Rodney J. Pelchat

Psychiatric Consultation in the Nursing Home: A Survey of Six States

The authors examined availability, characteristics, and perceived adequacy of psychiatric consultation in nursing homes, as reported by directors of nursing, who returned 899 questionnaires. Thirty-eight percent of nursing home residents were judged to need a psychiatric evaluation; current frequency of consultation was rated as adequate by half of nursing directors. Nearly two-thirds reported that psychiatrists adequately provided diagnostic and medication recommendations; however, advice on nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts was largely viewed as inadequate. Findings suggest that perceived need for psychiatric services is far greater than the level actually provided. Overall, more attention must be directed to identifying incentives for psychiatrists to practice in nursing homes, determining clinical effectiveness of mental health services, and examining effects of alternative payment mechanisms on level of care.

Postpartum copulatory and maternal behaviour in Norway rats under seminatural conditions

Abstract Virgin female rats were mated at a freely cycling oestrus, and then again with the same males at the subsequent postpartum oestrus. Copulatory behaviour at each mating was compared and the temporal patterning of the females mating and maternal behaviour was analysed. Postpartum females were found to conserve the number of ejaculatory series received, yet the series were shorter, resulting in a shorter time being occupied, by this mating. During mating, females spent little time with their litters, and then mainly in the post-ejaculatory intervals. Ejaculatory series were rarely disrupted by nesting. The postpartum female rat seems to engage in behavioural time-sharing.

ECT in the Treatment of Patients with Neurological and Somatic Disease

Objective: An evaluation of the safety and efficacy of electroconvulsive therapy (ECT), for the treatment of patients with severe medical and neurological illness, was undertaken. Method: The English-language literature reporting the use of ECT in patients with neurological and somatic disease was reviewed. This review included reports describing ECT used for the treatment of affective disturbances and catatonia in patients with concurrent neurological or somatic disease, as well as reports dealing with the efficacy of ECT for the treatment of certain neurological conditions for which it has been reported to have some benefit independent of its psychiatric effect. Conclusions: ECT is safe and effective for the treatment of affective and catatonic disorders in patients with most neurological and medical diseases, including elderly and debilitated patients with multiple illnesses, if the specific medical risks are carefully evaluated in each case, and appropriate modifications of technique are used to reduce the risk of potential complications. Apart from its use in psychiatry, ECT has been reported to have therapeutic effects in Parkinsons disease, neuroleptic malignant syndrome, aggressive behavioral disorders following brain injury, certain forms of epilepsy, and some forms of delirium due to toxic or metabolic encephalopathies. The potential for ECT to play an active role in the clinical management of patients with these disorders, many of whom are presently refractory to maximal medical treatment, should be evaluated by systematic studies.

Sexual and maternal behaviour at the postpartum oestrus: The role of experience in time-sharing

Abstract The postpartum sexual and maternal behaviour of Norway rats (Rattus norvegicus) was observed in a seminatural habitat. Behavioural decision-making by the female was examined by disrupting the nest and newborn offspring during mating. In experiment 1, multiparous females responded to nest disruption with an increase in maternal behaviour that was largely restricted to the post-ejaculatory intervals. The temporal and frequency measures of copulation were largely unaffected, implicating behavioural time-sharing. In experiment 2, following nest disruption primiparous females did not switch efficiently between maternal and sexual behaviour, showed poor retrieval of pups, and returned to the nest during ejaculatory series. They did not display the characteristics of behavioural time-sharing, indicating that previous experience may play a role in the ability to time-share.

Factors affecting compliance with maintenance electroconvulsive therapy: A preliminary study

Maintenance electroconvulsive therapy (ECT) has been shown to be an effective treatment modality in preventing relapse in major depression following acute treatment. Nevertheless, clinical experience suggests that are obstacles to pursuing this form of long‐term treatment. A retrospective chart review was conducted on 17 patients recommended for maintenance ECT following inpatient ECT for major depression over a 2‐year period. Eleven (64.7%) accepted the recommendation and six (35.3%) refused. The two groups did not differ with respect to age, race, gender or number of medical codiagnoses. Patients who agreed to undergo maintenance ECT tended to live at home while all but one who refused lived in institutional settings (p

Electroconvulsive therapy performed 6 days after repair of an intracranial aneurysm using a liquid embolic system.

There exists a small, but growing body of literature that describes electroconvulsive therapy (ECT) performed on patients with intracranial aneurysms. These reports include patients with unrepaired aneurysms and others in which aneurysms have been repaired by clipping or coil embolization methods. To date, these cases have described favorable results and minimal complications. We describe the case of a 34-year-old woman, who received ECT 6 days after balloon-assisted embolization, with Onyx HD-500, of a 7-mm aneurysm of the ophthalmic segment of her left internal carotid artery. The patient experienced a significant reduction in depressive symptoms and tolerated a series of 8 treatments with no aneurysm-related complications. To our knowledge, this represents the earliest administration of ECT after repair of an intracranial aneurysm reported in the literature. Also, this is the only report in the literature of ECT performed after an intracranial aneurysm was repaired using the Onyx Liquid Embolic System.