metricas
covid
Buscar en
Revista de Psiquiatría y Salud Mental (English Edition)
Toda la web
Inicio Revista de Psiquiatría y Salud Mental (English Edition) Dignifying Electroconvulsive Therapy based on evidence
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Dignifying Electroconvulsive Therapy based on evidence
Dignificando una terapia electroconvulsiva basada en la evidencia
Miguel Bernardoa,
Corresponding author
bernardo@clinic.ub.es

Corresponding author.
, Mikel Urretavizcayab
a Unidad de Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
b Hospital Universitario de Bellvitge, IDIBELL, CIBERSAM, Barcelona, Spain
Read
4546
Times
was read the article
1197
Total PDF
3349
Total HTML
Share statistics
 array:23 [
  "pii" => "S2173505015000151"
  "issn" => "21735050"
  "doi" => "10.1016/j.rpsmen.2015.01.002"
  "estado" => "S300"
  "fechaPublicacion" => "2015-04-01"
  "aid" => "267"
  "copyright" => "SEP y SEPB"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Rev Psiquiatr Salud Ment. 2015;8:51-4"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2015
    "formatos" => array:3 [
      "EPUB" => 23
      "HTML" => 1389
      "PDF" => 603
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1888989115000233"
      "issn" => "18889891"
      "doi" => "10.1016/j.rpsm.2015.01.002"
      "estado" => "S300"
      "fechaPublicacion" => "2015-04-01"
      "aid" => "267"
      "copyright" => "SEP y SEPB"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Rev Psiquiatr Salud Ment. 2015;8:51-4"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 12215
        "formatos" => array:3 [
          "EPUB" => 11
          "HTML" => 10572
          "PDF" => 1632
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Dignificando una terapia electroconvulsiva basada en la evidencia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "51"
            "paginaFinal" => "54"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Dignifying Electroconvulsive Therapy based on evidence"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Miguel Bernardo, Mikel Urretavizcaya"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Miguel"
                "apellidos" => "Bernardo"
              ]
              1 => array:2 [
                "nombre" => "Mikel"
                "apellidos" => "Urretavizcaya"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173505015000151"
          "doi" => "10.1016/j.rpsmen.2015.01.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173505015000151?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888989115000233?idApp=UINPBA00004N"
      "url" => "/18889891/0000000800000002/v2_201504291213/S1888989115000233/v2_201504291213/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173505015000187"
    "issn" => "21735050"
    "doi" => "10.1016/j.rpsmen.2015.04.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-04-01"
    "aid" => "268"
    "copyright" => "SEP y SEPB"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Psiquiatr Salud Ment. 2015;8:55-64"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2521
      "formatos" => array:3 [
        "EPUB" => 16
        "HTML" => 1931
        "PDF" => 574
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "The real world cost and health resource utilization associated to manic episodes&#58; The MANACOR study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "55"
          "paginaFinal" => "64"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Los costos y consumo de recursos sanitarios asociados a episodios man&#237;acos en la pr&#225;ctica cl&#237;nica diaria&#58; el estudio MANACOR"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1318
              "Ancho" => 2158
              "Tamanyo" => 108088
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution and total direct healthcare costs between initial FAST score categories&#46; &#42;Cutoff score was based on FAST score percentiles among the total sample&#46; The figure shows the distribution among the direct healthcare cost components associated to the different levels of the baseline FAST score&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">FAST&#58; Functional Assessment Short Test&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Diego Hidalgo-Mazzei, Juan Undurraga, Mar&#237;a Reinares, Caterina del Mar Bonn&#237;n, Cristina S&#225;ez, Mar&#237;a Mur, Evaristo Nieto, Eduard Vieta"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Diego"
              "apellidos" => "Hidalgo-Mazzei"
            ]
            1 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Undurraga"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Reinares"
            ]
            3 => array:2 [
              "nombre" => "Caterina del Mar"
              "apellidos" => "Bonn&#237;n"
            ]
            4 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "S&#225;ez"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Mur"
            ]
            6 => array:2 [
              "nombre" => "Evaristo"
              "apellidos" => "Nieto"
            ]
            7 => array:2 [
              "nombre" => "Eduard"
              "apellidos" => "Vieta"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888989115000245"
        "doi" => "10.1016/j.rpsm.2015.01.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888989115000245?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173505015000187?idApp=UINPBA00004N"
    "url" => "/21735050/0000000800000002/v1_201506091518/S2173505015000187/v1_201506091518/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Dignifying Electroconvulsive Therapy based on evidence"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "51"
        "paginaFinal" => "54"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Miguel Bernardo, Mikel Urretavizcaya"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Miguel"
            "apellidos" => "Bernardo"
            "email" => array:1 [
              0 => "bernardo&#64;clinic&#46;ub&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mikel"
            "apellidos" => "Urretavizcaya"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Unidad de Esquizofrenia Cl&#237;nic&#44; Instituto Cl&#237;nic de Neurociencias&#44; Hospital Cl&#237;nic de Barcelona&#44; Universidad de Barcelona&#44; IDIBAPS&#44; CIBERSAM&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Universitario de Bellvitge&#44; IDIBELL&#44; CIBERSAM&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dignificando una terapia electroconvulsiva basada en la evidencia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The electroconvulsive therapy &#40;ECT&#41; is one of the treatments that have received more qualifying value judgements in the field of psychiatry and probably all medicine&#46; Besides the polemics and after 80 years of history&#44; it is still considered nowadays controversial but reliable&#44; effective&#44; long-standing and valid&#46; This treatment saves lives but its availability is still changeable and unequal&#44; even though its pattern of use remains constant or increases in some places&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Adequate