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Stojanović Z, Simić K, Tepšić Ostojić V, Gojković Z, Petković-Ćurčin A. Electroconvulsive therapy in the Fourth Industrial Revolution (Review). Biomed Rep 2024; 21:129. [PMID: 39070111 PMCID: PMC11273193 DOI: 10.3892/br.2024.1817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
There are very few treatments in psychiatry, even in medicine, that have experienced longevity and effectiveness such as electroconvulsive therapy (ECT), despite the controversies and stigma that accompany it. The experience of the COVID-19 pandemic has highlighted the need to strengthen mental health systems in most countries, given that depression is one of the leading health problems and that there is an evident shortage of psychiatrists worldwide. The Fourth Industrial Revolution, has witnessed great progress in artificial intelligence (AI) technology, which opens up the possibility of its application both in the diagnosis and in the therapy of mental disorders. It is no exaggeration to suggest that tools such as AI, neuroimaging and blood tests will bring significant change to psychiatry in the coming years, but even so, treating severe mental disorders remains a challenge. The present review summarized the development of ECT over time, its application in clinical practice, neurobiological correlates and mechanisms of action and sheds light on the important place of ECT in the era of technological development, considering that ECT is still the most effective therapy for the treatment of severe mental disorders, especially depressive disorder.
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Affiliation(s)
- Zvezdana Stojanović
- Clinic for Psychiatry, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
| | - Katarina Simić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vesna Tepšić Ostojić
- Clinic for Psychiatry, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
| | - Zagorka Gojković
- Clinic for Psychiatry, Military Medical Academy, 11000 Belgrade, Serbia
| | - Aleksandra Petković-Ćurčin
- Medical Faculty of the Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia
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2
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Besse M, Gather J, Schiffer B, Zilles-Wegner D. Electroconvulsive Therapy in Forensic Psychiatry: A Systematic Review. J ECT 2024:00124509-990000000-00186. [PMID: 38984839 DOI: 10.1097/yct.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
ABSTRACT Patients with schizophrenia are the largest population in forensic hospitals, and treatment-resistant psychosis is associated with length of stay. For patients with severe and treatment-resistant psychotic disorders, electroconvulsive therapy (ECT) is a potentially effective treatment. Data regarding the use of ECT in forensic psychiatry are scarce. This systematic review aims to provide an overview of the use of ECT in forensic psychiatry. Three databases (PubMed, Web of Science, and PsycINFO) were searched for publications since 1980. Peer-reviewed articles describing patients who underwent ECT treatment in the context of forensic psychiatry were included when a treatment outcome was reported. We identified 5 case reports and 1 case series comprising 13 patients treated with ECT in forensic settings. The quality of evidence was poor accompanied by a considerable risk of bias. Patients were diagnosed with schizophrenia spectrum disorders (n = 10) or depression with psychotic features (n = 3). Eleven patients (84.6%) were described as responders in terms of symptom improvement associated with a reduction of aggressive behavior and improved functioning. At least 3 patients were able to return to community settings. Despite the very limited evidence base, our review suggests that patients in forensic hospitals may benefit from ECT, but more systematic and higher-quality evidence is urgently needed. In addition to prospective, controlled observational studies, a qualitative view focusing on patients' perspectives in this specific setting is of particular importance.
