• 생물정신의학
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• 제24권3호
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• pp.110-128
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• 2017

Electroconvulsive therapy (ECT) has been recognized effective as primary or secondary treatments for major psychiatric disorders including depression and schizophrenia, as well as psychiatric emergency such as suicide, food refusal and catatonia, and so on. Medicines used in anesthetic induction for ECT, cause various reactions in autonomous, hemodynamic, and neuromuscular systems. The anesthetics also affect the duration, threshold, and intensity of seizures evoked with electric stimuli, and thus modify the seizure quality in ECT. Individual characteristics of age, sex, weight, comorbid physical disorders, and medications should also be considered for optimal clinical response after ECT. When preparing for anesthesia, adequate anesthetic agents and muscle relaxants, and rapid recovery should be carefully considered. We conducted a case-series study to address practical issues that are frequently encountered during ECT anesthesia with reviews of updated journals in order to provide practical helps to clinicians who are preparing ECT for their patients.

• 생물정신의학
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• 제27권2호
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• pp.42-57
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• 2020

Electroconvulsive therapy (ECT) is indicated for various mental disorders (e.g., major depressive disorder, schizophrenia, and bipolar disorder) and the behavioral and psychological symptoms of dementia in elderly patients. Furthermore, ECT is a useful first-line treatment in emergency and crisis situations such as suicide risk, violent behavior, catatonia, and food refusal, which are more frequent in elderly patients. ECT is also effective in the treatment of the motor symptoms of neurological disorders, such as Parkinson's disease and Huntington's disease. Due to the high risk of various physical diseases, the comorbid physical conditions of elderly patients should be individually controlled to optimize ECT treatment. Compared to young adults, in elderly patients the seizure threshold is higher, the seizure duration is shorter, and the anesthetic dose is lower. On the contrary, the response rate in the elderly is both faster and higher. Considering potential cognitive decline and the prevention of further deterioration of cognitive function in elderly patients, in the absence of significant comorbidities, twice weekly sessions and right unilateral electrode placement with a lower seizure threshold and less cognitive effect are preferred to bilateral electrode placement, which has a high risk of adverse cognitive effects. After an acute course of ECT, continuation and maintenance of ECT, combined with prescription of therapeutic drugs, may prevent possible relapse or recurrence of mental disorders. In conclusion, ECT can be used to treat mental disorders in elderly adults, with safety and effectiveness comparable to that in young adults.

• 생물정신의학
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• 제15권2호
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• pp.75-82
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• 2008

Major depressive disorder(MDD) is one of the most common diseases with serious health consequences such as increased morbidity, disability, and mortality. Electroconvulsive therapy(ECT) has been used as a treatment for mental disorder since the 1930s. A growing number of recent publications support the conclusions that ECT is an effective and safe treatment for depressed patients. Dosing strategies, frequency, safety, side effects and efficacy of ECT in MDD will be considered. ECT may be an alternative to treatment with antidepressants.

• 생물정신의학
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• 제27권2호
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• pp.37-41
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• 2020

Modified electroconvulsive therapy (ECT) which started in 1950s is a safe and efficacious treatment for several mental disorders including mood disorders and psychotic disorders. However, its usage in present days is still limited by misconceptions and stigmata of ECT. This paper overviews the background from which the stigmata of ECT stemmed and the current status of stigmata surrounding ECT among the public and medical professionals. In addition, a few potential strategies for reducing stigmata of ECT are provided in this review.

• 생물정신의학
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• 제18권3호
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• pp.163-167
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• 2011

Complex regional pain syndrome (CRPS) is a disease that causes chronic spontaneous pain and hyperesthesia of one or more parts of legs and arms, which is accompanied with problems of the automatic nervous system or the motor nervous system. However, up to date, it is unclear what causes the syndrome and how to diagnose and treat it. Although several treatments including medication and sympathetic nerve block are performed against CRPS, the therapeutic effect of the treatments is limited. The electroconvulsive thera-py (ECT), of which the mechanism is not clarified, is a treatment used for treatment-resistant depression. ECT is also reported to be effective against pain. Therefore, we performed the ECT for a 24-year-old female patient who has been diagnosed as CRPS. Her pain had not been much improved by medications and interventional procedures. At admission to a psychiatric ward for ECT, she com-plained of over 8 points of pain on visual analogue scale and the constrained movement around the painful part. Eight ECTs-three times a week-were performed for three weeks in hospital and then the ECT once a week was performed after her leaving the hospital. During the ECTs, pain had been reduced and the range of movement in the constrained parts had increased. Further systematic re-search is needed to confirm the effect of electroconvulsive therapy against CRPS.

