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Copersino ML, Long MP, Bolton P, Ressler KJ, Seiner SJ, Yip AG. First Acute-Course Electroconvulsive Therapy for Moderate-to-Severe Depression Benefits Patients With or Without Accompanying Baseline Cognitive Impairment. J ECT 2022; 38:74-80. [PMID: 34966040 DOI: 10.1097/yct.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Researchers are increasingly investigating therapeutic response associated with new patient subgroups as a way to improve electroconvulsive therapy (ECT) treatment outcomes and reduce adverse events. This study is the first to examine baseline cognitive impairment status as a predictor of clinical outcome in first acute-course ECT patients. METHODS Baseline cognitive function at various thresholds and serial depressive symptom severity data from first-time ECT patients were examined using generalized linear mixed-effects models. RESULTS Of 1345 patients who met the inclusion criteria, 617 had available data at their third assessment visit (~15th treatment visit). There was a robust improvement in depression symptoms over time (P < 0.0001), and cognitive function was not associated with baseline levels of depressive symptoms or serially measured change in self-reported symptom severity during acute-phase ECT. CONCLUSIONS These results indicate that an acute course of ECT for the treatment of moderate-to-severe depression benefits patients with or without accompanying baseline cognitive impairment. These findings may be useful in informing shared decision-making discussions about ECT risks and expected benefits.
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Zheng W, Jiang ML, He HB, Li RP, Li QL, Zhang CP, Zhou SM, Yan S, Ning YP, Huang X. A Preliminary Study of Adjunctive Nonconvulsive Electrotherapy for Treatment-Refractory Depression. Psychiatr Q 2021; 92:311-320. [PMID: 32661940 DOI: 10.1007/s11126-020-09798-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nonconvulsive electrotherapy (NET) defined as electrical brain stimulation administered like standard electroconvulsive therapy (ECT), but below seizure threshold, could be effective for patients with treatment-refractory depression (TRD) with fewer adverse neurocognitive outcomes. However, there is a lack of studies in Chinese patients with TRD. Thus, this study was conducted to examine the efficacy and safety of adjunctive NET for Chinese patients with TRD. Twenty TRD patients were enrolled and underwent six NET treatments. Depressive symptoms, response, and remission were assessed with the 17-item Hamilton Depression Rating Scale (HAMD-17) at baseline and after 1, 3, and 6 NET treatments. Neurocognitive function was assessed by the Wisconsin Card Sorting Test (WCST) at baseline and after the completion of six NET treatments. Mean HAMD-17 scores declined significantly from 26.2 to 10.4 (p < 0.001) after post-NET. The rates of response and remission were 60.0% (95% CI: 36.5-83.5) and 10.0% (95% CI: 0-24.4), respectively. Neurocognitive performance improved following a course of NET. No significant association was found between changes in depressive symptoms and baseline neurocognitive function. Adjunctive NET appeared to be effective for patients with TRD, without adverse neurocognitive effects. Randomized controlled studies were warranted to confirm these findings.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Miao-Ling Jiang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Hong-Bo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ri-Peng Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Qi-Long Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chun-Ping Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Su-Miao Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Su Yan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China. .,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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Dominiak M, Goetz Z, Antosik-Wojcinska AZ, Swiecicki L. Right unilateral versus bilateral formula-based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial. Psychogeriatrics 2021; 21:175-184. [PMID: 33442924 DOI: 10.1111/psyg.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/27/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the most effective treatment of depression in the elderly population; however, it is still unclear which type of ECT is most beneficial in this population. The aims of this study were: (i) to assess the feasibility of a randomised controlled trial in elderly depressed patients treated with right unilateral (RUL) or fronto-temporal bilateral (BT) formula-based ECT; (ii) to compare formula-based RUL and BT ECT in terms of efficacy, safety and tolerability in this population. METHODS The study lasted 3 years and managed to randomise 29 patients over 65 years old to receive either BT (n = 14) or RUL (n = 15) ECT. Brief pulse width (0.5 ms) and age-based dosing method were applied. The clinical efficacy was assessed using Hamilton Depression Rating Scale, somatic state was monitored throughout the ECT course. In neuropsychological examination general cognitive performance, executive functions, verbal fluency, memory, autobiographical memory were evaluated. RESULTS The recruitment was poor due to small number of patients able to give informed consent. ECT proved to be a highly effective and safe method of treatment among elders. Formula-based RUL ECT did not differ from BT in antidepressant efficacy and had cognitive advantages - the indices of general cognitive performance, verbal fluency and memory were significantly better than before the treatment in the RUL group. Decline in retrieval consistency of autobiographical memory was more pronounced in the BT group, although it was observed across both groups. CONCLUSIONS Formula-based RUL ECT might not differ from BT in antidepressant efficacy and has an advantage in terms of tolerability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Zuzanna Goetz
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Lukasz Swiecicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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Vermeulen T, Lauwers T, Van Diermen L, Sabbe BG, van der Mast RC, Giltay EJ. Cognitive Deficits in Older Adults With Psychotic Depression: A Meta-Analysis. Am J Geriatr Psychiatry 2019; 27:1334-1344. [PMID: 31378679 DOI: 10.1016/j.jagp.2019.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
A major depressive disorder with psychotic features, that is, psychotic depression (PD), is often accompanied by cognitive deficits, particularly in older patients. We aimed to assess to what extent various cognitive domains are affected in older patients with PD compared to those with nonpsychotic depression (NPD). Therefore, a systematic search was conducted in Medline, Embase, Web of Science, the Cumulative Index to Nursing and Allied Literature (CINAHL), Google Scholar, and Cochrane for all relevant studies. Hereafter, we conducted a meta-analysis of seven studies on cognitive deficits in older adults (55+ years), comparing patients with PD and patients with NPD. Compared to patients with NPD, those with PD not only showed a significantly poorer performance on overall cognitive function, with a Hedges' g effect size of -0.34 (95% confidence interval: -0.56; -0.12; p = 0.003), but also on nearly all separate cognitive domains, with Hedges' g effect sizes ranging from -0.26 to -0.64 (all p's <0.003), of which attention was most adversely affected. Verbal fluency showed no significant effect, although this analysis may have been underpowered. The funnel plot suggested no significant publication bias (Egger test intercept: -2.47; 95% confidence interval: -5.50; 0.55; p = 0.09). We conclude that older patients with PD show more cognitive deficits on all cognitive domains, except for verbal fluency, compared to patients with NPD. It is crucial that clinicians and researchers take cognitive deficits into consideration in older adults with PD.
