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Electroconvulsive Therapy (ECT) is a safe and effective technique widely used in our area. Scientific literature related to the application of this technique is continuously developing, specifically with regard to the placement of the electrodes, the amplitude of the stimulus pulse administered, the initial charge used, and the anesthetic agent involved.
The primary aim of this study was to analyze technical variables associated with the use of ECT in our hospital, and compare them to the guidelines of the protocol developed in our hospital and international standards.
We performed a review of Clinical Histories of the patients that were treated with ECT in the “Hospital 12 de Octubre” (Madrid, Spain), in the period comprised between January 1st, 2008 and December 31st, 2009. We collected data related to the application of the technique, socio-demographic variables and clinical profiles. We used descriptive statistics to analyze our data.
During this period, 602 ECT sessions were applied. Placement of the electrodes was unilateral in 58% of subjects with Affective Disorders and 8% of subjects with Schizophrenia. The amplitude of the stimulus pulse was 1 ms. Mean charge administered in the initial and final session was 236.85 mC and 357.16 mC, respectively. Etomidate was used as anesthetic in 68% of cases.
ECT technical variables applied in our hospital are adjusted to guidelines of our area and international recommendations. Longitudinal studies are warranted in order to objectively assess techinical variables associated to ECT.
ECT has demonstrated to be an effective and safe biological treatment that can be considered as an alternative to pharmacotherapy, especially for treating severe, resistant and recurrent, affective, psychotic and catatonic symptoms. CECT refers to the one that is started after acute treatment and lasts for a maximum period of 6 months with the objective of preventing relapse. M-ECT is the one that is started once C-ECT has ended with the aim of preventing recurrences. The aim of this study was to explore the evidence for using C-ECT and M-ECT as an alternative to pharmacotherapy.
We performed a search in MEDLINE, PubMed and Cochrane, from 1950 until the present to identify articles in which C-ECT and M-ECT were used as alternative treatments to pharmacotherapy.
C-ECT and M-ECT have demonstrated to be an effective and safe alternative to pharmacotherapy in Unipolar Depression, Bipolar Disorder and Schizophrenia, especially in the prevention of relapse and recurrences. It reduces number and days of hospitalization. In combination with pharmacotherapy, it increases effectiveness of pharmacological treatment. It does not affect cognitive functioning.
C-ECT and M-ECT should be considered as an alternative to pharmacotherapy in the treatment of affective and psychotic, severe, resistant and recurrent symptoms. It is an effective and safe treatment, which prevents relapse and recurrences in severe mental illness, reducing hospitalization rates and health costs.
Pathological Gambling (PG) tends to be a heterogeneous disorder where patients differ with type and severity of gambling behaviour, psychiatric co-morbidity, family history, sex and age of onset. Age of disease onset in PG varies significantly, with many individuals having onset during childhood and adolescence and others in various stages of adulthood. Previous studies have demonstrated that age of onset is an important characteristic for a better understanding of the PG heterogeneity.
(1) To analyze differences in sociodemographic aspects between early-onset PG and non early-onset PG, (2) to study whether early-onset PG is associated with specific psychiatric diagnosis in axis I and II.
We used data from a large and nationally representative community sample of United States (US) adults, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We selected age 25 years as a threshold for early-onset PG.
Individuals with early-onset PG were more likely to be male, never married, and young and to have a lower education level and individual income than non early-onset PGs. Early-onset PG were less likely to have mood disorder (OR = 0.42 (0.19 − 0.94)) and had non-significant higher odds of having substance and anxiety disorders than non early-onset. The odds of having Cluster B disorder were significantly higher among early-onset PGs than non early-onset PGs (OR = 4.11 (1,77 − 9.55)).
Our findings support that subgroups of Pathological Gambling defined by onset age have phenotypic differences.
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