• 생물정신의학
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• 제27권2호
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• pp.64-73
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• 2020

Suicidality is the most serious complication of mood disorders and psychosis; effective treatment should reduce suicide rates. The Organization for Economic Cooperation and Development age-standardized suicide rate in Korea was 22.6 in 2018, much higher compared to other countries worldwide. As mental and psychiatric problems are the main reasons for suicide attempts, accounting for 31.6% in 2018, targeting such problems should be the focus of efforts to reduce suicide rates. However, the ability of current pharmacotherapeutic and psychotherapeutic interventions to reduce suicide rates is limited due to their delayed effects. Therefore, electroconvulsive therapy (ECT) has been proposed as an alternative treatment. This approach is effective for treating most mental disorders associated with high suicide rates, including severe depression, bipolar disorder, and intractable psychotic disorders; ECT is also effective for Parkinson's disease, which has the highest suicide rate among all disorders in Korea. The acute, long-term, and prophylactic effects of ECT on suicidality have been reported in the literature, and treatment guidelines outside of Korea recommend that ECT be used at an early stage for rapid reduction of suicide rates, as opposed to being applied as a treatment of last resort. However, only ~0.092 of every 10000 members of the Korean general population received ECT in 2018; this is much lower than the average rate worldwide, of 2.2 per 10000. Elimination of obstacles to the use of ECT, early crisis intervention involving administration of ECT for rapid stabilization, and maintenance ECT to prevent recurrence should reduce suicide rates.

• 생물정신의학
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• 제27권1호
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• pp.1-8
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• 2020

Objectives In electroconvulsive therapy (ECT) research and practice, the precise determination of seizure duration is important in the evaluation of clinical relevance of the ECT-induced seizure. In this study, we have developed computerized algorithms to assess the duration of ECT-induced seizure. Methods Subjects included 5 males and 6 females, with the mean age of 33.1 years. Total 55 ECT sessions were included in the analysis. We analyzed the standard deviation of a finite block of electroencephalography (EEG) data and the change in the local slope of RR intervals in electrocardiography (ECG) signals during ECT-induced seizure. And then, we compared the calculated seizure durations from EEG recording (EEG algorithm) and ECG recording (ECG algorithm) with values determined by consensus of clinicians based on the recorded EEG (EEG consensus), as a gold standard criterion, in order to testify the computational validity of our algorithms. Results The mean seizure durations calculated by each method were not significantly different in sessions with abrupt flattened postictal suppression and in sessions with non-abrupt flattened postictal suppression. The intraclass correlation coefficients (95% confidence interval) of the three methods (EEG algorithm, ECG algorithm, EEG consensus) were significant in the total sessions [0.79 (0.70-0.86)], the abrupt flattened postictal suppression sessions [0.84 (0.74-0.91)], and the non-abrupt flattened postictal suppression sessions [0.67 (0.45-0.84)]. Correlations between three methods were also statistically significant, regardless of abruptness of transition. Conclusions Our proposed algorithms could reliably measure the duration of ECT-induced seizure, even in sessions with non-abrupt transitions to flat postictal suppression, in which it is typically difficult to determine the seizure duration.

• 수면정신생리
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• 제1권1호
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• pp.87-98
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• 1994

