Faculty Bibliography

Objective: To review issues with ECT and fire safety. Background: Regulatory agencies are increasing concerned with fire safety in procedural areas. While surgical lasers and electrocautery are more common culprits, ECT may come to the attention of internal and external agencies. ECT providers will need to respond to inquiries about fire safety and demonstrate safety protocols. Design/Methods: We reviewed the literature on fire safety and ECT as well as the Food and Drug Administration's Manufacturer and User Facility Device Experience for adverse events regarding ECT, fire or burns. We developed a fire-safety protocol based on our findings. Results: There are no reports of fire in the FDA database with either of the two commercially available machines in the United States. We discovered only two reported cases of fires related to ECT from the time period of 1992-2015, and none in the last ten years. In the both reported cases, the presence of 100% oxygen has been implicated as an important factor. There are roughly 26 cases of burns or suspected burns reported to the FDA between 1992-2015. Many of these burns appear to be related to improper use of adhesive electrodes or improper preparation of the treatment site. Fire safety in procedural areas focuses on reducing the three components required for ignition: spark, fuel source and oxygen. We adapted these concepts in creating a fire-safety protocol for ECT. Conclusions: Fires and burns are an extremely rare complication in ECT. A reasonable fire-safety protocol can reduce this risk even further

We report a case of a 33-year-old woman with depression and suicidal ideation, treated successfully with electroconvulsive therapy (ECT) in the past. Since her previous course of ECT, she underwent gastric banding, a bariatric surgical procedure associated with increased risk of gastric regurgitation. Despite increasingly stringent measures to minimize the risk of regurgitation and aspiration during ECT, she had several episodes of regurgitation, the last of which precipitated an acute illness consistent with aspiration pneumonitis. We took additional precautions after each event, until she had no further episodes of regurgitation. We discuss the risk posed by the gastric band, the measures we implemented to minimize that risk, and our recommendations for assessment and management of post-gastric banding patients who present for ECT.

OBJECTIVE: Little is known about maintenance treatment for panic disorder. The purpose of this naturalistic study is to compare outcomes of remitted panic disorder patients continued on versus those successfully discontinued from maintenance medication. METHODS: After 3 years of sustained remission with medication in a naturalistic setting, 168 patients were continued on, whereas 37 successfully discontinued from medication. Continued and discontinued groups were followed for an additional 4 to 8 years and compared for differences in treatment outcome using chi(2) and Wilcoxon rank sum tests. Times to relapse were analyzed using the Kaplan-Meier product-limit method, and risk factors for relapse were assessed using Cox proportional hazards regression. RESULTS: The discontinued group was healthier at baseline but had a significantly worse outcome compared with the continued group. Panic-free survival probabilities for the continued group at 1, 2, 3, and 4 years were 0.87, 0.81, 0.71, and 0.64, respectively, and were significantly higher than respective probabilities of 0.53, 0.35, 0.29, and 0.15 for the discontinued group. Median survival time in the continued group was significantly longer, at 5.67 years, than in the discontinued group, at 1.17 years. Cognitive behavioral therapy significantly reduced hazard in the discontinued but not in the continued group. Residual symptoms in either group at time of assignment predicted poorer outcome. CONCLUSION: Our small study suggests that relapse of panic disorder in routine clinical practice occurs even after long-standing remission on maintenance medication, and that relapse risk appears to be markedly higher after medication discontinuation. Discontinuation may be more successful in candidates who received cognitive behavioral therapy and have minimal residual symptoms