Publications by authors named "Shane Gill"

22 Publications

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Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial.

Brain Stimul 2021 Sep-Oct;14(5):1095-1105. Epub 2021 Jul 29.

Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia.

Introduction: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established.

Methods: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4.

Results: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p = 0.680).

Conclusion: This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub- and supra-threshold accelerated bilateral TBS.
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http://dx.doi.org/10.1016/j.brs.2021.07.018DOI Listing
November 2021

The place of non-invasive brain stimulation in the RANZCP clinical practice guidelines for mood disorders.

Aust N Z J Psychiatry 2021 04;55(4):349-354

Psychiatry, University of NSW and Black Dog Institute, Sydney, NSW, Australia.

Clinical practice guidelines are important documents as they have the capacity to significantly influence and shape clinical practice in important areas of therapeutics. As such, they need to be developed informed by comprehensive and quality-based systematic reviews, involve consensus deliberations representative of the appropriate experts in the field and be subject to thorough critical review. A revised clinical practice guideline for the management of patients with mood disorders was recently published under the auspices of the Royal Australian and New Zealand College of Psychiatrists. However, this clinical practice guideline was not developed in a manner that reflects the appropriate standards that should apply to clinical practice guideline development and it has critical flaws, especially as it pertains to the use of repetitive transcranial magnetic stimulation treatment for patients with depression. The revision of the college clinical practice guideline has explicitly removed clear and unequivocal evidence-based recommendations that were found in a previous version of the clinical practice guideline and replaced these with consensus-based recommendations. However, the consensus-based recommendations were developed without consultation of the appropriate expert body within the college and contradict the scientific literature. There is substantive and unequivocal evidence supporting the antidepressant use of repetitive transcranial magnetic stimulation in the treatment of patients with depression and its use after a patient with depression has failed a limited number (typically around two) of antidepressant medication trials. Readers should refer to the college Professional Practice Guidelines for repetitive transcranial magnetic stimulation published in 2018 for thorough information about the use of this important new treatment.
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http://dx.doi.org/10.1177/00048674211004344DOI Listing
April 2021

A comparison of 15 minute vs 30 minute repetitive transcranial magnetic stimulation sessions for treatment resistant depression - are longer treatment sessions more effective?

J Affect Disord 2021 03 7;282:974-978. Epub 2021 Jan 7.

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services; Discipline of Psychiatry, University of Adelaide; Northern Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address:

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and effective treatment for treatment resistant depression (TRD). The number of patients able to be treated with rTMS is determined by the availability of the machine and staff. If treatment delivered in a shorter time were just as effective as longer treatments, then more patients could be treated with the same resources.

Method: This naturalistic study investigated 145 first-time patients treated with 15 minute (900 pulses) or 30 minute (1800 pulses) RLF rTMS for TRD 3 days/week for 6 weeks. Response and remission rates for the two groups were compared. We investigated whether longer right unilateral low (1Hz) frequency (RLF) repetitive transcranial magnetic stimulation (rTMS) treatment sessions are more effective than shorter sessions in achieving response and remission for treatment resistant depression (TRD).

Results: The duration of rTMS treatment sessions had no effect on treatment outcomes over the course of 6 weeks. The group treated with 15 minute rTMS sessions showed a partial response rate of 28.2%, a response rate of 11.5% and remission rate of 21.8%, which did not differ significantly from patients receiving 30 minute sessions who had a partial response rate of 25.4%, response rate of 17.9% and remission rate of 22.4%.

Limitations: Participants were not randomized and the inclusion criteria were broad and reflected the nature of patients seen in routine practice.

Conclusions: Fifteen minute rTMS sessions 3 days/week for 6 weeks were as effective as 30 minute sessions, providing a pragmatic advantage for shorter treatments.
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http://dx.doi.org/10.1016/j.jad.2021.01.009DOI Listing
March 2021

Up-to-date review of psychotherapy via videoconference: implications and recommendations for the RANZCP Psychotherapy Written Case during the COVID-19 pandemic.

Australas Psychiatry 2020 10 20;28(5):517-520. Epub 2020 Jul 20.

South Australia Psychiatry Branch Training Committee, Glenside Health Service, Australia.

Objective: There has been a surge in videoconferencing technology use in response to the COVID-19 pandemic. RANZCP registrars engaged in the Psychotherapy Written Case are met with new challenges in navigating the psychodynamic processes that can occur when transitioning from in-person to videoconferencing psychotherapy. There is also a myriad of videoconferencing platforms to choose from.