연구배경 : 정신분열증 환자들이 정보처리 과정의 문제가 있을 것이라는 가설을 지지해 주는 사건관련유발 전위인 P3의 이상을 보고하는 연구들이 있어 저자들은 정신분열증 환자들에게 청각사건관련유발 전위를 실시하여 P3의 이상을 확인하고자 하였다. 또한, 음성 및 양성 정신분열증환자에 P3의 차이가 있는지 비교하였으며, 가족력이나 전기충격경련요법, 밖에 임상양상과 P3와의 연관성을 알아보기 위하여 본 연구를 실시하였다. 방법 : DSM-III-R 진단기준에 맞는 정신분열증 환자 54명 (남자 31, 여자 23) 과 그 대조군 75 명 (남자 33, 여자 42) 을 대상으로 oddball paradigm 을 이용한 사건관련유발전위를 실시하여 P3의 잠복기와 진폭을 측정하였으며, 정신분열증의 인지기능이상을 알아볼 수 있는 프랑크푸르트 임상검사를 같이 실시하였다. 결과 : 정신분열증 환자의 P3 잠복기는 그 대조군에 비해 의미 있게 지연되어 있었으며, 또한 모든 진폭도 대조군에 비해 의미 있게 감소되어 있었다. 정신분열증 환자군에서 프랑크푸르트 임상검사의 10가지 임상증상 모두에서 통계적으로 유의하게 높은 점수를 보였다. PANSS의 종합점수에 따라 음성과 양성으로 나누어 비교한 결과, P3의 잠복기 및 진폭에서 의미 있는 차이가 발견되지 않았다. 또한, 정신과질환의 가족력의 유무에 따라, 전기 충격경련요법 유무에 따라 비교한 결과 의미 있는 차이를 발견할 수 없었다. 환자군에서 프랑크푸르트 임상검사의 임상증상, 그밖에 임상특성과 P3의 잠복기와 진폭 사이에 연관성을 발견할 수 없었다. 결론 : 본 연구의 결과로 정신분열증 환자들에서 선택적 주의집중 과정의 이상이 있을 것이고 추측할 수 있었으며, 임상양상이나 가족력 유무와 P3사이에 연관성이 없다는 것을 시사해 주었다.

• 생물정신의학
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• 제5권2호
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• pp.149-154
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• 1998

Antipsychotic drugs(APDs) have been effective to alleviate psychotic symptoms of schizophrenia. However, some schizophrenic patients do not respond to APDs. In addition to psychotic symptoms of schizophrenia, negative symptoms, excitement, violence, agitation, depression, and disorganization are frequently noted in patients with schizophrenia. Though APDs are the first line drugs for these symptoms, other drugs than APDs to augment the effects of APDs are efficacious for the treatment of these symptoms. Such augmenting drugs include benzodiazepines, anticonvulsants, antidepressants, lithium, and electroconvulsive therapy. These augmentation strategies can boost the effects of APDs or decrease the requirements of APDs, and consequently decrease the chance of the occurrence of side effects of APDs. Augmenting strategies are revewed for each class of drugs or treatment modality.

• 생물정신의학
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• 제3권2호
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• pp.288-294
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• 1996

전기경련요법을 시행받은 9명의 정동자애 환자들과 2명의 정신분분열형장애 환자들에서 각각 3분 간격으로 혈액을 채취하여 각 채취하여 AVF, ACTH, PRL, cortisol 등의 호르몬에 대해 기저농도 및 전기경련요법 후의 농도 변화를 측정함으로써 각 호르몬 분비 반응 사이의 시간적인, 그리고 양적인 관계를 비교분석하였다. 또한 경련 지속 시간과 각 호르몬 분비반응들 사이의 상관관계도 검토하였다. 상기 호르몬 모두에서 전기경련요법 대한 의미있는 분비반응이 관찰되었다. 즉, AVP는 1.2pg/ml에서 33.3pg/ml(P<0.001). PRL은 21.8ng/ml에서 102.2ng/ml(P<0.005)로 cortsol은 20.1ug/dl에서 31.1ug/dl(P<0.001)로 각각 중가 되었다. 뇌하수체에서 분비되는 AVP, ACTH, PRL 세가지 호르몬 모두는 전기경련 요법 후 3분내에 분비 반용이 시작되었지만, 최고 농도에 도달하는 시간은 각각 3분, 6분, 12~15분대로 분명히 구별되는 소견을 보였다. cortisol은 6분후부터 증가하기 시작하여 20~30분 사이에 최고 농도를 보였다. 경련 지속 시간과 분비 반응과는 의미있는 상관관계를 보이지 않았다. 이상의 연구결과를 토대로 저자들은 다음과 같은 결론에 도달하였다. 1) 전기경련 요법에 대한 뇌하수체 호르몬의 반응은 동시적이라기 보다는 순차식으로 일어나는 것이다. 2) AVP는 다른 어떤 호르몬 보다도 아주 빠르고 양적으로 많은 반응을 보였다. 3) AVP 반응 후에 뒤따르는 ACTH 반응은 대부분의 과거 연구들에서 보고된 것보다 빠르고 강력했다. 4) 이러한 결과들은 뇌하수체 호르몬이 전기 자극보다는 경련의 결과로 분비된다는 가설을 지지해 주는 소견이다. 5) 시상하부-뇌하수체-부신피질 축 호르몬들의 순차적 반웅 양상은 각 호르몬의 분비 반응에 되먹임 조절 기전이 관여할 수 있음을 추정케 한다.