| European Psychiatry14 AEP Congress 4-8 Mach 2006 |
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| Опубликовано Sun 14 May 2006 (4374 прочтений) |
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European Psychiatry (The journal of the association of European Psychiatrists) Vol. 21 / Supp. 1 (2006) Abstract book 14th AEP Congress Nice 4-8 March 2006 Poster Session 3: ECT/TMS S196-S197 S196 Posters / European Psychiatry 21 (2006) S191S250 Poster Session 3: ECT/TMS P18 Clinical predictors of efficacy in ЕСТ and rTMS E-L. Brakemeier, A. Luborzewski, H. Danker-Hopfe, M. Bajbouj. Department of Psychiatry and Psychotherapy, Charite -Universitdtsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany Background and Aims: Several variables have been suggested that can predict the efficacy of antidepressant stimulation techniques like electroconvulsive therapy (ЕСТ) and repetitive transcranial magnetic stimulation (rTMS) in patients suffering from depression. However, the results of studies into these predictors of therapeutic efficacy are not consistent. Object of the study was to identify and compare predictors for antidepressive response to ЕСТ and to rTMS in a large sample of depressive patients. Method: In a retrospective chart review of a large sample of patients suffering from major depressive disorder and bipolar disorder according to DSM-IV criteria who have been given ЕСТ and rTMS, predictors for efficacy were explored. Information was gathered for a broad variety of clinical, biographical, and technical predictors in 70 patients receiving rTMS and 50 patients receiving ЕСТ. Antidepressant treatment response was defined as a 50% reduction of the initial Hamilton score (HAMD). Results: After two weeks of rTMS treatment, 21% of the patients showed an antidepressant response. In the model, a high level of sleep disturbances and a low level of agitation were significant clinical predictors for treatment response to rTMS. Also, a low score of treatment resistance and a short duration of episode were general positive predictors. To prove the discriminant validity of this model, we will conduct the same analyses in a large sample of 50 depressive patients treated with ЕСТ. Conclusion: Assessment of baseline clinical parameters may be a valuable tool to predict efficacy of antidepressant stimulation techniques. P19 Working memory in major depression patients treated with ЕСТ W. Datka, M. Siwek, G. Maczka, T. Zyss, A. Zieba, D. Dudek, M. Jablonski. Department of Psychiatry, Collegium Medicum of Jagiellonian University, University Hospital, Krakow, Poland Introduction: Electroconvulsive therapy (ЕСТ) is the most effective treatment in a variety of psychiatric syndromes (especially mood disorders). However one of its adverse effects is neurocognitive dysfunction. Declarative memory impairment after ЕСТ is unquestionable and well investigated. There are only few ambigous studies focused on nondeclarative and immediate memory changes during ЕСТ. Method: A study of immediate (woking) memory changes in depressed patients treated with ЕСТ (и = 25; bitemporal ЕСТ 3 times a week) or imipramine (mean dose 150 mg/day; n = 25) was conducted in patients who fulfilled DSM-IV criteria for major unipolar depression. Hamilton depression rating scale (HDRS) and Beck depression inventory (BDI) were used to assess efficacy of antidepressant therapy. Cognitive functions were assessed with neuropsychological tests: Stroop A and В, ТМТ (Trial Making) A and B. The patients' status was evaluated 1 day before the treatment and 1 day, 2 weeks, 1 month and 6 month after its commencement. Results: Patient's working memory was slightly, but not statistically significant impaired 1 day after ЕСТ treatment. There were no differences between ЕСТ and pharmacologically treated groups at the 1 month of therapy. However there was statistically significant improvement in working memory 1 month after ЕСТ treatment. There was a significant correlation between clinical recovery and working memory functioning. Conclusion: ЕСТ treatment only temporally affect working memory function. The improvement of function may be a result of clinical recovery from depressant symptomatology. P20 Transcranial magnetic stimulation (TMS) and its use in neuropsychiatry E.M. Goncalves. Department of Psychiatry and Bioengineering -University of Porto, Portugal Non-invasive "focal" stimulation of the brain is possible, now, by means of transcranial magnetic stimulation (TMS), which is a tool to be used in the study of the functional localization and connectivity between brain regions and the pathophysiology of neuropsychiatric disorders. Also, TMS holds therapeutical interest at the field of Clinical Neuropsychiatry. In this paper, it will be reviewed the biophysical principles of TMS. The generated magnetic field (B) acts as the medium between the electrical current in the coil (CO) of the magnetic stimulator (i') and the induced electro-ionic currrent in the brain (i"). Underneath the CO, placed upon the head there is electroconductive tissue, at which, i" causes neural depolarization. Unlike Electroconvulsivetherapy (ЕСТ), where skull behaves like an electrical resistor, with TMS, В isn't deflected nor attenuated by the intervening tissue (skin, muscle, bone). Also, in this communication, it will be reviewed some clinical indications of TMS other than depressive disorder. S197 Posters /European Psychiatry 21 (2006) S191-S250 P21 Status epilepticus, electroconvulsive therapy, and malignant melanoma K.R.Kaufman ', A. Olsavsky 2„ С.