The problem of this investigation is twofold. First, to demonstrate the effects of the variation of convulsive-nonconvulsive electroshock treatment used in this study in relation to memory alteration in schizophrenia as measured by the Wechsler Memory Scale. Second, to determine those aspects of memory that are the most affected, and those that are the least affected by this form of treatment.

Reliable observation of ECT-induced hormone release requires that other processes that affect hormone levels remain constant and not obscure it. This article reviews principles and pitfalls in making such observations. Clinical applicability and limitations of measurements of prolactin, cortisol, oxytocin, in vasopressin, and other hormones are described. Applications, include elucidation of ECT physiology and seizure quality, comparison of ECT techniques, and description of illness severity. Accounting for each of these different effects can be needed to characterize any of them. An important but unrealized application of neuroendocrine measurement is prediction of the stability of individual ECT response.

No description available.

The purpose was to investigate some aspects of epidemiology, risk factors and treatment with ECT in advanced Parkinson’s disease (PD). In study I, we performed a descriptive epidemiologic population-based survey in the Central Health Care District in Östergötland in south-east Sweden, with a population of almost 150,000 inhabitants 1989. The case finding was accomplished in three ways: 1. Collection of all prescriptions for Parkinson’s disease. 2. Search in medical files. 3. Checking with all nursing homes in the area. The crude prevalence was found to be 115 per 100,000 inhabitants. When we used the European Standard Population as a tool for easy comparisons of PD prevalence between different areas and time periods 76 PD-cases per 100,000 inhabitants were found. The corresponding incidences were 11.0 (crude) and 7.9 (age standardised) per 100,000 person-years. Mean age at onset was 65.6. A low prevalence and a high age at onset suggested that e.g. environmental factors could influence the occurrence of PD, and the results implies that only few such factors were present in the investigated area. The findings led to study II, a case-control study which investigated the possible impact of nutritional and environmental risk factors for idiopathic Parkinson’s disease (IP), including 113 cases and 263 control subjects. Dietary, drinking, and smoking habits, as well as previous occupation, were requested in a structured questionnaire. No increased risk was found for any of the nutrients. A reduced risk was found for coffee, wine, and spirits but also for broiled meat, smoked ham or meat, eggs, French loaf or white bread, and tomatoes. These findings could indicate an antioxidant effect. Frequency of preceding and present smoking was reduced in IP patients. Possible mechanisms are discussed. Various occupational groups and exposures were analysed and increased risks of IP in men were found for agricultural work, pesticide exposure, male carpenters, and in female cleaners. In advanced PD there is a need for further therapeutic improvements, and electroconvulsive therapy (ECT) is one insufficiently explored and evaluated method. In study III ECT 16 non-depressed, nondemented PD patients with advanced disease were treated with ECT. In all patients an antiparkinsonian effect of ECT was seen, lasting between a few days and 18 months. Five patients, all with signs of blood brain barrier damage, developed transitory mental confusion after ECT. The results indicated that ECT could cause increased dopaminergic activity, which led us to study IV. Single photon emission computed tomography (SPECT) with the cocaine analogue [123I]-β-CIT was used in order to visualise dopaminergic neurones in the brain. Six patients with PD were examined before and after a series of ECT, and in three cases SPECT was also repeated after one year. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with most pronounced symptomatology. No significant change in uptake of [123I]-β-CIT was seen after ECT, although all patients improved and the most pronounced improvement was seen in patients with less advanced PD. Study V points at two new positive observations with maintenance ECT (MECT). i.e. repeated ECT treatment of PD. One patient had either severe mental side effects on higher L-dopa doses or intolerable parkinsonian symptoms on lower doses. MECT implied marked improvement in parkinsonian symptoms without mental side effects. Another PD patient, who also had a mental depression, showed slight improvement of motor symptoms on a series of ECT. When treated with MECT further antiparkinsonian effects were seen. / On the day of the public defence the status of the article IV was: Submitted; articel V was: Accepted for publication after revision.

