The European Journal of Psychiatry

Safe performance of ECT in severely ill patients: A retrospective study

Background and Objectives: Electroconvulsive therapy (ECT) is nowadays known as a first line therapy in many certain illness conditions. Despite the fact that psychotic depression and treatment resistant depression are more common in geriatric psychiatry, the use of ECT is not. The aim of our study was to show that ECT can be safely performed even if patients show high comorbidity and are therefore per se at a higher risk for experiencing severe side effects. Methods: We examined 25 ECT treated and severely ill patients of advanced age (mean 66 years) by chart review. Results: Mean age corrected Charlson Comorbidity Index (CCI) was 4.1, mean Cumulative Illness Rating Scale for Geriatrics (CIRS-G) 10.5. Generally, ECT- related complications were rated as mild and short termed, 14 patients showed no complications at all. Complications did not correlate with age or comorbidity. Post hoc, we noted a significant advantage for the use of propofol or etomidate compared with thiopental as narcotic agents. Conclusions: Under optimized somatic treatment conditions ECT can be performed safely in comorbid patients of advanced age. However, a risk/benefit analysis should always be performed individually.

Influence of affective personality on cognition-mediated emotional processing: Need for empowerment

Background and Objectives: The notion that both positive and negative affect contribute not only to affective personality profiles but also to self-report estimations of both psychological and physical well-being or discomfort. Method: Two studies are described, based upon applications of psychometric and clinical instruments, including the Positive Affective and Negative Affect Scale (PANAS), Stress and Energy (SE), Dispositional optimism (LOT), Locus of Control, Beck Depression Inventory (BDI), Perfectionism, Hospital Anxirty and Depression (HAD) and the Uppsala Sleep Inventory (USI). In Study 1, one hundred and twenty-two high school students (Gothenburg, Sweden), aged 17-19 years participated, whereas in Study 2, two hundred and eight professional office employees from a number of government agencies and corporations (Borås, Sweden), aged 27-61 years participated. Measures for HAD-anxiety and HAD-depression from five other studies of affective personality profiles were included also. Results: The results indicated marked differences in both psychological and physical well-being or discomfort due to affective personality profiles, whereby "Self-fulfilling" individuals, expressing high positive affect and low negative affect, presented markedly better health profiles than the other three types of affective personality, i.e. "Low affective", "High affective" and "Self-destructive". Conclusions: In this regard the notion of "empowerment" as a vehicle for putative reinforcements of cognitive abilities that modulate emotional systems is discussed.

Pulse Intravenous Clomipramine as an alternative antidepressant treatment to ECT: A pilot study

Background and Objectives: The aim of the study was to examine the antidepressant effect of a single pulse dose of intravenous clomipramine (200 mg i.v.) followed by oral administration as an alternative method to electroconvulsive therapy. Methods: Twenty-one inpatients (8 male, 13 female) with major depression were included. Depression severity was measured by Montgomery Asberg Rating Scale (MADRS) and Clinical Global Impression severity scale (CGI-S) before the pulse dose and 1 week after. The day after the pulse dose, the patient was medicated with 75 mg of oral clomipramine and from day two with 150 mg clomipramine daily. Results: The MADRS score dropped with 39% ± 22% and the CGI score with 28% ± 19% in one week. The improvement of the MADRS score after one week was 13.1 (C.I.9.5-17.0). CGI-ratings dropped from a mean of 5.5 (SD 1.2) to 3.9 (SD 1.1), an improvement of 28% ± 19%.(C.I. 1.0-2.1). Both improvements were significant (p<000.1). Conclusions: Single pulse dose clomipramine administration ameliorates depressive symptoms, and may be an alternative to ECT.

Short-term outcome of young homeless people in contact with a designated mental health service

Background and Objectives: Young homeless people have high rates of psychiatric disorders and related complex needs. However, they often find it difficult to access mainstream mental health services. The aim of this study was to establish the short-term clinical outcome of young homeless people in contact with a designated mental health service, and whether this is predicted by variables in young people´s profiles. Methods: A designated mental health service was provided across five areas covering 18 shelters for young homeless people aged 16-25 years. Data on 150 consecutively referred young people, included the Health of the Nation Outcome Scales (HoNOS), a risk assessment, and a service checklist at referral and final service contact. Results: Young people reported a range of previous adversities and service contacts, and high HoNOS and risk scores. There was significant improvement on most HoNOS items for those who attended more than one session, but only one risk behaviour (self-harm) significantly decreased. Previous experience of mental health problems and agreed completion of treatment predicted better clinical outcome. Conclusions: Despite their multiple and complex mental health needs, at least a proportion of young homeless people, can engage and benefit from their contact with a designated mental health service. The HoNOS could be a useful clinical tool for similar community teams.

Stress and ego-defense mechanisms in medical staff at oncology and physical medicine departments

Background and Objectives: Work on the oncology department has proved to be very stressful, so the medical staff indirectly copes with it by trying to escape it through the ego-defense mechanisms. On the other hand, working on the physical medicine department does not seem to be so stressful. The objective of this study was to determine the main ego- defense mechanisms at oncology and physical medicine department and to explain the differences between their frequencies. The other part was to obtain data about socio- demographic status and working environment of the participants. Methods: General structural interview for collecting data on socio-demographic status and working environment and Life Style Questionnaire and Defense Mechanisms for obtaining data about ego-defense mechanisms were carried out among a random sample of 40 medical staff members at each department. Results: A significantly higher level (p≤.05) of the following ego-defense mechanisms has been found at the oncology department: regression, intellectualization, projection and dislocation. Also, statistically significant difference (p≤.05), showing higher score on oncology department is observed in following variables: death of patients, facing the patient or his family with possible death, being overloaded with number of patients, facing pain, suffering and handicap, insufficiency of medications, insufficient positive feedback from the patients and bad interpersonal relations at work as well as lack of support from the colleagues. Conclusions: Extreme exposure to stressful events at the oncology department favours development of inadequate defensive mechanisms among the medical staff, which may enhance the risk of burnout.

Neuroleptic malignant syndrome: Possible relationship between neuroleptic treatment and smoking cessation

We report the case of M., a schizophrenic patient who was treated with high doses of antipsychotics for a long time allowing him to be stable for years. He then decided to give up smoking and two weeks later he suffered a syndrome diagnosed as Neuroleptic Malignant Syndrome with somatic complications. This caused his death two months after the start of the symptoms. We discuss the implications of smoking cessation in the origin of the syndrome due to a lower metabolism of psychotropic medications, which previously had been well tolerated. We conclude that it is important to take into account the smoking and caffeine intake of these patients, as well as other metabolic inductor or inhibitor drugs.