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ABSTRACT: The clinical benefit of implementing Bayesian approach for lithium drug monitoring was evaluated. Intervention group (N = 42) and historical control group (N = 55) patients were each divided into two groups: Dosage with immediate-release lithium carbonate or a sustained-release formulation, lithium citrate. Bayesian approach was performed in the intervention groups, and estimation of lithium steady-state trough concentration was obtained from non-steady-state blood sample, collected about 12 hr after the first lithium study dose. The estimate was compared with the actually measured steady-state concentration. In the control group, lithium monitoring was traditionally performed as steady-state blood sampling. Predicted and measured lithium concentrations were comparable. The desired lithium dose was reached significantly faster in the intervention group compared to control; 2.47 ± 2.22 days versus 9.96 ± 11.24 days (mean ± S.D.) (p = 0.0003). Bayesian approach was an advantage for the clinicians as a fast and safe aid to obtain the optimal lithium treatment dose.
Basic & Clinical Pharmacology & Toxicology 09/2011; 110(3):259-63. · 2.18 Impact Factor
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ABSTRACT: The stimulation phase of electroconvulsive therapy (ECT) induces bradycardia. We evaluated the effect of this bradycardia on cerebral perfusion and oxygenation by administration of the anticholinergic drug glycopyrrolate (Glp). Cerebral perfusion was estimated by transcranial ultrasound in the middle cerebral artery reporting the mean flow velocity (middle cerebral artery [MCA] V(mean)), and cerebral oxygenation was determined by near-infrared spectroscopy of the frontal lobe. Before ECT, heart rate (HR) was 84 beats min(-1) (66-113; median and range) and decreased to 17 (7-85) beats min(-1) during the stimulation phase of ECT (P < 0.001). Middle cerebral artery V(mean) decreased 43% (9%-71%; P < 0.001), and frontal lobe oxyhemoglobin (O(2)Hb) concentration decreased from 0.6 (0.0-25.3) to 0.1 (-1.9 to 7.6) microM, whereas the deoxyhemoglobin concentration increased from -0.2 (-13.9 to 0.8) to 0.0 (-4.2 to 0.8) microM (P < 0.001). Pretreatment with Glp largely eliminated these effects during the stimulation phase of ECT, maintaining HR at 78 (40-94) beats min(-1), MCA V(mean) at 53 (37-77) cm s(-1), and O(2)Hb at 5.6 (10.6-38.5) microM (P < 0.05). After ECT, HR, cerebral perfusion and oxygenation normalized over approximately 3 minutes, whereas the electroencephalogram was unaffected by Glp. The results demonstrate that ECT is associated with hemodynamic effects severe enough to affect cerebral oxygenation and perfusion, and that these effects can be attenuated by Glp treatment.
Journal of Ect 09/2007; 23(3):147-52. · 1.54 Impact Factor
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ABSTRACT: The use of ECT in Denmark has not been systematically evaluated since 1979. Many changes have since taken place in the organisation of psychiatric care and the number of new drugs for the treatment of affective disorders has grown. We wanted to see whether the frequency of treatments and the technical standard of ECT had undergone changes in the same period.
A questionnaire was sent to all psychiatric departments in Denmark concerning the number of ECT sessions and ECT patients in 1999, and technical aspects and organisation of this treatment-modality.
The percentage of replies was 100, all departments used ECT, and 86% of the departments adequately reported the number of ECT sessions and ECT-treated patients. The total number of sessions and patients treated was estimated from these answers. We found that the number of ECT sessions had fallen from 19,564 in 1979 to 16,306 in 1999 and the number of ECT patients from 2,332 in 1979 to 1,710 in 1999. ECT is thus given to an average of 5% of all hospitalised psychiatric patients. The number of sessions per patient had increased slightly. The technical quality of treatment with regard to the ECT devices used had improved considerably during the period.
The use of ECT in Denmark shows a decline since the last evaluation in 1979. However, it still plays an important role in the treatment of hospitalised patients with depression in Denmark.
Ugeskrift for laeger 07/2002; 164(26):3449-52.
