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ECT stimulus intensity: are present ECT devices too limited?

Publication ,  Journal Article
Krystal, AD; Dean, MD; Weiner, RD; Tramontozzi, LA; Connor, KM; Lindahl, VH; Massie, RW
Published in: Am J Psychiatry
June 2000

OBJECTIVE: The maximum output charge for ECT devices is limited to 576 millicoulombs in the United States, although there are no data ensuring that this limit will allow consistently effective treatments. The authors examined whether this limit has a negative impact on therapeutic response and, therefore, whether a higher stimulus charge should be available. METHOD: They retrospectively reviewed the records of 471 patients who received a clinical index course of ECT at Duke University between 1991 and 1998. These patients received conservative stimulus dosing of 2.25 times seizure threshold for unilateral ECT and 1.5 times seizure threshold for bilateral ECT. RESULTS: Seventy-two (15%) of the 471 patients required the maximum stimulus intensity during their index ECT course. Of these, 24 (5% of the total) had either a short EEG seizure (less than 25 seconds) or had no seizure at the maximum level. Strategies to augment therapeutic response with caffeine, ketamine, or hyperventilation were used in 14 of the 24 patients, and data on therapeutic response were available for 22 of the 24. Only seven (32%) of these 22 patients were considered ECT responders, compared with 242 (66%) of the remaining 364 patients for whom data on response to ECT were available. Older age and pre-ECT course EEG slowing were predictors of requiring the maximum stimulus level. CONCLUSIONS: The maximum available stimulus output was therapeutically insufficient for 5% of the patients studied even when available means to augment response were instituted. This percentage would likely be even larger with the use of a less conservative dosing protocol for unilateral ECT. Increases in maximum stimulus output for ECT devices should be considered as a means to ensure adequate treatment response.

Duke Scholars

Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

June 2000

Volume

157

Issue

6

Start / End Page

963 / 967

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Schizophrenic Psychology
  • Schizophrenia
  • Retrospective Studies
  • Regression Analysis
  • Psychiatry
  • Multivariate Analysis
  • Middle Aged
  • Mental Disorders
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Krystal, A. D., Dean, M. D., Weiner, R. D., Tramontozzi, L. A., Connor, K. M., Lindahl, V. H., & Massie, R. W. (2000). ECT stimulus intensity: are present ECT devices too limited? Am J Psychiatry, 157(6), 963–967. https://doi.org/10.1176/appi.ajp.157.6.963
Krystal, A. D., M. D. Dean, R. D. Weiner, L. A. Tramontozzi, K. M. Connor, V. H. Lindahl, and R. W. Massie. “ECT stimulus intensity: are present ECT devices too limited?Am J Psychiatry 157, no. 6 (June 2000): 963–67. https://doi.org/10.1176/appi.ajp.157.6.963.
Krystal AD, Dean MD, Weiner RD, Tramontozzi LA, Connor KM, Lindahl VH, et al. ECT stimulus intensity: are present ECT devices too limited? Am J Psychiatry. 2000 Jun;157(6):963–7.
Krystal, A. D., et al. “ECT stimulus intensity: are present ECT devices too limited?Am J Psychiatry, vol. 157, no. 6, June 2000, pp. 963–67. Pubmed, doi:10.1176/appi.ajp.157.6.963.
Krystal AD, Dean MD, Weiner RD, Tramontozzi LA, Connor KM, Lindahl VH, Massie RW. ECT stimulus intensity: are present ECT devices too limited? Am J Psychiatry. 2000 Jun;157(6):963–967.
Journal cover image

Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

June 2000

Volume

157

Issue

6

Start / End Page

963 / 967

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Schizophrenic Psychology
  • Schizophrenia
  • Retrospective Studies
  • Regression Analysis
  • Psychiatry
  • Multivariate Analysis
  • Middle Aged
  • Mental Disorders
  • Male