Electroconvulsive and Neuromodulation Therapies 1st Edition by Conrad M Swartz ISBN 051150862X 9780521883887

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ISBN 10: 051150862X 
ISBN 13: 9780521883887
Author: Conrad M Swartz

Electroconvulsive and Neuromodulation Therapies 1st Table of contents:

The reboot theory of ECT mechanism and its implications
My ECT clinical preferences
Approach to informed consent
Sedation for sleep on the night before ECT
Pre-ECT intramuscular medication
Pre-ECT oral medication (two to four hours prior to ECT with water sip)
Atropinic agent IV
Routine narcosis agent, dose range
Routine muscle relaxant, dose
Other common pre-ECT IV agents
Extra steps (if any) for patients taking benzodiazepines
Oxygenation
Other anesthetic considerations
Electrode placement
Stimulus dose method
Stimulus potentiation (after maximum stimulus dose is reached)
Physiological monitoring (and specific signs)
Recovery from ECT
Ward management
Discharge considerations
Acknowledgments
References
Part I Scientific and experimental bases of electroconvulsive therapy
1 Electricity and electroconvulsive therapy
Basic electrical facts and safety
Seizure generation
Brief-pulse stimulus dose
Sine wave stimulus dose
Stimulus efficiency
Sine wave versus brief-pulse stimuli
Efficiency of brief-pulse stimuli
Ultrabrief pulse
References
2 Nonelectrical convulsive therapies
Introduction
Historical background
Chemical convulsants
Procedure
Indications and results
Complications
Replacement by ECT
Insulin coma treatment
Procedure
Indications and results
Complications
Combined insulin and chemical convulsants
Procedure
Indications and results
Complications
Flurothyl inhalation
Theoretical implications
The fear factor in convulsive therapy
The convulsive factor in insulin coma therapy
Antagonism revisited
Conclusions
Acknowledgment
References
3 Neurochemical effects of electrically induced seizures: Relevance to the antidepressant mechanism
Introduction
The effect of ECT on neurotransmitters and receptors in the brain
Neurotransmitters, receptors, depression, and ECT
The serotonergic pathway
Serotonin, depression, and the effects of ECT
Effects of ECS on serotonin receptors
The noradrenergic (norepinephrine) pathway
Norepinephrine, depression, and the effects of ECT
Effects of ECT on NE receptors
The dopaminergic pathway
The GABA pathway
Glutamatergic systems
The effect of ECT on neuropeptides
Background
NPY
NCS-1
Neuroserpin
Neurotensin
Tachykinins
The effect of ECT on gene transcription and neurotrophic factors
Overall effects
The BDNF/CREB pathway
Arachidonic acid cascade genes
Angiogenesis-, metabolism-, and homeostasis-regulating genes
Other genes
FGF-2
Nerve growth factor
Activity regulated cytoskeleton gene
ERK5-MEF2C
Thyrotropin-releasing hormone
Tissue inhibitors of metalloproteinases-1
ELL2
Kf-1
N-Myc downstream-regulated protein 2 gene
Frizzled-3 gene
Vesicle-associated membrane protein 2
The effect of ECS on synaptic plasticity and neurogenesis
Conclusions
References
4 Hypothesized mechanisms and sites of action of electroconvulsive therapy
Introduction
Current hypotheses
Neurochemical theories
Neurotransmitter theories
Intracellular signaling, gene transcription, and neurotrophic action
The diencephalic theory or neuroendocrine view
Anticonvulsant theory
Anatomical theory or prefrontal model
Seizure generalization theory
Developing a theory of ECT action ? synthesis
Different organizational levels are involved in the pathophysiology of mental disorders
What happens during electrical stimulation?
Eliciting a seizure by overcoming surrounding inhibition
Functional consequences in response to ECT
Restoring balanced neuronal network function after repeated seizures
Overall view
5 Brain imaging and electroconvulsive therapy
Introduction
Definition of the ictal and interictal periods
What does neuroimaging measure?
Ictal neuroimaging in ECT
Interictal neuroimaging in ECT
Conclusions and future directions
References
6 Evidence for electroconvulsive therapy efficacy in mood disorders
Introduction
How effective is ECT for depression?
Is ECT more effective than placebo procedure?
Is ECT more effective than antidepressant medications?
Do various forms of ECT differ in therapeutic efficacy?
Do subtypes of depression respond differently to ECT?