training&#44; education and accreditation of psychiatrists and other medical professionals&#44; particularly anaesthetists and mental health nursing staff&#44; are essential to dignify a treatment that was stigmatised and is stigmatising even nowadays&#44; and to guarantee access to what could be vital for some patients&#46; In the last years&#44; there has been definite progress in this field&#46; There is regulated training available in various Spanish communities &#40;a total amount of eight periodic courses today&#41;&#46; Guidelines for the accreditation of services or units of ECT have been implemented&#44; which safeguard technical&#44; ethical and legislative suitable standards&#46; Guidelines such as NICE&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">1</span></a> the British ECTAS &#40;ECT Accreditation Service&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">2</span></a> the Scottish SEAN &#40;Scottish ECT Accreditation network&#41;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">3</span></a> or the recent Catalan guideline &#40;Guideline of clinical good practice about electroconvulsive therapy&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">4</span></a> have given recommendations&#44; positioning and standards for the practice and the accreditation of the treatment and the professionals responsible for the intervention&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evidence at a Spanish level goes back to the beginning of the 1990s with the first description of the situation in the city of Barcelona&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">5&#44;6</span></a> In 1999&#44; the Spanish consensus on ECT<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">7</span></a> was reached among professionals of various fields&#46; Since then&#44; the pattern of use has been standardised although there are citizens who have many additional possibilities of receiving the treatment according to their geographic area of registration&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain&#44; there are only published data of Catalonia which inform that around 1000 people receive treatment throughout a year&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">4&#44;10</span></a> At the moment&#44; a wide descriptive study is being carried out and it will be soon published&#46; In the United States&#44; it is estimated that about 100&#44;000 patients receive treatment in the same period and about 1&#44;000&#44;000 people receive it around the world&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">For years&#44; the ECT has been a regulated and defined treatment with the objective of being applied to standardised and good clinical practice conditions&#46; The main scientific societies have taken their stance about this matter &#40;APA&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">13</span></a> RCP&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">14</span></a> SEPB&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">7</span></a> WPA<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">15</span></a>&#41; and how to make the treatment safe&#44; adequate and as respectable as possible&#46; Since the first edition of the guideline of the American Psychiatric Association &#40;APA&#41; in 1990&#44; concrete and ambitious objectives have already been defined&#44; which included recommendations about the treatment&#44; education&#44; training and the optimisation of the ECT&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This positioning made by the most relevant psychological organisations about ECT is not usual in other treatments&#46; It has been motivated by its former storm of controversy and stigma&#44; which converted it into the current regulated and structured therapeutic intervention&#46; Nevertheless&#44; there is high variability in its pattern of use&#46; Different factors can contribute to these variations&#44; such as misinformed beliefs of citizens and professionals about the treatment&#44; the lack of agreement regarding its use&#44; in addition to a certain degree of nihilism and&#44; why not&#44; negligence by the psychiatrists themselves&#46; A feasible way to overcome the problems of this changeable and irregular practice is to promote and establish a policy for the follow-up and accreditation of ECT services or units in order to guarantee its practice and security&#46; The possible creation of reference units specialised in ECT<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">2&#44;4&#44;16</span></a> should be considered separately&#46; An unavoidable objective is that patients can receive ECT in optimal conditions&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Even nowadays&#44; the ECT is being underused in many psychiatric fields&#46; The fact that the ECT has a guaranteed accessibility is especially important and constitutes an aspect to regulate&#44; since it is not only an effective but also an elective treatment in some disorders&#44; such as catatonia and different forms of depression and schizophrenia&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There are specific associations of the ECT such as the European Forum For ECT or the Association for Convulsive Therapy with the aim&#44; among many others&#44; of promoting investigation&#44; fighting against the stigma associated with ECT&#44; and promoting good practices&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition&#44; the scientific literature is focusing more on the issues related to the ECT practice&#44; its psychological context&#44; and how to improve the perception of patients regarding their own treatment to reduce the related stigma and to favour the development of ECT under dignifying conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">19&#8211;21</span></a> While investigating this matter&#44; it has been studied whether patients undergoing ECT were satisfied with the treatment and showed more favourable attitudes towards the ECT compared to other controls&#46; The results were that they effectively showed a positive response towards the ECT&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Nevertheless&#44; it is necessary to keep working in order to better assess the need for information and the factors implied in the decision-making of the people who are offered ECT&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Another aspect to consider is the special populations&#44; such as children&#44; adolescents&#44; pregnant women and the elderly population&#46; The effectiveness and security of the ECT in pedo-psychiatry obtain results similar to the results of adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">26&#8211;30</span></a> The ECT can be used during the three trimesters of pregnancy and postpartum with good therapeutic response&#44; especially in the treatment of major depression and bipolar disorder&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">4&#44;31&#44;32</span></a> The data are also clear about the security of the treatment among elderly