Jeffrey J. Kellams

Manic symptoms: An indication for bilateral ECT

As a follow-up to pilot observations that six manic patients who failed to respond to unilateral electroconvulsive therapy (ECT) recovered rapidly when switched to bilateral treatment, a retrospective study was conducted. Twenty-five patients who responded after switchover from unilateral to bilateral ECT, 25 age- and sex-matched controls, and 25 concurrent controls who responded to right unilateral ECT alone were evaluated. Demographic variables and DSM-III diagnosis did not discriminate between the groups, nor were they different in terms of electroencephalographic (EEG) findings, neuropsychological test results, numbers of ECT, and duration of seizure discharges. Standard assessments of psychopathology performed by independent psychiatrists showed no differences in ratings of psychosis or depressive phenomena. However, scales assessing manic symptoms showed highly significant differences with many more features of unrestrained behavior, elevated mood, hurried speech, and other typical features of mania in the patients who were switched from unilateral to bilateral ECT. Although there were no differences in prescribed drugs, the use of prn medications for sleep was greater in the experimental-switched patients than in controls. Patients who responded to unilateral ECT alone exhibited virtually no manic features, whereas those who demonstrated these characteristics failed to respond to unilateral ECT but benefited when switched to bilateral treatment.

Quetiapine in schizophrenia: onset of action within the first week of treatment

SUMMARY Objective: Three placebo-controlled clinical trials have established the efficacy of the atypical antipsychotic quetiapine (Seroquel*) in schizophrenia. These trials were designed and powered to detect a treatment difference in the primary endpoint at Week 6. The objective of the current analysis was to investigate the effect of quetiapine at earlier timepoints. Research design and methods: A combined analysis of data from three acute, double-blind, placebo-controlled, randomised trials was carried out. The trials comprised hospitalised patients with an acute exacerbation of chronic or subchronic schizophrenia who were randomised to receive quetiapine 150–750 mg/day (n = 422) or placebo (n = 198). Symptoms were assessed using changes from baseline to Week 1 in the Brief Psychiatric Rating Scale (BPRS) total score, BPRS positive symptom cluster score and the individual BPRS items of excitement, tension and depression. Changes from baseline to Weeks 1–6 were calculated for BPRS Factor 1 scores (which measures mood symptoms) and Scale for Assessment of Negative Symptoms (SANS) summary scores. Results: Within 1 week, overall symptom improvement (BPRS total score) was significantly ( p < 0.05) greater with quetiapine than with placebo; improvement also occurred in individual BPRS items of excitement, tension and depression. Improvement in negative symptoms was significantly ( p < 0.05) greater with quetiapine than with placebo from Week 1, as was the BPRS Factor I score from Week 2. More quetiapine- than placebo-treated patients showed a response of positive symptoms to treatment within 1 week ( p < 0.05). Conclusions: The beneficial effects of quetiapine are observed within 1 week across a broad spectrum of symptoms.

Comparative Onset of Improvement in Depressive Symptomatology with Drug Treatment, Electroconvulsive Therapy, and Placebo

Depressive symptomatology responds very similarly to treatment with trazodone, imipramine, placebo, and electroconvulsive therapy. In one study positive therapeutic response was evident within the 1st week of therapy in most patients. If this did not occur, an unfavorable response to treatment was likely to follow. The close resemblance of the electroconvulsive therapy response profiles to those of antidepressant drugs and placebo suggests that it exerts similar effects and that all of the treatments examined probably operate through a final common pathway in those patients who respond. Among the nonresponders, there were few features that distinguished the therapeutic groups.

EEG Topography in Psychiatric Diagnosis and Drug Treatment

AbstractBrain surface activity monitoring (BSAM) of drug-free adult patients with mania, depression, and obsessive-compulsive disorder revealed no significant differences between them and age-sex-matched normal controls. Distinctive EEG changes were observed during treatment with carbamazepine and lithium in patients with affective disorders. Drug-free schizophrenics had more anterior slowing than did normals. Increased delta and theta activity was associated with neuroleptic therapy—most with clozapine and chlorpromazine and least with naloperidol. Higher left frontal alpha amplitudes were correlated with fewer negative symptoms of schizophrenia and better therapeutic response. Computerized tomographic ventricle-to-brain ratios exhibited robust positive correlations with beta-1 amplitudes that occurred exclusively during treatment with chlorpromazine. Alpha and beta-1 amplitudes were positively correlated with the BPRS anxiety depression factor in schizophrenic patients under all treatment conditions. En...

Comparison of Molindone and Tranylcypromine in the Treatment of Refractory Depression

Abstract: A single‐blind parallel study of 20 treatment‐resistant hospitalized depressed patients showed that 10–30 mg/day molindone was more effective and less toxic than 20–30 mg tranylcypromine. Molindone‐treated patients responded during the first week with particular improvement in anxiety symptoms and agitation. Extrapyramidal symptoms developed in half of the patients on molindone, which were effectively managed with amantadine. Early termination from the study because of clinical worsening or side effects occurred in seven patients on tranylcypromine and in none on molindone. These results suggest that molindone in low dosage may be helpful in the management of refractory depression and may have the further advantage of producing a more rapid response to treatment with fewer disabling side effects.