INDIAN STUDIES

BOOKS PUBLISHED IN INDIA

Proceedings of the National Workshop on ECT: Priorities for research and practice in India. Edited by Gangadhar BN

Held from October 11-12, 1990 at the National Institute of Mental Health and Neurosciences, Bangalore.

ECT Administrative Manual.

Edited by Gangadhar BN

Published by National Institute of Mental Health and Neurosciences, Bangalore.

ECT and T2 relaxometry: a static water proton magnetic resonance imaging study

Girish K, Jayakumar PN, Murali N, Gangadhar BN, Janakiramiah N and Subbakrishna.

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychiatry 43:20-22, 2001.

This study was conducted with the aim of detecting brain edema with electroconvulsive therapy (ECT). Magnetic resonace imaging (MRI) T2 relaxation time which is an indicator of brain water was measured one day prior to first ECT and two hours after second ECT in five patients prescribed unilateral ECT. MRI T2 relaxation time was measured in hippocampus and thalamus bilaterally. No significant change in T2 relaxation time following ECT occured in any of the four regions. ECT did not produce any detectable brain oedema and hence the treatment can be considered safe. The pilot study needs to be replicated in a larger sample and also in bilateral ECT patient group.

Key words: depression, electroconvulsive therapy, magnetic resonance imaging.

 

Electroconvulsive therapy: therapeutic relevance of seizure and cardiovascular response

Gangadhar BN, Girish K, Janakiramiah N and Saravanan ESM.

National Institute of Mental Health and Neurosciences, Bangalore.

Annals of Neurology 2001 (in press).

Electroconvulsive therapy (ECT) is used to induce therapeutic seizures in various clinical conditions. It is specifically useful in depression, catatonia, patients with high suicidal risk, and those intolerant to drugs. Its beneficial effects surpass its side effects. Memory impairment is benign and transient. Its mechanism of action is unknown, though numerous neurotransmitters and neuroreceptors have been implicated. The standards of ECT practice are well established but still evolving in some respects. ECT stimuli, must be set in relation to individuals' seizure threshold. Stimulus higher than threshold is more therapeutic particularly in unilateral ECT. Assessment of threshold by formula method may deliver higher stimulus dose compared with titration method. Cerebral seizure during ECT procedure is necessary. Motor (cuff method) and EEG seizure monitoring are mandatory. Recent studies have shown some EEG parameters (amplitude, fractal dimension, symmetry, and post ictal suppression) to be associated with therapeutic outcome. Besides seizure monitoring, measuring other physiological parameters such as heart rate (HR) and blood pressure (BP) may be useful indicators of therapeutic response. Use of ECT in neurological conditions as well as its application in psychiatric illnesses associated with neurological disorders has also been reviewed briefly.

Key Words: Cardiovascular responses, EEG, electroconvulsive therapy, neurological conditions.

 

Is a grandmal seizure necessary and sufficient for the efficacy of ECT?

Gangadhar BN, Girish K and Janakiramiah N.

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychiatry 42:443-444, 2000 (letter).

 

Unilateral ECT and dosing.

Andrade C

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychiatry 42:442, 2000 (letter).

 

Modified versus unmodified ECT.

Shukla GD

Consultant Psychiatrist, Jhansi.

Indian Journal of Psychiatry 42:445, 2000 (letter).

ECT, hypertensive mechanisms and cognitive dysfuction.

Andrade C

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychological Medicine 23:40-41, 2000.

 

Ictal systolic blood pressure and ECT-induced memory impariment

Girish K, Gangadhar BN, Jankiramaiah N and Mukundhan CR.

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychological Medicine 22:27-31, 1999.

Electroconvulsive therapy (ECT) induces memory impairment. The mechanism of ECT-induced memory disturbance is not well established. This study examined the relationship between rise in ictal systolic blood pressure (BP) and short term memory impairment following ECT.

Twenty, right-handed, consenting major depressive disorder patients with melancholic features (males=10; unilateral ECT=10) were administered ECT thrice weekly. No psychotropic drugs were given. Ictal systolic BP was recorded using Cardiocap-II at second ECT. Short term memory was measured using paired associate learning test (verbal) and Benton visual retention test (BVRT; nonverbal). These tests were administered before first ECT and after second ECT. Ictal systolic BP negatively correlated with nonverbal memory scores but not with verbal memory scores following second ECT. Rise in BP and memory impairment may be related epiphenomena of generalization of seizure and/or the stimulus administered.

