present experimental design; in both the control and CSS mice ECS reduced fear learning and fear memory expression. CSS induced the expected fatigue-like effect in the treadmill-running test; ECS induced increased fatigue in CSS and control mice. In CSS and control mice ECS induced inflammation in hippocampus in terms of increased expression of Iba-1 in radiatum of CA1 and CA3. CSS and ECS both reduced acetylcholine function in hippocampus as indicated by decreased expression of ChAT in several hippocampal sub-regions. Therefore, CSS increased fatigue and reduced hippocampal ChAT activity and, rather than reversing these effects, a repeated ECS regimen resulted in impaired fear learning-memory, increased fatigue, increased hippocampal Iba-1 expression, and decreased hippocampal ChAT expression. As such, the current model does not provide insights into the mechanism of ECT antidepressant function but does provide evidence for pathophysiological mechanisms that might contribute to important ECT side-effects.
[Mh] Termos MeSH primário: Proteínas de Ligação ao Cálcio/metabolismo
Depressão/psicologia
Eletroconvulsoterapia/efeitos adversos
Hipocampo/imunologia
Proteínas dos Microfilamentos/metabolismo
Estresse Psicológico/psicologia
[Mh] Termos MeSH secundário: Animais
Condicionamento (Psicologia)
Depressão/imunologia
Depressão/terapia
Modelos Animais de Doenças
Teste de Esforço
Masculino
Aprendizagem em Labirinto
Camundongos
Estresse Psicológico/imunologia
Estresse Psicológico/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aif1 protein, mouse); 0 (Calcium-Binding Proteins); 0 (Microfilament Proteins)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184603


  6 / 9053 MEDLINE  
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[PMID]:28787312
[Au] Autor:Watts BV
[Ad] Endereço:Dartmouth Medical School, White River Junction, VT, bradley.v.watts@dartmouth.edu.
[Ti] Título:A Time-Out Before Every Electroconvulsive Therapy Treatment-Response to Letter.
[So] Source:J ECT;33(3):219, 2017 09.
[Is] ISSN:1533-4112
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Eletroconvulsoterapia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1097/YCT.0000000000000447


  7 / 9053 MEDLINE  
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[PMID]:28671238
[Au] Autor:Brown AM
[Ti] Título:Reducing Falls After Electroconvulsive Therapy: A Quality Improvement Project.
[So] Source:J Psychosoc Nurs Ment Health Serv;55(7):20-29, 2017 Jul 01.
[Is] ISSN:0279-3695
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Falls after electroconvulsive therapy (ECT) in patients 60 and older have been long recognized as a major clinical care issue across many mental health care settings. The evidence base for fall prevention strategies after receiving ECT is sparse. The risk factors for falls after ECT are vast and complex in nature, especially considering existing comorbid medical conditions. The dearth of research in guiding practitioners on fall reduction interventions for this patient population illuminates a gap in mental health care quality and safety. The purpose of the current nurse-led quality improvement project was to reduce falls in patients undergoing ECT by enhancing safety measures through education and a post-ECT treatment protocol. The project did not prove to be as efficacious as anticipated as measured by fall rate outcomes. Several factors that may account for the project's findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 20-29.].
[Mh] Termos MeSH primário: Acidentes por Quedas/prevenção & controle
Eletroconvulsoterapia/métodos
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Idoso
Eletroconvulsoterapia/enfermagem
Seres Humanos
Serviços de Saúde Mental
Meia-Idade
Papel do Profissional de Enfermagem
Educação de Pacientes como Assunto
Fatores de Risco
Segurança
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.3928/02793695-20170619-04


