Increased Attendance During Rapid Implementation of Telehealth for Substance Use Disorders During COVID-19 at the Largest Public Hospital System in the United States.

Objective: The objective of this study is to examine differences between; telehealth and in-person visits during COVID-19 and in a pre-COVID-19 reference period; COVID-19 televisit completion for patients with varying engagement in treatment during the reference period.

Methods: Electronic medical record data were collected and analyzed with chi-squared or -tests to compare patient demographics. Generalized estimating equations for estimating the odds of outcomes were used, controlling for demographics.

Associations between medical students' beliefs about obesity and clinical counseling proficiency.

Background: Despite evidence that biological and genetic factors contribute strongly to obesity, many healthcare providers still attribute obesity more to controllable behavioral issues rather than factors outside a person's control. We evaluated whether medical school students' beliefs about obesity correlate with ability to effectively counsel patients with obesity.

Methods: Clerkship-year medical students at NYU School of Medicine completed an Objective Structured Clinical Experience (OSCE) that tests ability to effectively counsel standardized actor-patients with obesity.

Development of Geriatric Mental Health Learning Objectives for Medical Students: A Response to the Institute of Medicine 2012 Report.

America is aging as the population of older adults increases. The shortage of geriatric mental health specialists means that most geriatric mental healthcare will be provided by physicians who do not have specialty training in geriatrics. The Institute of Medicine Report of 2012 highlighted the urgent need for development of national competencies and curricula in geriatric mental health for all clinicians.

Geriatric psychiatry in the psychiatry clerkship: a survey of current education practices.

Objective: The aging of the US population and shortage of geriatric psychiatrists mean that all medical students must be prepared to evaluate psychiatric symptoms in older patients. The authors sought to describe current geriatric psychiatry teaching practices during the psychiatry clerkship.

Methods: Psychiatry clerkship directors at 110 American medical schools were surveyed about didactic and clinical experiences of geriatric psychiatry.

Automatic implantable cardioverter defibrillator in electroconvulsive therapy.

As the number of patients with implantable cardiac devices increases so too does the frequency with which these individuals present for electroconvulsive therapy (ECT). The rationale for deactivating an automatic implantable cardioverter defibrillator before ECT has been made based on the concern that artifacts generated during treatment could be interpreted as a treatable rhythm by the internal device, resulting in a discharge. We believe that the risk of inappropriate discharge during ECT is very low and outweighed by the considerable benefit of an active device being able to more quickly treat a malignant dysrhythmia.

Depression severity in electroconvulsive therapy (ECT) versus pharmacotherapy trials.

Objective: We sought to compare the level of severity of depressive symptoms on entry into electroconvulsive therapy (ECT) clinical trials versus pharmacotherapy clinical trials.

Data Sources: English-language MEDLINE/PubMed publication databases were searched for ECT literature (search terms: ECT, electroconvulsive therapy, depression, and Hamilton) for clinical trials in which depressed patients had baseline Hamilton Rating Scale for Depression (HRSD) scores. For comparison, we used a convenience sample of 7 large pharmacotherapy trials in major depression (N = 3677).

Low-dose right unilateral electroconvulsive therapy (ECT): effectiveness of the first treatment.

Background: Electroconvulsive therapy (ECT) is a widely used, highly effective antidepressant treatment. Except for the most severely ill patients, right unilateral (RUL) electrode placement is the most frequent initial treatment choice. In current practice, RUL ECT is administered at several multiples of seizure threshold (ST) based on reports that lower stimulus intensity results in lower response/remission rates.

Methohexital and succinylcholine dosing for electroconvulsive therapy (ECT): actual versus ideal.

This report compares the actual doses of methohexital and succinylcholine used for optimal anesthesia and muscle relaxation in electroconvulsive therapy with written guidelines for dosing. The initial doses of methohexital and succinylcholine in milligrams per kilogram were reviewed and compared with subsequent doses of each agent after adjustments were made for individual patient responses during treatment. The dose of methohexital required to induce general anesthesia for most patients is 1.

Electrocardiographic "bleed through" to the electroencephalogram on an electroconvulsive therapy (ECT) tracing: the return of the tell-tale heart.

Improper recording electrode placement can cause artifacts on electroconvulsive therapy tracings. This shows an example of electrocardiogram artifact in the electroencephalogram.

Electroconvulsive therapy (ECT) after pulmonary edema.

We report a case of pulmonary edema after electroconvulsive therapy (ECT) in an 88-year-old man with controlled hypertension and treatment-refractory depression. Despite this unexpected episode of pulmonary edema, the patient was able to complete this course of ECT without further complications. Because the pulmonary edema was thought to be due to extremely elevated blood pressures, nitroglycerine and esmolol were used during subsequent treatments, and electrode placement was changed to bilateral to speed recovery.

Multiple episodes of intraictal cessation during electroconvulsive therapy.

A recent case reported an episode of a "stop-start-stop" phenomenon during an electroconvulsive therapy treatment. We report an example of multiple stop-start-stop episodes during several electroconvulsive therapy treatments of a 16-year-old boy.

The Telltale Heart or the importance of the "Tap Test" in electroconvulsive therapy (ECT).

The "Tap Test" is a maneuver used to test the functioning of the electroencephalogram and electromyogram leads just prior to electroconvulsive therapy. Here we present a brief case and image that reinforces the importance of this simple test.

Appropriateness for electroconvulsive therapy (ECT) can be assessed on a three-item scale.

Electroconvulsive therapy (ECT) is the most effective and rapid treatment for severe depression; however, it should be prescribed to the limited number of patients with severe mood and psychotic disorders for whom it is clearly appropriate. We present an assessment scale that we hypothesize can be used to predict a patient's appropriateness for ECT, based on the severity, heritability, and episodic nature of their depression. This scale is offered as a tool to help the practitioner and patient gain a sense of how well the patient fits the profile of someone for whom ECT is a reasonable treatment option.

Febrile reaction with elevated CPK after a single electroconvulsive therapy (ECT) in an adolescent patient with severe bipolar disorder.

This report describes the electroconvulsive therapy (ECT) course of a 15-year-old male with severe bipolar disorder unresponsive to medical management. After his first treatment, the patient exhibited fever, elevated creatine phosphokinase levels, and leukocytosis. Treatment was halted although the patient reported an improvement in symptoms, which was not maintained with pharmacotherapy alone.

Rocuronium as muscle relaxant for electroconvulsive therapy in a patient with adult-onset muscular dystrophy.

Adult-onset muscular dystrophy is an inherited myopathy characterized by a variable degree of progressive muscle weakness and degeneration. Although not usually fatal, significant muscle weakness results in an up-regulation of acetylcholine receptors on the less responsive postjunctional muscles. The resulting profound potassium release when these receptors are stimulated by the depolarizing muscle relaxant succinylcholine can result in potentially fatal cardiac arrhythmias.