Conclusion: It has become necessary to adapt our clinical practice to the current COVID-19 pandemic and physical distancing regulations. The literature recognises videoconferencing psychotherapy as a valid therapeutic medium which can facilitate healthy psychological maturation, but there are theoretical drawbacks. A transition to videoconferencing psychotherapy requires patient agreeability, consistency and reflection upon patient-therapist dynamics; this will aide in the Psychotherapy Written Case submission. Registrars must balance usability, digital security and patient preferences when choosing videoconferencing platforms.
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http://dx.doi.org/10.1177/1039856220939495DOI Listing
October 2020

The RANZCP professional practice guidelines for electroconvulsive therapy: Time for evidence-based, best practice electroconvulsive therapy to become the uniform standard across Australia and New Zealand.

Authors:
Shane P Gill

Aust N Z J Psychiatry 2019 Sep 4;53(9):920-921. Epub 2019 Aug 4.

1 Neurostimulation Service, Ramsay Health Care, Adelaide, SA, Australia.

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http://dx.doi.org/10.1177/0004867419866915DOI Listing
September 2019

We need to know more information about the type of electroconvulsive therapy given before concluding whether or not a trial of electroconvulsive therapy was adequate.

Authors:
Shane P Gill

Aust N Z J Psychiatry 2019 Aug 17;53(8):808-809. Epub 2019 Jul 17.

1 Neurostimulation Service, Ramsay Health Care, Adelaide, SA, Australia.

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http://dx.doi.org/10.1177/0004867419864437DOI Listing
August 2019

Efficacy of repetitive transcranial magnetic stimulation in the treatment of depression with comorbid anxiety disorders.

J Affect Disord 2019 06 30;252:435-439. Epub 2019 Mar 30.

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, South Australia, Australia. Electronic address:

Background: The presence of comorbid anxiety is generally associated with poorer treatment outcomes in people with depression. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective for treatment resistant depression, but there has been little research examining rTMS in depressed patients with comorbid anxiety disorders. This study aimed to investigate the efficacy of rTMS in patients with treatment resistant Major Depressive Disorder (MDD) and comorbid anxiety disorders.

Methods: This study included 248 patients with treatment resistant MDD who were treated with rTMS. Of these, 172 patients had one or more comorbid anxiety disorders, so their outcomes were compared with patients who did not have comorbid anxiety.

Results: Patients both with and without comorbid anxiety disorders showed improvement in depression ratings after rTMS treatment, with no significant difference in remission rates between groups. In those with comorbid anxiety disorders, 23.3% met criteria for remission and 39.5% met response criteria. For each anxiety disorder diagnosis, there was a significant reduction in HAM-A, HAM-D21, MADRS and ZUNG scores (p = <0.001 for all).

Limitations: This was not a sham-controlled study, so placebo response rates are not known. Patients were referred by private psychiatrists so are not representative of all patients with depression.

Conclusion: Our study indicates that rTMS is an effective treatment for Major Depressive Disorder in people who have comorbid anxiety disorders.
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http://dx.doi.org/10.1016/j.jad.2019.03.085DOI Listing
June 2019

Does rTMS reduce depressive symptoms in young people who have not responded to antidepressants?

Early Interv Psychiatry 2019 10 10;13(5):1129-1135. Epub 2018 Oct 10.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.

Aim: Depression is common in young people, and there is a need for safe, effective treatments. This study examined the efficacy of repetitive transcranial magnetic stimulation in a sample of young people aged 17 to 25 years.

Methods: This retrospective study included 15 people aged 17 to 25 years referred by their private psychiatrists affiliated with Ramsay Health Care, South Australia Mental Health Services. All patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for treatment-resistant Major Depressive Disorder. Eleven patients received right unilateral treatment and four patients received bilateral treatment. Patients were assessed at baseline and after treatment.

Results: There was a significant improvement on the Hamilton Rating Scale for Depression (t(14) = 4.71, P < 0.0001); Montgomery-Åsperg Depression Rating Scale (t(14) = 3.96, P < 0.01) and the Zung Self-Rating Depression Scale (t(14) = 4.13, P < 0.01). There was no difference in response by gender or age. The response rates in these young people did not differ significantly from those of adults aged 25 to 82 years.

Conclusion: This open label, naturalistic study suggests that repetitive transcranial magnetic stimulation is an effective treatment in young adults who have treatment-resistant depression. Randomized sham-controlled studies are needed to further investigate the efficacy of this treatment in this age group.
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http://dx.doi.org/10.1111/eip.12743DOI Listing
October 2019

Facilitated Learning Groups: an initiative to enhance psychiatric training in South Australia.

