90 This may occur shortly after a seizure, or after a return to n

90 This may occur shortly after a seizure, or after a return to normal mental status. One case report by So et al demonstrated that postictal psychosis is not necessarily an “epileptic equivalent” of the limbic system.110 During an admission for epilepsy surgery, their patients, were Implanted with AP24534 molecular weight electrodes, and after nine complex partial seizures over several days, followed by a 9-hour lucid interval, psychosis appeared. Inhibitors,research,lifescience,medical Recording showed frequent bitemporal, independent, epileptiform discharges over the mesial limbic structures, but without electrographic seizures.110 Logsdail and Toon suggest criteria to distinguish postictal psychiatric disturbances and other syndromes (Table II).90 Conclusion

Delirium and epilepsy may be difficult to differentiate, and there may be considerable overlap between the two states. One imitates the other because of the commonly fluctuating level of consciousness, abnormal behaviors, and subtle motor manifestations. ASE and CPSE can be mistaken for delirium, encephalopathy, or psychiatric diseases

( Table V). 98 Seizures Inhibitors,research,lifescience,medical may present with ictal, interictal, or postictal delirium. Many of the conditions resulting in delirium may also induce seizures, including hepatic and renal failure, electrolyte Inhibitors,research,lifescience,medical and metabolic abnormalities, drug intoxications, intracranial infections, and occasionally lateralized acute cerebrovascular events. In some overtreated patients Inhibitors,research,lifescience,medical with epilepsy, there may be intoxication with anticonvulsants and delirium. Other patients may have both delirium and epilepsy Moreover, borderline states between the two have been delineated. There is an increasing understanding of the different nonconvulsive states and borderline ictal states that continue to evade diagnosis and appropriate treatment in the

absence of an EEG. Table V. Clinical examples in which the diagnosis of nonconvulsive status epilepticus (NCSE) was missed or delayed according to experience at Johns Hopkins Bayview Medical Center, Baltimore, Md. Adapted from reference 98: Kaplan PW. Inhibitors,research,lifescience,medical Behavioral manifestations of … Some broad differences, aminophylline albeit with exceptions, can be noted. Delirium typically begins more gradually and persists longer than seizures, or even NCSE. Most patients with NCSE have a prior history of seizures, but a recently delineated entity of de novo NCSE in the elderly is being increasingly recognized.111 Aside from medication or toxic screening of blood and urine, the single most helpful test is EEG, but interpretation may be problematic. At one end of the spectrum, clear electrographic epileptiform activity in a rapid waxing and waning pattern suggests seizures, but certain metabolic and particularly toxic encephalopathies may also have sharply contoured morphologies on EEG, such as triphasic waves, which may strongly resemble – or indeed be indistinguishable from- electrographic seizures.

However, in the absence of either facilitated or receptor mediate

However, in the absence of either facilitated or receptor mediated transport systems, only lipophilic molecules of less than 400Da are able to cross the BBB by simple diffusion [1]. Naked DNA molecules are not transported through this barrier [2–4]. Viruses have been used as brain DNA mTOR inhibitor drugs delivery systems with disappointing results associated with preexisting immunity, immunological response induced by viral coat proteins, and inflammation that led to demyelination [5–15]. Cationic lipids are widely used for transfection of DNA in in vitro tissue culture models. However, cationic lipid-DNA complexes in vivo are unstable or form large molecular weight aggregates that deposit

Inhibitors,research,lifescience,medical in the pulmonary Inhibitors,research,lifescience,medical vascular bed [16–18], which decreases its bioavailability for delivery to the brain. An alternative approach for DNA delivery to the central nervous system (CNS) is the “Trojan horse liposome” (THL) technology [3, 4, 19–23] (Figure 1(a)). The construction of THLs has been optimized for plasmid DNA encapsulation [19]. The encapsulation of the transgene in the interior of a liposome protects the coding DNA against degradation by ubiquitous nucleases. Any DNA not fully encapsulated in the interior of the THL is removed by treatment of the THL with a mixture of exo/endonucleases. The THL is constructed with polyethylene glycol- (PEG-) conjugated lipids, and the PEG strands on Inhibitors,research,lifescience,medical the surface