  8 / 9053 MEDLINE  
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[PMID]:28658489
[Au] Autor:Slade EP; Jahn DR; Regenold WT; Case BG
[Ad] Endereço:Department of Psychiatry, University of Maryland School of Medicine, Baltimore2US Department of Veterans Affairs, Veterans Affairs Capitol Healthcare Network, Mental Illness Research, Education, and Clinical Center, Baltimore, Maryland.
[Ti] Título:Association of Electroconvulsive Therapy With Psychiatric Readmissions in US Hospitals.
[So] Source:JAMA Psychiatry;74(8):798-804, 2017 Aug 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Although electroconvulsive therapy (ECT) is considered the most efficacious treatment available for individuals with severe affective disorders, ECT's availability is limited and declining, suggesting that information about the population-level effects of ECT is needed. Objective: To examine whether inpatient treatment with ECT is associated with a reduction in 30-day psychiatric readmission risk in a large, multistate sample of inpatients with severe affective disorders. Design, Setting, and Participants: A quasi-experimental instrumental variables probit model of the association correlation of ECT administration with patient risk of 30-day readmission was estimated using observational, longitudinal data on hospital inpatient discharges from US general hospitals in 9 states. From a population-based sample of 490 252 psychiatric inpatients, a sample was drawn that consisted of 162 691 individuals with a principal diagnosis of major depressive disorder (MDD), bipolar disorder, or schizoaffective disorder. The key instrumental variable used in the analysis was ECT prevalence in the prior calendar year at the treating hospital. To examine whether ECT's association with readmissions was heterogeneous across population subgroups, analyses included interactions of ECT with age group, sex, race/ethnicity, and diagnosis group. The study was conducted from August 27, 2015, to March 7, 2017. Main Outcome and Measures: Readmission within 30 days of being discharged. Results: Overall, 2486 of the 162 691 inpatients (1.5%) underwent ECT during their index admission. Compared with other inpatients, those who received ECT were older (mean [SD], 56.8 [16.5] vs 45.9 [16.5] years; P < .001) and more likely to be female (65.0% vs 54.2%; P < .001) and white non-Hispanic (85.3% vs 62.1%; P < .001), have MDD diagnoses (63.8% vs 32.0%; P < .001) rather than bipolar disorder (29.0% vs 40.0%; P < .001) or schizoaffective disorder (7.1% vs 28.0%; P < .001), have a comorbid medical condition (31.3% vs 26.6%; P < .001), have private (39.4% vs 21.7%; P < .001) or Medicare (49.2% vs 39.4%; P < .001) insurance coverage, and be located in urban small hospitals (31.2% vs 22.3%; P < .001) or nonurban hospitals (9.0% vs 7.6%; P = .02). Administration of ECT was associated with a reduced 30-day readmission risk among psychiatric inpatients with severe affective disorders from an estimated 12.3% among individuals not administered ECT to 6.6% among individuals administered ECT (risk ratio [RR], 0.54; 95% CI, 0.28-0.81). Significantly larger associations with ECT on readmission risk were found for men compared with women (RR, 0.44; 95% CI, 0.20-0.69 vs 0.58; 95% CI, 0.30-0.88) and for individuals with bipolar disorder (RR, 0.42; 95% CI, 0.17-0.69) and schizoaffective disorder (RR, 0.44; 95% CI, 0.11-0.79) compared with those who had MDD (RR, 0.53; 95% CI, 0.26-0.81). Conclusions and Relevance: Electroconvulsive therapy may be associated with reduced short-term psychiatric inpatient readmissions among psychiatric inpatients with severe affective disorders. This potential population health effect may be overlooked in US hospitals' current decision making regarding the availability of ECT.
[Mh] Termos MeSH primário: Transtorno Bipolar/terapia
Transtorno Depressivo Maior/terapia
Eletroconvulsoterapia/estatística & dados numéricos
Hospitais Gerais/estatística & dados numéricos
Readmissão do Paciente/estatística & dados numéricos
Transtornos Psicóticos/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Estudos Longitudinais
Masculino
Meia-Idade
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2017.1378


