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The influence of ect on olfactory memory
P Poster Presentations
182
I P-18-1 I Electroconvulsive Therapy in Elderly Depressed Patients G.N. Paoadimitriou, Y.G. Papakostas, LM. Zervas, GJ. Kanaras, CN. Stefanis. Department of Psychiatry, Eginition Hospital, Athens, Greece Depression is a common psychiatric disorder in the elderly which tends to be more chronic and more difficult to manage with antidepressants than in younger patients. Use of electro-convulsive therapy (ECT) in this age group is not widespread in everyday clinical practice. In this study we examined the effectiveness and safety of ECT in 24 depressed female patients with a mean age of70 years (S.D.: 3.5, range: 65-80). Unilateral and bilateral treatments were used with a mean number of 13 sessions (S,D.: 3.7, range: 5-20) and a mean seizure time (cuff) 27 (S.D.: 4.5, range: 20-69) seconds. Response to treatment was excellent (Hamilton score reduction over 50%) in 19 patients (79%), satisfactory (score reduction between 30% and 50%) in 3 patients (12%) and minimal response (under 30% reduction) in 2 patients (9%). Most patients tolerated the procedure quite well with no medical complications significant enough to require discontinuation of treatment. Regarding cognitive function, mild forgetfulness was observed in 7 patients (29%), and severe dysfunction requiring interruption of treatment in 3 patients (12%). All cognitive side effects were reversed after completion or interruption of ECT. These results suggest that ECT is a safe and effective treatment for geriatric patients and should be considered as a viable alternative in the management of depression in the elderly.
than thiopentone (Mean = 21.73 seconds, SD = 9.33). These results suggest that etomidate may be a superior induction agent for ECT with regard to seizure duration.
I P-18-4j
The Influence of Ect on Olfactory Memory
Pinkhas Sirota, Tanya Mosheva. Abarbanel Mental Health Center, Bat- Yam, Israel; Sac/der Faculty ofMedicine, Tel Aviv University, Ramat Aviv, Israel Memory impairments post ECT are well known and documented in the psychiatric literature. The present study was designed to answer the question of whether ECT affects olfactory memory. Twenty-three patients 12 schizophrenic patients and 11 major depressive disorder patients - and 14 control subjects participated in the study. Eugenol, geraniol, vanilin and isoamyl acetate were dissolved in Lubinol (heavy odorless-tasteless) mineral oil. Subjects were presented with the eugenol bottle and were asked to remember its odor. One hour later all 4 bottles were presented to the subjects who were asked to identify the bottle containing eugenol. This procedure was performed three more times: after the first ECT, the third ECT and the sixth EeT. Each time the test was performed twice: after 20' and 120'. The clinical improvement post the third ECT and drugs was significantly better than in those with only ECT (p > 0.05). The improvement in olfactory memory paralleled the clinical improvement, especially post the third ECT after 120' (p > 0,040). Conclusion: No difference in olfactory memory was found between patients treated with ECT and controls.
I P-18-2! Cognitive Effects of ECTafterTRH Administration 1M. Zervas, A. Pehlivanidis, Y.G. Papakostas, G.N. Papadimitriou, M. Markianos, C.N. Stefanis. Department of Psychiatry, Eginition Hospital, Athens, Greece Various hormonal compounds have been used to ameliorate the cognitive disturbance after ECT, all with inconsistent results. Thyrotropin Releasing Hormone (TRH) reportedly ameliorates certain cognitive parameters pertaining to alertness and attention span. We investigated the effect of pretreatment with TRH on orientation time (time required to answer correctly five orientation questions) and recall. In a balanced order crossover design, nine depressed female inpatients were given a bolus of 0.4 mg TRH or placebo i.v, 20 minutes before the first two ECT sessions. One half hour following reorientation, patients were asked to recall seven words memorized half hour before ECT, as a test of retrograde amnesia. To test the anterograde component a short story from the Randt Memory Test was read to the patients and asked to recall as much of it as they could immediately and 24 hours later. Administration of TRH did not influence orientation time, word recall, and short story recall (immediate or 24 hours) compared to ECT alone (ANOVA). Interestingly, in the TRH condition, there was a significant time effect in number of short story items remembered after 24 hours, compared to those remembered immediately after ECT (Repeated Measures ANOVA, p < 0.05). This indicates that, with the limitation of the small number of cases studied thus far, TRH may have a positive effect on recall after ECT in depression.