of the THL stabilizes the liposome in vivo and increases the plasma residence time [24, 25]. A small fraction of the PEG molecules, that is, 1-2%, carry a terminal maleimide functional group to allow for conjugation of the liposome surface with thiolated targeting ligands. The targeting ligand acts as a molecular Trojan horse (MTH) and is directed at an endogenous BBB receptor/transporter, Inhibitors,research,lifescience,medical such as the insulin receptor (IR) or transferrin receptor (TfR) receptor (Table 1) [3, 4, 19–23]. Widely used MTHs included peptidomimetic monoclonal antibodies (MAb) against BBB receptors. The extension

of the PEG-conjugated MAb from the surface of the THL is illustrated by electron microscopy (Figure 1(b)). The IR or TfR are also expressed Inhibitors,research,lifescience,medical Bumetanide on the plasma membrane of brain cells, which enables the THL to traverse the brain cell membrane following delivery across the BBB (Figure 1(c)). MAbs against the IR or TfR are almost always species specific, and a MAb against the mouse TfR will not recognize the TfR on human cells. Therefore, in mixed animal models such as a brain tumor model produced by the intracranial growth of a human glioma in the mouse, a combination of targeting MAbs is used, so that the THL is targeted across both the mouse BBB and the human tumor cell membrane. For example, THLs were constructed with a MAb to the mouse TfR, to target the THL complex across the mouse BBB, and with a second MAb against the human insulin receptor (HIR), to target the THL across an intracranial human U87 glioma, as illustrated in Figure 1(a) [23].

e “the right of individuals to make their own choices about how

e. “the right of individuals to make their own choices about how they should live and die” [9]. In order to understand if an implicit model of best practice in palliative care does exist, we carried out a qualitative analysis of the statements on practice and ethics of palliative care expressed by the main health VX-770 order organizations to show which dimensions of end-of-life care are taken into consideration. Methods This qualitative study aims at investigating the notion of “best palliative care practice” arising from the official documents by the most representative

health organizations Inhibitors,research,lifescience,medical committed to the definition of policies and guidelines for palliative and end-of-life care. The organizations and their documents were selected on the basis of the following three criteria: – The organization is representative (e.g. on an international or on a national level) of several associations or of professional Inhibitors,research,lifescience,medical groups involved in health care. – The organization has produced documents on ethical, physical and psycho-social issues related to end-of-life care. – The documents analysed focus on the general practice of palliative

care, pain relief and the care of dying patients in general, or deal with more specific end-of-life issues, such as euthanasia, assistance of patients in a permanent vegetative state, sedation at Inhibitors,research,lifescience,medical the end of life, and the use of nutrition and hydration, assisted suicide. The selection and analysis of the documents have been carried out in two phases: a first survey Inhibitors,research,lifescience,medical was completed in 2007; this first survey was updated in 2008 in order to find out recently published documents, as well as revisions of the documents included in the first survey. The procedure adopted for finding the documents combined two methods: – A retrieval of the Inhibitors,research,lifescience,medical directories of organizations available on the websites of the International Association for Hospice and Palliative Care (IAHPC Directory: http://www.hospicecare.com/yp/)

and of the European Association for Palliative Care (EAPC Directory: http://www.eapcnet.org/organisations/OffBodies&Ass.html), which allowed to identify several organizations that produced documents. – A document research on the web (Google search: “position statement” AND (“dying” OR “end of life care” OR “good death” OR “palliative care”)), by which it was possible to find out additional documents from a number of organizations that were not included in the directories of the IAHPC and of the EAPC. The documents mafosfamide were classified as: a) Documents of palliative care institutions, or other medical or health institutions; b) Documents on end-of-life/terminality in general, or on a specific situation/need/symptom of end-of-life; c) Documents classifying themselves as “position statement” (in the title), or “others”. The documents were analysed through a framework of the components of end-of-life care which was developed on the basis of a literature search in a previous work [33].

