A survey of methohexitone use by anesthetists in the clinical practice of ECT in Edinburgh

The dosage of methohexitone (methohexital) administered by anesthetic staff was surveyed in a consecutive series of 52 patients referred for electroconvulsive therapy (ECT) in routine clinical practice in Edinburgh. Patients were weighed before the first treatment, and the ratio of administered dose to weight in kilograms calculated. Anesthesia was administered by three consultant staff and six nonconsultant staff. In only one patient (2%) was the administered dose within the range recommended by the Royal College of Psychiatrists (0.75-0.9 mg/kg), and in only four patients (8%) were the doses within the range recommended by the American Psychiatric Association (0.75-1.0 mg/kg). In all other patients the dose exceeded these recommended ranges; the average dose was 1.5 (+/- 0.3) mg/kg. The possible implications of these findings are discussed.     

Cannabis use in young people: the risk for schizophrenia

Cannabis is one of the most commonly used illicit drugs, and despite the widely held belief that it is a safe drug, its long-term use has potentially harmful consequences. To date, the research on the impact of its use has largely been epidemiological in nature and has consistently found that cannabis use is associated with schizophrenia outcomes later in life, even after controlling for several confounding factors. While the majority of users can continue their use without adverse effects, it is clear from studies of psychosis that some individuals are more vulnerable to its effects than others. In addiction, evidence from both epidemiological and animal studies indicates that cannabis use during adolescence carries particular risk. Further studies are warranted given the increase in the concentration of the main active ingredient (Δ⁹-tetrahydrocannabinol) in street preparations of cannabis and a decreasing age of first-time exposure to cannabis.     

Cannabis use and the mental health of young people

OBJECTIVE: To review the evidence on the mental health and psychosocial consequences of rising rates of cannabis use among young people in developed countries. METHOD: This paper critically reviews epidemiological evidence on the following psychosocial consequences of adolescent cannabis use: cannabis dependence; the use of heroin and cocaine; educational underachievement; and psychosis. Leading electronic databases such as PubMed have been searched to identify large-scale longitudinal studies of representative samples of adolescents and young adults conducted in developed societies over the past 20 years. RESULTS: Cannabis is a drug of dependence, the risk of which increases with decreasing age of initiation. Cannabis dependence in young people predicts increased risks of using other illicit drugs, underperforming in school, and reporting psychotic symptoms. Uncertainty remains about which of these relationships are causal although the evidence is growing that cannabis is a contributory cause of psychotic symptoms. CONCLUSIONS: We face major challenges in communicating with young people about the most probable risks of cannabis use (dependence, educational underachievement and psychosis) given uncertainties about these risks and polarized community views about the policies that should be adopted to reduce them.     

The use of ECT in intellectual disability

The present survey examines the use of electroconvulsive therapy (ECT) by consultant psychiatrists working with people with intellectual disability in Trent Region, UK, which has a population of 4.7 million people. In the first phase of the study, all consultants in the area were sent a questionnaire to find out how many patients had been given ECT during the previous 5 years. Some 92% of the consultant psychiatrists returned the questionnaires. Eight patients were given a total of 122 ECTs, which is low when compared with the use of ECT by general adult psychiatrists. The second phase of the research involved a study of the individual medical case notes to obtain information about individual indications for ECT, outcome and consent issues. The commonest indication for ECT was depression, and the best response was obtained when the clinical picture was dominated by biological and/or psychotic symptoms.     

Successful use of ECT in post-stroke depression

Post-stroke depression is a potentially persistent complication of stroke. Electroconvulsive therapy (ECT) is an effective treatment for depression, but with limited data regarding safety in stroke patients. We report the case of a 30-year-old woman with a history of stroke and antiphospholipid syndrome, who became depressed and suicidal. Neurologic and Internal Medicine consults did not reveal any contraindications to ECT, but stroke risk factor management was identified as an important measure for patient safety. The patient tolerated ECT well, reporting improvement of mood and abatement of hopelessness. This case suggests that ECT may be a safe and well-tolerated treatment for post-stroke depression.     

Motives for substance use among young people seeking mental health treatment

Aims: To explore substance use motives among young people seeking mental health treatment. Methods: Participants consisted of 103 young people seeking mental health treatment, who had used drugs or alcohol in the past year. The young people completed a 42‐item substance use motives measure based on the Drinking Motives Measure for their most frequently used substance in the past year. Results: Exploratory factor analysis of the substance use motives scale indicated the young people reported using substances for positive and negative drug effects, to socialize with their peers, and to cope with a negative affect. They did not report using substances for enhancement or conformity motives. Coping motives predicted the presence of a current substance use disorder. Conclusions: The findings support the need for integrated treatment approaches within mental health settings, particularly targeted at young people with co‐occurring mental health and substance use problems.     

ECT: use in individuals with mental retardation

Electroconvulsive therapy (ECT) is an effective treatment of a variety of serious psychiatric and neurologic disorders. There are infrequent case reports of its use in individuals with mental retardation (MR). We describe 10 patients with MR and complex comorbid psychiatric disorder treated with ECT. Seven patients had an excellent response to treatment. Side effects of treatment were minimal and transitory.     

Mental health in young people

Summary The aim of this study is the investigation of psychological discomforts in workers considered to be exposed to mental health risks. The subjects chosen were all young males, aged between twenty and twenty-nine, resident in the same geographical area for at least ten years and still living with their original family. Through a random process of selection four groups were sampled: metalworkers exposed to mental health occupational risks, metalworkers not exposed to mental health occupational risks, full-time students, and persons unemployed or seeking their first job. The subjects from each group completed the questionnaire to determine the index of psychological discomforts (IDP). Significantly higher frequencies and averages were found in the group of metalworkers exposed to mental health risks, while no statistically significant results were noted in the other groups, including the group of unemployed.     

The use of ECT in the treatment of schizophrenia

ECT has been replaced by neuroleptics for the treatment of schizophrenia. The production of serious drug-related side effects, particularly tardive dyskinesia, raises the question of the efficacy and toxicity of ECT versus neuroleptics. Most of the studies in the English literature on the use of ECT in the treatment of schizophrenia are unacceptable according to contemporary criteria: the question of ECT versus neuroleptic drugs thus remains unanswered. In the few acceptable published studies, clinical response to ECT was inversely proportional to duration of schizophrenic symptoms. Schizophrenic patients with affective and catatonic symptoms responded best: those with chronic symptoms rarely responded. ECT does not alter the fundamental psychopathology of schizophrenia.     

The use of ECT in children: case report

A case is presented in which electroconvulsive therapy (ECT) was successfully used to treat childhood depression. In addition, the literature of ECT use in childhood disorders is briefly reviewed. It is proposed that ECT is a valid therapy for children only in depression, mania, or acute schizophreniform psychoses, refractory to pharmacotherapy.     

The use of ECT and MST in treating depression

Electroconvulsive therapy (ECT) has been used clinically since 1938. Its most common use is in the treatment of depression: first line treatment where rapid recovery is a priority, but more frequently as an effective treatment for patients who do not respond to pharmacological and psychological approaches. Whilst it is widely hailed as an effective treatment, concerns about its effect on cognition remain. The development of magnetic seizure therapy (MST) over the past decade has attempted to devise a therapy with comparable efficacy to ECT, but without the associated cognitive side effects. The rationale for this is that MST uses magnetic fields to induce seizures in the cortex, without electrical stimulation of brain structures involved with memory. MST has been used successfully in the treatment of depression, yet there is a dearth of literature in comparison with ECT. We present a systematic review of the literature on ECT (from 2009-2011) and MST (from 2001-2011).