1 / 23

Ultrabrief Pulsewidth RUL ECT

akasma
Download Presentation

Ultrabrief Pulsewidth RUL ECT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Ultrabrief Pulsewidth RUL ECT Colleen Loo Assoc Prof, School of Psychiatry St George Hospital Clinical School/ University of NSW & Black Dog Institute & Northside Clinic Sydney, Australia

    2. Conventional ECT Variations in Electrical Dose and Electrode Placement

    4. Pulse Width Typical ECT pulse : 0.5 – 1.5 ms Chronaxie of neurons : 0.1-0.2 ms seizure threshold with shorter pulse width < 0.5 ms

    5. Ultrabrief pulse ECT Sackeim, 2004 0.3 ms RUL 6 T Randomised 1.5 ms 0.3 ms BL 2.5 T 1.5 ms

    8. Comparison RUL-UB (6xST) with RUL (1.0ms, 3.5xST) Retrospective comparison: RUL-UB from Dec 2005 - 2006 RUL from 2003- Nov 2005 N=30 per group Matched for age & gender Compared clinical characteristics – treatment resistance etc File review – Likert scores re improvement (0-3) File review – clinical impression of response (yes / no)

    9. Methods ECT given 3 times per week Anaesthetic: thiopentone, suxamethonium Number of ECT clinically decided by treating psychiatrist RUL-UB group – also had prospective ratings of mood and cognitive function

    11. Outcomes of RUL-UB Group Average no of ECT: 11.8 14/30 switched to bilateral ECT For completers: Mean reduction MADRS 45% 17/30 response (MADRS < 50% baseline) 4/30 remission (MADRS < 10)

    14. Retrospective comparison : ECT treatment efficacy, length and parameters (n=60)

    15. The Northside Clinic ECT Trial Effectiveness trial (non randomised): Bitemporal ECT @ 1.5 ST Bifrontal ECT @ 1.5 ST RUL ECT @ 5 ST RUL-UB ECT @ 6 ST Prospective, single blind ratings of efficacy (weekly MADRS) & cognitive function

    16. The Northside Clinic ECT Trial Cognitive Tests – baseline, after 6 ECT, end course: Digit Span (attention) Rey Auditory Verbal Learning Test (verbal memory) Rey figure (non-verbal memory) Controlled Oral Word Association Test (frontal function) STROOP (attention, frontal function) Autobiographical Memory Interview (retrograde memory)

    17. Northside Clinic ECT Trial DSM-IV Major Depressive Episode MADRS = 25 No recent drug/alcohol abuse/ ECT MMSE = 20 ECT 3 x/ week Anaesthesia: thiopentone & suxamethonium

    18. Demographics/Baseline Differences

    19. Rey Complex Figure Drawing- % Recall

    20. RAVLT Verbal Learning

    21. Autobiographical Memory Inventory

    22. MADRS Scores

    23. Conclusions RUL – UB ECT @ 6 x ST: Promising – cognitive outcomes Efficacy reduced? Require more treatments? Similar in efficacy to RUL @ 3 x ST, with fewer cognitive side effects? Lesser efficacy than RUL @ 6 x ST, markedly fewer side effects

    24. Acknowledgements The Northside Clinic ECT Trial: Co-Investigator: Dr Bill Lyndon Research staff: Sarah Campbell Magdalena Pusok Patrick Sheehan Melissa Pigot ECT service: Dianne Hollings (ECT coordinator) ECT psychiatrists Patients

More Related