A scale to measure motor seizure modification during ECT: Reliability and vialidy.

Latha. V, Saravanan. ESM Prashanth M. Mayur, Gangadhar BN Janakiramaiah N,

Uma Maheshwara Rao, G.

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychological Medicine 22:28-31, 1999.

A 5-point scale was developed to measure the extent of motor seizure modification. Higer score on the scale indicates better modification. Extent of motor seizure modification was rated in 50 consecutive patients referred for modified ECT. Rating was done during second or third ECT sessions. Two independent raters scored the extent of motor seizure modification using this scale. The interrater agreement (Kappa correlation) between the two raters was 0.72. Scores on this scale was significantly (P<0.04) and positively correlated with succinylcholine (mg/kg) dose. Patients on lithium had higher modification scores. This scale can be used to assess the extent of motor seizure modification in ECT as it is reliable (high interrater reliability) and is also valid.

 

ECT practice guidelines

Gangadhar BN, Girish K and Janakiramiah N.

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Psychiatric Society-Karnataka Chapter News letter June 1999.

In the past two decades several clinically applicable refinements have been made in ECT practice. It is desirable that clinicians incorporate these in routine ECT. This article focuses on the contemporary standards of ECT in respect of stimulus parameters (threshold and seizure duration), seizure monitoring, concurrent drugs, etc.

 

Predicting seizure threshold during ECT: a discriminate analysis study

Mayur PM, Subbakrishna DK, Gangadhar BN, Girish K, Janakiramiah N and Parameshwara G.

National Institute of Mental Health and Neurosciences, Bangalore.

NIMHANS Journal 16:193-196, 1998.

Several factors such as age, gender, medication status, head measurements and stimulus laterality are known to influence seizure threshold in ECT. Determinants of high (>=median stimulus dose) or low (<median stimulus dose) threshold were identified using discriminant function analysis. Separate analysis was conducted on unilateral (n=60) and bilateral ECT (n=110) patients in a prospective design. Among bilateral ECT patients, age and inion-nasion distance and among unilateral ECT patients, age, clinical global impression of severity and benzodiazepine status predicted the high or low threshold groups. Age emerged as the most significant predictor (p<0.001) which classified 69% of bilateral and 70% of unilateral ECT patients to either a high or a low seizure threshold groups.

Key Words: Electroconvuslive threapy, predictors, seizure threshold.

 

 

Clinical predictors of seizure threshold in bilateral ECT

Girish K, Prasad KMR, Gangadhar BN, Janakiramiah N, Subbakrishna DK & Parameshwara G.

National Institute of Mental Health and Neurosciences, Bangalore.

Indian Journal of Psychiatry 40:327-330, 1998.

Research on determinants of ECT seizure threshold is inadequate. In view of differences in ECT populations and confounding factors, there is a need for examining this in our population. Consecutive consenting inpatients (n=100), referred for bilateral (BL) ECT by treating psychiatrist at National Institute of Mental Health and Neurosciences Hospital, Bangalore, formed the sample for the study. Thiopentone, succinylcholine and atropine were used for modification. Seizure threshold (dependent variable) was determined by titration method at first (1st) ECT. The independent variables were age, gender, diagnosis, illness severity (clinical global impression; CGI), concurrent drugs, head circumference (HC) and inion-nasion distance (IND). Age, IND and CGI severity predicted seizure threshold in forward, stepwise, linear regression model.

Key words: ECT, predictors, seizure threshold

 

Prolonged seizures during electroconvulsive therapy

Jayaprakash MS, Gangadhar BN, Girish K and Janakiramiah N.

National Institute of Mental Health and Neurosciences, Bangalore.

NIMHANS Journal 15: 139-142, 1997.

Seizures were monitored using both cuff method and EEG, during the first ECT session in 89 consecutive patients. Six (7%) did not develop motor seizure but had adequate EEG seizures. In the group manifesting both EEG and motor seizures (n=83), twenty-one (25%) patients developed EEG seizure 120 seconds more in duration (Group B) and the other 62 patients had adequate EEG seizure (Group A). The motor and EEG seizure duration correlated significantly in Group A (r=0.8, p=<0.01) but not in Group B (r=0.4, p>0.05). Linear regression analysis demonstrated that motor seizure could predict the EEG seizure in Group A (t=10.42, p<0.001), but not so in Group B (t=2.0, p>0.05). This suggests that motor seizure monitoring alone is unreliable to detect prolonged seizure and hence the need for EEG seizure monitoring. The seizure should be terminated by using intravenous diazepam when the EEG seizure duration exceeds 120 seconds.