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Affiliation(s)
- Tom Vermeulen
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (TV, LVD, BGS, and RCvdM), Antwerp, Belgium.
| | - Tina Lauwers
- Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Hospital Duffel (TL, LVD, and BGS), Duffel, Antwerp, Belgium
| | - Linda Van Diermen
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (TV, LVD, BGS, and RCvdM), Antwerp, Belgium; Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Hospital Duffel (TL, LVD, and BGS), Duffel, Antwerp, Belgium
| | - Bernard G Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (TV, LVD, BGS, and RCvdM), Antwerp, Belgium; Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Hospital Duffel (TL, LVD, and BGS), Duffel, Antwerp, Belgium
| | - Roos C van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (TV, LVD, BGS, and RCvdM), Antwerp, Belgium; University Medical Centre Leiden, University of Leiden, (RCvdM and EJG), Leiden, the Netherlands
| | - Erik J Giltay
- University Medical Centre Leiden, University of Leiden, (RCvdM and EJG), Leiden, the Netherlands
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Rubinsztein JS, Sahakian BJ, O'Brien JT. Understanding and managing cognitive impairment in bipolar disorder in older people. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SUMMARYBipolar disorder is less prevalent in older people but accounts for 8–10% of psychiatric admissions. Treating and managing bipolar disorder in older people is challenging because of medical comorbidity. We review the cognitive problems observed in older people, explore why these are important and consider current treatment options. There are very few studies examining the cognitive profiles of older people with bipolar disorder and symptomatic depression and mania, and these show significant impairments in executive function. Most studies have focused on cognitive impairment in euthymic older people: as in euthymic adults of working age, significant impairments are observed in tests of attention, memory and executive function/processing speeds. Screening tests are not always helpful in euthymic older people as the impairment can be relatively subtle, and more in-depth neuropsychological testing may be needed to show impairments. Cognitive impairment may be more pronounced in older people with ‘late-onset’ bipolar disorder than in those with ‘early-onset’ disorder. Strategies to address symptomatic cognitive impairment in older people include assertive treatment of the mood disorder, minimising drugs that can adversely affect cognition, optimising physical healthcare and reducing relapse rates.LEARNING OBJECTIVESAfter reading this article you will be able to:
•understand that cognitive impairment in euthymic older people with bipolar disorder is similar to that in working-age adults with the disorder, affecting attention, memory and executive function/processing speeds•recognise that cognitive impairment in older people is likely to be a major determinant of functional outcomes•Implement approaches to treat cognitive impairment in bipolar disorder.DECLARATION OF INTERESTB.J.S. consults for Cambridge Cognition, PEAK (www.peak.net) and Mundipharma.
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Abstract
OBJECTIVE The aim of the study was to explore patient perception and perceived benefit of electroconvulsive therapy (ECT) by assessing the real-world experience of adult patients who received ECT, focusing on clinical outcomes and patient satisfaction. METHODS This retrospective study analyzed patient self-report of depressive symptoms (Patient Health Questionnaire), perception of physical and cognitive ECT adverse effects (ECT Outcomes Survey) and satisfaction with treatment (Patient Satisfaction Survey). Symptoms and adverse effects were measured at both intake and final ECT session for comparison over time. Data were collected from 1089 adult patients with depression, bipolar disorder, or schizoaffective disorder in 23 psychiatric facilities in the United States and its territories from 2014 to 2015. RESULTS On average, patient scores reflect satisfaction with treatment and reduction in depressive symptoms and adverse effects across the course of ECT treatment. Patients reported a decrease in depression, with an average Patient Health Questionnaire change of 13.2 from intake to final ECT session (P < 0.001). Furthermore, 85.5% of patients indicated on the Patient Satisfaction Survey that they benefited or improved as a result of their ECT. Subsequent analyses revealed alleviation of depressive symptoms and ability to return to social, and work life tasks are significant contributors to satisfaction with treatment, whereas adverse effects including memory problems have less influence on satisfaction. CONCLUSIONS Patients tend to perceive ECT as a safe and beneficial treatment option for severe mood disorders, even when considering adverse effects. This study reinforces the value of standardized data collection and outcomes measures to better monitor patient response to treatment, refine the clinical practice of ECT, and provide data to support patient education.
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Watt S, Crowe SF. Examining the beneficial effect of neuropsychological assessment on adult patient outcomes: a systematic review. Clin Neuropsychol 2017; 32:368-390. [DOI: 10.1080/13854046.2017.1414885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Stephanie Watt
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Simon F. Crowe
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Abstract
This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.
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Affiliation(s)
- Emma T Geduldig
- The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
| | - Charles H Kellner
- The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
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