ECT in mania
Concluding remarks
References
7 Clinical evidence for the efficacy of electroconvulsive therapy in the treatment of catatonia and
Introduction
Methodological limitations
ECT in schizophreniform disorder
ECT in the acute phase of schizophrenia
ECT in the acute phase of catatonic schizophrenia
ECT in malignant catatonia
ECT in schizoaffective disorders
ECT in the chronic phase of schizophrenia
Effect of catatonic features on response to ECT in chronic schizophrenia
Continuation ECT and MECT
ECT in catatonia associated with depression
ECT in catatonia associated with mania
ECT in catatonia associated with medical conditions (?organic? catatonia)
ECT in childhood and adolescent psychoses associated with catatonia
References
8 Hormonal effects of electroconvulsive therapy
Introduction
Consequences of ECT-induced hormone release
Comparing hormone changes
Prolactin release, an archetype
Posterior pituitary hormone release
Cortisol release
Resting hypercortisolism
Future clinical applications
References
Part II Historical, societal, and geographic perspectives
9 History of electroconvulsive therapy
Introduction
Origin of concept
Insulin coma and early convulsive therapies
ECT in the United States
The debate over technique
Stigmatization and the decline of ECT
The road back begins
The placement debate resurfaces
Electrode placement: Recent innovations
The revival of ECT
Acknowledgment
References
10 Electroconvulsive therapy in biographical books and movies
Introduction
The accounts of early treatment
Later accounts
The movies
Discussion
References
11 Professional barriers to providing electroconvulsive therapy
Introduction
Barriers to care
Professional barriers to providing electroconvulsive therapy 199
Training issues
Nonpsychiatric physicians
Psychiatry residency
Interference from practice patterns and settings
Sociopolitical barriers
Regulation as a professional barrier
Malpractice and other liability concerns
?Mindset?
References
12 Legislation that regulates, limits, or bans electroconvulsive therapy
Introduction
Legislation that regulates, limits, or bans electroconvulsive therapy 209
Legislation recapitulates litigation
Cinematic images of ECT
Popular and professional literature on ECT
Anti-ECT ideology and movement
A brief legislative history
The Texas experience
The informed consent model
Toward constructive law making
Conclusions
References
Part III International perspectives
13 Electroconvulsive therapy availability in the United States
Introduction
Sources of variation
Small-area analysis
State and regional variation
Service system variation
Service site: Public versus private hospital
Service site: Inpatient versus outpatient
Demographic variation: Age, gender, race/ethnicity, and socioeconomic factors
Age
Gender
Race/Ethnicity
Socioeconomic factors/insurance
State regulations (sociopolitical factors)
The future of ECT
Acknowledgments
References
14 Electroconvulsive therapy in Scandinavia and the United Kingdom
The practice of ECT in Scandinavia, past and present
A Scandinavian research tradition
Standards and practice of ECT: The United Kingdom context before the National Institute for Clinical