No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23076号 / 医博第4703号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 花川 隆, 教授 古川 壽亮, 教授 髙橋 良輔 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

While the learned helplessness effect has been reliably found in dogs and other species (e.g., cats, mice, fish, and humans), it has been somewhat difficult to obtain in rats. In addition, it has been demonstrated that electroconvulsive shock (ECS) reverses learned helplessness in dogs, but ECS induced reversal has not been demonstrated in the rat. Thus, the purpose of this dissertation was twofold: (1) to determine if the learned helplessness effect could be reliably demonstrated in rats; and (2) if so, will a single ECS attenuate this phenomenon. If it could be shown that ECS attenuates helplessness, then two purposes would be served: (a) it would extend the generality of learned helplessness theory by indicating additional parallels between dog helplessness and rat helplessness; and (b) it would expand the parallels between learned helplessness and human depression, thereby increasing the validity of the learned helplessness model of depression. In Experiment 1, rats were randomly assigned to one of three groups: escape, yoked-inescapable, and no shock control. Each rat in the escape group received 80 trials of unsignaled escapable shock. The escape group rats were required to perform a progressive fixed-ratio bar press to escape shock. The yoked-inescapable group received exactly the same intensity, frequency, and duration of shock its escape partner received; but no response would escape shock. The no-shock control group received only pre-exposure to the training apparatus. The following day all rats were tested on a FR-2 shuttlebox escape/avoidance task. After test, half the rats in each group were given a single ECS and then were retested 24 hours later in the shuttlebox. The learned helplessness effect was clearly demonstrated during the test phase. In addition, a single ECS attenuated the learned helplessness effect in rats. In Experiment 2 rats were given training exactly as described in Experiment 1. Following training, one-third of the rats in the escape and yoked-inescapable groups were given a single ECS immediately, one-third were given a single ECS 23.5 hours later, and one-third received no treatment. In the no-shock control group one-third of the rats were given a single ECS 24 hours prior to test, one-third of the rats were given ECS 30 minutes prior to test, and one-third of the rats were not given ECS. Then, all rats were tested 24 hours following training. The test session was identical to the test session in Experiment 1. The learned helplessness effect was clearly demonstrated during test in the NO-ECS condition. In addition, it was demonstrated that ECS attenuates or reverses learned helplessness training when given immediately following training. Delayed ECS also reverses helplessness, but less dramatically than immediate ECS. In both experiments the criteria which characterize learned helplessness were matched: (1) Failure to initiate the escape response in the presence of shock; (2) failure to maintain escape behavior even after occasional escape response occur; and (3) that conditions 1 and 2 above are a result of inescapability and not a result of shock per se. In addition, since ECS attenuates helplessness, the generality of helplessness theory was extended to rats, and the validity of learned helplessness model of depression was strengthened. / Doctor of Philosophy

