Proceedings of the National Workshop on ECT: Priorities for research and practice in India. Edited by
Gangadhar BN
Held from October 11-12, 1990 at the National Institute of Mental Health and Neurosciences, Bangalore.
ECT Administrative Manual.
Edited by Gangadhar BN
Published by National Institute of Mental Health and Neurosciences, Bangalore.
ECT and T2 relaxometry: a static water proton magnetic resonance imaging
study
Girish K, Jayakumar PN, Murali N, Gangadhar BN, Janakiramiah N and Subbakrishna.
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychiatry 43:20-22, 2001.
This study was conducted with the aim of detecting brain edema with electroconvulsive therapy (ECT).
Magnetic resonace imaging (MRI) T2 relaxation time which is an indicator of brain water was measured
one day prior to first ECT and two hours after second ECT in five patients prescribed unilateral ECT.
MRI T2 relaxation time was measured in hippocampus and thalamus bilaterally. No significant change in
T2 relaxation time following ECT occured in any of the four regions. ECT did not produce any
detectable
brain oedema and hence the treatment can be considered safe. The pilot study needs to be replicated in
a
larger sample and also in bilateral ECT patient group.
Key words : depression, electroconvulsive therapy, magnetic resonance imaging.
Electroconvulsive therapy: therapeutic relevance of seizure and
cardiovascular response
Gangadhar BN, Girish K , Janakiramiah N and Saravanan ESM.
National Institute of Mental Health and Neurosciences, Bangalore.
Annals of Neurology 2001 (in press).
Electroconvulsive therapy (ECT) is used to induce therapeutic seizures in various clinical conditions.
It is specifically useful in depression, catatonia, patients with high suicidal risk, and those
intolerant to drugs. Its beneficial effects surpass its side effects. Memory impairment is benign and
transient. Its mechanism of action is unknown, though numerous neurotransmitters and neuroreceptors
have been implicated. The standards of ECT practice are well established but still evolving in some
respects. ECT stimuli, must be set in relation to individuals' seizure threshold. Stimulus higher than
threshold is more therapeutic particularly in unilateral ECT. Assessment of threshold by formula
method may deliver higher stimulus dose compared with titration method. Cerebral seizure during ECT
procedure is necessary. Motor (cuff method) and EEG seizure monitoring are mandatory. Recent studies
have shown some EEG parameters (amplitude, fractal dimension, symmetry, and post ictal suppression) to
be associated with therapeutic outcome. Besides seizure monitoring, measuring other physiological
parameters such as heart rate (HR) and blood pressure (BP) may be useful indicators of therapeutic
response. Use of ECT in neurological conditions as well as its application in psychiatric illnesses
associated with neurological disorders has also been reviewed briefly.
Key words : Cardiovascular responses, EEG, electroconvulsive therapy, neurological conditions.
Is a grandmal seizure necessary and sufficient for the efficacy of ECT ?
Gangadhar BN, Girish K and Janakiramiah N.
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychiatry 42:443-444, 2000 (letter).
Unilateral ECT and dosing.
Andrade C
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychiatry 42:442, 2000 (letter).
Modified versus unmodified ECT.
Shukla GD
Consultant Psychiatrist, Jhansi.
Indian Journal of Psychiatry 42:445, 2000 (letter).
ECT, hypertensive mechanisms and cognitive dysfuction.
Andrade C
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychological Medicine 23:40-41, 2000.
Ictal systolic blood pressure and ECT-induced memory impariment
Girish K, Gangadhar BN, Jankiramaiah N and Mukundhan CR.
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychological Medicine 22:27-31, 1999.
Electroconvulsive therapy (ECT) induces memory impairment. The mechanism of ECT-induced memory
disturbance
is not well established. This study examined the relationship between rise in ictal systolic blood
pressure (BP)
and short term memory impairment following ECT.
Twenty, right-handed, consenting major depressive disorder patients with melancholic features
(males=10; unilateral ECT=10) were administered ECT thrice weekly. No psychotropic drugs were given.
Ictal systolic BP was recorded using Cardiocap-II at second ECT. Short term memory was measured using
paired associate learning test (verbal) and Benton visual retention test (BVRT; nonverbal). These
tests were administered before first ECT and after second ECT. Ictal systolic BP negatively correlated
with nonverbal memory scores but not with verbal memory scores following second ECT. Rise in BP and
memory impairment may be related epiphenomena of generalization of seizure and/or the stimulus
administered.