  9 / 9053 MEDLINE  
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[PMID]:28636570
[Au] Autor:Gazdag G; Dragasek J; Takács R; Lõokene M; Sobow T; Olekseev A; Ungvari GS
[Ad] Endereço:Centre for Psychiatry and Addiction Medicine, Szt. István and Szt. László Hospitals, Budapest, Gyáli út 17-19. 1097 Hungary, gazdag@lamb.hu.
[Ti] Título:Use of Electroconvulsive Therapy in Central-Eastern European Countries: an Overview.
[So] Source:Psychiatr Danub;29(2):136-140, 2017 Jun.
[Is] ISSN:0353-5053
[Cp] País de publicação:Croatia
[La] Idioma:eng
[Ab] Resumo:Though a number of reports on the use of electroconvulsive therapy (ECT) has been published from the Central-Eastern European region over the past two decades, a systematic review of this literature has not been published. Thus the aim of this paper was to review recent trends in ECT practice in Central-Eastern Europe. Systematic literature search was undertaken using the Medline, PSYCHINFO and EMBASE databases covering the period between January 2000 and December 2013. Relevant publications were found from the following countries: Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, Ukraine, but none from Albania and Moldova. ECT practice in the region shows a heterogeneous picture in terms of utilization rate, main indications, and the technical parameters of application. On one end of the spectrum is Slovakia where the majority of psychiatric facilities offer ECT, on the other end is Slovenia, where ECT is banned. In about half of the countries schizophrenia is the main indication for ECT. In Ukraine, unmodified ECT is still in use. Clinical training is generally lacking in the region and only 3 countries have a national ECT protocol. Possible ways of improving ECT practice in the region are briefly discussed.
[Mh] Termos MeSH primário: Eletroconvulsoterapia/utilização
Transtornos do Humor/terapia
Esquizofrenia/terapia
Psicologia do Esquizofrênico
[Mh] Termos MeSH secundário: Comparação Transcultural
Europa (Continente)
Seres Humanos
Transtornos do Humor/psicologia
Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170622
[St] Status:MEDLINE


  10 / 9053 MEDLINE  
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[PMID]:28570803
[Au] Autor:Andrade C
[Ad] Endereço:Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. candrade@psychiatrist.com.
[Ti] Título:Ketamine for Depression, 2: Diagnostic and Contextual Indications.
[So] Source:J Clin Psychiatry;78(5):e555-e558, 2017 May.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is a substantial body of literature comprising anecdotal material and descriptions of uncontrolled and randomized controlled trials addressing the use of subanesthetic doses of ketamine for the off-label treatment of major depressive episodes. This article examines diagnostic indications for the off-label use of ketamine as an antidepressant and possible contexts in which ketamine may be trialled. Ketamine is indicated in patients who are in a major depressive episode. Most of the research data have been collected from patients with major depressive disorder, but patients with bipolar depression have also been studied. Ketamine is effective in both diagnostic groups, but its benefits are impermanent, perhaps more so in bipolar depression. There are several contexts within this diagnostic framework when a ketamine trial may be considered. These include severe depression and depression that is refractory to conventional antidepressant medication; this is because there is little purpose in trialling an experimental treatment in patients who are less severely ill and those who are antidepressant responsive. More importantly, ketamine has demonstrated efficacy in the rapid reduction of suicidal symptoms and can therefore be trialled when rapid reduction in suicidality is necessary. Likewise, because of its swift and dramatic antidepressant action, it can be trialled in patients in whom improvement is urgently desired in order to allow the patient to attend to pressing life circumstances. Some data suggest that the use of ketamine early during the course of an antidepressant trial, or as anesthesia during electroconvulsive therapy, can improve early antidepressant outcomes. It is not clear whether the presence of psychotic symptoms is a contraindication for ketamine use. Issues related to these indications and contexts are briefly discussed.
[Mh] Termos MeSH primário: Transtorno Bipolar/diagnóstico
Transtorno Bipolar/tratamento farmacológico
Transtorno Depressivo Maior/diagnóstico
Transtorno Depressivo Maior/tratamento farmacológico
Ketamina/uso terapêutico
Uso Off-Label
[Mh] Termos MeSH secundário: Antidepressivos/uso terapêutico
Transtorno Bipolar/psicologia
Ensaios Clínicos como Assunto
Transtorno Depressivo Maior/psicologia
Resistência a Medicamentos
Eletroconvulsoterapia
Seres Humanos
Ketamina/efeitos adversos
Ideação Suicida
Suicídio/prevenção & controle
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antidepressive Agents); 690G0D6V8H (Ketamine)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170616
[Lr] Data última revisão:
170616
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170602
[St] Status:MEDLINE



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