Os estudos publicados nos últimos anos sobre a utilização da estimulação magnética transcraniana de repetição (EMTr) têm sugerido significativas ações antidepressivas. Neste trabalho foi realizado um estudo comparativo da EMTr com a eletroconvulsoterapia (ECT) que é um método consagrado para o tratamento de transtornos depressivos. Foi feita, em primeiro lugar, uma extensa revisão a respeito destes dois métodos de tratamento não medicamentoso, expondo a sua história, a sua eficácia, as principais indicações, contra-indicações e efeitos colaterais, além dos possíveis mecanismos de ação, que ainda não estão completamente esclarecidos. A seguir foi realizado um ensaio clínico controlado, randomizado, simples-cego, comparando a eficácia de ambos para o tratamento da Depressão Maior unipolar refratária, sem sintomas psicóticos, com indicação de ECT. Também foi realizada uma avaliação dos efeitos cognitivos, especialmente da memória. Trinta e cinco pacientes foram incluídos. A eletroconvulsoterapia foi realizada com indução anestésica geral e relaxamento muscular. Foram feitas aplicações na posição unilateral direita com carga 4,5 vezes o limiar convulsígeno. A EMTr foi aplicada no córtex pré-frontal dorso-lateral esquerdo com intensidade de 100% do limiar motor. Os pacientes receberam 20 sessões (cinco dias por semana por quatro semanas), com 25 séries de estimulação por dia (com freqüência de 10 Hz por 10 segundos, com intervalos de 20 segundos). As escalas de avaliação foram aplicadas nos tempos basal, após duas semanas de tratamento e após quatro semanas de tratamento. Ambos os tratamentos tiveram eficácia equivalente, com uma taxa de redução média dos escores na escala de Hamilton para depressão de 42 %, uma resposta clínica de 46 % e uma taxa de remissão de 14%. A EMTr apresentou um perfil mais benigno de efeitos colaterais (cefaléia em 1 %). A ECT resultou em cefaléia (em 20 %) e náuseas (em 10%).Não houve diferença nos efeitos cognitivos entre os dois tratamentos, tendo ambos se mostrado bastante benignos. Este estudo é uma contribuição para a crescente literatura a respeito do assunto e sugere um efeito antidepressivo da EMTr, comparável ao da ECT em pacientes com depressão maior unipolar sem sintomas psicóticos / Studies published over the past few years suggest that repetitive transcranial magnetic stimulation (rTMS) may have significant antidepressant actions. This work performs a comparison between rTMS and electroconvulsive therapy (ECT), an established method to treat depression disorders. First there was an extensive review on the knowledge of both non pharmacological treatments including their history, efficacy, main indications, contraindications and side effects, in addition to the possible mechanisms of action, not yet fully understood. After that, a controlled randomized, single-blind clinical trial was conducted, comparing the efficacy to treat unipolar resistant nonpsychotic major depression that were referred to receive ECT. An evaluation of cognitive effects was also performed, specially memory effects. Thirty five patients were included. Electroconvulsive therapy was performed with general anesthesia and muscular relaxation. Right unilateral electrodes positioning was used, with a charge 4.5 times the convulsive threshold. rTMS was performed over the left dorsolateral prefrontal cortex at 100% motor threshold. Patients were treated with 20 sessions (five times per week for four weeks) with 25 trains a day (frequency of 10 Hz, duration of 10 seconds with 20 seconds intertrain interval). Patients were evaluated at baseline, after two weeks and after four weeks of either treatment. Both groups were equivalent in efficacy, showing a means of reduction on Hamilton depression rating scale of 42%, an overall clinical response of 46% and a remission rate of 14%. rTMS showed a more benign profile regarding side effects (headache on 1%). ECT induced headache (20%) and nausea (10%). No cognitive effects were observed on either treatments. This study adds to the growing literature supporting an antidepressant effect for rTMS, similar to ECT on patients with unipolar nonpsychotic major depression

Os estudos publicados nos últimos anos sobre a utilização da estimulação magnética transcraniana de repetição (EMTr) têm sugerido significativas ações antidepressivas. Neste trabalho foi realizado um estudo comparativo da EMTr com a eletroconvulsoterapia (ECT) que é um método consagrado para o tratamento de transtornos depressivos. Foi feita, em primeiro lugar, uma extensa revisão a respeito destes dois métodos de tratamento não medicamentoso, expondo a sua história, a sua eficácia, as principais indicações, contra-indicações e efeitos colaterais, além dos possíveis mecanismos de ação, que ainda não estão completamente esclarecidos. A seguir foi realizado um ensaio clínico controlado, randomizado, simples-cego, comparando a eficácia de ambos para o tratamento da Depressão Maior unipolar refratária, sem sintomas psicóticos, com indicação de ECT. Também foi realizada uma avaliação dos efeitos cognitivos, especialmente da memória. Trinta e cinco pacientes foram incluídos. A eletroconvulsoterapia foi realizada com indução anestésica geral e relaxamento muscular. Foram feitas aplicações na posição unilateral direita com carga 4,5 vezes o limiar convulsígeno. A EMTr foi aplicada no córtex pré-frontal dorso-lateral esquerdo com intensidade de 100% do limiar motor. Os pacientes receberam 20 sessões (cinco dias por semana por quatro semanas), com 25 séries de estimulação por dia (com freqüência de 10 Hz por 10 segundos, com intervalos de 20 segundos). As escalas de avaliação foram aplicadas nos tempos basal, após duas semanas de tratamento e após quatro semanas de tratamento. Ambos os tratamentos tiveram eficácia equivalente, com uma taxa de redução média dos escores na escala de Hamilton para depressão de 42 %, uma resposta clínica de 46 % e uma taxa de remissão de 14%. A EMTr apresentou um perfil mais benigno de efeitos colaterais (cefaléia em 1 %). A ECT resultou em cefaléia (em 20 %) e náuseas (em 10%).Não houve diferença nos efeitos cognitivos entre os dois tratamentos, tendo ambos se mostrado bastante benignos. Este estudo é uma contribuição para a crescente literatura a respeito do assunto e sugere um efeito antidepressivo da EMTr, comparável ao da ECT em pacientes com depressão maior unipolar sem sintomas psicóticos / Studies published over the past few years suggest that repetitive transcranial magnetic stimulation (rTMS) may have significant antidepressant actions. This work performs a comparison between rTMS and electroconvulsive therapy (ECT), an established method to treat depression disorders. First there was an extensive review on the knowledge of both non pharmacological treatments including their history, efficacy, main indications, contraindications and side effects, in addition to the possible mechanisms of action, not yet fully understood. After that, a controlled randomized, single-blind clinical trial was conducted, comparing the efficacy to treat unipolar resistant nonpsychotic major depression that were referred to receive ECT. An evaluation of cognitive effects was also performed, specially memory effects. Thirty five patients were included. Electroconvulsive therapy was performed with general anesthesia and muscular relaxation. Right unilateral electrodes positioning was used, with a charge 4.5 times the convulsive threshold. rTMS was performed over the left dorsolateral prefrontal cortex at 100% motor threshold. Patients were treated with 20 sessions (five times per week for four weeks) with 25 trains a day (frequency of 10 Hz, duration of 10 seconds with 20 seconds intertrain interval). Patients were evaluated at baseline, after two weeks and after four weeks of either treatment. Both groups were equivalent in efficacy, showing a means of reduction on Hamilton depression rating scale of 42%, an overall clinical response of 46% and a remission rate of 14%. rTMS showed a more benign profile regarding side effects (headache on 1%). ECT induced headache (20%) and nausea (10%). No cognitive effects were observed on either treatments. This study adds to the growing literature supporting an antidepressant effect for rTMS, similar to ECT on patients with unipolar nonpsychotic major depression

