Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients

Pichai Ittasakul,1 Apichaya Likitnukul,1 Umporn Pitidhrammabhorn,1 Punjaporn Waleeprakhon,1 Morris B Goldman2 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine,...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Ittasakul P, Likitnukul A, Pitidhammabhorn U, Waleeprakhon P, Goldman MB
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	ECT dosing Thai patients dose titration age-based methods Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/acf97a93d82249a5b3354d8f323acc28
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:acf97a93d82249a5b3354d8f323acc28
record_format	dspace
spelling	oai:doaj.org-article:acf97a93d82249a5b3354d8f323acc282021-12-02T02:20:20ZStimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients1178-2021https://doaj.org/article/acf97a93d82249a5b3354d8f323acc282019-02-01T00:00:00Zhttps://www.dovepress.com/stimulus-intensity-determined-by-dose-titration-versus-age-based-metho-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Pichai Ittasakul,1 Apichaya Likitnukul,1 Umporn Pitidhrammabhorn,1 Punjaporn Waleeprakhon,1 Morris B Goldman2 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Objectives: This study aimed to compare the accuracy of the stimulus intensity (SI) calculated by age-based methods with that using the dose-titration method. Methods: The initial seizure threshold (IST) was determined using a standardized dose titration in hospitalized Thai patients treated with right unilateral (RUL, n=32) and bilateral (BL, n=57) electrode placement. The correlation between the IST and clinical variables was analyzed. The estimated SI based on the patient’s age was compared with the SI determined by dose titration. Results: Age was highly predictive of the IST for both groups (RUL, P=0.012; BL, P=0.045). Gender (P=0.006) and anticholinergic drug use (P=0.025) predicted the IST for the BL group. For the RUL group, the mean±SD (median) SI estimated using the half-age and age methods was 158±46 (169) mC and 315±92 (338) mC, respectively. The SI determined using the dose-titration method was higher compared with the half-age method and lower compared with the age method. For the RUL group, 31% of subjects using the half-age method and 22% of subjects using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 19% of subjects using the half-age method and 19% using the age method would have received unacceptably low (<50%) or high (>200%) intensities. For the BL group, 18% of subjects using the half-age method and 32% using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 39% with the half-age method and 18% with the age method would have received an unacceptably low or high SI, respectively. Conclusion: Age strongly predicts the IST, but it does not robustly predict the SI compared with dose titration because the SI calculated using age-based methods results in an unacceptably low or high SI that is associated with a marked risk of adverse effects or inadequate response. We recommend the dose-titration method to determine the SI. Keywords: electroconvulsive therapy, dosing, Thai patients, dose titration, age-based methods, seizure threshold, predictorsIttasakul PLikitnukul APitidhammabhorn UWaleeprakhon PGoldman MBDove Medical PressarticleECTdosingThai patientsdose titrationage-based methodsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 15, Pp 429-434 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	ECT dosing Thai patients dose titration age-based methods Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	ECT dosing Thai patients dose titration age-based methods Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Ittasakul P Likitnukul A Pitidhammabhorn U Waleeprakhon P Goldman MB Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
description	Pichai Ittasakul,1 Apichaya Likitnukul,1 Umporn Pitidhrammabhorn,1 Punjaporn Waleeprakhon,1 Morris B Goldman2 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Objectives: This study aimed to compare the accuracy of the stimulus intensity (SI) calculated by age-based methods with that using the dose-titration method. Methods: The initial seizure threshold (IST) was determined using a standardized dose titration in hospitalized Thai patients treated with right unilateral (RUL, n=32) and bilateral (BL, n=57) electrode placement. The correlation between the IST and clinical variables was analyzed. The estimated SI based on the patient’s age was compared with the SI determined by dose titration. Results: Age was highly predictive of the IST for both groups (RUL, P=0.012; BL, P=0.045). Gender (P=0.006) and anticholinergic drug use (P=0.025) predicted the IST for the BL group. For the RUL group, the mean±SD (median) SI estimated using the half-age and age methods was 158±46 (169) mC and 315±92 (338) mC, respectively. The SI determined using the dose-titration method was higher compared with the half-age method and lower compared with the age method. For the RUL group, 31% of subjects using the half-age method and 22% of subjects using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 19% of subjects using the half-age method and 19% using the age method would have received unacceptably low (<50%) or high (>200%) intensities. For the BL group, 18% of subjects using the half-age method and 32% using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 39% with the half-age method and 18% with the age method would have received an unacceptably low or high SI, respectively. Conclusion: Age strongly predicts the IST, but it does not robustly predict the SI compared with dose titration because the SI calculated using age-based methods results in an unacceptably low or high SI that is associated with a marked risk of adverse effects or inadequate response. We recommend the dose-titration method to determine the SI. Keywords: electroconvulsive therapy, dosing, Thai patients, dose titration, age-based methods, seizure threshold, predictors
format	article
author	Ittasakul P Likitnukul A Pitidhammabhorn U Waleeprakhon P Goldman MB
author_facet	Ittasakul P Likitnukul A Pitidhammabhorn U Waleeprakhon P Goldman MB
author_sort	Ittasakul P
title	Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
title_short	Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
title_full	Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
title_fullStr	Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
title_full_unstemmed	Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients
title_sort	stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in thai patients
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/acf97a93d82249a5b3354d8f323acc28
work_keys_str_mv	AT ittasakulp stimulusintensitydeterminedbydosetitrationversusagebasedmethodsinelectroconvulsivetherapyinthaipatients AT likitnukula stimulusintensitydeterminedbydosetitrationversusagebasedmethodsinelectroconvulsivetherapyinthaipatients AT pitidhammabhornu stimulusintensitydeterminedbydosetitrationversusagebasedmethodsinelectroconvulsivetherapyinthaipatients AT waleeprakhonp stimulusintensitydeterminedbydosetitrationversusagebasedmethodsinelectroconvulsivetherapyinthaipatients AT goldmanmb stimulusintensitydeterminedbydosetitrationversusagebasedmethodsinelectroconvulsivetherapyinthaipatients
_version_	1718402548394622976

Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients

Ejemplares similares