 

EEG Delta Band Spectral Power: Differences Between Unilateral and Bilateral ECT Seizures

Dutt, Narayan D, Mahapatra, P K, Gangadhar, B N, Janakiramaiah, N, Subbakrishna, D H, Rao, Jyothi K M

Associate professor, Department of Electrical Communication Engineering, Indian Institute of Science, Bangalore

Indian Journal of Psychiatry 39: 61-63, 1997

EEG was recorded form right and left frontal leads during bilateral (n = 1) and unilateral (n = 14) ECTs. The seizure EEG was analyzed using Fast Fourier Transform and the spectral power of the Delta (1-4 Hz) band was computed. The spectral power on both sides was similar in the bilateral ECT, Unilateral ECT produced asymmetry in the early - (first 8 seconds after stimulus offset) and mind - (17-32 seconds after the stimulus offset) seizure phase; the spectral power was lower on the unstimulated hemisphere. Studies to elucidate the relevance of EEG delta band of the seizure to therapeutic potency of ECT are suggested.

Key words EEG, ECT, Unilateral, Bilateral

 

Assessment of the therapeutic adequacy of the ECT seizure: current status.

Andrade C

National Institute of Mental Health and Neurosciences, Bangalore.

NIMHANS Journal 15: 319-329, 1997

Assessment of a seizure is essential for electroconvuslive therapy (ECT) to be effective. However, the ECT seizure is not all or none phenomenon: seizures elicited by different methods differ in efficacy, and some seizures may indeed have little or no therapeutic potential. A number of other factors, including physiological changes across time, can also alter seizure characteristics (and hence, possibly, efficacy) despite constancy in the method of induction. It is therefore necessary to define the characteristics of an adequate seizure, and also those of the ideal seizure. Seizure duration, a traditional measure of seizure adequacy, is recognized to have marked limitations. Electroencephalographic (EEG) changes with ECT are now considered to hold promise for the identification of more meaningful markers of efficacy. Both visual and spectrally analysed EEG features differentiate ECT seizures with high and low therapeutic potential. High EEG amplitude during, and low EEG frequency after the seizure may comprise the most promising markers of efficacy; however, many intricately inter-related variables also need to be considered in developing efficacy algorithms. Three operationally-defined EEG indices have recently been recommended to define ECT therapeutic potential; these remain to be prospectively validated. Available research has chiefly addressed depressed patients; other diagnostic categories also need to be examined.

Key words: ECT, ECG, Seizure duration, Depression

 

Indian Psychiatrists' Attitudes towards Electroconvulsive Therapy

Agarwal, A K, Andrade, Chittaranjan

Professor and Head, Department of Psychiatry, King George's Medical College, Lucknow

Indian Journal of Psychiatry 39: 54-60, 1997

A questionnaire on ECT, tapping attitudes, usage and experience, was mailed to all medical members of the Indian Psychiatric Society whose addresses were known; 263 (28.8%) of 913 psychiatrists responded. This paper describes Indian psychiatrists attitudes towards ECT. A global attitude favouring the treatment was expressed by 81.4% of respondents. The psychiatrists considered that for many patients ECT may be the safest, cheapest and most effective treatment (79.8%), disagreed that ECT should be used as a last resort (68.4%) and disagreed that drugs have made ECT obsolete (81%). While many (44.1%) opined that use of ECT should be curtailed, few (5.3%) considered that ECT should be abandoned - in fact, most respondents (86.3%) stated that comprehensive psychiatric care should include ECT services. A need was expressed for explicit guidelines for proper use of ECT (77.2%). conflicting opinions were expressed about the use of ECT in children. Many psychiatrists (38%) thought that ECT may produce subtle brain damage: nevertheless, of those actively using ECT, 82.9% expressed willingness to receive ECT themselves, if indicated.attitudesECTIndiaPsychiatrists

Key words Attitudes ECT India Psychiatrists

 