A scale to measure motor seizure modification during ECT: Reliability and
vialidy.
Latha. V, Saravanan. ESM Prashanth M. Mayur, Gangadhar BN Janakiramaiah N,
Uma Maheshwara Rao, G.
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychological Medicine 22:28-31, 1999.
A 5-point scale was developed to measure the extent of motor seizure modification. Higer score on the
scale indicates
better modification. Extent of motor seizure modification was rated in 50 consecutive patients
referred for modified
ECT. Rating was done during second or third ECT sessions. Two independent raters scored the extent of
motor seizure
modification using this scale. The interrater agreement (Kappa correlation) between the two raters was
0.72. Scores on
this scale was significantly ( P < 0.04 ) and positively correlated with succinylcholine
(mg/kg) dose. Patients on lithium
had higher modification scores. This scale can be used to assess the extent of motor seizure
modification in ECT as it
is reliable (high interrater reliability) and is also valid.
ECT practice guidelines
Gangadhar BN, Girish K and Janakiramiah N.
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Psychiatric Society-Karnataka Chapter News letter June 1999.
In the past two decades several clinically applicable refinements have been made in ECT practice. It
is desirable
that clinicians incorporate these in routine ECT. This article focuses on the contemporary standards
of ECT in
respect of stimulus parameters (threshold and seizure duration), seizure monitoring, concurrent drugs,
etc.
Predicting seizure threshold during ECT: a discriminate analysis study
Mayur PM, Subbakrishna DK, Gangadhar BN, Girish K, Janakiramiah N and Parameshwara G.
National Institute of Mental Health and Neurosciences, Bangalore.
NIMHANS Journal 16:193-196, 1998.
Several factors such as age, gender, medication status, head measurements and stimulus laterality are
known to
influence seizure threshold in ECT. Determinants of high (>=median stimulus dose) or low ( median
stimulus dose)
threshold were identified using discriminant function analysis. Separate analysis was conducted on
unilateral
(n=60) and bilateral ECT (n=110) patients in a prospective design. Among bilateral ECT patients, age
and
inion-nasion distance and among unilateral ECT patients, age, clinical global impression of severity
and
benzodiazepine status predicted the high or low threshold groups. Age emerged as the most significant
predictor
(p < 0.001) which classified 69% of bilateral and 70% of unilateral ECT patients to either a high or a
low seizure threshold groups.
Key Words : Electroconvuslive threapy, predictors, seizure threshold.
Clinical predictors of seizure threshold in bilateral ECT
Girish K, Prasad KMR, Gangadhar BN, Janakiramiah N, Subbakrishna DK & Parameshwara G.
National Institute of Mental Health and Neurosciences, Bangalore.
Indian Journal of Psychiatry 40:327-330, 1998.
Research on determinants of ECT seizure threshold is inadequate. In view of differences in ECT
populations and confounding factors, there is a need for examining this in our population. Consecutive
consenting inpatients (n=100), referred for bilateral (BL) ECT by treating psychiatrist at National
Institute of Mental Health and Neurosciences Hospital, Bangalore, formed the sample for the study.
Thiopentone, succinylcholine and atropine were used for modification. Seizure threshold (dependent
variable) was determined by titration method at first (1st) ECT. The independent variables were age,
gender, diagnosis, illness severity (clinical global impression; CGI), concurrent drugs, head
circumference (HC) and inion-nasion distance (IND). Age, IND and CGI severity predicted seizure
threshold in forward, stepwise, linear regression model.
Key Words : ECT, predictors, seizure threshold
Prolonged seizures during electroconvulsive therapy
Jayaprakash MS, Gangadhar BN, Girish K and Janakiramiah N.
National Institute of Mental Health and Neurosciences, Bangalore.
NIMHANS Journal 15: 139-142, 1997.
Seizures were monitored using both cuff method and EEG, during the first ECT session in 89 consecutive
patients. Six (7%) did not develop motor seizure but had adequate EEG seizures. In the group
manifesting both EEG and motor seizures (n=83), twenty-one (25%) patients developed EEG seizure 120
seconds more in duration (Group B) and the other 62 patients had adequate EEG seizure (Group A). The
motor and EEG seizure duration correlated significantly in Group A (r=0.8, p=<0.01) but not in Group B
(r=0.4, p>0.05). Linear regression analysis demonstrated that motor seizure could predict the EEG
seizure in Group A (t=10.42, p<0.001), but not so in Group B (t=2.0, p>0.05). This suggests that
motor seizure monitoring alone is unreliable to detect prolonged seizure and hence the need for
EEG seizure monitoring. The seizure should be terminated by using intravenous diazepam when the
EEG seizure duration exceeds 120 seconds.
