Age-related cognitive effects of ECT and ECT-induced mood improvement in depressive patients

This explorative study investigated the interaction between electroconvulsive therapy (ECT) treatment-effect, reduced depression, and neuropsychological outcome in relation to age. Follow-up neuropsychological assessment was conducted with depressive patients treated with ECT. From a potential sample of 45 patients, the neuropsychological measures (pre-ECT, three times post-ECT, up to 12 months) and clinical data from the remaining 21 patients who completed all assessments were evaluated (mean age = 56.76; SD = 14.12; range, 33-79). ECT resulted in a decrease in the depression scores. A distinct impact of ECT and depression decrease on cognitive domains was found. Depression alleviation was mainly associated with improvement in cognitive domains such as memory, information processing, and executive function. ECT improved cognitive domains such as information processing and perception. Short-term cognitive improvement was greater in older patients but showed an increase similar to that at long-term follow-up in younger patients (<60). Current findings provide evidence that ECT may improve cognitive functioning in nondemented elderly, which has strong clinical relevance concerning the Use of ECT. © 2006 Wiley-Liss, Inc

Het zelfgekozen levenseinde:Levensbeeindiging als oplossing?

Suïcidaal gedrag bestaat uit gedachten, voorbereidingshandelingen en pogingen die een zekere intentie uitdrukken om zichzelf te doden. Een geïntegreerd model van stress-kwetsbaarheid en entrapment wordt gebruikt om het psychologisch proces te beschrijven waarlangs kwetsbare individuen onder invloed van stressoren suïcidaal gedrag kunnen ontwikkelen. Daarnaast wordt de ‘interpersonal theory of suicide’ van Thomas Joiner geïntroduceerd, die cruciale psychologische factoren identificeert voor een verhoogd suïciderisico. Volgens deze theorie is de wijze waarop iemand zich verhoudt tot zijn omgeving bepalend bij suïcidaal gedrag. Dit zien we zeker bij suïcidale ouderen; zij voelen zich vaak een last voor hun omgeving en missen de verbondenheid met anderen. De theorie van Joiner geeft ook aanknopingspunten voor preventie en behandeling. Verder wordt het CASE-interview toegelicht, een systematische onderzoeksmethode naar suïcidaal gedrag, en komt de structuurdiagnose aan de orde. Deze aanpak wordt geïllustreerd aan de hand van een casus

Drug-drug interactions as a determinant of elevated lithium serum levels in daily clinical practice.

Item does not contain fulltextOBJECTIVE: Lithium is a drug with a narrow therapeutic window. Concomitantly used medication is a potentially influencing factor of lithium serum concentrations. We conducted a multicentre retrospective case-control study with the aim of investigating lithium-related drug interactions as determinants of elevated lithium serum levels in daily clinical practice. METHODS: Cases were patients with an increase of at least 50% in lithium serum concentrations resulting in an elevated lithium serum level of at least 1.3 mmol/L, and who were not suspected of a suicide attempt. Controls were patients who showed stable lithium serum levels within the therapeutic range. Use and start of non-steroidal anti-inflammatory drugs, diuretics, renin-angiotensin inhibitors, theophyllin and antibiotics were investigated as potential determinants of the elevated lithium serum levels. Irregularity in lithium dispensing pattern, change in lithium dosing regimen, age, gender, prescribing physician and laboratory parameters were investigated as potential confounders. RESULTS: We included 51 cases and 51 controls in our study. Five (9.8%) controls and 15 (29.4%) cases used potentially interacting co-medication [OR of 3.83 (95%CI 1.28-11.48)]. Start of potentially interacting co-medication was observed in eight (15.7%) cases and in zero (0%) controls resulting in an OR of 20.13 (95% CI 1.13-359). After adjustment for co-medication, irregularity in lithium dispensing pattern, change in lithium dosing regimen, and age, the statistically significant association was lost. We report an OR of 2.70 (95% CI 0.78-9.31) for use of concomitant medication, with a large contribution of antibiotic agents, and an OR of 3.14 (95% CI 1.15-8.61) for irregularity in lithium dispensing pattern. CONCLUSION: Use of co-medication, especially antibiotics, tends to be associated with elevated lithium serum levels