SAFETY OF THE ELECTROCONVULSIVE THERAPY AND AMISULPRIDE COMBINATION

Background: Electroconvulsive therapy is frequently considered when pharmacotherapy is ineffective. In such cases the combination of the two treatment modalities are commonly used. Amisulpiride, a second generation antipsychotic drug is used in the treatment of schizophrenia and psychotic depression. When amisulpiride is ineffective as a monotherapy, combination with ECT could be an option to enhance its efficacy. To the best of our knowledge, to date there have been no data about the safety of this combination. Subjects and methods: Medical notes of all patients who were given ECT while on amisulpiride were selected from the archives of the Department of Psychiatry, Semmelweis University Medical School, Budapest, covering a 10-year period. A randomly selected matched control group was formed from patients who underwent ECT but were not taking amisulpiride. Patients in both groups also received a variety of psychotropic drugs other than amisulpide. Side effects were compared between the two groups of patients. Results: Twenty patients received amisulpride with ECT. The most common side effects were headache, hypertension, tachycardia, nausea, dizziness, confusion, psychomotor agitation, sialorrhea, and prolonged seizure activity. All adverse effects resolved within 24 hours. No side effects of any kind were observed in 7 and 8 cases in the study and control groups, respectively. Conclusions: This was the first study that examined the safety of amisulpride-ECT combination in schizophrenia. Comparing the side-effects between the study and control groups, no significant differences were detected in terms of their types or frequency. The amisulpiride-ECT combination appears to be a safe treatment option

WHEN DO PSYCHIATRIC SIDE EFFECTS EMERGE DURING ANTIVIRAL TREATMENT OF HEPATITIS C?

Background: This retrospective study aimed to determine the time-frame regarding the first appearance of psychiatric side effects in the course of antiviral treatment and the subsequent referral to consultation-liaison psychiatric services. Subjects and methods: Medical records of patients receiving combined antiviral treatment with alpha interferon and ribavirin for hepatitis C at a hepatology outpatient clinic and referred to psychiatric consultation between April 2000 and July 2011 were scrutinized. Results: Time between the initiation of antiviral treatment and the first appearance of psychiatric symptoms was 10.64±10.68 weeks. Patients were referred to psychiatric examination 16.1±12.7 weeks after antiviral treatment had been commenced. The time frame of the emergence of psychiatric symptoms and the referral for psychiatric consultation did not correlate with the patients’ age or sex. No relationship between substance/alcohol abuse and psychiatric history and the timing of psychiatric side effects and their assessment were found. Conclusions: This study confirmed that psychiatric side effects appear late in the course of combined antiviral treatment arising after 10.64±10.68 weeks the treatment started. The results also showed that some patients’ psychiatric symptoms appeared immediately after the beginning of the antiviral therapy. This finding underlines the importance of monitoring patients’ psychiatric condition as soon as antiviral treatment commences

Non-pharmacological biological therapies in schizophrenia

Non-pharmacological biological therapies of schizophrenia have dramatically developed over the last eight decades. Starting from a historical perspective authors aim to give an overview about the development of convulsive therapy. Recommendations of the most influential guidelines and the controversies in the worldwide clinical practice are discussed and clinical conditions responsive to electroconvulsive therapy are reviewed. Finally, the place of the new neurostimulation techniques, particularly TMS is outlined

ELECTROCONVULSIVE THERAPY ON HUNGARIAN WEBSITES

Background: Although there are several similarities in terms of their equipment and the way they are performed, the social perception and public attitudes towards electroconvulsive therapy (ECT) and electric cardioversion (ECV) is entirely different. The aim of this study was to assess and compare the information on Hungarian Internet sites on ECT and ECV with respect to their depiction and acceptance by the public. Subjects and methods: An Internet search was undertaken with the Google search engine using the terms „ECT”, „electroconvulsive therapy”, „electroshock”, „defibrillator” and „electric cardioversion”. The search was restricted to information published in the Hungarian language from 1 January 2000 to 31 December 2010. All communications were classified into negative, neutral and positive groups depending on their attitude towards the aforementioned treatment methods. Professional or nonprofessional categories were also distinguished. Results: The total number of communications, which appeared between 2000 and 2010 and contained one of the search words for ECT was 66. The majority of them portrayed ECT in a negative (24; 36.4%) or neutral (25; 37.9%) fashion. Most of the websites (139; 95.2%) related to ECV were reflected positive (120; 82.2%) and neutral opinions (19; 13.0%). Conclusions: Hungarian-language Internet sites mainly view ECT as negative or neutral in contrast to ECV cardioversion, which has almost entirely a positive reputation. Although the effectiveness of both therapies is equally well established, their public image as manifested on the Internet differs significantly. This may have a major impact on the frequency of their use

