The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode.

Background: Electroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies.

Objective: To document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received.

Methods: Patients were classified as receiving Weak, Strong, or HD BP BL ECT during three randomized trials at Columbia University.

Guidelines for preventing common medical complications of catatonia: case report and literature review.

Objective: Comprehensive hospital-based care for individuals with catatonia relies on preventive approaches to reduce medical morbidity and mortality. Without syndrome-specific guidelines, psychiatrists must draw from measures used for general medical and surgical inpatients. We employ a prototypical case to highlight medical complications of catatonia and review preventive guidelines for implementation in the inpatient setting.

Electroconvulsive therapy's mechanism of action: neuroendocrine hypotheses.

Despite a range of etiological theories since the introduction of electroconvulsive therapy (ECT) more than 75 years ago, its mechanism of action remains poorly understood. The neuroendocrine hypothesis is based on the seizure-related release of hypothalamic hormones into the blood and cerebrospinal fluid and evidence of endocrine dysfunction in many patients with severe mood disorder. The specific effect of ECT was hypothesized to result from the transverse passage of current through the brain with direct stimulation of axial structures including the diencephalon.

An evaluation of inpatient treatment continuation and hospital readmission rates in patients with bipolar disorder treated with aripiprazole or quetiapine.

Objective: The primary objective of this study was to assess patient and treatment variables that have an impact on inpatient antipsychotic treatment continuation and 30-day hospital readmission rates in patients with bipolar disorder treated with aripiprazole or quetiapine.

Methods: This was a retrospective cohort study of adult patients with bipolar disorder admitted to a psychiatric hospital. Patients who were initiated on aripiprazole or quetiapine during hospitalization were included in the analysis.

Pharmacological strategies in the prevention of relapse after electroconvulsive therapy.

Objective: To determine whether starting antidepressant medication at the start of electroconvulsive therapy (ECT) reduces post-ECT relapse and to determine whether continuation pharmacotherapy with nortriptyline (NT) and lithium (Li) differs in efficacy or adverse effects from continuation pharmacotherapy with venlafaxine (VEN) and Li.

Methods: During an acute ECT phase, 319 patients were randomized to treatment with moderate dosage bilateral ECT or high-dosage right unilateral ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN.

Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT.

Background: Health-related quality of life (HRQOL) is diminished in depressed adult outpatients and especially impaired among depressed patients referred for ECT. We compare pretreatment HRQOL in ECT and non-ECT depressed patients from two large samples, and examined whether sustained remission in depressive symptoms after ECT is associated with normalization of HRQOL.

Methods: HRQOL was measured with the Medical Outcomes Study Short Form 36 (SF36) before ECT and 6 months after ECT in an effectiveness (n=286) and an efficacy (n=243) clinical trial.

The premenstrual tension syndrome rating scales: an updated version.

Background: The Premenstrual Tension Syndrome (PMTS) Rating Scales have been widely used as inclusion criteria and/or outcome measures in clinical trials of treatment of Premenstrual Syndromes (PMS). However, both the PMTS Observer Rating Scale (PMTS-O) and the PMTS Self Rating Scale (PMTS-SR) are outdated. We propose to bring them in line with the DSM-IV criteria for Premenstrual Dysphoric Disorder (PMDD) by updating the PMTS-O and replacing the PMTS-SR with a Multiple Visual Analogue Scale (PMTS-VAS).

Citalopram improves metabolic risk factors among high hostile adults: results of a placebo-controlled intervention.

Hostility is associated with a number of metabolic risk factors for cardiovascular disease, including waist-hip ratio, glucose, and triglycerides. Along with hostility, many of these measures have also been shown to be associated with reduced central serotonergic function. We have previously reported that a citalopram intervention was successful in reducing hostility by self-report assessment (Kamarck et al.

Health-related quality of life in a clinical trial of ECT followed by continuation pharmacotherapy: effects immediately after ECT and at 24 weeks.

