426
CORRESPONDENCE
HONIGELD,G. & PATIN,J. (1990) A two-year clinical and economic follow-up of patients on clozapine. Hospital and Community
on injection of methohexitone during anaesthesia for electro
convulsivetherapy.Anaesthesia,44,688—689.
Psychiatry, 41,882—885. MELTZER, H. Y., Buiu'irrr,
S., BASTANI,B., et al (1990) Effects of
six months of clozapine treatment on the quality of life of schizophrenic patients. Hospital and Community Psychiatry, 41, 892—897. MICHAEL PHELAN
K. H. SIMPSON
Departmentof Anaesthesia St James'sUniversityHospital BeckettStreet LeedsLS9 7TF
Institute of Psychiatry
De CrespignyPark LondonSES8AZ GERALDINE STRATHDEE
Out-patient ECT for depressionin a manwith moderate learning disability
KAa@ JONES There is little written on the place of ECT in the Maudsley Hospital
treatment of mental illness in those with learning
DenmarkHill LondonSE58AZ
disabilities (Lazarus et al, 1990). We would like to
report the caseof a 69-year-old man with moderate learningdisability(IQ of 40).
ECT anaesthetics SIR: I read with interest the audit of ECT in two NHS regions by Pippard (Journal, May 1992,160, 621—638) which was a fascinating follow-up to his earlier work. As an anaesthetistwith responsibility for provision of anaesthesia to an ECT treatment unit, I would like to commenton onesmall point. Dr Pippard statesquitecorrectly that the useof propofol is probably
contraindicated
for ECT, because it
Casereport.Mr X presentedwith a six-weekhistory of weepiness, lethargy, social withdrawal, weight loss, and
poorsleepfollowingan uneventfulinguinalherniarepair. On examination he looked sad and described his mood as
such.Hespokein monosyllables andcomplainedof aches andpainsinhisfeet(forwhichnoorganiccausewasfound). He had a past history of depression, following a previous
inguinal hernia repair at age61 years,which respondedto
tricyclic antidepressants. Otherwisehe had alwaysbeen in good health. A diagnosis of depression was made.
Dothiepin,50mgdaily,wasstarted,increasingto 150mg reducesseizureduration. Therefore methohexitone daily. However,he becamemore agitated and distressed. remainstheagentofchoice, particularly in viewof its Hewaspreoccupied withbeingunabletoswallow, believed hehad no throat and atevery little. He lost over 13kg (two proconvulsant potential. Unfortunately, the injec tion of methohexitoneis often painful, and repeated stones) in weight. His self-care skills deteriorated and he anaesthesiawith this agent can be distressing for becamedoubly incontinent.The dothiepinwas discon some patients. Dr Pippard stated that the use of tinued after two monthsand replacedwith fluoxetine, 10mg lignocainewith anaestheticinduction agentsis 20mgdaily, increasingto 40mgdaily with no improvement afteronemonth.At thisstagehispermissionto commence not recommendedbecauseof the potential anticon ECTwassoughtandgiven.Hereceived11bilateraltreat vulsant activity of this local anaesthetic.The useof ments.After the first treatment a marked improvement in lignocaine to modify the pain of injection of metho his appetite was noted with a reduction in his agitation. hexitoneduring anaesthesiafor electroconvulsive This continued to improve, as did his sleep; his bodily pre therapy has beenstudied (Simpsonet al, 1989).We occupationsand delusionsthen faded,followed lastly by a showed that pain on injection of methohexitone reduction of his social withdrawal. Three months later he is self' and is on fluoxetine, 40mg occurred in nearly half of the patients, and in a consideredto be his ‘¿old quarter of them pain was reported as moderate or daily. severe.The useof 10mg lignocaine before or mixed This caseaddsto the small literature on the useof with the methohexitone reduced this significantly. We measured seizure duration using an isolated ECT in those with learning disability and mental arm technique and demonstrated that the use of illness. The majority of the casesdescribed are, as is 10mg lignocaine did not significantly affect seizure this one, of major depression. Goldstein & Jensvold's duration. In view of thesefindings I would urge that (1989)casebearsparticularsimilaritiesin that their patient's depressionwasseeminglyprecipitated by a lignocainecontinue to beusedroutinely wheninject ing methohexitone into a vein on the dorsum of the surgicalprocedure.Kearns(1987)describeda caseof hand, particularly when patients are to undergo a man with learning disabilities with Cotard's syn drome who respondedto ECT. In the present case repeatedanaesthesia. the patient similarly denied the existenceof part of his body (his throat). Our patient had ECT asan out SIMPSON,K. H., HALSALL,P. J., SIDES, C. A., et a! (1989) Pain on patient. Lazaruset al(1990) advocatethe useof this, injection of methohexitone. The use of lignocaine to modify pain
CORRESPONDENCE
HONIGELD,G. & PATIN,J. (1990) A two-year clinical and economic follow-up of patients on clozapine. Hospital and Community
on injection of methohexitone during anaesthesia for electro
convulsivetherapy.Anaesthesia,44,688—689.
