TY - JOUR
T1 - Electroconvulsive therapy pre-treatment with low dose propofol
T2 - Comparison with unmodified treatment
AU - Tripathi, Adarsh
AU - Winek, Nathan C.
AU - Goel, Kapil
AU - D'Agati, Douglas
AU - Gallegos, Jesus
AU - Jayaram, Geetha
AU - Nguyen, Thai
AU - Vaidya, Punit
AU - Zandi, Peter
AU - Trivedi, Jitendra K.
AU - Reti, Irving M.
N1 - Funding Information:
This work was supported by a Johns Hopkins Center for Global Health Award (Reti).
Funding Information:
Drs. Reti and Vaidya have received research support from NIH, HDRF, Neuronetics Inc. and Brainsway Inc. Other authors report no disclosures.
PY - 2014
Y1 - 2014
N2 - Background: Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. Method: We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. Results: Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration. Conclusion: Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
AB - Background: Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. Method: We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. Results: Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration. Conclusion: Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
KW - Anxiety
KW - Electroconvulsive therapy
KW - Modified
KW - Propofol
KW - Sedating
KW - Unmodified
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U2 - 10.1016/j.jpsychires.2014.02.004
DO - 10.1016/j.jpsychires.2014.02.004
M3 - Article
C2 - 24602447
AN - SCOPUS:84897435561
SN - 0022-3956
VL - 53
SP - 173
EP - 179
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
IS - 1
ER -