people&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">33</span></a> While some data suggest a reduction in the number of young patients treated with ECT&#44;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">34</span></a> on the other hand&#44; there seems to be an increase in the number of elderly people who receive the treatment&#46; This phenomenon might be related to the progressive ageing of the general population and the greater vulnerability of this population segment to affective disorders&#46; Furthermore&#44; the reports suggest that the ECT is particularly effective in the treatment of geriatric depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">4&#44;35</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Among other special populations &#40;not psychiatric in this case&#41; such as patients with advanced Parkinson disease&#44; there is evidence of an improvement in some parameters of the disease when treated with ECT&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">36</span></a> It is also effective with the neuroleptic malignant syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">37</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As regards the investigation&#44; there is a considerable increase in the studies performed in the field of genetics&#44; neuroimaging&#44; neurobiology&#44; biomarkers&#44; and in neuropsychological and psychosocial investigation in order to assess the effects in the cognition and the emotional impact&#46; In all neuroscience areas&#44; the data are conclusive that the ECT is a safe and generally well-tolerated treatment upon which new evidence has been produced regarding the action mechanisms involved&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">38</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the last years&#44; there has been an increase in the use of maintenance electroconvulsive therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">39&#44;40</span></a> The antidepressant effect of the ECT does not represent an addition in the cognitive deficit in these patients in the long term&#44;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">41&#44;42</span></a> although it is observed that they can suffer from short-term memory dysfunction and frontal functionalism&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">43</span></a> The declarative memory is altered after ECT&#44; whereas the immediate memory is widely conserved&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">44</span></a> It is a slight cognitive dysfunction of the right hemisphere that is detected through a reduced visuospatial skill in patients treated with ECT compared to the control group&#46;<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">45&#44;46</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Also in this area&#44; as well as in other psychiatric therapy areas&#44; pragmatic studies are being carried out&#44; such as the ones made by the Consortium for Research in Electroconvulsive Therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">47&#44;48</span></a> These studies have allowed for the consideration of continuation&#47;maintenance ECT as an effective therapeutic alternative similar to lithium and nortriptyline&#44; the contribution in the demonstration of the efficiency of the bilateral positioning of electrodes and the usefulness of ECT in not only unipolar&#44; but also bipolar depression&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">49</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Recently&#44; scientific interest in the indication of ECT for schizophrenia has reappeared since the confirmation that it can be an effective and safe option&#44; combined with drugs&#44; for a concrete group of patients with schizophrenia&#44; such as patients with refractory schizophrenia&#44; catatonia&#44; who suffer suicidal behaviour or aggressiveness as well as those who require fast global improvement and reduction of severe symptomatology&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">50&#8211;52</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">From the point of view of health economics&#44; through systematic revisions and studies of the economic model&#44; it has been confirmed that the ECT&#44; beyond its clinical benefits&#44; is a cost-benefit alternative for depression diseases&#44; schizophrenia&#44; catatonia and mania&#46;<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">53&#44;54</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In these almost 80 years of history of ECT&#44; there are plenty of therapeutic alternatives that have been compared to this technique without detriment of the validity of the ECT&#46; Nowadays&#44; ECT is compared with other physical therapies&#44; such as transcranial magnetic stimulation&#44; and with new pharmaceutical treatments&#44; such as the repeated administration of intravenous infusion of ketamine hydrochloride&#46; The accurate transcranial magnetic stimulation requires further investigation in order to be incorporated into the clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">55</span></a> The intravenous treatment with ketamine&#44; which rapidly improves the depressive symptoms&#44; needs to demonstrate a long-lasting response and security before its implementation in the clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">56</span></a> As Kellner<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">57</span></a> states&#44; the interest and enthusiasm must not cloud the clinical judgement&#46; First of all&#44; approaches based on experimental evidence should be offered&#46; The ECT based on evidence is an effective and efficient technique&#44; more effective and efficient than many other therapeutic strategies that are the object of major attention and investigation budget&#46; Beyond its effectiveness and efficiency&#44; there are a lot of pending challenges that the ECT has to deal with in our country and&#44; probably&#44; in most parts of the world&#44; such as&#58; to find a possible under-usage of the technique&#44; to provide patients with universal access to this treatment regardless of their geographic location&#44; and to ensure the compliance with minimum standards when indicating and&#47;or applying the ECT&#44; with the purpose of reducing the variability in the ECT practice&#46; In order to face these challenges&#44; health care professionals have to be well prepared&#44; ECT units should comply with certain requirements&#44; and the organisations competent on health care planning matters should be aware of the importance of this technique so as to achieve symptomatic remission and functional recovery of many patients&#46; The scientific societies are essential to reach the expected challenges and to contribute to definitely bringing down the social stigma that comes along with this technique&#44; dignifying a treatment &#40;ECT&#41; totally supported by scientific evidence&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bernardo M&#44; Urretavizcaya M&#46; Dignificando una terapia electroconvulsiva basada en la evidencia&#46; Rev Psiquiatr Salud Ment &#40;Barc&#46;&#41;&#46; 2015&#59;8&#58;51&#8211;54&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:57 [