EEG Delta Band Spectral Power: Differences Between Unilateral and Bilateral
ECT Seizures
Dutt, Narayan D, Mahapatra, P K, Gangadhar, B N, Janakiramaiah, N, Subbakrishna, D H, Rao, Jyothi K M
Associate professor, Department of Electrical Communication Engineering, Indian Institute of Science,
Bangalore
Indian Journal of Psychiatry 39: 61-63, 1997
EEG was recorded form right and left frontal leads during bilateral (n = 1) and unilateral (n = 14)
ECTs. The seizure EEG was analyzed using Fast Fourier Transform and the spectral power of the Delta
(1-4 Hz) band was computed. The spectral power on both sides was similar in the bilateral ECT,
Unilateral ECT produced asymmetry in the early - (first 8 seconds after stimulus offset) and mind -
(17-32 seconds after the stimulus offset) seizure phase; the spectral power was lower on the
unstimulated hemisphere. Studies to elucidate the relevance of EEG delta band of the seizure to
therapeutic potency of ECT are suggested.
Key words – EEG, ECT, Unilateral, Bilateral
Assessment of the therapeutic adequacy of the ECT seizure: current status.
Andrade C
National Institute of Mental Health and Neurosciences, Bangalore.
NIMHANS Journal 15: 319-329, 1997
Assessment of a seizure is essential for electroconvuslive therapy (ECT) to be effective. However, the
ECT seizure is not all or none phenomenon: seizures elicited by different methods differ in efficacy,
and some seizures may indeed have little or no therapeutic potential. A number of other factors,
including physiological changes across time, can also alter seizure characteristics (and hence,
possibly, efficacy) despite constancy in the method of induction. It is therefore necessary to define
the characteristics of an adequate seizure, and also those of the ideal seizure. Seizure duration, a
traditional measure of seizure adequacy, is recognized to have marked limitations.
Electroencephalographic (EEG) changes with ECT are now considered to hold promise for the
identification of more meaningful markers of efficacy. Both visual and spectrally analysed EEG
features differentiate ECT seizures with high and low therapeutic potential. High EEG amplitude
during, and low EEG frequency after the seizure may comprise the most promising markers of efficacy;
however, many intricately inter-related variables also need to be considered in developing efficacy
algorithms. Three operationally-defined EEG indices have recently been recommended to define ECT
therapeutic potential; these remain to be prospectively validated. Available research has chiefly
addressed depressed patients; other diagnostic categories also need to be examined.
Key words ECT, ECG, Seizure duration, Depression
Indian Psychiatrists' Attitudes towards Electroconvulsive Therapy
Agarwal, A K, Andrade, Chittaranjan
Professor and Head, Department of Psychiatry, King George's Medical College, Lucknow
Indian Journal of Psychiatry 39: 54-60, 1997
A questionnaire on ECT, tapping attitudes, usage and experience, was mailed to all medical members of
the Indian Psychiatric Society whose addresses were known; 263 (28.8%) of 913 psychiatrists responded.
