无抽搐电休克治疗对抑郁症的疗效及记忆影响的研究

目的 评价无抽搐电休克治疗与选择性5-羟色胺再摄取抑制剂治疗抑郁症的疗效及对记忆的影响.方法 60例抑郁症患者随机分成两组,分别实施无抽搐电休克治疗（MECT）及选择性5-羟色胺再摄取抑制剂（SSRI）治疗,采用汉密顿抑郁量表（HAMD）、修订韦氏记忆量表（WMS）分别评定2组的疗效及对记忆的影响.结果 无抽搐电休克治疗与SSRI总体疗效相当,但无抽搐电休克治疗起效更快.无抽搐电休克治疗对记忆有影响,但在1～2周内逐渐得到恢复.结论 无抽搐电休克治疗是一种值得推广的安全有效的治疗抑郁症的方法。     

影响无痉挛电休克治疗成败的因素分析

对１３１次无痉挛电休克治疗（ＥＣＴ）进行分组对照研究，发现除适当的肌肉松弛剂（司可林）、麻醉药量和通电量外，通电时机是影响治疗成败的关键。当去极化成束肌颤在四肢远端结束时，是通电治疗的最佳时刻。     

无抽搐电休克对抑郁症记忆功能及抽象思维能力的影响

目的初步探讨无抽搐电休克治疗(MECT)对抑郁症患者的记忆功能及抽象思维能力的影响.方法对19名抑郁症患者采用修订韦氏成套记忆测验(WMS)、木块图和第四例外测验对19例抑郁症患者在治疗前、治疗后第一个24 h以及所有治疗终止后第一个24 h共三个时间段进行重复测验. 结果三个时间段的记忆商数差异均无显著性(P＞0.05);"联想"和"木块图"得分在三个不同时间段的得分差异有显著性(P＜0.05),治疗后得分明显高于治疗前. 结论无抽搐电休克可能对抑郁症的记忆功能和抽象思维能力不造成影响.     

无抽搐电休克治疗对抑郁症患者自伤行为的影响

目的:探讨无抽搐电休克治疗(MECT)对抑郁症患者自伤行为的疗效.方法:采用对照研究设计,根据伴有自伤行为的抑郁症患者是否同意接受MECT的意愿将其分为研究组(共43例)和对照组(共42例);两组患者在服用抗抑郁药治疗的基础上,给予研究组每周3次MECT,共9次,刺激部位为双侧颞叶.治疗前及治疗后6个月采用自伤行为问卷...     

无抽搐电休克治疗对抑郁症患者γ-氨基丁酸的影响

目的 探讨无抽搐电休克治疗（MECT）对抑郁症患者γ-氨基丁酸（GABA）的影响。方法 入组45例抑郁症患者,接受12次MECT治疗,采用汉密尔顿抑郁量表（HAMD）评估疗效;采用ET-脑超慢涨落分析仪测定MECT治疗前后患者的GABA的相对功率。结果 经过12次MECT治疗,患者HAMD评分由治疗前的（28．87±6．01）分降低为（11．64±4．04）分,GABA相对功率由（14．21±7．93）升高为（29．71±8．46）,差异均有统计学意义（t值分别为-23．540,14．601;P〈0．01）;GABA递质相对功率的变化与抑郁症患者临床症状的改善呈正相关（r=0．61,P〈0．01）;GABA递质相对功率的变化能预测抑郁症临床症状变化的35．3％。结论 MECT可以使抑郁症患者异常降低的GABA的递质相对功率增高,GABA可能参与了抑郁症的发病机制。     

电休克治疗对抑郁症的疗效研究

目的:评价无抽搐电休克治疗与传统电休克治疗抑郁症的疗效及不良反应.方法:80例抑郁症患者随机分成两组,分别实施无抽搐电休克治疗与传统电休克治疗,采用汉密尔顿抑郁量表(HAMD)、韦氏记忆量表(WMS)及自制不良反应观察表分别评定两组的疗效及不良反应.结果:无抽搐电休克治疗与传统电休克治疗总体疗效相当,但传统电休克治疗起效更快.二者对记忆均有影响,前者对记忆的影响在1～2周内恢复,后者持续2周以上.其他不良反应均较小.结论:无抽搐电休克治疗是一种值得推广的安全有效的治疗抑郁症方法,而传统电休克治疗起效更快,对有高度自杀风险的抑郁症患者的治疗效率可能更高.     

