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Eda M, Matsuki R. When to switch from bilateral to unilateral electroconvulsive therapy: A simple way to elicit seizures in high seizure threshold cases. Neuropsychopharmacol Rep 2019; 39:36-40. [PMID: 30447051 PMCID: PMC7292315 DOI: 10.1002/npr2.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/16/2018] [Accepted: 10/20/2018] [Indexed: 11/10/2022] Open
Abstract
Aims Although electroconvulsive therapy (ECT) is effective for various psychiatric disorders, its therapeutic effect depends on the occurrence of adequate seizures. Thus, the management of inadequate seizures remains a clinical problem. Here, we aimed to develop a simple method to elicit adequate seizures in high seizure threshold patients during ECT sessions. Methods Right unilateral ECT was performed in 87 sessions (22 inpatients) in which 504 millicoulombs bilateral (bitemporal or bifrontal) electrical stimulation had failed to induce adequate seizures. A Thymatron® System IV (Somatics LLC, Lake Bluff, IL, USA) and the LOW 0.5 program were used in accordance with the manufacturer's instructions. The electrode placement was bitemporal, bifrontal, or right unilateral (d'Elia placement). The minimum duration for an adequate seizure was 15 seconds in the electroencephalogram record of the Thymatron® stimulator. The efficacy of treatment was estimated by the Global Assessment of Functioning at the time of admission and discharge. Cognitive assessment was not performed. Results By switching to right unilateral stimulation immediately after failure of bilateral stimulation, adequate seizures were achieved in 71 of 87 (81.6%) sessions. Improvement in the Global Assessment of Functioning was observed in 23 of 28 (82.1%) treatment courses. Conclusion Switching from bilateral to unilateral electrode placement may be a simple clinical option for eliciting adequate seizures in high seizure threshold cases. Switching from bilateral to right unilateral ECT may be a simple clinical option for eliciting adequate seizures in high seizure threshold cases.
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Affiliation(s)
- Masatoshi Eda
- Hokkaido Prefectural Midorigaoka Hospital; Midorigaoka Japan
| | - Ryo Matsuki
- Hokkaido Prefectural Midorigaoka Hospital; Midorigaoka Japan
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Serum Oxytocin Concentration in Patients Receiving Electroconvulsive Therapy: An Exploratory Study and Review of Literature. J ECT 2017; 33:122-125. [PMID: 28072661 DOI: 10.1097/yct.0000000000000388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuroendocrine biomarkers have long been studied in the context of electroconvulsive therapy (ECT). We prospectively assessed serum oxytocin change and moderators thereof in an exploratory study of patients receiving ECT. METHODS Serum oxytocin concentrations were assessed immediately before and 1 to 3 minutes after the first ECT in 33 patients with schizophrenia (n = 14), other nonaffective psychosis (n = 6), mania (n = 10), and depression (n = 3) who received 6 to 7 bitemporal, brief-pulse ECTs. Change in serum oxytocin was assessed in the sample as a whole, and as a function of age, sex, diagnosis, and treatment response. The primary outcome was change in serum oxytocin in the overall sample. RESULTS There was much variation across patients; oxytocin concentrations increased marginally by a mean (standard deviation) (M [SD]) of 6.4 (82.7) pg/mL (P = 0.43). The M (SD) change was -8.2 (85.0) pg/mL in patients with schizophrenia and other nonaffective psychoses (P = 0.84). There was no significant correlation between change in Brief Psychiatric Rating Scale scores and change in oxytocin concentrations in patients with schizophrenia, other nonaffective psychoses, and mania (ρ = 0.10, P = 0.61). Serum oxytocin rose in men, after ECT, and fell in women (P = 0.01). CONCLUSIONS Change in serum oxytocin immediately after the first ECT in a course may not be a useful biomarker of ECT action. This is the first report on the subject in a sample comprising mostly patients with nonaffective psychosis and mania rather than depression. We discuss our findings in the light of previous research and offer general conclusions about the field.