This paper describes Indian psychiatrists attitudes towards ECT. A global attitude favouring the
treatment was expressed by 81.4% of respondents. The psychiatrists considered that for many patients
ECT may be the safest, cheapest and most effective treatment (79.8%), disagreed that ECT should be
used as a last resort (68.4%) and disagreed that drugs have made ECT obsolete (81%). While many
(44.1%) opined that use of ECT should be curtailed, few (5.3%) considered that ECT should be abandoned
- in fact, most respondents (86.3%) stated that comprehensive psychiatric care should include ECT
services. A need was expressed for explicit guidelines for proper use of ECT (77.2%). conflicting
opinions were expressed about the use of ECT in children. Many psychiatrists (38%) thought that ECT
may produce subtle brain damage: nevertheless, of those actively using ECT, 82.9% expressed
willingness to receive ECT themselves, if indicated.attitudesECTIndiaPsychiatrists
Key words Attitudes ECT India Psychiatrists
Issues In The Use Of Maintenance Electroconvulsive Therapy
Srinivasan, T N, Suresh, T R, Jayaram, Vasantha
Assistant Professor - Department of Psychiatry, Sri Ramachandra Medical College & Research Institute,
Porur, Madras
Indian Journal of Psychiatry 37: 139-142, 1995
This case report on the use of Maintenance Electroconvulsive Therapy (ECT-M) presents certain
observations and raises some issues in the use of the method. The report offers wider indication for
ECT-M, including schizophrenia and bipolar disorders and younger patients. It raises the issues that
the duration of use of ECT-M can be short rather than indefinite and that in the post ECT-M period,
drug maintenance using the same drugs which were ineffective pre-ECT-M can be used effectively. The
report presents those observations for further systematic study. The cost benefit advantage of the
method and its relevance to the need for more frequent use in developing countries is
illustrated.maintenance ECT, non-depressive psychoses, short-term use, post-ECT-M, drug therapy,
economic advantage
Key words Maintenance ECT, Non-depressive psychoses, Short-term use, Post-ECT-M, Drug therapy,
Economic advantage
Electroconvulsive Therapy In Catatonia Associated With Pneumothorax
Thomas, Ninan, Suresh, T R, Srinivasan*, T N
Assistant Professor - Department of Psychiatry, Sri Ramachandra Medical College & Research Institute,
Porur, Madras
Indian Journal of Psychiatry 36: 91-92, 1994
Recent advances in the method of application and monitoring of Electroconvulsive therapy (ECT) has
facilitated its use even in the presence of serious physical illness. This case report is of a patient
in catatonic stupor who developed an acute respiratory crisis and in whom the use of ECT led to quick
recovery not only from the psychiatric state but also helped recovery from the medical illness. The
report highlights the need to use ECT, if indicated, in the presence of serious medical illness
without hesitation.electroconvulsive therapy, serious physical illness
Key words Electroconvulsive therapy, Serious physical illness
Seizure Duration And Related Issues In ECT For Endogenous Depression
Andrade C
National Institute of Mental Health & Neuro-Sciences, Bangalore
Indian Journal of Psychiatry 35: 43-47, 1993
In a study comparing sinusoidal wave and brief-pulse ECT in endogenous depression, seizure duration
was monitored by the cuff method in 29 patients over 180 treatment sessions. Mean seizure duration
across all treatments was 26.5 secs and the mean for individual patients across their ECT course
ranged from a minimum of 15.7 secs to maximum of 38.5 secs. Regression analysis found no variable
which significantly predicted mean seizure duration. Of the 22 good responders in the study, response
to ECT was associated with a mean seizure duration of secs in 1 patient and 0 cs in 11 patients; as
just 2 of 7 poor responders to ECT had a mean seizure duration of < 20 secs in 1 patients, < 25 in 11
patients, of the 22 good responders in the study; as just 2 of 7 poor responders to ECT had a mean
seizure duration of < 25 secs, it appears that a cuff seizure duration of over 20 secs may suffice
for the seizure to be therapeutic in depression. With (constant current) brief pulse ECT, seizure
threshold significantly increased with successive ECTs; thresholds did not however differ between
the good and poor responders. There was a trend for seizure duration to decrease over time; again,
good an poor responders did not differ. These findings provide little support for the anticonvulsant
hypothesis for the antidepressant effect of ECT, but support the literature that ECT exerts an
anticonvulsant effect.
The Practice Of ECT In India: II. The Practical Administration Of ECT
Andrade, Chittaranjan, Agarwal, A K, Reddy, Venkataswamy M
National Institute of Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 35: 81-86, 1993
A questionnaire on ECT, tapping attitudes, opinions and usage, was mailed to all medical members of
the Indian Psychiatric Society whose addresses were known; 263 (28.8%) responded. This paper, the
second in a series that presents the results of the survey, describes the practical administration of
ECT. Specific issues discussed are the availability of cardiopulmonary resuscitation kit, ECT
premedication, the ECT device, certain aspects of ECT stimulation, the electrode placement during ECT,
administration of multiple ECT during a single treatment session and monitoring of the seizure
duration. It is concluded that, in many respects, the practical administration of ECT in India in
suboptimal; further research is required in certain areas.
ECT Induced EEG Seizure: Validity Of Duration Estimation By Last Spike
Gangadhar, B N, Rao, Jyothi K M, Sujatha, B L, Janakiramaiah, N, Subbakrishna, D K
National Institute of Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 35: 175-176, 1993
The seizure EEG records of 25 depressive receiving ECT were 'blindly' rated by two trained rater using
a uniform definition of seizure endpoint. The EEG seizure duration estimates were validated against
five expected relationships. EEG seizure duration correlated with and was more than motor seizure
duration, reduced over the course of ECTs, was consisted within subjects and negatively varied with
age. Within clinical constraints, the method of seizure duration estimation by the last spike is
valid.