The National Institute for Clinical Excellence and ECT in the United Kingdom
Post-NICE developments in the United Kingdom
Training in ECT in Scandinavia
Training in ECT in the United Kingdom
The future of ECT in Scandinavia and the United Kingdom
References
15 Electroconvulsive therapy in continental Western Europe: A literature review
Introduction
Belgium
France
Germany
The Netherlands
Portugal
Spain
Discussion
References
16 Electroconvulsive therapy in Asia
Introduction
ECT rates
Indications for ECT
Age classification of patients receiving ECT
Sex distribution of patients receiving ECT
Technical aspects of ECT
Regulation of ECT and training of ECT professionals in Asia
Summary
References
17 History of electroconvulsive therapy in the Russian Federation
Introduction
ECT in the 1940s and 1950s: The bloom and the freeze
ECT in the 1960s and 1970s
From the 1980s through the end of the 20th century
Present ECT use in the Russian Federation
Editor?s note
18 Electroconvulsive therapy in Latin America
Introduction
Overview
Mental health in Latin America
The use of ECT
Rate of use
ECT technique
Informed consent
ECT training
History and use of ECT in specific countries
Argentina
Chile
Cuba
Mexico
Uruguay
Brazil
Conclusion
References
Part IV Administrative perspectives
19 Electroconvulsive therapy hospital policy and quality assurance
Introduction
General policies for ECT
I. Purpose
II. Policy
III. Definition
IV. Procedure
A. Legal requirements for informed consent
B. Convulsive treatment procedures for voluntary patients
C. Convulsive treatment procedures for involuntary patients (including anyone under Lanterman-Petris
D. ECT procedures for minors
E. Review and post-treatment audit committee
F. Excessive use of convulsive treatment
G. Reports on convulsive treatment
H. Violation penalties
I. General guidelines for electroconvulsive therapy
J. Care of the patient receiving ECT: See ?nursing responsibilities?
K. Outpatient ECT
L. ECT forms
ECT nursing responsibilities
I. Purpose
II. Policy
III. Procedures
A. Pre-ECT patient preparation
B. Inpatient transportation
C. Treatment room preparation
D. Nursing staff assistance during the ECT treatment
E. ECT recovery procedure
F. General post-ECT duties
Treating patients who are inpatients elsewhere
I. Purpose
II. Policy
III. Procedure
A. Pre-treatment
B. Treatment
C. Post-treatment/recovery
D. Medical emergencies
ECT for regional center patients
I. Purpose
II. Policy
III. Procedure
IV. Reporting requirements
Scope of service: electroconvulsive therapy (ECT)
Location and hours of operation
Scope of services provided
Staffing plan
Departmental performance improvement
Quality assurance monitors
References
20 Staff management and physical layout for electroconvulsive therapy
General concerns
Equipment necessary for ECT
The small hospital and small-volume operations
High-volume operations
IV access
Outpatient considerations
Treatment room considerations
Recovery room issues
The design of the ECT suite
Personnel summary
ECT nurse
Psychiatrist
Anesthetist
Recovery room nurse
Miscellany
References
21 Electroconvulsive therapy forms
Standing orders lists
The progress note
Nursing record and procedure verification
Ambulatory forms
Part V The clinical manual
22 Patient selection and electroconvulsive therapy indications
Introduction
The depression that ECT does not treat
ECT preventing anxiety disorders
DSM versus observable melancholia
ECT as first choice treatment
ECT or antipsychotics as first choice
Antidepressant-resistant depression
Antimanic medication?resistant manic episode
Medication-resistant acute psychosis
Medication-resistant intermediate-duration psychosis versus schizophrenia
Medication-resistant chronic psychosis or schizophrenia
ECT as prerequisite for other procedures
Medication-resistant agitated dementia
Closing
References
23 Electroconvulsive therapy or antipsychotic drugs (or benzodiazepines for catatonia)
Introduction
Mental side effects: Hypofrontality
Mental side effects: Tardive
Mental side effects: Other
Medical adverse effects
Patient tolerance and compliance
Therapeutic benefits
ECT versus benzodiazepines in catatonia
Physician behavior
References
24 Informed consent
Informed consent: Definitions and historical development
Legal application of the doctrine of informed consent
Practical strategies and methods to achieve informed consent
Discussion of the consent process
Discussion of the nature of the illness
Discussion of the reason for ECT and comparison with other treatment alternatives
Discussion of the nature of ECT treatment
Discussion of risk
Obstacles to informed consent with a competent patient
Competency
The incapacitated ECT patient
Court-ordered treatment and advance directives
Summary
References
25 Electroconvulsive therapy in the medically ill
Introduction
Cardiovascular disorders
CHF
CAD/Post-MI
Dysrhythmias
Pacemakers/Implantable cardioverter defibrillators
Vascular disease
Valvular disease
Anticoagulation
Neurological disorders
Dementia
Movement disorders
Cerebrovascular disease
Epilepsy
Intracranial space-occupying lesions
Pregnancy
Diabetes mellitus
Miscellaneous conditions
References
26 Anesthesia for electroconvulsive therapy
Anesthesia for electroconvulsive therapy
Rationale for anesthesia in electroconvulsive therapy
History
Anticholinergics
Induction agents
Muscle relaxants
Airway management
Concomitant medications
Issues related to the collaboration between anesthesiology and psychiatry
References
27 Stimulus electrode placement
Introduction
Efficacy
Cognitive issues
Neurobiology
Bitemporal ECT
Right unilateral ECT
LART ECT
Bifrontal ECT
References
28 Stimulus dosing
Introduction
Units of measure in defining the stimulus dose
Convulsive, subconvulsive, and sham stimulation
Stimulus waveform morphology
Antidepressant efficacy and the magnitude of the stimulus dose
Titrated dosing
Formula-based dosing
Fixed dosing
Cognitive side effects and the stimulus dose
Generalizations regarding stimulus dosing for acute treatment of depression
Adjusting the stimulus dose in response to dynamic physiology: ?Benchmarking?