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Affiliation(s)
- Matthias Besse
- From the Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | | | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - David Zilles-Wegner
- From the Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
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3
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Correll CU, Arango C, Fagiolini A, Giordano GM, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024; 20:1293-1307. [PMID: 38911102 PMCID: PMC11194005 DOI: 10.2147/ndt.s459450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine. Methods A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion. Results First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics. Conclusion Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | | | - Stefan Leucht
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services (CAMHS) South London and Maudsley NHS Foundation Trust London, London, UK
- Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
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4
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Melzer-Ribeiro DL, Napolitano IC, Leite SA, Alencar de Souza JA, Vizzotto ADB, Di Sarno ES, Fortes M, Gomes ML, de Oliveira GM, Avrichir BS, Talib LL, Correll CU, Elkis H. Randomized, double-blind, sham-controlled trial to evaluate the efficacy and tolerability of electroconvulsive therapy in patients with clozapine-resistant schizophrenia. Schizophr Res 2024; 268:252-260. [PMID: 38151432 DOI: 10.1016/j.schres.2023.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
There is no established treatment for patients with clozapine-resistant schizophrenia (CRS). Clozapine augmentation strategies with antipsychotics or others substances are effective in comparison with placebo while and Electroconvulsive therapy (ECT) showed to be effective in comparison with treatment as usual (TAU) but not with placebo (sham-ECT). In the present double- blind randomized controlled trial, we compared 40 outpatients who received 20 sessions of ECT (n = 21) or sham-ECT (n = 19) (age = 37.40 ± 9.62, males = 77.5 %, illness duration = 14.95 ± 8.32 years, mean total Positive and Negative Syndrome Scale (PANSS) = 101.10 ± 24.91) who fulfilled well-defined CRS criteria including baseline clozapine plasma levels ≥350 ng/mL. The primary outcome was the ≥50 % PANSS Total Score reduction; secondary outcomes were the scores of the PANSS subscales, PANSS five-factor dimensions, PANSS-6 and the Calgary Depression Rating Scale (CDRS). Treatment response was analyzed by percentage reduction, Linear Mixed Models and effect sizes. At baseline both groups showed no differences except for years of school education (included as a covariate). At endpoint, only 1/19 of the completers (5.26 %) in the ECT group and 0/17 in the sham-ECT group showed a ≥50 % total PANSS score reduction. Both groups showed no significant differences of the total PANSS score (F = 0.12; p = 0.73), Positive (F = 0.27, p = 0.61), Negative (F = 0.25, p = 0.62), and General Psychopathology scores (F = 0.01, p = 0.94) as well for all PANSS five factors, the PANSS-6 and CDRS. Thus, the present study found no evidence that ECT is better than Sham-ECT in patients with CRS. Future sham-ECT controlled studies with larger sample sizes are warranted to test the efficacy of ECT for patients with CRS.
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Affiliation(s)
- D L Melzer-Ribeiro
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - I C Napolitano
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - S A Leite
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - J A Alencar de Souza
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - A D B Vizzotto
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - E S Di Sarno
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - M Fortes
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - M L Gomes
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - G M de Oliveira
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - B S Avrichir
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - L L Talib
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil
| | - C U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - H Elkis
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Brazil.
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5
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Mo Y, Shi ZM, Yang XH, Lan XJ, Deng CJ, Huang XB, Tan XL, Pridmore S, Ungvari GS, Xiang YT, Zheng W. Deep transcranial magnetic stimulation for schizophrenia: a systematic review. Front Psychiatry 2024; 15:1390913. [PMID: 38881546 PMCID: PMC11176548 DOI: 10.3389/fpsyt.2024.1390913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Background The efficacy and safety of deep transcranial magnetic stimulation (dTMS) as an intervention for schizophrenia remain unclear. This systematic review examined the efficacy and safety of dTMS for schizophrenia. Methods A systematic search of Chinese (WanFang and Chinese Journal Net) and English databases (PubMed, EMBASE, PsycINFO, and Cochrane Library) were conducted. Results Three randomized clinical trials (RCTs) comprising 80 patients were included in the analyses. Active dTMS was comparable to the sham treatment in improving total psychopathology, positive symptoms, negative symptoms, and auditory hallucinations measured by the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Auditory Hallucinations Rating Scale (AHRS), respectively. Only one RCT reported the effects on neurocognitive function measured by the Cambridge Neuropsychological Test Automated Battery (CANTAB), suggesting that dTMS may only improve one Stockings of Cambridge measure (i.e., subsequent times for five move problems). All three studies reported overall discontinuation rates, which ranged from 16.7% to 44.4%. Adverse events were reported in only one RCT, the most common being tingling/twitching (30.0%, 3/10), head/facial discomfort (30.0%, 3/10), and back pain (20.0%, 2/10). Conclusion This systematic review suggests that dTMS does not reduce psychotic symptoms in schizophrenia, but it shows potential for improving executive functions. Future RCTs with larger sample sizes focusing on the effects of dTMS on psychotic symptoms and neurocognitive function in schizophrenia are warranted to further explore these findings.