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Hagen E, Shprung D, Minakova E, Washington J, Kumar U, Shin D, Sankar R, Mazarati A. Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy. Neurotherapeutics 2015; 12:657-66. [PMID: 25916397 PMCID: PMC4489959 DOI: 10.1007/s13311-015-0357-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Autism is a developmental disorder characterized by impairments in social and communication abilities, as well as by restricted and repetitive behaviors. Incidence of autism is higher than earlier estimates, and treatments have limited efficacy and are costly. Limited clinical and experimental evidence suggest that patients with autism may benefit from electroconvulsive therapy (ECT). We examined the therapeutic potential of ECT in BTBR T+ tf/j mice, which represent a validated model of autism. A series of 13 electroconvulsive shocks (ECS) delivered twice a day over 7 days reversed core autism-like behavioral abnormalities-impaired sociability, social novelty, and repetitive behavior-when the animals were tested 24 h after the last ECS. The effect lasted up to 2 weeks after ECT. Neither single ECS nor a series of 6 ECS modified animals' behavior. Chronic infusion into the lateral brain ventricle of a preferential oxytocin receptor blocker (2S)-2-Amino-N-[(1S,2S,4R)-7,7-dimethyl-1-[[[4-(2-methylphenyl)-1-piperazinyl]sulfonyl]methyl]bicyclo[2.2.1]hept-2-yl]-4-(methylsulfonyl)butanamide hydrochloride abolished ECT-induced improvement of sociability and mitigated improvement of social novelty but did not affect ECT-induced reversal of repetitive behavior. These proof-of-principle experiments suggest that ECT may, indeed, be useful in the treatment of autism, and that its therapeutic effects may be mediated, in part, by central oxytocin signaling.
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Affiliation(s)
- Eunice Hagen
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Dana Shprung
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Elena Minakova
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - James Washington
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Udaya Kumar
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Don Shin
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Raman Sankar
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
- />Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Andrey Mazarati
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
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Cochran D, Fallon D, Hill M, Frazier JA. The role of oxytocin in psychiatric disorders: a review of biological and therapeutic research findings. Harv Rev Psychiatry 2013; 21:219-47. [PMID: 24651556 PMCID: PMC4120070 DOI: 10.1097/hrp.0b013e3182a75b7d] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
LEARNING OBJECTIVES After participating in this educational activity, the physician should be better able to 1. Identify the biological role of oxytocin in forming attachments. 2. Evaluate the relationship between various neuropsychiatric disorders and oxytocin. 3. Identify clinical implications of using oxytocin to treat various neuropsychiatric disorders. Oxytocin is a peptide hormone integral in parturition, milk letdown, and maternal behaviors that has been demonstrated in animal studies to be important in the formation of pair bonds and in social behaviors. This hormone is increasingly recognized as an important regulator of human social behaviors, including social decision making, evaluating and responding to social stimuli, mediating social interactions, and forming social memories. In addition, oxytocin is intricately involved in a broad array of neuropsychiatric functions and may be a common factor important in multiple psychiatric disorders such as autism, schizophrenia, and mood and anxiety disorders. This review article examines the extant literature on the evidence for oxytocin dysfunction in a variety of psychiatric disorders and highlights the need for further research to understand the complex role of the oxytocin system in psychiatric disease and thus pave the way for developing new therapeutic modalities. Articles were selected that involved human participants with various psychiatric disorders and that either compared oxytocin biology to healthy controls or examined the effects of exogenous oxytocin administration.
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Affiliation(s)
- David Cochran
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Massachusetts Medical School
| | - Daniel Fallon
- Department of Psychiatry, University of South Florida
| | - Michael Hill
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Massachusetts Medical School
| | - Jean A. Frazier
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Massachusetts Medical School
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Comparison of methohexital and etomidate as anesthetic agents for electroconvulsive therapy in affective and psychotic disorders. J Psychiatr Res 2013; 47:686-93. [PMID: 23399487 DOI: 10.1016/j.jpsychires.2012.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 12/03/2012] [Accepted: 12/14/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND ECT is a well-established treatment for severe depression. The available data on psychosis are limited, but reliable. Its therapeutic potential relies on the induction of a generalized seizure. Besides other narcotics, methohexital and etomidate are used for general anesthesia in ECT. Since prolonged seizures have been reported following the use of etomidate, it can be deduced that the substances might differ in their anticonvulsant properties, resulting in a lower increase in stimulus intensity during the course of treatment under etomidate. Besides this hypothesis, we aimed to investigate the differential effects of etomidate and methohexital on clinical features, ECT parameters and side effects of the treatment. METHODS We performed a retrospective analysis of treatment data of patients with affective and psychotic diagnosis who received general anesthesia for ECT either with etomidate or with methohexital. RESULTS ECT with etomidate and methohexital was equally effective. During the course of therapies the administered electric charge increased significantly and equally in both treatment groups. In the methohexital group, but not in the etomidate group, electroencephalographic seizure duration had a declining trend during the course of therapies. We observed more side effects during and immediately after ECT in the methohexital group than in the etomidate group. LIMITATIONS The limitations of this study are that the patients received various psychotropic co-medications, which influence ictal parameters differently, and, secondly, the study is based on a retrospective analysis. CONCLUSION The results of our analysis suggest that etomidate and methohexital affect ictal parameters to different extents. Longer seizure duration and fewer side effects are in favor of etomidate.