            0 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidance on the use of electroconvulsive therapy &#40;technology appraisal 59&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "National Institute for Clinical Excellence &#40;NICE&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2003"
                        "editorial" => "NICE"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ECT Accreditation Service &#40;ECTAS&#41;&#46; Standards for the administration of ECT&#46; Eleventh Edition&#58; December 2013"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Royal College of Psychiatrists"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Publication Number&#58; CCQI162 2013&#44; Royal College of Psychiatrists"
                        "serieFecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy in Scottish clinical practice&#58; a national audit of demographics&#44; standards&#44; and outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;M&#46; Fergusson"
                            1 => "L&#46;A&#46; Cullen"
                            2 => "C&#46;P&#46; Freeman"
                            3 => "J&#46;D&#46; Hendry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JECT"
                        "fecha" => "2004"
                        "volumen" => "20"
                        "paginaInicial" => "166"
                        "paginaFinal" => "173"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Pla director de salut mental i addiccions&#46; Guia de bona pr&#224;ctica cl&#237;nica sobre la ter&#224;pia electroconvulsiva"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2014"
                        "editorial" => "Direcci&#243; General de Planificaci&#243; i Recerca en Salut&#44; Generalitat de Catalunya"
                        "editorialLocalizacion" => "Barcelona"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patrones de uso de la terap&#233;utica electroconvulsiva en Barcelona"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Bernardo"
                            1 => "F&#46; Arrufat"
                            2 => "L&#46; Pintor"
                            3 => "S&#46; Catarineu"
                            4 => "E&#46; Buis&#225;n"
                            5 => "C&#46; Ball&#250;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Cl&#237;n"
                        "fecha" => "1996"
                        "volumen" => "106"
                        "paginaInicial" => "201"
                        "paginaFinal" => "204"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terap&#233;utica electroconvulsiva&#58; aplicaci&#243;n actual"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Bernardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Cl&#237;n"
                        "fecha" => "1999"
                        "volumen" => "113"
                        "paginaInicial" => "631"
                        "paginaFinal" => "634"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consenso Espa&#241;ol sobre la terapia electroconvulsiva"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Sociedad Espa&#241;ola de Psiquiatr&#237;a"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1999"
                        "editorial" => "Emisa"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of electroconvulsive therapy use in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Bertol&#237;n-Guill&#233;n"
                            1 => "S&#46; Peir&#243;-Moreno"
                            2 => "M&#46;E&#46; Hern&#225;ndez-de-Pablo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eurpsy.2004.11.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Psychiatry"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "463"
                        "paginaFinal" => "470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17055950"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pautas actuales en la utilizaci&#243;n de la terapia electroconvulsiva en Europa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Bernardo"
                            1 => "F&#46; Arrufat"
                            2 => "S&#46; Catarineu"
                            3 => "J&#46;M&#46; Peri"
                            4 => "A&#46; Mi&#241;arro"
                            5 => "L&#46; Pintor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Psiquiatr Biol"
                        "fecha" => "1995"
                        "volumen" => "2"
                        "paginaInicial" => "213"
                        "paginaFinal" => "219"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy practice in Catalonia&#58; a survey study comparing data from 1993 and 2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Mart&#237;nez-Amor&#243;s"
                            1 => "V&#46; G&#225;lvez"
                            2 => "N&#46; Cardoner"
                            3 => "D&#46; Palao"
                            4 => "M&#46; Bernardo"
                            5 => "M&#46; Urretavizcaya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporary use and practice of electroconvulsive therapy worldwide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;A&#46; Leiknes"
                            1 => "L&#46; Jarosh-von Schweder"
                            2 => "B&#46; H&#248;ie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/brb3.37"
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain Behav"
                        "fecha" => "2012"
                        "volumen" => "2"
                        "paginaInicial" => "283"
                        "paginaFinal" => "344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22741102"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electro-convulsive therapy practices in the community"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Prudic"
                            1 => "M&#46; Olfson"
                            2 => "H&#46;A&#46; Sackeim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychol Med"
                        "fecha" => "2001"
                        "volumen" => "31"
                        "paginaInicial" => "929"
                        "paginaFinal" => "934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11459391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The practice of electroconvulsive therapy&#58; recommendations for treatment&#44; training and privileging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Psychiatric Association"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1990"
                        "editorial" => "American Psychiatric Association"
                        "editorialLocalizacion" => "Washington&#44; DC"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "The ECT handbook"
                        "edicion" => "3rd ed&#46;"