Issues In The Use Of Maintenance Electroconvulsive Therapy

Srinivasan, T N, Suresh, T R, Jayaram, Vasantha

Assistant Professor - Department of Psychiatry, Sri Ramachandra Medical College & Research Institute, Porur, Madras

Indian Journal of Psychiatry 37: 139-142, 1995

This case report on the use of Maintenance Electroconvulsive Therapy (ECT-M) presents certain observations and raises some issues in the use of the method. The report offers wider indication for ECT-M, including schizophrenia and bipolar disorders and younger patients. It raises the issues that the duration of use of ECT-M can be short rather than indefinite and that in the post ECT-M period, drug maintenance using the same drugs which were ineffective pre-ECT-M can be used effectively. The report presents those observations for further systematic study. The cost benefit advantage of the method and its relevance to the need for more frequent use in developing countries is illustrated.maintenance ECT, non-depressive psychoses, short-term use, post-ECT-M, drug therapy, economic advantage

Key words - Maintenance ECT, Non-depressive psychoses, Short-term use, Post-ECT-M, Drug therapy, Economic advantage

 

 

Electroconvulsive Therapy In Catatonia Associated With Pneumothorax

Thomas, Ninan, Suresh, T R, Srinivasan*, T N

Assistant Professor - Department of Psychiatry, Sri Ramachandra Medical College & Research Institute, Porur, Madras

Indian Journal of Psychiatry 36: 91-92, 1994

Recent advances in the method of application and monitoring of Electroconvulsive therapy (ECT) has facilitated its use even in the presence of serious physical illness. This case report is of a patient in catatonic stupor who developed an acute respiratory crisis and in whom the use of ECT led to quick recovery not only from the psychiatric state but also helped recovery from the medical illness. The report highlights the need to use ECT, if indicated, in the presence of serious medical illness without hesitation.electroconvulsive therapy, serious physical illness

Key words - Electroconvulsive therapy, Serious physical illness

 

Seizure Duration And Related Issues In ECT For Endogenous Depression

Andrade C

National Institute of Mental Health & Neuro-Sciences, Bangalore

Indian Journal of Psychiatry 35: 43-47, 1993

In a study comparing sinusoidal wave and brief-pulse ECT in endogenous depression, seizure duration was monitored by the cuff method in 29 patients over 180 treatment sessions. Mean seizure duration across all treatments was 26.5 secs and the mean for individual patients across their ECT course ranged from a minimum of 15.7 secs to maximum of 38.5 secs. Regression analysis found no variable which significantly predicted mean seizure duration. Of the 22 good responders in the study, response to ECT was associated with a mean seizure duration of secs in 1 patient and 0 cs in 11 patients; as just 2 of 7 poor responders to ECT had a mean seizure duration of < 20 secs in 1 patients, < 25 in 11 patients, of the 22 good responders in the study; as just 2 of 7 poor responders to ECT had a mean seizure duration of < 25 secs, it appears that a cuff seizure duration of over 20 secs may suffice for the seizure to be therapeutic in depression. With (constant current) brief pulse ECT, seizure threshold significantly increased with successive ECTs; thresholds did not however differ between the good and poor responders. There was a trend for seizure duration to decrease over time; again, good an poor responders did not differ. These findings provide little support for the anticonvulsant hypothesis for the antidepressant effect of ECT, but support the literature that ECT exerts an anticonvulsant effect.

 

The Practice Of ECT In India: II. The Practical Administration Of ECT

Andrade, Chittaranjan, Agarwal, A K, Reddy, Venkataswamy M

National Institute of Mental Health & Neuro Sciences, Bangalore

Indian Journal of Psychiatry 35: 81-86, 1993

A questionnaire on ECT, tapping attitudes, opinions and usage, was mailed to all medical members of the Indian Psychiatric Society whose addresses were known; 263 (28.8%) responded. This paper, the second in a series that presents the results of the survey, describes the practical administration of ECT. Specific issues discussed are the availability of cardiopulmonary resuscitation kit, ECT premedication, the ECT device, certain aspects of ECT stimulation, the electrode placement during ECT, administration of multiple ECT during a single treatment session and monitoring of the seizure duration. It is concluded that, in many respects, the practical administration of ECT in India in suboptimal; further research is required in certain areas.