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Affiliation(s)
- Yu Mo
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Zhan-Ming Shi
- Department of Psychiatry, Chongqing Jiangbei Second Hospital, Chongqing, China
| | - Xin-Hu Yang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xian-Jun Lan
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Can-Jin Deng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xing-Bing Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiao-Lin Tan
- Department of Psychiatry, Chongqing mental health center, Chongqing, China
| | - Saxby Pridmore
- Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Gabor S Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Wei Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
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Skouras S, Kleinert ML, Lee EHM, Hui CLM, Suen YN, Camchong J, Chong CSY, Chang WC, Chan SKW, Lo WTL, Lim KO, Chen EYH. Aberrant connectivity in the hippocampus, bilateral insula and temporal poles precedes treatment resistance in first-episode psychosis: a prospective resting-state functional magnetic resonance imaging study with connectivity concordance mapping. Brain Commun 2024; 6:fcae094. [PMID: 38707706 PMCID: PMC11069118 DOI: 10.1093/braincomms/fcae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 12/04/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Functional connectivity resting-state functional magnetic resonance imaging has been proposed to predict antipsychotic treatment response in schizophrenia. However, only a few prospective studies have examined baseline resting-state functional magnetic resonance imaging data in drug-naïve first-episode schizophrenia patients with regard to subsequent treatment response. Data-driven approaches to conceptualize and measure functional connectivity patterns vary broadly, and model-free, voxel-wise, whole-brain analysis techniques are scarce. Here, we apply such a method, called connectivity concordance mapping to resting-state functional magnetic resonance imaging data acquired from an Asian sample (n = 60) with first-episode psychosis, prior to pharmaceutical treatment. Using a longitudinal design, 12 months after the resting-state functional magnetic resonance imaging, we measured and classified patients into two groups based on psychometric testing: treatment responsive and treatment resistant. Next, we compared the two groups' connectivity concordance maps that were derived from the resting-state functional magnetic resonance imaging data at baseline. We have identified consistently higher functional connectivity in the treatment-resistant group in a network including the left hippocampus, bilateral insula and temporal poles. These data-driven novel findings can help researchers to consider new regions of interest and facilitate biomarker development in order to identify treatment-resistant schizophrenia patients early, in advance of treatment and at the time of their first psychotic episode.
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Affiliation(s)
- Stavros Skouras
- Department of Fundamental Neurosciences, Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
- Department of Neurology, Inselspital University Hospital Bern, CH3010 Bern, Switzerland
| | | | - Edwin H M Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Christy L M Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Jazmin Camchong
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
| | | | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Sherry K W Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - William T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, China
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
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Pandey A, Joseph R, Arumugham SS, Thirthalli J. Erroneous conclusions about the long-term cognitive effects of electroconvulsive therapy. Psychiatry Res 2024; 335:115864. [PMID: 38547602 DOI: 10.1016/j.psychres.2024.115864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Abhinav Pandey
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Rini Joseph
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
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Cipolla S, Catapano P, D’Amico D, Monda R, Sallusto NP, Perris F, De Santis V, Catapano F, Luciano M, Fiorillo A. Combination of Two Long-Acting Antipsychotics in Schizophrenia Spectrum Disorders: A Systematic Review. Brain Sci 2024; 14:433. [PMID: 38790412 PMCID: PMC11117856 DOI: 10.3390/brainsci14050433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Up to 34% of patients with schizophrenia are resistant to several treatment trials. Lack of continuous and adequate treatment is associated with relapse, rehospitalization, a lower effect of antipsychotic therapy, and higher risk of side effects. Long-acting injectables antipsychotics (LAI APs) enhance compliance and improve clinical outcomes and quality of life in patients with schizophrenia, and thus it may be advisable to administer two LAI APs at the same time in cases of treatment-resistant schizophrenia. The purpose of this review is to summarize the available literature regarding the combined use of two LAI APs in patients with schizophrenia or other psychotic spectrum disorders. METHODS An extensive literature search for relevant articles regarding any combination of two long-acting injectable antipsychotics has been performed from inception up to 9 February 2024, on PubMed, Scopus and APA PsycInfo, according to the PRISMA statement. Only studies reporting combination of two LAI APs and its clinical outcome in patients with schizophrenia and related disorders were selected. RESULTS After the selection process, nine case reports, four case series and two observational retrospective studies were included in the final analysis. All patients treated with dual LAI APs reported a good response, and no new or unexpected adverse effects due to the combination of two LAIs were reported. Different drug combinations were used, and the most frequent association resulted in aripiprazole monohydrate + paliperidone palmitate once monthly (32 times). CONCLUSIONS Our review highlights that the treatment regimen with two concurrent LAI APs is already widely used in clinical practice and is recognized as providing a promising, effective, and relatively safe therapeutic strategy for treating the schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mario Luciano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (S.C.); (P.C.); (D.D.); (R.M.); (N.P.S.); (F.P.); (V.D.S.); (F.C.); (A.F.)