                        "serieFecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "World Psychiatric Association&#58; position statement on the use and safety of electroconvulsive therapy&#46; Science and care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;T&#46; Abou-Saleh"
                            1 => "Y&#46; Papakostas"
                            2 => "I&#46; Zervas"
                            3 => "G&#46; Christodoulou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull WPA Sci Sect"
                        "fecha" => "2004"
                        "volumen" => "1"
                        "paginaInicial" => "7"
                        "paginaFinal" => "11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy &#8211; state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;V&#46; Eranti"
                            1 => "D&#46;M&#46; McLoughlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Psychiatry"
                        "fecha" => "2003"
                        "volumen" => "182"
                        "paginaInicial" => "8"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12509311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of electroconvulsive therapy in depressive disorders&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "UK ECT Review Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(03)12705-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2003"
                        "volumen" => "361"
                        "paginaInicial" => "799"
                        "paginaFinal" => "808"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12642045"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment-resistant bipolar depression&#58; a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;K&#46; Schoeyen"
                            1 => "U&#46; Kessler"
                            2 => "O&#46;A&#46; Andreassen"
                            3 => "B&#46;H&#46; Auestad"
                            4 => "P&#46; Bergsholm"
                            5 => "U&#46;F&#46; Malt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1176/appi.ajp.2014.13111517"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Psychiatry"
                        "fecha" => "2015"
                        "volumen" => "172"
                        "paginaInicial" => "41"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25219389"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevos avances en terapia electroconvulsiva &#191;Cu&#225;l es la influencia de los agentes anest&#233;sicos&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Guerrero-Dom&#237;nguez"
                            1 => "D&#46; L&#243;pez-Herrera-Rodr&#237;guez"
                            2 => "J&#46; Acosta-Mart&#237;nez"
                            3 => "I&#46; Jim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Psiquiatr Salud Ment"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perceptions and awareness of electroconvulsive therapy among patients and their families&#58; a review of the research from developing countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Chakrabarti"
                            1 => "S&#46; Grover"
                            2 => "R&#46; Rajagopal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "317"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21155155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy&#58; a review of knowledge&#44; experience and attitudes of patients concerning the treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Chakrabarti"
                            1 => "S&#46; Grover"
                            2 => "R&#46; Rajagopal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/15622970903559925"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Biol Psychiatry"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "525"
                        "paginaFinal" => "537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20128713"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient satisfaction with electroconvulsive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;A&#46; Goodman"
                            1 => "L&#46;E&#46; Krahn"
                            2 => "G&#46;E&#46; Smith"
                            3 => "T&#46;A&#46; Rummans"
                            4 => "T&#46;S&#46; Pileggi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Proc"
                        "fecha" => "1999"
                        "volumen" => "74"
                        "paginaInicial" => "967"
                        "paginaFinal" => "971"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Satisfaction with electroconvulsive therapy among patients and their relatives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Rajagopal"
                            1 => "S&#46; Chakrabarti"
                            2 => "S&#46; Grover"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/YCT.0b013e318292b010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "283"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23670027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The practice of consenting to electroconvulsive therapy in the European Union"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Gazdag"
                            1 => "R&#46; Tak&#225;cs"
                            2 => "G&#46;S&#46; Ungvari"
                            3 => "P&#46; Sienaert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/YCT.0b013e318223c63c"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "4"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22343577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethics in electroconvulsive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;-O&#46; Ottosson"
                            1 => "M&#46; Fink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "Brunner-Routledge"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratamiento electroconvulsivo en ni&#241;os y adolescentes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Dom&#232;nech"
                            1 => "M&#46; Bernardo"
                            2 => "F&#46; Arrufat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Cl&#237;n"
                        "fecha" => "2004"
                        "volumen" => "122"
                        "paginaInicial" => "349"
                        "paginaFinal" => "354"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical experience using electroconvulsive therapy in adolescents with schizophrenia spectrum disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Baeza"
                            1 => "I&#46; Flamarique"
                            2 => "J&#46;M&#46; Garrido"
                            3 => "G&#46; Horga"
                            4 => "A&#46; Pons"
                            5 => "M&#46; Bernardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/cap.2009.0066"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Child Adolesc Psychopharmacol"
                        "fecha" => "2010"
                        "volumen" => "20"
                        "paginaInicial" => "205"
