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Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Dept Psychiat, Lhospitalet De Llobregat, Barcelona, Spain

Resumen Objetivo Determinar la influencia de la utilizacion de propofol y pentotal como anestesicos en la terapia electroconvulsiva (TEC), en relacion con la duracion de la crisis, la dosis electrica, la eficacia clinica, el perfil cardiovascular y la aparicion de efectos cognitivos. Metodo Estudio retrospectivo sobre 127 pacientes que recibieron TEC bilateral como tratamiento de un episodio depresivo mayor. Resultados La duracion media de la convulsion electrica en el grupo de propofol fue significativamente mas corta que en el de pentotal (21,23 ± 6,09 versus 28,24 ± 6,67 s; p Conclusiones El anestesico utilizado en la TEC puede determinar diferencias en parametros como la duracion de la crisis o la carga electrica aplicada. Sin embargo, estas diferencias no parecen traducirse en la eficacia clinica ni en el patron de efectos adversos.

OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.

OBJECTIVE In a prior study of bipolar disorder pedigrees, we demonstrated distinct clinical differences between depressive episodes in bipolar disorder and major depressive disorder (MDD), including differentiation between these conditions using the Probabilistic Approach to Bipolar Depression. The aim of this retrospective study was to compare the phenomenology of the most severe lifetime depressive episodes between bipolar I (BP-I) and II (BP-II) disorder subtypes and MDD in these pedigrees. METHOD Patients with DSM-IV diagnoses of BP-I (n = 202), BP-II (n = 44), and MDD (n = 120) from bipolar disorder pedigrees were assessed using the Diagnostic Interview for Genetic Studies between 1998 and 2012. Multivariate logistic regression was used to identify distinguishing clinical features. The utility of the Probabilistic Approach in distinguishing BP-I and BP-II depression from MDD was assessed. RESULTS BP-I differed from MDD in terms of greater rates of psychomotor retardation (P < .05) and psychotic features (P < .05). BP-II was distinguished from MDD (P < .01) by the greater likelihood of mixed features. Patients with BP-II had a greater likelihood of mixed features (P < .001) and a lesser likelihood of psychomotor retardation (P < .05) compared to those with BP-I. The Probabilistic Approach significantly differentiated both BP-I and BP-II from MDD (P < .01 to P < .001, depending on cutoff) but did not robustly distinguish between BP-I and BP-II. CONCLUSIONS First, the differentiation of BP-II from both BP-I depression and MDD in terms of the presence of mixed symptoms is of particular interest given the current debate over "mixed specifiers" for these conditions in DSM-5. Second, the Probabilistic Approach to Bipolar Depression was demonstrated for the first time to significantly distinguish both bipolar disorder subtypes from MDD.

To determine the influence of propofol and thiopental as anesthetics in electroconvulsive therapy (ECT), as regards, seizure duration, electrical charge, clinical efficacy, cardiovascular profile, and presence of adverse cognitive effects.A retrospective design including 127 patients who received bilateral ECT for the treatment of a major depressive episode.The mean seizure duration in the propofol group was significantly shorter than in the thiopental group (21.23±6.09 versus 28.24±6.6 7s, P.001). The mean stimulus charge was 348.22 mC in the propofol group, and 238 mC in the thiopental group (P.001). Propofol was associated with a lower increase in blood pressure. There were no differences between groups in treatment response or presence of adverse effects.The anesthetic agent used in ECT might determine differences in parameters such as seizure duration or electrical charge. However, this does not seem to be translated into differences in clinical efficacy or the pattern of adverse effects observed.

Electroconvulsive therapy (ECT) is the most effective treatment for depression. However, the use of concomitant medications during ECT is controversial, especially benzodiazepines, as some past evidence suggests these may reduce the efficacy of ECT. This study analysed the effect of benzodiazepines on treatment outcomes in a group of depressed patients treated with bitemporal (BT) ECT.90 patients with major depression who received BT ECT were analysed. Clinical, demographic and ECT data were extracted from clinical records. Mood improvement was rated by trained psychiatrists using the Hamilton Depression Rating Scale (HDRS-21) at baseline and after the final ECT treatment. The association between benzodiazepine dose and mood outcomes over the ECT course was examined with regression analyses, controlling for variables that may affect ECT efficacy.Hierarchical multiple regression analysis found only current episode duration (t=-4.77, p0.001) was a significant predictor of change in HDRS. Benzodiazepine dose was not associated with a change in HDRS (p0.05, R(2)=0.39).This was a retrospective study. The use of the half-age dosing method for ECT did not permit examination of the effects of benzodiazepines on seizure threshold.Benzodiazepines did not affect the efficacy of BT ECT with the dosing method used. However, these results may not generalise to other forms of ECT, ECT given with other methods of dose determination or to other populations less responsive to ECT.