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Methods of electroconvulsive therapy augmentation
Buday, Jozef ; Anders, Martin (advisor) ; Kašpárek, Tomáš (referee) ; Dragašek, Jozef (referee)
In the theoretical part of our study, we provide a systematic review of contemporary methods (pharmacological and non-pharmacological) of ECT augmentation, as scored by three factors - manipulation of the seizure threshold, length of therapeutic seizures and the effect on ECT efficacy measured by the total number of ECT sessions and the rate/quantity of change on used objective/subjective scales. We also provide a summary of possible side effects and risks associated with the use of respective ECT augmentation methods. In the research part of our study, we explore the effect of high frequency transcranial magnetic stimulation on the respective ECT parameters, in a double blinded, placebo controlled, randomised study on a sample of 46 patients treated for a major depressive episode. During ECT titration, we registered a significantly lower seizure threshold in the experimental group, an average decrease in charge by 34.55%, from 34.23mC to 22.4mC, p< 0.001 (Wilcox test). We have not observed a significant effect of HF rTMS on the length of seizure or ECT efficacy. Our study confirms the hypothesis, that the application of HF rTMS briefly before an ECT session reduces the seizure threshold, which might be useful in certain types of patients.
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The use of coercive measures in psychiatry
Nawka, Alexander ; Raboch, Jiří (advisor) ; Vevera, Jan (referee) ; Dragašek, Jozef (referee)
Psychiatry has unique status among other medical disciplines where patients` autonomy might be restricted in the best interest of the patient in order to both cure and control the patient. Coercive measures such as seclusion, physical restraint or forced medication are widely used in clinical practice as methods for managing acute, disturbed or violent psychiatric patients. This thesis was carried out as a part of the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) in which centers from twelve European countries recruited involuntary admitted patients. The research questions of this thesis were the following: what are the socio-demographic and clinical characteristics of the patients who receive coercive measures; what types of coercive measures are used with involuntarily treated patients; what are the internal and external risk factors for their use; and finally what are the gender differences among involuntary admitted coerced patients with schizophrenia. All together we evaluated a group of 2,030 involuntarily admitted patients, in which 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. These twelve countries varied greatly in...
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