BACKGROUND: Ultrabrief stimulation in electroconvulsive therapy (ECT) using a 0.25 or 0.30 ms pulse width markedly reduces the charge required to reach the seizure threshold (ST) and cognitive side effects. It is not known whether further reduction of pulse width to 0.15 ms is advantageous. METHODS: Thirty-seven patients were randomized to ST titration at the first session applying right unilateral (RUL) ECT with either a 0.15 or 0.30 ms pulse width and were titrated again in the second session using the alternative pulse width. All subsequent treatments used the pulse width applied in the second titration session, administering RUL ECT, starting at 6xST. The primary outcome was difference between the pulse widths in ST at the two titration sessions. Exploratory analyses examined differences in seizure duration and postictal time to recover orientation (TRO), averaged across all ECT sessions from the third onwards. Other exploratory analyses examined clinical improvement and retrograde amnesia for autobiographical information and other neuropsychological functions following the ECT course. RESULTS: In the first titration session, ST was significantly lower with the 0.15 ms than 0.30 ms pulse width. ST significantly increased when re-titrating with the 0.30 ms pulse width and significantly decreased when re-titrating with a 0.15 ms pulse width. There were no differences between the pulse width groups in clinical improvement, TRO, or neuropsychological measures. CONCLUSIONS: Ultra-ultrabrief stimulation with a 0.15 ms pulse width is more efficient in seizure induction than a 0.30 ms pulse width. Comprehensive studies should determine whether ultra-ultrabrief stimulation replaces ultrabrief stimulation as a default parameter for ECT.
- Klíčová slova
- Youtube, digital media, electroconvulsive therapy, mental health, sexual victimization, stigma, virtual reality,
- Publikační typ
- úvodníky MeSH
Electroconvulsive therapy (ECT) is an important treatment modality in psychiatry, considered to be the most effective option for pharmaco-resistant affective and psychotic disorders. Despite its great efficacy, it still remains a rather controversial method, which hinders its full potential. It is feasible to say that in part, this controversy is caused by a largely negative image of ECT displayed through media. The depiction of ECT in movies has been studied and well documented in the past. The aim of our study was to provide an overview of how ECT is represented in video games - a form of media where ECT representation has been overlooked in scientific literature so far. As with movies, most of these portrayals are negative, depicting ECT as an obsolete, aggressive or torturous treatment method.
- Klíčová slova
- electroconvulsive therapy (ECT), electroshock device, electroshock therapy, stigma, videogame,
- Publikační typ
- časopisecké články MeSH
BACKGROUND Long-acting injectable (LAI) antipsychotics are one of the forms of therapy for severe mental illness. Post-injection delirium/sedation syndrome (PDSS) is a very rare but serious adverse effect following the application of an olanzapine in a long-acting form. The most common symptoms of the syndrome are sedation, delirium, dysarthria, ataxia, extrapyramidal symptoms, agitation, dizziness, or seizure. The predispositions, prevention, and exact mechanism of PDSS remain unclear. CASE REPORT We present a case report of a 30-year-old male patient experiencing PDSS, including the main symptoms of PDSS, diagnostic methods, olanzapine plasma concentrations, therapeutic process, and outcome. We then include a follow-up of the patient 2.5 years later. The patient did not have any long-term damage, had no disabilities, and no post-traumatic stress disorder following the event. We include information about his current medications, further use of LAI antipsychotics, and update about his everyday life. CONCLUSIONS PDSS is a life-threatening condition clinicians must be aware of, and the easiest precaution is a 3-h observation after the application of an injection. Because the predispositions, prevention, and exact mechanism of PDSS remains unclear, it is very important to report the rare cases of PDSS and conduct further research for the safety of our patients. The follow-up of the patient showed that the patient is doing well, he has no post-traumatic stress disorder following the event, and he did continue to use LAI antipsychotic medication.