Physical Morbidity With Unmodified ECT - A Decade Of Experience
Tharyan, Prathap, Saju, P J, Datta, Sunil, John, Jacob K, Kuruvilla*, K
Department of Psychiatry, Christian Medical College, Vellore
Indian Journal of Psychiatry 35: 211-214, 1993
Recent recommendations for the routine use of modified ECT prompted an audit to be undertaken to
determine the incidence of musculo-skeletal complications occurring in patients who received ECT at
our centre from 1980 to 1990. Of the 13,597 treatments given, 98% were unmodified, due to the lack of
availability of anesthestis. Musculo-skeletal complications occurred in less than 1% of treatments and
were of little clinical significance. However, modified ECT was associated with significantly greater
frequency of potentially fatal complications such as cardiac arrest. The findings of this audit
indicate that unmodified ECT administered by a trained team does not result in significant
musculo-skeletal morbidity and may be preferable to modified ECT in the absence of trained anaesthetic
personnel. The decision to routinely recommend modified ECT in developing countries should await
scientific debate with due consideration of the complications, resources, ethics, practicality and
cost as well as the consequences of such a recommendation on clinical practice.
Physical Morbidity With Unmodified ECT - A Decade Of Experience
Tharyan, Prathap, Saju, P J, Datta, Sunil, John, Jacob K, Kuruvilla*, K
Department of Psychiatry, Christian Medical College, Vellore
Indian Journal of Psychiatry 35: 211-214, 1993
Recent recommendations for the routine use of modified ECT prompted an audit to be undertaken to
determine the incidence of musculo-skeletal complications occurring in patients who received ECT at
our centre from 1980 to 1990. Of the 13,597 treatments given, 98% were unmodified, due to the lack of
availability of anesthestis. Musculo-skeletal complications occurred in less than 1% of treatments and
were of little clinical significance. However, modified ECT was associated with significantly greater
frequency of potentially fatal complications such as cardiac arrest. The findings of this audit
indicate that unmodified ECT administered by a trained team does not result in significant
musculo-skeletal morbidity and may be preferable to modified ECT in the absence of trained anaesthetic
personnel. The decision to routinely recommend modified ECT in developing countries should await
scientific debate with due consideration of the complications, resources, ethics, practicality and
cost as well as the consequences of such a recommendation on clinical practice.
Seizure Duration over ECT Sessions : Influence of Spacing ECTs
National Institute of Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 34: 124-127, 1992
Thirty melancholic patients participated in a double blind trail comparing efficacy of modified
bilateral sinewave ECT given twice or thrice weekly. Seizure was monitored on a single channel EEG
tracing. All patients received ECTs in the first two weeks of the four week study period. Seizure
duration estimate from EEG tracings available for 22 patients (10 patients of thrice weekly group) on
all occasions of first two weeks were analysed. Seizure durations significantly reduced through the
course in both the groups. Twice weekly ECTs led to significantly less decrements in the seizure
duration. The differential reduction was not related to the therapeutic outcome. The improvement in
depression in both groups of patients was comparable at the end of two weeks
The Practice Of ECT In India : Issues Relating To The Administration Of ECT
Agarwal, A K, Andrade, Chittaranjan, Reddy, Venkataswamy M
Professor in Psychiatry K G's Medical College, Lucknow
Indian Journal of Psychiatry 34: 285-297, 1992
A questionnaire on ECT, tapping attitudes, opinions and usage, was mailed to all medical members of
the Indian Psychiatric Society whose addresses were known; 263 (28.8%) responded. This paper the first
in a series that presents the results of the survey, provides demographic data on the respondents and
covers issues relating to the administration of ECT. Specific issues discussed include the ECT
personnel, location of ECT facility, certain ECT prescription patterns, psychiatrist-patient
interactions on suggestion of ECT, pre-ECT investigations, frequency of administration of ECT, use of
regressive ECT and maintenance ECT, length of the ECT course across diagnoses and use of psychotropic
drugs in relation to the ECT course.
Bilateral Frontal Lobe CT Scan Abnormality Following ECT In An Adolescent
Jana, D, Banerjee, G
NRS Medical College, Calcutta
Indian Journal of Psychiatry34: 392-394, 1992
A case is described of bilateral frontal lobe CT Scan abnormality associated with ECT in an
adolescent. Possible causes and risk factors are discussed.
