Little John D, Munday Jo, Atkins Martin
Grampians Psychiatric Services, Ballarat, Victoria, Australia.
J ECT. 2003 Sep;19(3):158-63. doi: 10.1097/00124509-200309000-00008.
To date, right unilateral electroconvulsive therapy administered at 6x seizure threshold (6x RUL-ECT) has been described in relation to unipolar depression alone. For clinicians who have developed an experience and confidence in bilateral ECT, the effectiveness of 6x RUL-ECT in other psychiatric disorders, particularly those who are severely ill, has remained untested and therefore unknown. This article describes the results of 6x RUL-ECT in a select series of patients with a nondepressive psychotic illness.
Six patients with psychotic disorders of nondepressive origin were selected from a recent 2-year retrospective review of 6x RUL-ECT practice. The clinical presentation, ECT parameters, and responses were recorded.
Four patients with severe psychotic disorders, two of whom met broad criteria for catatonia, responded to an index course of 6x RUL-ECT. One psychogeriatric patient who had protracted inpatient mania continues to benefit from outpatient maintenance 6x RUL-ECT over 18 months. Two elderly males, in whom seizures were difficult to elicit and maintain, responded poorly.
6x RUL-ECT was effective in 4 patients with nondepressive, psychotic disorders. While clinically viable and although memory was not assessed, it is uncertain what advantage 6x RUL-ECT confers over a bilateral electrode placement. The real focus should remain on clinical responsivity.
迄今为止，仅针对单相抑郁症描述了以6倍癫痫阈值进行的右侧单侧电休克治疗（6x RUL-ECT）。对于已在双侧电休克治疗方面积累了经验并建立起信心的临床医生而言，6x RUL-ECT在其他精神疾病，尤其是重症患者中的有效性尚未得到检验，因此尚不清楚。本文描述了6x RUL-ECT在一系列特定的非抑郁性精神病患者中的治疗结果。
从最近对6x RUL-ECT治疗实践的2年回顾性研究中选取了6例非抑郁性起源的精神病患者。记录其临床表现、电休克治疗参数及反应。
4例重症精神病患者对6x RUL-ECT的一个疗程有反应，其中2例符合紧张症的广泛标准。1例患有持续性住院性躁狂症的老年精神病患者在18个月的门诊维持性6x RUL-ECT治疗中持续受益。2例老年男性患者难以诱发和维持癫痫发作，反应较差。
6x RUL-ECT对4例非抑郁性精神病患者有效。虽然在临床上可行，且未评估记忆情况，但尚不确定6x RUL-ECT相对于双侧电极放置有何优势。真正的重点应仍放在临床反应性上。