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Lee J, Huh S, Park K, Kang N, Yu HS, Park HG, Kim YS, Kang UG, Won S, Kim SH. Behavioral and transcriptional effects of repeated electroconvulsive seizures in the neonatal MK-801-treated rat model of schizophrenia. Psychopharmacology (Berl) 2024; 241:817-832. [PMID: 38081977 DOI: 10.1007/s00213-023-06511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024]
Abstract
RATIONALE Electroconvulsive therapy (ECT) is an effective treatment modality for schizophrenia. However, its antipsychotic-like mechanism remains unclear. OBJECTIVES To gain insight into the antipsychotic-like actions of ECT, this study investigated how repeated treatments of electroconvulsive seizure (ECS), an animal model for ECT, affect the behavioral and transcriptomic profile of a neurodevelopmental animal model of schizophrenia. METHODS Two injections of MK-801 or saline were administered to rats on postnatal day 7 (PN7), and either repeated ECS treatments (E10X) or sham shock was conducted daily from PN50 to PN59. Ultimately, the rats were divided into vehicle/sham (V/S), MK-801/sham (M/S), vehicle/ECS (V/E), and MK-801/ECS (M/E) groups. On PN59, prepulse inhibition and locomotor activity were tested. Prefrontal cortex transcriptomes were analyzed with mRNA sequencing and network and pathway analyses, and quantitative real-time polymerase chain reaction (qPCR) analyses were subsequently conducted. RESULTS Prepulse inhibition deficit was induced by MK-801 and normalized by E10X. In M/S vs. M/E model, Egr1, Mmp9, and S100a6 were identified as center genes, and interleukin-17 (IL-17), nuclear factor kappa B (NF-κB), and tumor necrosis factor (TNF) signaling pathways were identified as the three most relevant pathways. In the V/E vs. V/S model, mitophagy, NF-κB, and receptor for advanced glycation end products (RAGE) pathways were identified. qPCR analyses demonstrated that Igfbp6, Btf3, Cox6a2, and H2az1 were downregulated in M/S and upregulated in M/E. CONCLUSIONS E10X reverses the behavioral changes induced by MK-801 and produces transcriptional changes in inflammatory, insulin, and mitophagy pathways, which provide mechanistic insight into the antipsychotic-like mechanism of ECT.
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Affiliation(s)
- Jeonghoon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seonghoo Huh
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungtaek Park
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Nuree Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sook Yu
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hong Geun Park
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Ung Gu Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungho Won
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program of Bioinformatics, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- RexSoft Inc., Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Tandon R, Nasrallah H, Akbarian S, Carpenter WT, DeLisi LE, Gaebel W, Green MF, Gur RE, Heckers S, Kane JM, Malaspina D, Meyer-Lindenberg A, Murray R, Owen M, Smoller JW, Yassin W, Keshavan M. The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophr Res 2024; 264:1-28. [PMID: 38086109 DOI: 10.1016/j.schres.2023.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI 49008, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine Cincinnati, OH 45267, United States of America
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, United States of America
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Dusseldorf, Heinrich-Heine University, Dusseldorf, Germany
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States of America; Greater Los Angeles Veterans' Administration Healthcare System, United States of America
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States of America
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY 11004, United States of America
| | - Dolores Malaspina
- Department of Psychiatry, Neuroscience, Genetics, and Genomics, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannhein/Heidelberg University, Mannheim, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK
| | - Michael Owen
- Centre for Neuropsychiatric Genetics and Genomics, and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Psychiatric and Neurodevelopmental Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Walid Yassin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
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Nyhuis P, Mücke D, Specka M, Scherbaum N. Augmentation of Electroconvulsive Therapy with Oral Caffeine: A Retrospective Analysis of 40 Patients with Major Depression. PHARMACOPSYCHIATRY 2024; 57:30-34. [PMID: 37995720 DOI: 10.1055/a-2197-9635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Studies have demonstrated the efficacy of injectable caffeine as an augmentation method in electroconvulsive therapy (ECT). This study investigated whether orally administered caffeine increases seizure duration during ECT. METHODS Medical records of 40 patients treated with a series of ECT were retrospectively analyzed. Patients whose electroencephalogram (EEG) seizure duration had dropped<30 s, or motor seizure duration<15 s were included. They subsequently received oral caffeine (0.2 g) before ECT sessions. Primary outcomes were EEG seizure duration and motor seizure duration, compared with those from the last pre-caffeine session (baseline) and the first five caffeine-augmented sessions. The mental state was assessed with the Global Assessment of Functioning (GAF). In addition, data on maximum heart rate, maximal arterial pressure, and adverse effects were collected. RESULTS The EEG seizure duration increased by 14.9 s (52%) on average between baseline and the first caffeine-augmented session. The increased length remained widely stable over the subsequent ECT sessions. EEG seizure duration was>30 s in more than 80% of sessions. A statistically significant increase in motor seizure duration appeared only in the 2nd and 3rd of five sessions with augmentation. Oral caffeine pretreatment was overall well tolerated. The percentage of patients with at least serious mental impairment (GAF score≤50) dropped from 77.5 to 15%. CONCLUSIONS Results suggest the utility of oral caffeine (0.2 g) to increase ECT-induced seizures in patients with durations below clinically significant thresholds.