 

ECT Induced EEG Seizure: Validity Of Duration Estimation By Last Spike

Gangadhar, B N, Rao, Jyothi K M, Sujatha, B L, Janakiramaiah, N, Subbakrishna, D K

National Institute of Mental Health & Neuro Sciences, Bangalore

Indian Journal of Psychiatry 35: 175-176, 1993

The seizure EEG records of 25 depressive receiving ECT were 'blindly' rated by two trained rater using a uniform definition of seizure endpoint. The EEG seizure duration estimates were validated against five expected relationships. EEG seizure duration correlated with and was more than motor seizure duration, reduced over the course of ECTs, was consisted within subjects and negatively varied with age. Within clinical constraints, the method of seizure duration estimation by the last spike is valid.

 

Physical Morbidity With Unmodified ECT - A Decade Of Experience

Tharyan, Prathap, Saju, P J, Datta, Sunil, John, Jacob K, Kuruvilla*, K

Department of Psychiatry, Christian Medical College, Vellore

Indian Journal of Psychiatry 35: 211-214, 1993

Recent recommendations for the routine use of modified ECT prompted an audit to be undertaken to determine the incidence of musculo-skeletal complications occurring in patients who received ECT at our centre from 1980 to 1990. Of the 13,597 treatments given, 98% were unmodified, due to the lack of availability of anesthestis. Musculo-skeletal complications occurred in less than 1% of treatments and were of little clinical significance. However, modified ECT was associated with significantly greater frequency of potentially fatal complications such as cardiac arrest. The findings of this audit indicate that unmodified ECT administered by a trained team does not result in significant musculo-skeletal morbidity and may be preferable to modified ECT in the absence of trained anaesthetic personnel. The decision to routinely recommend modified ECT in developing countries should await scientific debate with due consideration of the complications, resources, ethics, practicality and cost as well as the consequences of such a recommendation on clinical practice.

 

Seizure Duration over ECT Sessions : Influence of Spacing ECTs

National Institute of Mental Health & Neuro Sciences, Bangalore

Indian Journal of Psychiatry 34: 124-127, 1992

Thirty melancholic patients participated in a double blind trail comparing efficacy of modified bilateral sinewave ECT given twice or thrice weekly. Seizure was monitored on a single channel EEG tracing. All patients received ECTs in the first two weeks of the four week study period. Seizure duration estimate from EEG tracings available for 22 patients (10 patients of thrice weekly group) on all occasions of first two weeks were analysed. Seizure durations significantly reduced through the course in both the groups. Twice weekly ECTs led to significantly less decrements in the seizure duration. The differential reduction was not related to the therapeutic outcome. The improvement in depression in both groups of patients was comparable at the end of two weeks

 

The Practice Of ECT In India : Issues Relating To The Administration Of ECT

Agarwal, A K, Andrade, Chittaranjan, Reddy, Venkataswamy M

Professor in Psychiatry K G's Medical College, Lucknow

Indian Journal of Psychiatry 34: 285-297, 1992

A questionnaire on ECT, tapping attitudes, opinions and usage, was mailed to all medical members of the Indian Psychiatric Society whose addresses were known; 263 (28.8%) responded. This paper the first in a series that presents the results of the survey, provides demographic data on the respondents and covers issues relating to the administration of ECT. Specific issues discussed include the ECT personnel, location of ECT facility, certain ECT prescription patterns, psychiatrist-patient interactions on suggestion of ECT, pre-ECT investigations, frequency of administration of ECT, use of regressive ECT and maintenance ECT, length of the ECT course across diagnoses and use of psychotropic drugs in relation to the ECT course.

 

Bilateral Frontal Lobe CT Scan Abnormality Following ECT In An Adolescent

Jana, D, Banerjee, G

NRS Medical College, Calcutta

Indian Journal of Psychiatry 34: 392-394, 1992

A case is described of bilateral frontal lobe CT Scan abnormality associated with ECT in an adolescent. Possible causes and risk factors are discussed.