Psychiatry, 41,882—885. MELTZER, H. Y., Buiu'irrr,
S., BASTANI,B., et al (1990) Effects of
six months of clozapine treatment on the quality of life of schizophrenic patients. Hospital and Community Psychiatry, 41, 892—897. MICHAEL PHELAN
K. H. SIMPSON
Departmentof Anaesthesia St James'sUniversityHospital BeckettStreet LeedsLS9 7TF
Institute of Psychiatry
De CrespignyPark LondonSES8AZ GERALDINE STRATHDEE
Out-patient ECT for depressionin a manwith moderate learning disability
KAa@ JONES There is little written on the place of ECT in the Maudsley Hospital
treatment of mental illness in those with learning
DenmarkHill LondonSE58AZ
disabilities (Lazarus et al, 1990). We would like to
report the caseof a 69-year-old man with moderate learningdisability(IQ of 40).
ECT anaesthetics SIR: I read with interest the audit of ECT in two NHS regions by Pippard (Journal, May 1992,160, 621—638) which was a fascinating follow-up to his earlier work. As an anaesthetistwith responsibility for provision of anaesthesia to an ECT treatment unit, I would like to commenton onesmall point. Dr Pippard statesquitecorrectly that the useof propofol is probably
contraindicated
for ECT, because it
Casereport.Mr X presentedwith a six-weekhistory of weepiness, lethargy, social withdrawal, weight loss, and
poorsleepfollowingan uneventfulinguinalherniarepair. On examination he looked sad and described his mood as
such.Hespokein monosyllables andcomplainedof aches andpainsinhisfeet(forwhichnoorganiccausewasfound). He had a past history of depression, following a previous
inguinal hernia repair at age61 years,which respondedto
tricyclic antidepressants. Otherwisehe had alwaysbeen in good health. A diagnosis of depression was made.
Dothiepin,50mgdaily,wasstarted,increasingto 150mg reducesseizureduration. Therefore methohexitone daily. However,he becamemore agitated and distressed. remainstheagentofchoice, particularly in viewof its Hewaspreoccupied withbeingunabletoswallow, believed hehad no throat and atevery little. He lost over 13kg (two proconvulsant potential. Unfortunately, the injec tion of methohexitoneis often painful, and repeated stones) in weight. His self-care skills deteriorated and he anaesthesiawith this agent can be distressing for becamedoubly incontinent.The dothiepinwas discon some patients. Dr Pippard stated that the use of tinued after two monthsand replacedwith fluoxetine, 10mg lignocainewith anaestheticinduction agentsis 20mgdaily, increasingto 40mgdaily with no improvement afteronemonth.At thisstagehispermissionto commence not recommendedbecauseof the potential anticon ECTwassoughtandgiven.Hereceived11bilateraltreat vulsant activity of this local anaesthetic.The useof ments.After the first treatment a marked improvement in lignocaine to modify the pain of injection of metho his appetite was noted with a reduction in his agitation. hexitoneduring anaesthesiafor electroconvulsive This continued to improve, as did his sleep; his bodily pre therapy has beenstudied (Simpsonet al, 1989).We occupationsand delusionsthen faded,followed lastly by a showed that pain on injection of methohexitone reduction of his social withdrawal. Three months later he is self' and is on fluoxetine, 40mg occurred in nearly half of the patients, and in a consideredto be his ‘¿old quarter of them pain was reported as moderate or daily. severe.The useof 10mg lignocaine before or mixed This caseaddsto the small literature on the useof with the methohexitone reduced this significantly. We measured seizure duration using an isolated ECT in those with learning disability and mental arm technique and demonstrated that the use of illness. The majority of the casesdescribed are, as is 10mg lignocaine did not significantly affect seizure this one, of major depression. Goldstein & Jensvold's duration. In view of thesefindings I would urge that (1989)casebearsparticularsimilaritiesin that their patient's depressionwasseeminglyprecipitated by a lignocainecontinue to beusedroutinely wheninject ing methohexitone into a vein on the dorsum of the surgicalprocedure.Kearns(1987)describeda caseof hand, particularly when patients are to undergo a man with learning disabilities with Cotard's syn drome who respondedto ECT. In the present case repeatedanaesthesia. the patient similarly denied the existenceof part of his body (his throat). Our patient had ECT asan out SIMPSON,K. H., HALSALL,P. J., SIDES, C. A., et a! (1989) Pain on patient. Lazaruset al(1990) advocatethe useof this, injection of methohexitone. The use of lignocaine to modify pain