I P-18-31 Anaesthetic Induction for ECTwith Etomidate is Associated with Longer Seizure Duration than Thiopentone: A Controlled Randomized Trial
Shoshana Saffer, Michael Berk, Alexander 1. O'Neill-Kerr. Department of Psychiatry, University ofthe Witwatersrand Medical School, 7 York Road, Parktown, 2193, Johannesburg, South Africa Seizure duration is positively associated with therapeutic response to electroconvulsive therapy (ECT). This is a controlled randomized trial to assess seizure duration measured with both EEG and EMG after anaesthetic induction with either thiopentone or etornidate. Thirty seven patients receiving ECT for depression were entered into the trial, and a pair of seizures was measured from each patient. Alternate induction agents were used in sequential pairings, and the trial was controlled for interval between seizures, laterality and percent energy. Etomidate was associated with a significantly (p = 0.0002, F = 15.84, df = I, ANOVA) longer seizure duration (Mean = 34.43 seconds, SD = 16.06
I P-18-SI NGFPlasma Levels in Psychiatric Patients Treated with ECl: Results at IV and VIII ECT G. Bersani I, L. Aloe 2, A. Iannitelli I, P. Maselli J, F. Angelucci 2, ~. Alleva], P. Orsi 4, P, Pancheri J. I ll/ Psychiatric Clinic, Rome, Italy; - lnst. ofNeurobiology CNR; 3 Section ofBehavioural Pathophysiology ISS; "Lns: ofAnaesthesia, Univ. "La Sapienza", Rome, Italy Several studies on animal models showed that NGF (Nerve Growth Factor) and mRNA NGF increase after limbic seizures induced by different agents (chemical, physical and electrical) in different brain areas (parietal and piriform cortex, girus dentatus, hippocampus, etc) [1]. In our first study [2] we showed increase of NGF plasma levels in 12 male psychiatric patients (both schizophrenic and depressed) during first ECT (Electroconvulsive Therapy) session: mean NGF plasma values increased after 5 min (baseline = 42.86 pglml; +5 min = 138.91 pg/ml) thereafter gradually returning to baseline levels (+15 min = 105.53 pg/rnl; +30 min = 54.50 pg/ml). Blood were immediately centrifuged at 3000 rpm for 15 min and thereafter plasma immediately frozen and kept at -20 "C. The technique used was ELISA. The aim of this study was to verify the possibility that NGF plasma levels increase also in IV and VIII session of ECT. In IV session we studied a sample of 7 male psychiatric patients and we observed an increase of NGF plasma levels after seizure (baseline = 72.92 pg/ml; +5 min 138.5 pg/ml). The same results were observed at VIII session, when the increase is more evident 15 min after seizure (baseline = 81.11 pg/ml; +5 min = 85.5 pgfml, +15 min = 155 pglml). Both in IV and VIII session the return to baseline levels is evident 30 min after session. These findings are consistent with our previous study and indicate that NGF is involved in intrinsic mechanism of ECT.
