Browsing by Author "Sales, Miguel"
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- Neuroversion: a possible mechanism of action of ECT in acute maniaPublication . Silva-dos-Santos, Amílcar; Venda, Diana; Sales, MiguelThe first-line treatments for acute mania are lithium, antiepileptic moodstabilizers, and antipsychotic drugs. Electroconvulsive therapy (ECT) is reserved for drug-resistant patients, although it is the first-line treatment for severe or delirious mania with life-threatening physical exhaustion. Contrary to depression, there is a paucity of evidence for the use of ECT in acute mania. However, available literature indicates that ECT seems effective in treating acute mania, with response rates between 80% and 90%, even in drug-resistant patients. Yet, its electrophysiological and molecular pathways remain unknown. We present the curious case of a 63-year-old woman, followed at our psychiatric outpatient clinic for bipolar disorder type I, admitted to our inpatient unit in a manic state with psychotic features. Due to bradycardia episodes secondary to the psychiatric medication, she was submitted to ECT. After a single session, her symptoms improved, despite no evoked seizures. We compare this curious phenomenon to the well-known procedure of cardioversion and name it neuroversion e in other words, a possible normalization of brain activity and behavior triggered by a unique session of electrical stimulation. However, we acknowledge that further research, including randomized clinical trials, are needed to study this reported event.
- Quantitative EEG (qEEG) in Patients with Bipolar Psychotic Depression and Unipolar Psychotic Depression under Electroconvulsive Therapy (ECT)Publication . Bravo, Joana; Silva dos Santos, Amílcar; Melo, António; Sales, Miguel; Mendonça, Pedro; Nagornova, Zhanna; Beljakov, Grigory; Shemyakina, Natalia; Lebedev, MikhailIn the last 21 years, there has been an increase in studies on quantitative electroencephalogram (qEEG) in psychiatry. Patients with unipolar and bipolar depression show different brain wave patterns. However, there is no consensus on the findings. In this study, we aimed to clarify some qEEG changes in patients with unipolar psychotic depression (UPD) and bipolar psychotic depression (BPD) during the ECT course. Methods: 10 patients undergoing treatment with ECT were considered. Of the 128 total ECT sessions, 34 sessions from six patients included had valid EEG recordings (3 patients with UPD and 3 with BPD, some with catatonic features). They underwent bifrontal ECT on a Thymatron IV device. EEG data were digitally recorded from two frontal leads with a Thymatron device and the Genie software. Data were analyzed with WinEEG soft package. EEG activity was divided into 4 phases: 1) background (resting state); 2) anesthesia; 3) ECT-induced stimulation/seizure, and 4) recovery. Regression analysis was performed for each phase through the sessions. The following EEG power spectrums were analyzed: delta (1.5-3.75 Hz), theta (4-7.75 Hz), alpha1 (8-9.75 Hz), alpha2 (10-13 Hz), beta1 (13.25-18 Hz), and beta2 (18.25-30 Hz). Results: Patients with psychotic unipolar depression showed an increase in the power spectrum of beta1 and/or beta2 in the resting phase over time (p < 0.05, linear regression). This increase was linked with clinical improvement. Patients with bipolar psychotic depression did not show this pattern. Conclusion: Clinical improvement in patients with unipolar psychotic depressionwas linked to an increase in the beta power spectrum. The same does not occur in bipolar patients. One possible reason for this finding might be that some bipolar patients have an increased basal beta activity. However, more studies are needed to assess the significance of our findings.