Australas Psychiatry 2018 Dec 21;26(6):655-658. Epub 2018 Jun 21.

Consultant Psychiatrist and Director of Training, South Australian Psychiatry Branch Training Committee, Adelaide, SA, Australia.

Objectives:: Facilitated Learning Groups (FLGs) were introduced by the South Australian Psychiatry Branch Training Committee in 2016 to provide support for trainees. These incorporated Balint group principles but also had roles that extended beyond a traditional Balint group. This paper reports an evaluation of these groups after their first 12 months.

Methods:: An evaluation form was sent to all trainee participants, seeking quantitative and qualitative feedback about their experience.

Results:: The majority of trainees found the FLGs to be beneficial. A thematic analysis of the written feedback revealed several key benefits for the participants, including having access to a senior psychiatrist who was outside of training and supervision, mixing with trainees across years and regions, and the capacity to discuss difficult work environments.

Conclusions:: A forum for trainees to develop reflective practice and discuss challenging issues, which is not involved in their assessment, was experienced positively by the majority of participants and should be considered for wider adoption across Australia and New Zealand.
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http://dx.doi.org/10.1177/1039856218781020DOI Listing
December 2018

Clinical Practice Recommendations for Continuation and Maintenance Electroconvulsive Therapy for Depression: Outcomes From a Review of the Evidence and a Consensus Workshop Held in Australia in May 2017.

J ECT 2019 Mar;35(1):14-20

New York Community Hospital, Brooklyn, NY.

Objectives: Continuation or maintenance electroconvulsive therapy (ECT) is often provided as a strategy for post-ECT relapse prevention. However, the evidence has been insufficient until recently to produce clear consensus on what best practice maintenance ECT (mECT) should be like in a real world ECT clinical service. The aims of this article are to help fill this gap and to provide a comprehensive set of practical, clinically-based recommendations for ECT clinicians and services.

Methods: A workshop was held at the Royal Australian and New Zealand College of Psychiatry Congress in Adelaide on April 30, 2017. This workshop was hosted by the authors. After a presentation on the state of the evidence, the 30 participants were asked to work in small groups to develop consensus recommendations on different aspects of mECT. These were then collated into one comprehensive set of clinical recommendations for the practice of mECT.

Results: These best practice recommendations are set out below.

Conclusions: These recommendations will assist ECT services and clinicians to provide best practice mECT according to currently available evidence.
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http://dx.doi.org/10.1097/YCT.0000000000000484DOI Listing
March 2019

How effective is repetitive transcranial magnetic stimulation for bipolar depression?

J Affect Disord 2017 02 27;209:270-272. Epub 2016 Nov 27.

Ramsay Health Care (SA) Mental Health Services, Ramsay Health Care, Adelaide, SA, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia.

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http://dx.doi.org/10.1016/j.jad.2016.11.041DOI Listing
February 2017

A Comparison of Right Unilateral and Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Major Depression: A Naturalistic Clinical Australian Study.

J ECT 2017 Mar;33(1):58-62

From the *Ramsay Health Care (SA) Mental Health Services, Ramsay Health Care, Adelaide; †Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide; ‡Northern Adelaide Local Health Network, Adelaide; and §South Australian Psychiatry Training Committee, Central Adelaide Local Health Network - Mental Health Directorate, Adelaide, South Australia, Australia.

Background: A great deal of research has established the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. However, questions remain about the optimal method to deliver treatment. One area requiring consideration is the difference in efficacy between bilateral and unilateral treatment protocols.

Objective: This study aimed to compare the effectiveness of sequential bilateral rTMS and right unilateral rTMS.

Methods: A total of 135 patients participated in the study, receiving either bilateral rTMS (N = 57) or right unilateral rTMS (N = 78). Treatment response was assessed using the Hamilton depression rating scale.

Results: Sequential bilateral rTMS had a higher response rate than right unilateral (43.9% vs 30.8%), but this difference was not statistically significant. This was also the case for remission rates (33.3% vs 21.8%, respectively). Controlling for pretreatment severity of depression, the results did not indicate a significant difference between the protocols with regard to posttreatment Hamilton depression rating scale scores.

Conclusions: The current study found no statistically significant differences in response and remission rates between sequential bilateral rTMS and right unilateral rTMS. Given the shorter treatment time and the greater safety and tolerability of right unilateral rTMS, this may be a better choice than bilateral treatment in clinical settings.
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http://dx.doi.org/10.1097/YCT.0000000000000359DOI Listing
March 2017

Assessing the Effects of Repetitive Transcranial Magnetic Stimulation on Cognition in Major Depressive Disorder Using Computerized Cognitive Testing.