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Affiliation(s)
- Peter Nyhuis
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Dorothea Mücke
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Michael Specka
- LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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12
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Sahib Din J, Boes T, Navarro Garcia E, Al-Rubaye H. The Role of Electroconvulsive Therapy in the Treatment of Catatonia Associated With Lewy Body Dementia: A Case Report. Cureus 2024; 16:e52500. [PMID: 38371130 PMCID: PMC10874228 DOI: 10.7759/cureus.52500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Catatonia is a complex amalgamation of neuropsychiatric symptoms that can manifest in both psychiatric and neurological conditions. The treatment of catatonia related to psychiatric illnesses is well documented as it typically responds to benzodiazepines and electroconvulsive therapy (ECT). However, the treatment of catatonia related to neurological disorders has shown to be more difficult, particularly when associated with Lewy Body Dementia (LBD). Here, we present the case of a 78-year-old woman with LBD, Bipolar I, depressive type, who successfully underwent twelve ECT sessions to treat catatonia refractory to benzodiazepine therapy. The effectiveness of the treatment was measured using the Bush-Françis Catatonia Scale (BFCS) to measure her catatonic symptoms as she progressed through the therapy. This report highlights the importance of considering ECT as a leading therapeutic approach in this particular subset of patients who do not respond adequately to pharmaceutical therapy and medical titrations.
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Affiliation(s)
| | - Thomas Boes
- Neuropsychiatry, Manhattan Psychiatric Center, New York, USA
| | - Ernesto Navarro Garcia
- Nanotechnology, University of Central Florida, Orlando, USA
- Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | - Hiba Al-Rubaye
- Neuroscience, St. George's University School of Medicine, St. George's, GRD
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13
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Koh AHK, Tan XW, Tor PC, Chatterton ML, Martin DM, Loo CK. The association between outpatient continuation/maintenance electroconvulsive therapy, readmission risk and total direct cost in patients with depressive, bipolar and psychotic disorders: A naturalistic retrospective cohort study. J Affect Disord 2023; 338:289-298. [PMID: 37295655 DOI: 10.1016/j.jad.2023.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The transdiagnostic effect of continuation/maintenance ECT (CM-ECT) across mood and psychotic disorders on hospital psychiatric readmission risk and total direct cost remains unclear. METHODS A naturalistic retrospective analysis of 540 patients who received inpatient acute ECT treatment from May 2017 to Mar 2021 in a tertiary psychiatric institution. Patients were assessed with validated clinical rating scales pre-ECT and after the first 6 treatments of a course of inpatient acute ECT. After discharge, patients who continued with CM-ECT were compared with those not receiving CM-ECT using survival analysis of hospital readmission. Total direct cost (hospitalisation and ECT treatment cost) was also analysed. All patients were subjected to a standard post-discharge monitoring program with case managers checking in on the patients regularly after discharge and ensuring they were given an outpatient appointment within a month of discharge. RESULTS Both cohorts had significant improvement in their rating scales scores after their first six 6 sessions of inpatient acute ECT. Patients who continued with CM-ECT after completing their inpatient acute ECT (mean number of acute ECT: N = 9.9, SD 5.3), had a significantly lower risk of readmission [adjusted hazard ratio of 0.68 (95 % CI: 0.49-0.94, p = 0.020)]. Patients who received CM-ECT also had a significantly lower average total direct cost compared to those who did not (SGD$35,259 vs SGD$61,337). For patients with mood disorders, the CM-ECT group had a significantly lower inpatient ECT cost, hospitalisation cost and total direct costs compared to those without CM-ECT. LIMITATIONS The naturalistic study cannot prove a causal relationship between CM-ECT and reduced readmission and lower healthcare costs. CONCLUSION CM-ECT is associated with lower readmission risks and lower total direct healthcare costs for the treatment of mood and psychotic disorders, especially for mood disorders.
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Affiliation(s)
- Azriel H K Koh
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore
| | - Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore
| | - Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore.