                        "paginaFinal" => "209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20578933"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two-year follow-up of cognitive functions in schizophrenia Spectrum Disorders adolescent patients treated with ECT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "De la Serna"
                            1 => "I&#46; Flamarique"
                            2 => "J&#46; Castro-Fornieles"
                            3 => "A&#46; Pons"
                            4 => "O&#46; Puig"
                            5 => "S&#46; Andr&#233;s-Perpi&#241;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/cap.2011.0012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Child Adolesc Psychopharmacol"
                        "fecha" => "2011"
                        "volumen" => "21"
                        "paginaInicial" => "611"
                        "paginaFinal" => "619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22136098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice parameter for use of electroconvulsive therapy with adolescents"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Work Group on Quality Issues&#59; AACAP"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Ghaziuddin"
                            1 => "S&#46;P&#46; Kutcher"
                            2 => "P&#46; Knapp"
                            3 => "W&#46; Bernet"
                            4 => "V&#46; Arnold"
                            5 => "J&#46; Beitchman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Child Adolesc Psychiatry"
                        "fecha" => "2004"
                        "volumen" => "43"
                        "paginaInicial" => "1521"
                        "paginaFinal" => "1539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15564821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Electroconvulsive therapy in children and adolescents"
                        "serieFecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of electroconvulsive therapy in pregnancy&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "O&#46; Saatcioglu"
                            1 => "N&#46;B&#46; Tomruk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Isr J Psychiatry Relat Sci"
                        "fecha" => "2011"
                        "volumen" => "48"
                        "paginaInicial" => "6"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21572236"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of depression during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Kellner"
                            1 => "R&#46;M&#46; Pasculli"
                            2 => "M&#46; Briggs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/YCT.0b013e318250e585"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "195"
                        "paginaFinal" => "196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22914631"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy&#58; a guide for professionals and their patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Fink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2&#46;nd ed&#46;"
                        "fecha" => "2009"
                        "editorial" => "Oxford University Press"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy&#44; practice and evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Scott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1192/bjp.bp.109.074054"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Psychiatry"
                        "fecha" => "2010"
                        "volumen" => "196"
                        "paginaInicial" => "171"
                        "paginaFinal" => "172"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20194535"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical manual of electroconvulsive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;V&#46; Mankad"
                            1 => "J&#46;L&#46; Beyer"
                            2 => "R&#46;D&#46; Weiner"
                            3 => "A&#46;D&#46; Krystal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2010"
                        "editorial" => "American Psychiatric Publishing"
                        "editorialLocalizacion" => "Arlington&#44; VA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of electroconvulsive therapy in Parkinson disease with residual axial symptoms partially unresponsive to L-dopa&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;P&#46; Pintor"
                            1 => "F&#46; Valldeoriola"
                            2 => "E&#46; Fern&#225;ndez-Egea"
                            3 => "R&#46; S&#225;nchez"
                            4 => "L&#46; Rami"
                            5 => "E&#46; Tolosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/YCT.0b013e31823c98c0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "87"
                        "paginaFinal" => "91"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22531200"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terapia electroconvulsiva como tratamiento del s&#237;ndrome neurol&#233;ptico maligno"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;J&#46; Verdura"
                            1 => "D&#46; Ballesteros"
                            2 => "J&#46; Sanz-Fuentenebro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Psiquiatr Salud Ment"
                        "fecha" => "2011"
                        "volumen" => "04"
                        "paginaInicial" => "169"
                        "paginaFinal" => "176"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of ECT&#46; Reviewing the science and dismissing the myths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Sienaert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/YCT.0000000000000118"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "85"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24625703"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eficacia y patr&#243;n de uso de la terapia electroconvulsiva de continuaci&#243;n y mantenimiento en el trastorno depresivo mayor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Mart&#237;nez-Amor&#243;s"
                            1 => "N&#46; Cardoner"
                            2 => "V&#46; G&#225;lvez"
                            3 => "M&#46; Urretavizcaya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rpsm.2012.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Psiquiatr Salud Ment"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "241"
                        "paginaFinal" => "253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23021297"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maintenance electroconvulsive therapy &#40;M-ECT&#41; after acute response&#46; Examining the evidence for who&#44; what&#44; when and how&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Rabheru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/YCT.0b013e3182455758"
