Barbiturates Definition Definition Electroconvulsive therapy (ECT) is a medical procedure in which a small, carefully controlled amount of electric current

is passed through the brain to treat symptoms associated with certain mental disorders. The electric current produces a convulsion for the relief of symptoms associated with such mental illnesses as major depressive disorder, bipolar disorder, acute psychosis, and catatonia. Purpose al are no longer routinely recommended for the treatment of insomnia because of their ability to cause dependence, tolerance, and withdrawal. These drugs also have significant side effects when taken in large doses and can cause respiratory failure and death. Description Precautions The EEG should be administered, monitored, and interpreted only by a specially trained health professional. It is important to recognize that diagnosis should not be based on the EEG alone the EEG represents an adjunct to the neurological history, examination, and other specialized studies. The EEG is an extremely sensitive instrument, and tracings can be greatly influenced by the actions and the physiologic status of the patient. It is important that the patient be properly prepared physically and psychologically in order to obtain an accurate and reliable record. Medications such as anticonvulsants, tranquilizers, stimulants including coffee, tea, cola drinks and alcohol should be withheld for at least 24 48 hours prior to the test. Inasmuch as hypoglycemia affects brain wave patterns, the patient is told not to withhold any meals. Description Brain function is associated with electrical activity, which is always accompanied by an electrical field. This field consists of two parts, the electrical field and the magnetic field, and is called an electromagnetic field. The electrical field is measured by surface electrodes and is recorded by the electroencephalogram. Prior to the recording session, approximately 16 20 electrodes are attached to the patient s scalp with a conductive washable paste, or collodion. Depending on the purpose of the EEG, implantable needle electrodes may be utilized, in which case the patient should be informed that there will be mild discomfort. The patient lies on a bed, padded table, or comfortable reclining chair and is asked to remain quiet and relaxed during the approximately one hour that is usually required. A sleep recording up to three hours in duration is usually obtained if the diagnosis is a seizure disorder. Under certain conditions, various stimuli such as flashing lights or deep breathing may be utilized. In an ambulatory EEG recording, the patient is attached to a portable cassette recorder and goes about regular activities, usually for up to 24 hours. Magnetoencephalography

Magnetoencephalography, a supplement to EEG, also uses an electroencephalogram to measure the patient s electrical field. In addition, however, the patient s magnetic field is also recorded to measure electrical activity. Every electrical current generates a magnetic field. The magnetic field is detected by an instrument called a biomagnetometer and recorded as a magnetoencephalograph (MEG). The information proElectroencephalography vided by the MEG is entirely different from that provided by computed tomography (CT), topographic encephalography, or magnetic resonance imaging (MRI) imaging instruments that provide still, structural, and anatomical information. The information recorded by the MEG provides important supplemental information to that recorded by the encephalogram and, used together and conjointly, they both provide a much more complete and comprehensive idea of cerebral events. Using MEG, the brain can be observed in action rather than just being viewed as a still image. Magnetoencephalography has been used to map the sensory and motor cortices of the brain, to determine the organization of the auditory center of the brain, and to study cognitive functions such as speech, memory, attention and consciousness. This information is critical for neurosurgical planning such as the removal of brain lesions. Thus, preoperative MEG is valuable in planning the surgical treatment of tumors and malformations. MEG can provide surgeons with real-time computergenerated images of deep-seated lesions that are essential before surgery. The quantitative EEG is also known by the acronym BEAM (brain electrical activity mapping). Preparation Prior to the EEG, the patient is before surgery, 1 mg to 3 mg per kilogram of body weight is given about one hour before the surgery. The typical dose of butalbital, as a component of headache preparations such as Fiorinal or Fioricet, is 50-100 mg admin Addiction A compulsive need for, and use of, a habit-forming substance or behavior. Anticonvulsant A medication used to control abnormal electrical activity in the brain that causes seizures. Corticosteroids Any one of a number of hormonal steroid compounds that are derived from the adrenal gland. Delirium A disturbance of consciousness marked by confusion, difficulty paying attention, delusions, hallucinations, or restlessness. Dependence The adaptation of neurons and other physical processes to the use of a drug, followed by withdrawal symptoms when the drug is removed; physiological and/ or psychological addiction. Hyperactive Behavior disturbances, usually in children and adolescents, that involves impulsiveness, low levels of concentration, and distractibility.

Intramuscular An injection that is given into a muscle. Monoamine oxidase inhibitors (MAOIs) A group of antidepressant drugs that decreases the activity of monoamine oxidase, a neurotransmitter found in the brain that affects mood. Status epilepticus Series of grand mal epileptic seizures that may occur when the patient is asleep or awake and involves diminished consciousness. Tolerance Progressive decrease in the effectiveness of a drug with long-term use. Withdrawal Symptoms experienced by a person who has become physically dependent on a drug, experienced when the drug use is discontinued. the seizures. Barbiturate use by pregnant women has been associated with increased risk of fetal damage and bleeding during childbirth. Women who are breast-feeding should not take barbiturates because these drugs enter the breast milk and may cause serious side effects in the nursing baby. Long-term barbiturate use should be avoided unless there is a strong medical need, as in the case of epilepsy, because of the potential for addiction, dependence, tolerance, and withdrawal. People should not drive, operate heavy equipment, or perform other hazardous activities requiring mental alertness while taking barbiturates. Side effects The most common side effect of barbiturate use is drowsiness. Less common side effects include agitation, confusion, breathing difficulties, abnormally low blood pressure, nausea, vomiting, constipation, lower body temperature, decreased heart rate, movement difficulty, nightmares, anxiety, nervousness, mental depression, and dizziness. Rare but reported side effects include fever, headache, anemia, allergic reactions, and liver damage. Interactions Patients should always tell their doctor and dentist when they are taking barbiturates. Barbiturates should generally not be taken with other drugs used to treat mental disorders. There are a number of drugs that barbiturates should not be combined with because the barbiturates may increase the metabolism of these drugs and thus, reduce the amount of these drugs available to be of benefit. These drugs include oral corticosteroids such as predisolone, methylprednisolone, prednisone, or dexamethasone, estrogen and oral contraceptives, blood-thinning medications such as warfarin (Coumadin), the antibiotic doxycycline (Vibramycin), and anticonvulsants such as phenytoin (Dilantin). Barbiturates should not be combined with alcohol because the combination produces additive depressant effects in the central nervous system. Barbiturates may lower the amount of absorption of the vitamins D and K. Resources BOOKS Consumer Reports Staff. Consumer Reports Complete Drug Reference. 2002 ed. Denver: Micromedex Thomson Healthcare, 2001.

Ellsworth, Allan J., and others. Mosby s Medical DrugAbuse is a complex psychosoci al problem that affects large numbers of adults as well as children throughout the world. It is listed in the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV-TR) under the heading of Other Conditions That May Be a Focus of Clinical Attention. Although abuse was first defined with regard to children when it first received sustained attention in the 1950s, clinicians and researchers now recognize that adults can suffer abuse in a number of different circumstances. Abuse refers to harmful or injurious tlude not only the direct costs of immediate medical and psychiatric treatment of abused people but also the indirect costs of learning difficulties, interrupted education, workplace absenteeism, and long-term health problems of abuse survivors.