Electroconvulsive therapy on Hungarian websites

Background: Although there are several similarities in terms of their equipment and the way they are performed, the social perception and public attitudes towards electroconvulsive therapy (ECT) and electric cardioversion (ECV) is entirely different. The aim of this study was to assess and compare the information on Hungarian Internet sites on ECT and ECV with respect to their depiction and acceptance by the public. Subjects and methods: An Internet search was undertaken with the Google search engine using the terms „ECT”, „electroconvulsive therapy”, „electroshock”, „defibrillator” and „electric cardioversion”. The search was restricted to information published in the Hungarian language from 1 January 2000 to 31 December 2010. All communications were classified into negative, neutral and positive groups depending on their attitude towards the aforementioned treatment methods. Professional or nonprofessional categories were also distinguished. Results: The total number of communications, which appeared between 2000 and 2010 and contained one of the search words for ECT was 66. The majority of them portrayed ECT in a negative (24; 36.4%) or neutral (25; 37.9%) fashion. Most of the websites (139; 95.2%) related to ECV were reflected positive (120; 82.2%) and neutral opinions (19; 13.0%). Conclusions: Hungarian-language Internet sites mainly view ECT as negative or neutral in contrast to ECV cardioversion, which has almost entirely a positive reputation. Although the effectiveness of both therapies is equally well established, their public image as manifested on the Internet differs significantly. This may have a major impact on the frequency of their use

Impact of the type of hematopoietic stem-cell transplant on quality of life and psychopathology

Background and purpose – Despite the decrease in transplant-related mortality, patients who receive hematopoietic stemcell transplants often suffer from short-and long-term morbidities, poorer quality of life, and psychosocial functioning deficits. Several studies have compared the quality of life and affective symptoms of patients after undergoing autologous and allogeneic hematopoietic stem-cell transplants. Some studies have reported similar or greater quality of life impairments in allogeneic hematopoietic stemcell recipients, but the findings have been inconsistent. Our purpose was to examine the influence of the type of hematopoietic stem-cell transplantation on the quality of life and affective symptoms of patients. Methods – The study sample comprised 121 patients with various hematological diseases who underwent hematopoietic stem-cell transplantation at St. István and St. László Hospitals, Budapest. The study had a cross-sectional design. Quality of life was evaluated using the Hungarian version of the Functional Assessment of Cancer Therapy– Bone Marrow Transplant scale (FACT-BMT). Anxiety and depressive symptoms were assessed using Spielberger’s State and Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), respectively. Basic sociodemographic and clinical variables were also recorded. Comparisons between autologous and allogeneic recipients were analyzed using a t-test when the variables were normally distributed and a Mann–Whitney U test otherwise. A stepwise multiple linear regression analysis was performed to identify the risk factors that contributed to the quality of life and the affective symptoms in each group. Results – Quality of life (p=0.83) and affective symptoms (pBDI=0.24; pSSTAI=0.63) were similar between the autologous and allogeneic transplant groups. The BDI scores of allogeneic transplant patients indicated mild depression, but their STAI scores were similar to those of the general population. Allogeneic transplant patients with symptoms of graft-versus-host disease (GVHD) experienced more severe clinical conditions (p=0.01), poorer functional status (p\u3c0.01) and received more immunosuppressive treatment (p\u3c0.01) than those without graft versus host disease. Patients suffering from graft versus host disease experienced more severe depression (p=0.01), and constant anxiety (p=0.03) than those without graft versus host disease. Quality of life was affected by depressive and anxiety symptoms and psychiatric comorbidity in both the allogeneic and autologous groups. Conclusion – Graft versus host disease-related severe somatic complaints seemed to influence the allogeneic transplant patients’ quality of life by inducing depressive and anxiety symptoms

Psychosocial aspects of hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented

Prevalence and correlates of aggressive behavior in psychiatric inpatient populations

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients

The practice of consenting to electroconvulsive therapy in the European Union

Objectives: To survey major aspects of obtaining informed consent to electroconvulsive therapy (ECT) in the countries of the European Union. Methods: Leading professionals in the field of biological psychiatry in all European Union countries and Norway and Switzerland were approached by e-mail asking about the national practice of obtaining consent to ECT including the form of consent, the legality of consent by proxy, and consent to anesthesia and maintenance treatment. Results: A considerable diversity was found across Europe regarding consent to ECT. In Slovenia and Luxembourg, ECT is not available at all. Informed consent is needed in written form in most European countries except for Sweden, Denmark, Finland, and Slovakia, where verbal consent is sufficient. Italy, Ireland, and Latvia are stricter in their approach because separate written consent is required before each ECT session. Conclusion: The practice of obtaining informed consent varies from country to country reflecting the individual European Union countries’ jurisdiction and their sociocultural traditions as well as their different development of psychiatric services. In line with the increasing cooperation in health care, developing a unified way of obtaining consent for ECT is recommended