Objective: : To examine the determinants of health-related quality of life (HRQOL) immediately after a clinical trial of electroconvulsive therapy (ECT) for major depression and then again after 24 weeks of a continuation pharmacotherapy in a clinical trial comparing nortriptyline (NT) plus lithium (Li) versus venlafaxine (VEN) plus Li.

Method: : During acute ECT, 184 patients randomized to treatment with moderate-dosage bilateral (BL) ECT or high-dosage right unilateral (RUL) ECT completed the Medical Outcomes Study Short Form-36 (SF-36) as a measure of HRQOL before and immediately after ECT. They were also randomized to concurrent treatment with placebo, NT, or VEN.

Adjunctive psychotropic medications during electroconvulsive therapy in the treatment of depression, mania, and schizophrenia.

Current guidelines regarding concomitant antidepressants during electroconvulsive therapy (ECT) are inconsistent. Although the American Psychiatric Association Task Force on ECT discouraged combination antidepressant treatment, owing to the minimal evidence for enhanced efficacy and concern about increased adverse effects, combination treatment is recommended and considered routine for many practitioners in the United States and other parts of the world. Considering the increasing levels of treatment resistance among patients referred for ECT and the high relapse rate after acute ECT, the role of concomitant antidepressant pharmacotherapy during ECT should be reevaluated.

Treatment of insomnia in depressed insomniacs: effects on health-related quality of life, objective and self-reported sleep, and depression.

Study Objectives: Insomnia is associated with poor health related quality of life (HRQOL) in depressed patients. Prior clinical trials of hypnotic treatment of insomnia in depressed patients have shown improvement in HRQOL, but in these studies HRQOL was relegated to a secondary outcome, and objective measures of sleep were not undertaken.

Design: Double-blind, randomized, placebo-controlled clinical trial.

Verapamil augmentation of lithium treatment improves outcome in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms.

Objectives: Attenuation of protein kinase C (PKC) is a mechanism common to both established (lithium, valproate) and some novel (tamoxifen) antimanic agents. Verapamil, although primarily known as a calcium channel blocker, also has PKC inhibitory activity. Verapamil has shown antimanic activity in some but not all studies.

Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects.

Context: Medication resistance is the leading indication for use of electroconvulsive therapy (ECT) in major depression. The practice of stopping antidepressant medications prior to ECT derived from studies in the 1960s and 1970s in nonresistant samples. There is also continuing controversy regarding the relative efficacy and adverse effects of right unilateral and bilateral ECT.

Best practices: an intervention to promote evidence-based prescribing at a large psychiatric hospital.

An intervention to affect prescribing behavior was implemented at a large psychiatric hospital. Articles providing support for appropriate dosing of quetiapine were distributed to physicians, and peer discussions about prescribing practices were held. From April 2005 through December 2006, low-dose quetiapine prescriptions ( View Article and Find Full Text PDF

Citalopram intervention for hostility: results of a randomized clinical trial.

Hostility is associated with an increased risk for cardiovascular disease (CVD). Because central serotonin may modulate aggression, we might expect selective serotonin reuptake inhibitors (SSRIs) to be effective in reducing hostility. Such effects have never been examined in individuals scoring high on hostility who are otherwise free from major Axis I psychopathology according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.

Screening for depression in the postpartum period: a comparison of three instruments.

Objectives: Postpartum depression, the most prevalent complication of childbirth, is often unrecognized. Our objective was to compare the effectiveness of three screening instruments--Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and the 7-item screen of the Postpartum Depression Screening Scale (PDSS)--for identifying women with postpartum depression in the first 6 months after delivery.

Methods: We administered the three instruments via telephone to women who were > or =18 years and had delivered infants 6-8 weeks earlier.

Dynamics of perfectly wetting drops under gravity.

We study the dynamics of small droplets of polydimethylsiloxane silicone oil on a vertical, perfectly wetting, silicon wafer. Interference videomicroscopy allows us to capture the dynamics of these droplets. We use droplets with a volumes typically ranging from 100 t o500nl (viscosities from 10 to 1000 cSt) to understand long time derivations from classical solutions.