Clinical signs, in vivo confocal

microscopy, and conjunct

Clinical signs, in vivo confocal

microscopy, and conjunctival impression cytology were performed to assess the safety profile of the different cationic emulsions with BAK or CKC as the cationic agent. This study demonstrated that cationic emulsions using BAK or CKC as the cationic agent were very well tolerated while the tested 0.02% BAK solution was responsible for corneal epithelial cell death related to the proinflammatory and proapoptotic activity of BAK. 4.1.2. Safety of Novasorb Loaded with Active Ingredients The safety profile of the Novasorb used as a vehicle for lipophilic drugs such as cyclosporine (Vekacia/Cyclokat) and latanoprost (Catioprost) was ALK inhibitor evaluated in Inhibitors,research,lifescience,medical animal models [56]. These studies demonstrated that neither Inhibitors,research,lifescience,medical of the two active ingredients (CsA or latanoprost) has an impact on the safety profile of the cationic emulsions as both drug-loaded cationic emulsions were as well tolerated as the cationic emulsion vehicle (Figure 3). For example, in the acute toxicity rabbit model, repeated instillations of Cyclokat/Vekacia Inhibitors,research,lifescience,medical (CsA-containing

0.05 and 0.1% CsA cationic emulsions) were as well tolerated as Restasis (0.05% CsA anionic emulsion), and Catioprost (preservative-free latanoprost 0.005% cationic emulsion) was better tolerated than the 0.02% BAK-preserved Xalatan. Local tolerance studies in the rabbit confirmed that chronic instillations (4–6 times daily over 28 days) with Cyclokat/Vekacia and twice daily for Catioprost were well tolerated by the rabbit eyes. Figure 3 In vivo confocal microscopy score of rabbit ocular surface following repeated instillations with Novasorb cationic emulsion of latanoprost. IVCM images of rabbit ocular surface and conjunctiva associated lymphoid Inhibitors,research,lifescience,medical tissue (CALT) were used to assess the … All the previous in vivo Inhibitors,research,lifescience,medical data were obtained in rabbits with a healthy ocular surface. However, it was of interest to

also assess the effect of Catioprost on damaged corneas to more closely mimic the clinical situation experienced when elderly patients are started on glaucoma therapy. For that purpose, a rat model of debrided cornea was used to assess the effect of Catioprost, its emulsion vehicle, and Xalatan (the commercially available product of latanoprost) on the ocular surface healing process. The in Phosphatidylinositol diacylglycerol-lyase vivo data demonstrated that Xalatan delayed corneal healing, while both Catioprost and its cationic emulsion vehicle (without latanoprost) promoted healing of the ocular surface and restored the function of the injured epithelium, thus confirming the better safety profile of the Novasorb cationic emulsions and confirming that Novasorb could hasten the repair of ocular surface damage. Novasorb was hence shown to be safe, but prior to human testing several other studies were necessary to fulfill the various European and American guidelines.

Problems in male factor fertility may be due to changes in semen

Problems in male factor fertility may be due to changes in semen quality as assessed by the semen analysis. The most significant of these are a low sperm concentration (oligospermia), poor sperm motility (asthenospermia), and abnormal sperm morphology (teratospermia). Other factors less well associated with infertility include semen volume and other seminal markers of epididymal, prostatic, and seminal vesicle function. As men age, these variables are impacted and correlate with decreased fertility. Sperm Concentration In 1969, Sasano and Ichijo first described the decrease Inhibitors,research,lifescience,medical in sperm concentration

as men age. They reported that 90% of seminiferous tubules in men in their 20s and 30s signaling pathway contained spermatids, whereas men in their 40s and 50s had