J ECT 2016 Sep;32(3):169-73

From the *Ramsay Health Care (SA) Mental Health Services, †Discipline of Psychiatry, School of Medicine, The University of Adelaide; ‡Northern Adelaide Local Health Network; and §South Australian Psychiatry Training Committee, Central Adelaide Local Health Network-Mental Health Directorate, Adelaide, South Australia, Australia.

Objectives: A range of different treatment approaches are available for depression; however, there is an ongoing concern about the cognitive impairment associated with many treatments. This study investigated the effect of treatment with repetitive transcranial magnetic stimulation (rTMS) on cognition in patients with major depressive disorder. Cognition before and after treatment was assessed using a computerized cognitive testing battery, which provided comprehensive assessment across a range of cognitive domains. This was a naturalistic study involving patients attending an outpatient clinical rTMS service.

Methods: A total of 63 patients with treatment-resistant depression completed the IntegNeuro cognitive test battery, a well-validated comprehensive computerized assessment tool before and after receiving 18 or 20 treatments of sequential bilateral rTMS. Change in the various cognitive domains was assessed, and analyses were undertaken to determine whether any change in cognition was associated with a change in rating of depression severity.

Results: There was a significant decrease in Hamilton Depression Rating Scale scores from baseline to posttreatment. There was no decline in performance on any of the cognitive tests. There were significant improvements in maze completion time and the number of errors in the maze task. However, these were accounted for by improvement in mood when change in depressive symptoms was included as a covariate.

Conclusions: This open-label study provides further support for the efficacy and safety of rTMS as a treatment option for people with major depressive disorder in a naturalistic clinical setting. Using a comprehensive, robust computerized battery of cognitive tests, the current study indicated that there was no significant cognitive impairment associated with rTMS and that any improvements in cognitive functioning were associated with a reduction in depressive symptoms.
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http://dx.doi.org/10.1097/YCT.0000000000000308DOI Listing
September 2016

A clinical repetitive transcranial magnetic stimulation service in Australia: 6 years on.

Aust N Z J Psychiatry 2015 Nov;49(11):1040-7

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia South Australian Psychiatry Training Committee, Central Adelaide Local Health Network - Mental Health Directorate, Adelaide, SA, Australia.

Objective: There is considerable research evidence for the effectiveness of repetitive transcranial magnetic stimulation in the treatment of depression. However, there is little information about its acceptability and outcomes in clinical settings.

Method: This naturalistic study reports on a clinical repetitive transcranial magnetic stimulation service that has been running in Adelaide, South Australia (SA), for 6 years. During this time, 214 complete acute courses were provided to patients with treatment-resistant Major Depressive Disorder. Patients received either sequential bilateral or right unilateral repetitive transcranial magnetic stimulation treatment involving either 18 or 20 sessions given over 6 or 4 weeks respectively. Data included patient demographic details, duration of depression, and medication at the beginning of their repetitive transcranial magnetic stimulation course. The Hamilton Depression Rating Scale was used to assess response to repetitive transcranial magnetic stimulation.

Results: Of those undergoing a first-time acute treatment course of repetitive transcranial magnetic stimulation (N = 167), 28% achieved remission, while a further 12% met the criteria for a response to treatment. Most patients (N = 123, 77%) had previously been treated with five or more antidepressant medications, and 77 (47%) had previously received electroconvulsive therapy. Referral rates remained high over the 6 years, indicating acceptance of the treatment by referring psychiatrists. There were no significant adverse events, and the treatment was generally well tolerated. In all, 41 patients (25%) had a second course of repetitive transcranial magnetic stimulation and 6 (4%) patients had a third course; 21 patients subsequently received maintenance repetitive transcranial magnetic stimulation.

Conclusion: This naturalistic study showed that repetitive transcranial magnetic stimulation was well accepted by both psychiatrists and patients, and has good efficacy and safety. Furthermore, repetitive transcranial magnetic stimulation can provide a useful treatment alternative as part of outpatient mental health services for people with depression.
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http://dx.doi.org/10.1177/0004867415607985DOI Listing
November 2015

How safe is repetitive Transcranial Magnetic Stimulation?

Aust N Z J Psychiatry 2015 May 19;49(5):485. Epub 2014 Dec 19.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia Northern Adelaide Local Health Network, Australia

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http://dx.doi.org/10.1177/0004867414563192DOI Listing
May 2015

A scholarly endeavour: some practical tips on completing the scholarly project.

Australas Psychiatry 2015 Feb 15;23(1):29-31. Epub 2014 Dec 15.