Relapse during continuation pharmacotherapy after acute response to ECT: a comparison of usual care versus protocolized treatment.

Background: ECT, an effective treatment for major depression, is associated with a high relapse rate. Roughly half of all responders during the acute treatment phase relapse during continuation treatment. Recent literature has pointed out an "efficacy-effectiveness gap" in outcomes of patients enrolled in study protocols when compared to "care as usual.

Urinary free cortisol levels among depressed men and women: differential relationships to age and symptom severity?

Background: Preclinical and clinical models of depression suggest sex differences may be mediated at least in part, by differences in hormonal modulation of hypothalamic-pituitary-adrenal (HPA) axis activity. Unraveling the consequences of moderating influences from the effect of sexual dimorphism will be vital to elaborating models of pathophysiology.

Methods: The current study investigated urinary free cortisol (UFC) among younger adults with mild to moderate major depressive disorder to clarify the relationship with potential demographic and clinical moderators.

Predictors of remission after electroconvulsive therapy in unipolar major depression.

Context: Electroconvulsive therapy (ECT) is the most effective biological treatment for major depression. However, there is little agreement about clinically useful predictors of acute ECT outcomes.

Objective: To assess whether age, sex, burden of comorbid physical illness, age at onset, history of recurrence, episode duration, chronic depression or comorbid dysthymia, melancholic features, episode severity, and medication resistance are predictors of remission after an acute course of ECT.

Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder.

Objective: Previous research suggests that the comorbidity of major depression with a personality disorder, especially borderline personality disorder, is associated with a poorer response to ECT. The authors compared the acute outcome of ECT in depressed patients with borderline personality disorder, with personality disorders other than borderline personality disorder, and with no personality disorder.

Method: The study subjects were 139 patients with a primary diagnosis of unipolar major depression and scores of at least 20 on the 24-item Hamilton Depression Rating Scale.

Addressing depression in obstetrics/gynecology practice.

Efforts to improve the care of depression in primary care patients have largely ignored the potential of obstetrics/gynecology (OB/GYN) practices. We describe feasibility studies of a depression screening and care management intervention in three diverse OB/GYN practices. Patients were screened using the Patient Health Questionnaire.

A randomized comparison of high-charge right unilateral electroconvulsive therapy and bilateral electroconvulsive therapy in older depressed patients who failed to respond to 5 to 8 moderate-charge right unilateral treatments.

Background: Electroconvulsive therapy (ECT) is the treatment of choice in some older patients with severe depression. When compared with younger depressed patients, older patients have been shown to be as likely to respond to ECT but more likely to develop cognitive impairment. This study addresses whether adults aged 50 years and over who have already failed to respond to at least 5 moderate-charge right unilateral (RUL) ECT treatments (150% above seizure threshold) are more likely to benefit from a switch to high-charge RUL ECT (450% above threshold) or to bilateral (BL) ECT.

Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial.

Context: Electroconvulsive therapy (ECT) is highly effective for treatment of major depression, but naturalistic studies show a high rate of relapse after discontinuation of ECT.

Objective: To determine the efficacy of continuation pharmacotherapy with nortriptyline hydrochloride or combination nortriptyline and lithium carbonate in preventing post-ECT relapse.

Design: Randomized, double-blind, placebo-controlled trial conducted from 1993 to 1998, stratified by medication resistance or presence of psychotic depression in the index episode.

Use of electroconvulsive therapy in a state hospital: a 10-year review.

Background: The use of electroconvulsive therapy (ECT) in the state hospital setting currently represents a very small percentage of the total overall use of this modality in the treatment of the mentally ill.

Method: Using records kept by a state hospital, we retrospectively identified all patients who had received ECT between the years 1986 and 1995. A review of the records at the state hospital from where patients were referred and the university hospital where ECT was administered was undertaken.