 

Computed Tomographic Study of Morphological Changes of the Brain in Patients with ECT Induced Seizures

Jayakumar, P N, Gangadhar, B N, Sinha, Vinod, Khanna, Sumanth, Arya, B Y T

Department of Neuro-radiology, National Institute of Mental Health & Neuro Sciences, Bangalore

Neurology India 40: 101-103, 1992

The case of disappearing CT abnormalities following seizures remains an enigma. Electroconvulsive therapy (ECT) used in the management of Psychiatric disorders is a good human model for understanding pathogenesis of epilepsy. Hence the study was designed to identify the morphological effects of ECT induced seizures on the brain by computed tomography. Densitometric and morphometric evaluation of the Pre-ECT and Post-ECT scans in 6 patients did not reveal any statistically significant differences. Though post-ictal changes cannot be excluded, we feel that underlying inflammatory causes have probably a role to play in some of those patients who demonstrate CT changes after seizures.

Key words - Brain oedema, Electronconvulsive therapy, Computed tomography, Epilepsy

 

Editorial : ECT: A Need Of Reappraisal

A K Agarwal

Indian Journal of Psychiatry 32: 295-296, 1990

 

Tilak Venkoba Rao Oration : Psychobiological Frontiers Of Electroconvulsive therapy In Depression : Evaluation Of Strategies For Rational Prescription And Reduction In Morbidity

Chittaranjan Andrade - Assistant Professor, Department of Psychopharmacology, National Institute of Mental Health & Neuro Sciences, Bangalore.

Indian Journal of Psychiatry 32: 109-130, 1990

 

Post Dexamethasone Plasma Cortisol Levels In Depressives Treated With Imipramine And Electroconvulsive Therapy

Lal Varma, S L, Trivedi, J K, Anand, Mohini, Gulam, Ram, Lal, Narottam

Department of Psychiatry, Institute of Medical Sciences Banaras

Indian Journal of Psychiatry 31: 78-82, 1989

Sixty patients of endogenous depression and thirty normal controls were studied to find out the relationship of post dexamethasone plasma cortisol levels (PDPC) and clinical improvement of endogenous depression in patients treated with electroconvulsive therapy and imipramine. The PDPC levels in both the group of patients showed significant decrease with clinical improvement (Pre and Post treatment PDPC Values of ECT group was 20. 7 m g/dl and 13. 6 m d/dl while it was 17. 9 m g/dl and 12. 7 m g/dl respectively for the Imipramine group). a significant correlation was also found between PDPC and severity of illness (p<0. 001) in the both groups which indicates that PDPC levels is independent of treatment modality used.

 

Effect Of Imipramine And ECT On Platelet Mao Activity In Depressives

Trivedi, J K, Singh, R P, Lal, Narottam, Viswanathan, P N, Kumar, Sudhir

Department of Psychiatry King George's Medical College, Lucknow

Indian Journal of Psychiatry 31: 139-143, 1989

Platelet monoamine Oxidase (MAO) activity was estimated in 30 depressed patients treated with Imipramine or ECT over a period of 5 weeks and pretreatment and post treatment values were compared. Imipramine and ECT caused significant reduction of platelet MAO, which after 7 days washout period comes to the pretreatment level while subjects clinical status remained unchanged. The percentage blockade in platelet MAO values by imipramine and ECT was 51.40 13.43 and 34.73 24.27 respectively

 

Initial Response To ECT As A Predictor Of Outcome In Endogenous Depression

Andrade, Chittaranjan, Gangadhar, B N, Vythilingam, Meena, Channabasavanna, S M, Pradhan, N

National Institute of Mental Health & Neuro Sciences, Bangalore

Indian Journal of Psychiatry 31: 293-295, 1989

In a double-blind, prospective study, 29 patients with endogenous depression were treated with electroconvulsive therapy (ECT). The degree of attention in Hamilton Rating Scale for Depressionscores after the first ECT was compared between ECT responders and non-responders at the end of the treatment course; a significant difference was obtained, indicating higher initial response in ECT responders. It is therefore suggested that response to a single trial ECT may form the basis for prediction of response of endogenous depression to a course of ECT. An operationalization of this concept is proposed, its sensitivity and specificity calculated and its implications discussed.

 

 

Efficacy of combined ECT after two weeks of neuroleptics in schizophrenia: a double blind controlled study.

Saritha EP, Janakiramaiah N, Gangadhar BN, Subbakrishna DK, Jyothi Rao

National Institute of Mental Health and Neurosciences, Bangalore.