spermatids in 50% of their seminiferous tubules. Only 10% of seminiferous tubules from men aged > 80 years contained spermatids.17 However, recent publications indicate that, of all the sperm parameters, Inhibitors,research,lifescience,medical changes in sperm concentration with advancing male age are the least consistent.18–20 There are studies that report a decrease in sperm concentration of up to 3.3% per year of age,21 but other data report no change in sperm concentration up to age 50.22 Some have even suggested increases in sperm concentrations with age. A study of 20,411 men found a statistically significant increase in concentration of 0.7% per year of Inhibitors,research,lifescience,medical age. This amounts to an increase in concentration of 14% over a 20-year period.23 Inhibitors,research,lifescience,medical In a study of 1283 men who cryobanked sperm

prior to vasectomy, sperm concentrations were found to be lower at both extremes of age as compared with men aged 26 to 45 years.24 Motility In contrast to concentration, evidence consistently indicates that sperm motility decreases with advancing age. Studies that adjusted for duration of abstinence revealed statistically significant decreases in motility of 0.17% to 0.6% decrease per year of age21,24 Inhibitors,research,lifescience,medical resulting in a 3% to 12% decline in motility over 20 years. More recently, Sloter and colleagues used Adenosine computer-assisted semen analysis in a population of 90 men aged 22 to 80 years with no history of infertility. Motility decreased 0.8% per year of age and linear motion decreased 0.2% per year.25 Because motility is acquired during sperm transit through the prostate and the epididymis, the decrease in motility is suspected to be due to age-related decline in the function of these posttesticular glands.12 Age-dependent alterations of the epididymis may also cause alterations in sperm mitochondrial functioning, which is paramount for sperm motility.26 Morphology Similar to motility, morphology appears to decrease with advancing male age. Studies indicate declines in normal sperm morphology of 0.2% to 0.9% per year of age, resulting in a 4% to 18% decrease in normal morphology over a 20-year period.

We address the following questions: (i) What is the frequency of

We address the following questions: (i) What is the frequency of each disorder when the other is present? (ii) Is the level of co-occurrence elevated? That is, is the prevalence of BPD significantly higher in patients with bipolar disorder than in other psychiatric disorders? (iii) Is BPD the most common personality disorder in bipolar patients or are other personality disorders Inhibitors,research,lifescience,medical more frequent? Methodological issues in personality disorder assessment Any review of

a topic involving personality disorders needs to consider assessment methodology, because assessment issues can have a significant impact on the findings. In short, there should be some consideration of the who, what, and when of personality disorder assessment.To be sure, these are also issues in the evaluation of Axis I disorders, though they have not been studied as much as they have been studied in the personality Inhibitors,research,lifescience,medical disorder field. Who should be questioned when assessing personality disorders-the target individual or someone who knows the target individual well? The evaluation

of personality disorders presents special problems that may require the use of informants. In contrast to the symptoms of major Axis I disorders, the defining features of personality disorders are based on an extended longitudinal perspective of how individuals act in different situations, how they Inhibitors,research,lifescience,medical perceive and

interact with a constantly changing environment, and the perceived reasonableness of their behaviors and cognitions. Only a minority of the personality disorder criteria are discrete, easily enumerated behaviors. For any individual to describe their normal personality they Inhibitors,research,lifescience,medical must be somewhat introspective and aware of the effect their attitudes and behaviors Inhibitors,research,lifescience,medical have on others. But insight is the very thing usually lacking in individuals with a personality disorder. DSM-IV notes that the characteristics defining a personality disorder may not be considered problematic by the affected individual (ie, ego-syntonic) and suggests that information be obtained from informants. VE-822 cost Research comparing patient and informant report of personality pathology has found marked disagreement between the two sources of information.36-39 Only one of the all studies examining the frequency of personality disorders in patients with bipolar disorder examined the impact of informant assessment on the rates of personality disorder diagnoses.40 Peselow et al40 presented personality disorder rates based on independent patient and informant interviews, and we have included in Table I the results based on the patient information in order to be consistent with other studies. Table I Methods of studies of the frequency of borderline personality disorder in individuals with bipolar disorder.

