Participants of a postgraduate biologic psychiatric course were surveyed about their attitudes toward electroconvulsive therapy (ECT) with a self-administered questionnaire. Among the respondents, 65 persons were specialists in psychiatry, 32% of whom would not consider using ECT even if they were in a psychotic depressive state. According to the bias factor, which has been calculated based on the answers to the 11 questions regarding attitudes, those psychiatrists who worked in inpatient care showed a less negative attitude. Among the items concerning knowledge of ECT, incorrect answers were most frequent to questions about myocardial infarction as a contraindication, and about the identity of the person who had pioneered this treatment. The negative attitude of Hungarian psychiatrists, especially of those who work in outpatient care, may have an important role in the decrease of the application of ECT in the past decade in Hungary.
Among drugs used for the anesthesia of electroconvulsive therapy (ECT), propofol reduces seizure duration to a greater degree than etomidate. The perceived difference between the 2 anesthetics is smaller in patients with schizophrenia than in patients who suffer depression. In this study, propofol and etomidate were compared during the ECT of patients with schizophrenia, on the basis of their impact on seizure activity and on seizure-induced hemodynamic reactions. Schizophrenics (n = 34) who were treated with ECT participated in this randomized crossover study. Propofol (1 mg/kg) and etomidate (0.2 mg/kg) were used alternately. The 2 drugs were compared on the basis of EEG- and EMG-registered seizure duration, mean arterial pressure (MAP), pulse frequency, energy index, and postictal suppression. We also analyzed the number of necessary restimulations. In case of anesthesia with etomidate, both EEG- (61.29 +/- 22.4 s, 47.9 +/- 21.3 s P = 0.014) and EMG- (46.3 +/- 23.8 s, 33.6 +/- 15.9 s P = 0.006) registered seizure durations were significantly longer than in case of propofol. When using propofol, the increase in MAP was significantly lower than when etomidate was used (8.1 +/- 10.2 mm Hg, 18.3 +/- 11.2 mm Hg, P = 0.001). There were no significant differences found in the postseizure increase in pulse frequency, in postictal suppression, or in the energy index, nor did the numbers of necessary restimulations differ significantly. Propofol was found to reduce seizure duration to a significantly greater extent than etomidate. At the same time, in electrophysiological parameters that show a correlation with clinical efficacy, there was no significant difference found between the 2 anesthetics. However, the seizure-induced increase in MAP was reduced by propofol to a significantly greater degree than by etomidate.
A survey using self-administered questionnaires was conducted among fifth-year medical students beginning their psychiatry clerkships to assess their attitude toward and their basic knowledge of electroconvulsive therapy (ECT). The questionnaire, consisting of 28 questions, was completed by 127 students. Ten rated their own knowledge on ECT as mediocre, the rest of them as minimal. A total of 67% of the students would not consent to undergoing ECT themselves, not even if they had severe depression with psychotic features. ECT was believed to be used to bring violent patients under control by 35% of the students, was believed to be painful by 54%, and to be even dangerous by 50%. A total of 61% of the participants believed that ECT should only be used as a last resort, 35% found ECT outmoded, 32% thought that ECT causes permanent brain damage, and 14% would ban its use. Among the students refusing to be treated with ECT, the proportion of women was higher, and their attitude toward ECT was significantly more negative (P = 0.031) than that of those who would consent to ECT. The answers that psychiatrists often misuse ECT, that ECT is an outmoded therapy causing brain damage, and that the use of which should be forbidden were given more frequently by those who refused to be treated with ECT. Also, the attitude of those describing themselves as more knowledgeable about psychiatry was found to be significantly (P = 0.005) more negative than the attitude of those with minimal psychiatric knowledge. The frequent occurrence of incorrect beliefs about and negative attitudes toward ECT support the necessity of covering ECT in the medical school curriculum more thoroughly and in more detail.
The visual information on ECT reduced the interns' negative attitudes, in general; however, acceptance of the treatment decreased in a subgroup of interns.
The effects of D-Met2, Pro5-enkephalinamide (EA) on pain tolerance and some cognitive functions have been examined in healthy male volunteers. Dihydrocodeine (DC) was used as reference substance. Applying the submaximum effort tourniquet technique EA (10 mg SC) was found to elevate the pain threshold similarly to DC (20 mg SC). Neither DC nor EA impaired the performance in the symbol cancellation test, which quantitates the intensity of attention. In this assay rather a slight improvement was detected. in addition the short-term memory performance (Wechsler test) was also improved by EA and DC. No alteration was seen in the word fluency test, an indicator of long-term (semantic) memory. The data show that EA not only improves pain tolerance but some of its mental effects are similar to those of a classical morphine congener DC.
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