Computed Tomographic Study of Morphological Changes of the Brain in Patients
with ECT Induced Seizures
Jayakumar, P N, Gangadhar, B N, Sinha, Vinod, Khanna, Sumanth, Arya, B Y T
Department of Neuro-radiology, National Institute of Mental Health & Neuro Sciences, Bangalore
Neurology India 40: 101-103, 1992
The case of disappearing CT abnormalities following seizures remains an enigma. Electroconvulsive
therapy (ECT) used in the management of Psychiatric disorders is a good human model for understanding
pathogenesis of epilepsy. Hence the study was designed to identify the morphological effects of ECT
induced seizures on the brain by computed tomography. Densitometric and morphometric evaluation of the
Pre-ECT and Post-ECT scans in 6 patients did not reveal any statistically significant differences.
Though post-ictal changes cannot be excluded, we feel that underlying inflammatory causes have
probably a role to play in some of those patients who demonstrate CT changes after seizures.
Key words - Brain oedema, Electronconvulsive therapy, Computed tomography, Epilepsy
Editorial : ECT: A Need Of Reappraisal
A K Agarwal
Department of Neuro-radiology, National Institute of Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 32: 295-296, 1990
Tilak Venkoba Rao Oration : Psychobiological Frontiers Of Electroconvulsive
therapy In
Depression : Evaluation Of Strategies For Rational Prescription And Reduction In Morbidity
Chittaranjan Andrade - Assistant Professor, Department of Psychopharmacology, National Institute of
Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 32: 109-130, 1990
Post Dexamethasone Plasma Cortisol Levels In Depressives Treated With
Imipramine And Electroconvulsive Therapy
Department of Psychiatry, Institute of Medical Sciences Banaras
Indian Journal of Psychiatry 31: 78-82, 1989
Sixty patients of endogenous depression and thirty normal controls were studied to find out the
relationship of post dexamethasone plasma cortisol levels (PDPC) and clinical improvement of
endogenous depression in patients treated with electroconvulsive therapy and imipramine. The PDPC
levels in both the group of patients showed significant decrease with clinical improvement (Pre and
Post treatment PDPC Values of ECT group was 20. 7 m g/dl and 13. 6 m d/dl while it was 17. 9 m g/dl
and 12. 7 m g/dl respectively for the Imipramine group). a significant correlation was also found
between PDPC and severity of illness (p < 0. 001) in the both groups which indicates that PDPC levels
is independent of treatment modality used.
Effect Of Imipramine And ECT On Platelet Mao Activity In Depressives
Trivedi, J K, Singh, R P, Lal, Narottam, Viswanathan, P N, Kumar, Sudhir
Department of Psychiatry King George's Medical College, Lucknow
Indian Journal of Psychiatry 31: 139-143, 1989
SPlatelet monoamine Oxidase (MAO) activity was estimated in 30 depressed patients treated with
Imipramine or ECT over a period of 5 weeks and pretreatment and post treatment values were compared.
Imipramine and ECT caused significant reduction of platelet MAO, which after 7 days washout period
comes to the pretreatment level while subjects clinical status remained unchanged. The percentage
blockade in platelet MAO values by imipramine and ECT was 51.40 ± 13.43 and 34.73 ± 24.27 respectively
Initial Response To ECT As A Predictor Of Outcome In Endogenous Depression
Andrade, Chittaranjan, Gangadhar, B N, Vythilingam, Meena, Channabasavanna, S M, Pradhan, N
National Institute of Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 31: 293-295, 1989
In a double-blind, prospective study, 29 patients with endogenous depression were treated with
electroconvulsive therapy (ECT). The degree of attention in Hamilton Rating Scale for Depressionscores
after the first ECT was compared between ECT responders and non-responders at the end of the treatment
course; a significant difference was obtained, indicating higher initial response in ECT responders.
It is therefore suggested that response to a single trial ECT may form the basis for prediction of
response of endogenous depression to a course of ECT. An operationalization of this concept is
proposed, its sensitivity and specificity calculated and its implications discussed.
Efficacy of combined ECT after two weeks of neuroleptics in schizophrenia: a
double blind controlled study.
Saritha EP, Janakiramaiah N, Gangadhar BN, Subbakrishna DK, Jyothi Rao
National Institute of Mental Health and Neurosciences, Bangalore.
