Impact of seizure duration in maintenance electroconvulsive therapy

Acute electroconvulsive therapy has anticonvulsive effects. The aim of the present study was to investigate the anticonvulsive efficiency of maintenance electroconvulsive therapy. Records of patients treated with maintenance electroconvulsive therapy were screened retrospectively, and the changes in seizure duration were measured. The patients were subdivided into responders and non‐responders. Responders had no significant seizure duration changes within the first week of maintenance electroconvulsive therapy. In contrast, the seizure duration of the non‐responder group increased significantly within the first week. It was concluded that the early increase in seizure duration at constant energy could be predictive of relapse.     

Resting state default‐mode network connectivity in early depression using a seed region‐of‐interest analysis: Decreased connectivity with caudate nucleus

Aim: Reports on resting brain activity in healthy controls have described a default‐mode network (DMN) and important differences in DMN connectivity have emerged for several psychiatric conditions. No study to date, however, has investigated resting‐state DMN in relatively early depression before years of medication treatment. The objective of the present study was, therefore, to investigate the DMN in patients seeking help from specialized mental health services for the first time for symptoms of depression. Methods: Fourteen depressed subjects and 15 matched controls were scanned using 4‐T functional magnetic resonance imaging while resting with eyes closed. All but one subject was medication free. A precuneus/posterior cingulate cortex (P/PCC) seed‐region connectivity analysis was used to identify the DMN and compare study groups in regions of relevance to depression. Results: The P/PCC analysis identified the DMN well in both study groups, consistent with prior literature. Direct comparison showed significantly reduced correlation between the P/PCC and the bilateral caudate in depression compared with controls and no areas of increased connectivity in the depressed group. Conclusions: The present study is the first to investigate resting‐state DMN in the early stages of treatment‐seeking for depression. Depressed subjects had decreased connectivity between the P/PCC and the bilateral caudate, regions known to be involved in motivation and reward processing. Deficits in DMN connectivity with the caudate may be an early manifestation of major depressive disorder.     

Differences in frontal lobe function between violent and nonviolent conduct disorder in male adolescents

Aims:  The objective of the present study was to investigate the differences in frontal lobe function between violent and nonviolent male adolescents with conduct disorder.
Methods:  A total of 309 male adolescents who had been admitted to the Nagoya Juvenile Classification Home participated. The participants were divided into two groups, a violent group composed of individuals who had committed violence against others, and a nonviolent group. The subjects were given the Wisconsin card sorting test (Keio version: KWCST) and the Iowa Gambling task. The presence of violent cases was analyzed in terms of age, family history (crime, drug abuse/dependence, alcohol-related disorder, and psychiatric treatment), experience of being abused by their parents or by the persons who were responsible for raising them, as well as categories achieved (CA) of KWCST (≤4, >4) and total selection of disadvantage cards of Iowa Gambling task (≥50, <50).
Results:  Multivariate logistic regression analyses indicated that a family history of drug abuse/dependence (odds ratio = 0.3, 95% confidence interval = 0.1–0.9) and a CA of the KWCST (odds ratio = 1.8, 95% confidence interval = 1.0–3.1) were significantly associated with violence.
Conclusions:  An impaired rate of CA of the KWCST was related to violence, whereas a family history of drug abuse/dependence was related to nonviolence in male adolescents with conduct disorder.     

Antidepressant effect detected on proton magnetic resonance spectroscopy in drug-naïve female patients with first-episode major depression

Aim:  Recent neuroimaging studies support functional and structural alterations in the dorsolateral prefrontal cortex (DLPFC), particularly on the left side in patients with major depressive disorders (MDD). The aim of the present study was to examine the biochemical characteristics of left DLPFC as measured on proton (¹H) magnetic resonance spectroscopy (MRS) in patients with drug-naïve first-episode MDD and a healthy control group. A second aim was to assess the effect of antidepressant treatment on the metabolites of DLPFC.
Methods:  Short-echo single-voxel ¹H-MRS was done for the left DLPFC in 17 female drug-free MDD patients (mean age ± SD, 30.9 ± 6.9 years) and 13 matched control subjects (mean age ± SD, 29.1 ± 6.2 years) and was repeated at 8 weeks following antidepressant treatment.
Results:  Comparison of baseline values indicated that there were no significant differences in any of the metabolite ratios ( N -acetyl aspartate/creatine [NAA/Cr], myoinositol [Ino]/Cr, and choline [Cho]/Cr) between patients and controls. Significant differences were detected between pre- and post-treatment Ino/Cr ratios (0.67 ± 0.13, 0.58 ± 0.22, P  = 0.032, respectively), although there was no difference in NAA/Cr and Cho/Cr ratios.
Conclusion:  Although no significant metabolic alterations exist in female patients with drug-naïve first-episode MDD as evaluated on ¹H-MRS, an increase in Ino/Cr was observed following 8-week antidepressant treatment. These findings give rise to the possibility that non-neuronal cells, particularly glial cells that are probably damaged, play a role in the action of antidepressant treatment.     

Characteristics of elderly people using the psychiatric emergency system

We investigated the differences between elderly and under-65-year-old patients using the psychiatric emergency system. The following characteristics were more common in elderly patients than in younger patients: organic mental disorder, mood disorder, dementia, disturbed consciousness, no excitation, physical complications, no history of visiting a psychiatrist and no history of hospitalization. In addition, significantly more elderly patients with mood disorder attempt suicide.     

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Purpose: To describe both the evolution and the main associated complications in the anesthetic management of the initial 40 patients at our centre who underwent percutaneous retrograde aortic valve replacement, a novel technique utilizing a catheterguided femoral artery approach. Clinical features: With institutional Research Ethics Board approval, we retrospectively reviewed the medical records of the first 40 patients who underwent percutaneous retrograde aortic valve replacement between January 2005 and March 2006. Information obtained included patient characteristics, anesthetic management, details of the procedure, and complications. All procedures were scheduled to be performed in the cardiac catheterization laboratory. The first four patients received monitored anesthesia care, and the subsequent 36 underwent general anesthesia. There were no anesthesia-related adverse events. The prosthetic valve was placed successfully in 33/40 patients (83%). Median anesthetic time was 3.5 hr (range, 1.25–7.25 hr). Thirty-two/40 patients required vasopressor support. The most common, serious procedural complications were myocardial ischemia and arrhythmia following rapid ventricular pacing, hemorrhage from vascular injury secondary to the placement and removal of the large-bore sheath in the ilio-femoral artery, aortic rupture, and prosthetic valve maldeployment; 30-day mortality was 13% (n=5/40). Conclusions: Percutaneous retrograde aortic valve replacement is a novel procedure that presents the anesthesiologist with unique challenges. Careful preoperative assessment, intraoperative monitoring appropriate for a major vascular procedure, and meticulous management of hemodynamics are imperative for a successful outcome. Serious complications, including major hemorrhage from vascular injury as well as arrhythmia and myocardial ischemia following rapid ventricular pacing, must be anticipated and managed in an expeditious fashion.