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "39"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22330700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cognitive status of psychiatric patients under maintenance electroconvulsive therapy&#58; a one-year longitudinal study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Rami"
                            1 => "M&#46; Bernardo"
                            2 => "T&#46; Boget"
                            3 => "J&#46; Ferrer"
                            4 => "M&#46;J&#46; Portella"
                            5 => "J&#46;A&#46; Gil-Verona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1176/jnp.16.4.465"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neuropsychiatry Clin Neurosci"
                        "fecha" => "2004"
                        "volumen" => "16"
                        "paginaInicial" => "465"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15616173"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Absence of additional cognitive impairment in schizophrenic patients during maintenance electroconvulsive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Rami-Gonz&#225;lez"
                            1 => "M&#46; Bernardo"
                            2 => "M&#46; Vald&#233;s"
                            3 => "T&#46; Boget"
                            4 => "M&#46;J&#46; Portella"
                            5 => "J&#46; Ferrer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Schizophr Bull"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "185"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15176772"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of frontal functions in psychiatric patients during maintenance electroconvulsive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Rami-Gonz&#225;lez"
                            1 => "M&#46; Bernardo"
                            2 => "M&#46;J&#46; Portella"
                            3 => "J&#46; Goti"
                            4 => "J&#46;A&#46; Gil-Verona"
                            5 => "M&#46; Salamero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Esp Psiquiatr"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "69"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12677470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subtypes of memory dysfunction associated with ECT&#58; characteristics and neurobiological bases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Rami-Gonzalez"
                            1 => "M&#46; Bernardo"
                            2 => "T&#46; Boget"
                            3 => "M&#46; Salamero"
                            4 => "J&#46;A&#46; Gil-Verona"
                            5 => "C&#46; Junque"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J ECT"
                        "fecha" => "2001"
                        "volumen" => "17"
                        "paginaInicial" => "129"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11417924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Rami"
                            1 => "M&#46; Salamero"
                            2 => "T&#46; Boget"
                            3 => "R&#46; Catal&#225;n"
                            4 => "J&#46; Ferrer"
                            5 => "M&#46; Bernardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychol Med"
                        "fecha" => "2003"
                        "volumen" => "33"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12622313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cognitive functions after only one ECT session&#58; a controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Rami"
                            1 => "J&#46; Goti"
                            2 => "J&#46; Ferrer"
                            3 => "T&#46; Marcos"
                            4 => "M&#46; Salamero"
                            5 => "M&#46; Bernardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.psychres.2007.01.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychiatry Res"
                        "fecha" => "2008"
                        "volumen" => "158"
                        "paginaInicial" => "389"
                        "paginaFinal" => "394"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18279973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression&#58; a multisite study from the Consortium for Research in Electroconvulsive Therapy &#40;CORE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Kellner"
                            1 => "R&#46;G&#46; Knapp"
                            2 => "G&#46; Petrides"
                            3 => "T&#46;A&#46; Rummans"
                            4 => "M&#46;M&#46; Husain"
                            5 => "K&#46; Rasmussen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Gen Psychiatry"
                        "fecha" => "2006"
                        "volumen" => "74"
                        "paginaInicial" => "967"
                        "paginaFinal" => "971"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is baseline medication resistance associated with potential for relapse after successful remission of a depressive episode with ECT&#63; Data from the Consortium for Research on Electroconvulsive Therapy &#40;CORE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;G&#46; Rasmussen"
                            1 => "M&#46; Mueller"
                            2 => "T&#46;A&#46; Rummans"
                            3 => "M&#46;M&#46; Husain"
                            4 => "G&#46; Petrides"
                            5 => "R&#46;G&#46; Knapp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Psychiatry"
                        "fecha" => "2009"
                        "volumen" => "70"
                        "paginaInicial" => "232"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19192459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What was learned&#58; studies by the consortium for research in ECT &#40;CORE&#41; 1997-2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Fink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Paediatr Scand"
                        "fecha" => "2014"
                        "volumen" => "129"
                        "paginaInicial" => "417"
                        "paginaFinal" => "426"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Indications for electroconvulsive treatment in schizophrenia&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Pompili"
                            1 => "D&#46; Lester"
                            2 => "G&#46; Dominici"
                            3 => "L&#46; Longo"
                            4 => "G&#46; Marconi"
                            5 => "A&#46; Forte"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.schres.2013.02.005"
                      "Revista" => array:7 [
                        "tituloSerie" => "Schizophr Res"
                        "fecha" => "2013"
                        "volumen" => "146"
                        "numero" => "1&#8211;3"
                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23499244"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eficacia y riesgos de la combinaci&#243;n de psicof&#225;rmacos con el tratamiento electroconvulsivo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;J&#46; Sanz-Fuentenebro"