| | - Mary Lou Chatterton
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Donel M Martin
- Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, Sydney, New South Wales, Australia
| | - Colleen K Loo
- Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, Sydney, New South Wales, Australia
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14
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Pape A, Kittel-Schneider S. [Practice of anaesthesia for electroconvulsive therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:422-435. [PMID: 37582353 DOI: 10.1055/a-1925-6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Electroconvulsive therapy (ECT) is an established therapeutic method for the treatment of severe mental disorders refractory to pharmaco- and psychotherapy. ECT is a first-line treatment option in delusional disorders, severe depression with acute suicidal tendency or life-threatening catatonia. Usually, ECT is performed as a treatment series. Under short-term anaesthesia and muscle relaxation, tonic-clonic seizures are induced using an external stimulation electrode. Convulsion can be exerted by uni- or bipolar stimulation using an electric charge up to 1000 millicoulomb (mC) with an amperage of 900 mA. Muscular relaxation is necessary to prevent injuries caused by uncontrolled movements during convulsion. During paralysis, consciousness is blocked by general anaesthesia, although ECT is associated with antegrade amnesia for seizure induction and the seizure itself. In the context of ECT, the ideal hypnotic should be characterised by rapid onset, short duration of action and negligible anticonvulsive effects (i.e., least possible impact on seizure quality and duration). As mutual awareness of psychiatric and anaesthesiologic techniques is essential for safe and effective conduction of ECT, this article presents ECT both from the psychiatrist's and the anaesthesiologist's perspective.
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15
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Kawashima H, Yamasaki S, Kubota M, Hazama M, Fushimi Y, Miyata J, Murai T, Suwa T. Commonalities and differences in ECT-induced gray matter volume change between depression and schizophrenia. Neuroimage Clin 2023; 38:103429. [PMID: 37150022 PMCID: PMC10193002 DOI: 10.1016/j.nicl.2023.103429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for depression and schizophrenia, particularly in urgent or treatment-resistant cases. After ECT, regional gray matter volume (GMV) increases have been repeatedly reported both in depression and schizophrenia. However, the interpretation of these findings remains entangled because GMV changes do not necessarily correlate with treatment effects and may be influenced by the intervention itself. We hypothesized that the comparison of longitudinal magnetic resonance imaging data between the two diagnostic groups will provide clues to distinguish diagnosis-specific and transdiagnostic changes. METHOD Twenty-nine Japanese participants, including 18 inpatients with major depressive disorder and 11 with schizophrenia, underwent longitudinal voxel-based morphometry before and after ECT. We investigated GMV changes common to both diagnostic groups and those specific to each group. Moreover, we also evaluated potential associations between GMV changes and clinical improvement for each group. RESULTS In both diagnostic groups, GMV increased in widespread areas after ECT, sharing common regions including: anterior temporal cortex; medial frontal and anterior cingulate cortex; insula; and caudate nucleus. In addition, we found a schizophrenia-specific GMV increase in a region including the left pregenual anterior cingulate cortex, with volume increase significantly correlating with clinical improvement. CONCLUSIONS Transdiagnostic volume changes may represent the effects of the intervention itself and pathophysiological changes common to both groups. Conversely, diagnosis-specific volume changes are associated with treatment effects and may represent pathophysiology-specific impacts of ECT.
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Affiliation(s)
- Hirotsugu Kawashima
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shimpei Yamasaki
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Kubota
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaaki Hazama
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Wang Z, Zou Z, Xiao J, Min W, Nan LP, Yuan C, Yuan L, Yang C, Huang R, He Y. Brain-derived neurotrophic factor blood levels after electroconvulsive therapy in patients with mental disorders: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 83:86-92. [PMID: 37148598 DOI: 10.1016/j.genhosppsych.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Multiple studies have indicated that electroconvulsive therapy (ECT) could increase brain-derived neurotrophic factor (BDNF) concentrations in patients with different mental disorders. The aim of this synthesis was to evaluate post-ECT BDNF concentrations in patients with various mental disorders. METHODS The Embase, PubMed and Web of Science databases were systematically searched for studies in English comparing BDNF concentrations before and after ECT through 11/2022. We extracted the pertinent information from the included studies and evaluated their quality. The standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated to quantify BDNF concentration differences. RESULTS In total, 35 studies assessed BDNF concentrations in 868 and 859 patients pre and post-ECT treatment, respectively. Post-ECT-treatment BDNF concentrations were significantly higher than the pretreatment concentrations (Hedges'g = -0.50, 95% CI (-0.70, -0.30), heterogeneity I2 = 74%, p < 0.001). The analysis that combined both ECT responders and non-responders demonstrated a marked increase in total BDNF levels subsequent to ECT treatment (Hedges'g = -0.27, 95% CI (-0.42, -0.11), heterogeneity I2 = 40%, p = 0.0007). CONCLUSION Irrespective of the effectiveness of ECT, Our study shows that peripheral BDNF concentrations increase significantly after the entire course of ECT, which may enhance our comprehension of the interplay between ECT treatment and BDNF levels. However, BDNF concentrations were not associated with the effectiveness of ECT, and abnormal concentrations of BDNF may be linked to the pathophysiological process of mental illness, necessitating more future research.
