Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica (original) (raw)
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Funciones cognitivas y terapia electroconvulsiva en pacientes psiquiátricos con enfermedad afectiva
Medicina UPB, 2018
Objective: Electroconvulsive therapy (ECT) has been considered a safe and effective treatment for depression, manic episodes, and other serious psychiatric conditions. Its main reported side effect has been cognitive impairment. This study describes the cognitive effects of ECT in psychiatric patients referred for treatment at a private clinic. Methodology: Descriptive case series study. A baseline assessment conducted before starting ECT, and another two (at one week and at six months) after completing the treatment cycle were used to describe the effects of frontotemporal bilateral ECT on neurocognitive function in terms of the change from the baseline to the final assessment in the domains of memory, psychomotor speed, reaction time, complex attention, and cognitive flexibility, as well as global cognitive function, as well as to determine ECT's safety by reporting adverse events. Cognitive assessment was conducted with a neuropsychological test battery and severity of psychiatric illness with the Clinical Global Impression-Severity scale (CGI-S). Six patients referred for treatment during six months were included. Results: No statistically significant differences were observed between the medians of the evaluations of CGI-S scale, global cognitive function or any of the domains evaluated. Conclusions: ECT did not produce changes in the cognitive functions assessed in the six studied patients.
Psychology and Electroconvulsive Therapy (II): Interested Consensus Lacking in Evidence
2020
132 he aim of this work and its first part is to provide arguments that allow a critical positioning with respect to electroconvulsive therapy (ECT). After reviewing the conceptual and historical aspects, this second part explores the available scientific evidence and the clinical implications of electroshock, including the view of mental disorders that it may create. Finally, a number of legal points are presented for consideration.
Medicina UPB, 2018
Objetivo: la terapia electroconvulsiva (TEC) se ha considerado un tratamiento seguro y eficaz para episodios de depresión mayor, para episodios maníacos y otros trastornos psiquiátricos serios. El estudio describe los efectos cognitivos de la TEC en pacientes referidos para tratamiento a una clínica privada. Metodología: estudio descriptivo del tipo de serie de casos. En cada participante se realizó una evaluación basal antes del inicio de la TEC y otras dos (una a la semana y otra a los seis meses) después de terminado el ciclo de tratamientos, para describir el efecto de la TEC frontotemporal bilateral en la función neurocognitiva mediante el cambio, desde el estado basal hasta la evaluación final en los dominios de memoria, velocidad psicomotora, tiempo de reacción, atención compleja y flexibilidad cognoscitiva, así como en la función cognoscitiva global; y determinar su seguridad por el reporte de eventos adversos. La evaluación cognitiva se realizó con una batería de pruebas neuropsicológicas y la severidad de la enfermedad psiquiátrica se evaluó con la escala Clinical Global Impression Severity (CGI-S). Se incluyeron seis pacientes remitidos para tratamiento durante el periodo de seis meses. Resultados: no se observaron diferencias estadísticamente significativas entre las medianas de las evaluaciones de CGI-S, ni de la función cognitiva global, así como de ninguno de los dominios evaluados. Conclusiones: la TEC no produjo cambios en las funciones cognitivas analizadas en los seis pacientes estudiados. ABSTRACT Objective: Electroconvulsive therapy (ECT) has been considered a safe and effective treatment for depression, manic episodes, and other serious psychiatric conditions. Its main reported side effect has been cognitive impairment. This study describes the cognitive effects of ECT in psychiatric patients referred for treatment at a private clinic. Methodology: Descriptive case series study. A baseline assessment conducted before starting ECT, and another two (at one week and at six months) after completing the treatment cycle were used to describe the effects of frontotemporal bilateral ECT on neurocognitive function in terms of the change from the baseline to the final assessment in the domains of memory, psychomotor speed, reaction time, complex attention, and cognitive flexibility, as well as global cognitive function, as well as to determine ECT’s safety by reporting adverse events. Cognitive assessment was conducted with a neuropsychological test battery and severity of psychiatric illness with the Clinical Global Impression-Severity scale (CGI-S). Six patients referred for treatment during six months were included. Results: No statistically significant differences were observed between the medians of the evaluations of CGI-S scale, global cognitive function or any of the domains evaluated. Conclusions: ECT did not produce changes in the cognitive functions assessed in the six studied patients. RESUMO Objetivo: a terapia eletroconvulsiva (TEC) se há considerado um tratamento seguro e eficaz para episódios de depressão maior, para episódios maníacos e outros transtornos psiquiátricos sérios. O estudo descreve os efeitos cognitivos da TEC em pacientes referidos para tratamento a uma clínica privada. Metodologia: estudo descritivo do tipo de série de casos. Em cada participante se realizou uma avaliação basal antes do início da TEC e outras dois (uma em uma semana e outra aos seis meses) depois de terminado o ciclo de tratamentos, para descrever o efeito da TEC frontotemporal bilateral na função neurocognitiva mediante a mudança, desde o estado basal até a avaliação final nos domínios de memória, velocidade psicomotora, tempo de reação, atenção complexa e flexibilidade cognoscitiva, assim como na função cognoscitiva global; e determinar sua segurança pelo reporte de eventos adversos. A avaliação cognitiva se realizou com uma bateria de provas neuropsicológicas e a severidade da doença psiquiátrica se avaliou com a escala Clinical Global Impression Severity (CGI-S). Se incluíram seis pacientes remitidos para tratamento durante o período de seis meses. Resultados: não se observaram diferencias estatisticamente significativas entre as média das avaliações de CGI-S, nem da função cognitiva global, assim como de nenhum dos domínios avaliados. Conclusões: a TEC não produziu mudanças nas funções cognitivas analisadas nos seis pacientes estudados.
Avaliação da eficácia da eletroconvulsoterapia contínua para esquizofrenia resistente ao tratamento
Archives of Clinical Psychiatry, 2014
Background: Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective: The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods: In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results: As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1 st month, 3 rd month and 6 th month; 3 rd and 6 th month's PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion: Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse.
Psychology and Electroconvulsive Therapy (I): Historical and Conceptual Aspects
2020
the need for interdisciplinary debate than that of mental health. There have always been numerous controversies in this field because theoretical perspectives coexist that allow psychopathological problems to be understood and dealt with in different ways. This plurality is neither provisional nor anomalous, but rather it is characteristic of mental health (Pérez-Álvarez, 2014). Such plurality is beneficial because of the multi-causal and multidimensional nature of mental disorders. Psychopathological phenomena, far from being symptoms of underlying diseases, can be understood as ways of responding to various life problems and situations and to the inherent complexity of the human being (Fonseca & Lemos, 2019). In this study we aim to investigate the roots of the controversy surrounding electroconvulsive therapy (ECT), a technique that is currently experiencing attempts at revival even among particularly vulnerable populations such as children and adolescents, pregnant women, and th...
The effectiveness of electroconvulsive therapy: a literature review
To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified. Declaration of Interest: Neither author has any financial conflicts of interest in relation to his paper. KEY WORDS: ECT, evidence-based medicine, literature review, cost-benefit analysis.
Efficacy of electroconvulsive therapy: Too Brief Or Not Too Brief?: Too Brief Or Not Too Brief?
2015
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