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The Effects of Electroconvulsive Therapy Augmentation of Antipsychotic Treatment on Cognitive Functions in Patients With Treatment-Resistant Schizophrenia. J ECT 2018; 34:31-34. [PMID: 29053485 DOI: 10.1097/yct.0000000000000463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Treatment-resistant schizophrenia (TRS) continues to be a challenge in modern psychiatry. Most of these patients have severe neurocognitive deficits. Electroconvulsive therapy (ECT) has proved effective and safe in the treatment of TRS, but because of potential neurocognitive adverse effects, it is associated with many controversies. The aim of this prospective, open study was to evaluate the effects of ECT augmentation of antipsychotics on cognitive functions in patients with TRS. METHODS Overall, 31 inpatients with TRS were included, 16 men, with an average (SD) age of 34.1 (11.187) years. The evaluation of clinical symptoms and global impression, as well as verbal memory, visual memory, working memory, psychomotor speed, verbal fluency, and executive functioning, was conducted before and after the completion of ECT treatment. RESULTS We ran a series of paired-samples t tests, and the Bonferroni adjustment for multiple comparisons reduced the significance level to P = 0.004. The neurocognitive domains that demonstrated statistically significant improvement were immediate and delayed verbal memory, and executive functioning, whereas statistical trend was observed for visual memory and psychomotor speed. None of the neurocognitive functions exhibited significant deterioration after the ECT treatment. Electroconvulsive therapy was effective in reducing general symptoms of schizophrenia, resulting in more than 30% decrease in the overall symptom severity measured by the Positive and Negative Syndrome Scale. CONCLUSIONS Notwithstanding some limitations of this study, the combination of ECT and antipsychotics has improved several neurocognitive domains, without evidence of worsening of any cognitive functions.
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Moirand R, Galvao F, Lecompte M, Poulet E, Haesebaert F, Brunelin J. Usefulness of the Montreal Cognitive Assessment (MoCA) to monitor cognitive impairments in depressed patients receiving electroconvulsive therapy. Psychiatry Res 2018; 259:476-481. [PMID: 29149717 DOI: 10.1016/j.psychres.2017.11.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 01/03/2023]
Abstract
There is a lack of consensual tools for evaluating the cognitive side-effects in patients with depression who are treated with electroconvulsive therapy (ECT). The objective of this study was to evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) and of the Mini Mental State Examination (MMSE) to monitor cognitive changes in patients with depression receiving ECT. Cognitive functioning was assessed prospectively in 48 patients with unipolar or bipolar depression before and after an ECT course. ECT-induced cognitive impairments were defined as a decrease of at least 2 points on the MoCA and the MMSE total scores and of at least one point on each sub-score. At baseline, the MoCA detected a higher number of patients with cognitive deficits than the MMSE. After ECT, the MoCA and MMSE total scores were comparable, but the MoCA detected more impairments than did the MMSE for visuo-executive, memory and language subscores. ECT significantly decreased the language capacities but improved the visuo-executive and abstraction performances measured by MoCA. In remitters, the MoCA total score and visuo-executive and abstraction performances were significantly improved, while other cognitive functions remained unchanged. The MoCA is a useful screening tool for monitoring cognitive functioning during an ECT course.
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Affiliation(s)
- Rémi Moirand
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France.
| | - Filipe Galvao
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
| | - Maxime Lecompte
- Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
| | - Emmanuel Poulet
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Haesebaert
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
| | - Jerome Brunelin
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
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103
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Abstract
Brain stimulation techniques can modulate cognitive functions in many neuropsychiatric diseases. Pilot studies have shown promising effects of brain stimulations on Alzheimer's disease (AD). Brain stimulations can be categorized into non-invasive brain stimulation (NIBS) and invasive brain stimulation (IBS). IBS includes deep brain stimulation (DBS), and invasive vagus nerve stimulation (VNS), whereas NIBS includes transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), electroconvulsive treatment (ECT), magnetic seizure therapy (MST), cranial electrostimulation (CES), and non-invasive VNS. We reviewed the cutting-edge research on these brain stimulation techniques and discussed their therapeutic effects on AD. Both IBS and NIBS may have potential to be developed as novel treatments for AD; however, mixed findings may result from different study designs, patients selection, population, or samples sizes. Therefore, the efficacy of NIBS and IBS in AD remains uncertain, and needs to be further investigated. Moreover, more standardized study designs with larger sample sizes and longitudinal follow-up are warranted for establishing a structural guide for future studies and clinical application.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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104
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Chu CW, Chien WC, Chung CH, Chao PC, Chang HA, Kao YC, Chou YC, Tzeng NS. Electroconvulsive Therapy and Risk of Dementia-A Nationwide Cohort Study in Taiwan. Front Psychiatry 2018; 9:397. [PMID: 30245639 PMCID: PMC6138057 DOI: 10.3389/fpsyt.2018.00397] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Electroconvulsive therapy (ECT) is an effective treatment for schizophrenia, bipolar disorder, and major depressive disorder, and a temporary memory loss may occur after ECT. However, the association between ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, and the risk of dementia is yet to be examined. Objective: This study aimed to clarify as to whether ECT is associated with the risk of dementia after ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, using Taiwan's National Health Insurance Research Database (NHIRD). Methods: A total of 3,796 enrolled participants (schizophrenia, 46.68%; bipolar disorder, 11.77%; and major depressive disorder, 41.55%) with 994 patients who had received ECT and 2,982 controls matched for sex and age, between January 1, and December 31, 2000, were selected from the NHIRD. After adjusting for confounding factors, Fine and Gray's survival analysis was used to compare the risk of developing dementia during the 10 years of follow-up. Results: Of the study patients, 45 (4.53%) of them developed dementia when compared to 149 (5.0%) in the control group. Fine and Gray's survival analysis revealed that the study patients were not associated with an increased risk of dementia [hazard ratio (HR) = 0.612, 95% confidence interval (CI) = 0.438-1.854, P = 0.325]. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 0.633 (95% CI = 0.448 - 1.895, P = 0.304). Conclusion: This study supports that ECT was not associated with the increased risk of dementia in patients with schizophrenia, bipolar disorder, and major depressive disorder, using the NHIRD.
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Affiliation(s)
- Ching-Wen Chu
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Pei-Chun Chao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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105
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Getty SS, Faziola LR. Adverse effects of electroconvulsive therapy on cognitive performance. Ment Illn 2017; 9:7181. [PMID: 29142661 PMCID: PMC5661121 DOI: 10.4081/mi.2017.7181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sasha S Getty
- University of California at Irvine, School of Medicine
| | - Lawrence R Faziola
- Department of Psychiatry and Human Behavior, University of California, Irvine Medical Center, CA, USA
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