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Affiliation(s)
- Zuxing Wang
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China.
| | - Zhili Zou
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Jun Xiao
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Wenjiao Min
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Li-Ping Nan
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Cui Yuan
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Lu Yuan
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Chenghui Yang
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Rui Huang
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - Ying He
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China.
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17
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Camprodon JA, Barbour T. Introduction. Harv Rev Psychiatry 2023; 31:97-100. [PMID: 37171470 DOI: 10.1097/hrp.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Joan A Camprodon
- From the Department of Psychiatry, Division of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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18
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Perry C, Budweg JB, Stein AP, Harder J, Gupta S, Nusbickel AJ, Smoot M, Patel K, Winchester DE. Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities. Am J Med 2023; 136:350-354. [PMID: 36566899 DOI: 10.1016/j.amjmed.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.
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Affiliation(s)
| | | | | | | | - Shishir Gupta
- University of Florida College of Medicine, Gainesville
| | | | | | - Keval Patel
- University of Florida College of Medicine, Gainesville
| | - David E Winchester
- University of Florida College of Medicine, Gainesville; Cardiology Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, Fla.
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19
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Purohith AN, Vaidyanathan S, Udupa ST, Munoli RN, Agarwal S, Prabhu MA, Praharaj SK. Electroconvulsive Therapy in Patients With Cardiac Implantable Electronic Devices: A Case Report and Systematic Review of Published Cases. J ECT 2023; 39:46-52. [PMID: 35482902 PMCID: PMC7614513 DOI: 10.1097/yct.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of the study were to report the case of a 54-year-old man with recurrent depressive disorder with multiple medical comorbidities having a dual-chamber pacemaker, treated successfully with 11 sessions of electroconvulsive therapy, and to conduct a systematic review of published cases documenting the use of electroconvulsive therapy (ECT) in patients with cardiac implantable electronic devices (CIEDs) for treating major psychiatric disorders. METHODS We searched electronic databases (MEDLINE, PubMed, Google Scholar, Embase, Cochrane Library, PsycINFO, and Crossref) and included studies reporting on the use of electroconvulsive therapy in patients with CIEDs. RESULTS Thirty-five publications across 53 years (1967-2021) reported on 76 patients (including current report) who received a pooled total of 979 modified ECT sessions. The most common adverse events were premature ventricular contraction and hypertension. There have been no reports of serious adverse effects that necessitated the cessation of ECT. CONCLUSIONS Electroconvulsive therapy is a safe and efficacious treatment for major psychiatric disorders, and the presence of CIEDs should not delay or deter the use of ECT in these patients.
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Affiliation(s)
- Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sivapriya Vaidyanathan
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Suma T. Udupa
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindra N. Munoli
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sheena Agarwal
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mukund A Prabhu
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Qureshi H, Jain L. Late to respond, but early to relapse - An abnormal course of electroconvulsive therapy in treatment-resistant schizophrenia during times of COVID-19. PSYCHIATRY RESEARCH CASE REPORTS 2022; 1:100052. [PMID: 36188755 PMCID: PMC9511015 DOI: 10.1016/j.psycr.2022.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Haris Qureshi
- Department of Psychiatry, UConn School of Medicine, Farmington, CT, United States
| | - Lakshit Jain
- Department of Psychiatry, UConn School of Medicine, Farmington, CT, United States
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21
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Goh KK, Chen CH, Wu TH, Chiu YH, Lu ML. Efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia: A meta-analysis of randomized sham-controlled trials. Front Pharmacol 2022; 13:944437. [PMID: 36071833 PMCID: PMC9441632 DOI: 10.3389/fphar.2022.944437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Theta-burst stimulation is a non-invasive brain stimulation technique that was introduced as a potential augmentation treatment for patients with schizophrenia. The purpose of this meta-analysis was to investigate the therapeutic efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia. Following the PRISMA guidelines, the MEDLINE, Embase, Cochrane, Scopus, Web of Science, and CNKI databases were searched for relevant studies from database inception to 9 January 2022. Change in symptom severity among patients with schizophrenia was the primary outcome, and changes in cognitive function and safety profiles, including the discontinuation rate and adverse events, were secondary outcomes. In total, 13 double-blind randomized sham-controlled trials with 524 patients were included. Intermittent theta-burst stimulation adjunct to antipsychotics was associated with significantly improved psychopathology in patients with schizophrenia, particularly for negative symptoms and general psychopathology but not for positive symptoms or cognitive function. The stimulation parameters influenced the effectiveness of intermittent theta-burst stimulation. A more favorable effect was observed in patients who received theta-burst stimulation at the left dorsolateral prefrontal cortex, with ≥1800 pulses per day, for ≥20 sessions, and using an inactive sham coil as a placebo comparison in the study. The intermittent theta-burst stimulation is well tolerated and safe in patients with schizophrenia. Intermittent theta-burst stimulation adjunct to antipsychotics treatment is associated with significant improvement in negative symptoms and favorable tolerability in patients with schizophrenia. This meta-analysis may provide insights into the use of intermittent theta-burst stimulation as an additional treatment to alleviate the negative symptoms of schizophrenia.