                            1 => "I&#46; Vidal"
                            2 => "D&#46; Ballesteros"
                            3 => "E&#46; Verdura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rpsm.2010.12.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Psiquiatr Salud Ment"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "42"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23446101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia&#58; a prospective&#44; randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Petrides"
                            1 => "C&#46; Malur"
                            2 => "R&#46;J&#46; Braga"
                            3 => "S&#46;H&#46; Bailine"
                            4 => "N&#46;R&#46; Schooler"
                            5 => "A&#46;K&#46; Malhotra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Am J Psychiatry"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness&#44; schizophrenia&#44; catatonia and mania&#58; systematic reviews and economic modelling studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Greenhalgh"
                            1 => "C&#46; Knight"
                            2 => "D&#46; Hind"
                            3 => "C&#46; Beverley"
                            4 => "S&#46; Walters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Health Technol Assess"
                        "fecha" => "2005"
                        "volumen" => "9"
                        "paginaInicial" => "1"
                        "paginaFinal" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16303099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression&#58; a decision model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Vallejo-Torres"
                            1 => "I&#46; Castilla"
                            2 => "N&#46; Gonz&#225;lez"
                            3 => "R&#46; Hunter"
                            4 => "P&#46; Serrano-P&#233;rez"
                            5 => "L&#46; Perestelo-P&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychol Med"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10722171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurobiological effects of transcranial direct current stimulation&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;F&#46; Medeiros"
                            1 => "I&#46;C&#46; de Souza"
                            2 => "L&#46;P&#46; Vidor"
                            3 => "A&#46; de Souza"
                            4 => "A&#46; Deitos"
                            5 => "M&#46;S&#46; Volz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Front Psychiatry"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "110"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Ghasemi"
                            1 => "M&#46;H&#46; Kazemi"
                            2 => "A&#46; Yoosefi"
                            3 => "A&#46; Ghasemi"
                            4 => "P&#46; Paragomi"
                            5 => "H&#46; Amini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.psychres.2013.12.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychiatry Res"
                        "fecha" => "2014"
                        "volumen" => "215"
                        "paginaInicial" => "355"
                        "paginaFinal" => "361"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24374115"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electroconvulsive therapy is a standard treatment&#59; ketamine is not &#40;yet&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;H&#46; Kellner"
                            1 => "R&#46;M&#46; Greenberg"
                            2 => "G&#46;M&#46; Ahle"
                            3 => "L&#46;S&#46; Liebman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1176/appi.ajp.2014.14030296"
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Psychiatry"
                        "fecha" => "2014"
                        "volumen" => "171"
                        "paginaInicial" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24980177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735050/0000000800000002/v1_201506091518/S2173505015000151/v1_201506091518/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7617"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735050/0000000800000002/v1_201506091518/S2173505015000151/v1_201506091518/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173505015000151?idApp=UINPBA00004N"
]
Article information
ISSN: 21735050
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 3 8
2024 October 19 11 30
2024 September 41 4 45
2024 August 26 11 37
2024 July 18 8 26
2024 June 15 5 20
2024 May 20 5 25
2024 April 22 12 34
2024 March 19 9 28
2024 February 27 6 33
2024 January 13 7 20
2023 December 17 6 23
2023 November 12 10 22
2023 October 19 23 42
2023 September 10 7 17
2023 August 22 11 33
2023 July 11 14 25
2023 June 37 6 43
2023 May 48 11 59
2023 April 45 11 56
2023 March 39 4 43
2023 February 24 4 28
2023 January 40 18 58
2022 December 38 12 50
2022 November 41 7 48
2022 October 17 17 34
2022 September 13 13 26
2022 August 24 23 47
2022 July 18 12 30
2022 June 51 6 57
2022 May 50 12 62
2022 April 59 10 69
2022 March 33 13 46
2022 February 58 7 65
2022 January 108 11 119
2021 December 52 10 62
2021 November 26 7 33
2021 October 36 15 51
2021 September 17 14 31
2021 August 54 9 63
2021 July 42 13 55
2021 June 27 8 35
2021 May 39 4 43
2021 April 86 33 119
2021 March 68 10 78
2021 February 56 8 64
2021 January 39 10 49
2020 December 38 13 51
2020 November 35 8 43
2020 October 22 7 29
2020 September 36 15 51
2020 August 37 12 49
2020 July 54 14 68
2020 June 41 12 53
2020 May 28 4 32
2020 April 31 5 36
2020 March 20 8 28
2020 February 34 9 43
2020 January 21 8 29
2019 December 17 17 34
2019 November 22 12 34
2019 October 28 8 36
2019 September 18 10 28
2019 August 11 7 18
2019 July 18 20 38
2019 June 38 20 58
2019 May 98 47 145
2019 April 46 33 79
2019 March 16 2 18
2019 February 24 9 33
2019 January 20 4 24
2018 December 22 7 29
2018 November 23 5 28
2018 October 17 10 27
2018 September 27 6 33
2018 August 7 7 14
2018 July 6 1 7
2018 June 8 11 19
2018 May 16 29 45
2018 April 20 8 28
2018 March 10 4 14
2018 February 15 6 21
2018 January 8 3 11
2017 December 8 4 12
2017 November 11 2 13
2017 October 9 5 14
2017 September 5 3 8
2017 August 10 1 11
2017 July 7 4 11
2017 June 19 8 27
2017 May 17 12 29
2017 April 33 6 39
2017 March 16 28 44
2017 February 15 2 17
2017 January 20 4 24
2016 December 20 4 24
2016 November 26 4 30
2016 October 30 5 35
2016 September 34 3 37
2016 August 30 5 35
2016 July 33 3 36
2016 June 35 11 46
2016 May 39 20 59
2016 April 40 15 55
2016 March 41 21 62
2016 February 50 20 70
2016 January 44 11 55
2015 December 27 10 37
2015 November 33 22 55
2015 October 54 19 73
2015 September 23 11 34
2015 August 25 6 31
2015 July 28 21 49
2015 June 34 16 50
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos