Judit Tolna

Etomidate versus propofol for electroconvulsive therapy in patients with schizophrenia

Among drugs used for the anesthesia of electroconvulsive therapy (ECT), propofol reduces seizure duration to a greater degree than etomidate. The perceived difference between the 2 anesthetics is smaller in patients with schizophrenia than in patients who suffer depression. In this study, propofol and etomidate were compared during the ECT of patients with schizophrenia, on the basis of their impact on seizure activity and on seizure-induced hemodynamic reactions. Schizophrenics (n = 34) who were treated with ECT participated in this randomized crossover study. Propofol (1 mg/kg) and etomidate (0.2 mg/kg) were used alternately. The 2 drugs were compared on the basis of EEG- and EMG-registered seizure duration, mean arterial pressure (MAP), pulse frequency, energy index, and postictal suppression. We also analyzed the number of necessary restimulations. In case of anesthesia with etomidate, both EEG- (61.29 ± 22.4 s, 47.9 ± 21.3 s P = 0.014) and EMG- (46.3 ± 23.8 s, 33.6 ± 15.9 s P = 0.006) registered seizure durations were significantly longer than in case of propofol. When using propofol, the increase in MAP was significantly lower than when etomidate was used (8.1 ± 10.2 mm Hg, 18.3 ± 11.2 mm Hg, P = 0.001). There were no significant differences found in the postseizure increase in pulse frequency, in postictal suppression, or in the energy index, nor did the numbers of necessary restimulations differ significantly. Propofolwas found to reduce seizure duration to a significantly greater extent than etomidate. At the same time, in electrophysiological parameters that show a correlation with clinical efficacy, there was no significant difference found between the 2 anesthetics. However, the seizureinduced increase in MAP was reduced by propofol to a significantly greater degree than by etomidate.

Attitudes towards electroconvulsive therapy among Hungarian psychiatrists

Participants of a postgraduate biologic psychiatric course were surveyed about their attitudes toward electroconvulsive therapy (ECT) with a self-administered questionnaire. Among the respondents, 65 persons were specialists in psychiatry, 32% of whom would not consider using ECT even if they were in a psychotic depressive state. According to the bias factor, which has been calculated based on the answers to the 11 questions regarding attitudes, those psychiatrists who worked in inpatient care showed a less negative attitude. Among the items concerning knowledge of ECT, incorrect answers were most frequent to questions about myocardial infarction as a contraindication, and about the identity of the person who had pioneered this treatment. The negative attitude of Hungarian psychiatrists, especially of those who work in outpatient care, may have an important role in the decrease of the application of ECT in the past decade in Hungary.

Survey of referrals to electroconvulsive therapy in Hungary

Background. The diagnostic distribution of patients treated with electroconvulsive therapy (ECT) in Hungary is significantly different from that in Western Europe or the USA. In Hungary most of the treated patients are diagnosed with schizophrenia. Aim. To analyze the practice of referring patients for ECT in Hungary. Methods. Questionnaires containing socio-demographic data were mailed to all Hungarian psychiatric units where ECT was used (n=34), and all of the psychiatrists working there were invited to participate. Respondents were asked to rate how often they considered ECT for various symptoms/syndromes on a five-point Likert Scale. Results. A total of 78 questionnaires were returned. Altogether, 89% of the respondents have referred patients to ECT, and 54.8% had done so in the last year. The respondents had most frequently recommended ECT for antipsychotic and antidepressant-resistant patients, catatonic symptoms, or patients with previous good treatment response to ECT. Conclusion. Considering the very high Hungarian suicide rate, the low referral rate in cases of severe suicidal intent and threat is surprising. The respondents also rarely considered ECT for NMS or severe depression. The discrepancy between current referral practices and standard recommendations could be decreased with more ECT training courses.

Impact on psychiatric interns of watching live electroconvulsive treatment

ObjectiveWatching a live electroconvulsive treatment (ECT) has both positive and negative effects on spectators. The authors aim to survey the attitude change towards ECT in interns after watching a live ECT session.MethodsA 23-item questionnaire was administered to 66 interns before and after watching ECT.ResultsIn five statements, the number of answers indicating negative attitudes decreased significantly after viewing ECT. A general change in attitude towards ECT depended on the interns’ knowledge about the treatment. In the group of interns claiming minimal knowledge about ECT, a positive attitude change toward ECT and an increase in the acceptance of ECT were found while in the group with moderate self-rated knowledge no significant attitude change, but a decrease in acceptance, were detected.ConclusionThe visual information on ECT reduced the interns’ negative attitudes, in general; however, acceptance of the treatment decreased in a subgroup of interns.

The predictive validity of the Leonhardean classification of endogenous psychoses: a 21-33-year follow-up of a prospective study ("BUDAPEST 2000").

To our knowledge, no previous long-term studies of the Leonhardean classification in the whole spectrum of endogenous psychoses have been conducted. This prospective study (n = 276; female patients n = 222; normal control persons n = 54) started in 1967–1976. The same population was followed-up by participation of a “blinded control” psychiatrist in 1997–2002 [patients available at follow-up = 125 (56.3%); available controls = 38 (70.4%)]. Patients for this investigation were selected by two independent diagnosticians from eight nosological groups based on full diagnostic agreement. Diagnostic agreement at follow-up (weighted-kappa) was 0.87. Predictive validity of the diagnostic categories was measured empirically and using a stochastic (Markovian) model, thus combining validity and reliability. Hebephrenias, group of normal persons and of schizophrenias proved to be valid categories, with diagnostic stabilities of 0.94, 0.91, and 0.93, for the three groups, respectively. In addition, bipolar manic-depressive psychoses and cycloid psychoses were also valid (diagnostic stability of 0.77 and 0.76, respectively). Unipolar depression was valid (diagnostic stability = 0.84) only by forming a “nosological family” based on diagnostic stability and on current status and clinical presentation during the period preceding the follow-up with regard to other mood-congruent disorders and outcome-diagnosis “normal control”. Validity of systematic paraphrenias (diagnostic stability = 0.69) was in the moderate range. Division of schizophrenias in “systematic versus non-systematic” nosological categories was inconclusive; the categories of affect-laden paraphrenia, periodic catatonia and systematic catatonias could not be confirmed reliably in this study.

Validity and reliability of leonhard's classification of endogenous psychoses: preliminary report on a prospective 25- to 30-year follow-up study.

Summary. A 25- to 30-year controlled follow-up investigation of endogenous psychoses started in 1997. The research program labeled Budapest 2000 was initiated in 1967 as a controlled prospective study. The assessment of 108 patients and 24 normal control persons has so far been completed. With regard to the middle groups in the Leonhardian classification, diagnoses of bipolar manic-depressive psychosis, cycloid psychosis, periodic catatonia, systematic paraphrenia, systematic catatonia and hebephrenia proved to be valid in the long term. Revision of the category affect-laden paraphrenia seems to be called for.

Human tolerability studies with D-Met2, Pro5-enkephalinamide

As reported previously D-Met2,Pro5-enkephalinamide (EA) is a highly active enkephalin analogue. To examine its human tolerability male volunteers were treated s.c. with increasing doses (0.1-30.0 mg). The observed autonomic effects were as follows: feeling of heaviness in the limbs, dry mouth, pallor of the face and conjunctival injection. There was no significant change in blood pressure, pulse and respiratory frequency. The autonomic effects appeared within 15-30 min. However, its effects on mood and wakefulness i.e. slight drowsiness, decrease in psychic tension and emotional detachment developed only later. The serum prolactin level increased dose-dependently, while the growth hormone (HGH) content showed biphasic dose-response pattern. The TSH content increased only at the highest doses applied (10.0-30.0 mg).

Validity of reliability: Comparison of interrater reliabilities of psychopathological symptoms

We have tested the stability of interrater reliability of psychiatric symptoms over a quarter of century using 2 rating scales. Interrater reliabilities of items of 2 psychiatric rating scales employed by 2 consecutive follow-ups were compared. Interrater reliabilites proved to be by and large stable. Interrater reliability depends on the standard deviation of the items scores. In addition to the traditional approach, a new statistical method for unifying the assessments from multiple raters is also presented. Using this method, we demonstrated that probabilities of correct ratings are higher in the absence of manifest symptoms, or in the presence of symptoms, as compared with cases characterized by middle scores. To interpret the relationships revealed in the setting of the experiment, we introduce for its theoretical designation the term “validity of reliability.” It is recommended for evaluation of results of rating scales in the context of psychiatric nosology.

Multi-trait-multi-method assessment of predictive variables of outcome in schizophrenia spectrum disorders. A nosological evaluation.

Abstract Adopting the nosological hypothesis of functional psychoses, we sought predictive factors for the outcome of two extreme illnesses within the schizophrenia spectrum: cycloid psychosis (N = 23) and hebephrenia (N = 22). The previously completed 5 1 2 years follow-through study of both disease entities showed that the two types of psychosis differ distinctly in accordance with nosological expectations. According to the findings of the present study, the predictive factors for the two groups of illness also differ significantly both qualitatively and numerically. The nosospecific predictive factors are probably largely of a biological nature. According to our findings, there is a wider scope for social and psychological predictive factors in cycloid psychosis where the tendency to clinical recovery predominates and where the biologically determined psychosis remains more a foreign body in the life history.

Effects of D-Met2, PrO5-enkephalinamide on pain tolerance and some cognitive functions in man

The effects ofd-Met2, Pro5-enkephalinamide (EA) on pain tolerance and some cognitive functions have been examined in healthy male volunteers. Dihydrocodeine (DC) was used as reference substance. Applying the submaximum effort tourniquet technique EA (10 mg SC) was found to elevate the pain threshold similarly to DC (20 mg SC). Neither DC nor EA impaired the performance in the symbol cancellation test, which quantitates the intensity of attention. In this assay rather a slight improvement was detected. In addition the short-term memory performance (Wechsler test) was also improved by EA and DC. No alteration was seen in the word fluency test, an indicator of long-term (semantic) memory. The data show that EA not only improves pain tolerance but some of its mental effects are similar to those of a classical morphine congener DC.