=
[I] Lindvall 0, Kokaia Z, Bengzon J, ElmerE, Kokaia M,Tins, J7 (1994) 490-496 [2] Iannitelli A, AloeL, Bersani G, Maselli P,et al, Behav. Pharmacol. 6 suppl I (1995) 93-94
IP-18-sl
Prolactin and Cortisol Release duringEct are not Influenced by Pretreatment withthe Serotonin Receptor Agonist Sumatrlptan
J. Hatzimanolis, L. Lykouras, M, Markianos, C. Stefanis. Athens University Medical School, Department of Psychiatry, Eginition Hospital, Athens, Greece The prolactin release during electroconvulsive therapy (ECT) can be inhibited by pretreatment with methysergide, a 5HTI, 5HT2 and dopamine
182
I P-18-1 I Electroconvulsive Therapy in Elderly Depressed Patients G.N. Paoadimitriou, Y.G. Papakostas, LM. Zervas, GJ. Kanaras, CN. Stefanis. Department of Psychiatry, Eginition Hospital, Athens, Greece Depression is a common psychiatric disorder in the elderly which tends to be more chronic and more difficult to manage with antidepressants than in younger patients. Use of electro-convulsive therapy (ECT) in this age group is not widespread in everyday clinical practice. In this study we examined the effectiveness and safety of ECT in 24 depressed female patients with a mean age of70 years (S.D.: 3.5, range: 65-80). Unilateral and bilateral treatments were used with a mean number of 13 sessions (S,D.: 3.7, range: 5-20) and a mean seizure time (cuff) 27 (S.D.: 4.5, range: 20-69) seconds. Response to treatment was excellent (Hamilton score reduction over 50%) in 19 patients (79%), satisfactory (score reduction between 30% and 50%) in 3 patients (12%) and minimal response (under 30% reduction) in 2 patients (9%). Most patients tolerated the procedure quite well with no medical complications significant enough to require discontinuation of treatment. Regarding cognitive function, mild forgetfulness was observed in 7 patients (29%), and severe dysfunction requiring interruption of treatment in 3 patients (12%). All cognitive side effects were reversed after completion or interruption of ECT. These results suggest that ECT is a safe and effective treatment for geriatric patients and should be considered as a viable alternative in the management of depression in the elderly.
than thiopentone (Mean = 21.73 seconds, SD = 9.33). These results suggest that etomidate may be a superior induction agent for ECT with regard to seizure duration.
I P-18-4j
The Influence of Ect on Olfactory Memory
Pinkhas Sirota, Tanya Mosheva. Abarbanel Mental Health Center, Bat- Yam, Israel; Sac/der Faculty ofMedicine, Tel Aviv University, Ramat Aviv, Israel Memory impairments post ECT are well known and documented in the psychiatric literature. The present study was designed to answer the question of whether ECT affects olfactory memory. Twenty-three patients 12 schizophrenic patients and 11 major depressive disorder patients - and 14 control subjects participated in the study. Eugenol, geraniol, vanilin and isoamyl acetate were dissolved in Lubinol (heavy odorless-tasteless) mineral oil. Subjects were presented with the eugenol bottle and were asked to remember its odor. One hour later all 4 bottles were presented to the subjects who were asked to identify the bottle containing eugenol. This procedure was performed three more times: after the first ECT, the third ECT and the sixth EeT. Each time the test was performed twice: after 20' and 120'. The clinical improvement post the third ECT and drugs was significantly better than in those with only ECT (p > 0.05). The improvement in olfactory memory paralleled the clinical improvement, especially post the third ECT after 120' (p > 0,040). Conclusion: No difference in olfactory memory was found between patients treated with ECT and controls.
I P-18-2! Cognitive Effects of ECTafterTRH Administration 1M. Zervas, A. Pehlivanidis, Y.G. Papakostas, G.N. Papadimitriou, M. Markianos, C.N. Stefanis. Department of Psychiatry, Eginition Hospital, Athens, Greece Various hormonal compounds have been used to ameliorate the cognitive disturbance after ECT, all with inconsistent results. Thyrotropin Releasing Hormone (TRH) reportedly ameliorates certain cognitive parameters pertaining to alertness and attention span. We investigated the effect of pretreatment with TRH on orientation time (time required to answer correctly five orientation questions) and recall. In a balanced order crossover design, nine depressed female inpatients were given a bolus of 0.4 mg TRH or placebo i.v, 20 minutes before the first two ECT sessions. One half hour following reorientation, patients were asked to recall seven words memorized half hour before ECT, as a test of retrograde amnesia. To test the anterograde component a short story from the Randt Memory Test was read to the patients and asked to recall as much of it as they could immediately and 24 hours later. Administration of TRH did not influence orientation time, word recall, and short story recall (immediate or 24 hours) compared to ECT alone (ANOVA). Interestingly, in the TRH condition, there was a significant time effect in number of short story items remembered after 24 hours, compared to those remembered immediately after ECT (Repeated Measures ANOVA, p < 0.05). This indicates that, with the limitation of the small number of cases studied thus far, TRH may have a positive effect on recall after ECT in depression.
I P-18-31 Anaesthetic Induction for ECTwith Etomidate is Associated with Longer Seizure Duration than Thiopentone: A Controlled Randomized Trial
Shoshana Saffer, Michael Berk, Alexander 1. O'Neill-Kerr. Department of Psychiatry, University ofthe Witwatersrand Medical School, 7 York Road, Parktown, 2193, Johannesburg, South Africa Seizure duration is positively associated with therapeutic response to electroconvulsive therapy (ECT). This is a controlled randomized trial to assess seizure duration measured with both EEG and EMG after anaesthetic induction with either thiopentone or etornidate. Thirty seven patients receiving ECT for depression were entered into the trial, and a pair of seizures was measured from each patient. Alternate induction agents were used in sequential pairings, and the trial was controlled for interval between seizures, laterality and percent energy. Etomidate was associated with a significantly (p = 0.0002, F = 15.84, df = I, ANOVA) longer seizure duration (Mean = 34.43 seconds, SD = 16.06
I P-18-SI NGFPlasma Levels in Psychiatric Patients Treated with ECl: Results at IV and VIII ECT G. Bersani I, L. Aloe 2, A. Iannitelli I, P. Maselli J, F. Angelucci 2, ~. Alleva], P. Orsi 4, P, Pancheri J. I ll/ Psychiatric Clinic, Rome, Italy; - lnst. ofNeurobiology CNR; 3 Section ofBehavioural Pathophysiology ISS; "Lns: ofAnaesthesia, Univ. "La Sapienza", Rome, Italy Several studies on animal models showed that NGF (Nerve Growth Factor) and mRNA NGF increase after limbic seizures induced by different agents (chemical, physical and electrical) in different brain areas (parietal and piriform cortex, girus dentatus, hippocampus, etc) [1]. In our first study [2] we showed increase of NGF plasma levels in 12 male psychiatric patients (both schizophrenic and depressed) during first ECT (Electroconvulsive Therapy) session: mean NGF plasma values increased after 5 min (baseline = 42.86 pglml; +5 min = 138.91 pg/ml) thereafter gradually returning to baseline levels (+15 min = 105.53 pg/rnl; +30 min = 54.50 pg/ml). Blood were immediately centrifuged at 3000 rpm for 15 min and thereafter plasma immediately frozen and kept at -20 "C. The technique used was ELISA. The aim of this study was to verify the possibility that NGF plasma levels increase also in IV and VIII session of ECT. In IV session we studied a sample of 7 male psychiatric patients and we observed an increase of NGF plasma levels after seizure (baseline = 72.92 pg/ml; +5 min 138.5 pg/ml). The same results were observed at VIII session, when the increase is more evident 15 min after seizure (baseline = 81.11 pg/ml; +5 min = 85.5 pgfml, +15 min = 155 pglml). Both in IV and VIII session the return to baseline levels is evident 30 min after session. These findings are consistent with our previous study and indicate that NGF is involved in intrinsic mechanism of ECT.
=
[I] Lindvall 0, Kokaia Z, Bengzon J, ElmerE, Kokaia M,Tins, J7 (1994) 490-496 [2] Iannitelli A, AloeL, Bersani G, Maselli P,et al, Behav. Pharmacol. 6 suppl I (1995) 93-94
IP-18-sl
Prolactin and Cortisol Release duringEct are not Influenced by Pretreatment withthe Serotonin Receptor Agonist Sumatrlptan
J. Hatzimanolis, L. Lykouras, M, Markianos, C. Stefanis. Athens University Medical School, Department of Psychiatry, Eginition Hospital, Athens, Greece The prolactin release during electroconvulsive therapy (ECT) can be inhibited by pretreatment with methysergide, a 5HTI, 5HT2 and dopamine