Е. Skotzko 3. ' Psychiatry and Neurology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 2 Neurology, Neurological Institute, Columbia University, New York, NY 3 Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA Introduction: Electroconvulsive therapy (ЕСТ) treatment for affective disorders consists of premedication, controlled electrical stimulus, and induced seizures lasting approximately 60 s. Status epilepticus (SE) following ЕСТ is an uncommon adverse event. Debate exists as to whether pre-ECT EEGs should be routine. Method: Case analysis with literature review. Findings: 70-year-old female was admitted for major depression by DSM-IV criteria. Her first psychiatric admission for depression was precipitated 32 years previously during treatment for cutaneous malignant melanoma. Then and during recurrent depressive episodes she had positive response to ~ 90 ЕСТ treatments. Pre-ECT work-up included hematology studies, spine series, EKG, CXR and two-part informed consent. No pre-ECT EEG was performed. All ЕСТ were right unilateral, the first two being uneventful. Autonomous breathing following the third treatment began at 2'15"; however, minimal generalized movement persisted with neurophysiologic SE as interpreted from the МЕСТА ЕСТ EEG monitor. She responded to 20 mg of IV-diazepam with 250 mg of IV-diphenylhydantoin. Neurological examination was normal. CT summary reported: "Large area of low density with central contrast enhancing area throughout the right temporal lobe spreading posteriorly into parietal and medially into deep parietal lobe; the lesion appears to be high glioma with significant surrounding edema (3-4 mm right-to-left midline shift); central necrosis is present within an active area of lesion." Craniotomy revealed a solitary but extensive lesion. Neuropathology stains with aminoperoxidase technique were (-) keratin, (-) glioma-specific, but (+) glioma/melanoma. Electron microscopy confirmed metastatic melanoma: Conclusion: Status epilepticus can occur following ЕСТ. In cases with potential CNS pathology, pre-ECT EEG or neuroimaging is indicated. P22 The effect of cerebellar rTMS on electrical brain activity detected by low resolution electromagnetic tomography M. Kopecek 1'2'3, M. Brunovsky U3, T. Novak 1'2-3, J. Horacek 1A3. 1 Prague Psychiatric Centre 3rd School of Medicine, Charles University Centre of Neuropsychiatric Studies, Prague, Czech Republic Background and aims: Previous studies have detected EEG, cognitive and motor cortex modulation after cerebellar rTMS. The aim of our study was to determine the influence of cerebellar rTMS on frontal activity controlling by the neck muscle magnetic sham stimulation. Methods: EEG recordings were obtained from six right-handed healthy volunteers before and after 1) rTMS applied over the right cerebellar hemisphere and 2) rTMS applied over the right muscle trapesius. We used 20 min of 10 Hz rTMS with 1200 impulses in one session. The spatial distribution of the rTMS-induced changes in the electrical brain activity was investigated by means of low-resolution electromagnetic tomography (LORETA). Results: Right cerebellar rTMS increased the electric current densities in the delta, theta, alpha-1 and beta-1 frequency bands. The changes in the delta, theta and beta-1 bands were found predominantly over the frontal lobes, whereas the alpha-1 power was increased bilaterally in the cingulum. No significant changes were detected after rTMS applied over the trapezius muscle. Conclusions: The present results suggest the feasibility to modulate prefrontal cortical activity by means of cerebellar rTMS. This could support the use of the cerebellar rTMS in patients with neuropsychiatric disorders where cortico-subcortico-cerebellar abnormalities have been detected. Support: This study was supported by a grant by MZCR MZ0PCP2005. P23 Effects of rTMS on auditory hallucinations T. Novak, J. Horacek, M. Kopecek, F. Spaniel. Prague Psychiatric Centre, Prague, Czech Republic Background and aims: The aim of our study was to confirm the effect of low frequency repetitive transcranial magnetic stimulation (LF-rTMS) on medication-resistant auditory hallucinations and to evaluate the changes in regional brain metabolism after this treatment. Methods: LF-rTMS (0.9 Hz, 100% of MT, 20 min) applied to the left TPC was used for ten days in the treatment of medication-resistant auditory hallucinations in patients with schizophrenia (n = 13). The clinical effect was assessed by the positive and negative syndrome scale (PANSS), hallucination change scale (HCS) and the auditory hallucination rating scale (AHRS) at baseline, and after the first and second week of treatment. The regional brain metabolism was investigated by the use of 18FDG PET in the resting state within 4 days before and after rTMS. The analysis (paired f-test) was performed using SPM99 (P-level 0.001; uncorrected). Results: We found a significant improvement in the total and positive symptoms (PANSS) and in hallucination scales (HCS, AHRS). These improvements were detectable for comparisons between baseline and after 2 weeks of rTMS (P 0.05). rTMS decreased the brain metabolism (18FDG PET) in the left superior temporal gyrus and effected increases in the contralateral temporal cortex and in the frontal lobes bilaterally. Conclusions: Our findings confirm the effect of rTMS on auditory hallucinations and are supported by decreased metabolism in the cortex under the coil position. P24 5 Year review of outpatient ЕСТ at an aged person's mental health service I.B. Presnell. School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne, Victoria, Australia Aim: The Kingston Centre Aged Person's Mental Health Service provides comprehensive aged psychiatry services to approximately 37,000 persons over the age of 65. This review describes patients receiving outpatient (OP) ЕСТ during the 5 years from January 2000 to December 2004. Method: ЕСТ records were examined and data obtained for the 30 patients who had at least one OP ЕСТ during the above 5 year period. Results: Most patients were female (83%) and most had a diagnosis of Major Depression (66%). 23 patients had OP ЕСТ over less than 2 years, averaging 6-8 treatments per year. Four patients, three with Schizophrenia, received ЕСТ over 4-5 years, averaging 18 treatments per year. Discussion: Most patients receiving OP ЕСТ had a diagnosis of Major Depression and received treatment over short periods, suggesting that they were receiving continuation ЕСТ. A small number of patients (most diagnosed with Schizophrenia) received long term (for more than 4 years) ЕСТ at intervals of 3 weeks on average, suggesting that they were receiving maintenance ЕСТ. |
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