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Striepens N, Kendrick KM, Maier W, Hurlemann R. Prosocial effects of oxytocin and clinical evidence for its therapeutic potential. Front Neuroendocrinol 2011; 32:426-50. [PMID: 21802441 DOI: 10.1016/j.yfrne.2011.07.001] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 07/06/2011] [Indexed: 12/29/2022]
Abstract
There has been unprecedented interest in the prosocial effects of the neuropeptide oxytocin in humans over the last decade. A range of studies has demonstrated correlations between basal oxytocin levels and the strength of social and bonding behaviors both in healthy individuals and in those suffering from psychiatric disorders. Mounting evidence suggests associations between polymorphisms in the oxytocin receptor gene and prosocial behaviors and there may also be important epigenetic effects. Many studies have now reported a plethora of prosocial effects of intranasal application of oxytocin, including the domains of trust, generosity, socially reinforced learning, and emotional empathy. The main focus of this review will be to summarize human preclinical work and particularly the rapidly growing number of clinical studies which have identified important links between oxytocin and a wide range of psychiatric disorders, and have now started to directly assess its therapeutic potential.
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Affiliation(s)
- Nadine Striepens
- Department of Psychiatry, University of Bonn, 53105 Bonn, Germany
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Abstract
For a physiological effect to be useful to regulate the electrical stimulus dose used in electroconvulsive therapy (ECT), it must show sensitivity to the stimulus dose. In the analogy of using blood drug concentration to regulate drug dosage, this concentration must be sensitive to the dose. Accordingly, we examined the sensitivity of several physiological effects to ECT stimulus dose. Previously no substantial sensitivity of physiological effects was found when generally effective ECT methods were used. EEG post-ictal suppression, recruitment phase duration, wave form regularity and spike-and-wave frequencies, peak seizure heart rate (HR), and several types of seizure duration were measured with standard and higher dose stimuli given on separate days to 24 subjects. Left frontal to right temporal asymmetric bilateral stimulus placement was applied. Peak HR (P=0.007, t=2.7) and EEG recruitment phase duration (P=0.04, t=1.9) varied with stimulus dose, by 12 beats/min and 1.3 s, respectively. Only peak HR (P=0.02, t=2.2) varied with stimulus dose (by 6 beats/min) when subjects who showed only EEG seizure but no motor seizures were excluded. Subjects who maintained peak HR near their individual maximum values received fewer ECTs than other subjects (P=0.00003, t=5.20); this greater efficacy suggests that the peak HR reflects clinical efficacy as well as stimulus dose. In addition to EEG measurements, peak HR is a candidate to measure ECT seizure quality and provide feedback for stimulus dose regulation.
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Affiliation(s)
- C M Swartz
- Department of Psychiatry, Southern Illinois University School of Medicine, P.O. Box 19642, Springfield, IL 62794-9642, USA.
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Abstract
The dosage of methohexitone (methohexital) administered by anesthetic staff was surveyed in a consecutive series of 52 patients referred for electroconvulsive therapy (ECT) in routine clinical practice in Edinburgh. Patients were weighed before the first treatment, and the ratio of administered dose to weight in kilograms calculated. Anesthesia was administered by three consultant staff and six nonconsultant staff. In only one patient (2%) was the administered dose within the range recommended by the Royal College of Psychiatrists (0.75-0.9 mg/kg), and in only four patients (8%) were the doses within the range recommended by the American Psychiatric Association (0.75-1.0 mg/kg). In all other patients the dose exceeded these recommended ranges; the average dose was 1.5 (+/- 0.3) mg/kg. The possible implications of these findings are discussed.