NIMHANS Journal 16: 243-251, 1988

Clinicians introduce ECT early in the course of ongoing acute neuroleptic treatment of schizophrenia when the therapeutic progress is unsatisfactory. It is not known if such addition of ECT confers advantage. Schizophrenic inpatients referred to ECT were randomly assigned to one of the three treatments given for four weeks: bilateral, nondominant unilateral or sham ECT (n=12 in each group). They were on therapeutic range doses of neuroleptics for two to twelve weeks before being referred for ECT and the same was continued through the study period. Double-blind clinical ratings were made weekly. No significant group differences were found on CGI scores, BPRS total psychopathology as well as thinking disturbances, hostile-suspiciousness, withdrawal-retardation and anxious-depression factors. At the end of four weeks of treatment, ECT groups performed poorer than sham ECT group on logical, verbal and visual memory. The results do not support the practice of adding ECT to schizophrenics early in the course of ongoing neuroleptic treatment.

Key words: ECT, Schizophrenia, Neuroleptic, Efficacy

 

Measuring extent of motor seizure modification: role of succinylcholine dose.

Sarvanan ESM, Latha V, Mayur PM, Gangadhar BN, Janakiramaiah N, Umamaheshwara Rao

National Institute of Mental Health and Neurosciences, Bangalore.

NIMHANS Journal 16: 203-206, 1988

Research on the role of succinylcholine dose for the modification of peripheral convulsions during electroconvulsive therapy (ECT) is limited. This aspect was examined in consecutive consenting patients (n=44) who received bilateral ECT. Succinylcholine dose for modification ranged between 30 and 50 mg (0.45-1.30mg/kg, mean=0.78mg/kg) as chosen by the attending anaesthesiologist. Motor seizure was monitored by the cuff method. Two independent raters blind to succinylcholine dose measured the extent of motor seizure modification on a five-point rating scale higher score indicating better modification. Measurement was obtained during one of the ECT sessions in each patient. The scale demonstrated good interrater agreement (Kappa coefficient=0.75). In stepwise, multiple, linear regression model only succinylcholine dose explained 11% of the variance (beta=0.33, t=2.104, r2=0.11, p=0.007) in the extent of modification; higher dose yielding better modification. Only five patients (11%) had a score >3. Relatively larger succinylcholine doses (1mg/kg) may be required to produce effective modification.

Key words: ECT, Succinylcholine, Motor seizure modification

 

Clinical Prediction Of Rate Of Response Of Endogenous Depression To Electroconvulsive Therapy

Chittaranjan, Gangadhar, B N, Subbakrishna, D K, Channabasavanna, S M, Pradhan, N

National Institute of Mental Health & Neuro-Sciences, Bangalore

Indian Journal of Psychiatry 30: 381-387, 1988

In depression, the identification of predictors of fast response is necessary to improve patient selection for ECT. In a double-blind, prospective study of 32 endogenously depressed patients treated with ECT, we attempted to identify the clinical characteristics of ECT responders which predicted fast (requiring < 5 treatments to produce maximum recovery) and slow (requiring > 6 treatments to produce maximum recovery) response to ECT. Of the 22 ECT responders in the study, 13 were fast and 9 were slow responders. We found that male sex and greater age associated with lesser initial severity of depression were significantly associated with fast recovery. Surprisingly, factors suggested or expected to predict good outcome with ECT failed to predict fast outcome. Finally, the treatment variables of mean seizure duration and stimulus waveform were found to be unrelated to recovery rate. The findings are briefly discussed.

 

Dexamethasone Supression Test In Depressives Treated With ECT

S L Varma, N Lal, J K Trivedi, Mohini Anand

Indian Journal of Psychiatry 29: 353-357, 1987

A cohort of endogenous depressives and normal controls were studied to examine the role of DST in depressives treated with ECT. Weekly DST estimation was done and depression was assessed on HRS-D. 73.6% patients were found to be non suppressors as compared to controls in whom 16.7% were non suppressors. 60% DST positive patients showed clinical improvement while 50% DST negative did not show improvement. This proves the notion that DST is a state dependent biological marker of endogenous depressed state

 

Effect of ECT in Endogenous Depression: A Double Blind Comparison with Imipramine

B N Gangadhar R L Kapur & S Kalyanasundram - Department of Psychiatry, National Institute of Mental Health & Neuro-Sciences, Bangalore.

