[Show abstract][Hide abstract] ABSTRACT: Background
Tardive dystonia and dyskinesia are potentially irreversible neurological syndromes. Successful electroconvulsive treatment (ECT) has been reported by multiple sources; however, the existing retrospective reviews and open prospective trials provide little information on the response rate.
Eighteen consecutive patients with tardive dystonia or dyskinesia received a standard course of ECT to treat abnormal movement. The severity of the tardive dystonia and dyskinesia was evaluated using the Abnormal Involuntary Movement Scale (AIMS) before and after the course of ECT. The patients who displayed a greater than 50% improvement in the AIMS score were classified as the responders.
The mean AIMS score decreased from 19.1±4.7 to 9.6±4.2. There were seven responders among the 18 patients, which yielded a 39% response rate.
ECT has a moderate but significant effect on tardive dystonia and dyskinesia.
[Show abstract][Hide abstract] ABSTRACT: Over 290,000 patients are undergoing hemodialysis (HD) in Japan. With old age, the odds of undergoing HD treatment sharply increase, as does the prevalence of cognitive impairment. The aim of the present work was to assess cognitive impairment in HD patients and its relation to clinical characteristics.
Using a cross-sectional design, we administered the Mini-Mental State Examination (MMSE) to 154 HD outpatients and 852 participants from the Iwaki Health Promotion Project 2010, representing the general population.
The prevalence of cognitive impairment based on the MMSE was 18.8% in HD patients. HD patients showed a higher prevalence of cognitive impairment in older groups (50 years and older). In a logistic regression model with age, gender and amount of education as covariates, undergoing HD was a significant independent factor (OR = 2.28, 95% CI 1.33 to 3.94) associated with a lower MMSE score. Among HD patients, we found that level of education was associated with MMSE score.
There is a high prevalence of cognitive impairment among HD patients that has adverse implications for hospitalization and shortens their life expectancy. HD treatment was an independent risk factor for cognitive impairment. Clinicians should carefully monitor and treat cognitive impairment in HD patients. Further studies are required to determine the reasons for cognitive impairment in HD patients.
Annals of General Psychiatry 08/2011; 10(1):20. DOI:10.1186/1744-859X-10-20 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pathological gambling has been described frequently in patients with Parkinson disease or other movement disorders who were treated with dopamine agonists. Here, we report a patient with recurrent depression who developed pathological gambling after administration of the dopamine agonist cabergoline. A 36-year-old male Japanese patient presented with his third episode of depression. His depressive symptoms responded minimally to fluvoxamine. Cabergoline was then added to augment the antidepressant's efficacy. Although this regimen resulted in dramatic improvement, he started to spend considerable money and time every day in pachinko parlors and go to the horse racing track every weekend. He spent more than twenty thousand US dollars in total. He tried to stop gambling many times but failed to control his urge. His gambling behavior did not stop even though he was experiencing a marital crisis. He had not displayed any manic symptoms during this entire period. This complication fulfilled the criteria for pathological gambling according to the Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition, Text Revision edition. The patient's perplexing behavior did not end until cabergoline was discontinued. Thus far, pathological gambling associated with cabergoline has rarely been reported while gambling associated with pramipexole and ropinirole, dopamine agonists, has frequently been documented. In addition, this is the first case of depression in which the patient developed pathological gambling during treatment with a dopamine agonist. In conclusion, clinicians should be aware of the potential for pathological gambling when prescribing cabergoline to patients with depression.
Drug discoveries & therapeutics 08/2009; 3(4):190-2.
[Show abstract][Hide abstract] ABSTRACT: Although electroconvulsive therapy (ECT) often causes post-ictal delirium (PID), to date, the specific risk factors of PID have not been described. The purpose of the present study was therefore to elucidate the predictors of PID via identification of the characteristics of patients with PID.
ECT was conducted in 50 patients and all patients underwent more than four sessions. A sine wave or a brief-pulse square wave ECT instrument was used. After convulsions the patients' PID was monitored for 30 min. The patients were allocated into four groups based on PID severity (none, mild, moderate or severe PID). Variables, including age, gender, duration of illness, diagnosis, clinical features (psychotic or catatonic features) and stimulus waveform (sine or brief pulse square waveform), were analyzed.
Moderate to severe PID developed during the ECT sessions in 18 patients (36%). Most patients with severe delirium were successfully treated with i.v. bolus of propofol (1-2 mg/kg). Although the incidence of PID was 24% in patients without catatonic features, the incidence in patients with catatonic features was extremely high (88%; P < 0.001). Multiple regression analyses showed that the severity of PID correlated significantly with the presence of catatonic features (beta = 0.428, P < 0.01).
The presence of catatonic features before ECT is a predictor of PID. Propofol is useful for the treatment of PID.
[Show abstract][Hide abstract] ABSTRACT: A 48-year-old man who had a history of schizophrenia for 30 years was treated with electroconvulsive therapies. Because of poor seizure even at maximum electrical dosage, aminophylline was administered just before initiating electroconvulsive therapy. Although aminophylline augmentation lengthened the seizure duration, tachycardia and hypertension were observed. Therefore, we switched to bemegride, an antagonist to barbiturate, and seizure length was improved without any side effects. The present case suggested that bemegride is one of the alternative measures in patients with poor seizure quality.
The journal of ECT 11/2008; 25(1):61-3. DOI:10.1097/0b013e3181723725 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 92-year-old woman who suffered from dementia with psychotic feature was admitted to a psychiatric ward. She refused to eat or take any medications. After 0.5 mg i.v. injection haloperidol, prolongation of QTc interval occurred in the electrocardiogram. Therefore two sessions of electroconvulsive therapy (ECT) were performed carefully after informed consent was obtained by her family. Almost no psychotic symptoms were observed after the first ECT. No cognitive side-effects were observed during and after the two ECT sessions. This demonstrates that ECT can be used as an alternative treatment when elderly dementia patients with psychotic feature cannot tolerate medication.