Intravenous nitroglycerine in the management of posttreatment hypertension during electroconvulsive therapy

Article Abstract:

Electroconvulsive (ECT) or shock therapy causes a central nervous system seizure by means of electric current. ECT has been shown to be very effective in treating severe depression, although the exact mechanisms by which it works are not well understood. However, the development of brief and potentially life-threatening episodes of high blood pressure (hypertension) is a well-known side effect of ECT. Blood pressure can rise to very high levels during treatment, putting the patient at risk for stroke or heart attack. To evaluate the effect of intravenous nitroglycerine (NTG) on ECT-related hypertension, 33 patients, each treated with a series of 45 ECT sessions over a five-year period, were studied. Nitroglycerin works by relaxing and expanding veins and arteries so that blood can flow freely through them. The patients ranged in age from 30 to 88 years. Most were diagnosed with major depression. They were monitored by electrocardiogram (a graphic record of the heart's action), blood pressure readings, and electroencephalogram tracings (graphed electronic brain potentials) before, during, and after each treatment. To undergo ECT, the patients received general anesthesia. When pressure readings indicated a hypertensive response, one-tenth of a milligram of NTG was infused intravenously. After 60 seconds, if pressure was not reduced to pre-treatment level, an identical dose was infused. In each case, blood pressure returned to a level approximating the pre-treatment level. The only patient complaints were of brief, mild headaches. Since NTG takes less than one minute to achieve its effect and since it only acts for five to seven minutes after administration, it can be given only as needed, when pressure rises excessively. If administered by a competent anesthesiologist with routine monitoring of blood pressure, cardiac and brain activity, NTG appears to be a safe and efficient means of reducing ECT-related hypertension. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Complications and side effects, Drug therapy, Electroconvulsive therapy, Electroshock, Nitroglycerin

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Neurochemical mechanisms of chronic antisocial behavior (psychopathy): a literature review

Article Abstract:

Research has shown that neurochemicals, substances that transmit messages in the brain, may be important in causing chronic antisocial behavior, also known as psychopathy. There are two types of psychopathy. Some individuals who are considered psychopaths engage in antisocial behavior, such as violent crime, while showing little remorse for their actions and little empathy for the people they harm. These psychopaths have an abnormal deficit of emotions. Other psychopaths exhibit an abnormal excess of emotions, typically experiencing much anger, depression, anxiety, guilt, and paranoia. There is strong evidence that both forms of psychopathy result, at least in part, from abnormalities in the neurochemical serotonin. A deficiency of serotonin may exert its adverse effect by preventing psychopaths from learning from punishment; this type of learning is known as passive-avoidance learning. Research suggests that normal human beings learn to avoid punishment (such as an electric shock given after they make an error) more quickly than psychopaths. Abnormalities in serotonin metabolism may also account for the inappropriate emotions and impulsive, aggressive behavior of psychopaths, but other neurochemicals may be involved as well. The exact mechanism behind this link between serotonin and behavior is not yet understood and is thought to be complex. It is noted that other factors, such as substance abuse, may also contribute to antisocial behavior. (Consumer Summary produced by Reliance Medical Information, Inc.)

Neural transmission, Synaptic transmission, Antisocial personality disorder, Psychology, Pathological, Psychopathology, Criminal behavior, Serotonin, Criminal psychology

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