NeuroStim_EO

Question 1

ECT is first line for?

Answer 1

SI : L1
TRD: L1
psychotic depression : L1
Catatonia : L3
Pregancy: L3
Rapid physical deterioration: L3
Prior response : L3
Repeated intolerance to Rx: L3
Patient preference : L4

Question 2

Less common indication sof ECT?

Answer 2

Delirium
NMS
Parkinson
Dementia with agitation

Question 3

Recommendations for delivery of ECT?

Answer 3

First line:
Brief pulse: 0.5-2msec
Right unilateral
Bifrontal

Second line:
Ultra brief: 0.3-0.5msec
RUL and Brifrontal

Bitemporal brief

Question 4

What to use for maintenance after ECT?

Answer 4

Maintenance ECT is as efficiant as pharmacotherapy

Use lithium + nortriptiline
Use Lithium + effexor
Use an antidepressant never use before ECT

Question 5

What to know about mortality in ECT?

Answer 5

Les mortality risk with ECT than with AD
Equals to delivery or general anesthisia risk
0.01%
When it happens it’s because of cardiovasc in a patient that already had cardiovasc issues

Question 6

What increases the seizure threshold?

Answer 6

Age
Male
Benzo
Phenobarb
Repeated ECT

Question 7

What reduces the seizure threshold?

Answer 7

Hyperventilation, pre-oxygentation
Clozapine (risks of prolonged seizure)
Wellbutrin
Lithium (but increases the risk of delirium)
Coffee
All antipsychotics
Sleep deprivation

Question 8

How to determine the seizure threshold?

Answer 8

Estimation: half the age = % output
Use a table where parameters include gender and age

Bitemp x2
RUL x6

Question 9

What medication is used for anesthesia?

Answer 9

Curare = succinylcholine
Methohexial = barbiturique ; prolonges apnea episode but do not give laryngospam

Propofol non barbituric agent
Ketamine non barbituric agent

Question 10

What is the strongest predictor of ECT non response?

Answer 10

Failure to previous psychological and pharmacological tx
50% (compared to 65% in others. Response to ECT is between 70-80%)
ECT is superior tx to AD in acute in MDD (in scz AP are superior)

Question 11

What is associated with higher cognitive deficits post ECT?

Answer 11

Bitemporal electrode placement (vs unilat and bifrontal)
Brief pulse (vs Ultra brief)
Suprathreshold stimulation
3 times per week (vs 2 times per week)

Question 12

What are the proposed mechanis of ECT?

Answer 12

1) decrease blood flow and glucose in the brain
2) down regulation of post synaptic beta-adrenergic receptors
3) action on second messenger - ECT has an impact on protein G
4) BDNF increase - neurogenisis, less apoptose

Question 13

On what do we base stimulus intensity in rTMS?

Answer 13

RMT: resting motor threshold - current needed to elicit twhiching
Most common intensity is 110%

Question 14

What is the tx course of rTMS?

Answer 14

5 times a week
Up to 20 tx or when sx remit
Extended course to 30 sessions
Maintenance

Question 15

What is the indication for rTMS?

Answer 15

MDD, first line iin acute L1 and maintenance L3

If failed one course of AD

Question 16

What is first line protocole for rTMS?

Answer 16

Left DLPFC high frquency

Right DLPFC low frequency

Question 17

what are the side effects of rTMS?

Answer 17

Scalp pain during stim
Headaches transient after stim
No cognitive side effects
Most serious side effect is seizure, hx of sz and metallic hardware is absolute contreindication
Pacemaker is a relative contreindication, and brain lesion (vasculare, traumatic, neoplasic)

Question 18

What is DBS?

Answer 18

Experimental investigationa Level 3 evidence

Anatomical targets are subcallosal cingulate, ventral capsuleventral striatum

Question 19

What is transcranial Direct Current stimulation (tDCS)?

Answer 19

Low amplitude continuous electric current.
DLPFC
Third line, L2 in acute depression

Question 20

What is vagual nerve stimulation?

Answer 20

The VNS system comprises an implantable pulse generator (IPG), which is surgically inserted underneath the skin of the chest, connected to an electrode placed in one of the vagus nerves in the neck
Third line
Level 3 in acute, level 2 in maintenance