NIMHANS Journal 16: 243-251, 1988
Clinicians introduce ECT early in the course of ongoing acute neuroleptic treatment of schizophrenia
when the therapeutic progress is unsatisfactory. It is not known if such addition of ECT confers
advantage. Schizophrenic inpatients referred to ECT were randomly assigned to one of the three
treatments given for four weeks: bilateral, nondominant unilateral or sham ECT (n=12 in each group).
They were on therapeutic range doses of neuroleptics for two to twelve weeks before being referred for
ECT and the same was continued through the study period. Double-blind clinical ratings were made
weekly. No significant group differences were found on CGI scores, BPRS total psychopathology as well
as thinking disturbances, hostile-suspiciousness, withdrawal-retardation and anxious-depression
factors. At the end of four weeks of treatment, ECT groups performed poorer than sham ECT group on
logical, verbal and visual memory. The results do not support the practice of adding ECT to
schizophrenics early in the course of ongoing neuroleptic treatment.
Key words : ECT, Schizophrenia, Neuroleptic, Efficacy
Measuring extent of motor seizure modification: role of succinylcholine
dose.
National Institute of Mental Health and Neurosciences, Bangalore.
NIMHANS Journal 16: 203-206, 198
Research on the role of succinylcholine dose for the modification of peripheral convulsions during
electroconvulsive therapy (ECT) is limited. This aspect was examined in consecutive consenting
patients (n=44) who received bilateral ECT. Succinylcholine dose for modification ranged between 30
and 50 mg (0.45-1.30mg/kg, mean=0.78mg/kg) as chosen by the attending anaesthesiologist. Motor seizure
was monitored by the cuff method. Two independent raters blind to succinylcholine dose measured the
extent of motor seizure modification on a five-point rating scale – higher score indicating better
modification. Measurement was obtained during one of the ECT sessions in each patient. The scale
demonstrated good interrater agreement (Kappa coefficient=0.75). In stepwise, multiple, linear
regression model only succinylcholine dose explained 11% of the variance (beta=0.33, t=2.104, r2=0.11,
p=0.007) in the extent of modification; higher dose yielding better modification. Only five patients
(11%) had a score >3. Relatively larger succinylcholine doses (1mg/kg) may be required to produce
effective modification.
Key words : ECT, Succinylcholine, Motor seizure modification
Clinical Prediction Of Rate Of Response Of Endogenous Depression To
Electroconvulsive Therapy
Chittaranjan, Gangadhar, B N, Subbakrishna, D K, Channabasavanna, S M, Pradhan, N
National Institute of Mental Health & Neuro-Sciences, Bangalore
Indian Journal of Psychiatry 30: 381-387, 1988
In depression, the identification of predictors of fast response is necessary to improve patient
selection for ECT. In a double-blind, prospective study of 32 endogenously depressed patients treated
with ECT, we attempted to identify the clinical characteristics of ECT responders which predicted fast
(requiring < 5 treatments to produce maximum recovery) and slow (requiring> 6 treatments to produce
maximum recovery) response to ECT. Of the 22 ECT responders in the study, 13 were fast and 9 were
slow responders. We found that male sex and greater age associated with lesser initial severity of
depression were significantly associated with fast recovery. Surprisingly, factors suggested or
expected to predict good outcome with ECT failed to predict fast outcome. Finally, the treatment
variables of mean seizure duration and stimulus waveform were found to be unrelated to recovery
rate. The findings are briefly discussed.
Dexamethasone Supression Test In Depressives Treated With ECT
S L Varma, N Lal, J K Trivedi, Mohini Anand
Indian Journal of Psychiatry 29: 353-357, 1987
A cohort of endogenous depressives and normal controls were studied to examine the role of DST in
depressives treated with ECT. Weekly DST estimation was done and depression was assessed on HRS-D.
73.6% patients were found to be non suppressors as compared to controls in whom 16.7% were non
suppressors. 60% DST positive patients showed clinical improvement while 50% DST negative did not show
improvement. This proves the notion that DST is a state dependent biological marker of endogenous
depressed state
Effect of ECT in Endogenous Depression: A Double Blind Comparison with
Imipramine
B N Gangadhar R L Kapur & S Kalyanasundram - Department of Psychiatry, National Institute of Mental
Health & Neuro-Sciences, Bangalore.