- MeSH
- antipsychotika * škodlivé účinky MeSH
- benzodiazepiny škodlivé účinky MeSH
- delirium * chemicky indukované diagnóza MeSH
- dospělí MeSH
- injekce intramuskulární MeSH
- léky s prodlouženým účinkem škodlivé účinky MeSH
- lidé MeSH
- následné studie MeSH
- olanzapin škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- antipsychotika * MeSH
- benzodiazepiny MeSH
- léky s prodlouženým účinkem MeSH
- olanzapin MeSH
INTRODUCTION: Tinnitus is an intrusive and chronic illness affecting a significant portion of the population, decreasing affected individuals' quality of life and socioeconomic functioning. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulatory method utilizing weak electrical currents to elicit short and long-term central nervous system changes. Several studies have proven its effect on tinnitus. We aimed to broaden the knowledge and provide data on the effect and its retention. METHODS: In the randomized, double-blinded, sham-controlled trial, 39 patients (active n = 19, sham n = 20) underwent bifrontal tDCS (anode over right dorsolateral prefrontal cortex (DLPFC), cathode left DLPFC, current of 1.5 mA, 20 min, 6 sessions in 2 weeks). Tinnitus Functional Index (TFI), Iowa Tinnitus Handicap Questionnaire (ITHQ), Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (SDS), and WHO-Quality of Life-BREF were employed in 4 evaluation points, including the follow-ups of 6 weeks and 6 months. RESULTS: We reached a delayed, significant long-term improvement (p < 0.05) in auditory difficulties associated with tinnitus and noticed it even after 6 months compared to placebo. We also reached a short-term, negative effect in the psychological domain of WHO-Quality of Life-BREF (p < 0.05). Not all subdomains of TFI and ITHQ reached statistical significance during the data analysis, even though specific positive trends were noticed. CONCLUSION: We proved partial, positive, long-term effects of tDCS on tinnitus and short-term, negative, transient effect on a specific aspect of the general quality of life. We expanded upon the results of previous trials and provided data concerning the longevity and the precise effect of multiple sessions, bifrontal DLPFC tDCS. Our sample size (n = 39) was limited, which might have contributed to the lesser statistical power of the analyzed items. CLINICAL TRIAL REGISTRATION: [www.ClinicalTrials.gov], identifier [NCT05437185].
- Klíčová slova
- bifrontal tDCS, dorsolateral prefrontal cortex, neurostimulation, non-invasive, protocol optimization, tDCS, tinnitus, transcranial direct current stimulation (tDCS),
- Publikační typ
- časopisecké články MeSH
Video games represent a rapidly growing media form that is a daily activity for many youths. So far, only a little attention has been paid to the portrayal of mental illnesses and psychiatric intervention within them. In our research, we explored the best-selling video games released between 2002-2021 in order to analyse these representations. We came to the conclusion that approximately 1 out of 10 popular games attempts to portray symptoms of mental illness - with a majority of 75% of them in a negative and stereotypical way. Despite the majority of mental illness depiction in popular video games being negative, there are mounting reports that certain representations have a positive impact on their player bases. Further studies are required, as to how much videogames influence the player's attitude toward this topic.
- Klíčová slova
- mental illness, psychiatric care, psychiatry-history, stigma, video game,
- Publikační typ
- časopisecké články MeSH
There are many situations of excessive production of reactive oxygen species (ROS) such as radiation, ischemia/reperfusion (I/R), and inflammation. ROS contribute to and arises from numerous cellular pathologies, diseases, and aging. ROS can cause direct deleterious effects by damaging proteins, lipids, and nucleic acids as well as exert detrimental effects on several cell signaling pathways. However, ROS are important in many cellular functions. The injurious effect of excessive ROS can hypothetically be mitigated by exogenous antioxidants, but clinically this intervention is often not favorable. In contrast, molecular hydrogen provides a variety of advantages for mitigating oxidative stress due to its unique physical and chemical properties. H2 may be superior to conventional antioxidants, since it can selectively reduce ●OH radicals while preserving important ROS that are otherwise used for normal cellular signaling. Additionally, H2 exerts many biological effects, including antioxidation, anti-inflammation, anti-apoptosis, and anti-shock. H2 accomplishes these effects by indirectly regulating signal transduction and gene expression, each of which involves multiple signaling pathways and crosstalk. The Keap1-Nrf2-ARE signaling pathway, which can be activated by H2, plays a critical role in regulating cellular redox balance, metabolism, and inducing adaptive responses against cellular stress. H2 also influences the crosstalk among the regulatory mechanisms of autophagy and apoptosis, which involve MAPKs, p53, Nrf2, NF-κB, p38 MAPK, mTOR, etc. The pleiotropic effects of molecular hydrogen on various proteins, molecules and signaling pathways can at least partly explain its almost universal pluripotent therapeutic potential.