无抽搐电休克治疗对首发抑郁症患者视觉P300的影响

目的:探讨无抽搐电休克治疗(MECT)对抑郁症患者视觉P300的影响. 方法:首发抑郁症患者(抑郁症组)40例和正常对照组40名.正常对照只行视觉P300检测,抑郁症组在MECT前后行视觉P300检测及HAMD评分;两组间进行P300指标比较及对抑郁症组MECT前后视觉P300与HAMD评分进行相关分析. 结果:与正常对照组比较,治疗前抑郁症组N2、P3潜伏期延长(t=3.36,8.38;P＜0.01),P3波幅降低(t=2.68,P＜0.01);治疗后抑郁症组N2、P3潜伏期较治疗前显著缩短(=2.01,2.98;P ＜0.01).相关分析显示,HAMD评分与N2、P3潜伏期治疗前(r=0.89,0.88)和治疗后(r=0.85,0.80)均呈高度正相关(P均＜0.01);与N2、P3波幅治疗前(r=-0.13,-0.16)和治疗后(r=-0.18,-0.23)呈微弱负相关(P均＞0.05). 结论:MECT可改善首发抑郁症患者视觉P300的各项指标.     

无抽搐电休克治疗对抑郁症患者血清C反应蛋白的影响

目的:探讨无抽搐电休克治疗(MECT)过程中抑郁症患者血清C反应蛋白(CRP)水平的动态变化及其与疗效的关系方法:30例抑郁症患者纳入本研究,分别在MECT前和MECT后第1次、第3次和第5次和最后1次结束后次日清晨空腹抽血检测血清CRP水平。采用汉密尔顿抑郁量表(HAMD)评估MECT的疗效。结果:MECT第1次后CRP水平即出现降低,随着MECT次数的增加CRP水平持续降低并伴随着抑郁症状的改善。抑郁症状缓解者在MECT结束时CRP水平显著降低,女性患者基线CRP水平显著预测MECT的疗效(P0.05)。结论:MECT前后CRP的变化与疗效相关,女性抑郁症患者基线CRP水平能够预测MECT治疗效果,提示MECT可能通过降低炎症因子起作用。     

抗抑郁剂联合无抽搐电休克治疗难治性抑郁症两例报告

1　病例例 1　患者 ,男性 ,72岁。因情绪低落、想死复发两个月 ,第 2次住本院。患者有抑郁症病史 33年。 1995年再次发作并住入我院服用氟西汀病情缓解出院 ,6个月后停药 ,病情一直稳定。两个月前病情复发 ,门诊用氟西汀治疗无效。收入院后给予米氮平 15mg/d ,3天后加至 30mg/d ,维持 4周 ,病情并无明显改善。后换用文拉法辛 5 0mg/d ,10天后加至2 0 0mg/d ,并联合奥氮平 5mg/d持续 4周治疗。在治疗过程中患者自杀未遂 ,乃决定联合无抽搐电休克治疗 ,每周 3次。继之情绪逐渐好转 ,治疗 8次后以病情缓解出院 ,并口服文拉法辛巩固治疗。例 2　…     

无抽搐电休克治疗对记忆及抽象思维的影响

目的:探讨无抽搐电休克治疗(MECT)对精神分裂症患者记忆功能及抽象思维能力的影响. 方法:对37例精神分裂症患者采用修订韦氏记忆测验(WMS)和韦氏智力测验中的木块图案分测验在治疗前后分别评定. 结果:治疗后患者图片、再认、再生、经历、联想和木块图案得分明显高于治疗前. 结论:MECT可能对精神分裂症患者的记忆功能和抽象思维能力不造成损害.     

A control study on memory and related factors in patients with depression]

The results of an analysis of memory function and related factors in 107 patients with depression and in 76 normal controls revealed that obvious disturbance of memory level and various functions including long-term memory, short-term memory and immediate memory, were seen in observation group. The disturbance of memory function was related to sex, age, education and occupation. No relationship in EGG and depression was found.     

抑郁障碍的无抽搐电休克疗法前后非匹配负波研究

目的 探讨焦虑障碍听觉认知性电位P300的特点.方法 对32例焦虑障碍患者(AN组)和30名健康成年人(NC组),应用美国脑诱发电位仪进行P300检测.结果 与NC组相比,AN组Oz点P3潜伏期后移[NC组(328±16)ms,AN组(340±18)ms,t=2.801,P<0.01],P3波幅降低[NC组(6.1±2.0)μV,AN组(4.6±2.2)μV,t=2.84,P<0.05],非靶P2波幅降低[NC组(3.1±0.8)μV,AN组 (1.9±0.9)μV,t=5.61,P<0.01].结论 焦虑障碍认知性电位P300变化诸特点值得进一步随访.     