25, which could be attributed to acidic pH A solution of 1% w/v

25, which could be attributed to acidic pH. A solution of 1% w/v CaCl2 was found to be strongly irritant whereas OCM-CS NPs showed no irritation. It is likely that the amount of CaCl2 in OCM-CSNPs was insufficient to produce an irritant effect. Another possible explanation could be that CaCl2 molecules are involved in interaction and bound to polymer and not present in free

form, which is likely to reduce their interaction Inhibitors,research,lifescience,medical with the ocular surface. Figure 15 Cumulative HET-CAM scores of controls and test formulations. Values are expressed as mean ± standard deviation, n = 5. Abbreviations: HET-CAM, hen’s egg test chorioallantoic membrane, NaCl, sodium chloride; SDS, sodium dodecyl sulphate; CaCl2 … 3.18. Therapeutic Efficacy Studies in Rabbits The values of the reduction in IOP (mm of Hg) in normotensive albino rabbits after instillation of a 50μL Inhibitors,research,lifescience,medical dose of each NPs formulation as a function of time were Lapatinib compared to marketed formulation [45]. It was observed that

the IOP lowering activity of marketed formulation reached to maximum value of 2.87mm of Hg within 2hr after instillation. This effect markedly decreased and abolished completely within 4h whereas NPs formulation Inhibitors,research,lifescience,medical produced a significant sustained reduction in IOP. DRZ loaded OCM-CSNPs showed pharmacological effect that was sustained up to 8h. The peak effect was observed at the 4th hour with reduction of IOP value by 2.19mm of Hg, which was less than marketed formulation owing to slow release of drug from NPs compared to marketed formulation, whereas DRZ loaded CSNPs showed pharmacological effect, which was sustained up to Inhibitors,research,lifescience,medical 6h. The peak effect was observed at the third hour with reduction of IOP value by 1.91mm of Hg. As shown in Figure 16, developed OCM-CSNPs and CSNPs formulations showed statistically significant response when compared

to the control group. Marketed formulation being solution showed pulse effect due to immediate availability of drug in large concentration. In case Inhibitors,research,lifescience,medical of NPs, drug was embedded/crosslinked in polymer matrix; large concentration of drug was not available immediately to produce the pulse effect. The prolonged duration of action was due to increased mucoadhesion of OCM-CS that interact with mucin effectively compared to CS. The mucoadhesion many phenomenon is independent of tear turnover rate and depends on the mucus turnover rate that is generally more than 15h. Figure 16 (a) Comparative therapeutic efficacy study of the DRZ loaded OCM-CSNPs, CSNPs, marketed formulation and control. (b) Application of ANOVA to efficacy data. Values are expressed as mean ± standard deviation, n = 3. Abbreviations: DRZ, dorzolamide … Hence, developed formulation of DRZ loaded OCM-CSNPs and CSNPs was found to be effective in lowering the IOP of eye when compared to marketed formulation. Thus, OCM-CSNPs showed better efficacy than CSNPs, which was attributed to better mucoadhesion of OCM-CS. 4. Conclusion In this study, OCM-CS was successfully synthesized from CS and characterized.

It remains to be determined whether the cellular pathology is the

It remains to be determined whether the cellular pathology is the reason for, or the consequence of, depression. Functional implications of glial abnormalities in depression The glial cells analyzed in the above studies do not represent a homogeneous population of cells. Glial cells are composed of distinct populations of oligodendrocytes, microglia, and astrocytes. The Inhibitors,research,lifescience,medical crucial role of glial cell types in brain function is currently being reevaluated.