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Affiliation(s)
- A Cook
- Monklands District General Hospital, Airdrie, Scotland, United Kingdom
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Luber B, Nobler MS, Moeller JR, Katzman GP, Prudic J, Devanand DP, Dichter GS, Sackeim HA. Quantitative EEG during seizures induced by electroconvulsive therapy: relations to treatment modality and clinical features. II. Topographic analyses. J ECT 2000; 16:229-43. [PMID: 11005044 DOI: 10.1097/00124509-200009000-00003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study tested three alternative theories of the mechanisms of therapeutic action of electroconvulsive therapy (ECT). The theories differed in predictions about the global and topographic effects of effective and ineffective forms of ECT on electroencephalogram (EEG) seizure expression. At the second treatment, 19-lead EEG recordings were obtained in 57 depressed patients randomized to conditions that differed in ECT electrode placement and stimulus dosage. Power in the delta frequency band was quantified during the seizure and analyzed with traditional multivariate methods and the Scaled Subprofile Model. Electrical dosage of the ECT stimulus had a powerful effect on ictal global delta power and, more so, than electrode placement. Greater ictal global delta power was associated with superior therapeutic outcome, but the magnitude of this effect was small. Effective forms of ECT resulted in a topography where delta power was accentuated in prefrontal EEG sites. High dosage right unilateral ECT also resulted in stronger asymmetry in prefrontal regions than the ineffective, low dosage right unilateral ECT. Greater bilateral generalization of seizure expression does not appear to be a prerequisite for therapeutic effects. Instead, more intense seizure expression in prefrontal regions may be critical for efficacy.
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Affiliation(s)
- B Luber
- Department of Biological Psychiatry, New York State Psychiatric Institute, New York 10032, USA
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Devanand DP, Lisanby S, Lo ES, Fitzsimons L, Cooper TB, Halbreich U, Sackeim HA. Effects of electroconvulsive therapy on plasma vasopressin and oxytocin. Biol Psychiatry 1998; 44:610-6. [PMID: 9787885 DOI: 10.1016/s0006-3223(98)00086-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Animal studies suggest that vasopressin has cognitive-enhancing properties and oxytocin may have amnestic effects. A clinical report suggests that the acute increase in oxytocin-associated neurophysin predicts clinical response to electroconvulsive therapy (ECT) in depressed patients. METHODS Medication-free patients with major depression were randomized to receive right unilateral or bilateral ECT administered with electrical stimulus intensity at either just above seizure threshold or at 150% above seizure threshold. The associations between plasma vasopressin, oxytocin, ECT treatment parameters, clinical outcome, and cognitive effects were assessed. RESULTS The sample comprised 55 patients. At the second ECT, patients receiving ECT at 150% above initial seizure threshold had significantly greater increases in plasma vasopressin than patients receiving low-dose ECT (ps < .01-.04), with no effects of electrode placement. At the second and ninth ECT treatments, the vasopressin or oxytocin surges were not associated with clinical improvement, seizure duration, time to orientation, or memory test performance. There were inverse trend-level associations between the acute surge in oxytocin levels at the ninth ECT and clinical response, contradicting a report in the literature. CONCLUSIONS Overall, these findings do not support the hypothesis that diencephalic seizure propagation is central to the mechanism of action of ECT.
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Affiliation(s)
- D P Devanand
- Department of Biological Psychiatry, New York State Psychiatric Institute, New York 10032, USA
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Swartz CM. Generalization, duration, and low-frequency electroencephalographic persistence of bilateral electroconvulsive therapy seizure. Biol Psychiatry 1995; 38:837-42. [PMID: 8750044 DOI: 10.1016/0006-3223(95)00080-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Measurements were made at the beginning and end of a course of bifrontotemporal brief-pulse ECT for 28 males to both determine how well seizure generalization is maintained along the course of electroconvulsive therapy (ECT) and examine correspondence between low-frequency EEG activity and other seizure durations. Durations of spike electroencephalographic (EEG) paroxysmal activity, heart rate elevation, and Ionic-clonic activity decreased about 30% along the course, p < 0.0001, yet correlated highly at both times, I = 0.69 to 0.88, p < 0.0005, as did their changes: these correlations demonstrate high-seizure generalization and its maintenance. EEG low-frequency persistence, the difference between total and spike EEG paroxysmal durations, doubled along the course (p = 0.041), but showed no association with any other seizure duration measure. This absence of association suggests that low-frequency activity and other seizure duration measures describe separate phenomena and should be expressed separately, rather than combined as the (traditional) total EEG paroxysmal duration.
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Affiliation(s)
- C M Swartz
- Department of Psychiatric Medicine, East Carolina University School of Medicine, Greeville, NC 27858-4354, USA
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Sackeim HA, Devanand DP, Cooper TB. Comment on "Does oxytocin release correlate with ECT's efficacy?". Biol Psychiatry 1994; 35:964-6. [PMID: 8080897 DOI: 10.1016/0006-3223(94)91247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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