Benchmarking: Seizure morphology
Benchmarking: Cardiovascular reactivity
Augmentation strategies when the maximum stimulus dose is reached
Integrating the science of stimulus dosing with the choice
of electrode placement
Stimulus dosing in continuation/maintenance ECT in major depression
Examples of stimulus dosing with case vignettes
Case 1
Case 2
Case 3
Conclusion
Acknowledgment
Editor?s note
References
29 Electroencephalogram monitoring and implications
History of electroencephalogram monitoring
Recording electrode placement
Time course of ictal EEG
Scalp distribution of ictal EEG
Ictal EEG interpretation
Seizure duration
Seizure expression
Relationship to clinical changes, adverse effects, and depression
Missed seizure
Abortive or brief seizure
Prolonged seizure
References
30 Heart rate and electroconvulsive therapy
HR reflecting seizure activity
Peak HR and seizure quality
Benchmark Method of stimulus dose regulation
Tachycardia duration
References
31 Cognitive side effects and psychological testing
Introduction
Clinical evaluation: Mini Mental State Examination
Neuropsychological examination of patients treated with ECT
Postictal disorientation and confusion
General intelligence
Memory and new learning
Subjective memory complaints
Retrograde amnesia
Anterograde amnesia
Executive functions
Language function
Editor?s note
References
32 Electroconvulsive therapy in children and adolescents
Rates of use
Assessing adolescent patients for ECT
Need for treatment with ECT
Patient?s fitness to undergo ECT
Further baseline evaluations
ECT technique
General approach
Special considerations
Seizure threshold
Stimulus dose
Adverse events
Editor?s note
References
33 Postelectroconvulsive therapy evaluation and prophylaxis
Introduction
Continuation treatment after successful ECT
Depression
Patients without medication failure: post-ECT antidepressant
Postelectroconvulsive therapy evaluation and prophylaxis 507
Patients without medication failure: post-ECT lithium
Patients with medication failure: post-ECT antidepressant
Conclusions and recommendations regarding continuation pharmacotherapy for depression
Continuation ECT for depression
Indications for cECT
Praxis of cECT
Schizophrenia
Continuation ECT for schizophrenia
Bipolar Disorder
Editor?s note
References
34 Ambulatory and maintenance electroconvulsive therapy
Introduction
Ambulatory ECT
Maintenance ECT
References
Part VI Neuromodulation treatment
35 Transcranial magnetic stimulation
Introduction
Neurobiological background
TMS treatment
Major depression
Bipolar depression
Dysthymic disorder
Schizophrenia
Auditory hallucinations
Catatonia
Negative symptoms of schizophrenia
Bipolar mania
Post-traumatic stress disorder
Obsessive-compulsive disorder
Panic disorder
Tinnitus
TMS comparison with ECT
Safety issues
Low-/high-frequency/repetitive TMS
Risk for seizures
Treatment-emergent mania/hypomania
Occurrence of delusions
Contraindications to TMS treatment
Future prospects
Deep TMS
Editor?s note
References
36 Vagus nerve stimulation: Indications, efficacy, and methods
Introduction and background
Neuroanatomy of the vagus nerve
Mechanisms of action
VNS therapy system and surgical implant procedure
Indications for the use of VNS
VNS for the treatment of epilepsy
Rationale for VNS in depression
Pilot study of VNS in depression
Pivotal trial of VNS to treat depression
Treatment-Resistant Depression (TRD)
Suggested guidelines for VNS applications
Patient selection
VNS stimulation parameter settings
Patient safety and adverse effects
Conclusions and future directions
Editor?s note
References
37 Deep brain stimulation: Methods, indications, locations, and efficacy
Introduction
DBS method
History and principles of DBS
Safety and advantages of DBS
Neurobiology of depression and OCD
Studies of DBS and psychiatric disorders
Problems in target selection
DBS targets in depression
Targets in OCD
Ethical considerations and quality standards in DBS research
Inclusion criteria
Exclusion criteria
Conclusions
Editor?s note
References
38 Transcranial direct current stimulation
Introduction
Brief historical facts
How it works
Importance as a clinical tool
Adverse events
Clinical applications
Depression
Fibromyalgia
Epilepsy
Craving disorders

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Tags: Conrad M Swartz, Electroconvulsive, Neuromodulation Therapies