Commentary: intoxication and settled insanity--unsettled matters.

The role of exogenous substances in the genesis of mental symptoms has found relevance in some jurisdictions when a defense of settled insanity is raised. However, the current nosology and knowledge base reveal ambiguity and unresolved questions about the present science related to settled insanity.

Comparison of seizure duration, ictal EEG, and cognitive effects of ketamine and methohexital anesthesia with ECT.

The authors retrospectively compared the seizure duration, ictal EEG, and cognitive side effects of ketamine and methohexital anesthesia with ECT. This comparison was carried out with data from consecutive index ECT treatments that occurred immediately before and after a switch from methohexital to ketamine in 36 patients. Ketamine was well tolerated and prolonged seizure duration overall, but particularly in those who had a seizure duration shorter than 25 seconds with methohexital at the maximum available stimulus intensity.