In addition to their traditional roles in neuronal migration (radial glia), myelin formation (oligodendrocytes), and inflammatory processes (astrocytes and microglia), glia (predominantly astrocytes) are now thought to provide trophic support to neurons, neuronal metabolism, and the formation of synapses and neurotransmission.15 The three distinct glial cell types cannot be identified in the previously mentioned studies as those tissues were Inhibitors,research,lifescience,medical stained for Nissl substance and such staining does not distinguish reliably between types of glial cells. Nissl staining only reveals morphological features of glial cell bodies and not glial cell processes. On the other hand, recent irnmunohistochemical examination of glial fibrillary acidic protein (GFAP), a marker of reactive astroglia, in Inhibitors,research,lifescience,medical the dorsolateral prefrontal cortex implicates

astrocytes in the overall glial pathology in MDD.68 buy Dolutegravir Although no significant group differences in the packing density of GFAP-reactive astrocytes are present Inhibitors,research,lifescience,medical in this study, there is a significant correlation between age and GFAP immunoreactivity among subjects with MDD, when the entire group of MDD (young and old) is compared with normal controls. A significant reduction in the population of reactive astroglia is found in a small subgroup of young (30 to 45 years old)

subjects with MDD, as compared to young control subjects and older (46 to 86 years old) subjects with MDD (Figures 3A and 3B). This subgroup of younger adults with MDD also had a shorter duration of depression and most of these subjects were suicide victims. Recent observations from our laboratory Inhibitors,research,lifescience,medical confirm that the levels of GFAP protein are also reduced in these new young adults with MDD as compared to age-matched control subjects (Figures 3C and 3D), and that GFAP levels are positively correlated with age at the time of death and with the age of onset of depression.69 Thus, the involvement of GFAP expression in early- versus late-life depression differs because the underlying pathophysiology in early-life depression is different from that in late-life depression. Clinical evidence confirms that late-onset depression (first depressive episode when older than 50 years) differs from early-onset depression by its etiology, phenomenology, and cerebrovascular pathology.70-72 Figure 3. An illustration of the pathology of glial cells found in the dorsolateral prefrontal cortex in MDD.


However, we did not observe a relationship between reported alcohol misuse and HIV screening uptake; reported sexual risk for HIV and HIV screening uptake; and HIV screening uptake and an intersection of sexual risk for HIV (sex while intoxicated, regret ever having had sex while intoxicated and unsure if ever had sex while

intoxicated) and alcohol misuse. There were some initial suggestions of a relationship between HIV screening uptake and the intersection of sexual risk for HIV and alcohol misuse, but demographic characteristics superseded this relationship. These results raise questions as to why some relationships were found and not others. We observed a disconnection between sexual risk behaviors, alcohol misuse and Inhibitors,research,lifescience,medical HIV screening uptake. This finding suggests that participants in our study were unable to make crucial connections between their alcohol misuse and their sexual risk behaviors and translate this connection into a need for HIV testing. Based upon these results, we believe there is a need to reevaluate current alcohol misuse and HIV prevention and screening efforts Inhibitors,research,lifescience,medical that are being utilized in EDs. This disconnection among self-perceived, reported and actual Inhibitors,research,lifescience,medical risk and uptake of HIV screening has been observed in other studies [51,64,70,86-89]. For example, in a

cross-sectional study conducted by MacKeller et al. in six US cities, 5,649 male participants who have sex with men were interviewed, were provided HIV sexual risk counseling and were offered HIV screening [90]. Of these participants, 77% of those that tested positive for HIV were unaware they were infected, 59% perceived themselves as low-risk for being Inhibitors,research,lifescience,medical infected with HIV and 44% perceived themselves as low-risk for ever becoming infected. The need for effective interventions for the co-occurring problems of alcohol misuse and sexual risk for HIV in the ED is strongly suggested given the high-risk alcohol consumption and sexually risky behaviors reported by

those in this study. A number of studies have demonstrated support Inhibitors,research,lifescience,medical for brief alcohol interventions in the ED [85,91]. However, we know of no published research examining sexual risk reduction interventions among ED patients. Furthermore, we know of no published research examining if a combination of brief alcohol interventions and HIV risk during interventions is effective within this population in reducing sexual risk and increasing uptake of HIV screening. Support for this approach has been voiced by researchers in non-ED settings. Volkow et al. advocate that integrating substance abuse treatment into HIV prevention may improve public health outcomes (e.g. Buparlisib decreasing HIV incidence) and aid in reducing HIV transmission among injection and non-injection substance users [92]. In a randomized trial by Kalichman et al., 313 participants were randomly assigned to a three-hour HIV-alcohol risk-reduction skills intervention or a single one-hour HIV-alcohol education control group [93].