Bakgrund: ECT har funnits inom den psykiatriska vården sedan 40-talet och används fortfarande idag. Behandlingen är vanligast hos patienter med djup depression. Trots att behandlingen är vanlig finns det en begränsad kunskap om patienters erfarenheter inom området.  Sjuksköterskorna ansvarar för omvårdnad och ska identifiera patienternas behov.  Syfte: Syftet är att beskriva erfarenheter av ECT hos patienter som lever med depression. Metod: En kvalitativ innehållsanalys av 12 narrativa texter i form av bloggar har lyfts fram. Resultat: En hoppfullhet finns inför behandlingen, men patienterna är rädda för att biverkningar efteråt ska påverka deras liv negativt. ECT hjälper patienterna att bryta depression, men biverkningar i form av minnesstörningar och kognitiv påverkan förekommer. Patienterna anser att delaktigheten blir lidande då informationen för att kunna ta ett beslut om ECT är bristfällig. Konklusion: Patienterna ser en ljusare framtid då ECT har hjälpt dem att bryta depressionen och lidandet. Patienterna önskar att informationen om ECT:s  risker och biverkningar skulle ha lyfts fram tydligare då biverkningarna påverkar deras liv negativt så som minnesstörningar och kognitiv biverkan. Det är viktigt att sjuksköterskorna samspelar med patienten och gör patienten delaktig i den egna vården för att minska lidandet. / Background: ECT has been a part of psychiatric health care since the 1940’s and is still used today. The treatment is most commonly used with patients suffering from deep depression. Despite the treatment being common, there is little knowledge of the patients’ experiences thereof. The nurses are responsible for the nursing of the patient and for identifying the patients’ needs. Aim: The aim of the study is to describe the experiences of ECT for patients suffering from depression. Method: The study applies a qualitative content analysis in 12 narratives from blogs. Results: Patients are hopeful before the treatment, but at the same time anxious that the treatment will have side effects affecting their lives. ECT helps patients defeat depression, thus sideeffects such as memory disorders and cognitive loss may occur. The patients experience losses in involvement as the information needed to make a decision on ECT is flawed. Conclusion: Patients see a brighter future as ECT has helped them to defeat their depression and suffering. The patients wish that they had been given clearer information regarding the risks and side effects of ECT as the side effects affected their lives. It is therefore important that the nurses cooperate with the patients in order to support their needs and reduce suffering.