NIMHANS Journal 3: 7-12, 1985
In a double blind randomised trial, both ECT and imipramine produced equal and clinically significant
improvements at the end of four weeks in endogenous depressives. The depression was assessed on the 17
item Hamilton rating scale for depression (HRSD) and was compared with its 6 item subscale. Whereas on
the former scale ECT seemed superior only once, i.e., at the end of second week, with the latter
scale, ECT seemed superior during all the first 3 weeks. Item analysis on the HRSD revealed
significant differences with respect to the therapeutic effects of these two treatment methods.
Key words - ECT, Imipramine, Hamilton Rating Scale for Depression (HSRD), Item subscale
Side Effects of Somatic Therapies in Depression: A Double Blind Comparison
of ECT & Imipramine
B N Gangadhar - Department of Psychiatry, National Institute of Mental Health & Neuro-Sciences,
Bangalore.
NIMHANS Journal 3: 13-16, 1985
In a double blind randomised study comprising ECT and imipramine, ECT was found to be superior as it
caused fewer subjective side effects than imipramine. Some of the side effects were common to both
treatment methods. ECT did not cause detectable organic brain damage.
Key words - ECT, Imipramine, Depression, Side effects
Impedence Measurements during Electroconvulsive Therapy
B N Gangadhar, Lakshmanna, D K Subba Krishna and Channabasavanna S M
National Institute of Mental Health & Neuro-Sciences, Bangalore
NIMHANS Journal 3: 135-139, 1985
Impedence measurements were conducted in 49 male patients during electroconvulsive therapy. Wide
fluctuations in impedence between and within patients across occasions were recorded. Age seemed to
positively influence the impedence, whereas the occasion at which ECT was given and the voltage used,
negatively influenced the impedence. Measurement of electrical energy dose using joules was found to
have large variations and thus may not accurately reflect the energy delivered to the brain tissue
Key words - Electroconvulsive therapy, Impedence
Re-evaluation Of ECT (Tilak Venkoba Rao Oration 1985)
Ravi Abhyankar - Honorary Assistant Psychiatrist, Jerbai Wadia Hospital for Children Parel, Bombay.
Senior Research Fellow, WHO Collaborating, Centre for Psychopharmacology, Department of Psychiatry,
KEM Hospital, Parel Bombay
Indian Journal of Psychiatry 27: 35-50, 1985
Death Following ECT - A Case Report
Shukla, G DMishra, D N
Lecturer in Psychiatry, M.L.B. Medical College, Jhansi (U.P)
Indian Journal of Psychiatry 27: 95-97, 1985
Electro-Convulsive Therapy (ECT) is regarded as a safe procedure since although several thousands of
treatments are given annually worldover, the occurrence of serious complications is rare (Sargant and
Slater 10 1963; Cropper and Hughes 4 1964; Royal College of Psychiatrists 9 1977; Kalinowsky 8 1980
and Shukla 11 1981). Nevertheless, complications do occur and are, at times, fatal (Barker and Baker 3
1959; Arneson and Butler 2 1961; Heggtveit 5 1963; Kalinowsky and Hippius 8 1969 and Gomez 6 1974). To
pour knowledge there has been no report of death following ECT from India. This prompted us to present
case who died within 10 hours of ECT and in whom ECT and / or anaesthesia could be inferred to have
caused or contributed towards death
Role Of ECT Phenothiazine Combination In Schizophrenia
Agarwal, A KWinny, G C
Department of Psychiatry, K.G.'s Medical College, Lucknow
Indian Journal of Psychiatry 27: 233-236, 1985
A prospective double blind study was conducted to evaluate the role of E.C.T. in schizophrenia. Before
the start of the trial patients were kept on chlorpromazine inadequate dosage for 30 days. those who
showed fifty percent or more improvement during this period were excluded. All patients were given
eight modified or simulated E. C. T. s. The patients were followed up for one month. E.C.T. did not
show any added advantage over chlorpromazine either initially or during short term follow-up
ECT And Drug Induced Parkinsonism
Gangadhar, B NChoudhary, Roy JChannabasavanna, S M
Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore
Indian Journal of Psychiatry 25: 212-213, 1983
A cross-sectional evaluation of the presence of drug induced parkinsonian symptoms in hospitalized
patients was done. Patients who had received two or more ECTs had lower scores of parkinsonism when
compared to those who were not receiving ECT. Since the patient groups were comparable on parameters
which would influence the occurrence and development of drug induced parkinsonism, the lowered scores
in one group could be attributed to the effect of ECT