- Klíčová slova
- MAPKs, Nrf2, Oxidative stress, autophagy, inflammation, molecular hydrogen,
- MeSH
- antioxidancia farmakologie MeSH
- faktor 2 související s NF-E2 * metabolismus MeSH
- KEAP-1 MeSH
- lidé MeSH
- oxidační stres * MeSH
- reaktivní formy kyslíku metabolismus MeSH
- vodík MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antioxidancia MeSH
- faktor 2 související s NF-E2 * MeSH
- KEAP-1 MeSH
- reaktivní formy kyslíku MeSH
- vodík MeSH
The increased production of reactive oxygen species and oxidative stress are important factors contributing to the development of diseases of the cardiovascular and central nervous systems. Molecular hydrogen is recognized as an emerging therapeutic, and its positive effects in the treatment of pathologies have been documented in both experimental and clinical studies. The therapeutic potential of hydrogen is attributed to several major molecular mechanisms. This review focuses on the effects of hydrogen on the cardiovascular and central nervous systems, and summarizes current knowledge about its actions, including the regulation of redox and intracellular signaling, alterations in gene expressions, and modulation of cellular responses (e.g., autophagy, apoptosis, and tissue remodeling). We summarize the functions of hydrogen as a regulator of nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated redox signaling and the association of hydrogen with mitochondria as an important target of its therapeutic action. The antioxidant functions of hydrogen are closely associated with protein kinase signaling pathways, and we discuss possible roles of the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) and Wnt/β-catenin pathways, which are mediated through glycogen synthase kinase 3β and its involvement in the regulation of cellular apoptosis. Additionally, current knowledge about the role of molecular hydrogen in the modulation of autophagy and matrix metalloproteinases-mediated tissue remodeling, which are other responses to cellular stress, is summarized in this review.
- Klíčová slova
- autophagy, matrix metalloproteinases, molecular hydrogen, oxidative stress,
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The safety and efficacy of electroconvulsive therapy (ECT) in patients with a brain tumor have been debated in the past without a clear conclusion. In the last large review published by Maltbie et al. in 1980, it was concluded that the presence of an intracranial mass should be considered an absolute contraindication to ECT. In our updated review, we investigated a total of 33 published and indexed case reports, case report series, and reviews of 75 individual patients who underwent ECT in the presence of a brain tumor over the last 80 years. Mounting case reports after the original Maltbie et al. review show that it is feasible to apply this method safely in patients with benign or otherwise clinically insignificant lesions. Certain precautionary measures, such as dexamethasone or phenytoin application before ECT, could lead to a further minimalization or even absence of adverse effects, particularly in higher risk individuals.
- Klíčová slova
- ECT, ECT and cancer, ECT safety, abnormal recovery, brain tumor,
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
We describe a case of a right-handed, 42-year-old, Caucasian female patient who manifested a set of unusual adverse effects during maintenance ultrabrief right-unilateral electroconvulsive therapy (ECT)-generalized myoclonic secondary seizure with lateralization nonresponsive to repeated intravenous diazepam application, deviation of the tongue and the head to the left, ping-pong gaze with nystagmoid jerks, postictal hypoactive confusion state lasting 15 minutes (with a total time to recovery 30 minutes), and likely Todd's paralysis after the procedure (subsided within 24 hours). These adverse effects led to a thorough clinical investigation and eventually the discovery of a brain tumor. In the article, we hypothesize about the possible interaction between the intracranial mass and ECT and provide a literature overview on the topic. Cases like this are likely underreported, and although several studies demonstrate that ECT can be applied safely to patients with an intracranial mass, this report demonstrates that brain tumor can interfere with ECT in an unpredictable way and have severe consequences (eg, unresponsiveness to diazepam when attempting to halt the seizure as our patient). Unusual symptoms after ECT, albeit reversible, such as in this case report, should be followed by a thorough neurological check-up to exclude any underlying organic pathology.
- MeSH
- depresivní porucha unipolární terapie MeSH
- diagnostické zobrazování MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- elektrokonvulzívní terapie škodlivé účinky MeSH
- lidé MeSH
- nádory mozku diagnóza MeSH
- náhodný nález MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