NIMHANS Journal 3: 7-12, 1985

In a double blind randomised trial, both ECT and imipramine produced equal and clinically significant improvements at the end of four weeks in endogenous depressives. The depression was assessed on the 17 item Hamilton rating scale for depression (HRSD) and was compared with its 6 item subscale. Whereas on the former scale ECT seemed superior only once, i.e., at the end of second week, with the latter scale, ECT seemed superior during all the first 3 weeks. Item analysis on the HRSD revealed significant differences with respect to the therapeutic effects of these two treatment methods.

Key words - ECT, Imipramine, Hamilton Rating Scale for Depression (HSRD), Item subscale

 

Side Effects of Somatic Therapies in Depression: A Double Blind Comparison of ECT & Imipramine

B N Gangadhar - Department of Psychiatry, National Institute of Mental Health & Neuro-Sciences, Bangalore.

NIMHANS Journal 3: 13-16, 1985

In a double blind randomised study comprising ECT and imipramine, ECT was found to be superior as it caused fewer subjective side effects than imipramine. Some of the side effects were common to both treatment methods. ECT did not cause detectable organic brain damage.

Key words - ECT, Imipramine, Depression, Side effects

 

Impedence Measurements during Electroconvulsive Therapy

B N Gangadhar, Lakshmanna, D K Subba Krishna and Channabasavanna S M

National Institute of Mental Health & Neuro-Sciences, Bangalore

NIMHANS Journal 3: 135-139, 1985

Impedence measurements were conducted in 49 male patients during electroconvulsive therapy. Wide fluctuations in impedence between and within patients across occasions were recorded. Age seemed to positively influence the impedence, whereas the occasion at which ECT was given and the voltage used, negatively influenced the impedence. Measurement of electrical energy dose using joules was found to have large variations and thus may not accurately reflect the energy delivered to the brain tissue.

Key words - Electroconvulsive therapy, Impedence

 

Re-evaluation Of ECT

(Tilak Venkoba Rao Oration 1985)

Ravi Abhyankar - Honorary Assistant Psychiatrist, Jerbai Wadia Hospital for Children Parel, Bombay. Senior Research Fellow, WHO Collaborating, Centre for Psychopharmacology, Department of Psychiatry, KEM Hospital, Parel Bombay

Indian Journal of Psychiatry 27: 35-50, 1985

 

Death Following ECT - A Case Report

Shukla, G DMishra, D N

Lecturer in Psychiatry, M.L.B. Medical College, Jhansi (U.P)

Indian Journal of Psychiatry 27: 95-97, 1985

Electro-Convulsive Therapy (ECT) is regarded as a safe procedure since although several thousands of treatments are given annually worldover, the occurrence of serious complications is rare (Sargant and Slater 10 1963; Cropper and Hughes 4 1964; Royal College of Psychiatrists 9 1977; Kalinowsky 8 1980 and Shukla 11 1981). Nevertheless, complications do occur and are, at times, fatal (Barker and Baker 3 1959; Arneson and Butler 2 1961; Heggtveit 5 1963; Kalinowsky and Hippius 8 1969 and Gomez 6 1974). To pour knowledge there has been no report of death following ECT from India. This prompted us to present case who died within 10 hours of ECT and in whom ECT and / or anaesthesia could be inferred to have caused or contributed towards death

 

Role Of ECT Phenothiazine Combination In Schizophrenia

Agarwal, A KWinny, G C

Department of Psychiatry, K.G.'s Medical College, Lucknow

Indian Journal of Psychiatry 27: 233-236, 1985

A prospective double blind study was conducted to evaluate the role of E.C.T. in schizophrenia. Before the start of the trial patients were kept on chlorpromazine inadequate dosage for 30 days. those who showed fifty percent or more improvement during this period were excluded. All patients were given eight modified or simulated E. C. T. s. The patients were followed up for one month. E.C.T. did not show any added advantage over chlorpromazine either initially or during short term follow-up

 

 

ECT And Drug Induced Parkinsonism

Gangadhar, B NChoudhary, Roy JChannabasavanna, S M

Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore

Indian Journal of Psychiatry 25: 212-213, 1983

A cross-sectional evaluation of the presence of drug induced parkinsonian symptoms in hospitalized patients was done. Patients who had received two or more ECTs had lower scores of parkinsonism when compared to those who were not receiving ECT. Since the patient groups were comparable on parameters which would influence the occurrence and development of drug induced parkinsonism, the lowered scores in one group could be attributed to the effect of ECT