Electroconvulsive Therapy: A German Perspective

A survey was undertaken in 1986 to provide reliable information on the present status of electroconvulsive therapy (ECT) in the Federal Republic of Germany (FRG). ECT was used in 26% of the state mental hospitals, 40% of the psychiatric departments of general hospitals, and in 78% of university hospitals. The number of treatment courses applied was low, with about 500 patients receiving ECT in 1985. The indications for ECT and patterns of administration appeared similar to those of other countries, although unilateral electrode placement was prescribed infrequently. The low use of ECT in the FRG (0.08/10,000 population) cannot be related to the attitudes of senior psychiatrists toward ECT, because the attitudes appear to be rather favorable. The majority maintained that indications for ECT exist and that every psychiatric hospital with comprehensive treatment facilities should offer this treatment. ECT usage seems to be partly determined by nonmedical factors, in particular, the recent attacks against psychiatry and ECT in the media. To correct the consequences of such attacks, the merits of ECT should become better known.     

Nursing Students' Perception of Electroconvulsive Therapy: Impact of Instruction with an Electroconvulsive Therapy Videotape

There has been little study of attitudes toward and knowledge of electroconvulsive therapy (ECT). Likewise, there have been no studies of how accurate information about ECT may be communicated. The authors studied the attitudes and opinions toward ECT of thirty-five nursing students before they had received any formal instruction on its use. The same subjects then viewed a didactic videotape explaining and demonstrating ECT. There were significant improvements in overall knowledge and positive opinions of ECT after this educational exposure.     

Attitude Studies on Electroconvulsive Therapy

Between 1971 and 1984, 11 studies have examined patient and/or lay attitudes to electroconvulsive therapy. These investigations are reviewed here. They vary in sample size, response rates, and in the way attitudes were assessed. Although none have used properly validated measures, the uniformity of their findings provides a considerable degree of validation. Studies have been conducted in the United States, United Kingdom, Eire, Australia, and Uganda. In general, patients felt positively about the treatment, and for most subjects the benefit of the treatment outweighed the cost, in terms of apprehension, side effects, and stigma. For a small, but important, minority, this was not so, and such individuals report quite negative attitudes to ECT. All the studies reviewed have faults, and suggestions for further research are outlined.     

Electroconvulsive therapy in medication-nonresponsive patients with mixed mania and bipolar depression

BACKGROUND: The aim of this study was to investigate the effectiveness of electroconvulsive therapy (ECT) in medication-nonresponsive patients with mixed mania and bipolar depression. METHOD: Forty-one patients with mixed mania (DSM-IV diagnosis of bipolar I disorder, most recent episode mixed) and 23 patients with bipolar depression (DSM-IV diagnosis of bipolar I disorder, most recent episode depressed) consecutively assigned to ECT treatment were included in this study. Subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impressions-Severity of Illness scale (CGI-S). Assessments were carried out the day before starting ECT, 48 hours after completion of the third session (T1), and a week after the last session of ECT (T2). RESULTS: Both groups received an equal number of ECT sessions (mean +/- SD = 7.2 +/- 1.7 vs. 7.3 +/- 1.6). In both groups, within-group comparisons showed that there was a significant reduction in CGI-S score (mixed mania, p <.0001 at T1 and T2; bipolar depression, p < .01 at T1, p < .0001 at T2), MADRS total score (both groups, p < .0001 at T1 and T2), BPRS total score (mixed mania, p < .0001 at T1 and T2; bipolar depression, p < .001 at T1, p < .0001 at T2), and BPRS activation factor score (mixed mania, p < .0001 at T1 and T2; bipolar depression, NS at T1, p < .01 at T2). Between-group comparisons revealed that patients with mixed mania showed significantly greater decrease in MADRS score (p < .001) and a greater proportion of responders (CGI-S) than patients with bipolar depression at endpoint (56% [N = 23] vs. 26% [N = 6], p = .02). Patients with mixed mania showed a greater reduction in suicidality, as measured by MADRS score, than patients with bipolar depression (p < .02). CONCLUSION: In our study, ECT was associated with a substantial reduction in symptomatology, in both patients with mixed mania and those with bipolar depression. However, the mixed mania group exhibited a more rapid and marked response as well as a greater reduction in suicidal ideation. Response to ECT was not influenced by the presence of delusions.