(91% had local protocols) Placement (more than one answer allowed

(91% had local protocols) Placement (more than one answer allowed): 55% BL (25% BL only) 2% BF 40% RUL 2% RFT 2% not described Mainly UL first, then change to BL France (L) Benadhira R (Benadhira and Teles 2001) Study: Questionnaire survey to all 815 French Psychiatric Public Hospital services N= 391 (response rate 48%) 51% of, responded hospitals administered ECT Period: 1996–1997 Time span: One year Diagnoses: 63% medication resistant depression 18% schizophrenia 10% mania Gender and age: not reported Other: Only half of all hospitals Inhibitors,research,lifescience,medical in France administer ECT No rate/prevalence data Modified Anesthesia: 65% Propofol 24% Thiopenthal Device: 55% Thymatron DG/Mecta SRI 44%Lapipe et Rondepierre Type:

brief pulse and sine wave Placement: 18% UL Denmark (L) Andersson JE (Andersson and Bolwig 2002) Study: Questionnaire survey to hospitals in Denmark, Greenland, and Faroe Islands N= Inhibitors,research,lifescience,medical 35 clinics, (100% response) All provided ECT N= 1556 patients received ECT Period: 1999 Time span: One year Diagnostic

Proteasomal inhibitors indication from 35 units (%): 35 (100%) depression 28 (80%) delirium 22 (63%) mania 12 (34%) schizophrenia 5 (14%) other Training: Provided by 49% (17 of 35) institutions. Psychiatrist administering ECT. In most institutions, junior doctors performed ECT. TPR: 3.0 iP: 5% (1.8–10.0%) AvE: Inhibitors,research,lifescience,medical 9 (range 6–18) Anesthesia, 33 units (%): 28 (85%) Barbiturate 3 (9%) propofol 2 (6%) unknown Devices and Type: Thymatron or Mecta (brief-pulse wave) one Siemens konvulsator

device (sine wave) Denmark Inhibitors,research,lifescience,medical (L) Sundhedsstyrelsen (Sundhedsstyrelsen 2011a) Study: National register data, 2000–2007 N= 17 psychiatric units, hospitals No. of ECT-treated patients/ECT administrations per year: 260/2336 (2000) 313/3237 (2001) 460/4686 (2002) 1399/15,174 (2003) 1563/16,606 (2004) 1786/19,173 (2005) 1774/19,389 (2006) 1772/19,127 (2007) Main indication: Elderly depressed patients Side effects: No. of deaths 24 h after ECT in study period = 6 and evaluated as not ECT-related Conditions: Prevalence of involuntary ECT treated patients (supplementary ECT data from same online source (http://www.sst.dk) Inhibitors,research,lifescience,medical in Use of coercion in Mental Health Care, 2009 (Sundhedsstyrelsen 2011b): 2.8%[722/25,199] (2002) AvE per year: 11.1 (2000) 9.2 (2001) 9.8 (2002) 9.2 (2003) 9.5 (2004) 9.3 (2005) 9.1 (2006) 9.2 (2007) No information Period: 2000–2007 Time span: Seven years during 2.6%[667/25,291] (2003) 2.8%[714/24,872] (2004) 2.9%[734/24,501] (2005) 3.1%[765/24,308] (2006) 3.1%[736/24,129] (2007) 3.3%[821/24,311] (2008) 3.2%[848/26,014] (2009) Guidelines: Not all institutions followed all instructions, developed by Sunhedsstyrelsen guidelines no. 9001, 20 November 2000. Other: High increase in no. of ECT-treated patients from 2000 to 2007. Norway (L) Schweder, LJ (Schweder et al. 2011a) Study: Questionnaire survey to psychiatric hospitals, mental health care community centers, including child and adolescent psychiatry about ECT practice.