Professor of Psychiatry, University of Adelaide, Regional Director of Training, Northern Adelaide Local Health Network, South Australia, South Australian Psychiatry Training Committee, SA, Australia.

Objectives: The current article aims to assist trainees to complete the scholarly project component of the 2012 Competency Based Fellowship Program. Practical tips on how to achieve competency in the scholarly project are outlined and discussed.

Conclusion: The scholarly project provides trainees with a good opportunity to experience and enjoy academic psychiatry. It is important to set up a clear plan so that the project can be completed in a timely manner.
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http://dx.doi.org/10.1177/1039856214562080DOI Listing
February 2015

Maintaining remission of depression with repetitive transcranial magnetic stimulation during pregnancy: a case report.

Arch Womens Ment Health 2014 Jun 18;17(3):247-50. Epub 2014 Mar 18.

Ramsay Healthcare (SA) Mental Health Services, 33 Park Tce, Gilberton, SA, 5081, Australia,

It is important to explore potential safe treatment options for the ongoing treatment of women's depression during pregnancy. One promising treatment is repetitive transcranial magnetic stimulation (rTMS). We report on the case of a woman who became pregnant while receiving regular maintenance rTMS combined with pharmacotherapy treatment for major depressive episode. The patient achieved remission following two acute courses of rTMS and continued with maintenance rTMS treatment over the course of 4 years, during which she became pregnant and gave birth to a healthy infant. Her remission was maintained over this time including during and after her pregnancy. There were no adverse effects to the patient or her infant during the pregnancy or in the post-natal period. Maintenance rTMS may be an effective and feasible treatment option for depression during pregnancy.
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http://dx.doi.org/10.1007/s00737-014-0418-7DOI Listing
June 2014

Practical considerations in the use of ultrabrief ECT in clinical practice.

J ECT 2014 Mar;30(1):10-4

From the *Discipline of Psychiatry, The University of Adelaide; †Ramsay Mental Health Services (SA), Ramsay Health Care; and ‡Northern Mental Health, Adelaide Metro Mental Health Directorate, Adelaide, South Australia, Australia.

Objective: Electroconvulsive therapy (ECT) is the most effective treatment for major depression. Brief pulse width (BPW; pulse width, 1.0 m/s) ECT is often associated with cognitive impairment. Ultrabrief (UB; pulse width, 0.3 m/s) ECT is better tolerated and causes less cognitive impairment so has been introduced as an alternative. Previous research has shown that more treatments are needed with UB ECT; however, there has not been any previous research into the impact of prescribing UB ECT on length of stay.

Methods: This study reports naturalistic data collected from 258 inpatients in a private psychiatric hospital for 2 years since the introduction of UB ECT. Clinician and self-rated scales of depression severity and hospital service data were used to evaluate the number of ECT treatments, length of stay, and efficacy.

Results: Patients prescribed UB ECT had, on average, 10.9 treatments compared to 8.8 for BPW ECT. They also spent more time in hospital; 30.3 days from the first ECT treatment to discharge compared to 24.7 days for patients prescribed BPW ECT. Excluding patients who switched treatments, 54% of patients prescribed UB ECT responded compared to 66.7% of patients prescribed BPW ECT. More patients (n = 42) switched from UB to BPW than from BPW to UB (n = 3). In the 4 years since the introduction of UB ECT, the number of patients prescribed ECT has increased, and the mean number of treatments per patient (for all patients receiving ECT) has increased from 7.7 to 11.6.

Conclusions: Ultrabrief ECT has significant advantages, reflected in the increased use of ECT since UB ECT became available. However, the greater number of treatments and the increased length of stay have important implications for service delivery, costs, and bed accessibility.
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http://dx.doi.org/10.1097/YCT.0000000000000081DOI Listing
March 2014

A practical guide to setting up a repetitive transcranial magnetic stimulation (rTMS) service.

Australas Psychiatry 2010 Aug;18(4):314-7

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia.

Objective: This paper outlines the process of developing a transcranial magnetic stimulation (rTMS) service in a private hospital setting, to provide a model for similar services elsewhere in Australia and New Zealand.

Methods: The practical issues involved in setting up the service, including funding, staffing, equipment, treatment protocols and associated research, are described.

Results: The service has been widely accepted by psychiatrists and patients. Forty-five patients have completed treatment and the research results show a significant clinical response to rTMS.

Conclusions: Clinicians involved in the service have found both the clinical and research components rewarding. In the longer term, the issue of ongoing funding of rTMS services remains to be resolved.
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http://dx.doi.org/10.3109/10398561003686771DOI Listing
August 2010
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