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Affiliation(s)
- Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Centre, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Centre, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Hua Wu
- Psychiatric Research Centre, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hang Chiu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Centre, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Centre, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Mong-Liang Lu,
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22
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Sugita K, Mori Y, Kanemoto K, Sugita S. Long-lasting leukocytosis in patients with schizophrenia treated with clozapine after electroconvulsive therapy : ECT stabilizes white blood cell count. Sci Prog 2022; 105:368504221117067. [PMID: 36000301 PMCID: PMC10358617 DOI: 10.1177/00368504221117067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The present study was conducted to investigate the possible hematologic impact of long-term electroconvulsive therapy (ECT) in patients with drug-resistant schizophrenia and receiving clozapine therapy. SUBJECTS AND METHODS In this retrospective study, clinical charts of 57 hospitalized patients with schizophrenia who required clozapine therapy because of active psychotic symptoms resistant to other antipsychotics were examined. For 18 who underwent ECT, the first assessment was conducted at the end of that therapy (average two months after start, 7.68 sessions) and the second two months later. As for the 39 patients who did not undergo ECT, the first and second assessment points were at two and four months, respectively, after a randomly chosen time point. RESULTS Multiple regression analysis revealed that modified ECT (m-ECT) (ß = 0.346, p = 0.005), gender (males showed greater increase) (ß = 0.273, p = 0.023), and disease duration (longer associated with greater increase) (ß = 0.258, p = 0.033) were correlated with a change in white blood cell (WBC) count (ΔR2 = 0.277, p < 0.001) at the first assessment point. At the second assessment point, multiple regression analysis showed that m-ECT (ß = 0.262, p = 0.039), gender (males showed greater increase) (ß = 0.264, p = 0.036), and disease duration (longer associated with greater increase) (ß = 0.234, p = 0.068) were again correlated with changed WBC count (ΔR2 = 0.203, p < 0.007). DISCUSSION An increase in leukocytes may have a protective influence against the adverse myelosuppressive effects of clozapine. However, a simple mobilization of leukocytes from bone marrow to peripheral circulation may not enhance the immune system, leading to only a masking of the effects of a potential immuno-insufficient state in the treated patient. In either case, should leukocytosis be induced and then remain for an extended period, hematologists, as well as psychiatrists involved in electroconvulsive intervention for clozapine-treated patients, must keep this factor in mind.
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Affiliation(s)
- Kotaro Sugita
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
| | - Yasuhiro Mori
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
| | - Kousuke Kanemoto
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
| | - Sotaro Sugita
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
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23
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Rosson S, de Filippis R, Croatto G, Collantoni E, Pallottino S, Guinart D, Brunoni AR, Dell'Osso B, Pigato G, Hyde J, Brandt V, Cortese S, Fiedorowicz JG, Petrides G, Correll CU, Solmi M. Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review. Neurosci Biobehav Rev 2022; 139:104743. [PMID: 35714757 DOI: 10.1016/j.neubiorev.2022.104743] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear. METHODS We conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE. RESULTS We selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRADE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high-quality meta-analyses/low-quality RCTs), GRADE low. DISCUSSION Despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines. FUNDING None.
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Affiliation(s)
- Stella Rosson
- Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Neurosciences, University of Padua, Padua, Italy
| | - Renato de Filippis
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giovanni Croatto
- Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy; Department of Neurosciences, University of Padua, Padua, Italy
| | | | | | - Daniel Guinart
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mard'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil; Departamentos de Clínica Médica e Psiquiatria, Faculdade de Medicina da USP, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA; Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
| | - Giorgio Pigato
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Georgios Petrides
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Division of ECT, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK; Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany; Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada.
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24
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Wang Z, Shi Q, Zhou Q, Zhao S, Hou R, Lu S, Gao X, Chen Y. Retracted systematic reviews were continued to be frequently cited: A Citation Analysis. J Clin Epidemiol 2022; 149:137-145. [PMID: 35636592 DOI: 10.1016/j.jclinepi.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To survey the citations of retracted non-Cochrane systematic reviews (SRs) in scientific literature . STUDY DESIGN AND SETTING We searched the Web of Science and Google Scholar from their inception to 30 April 2020 to find the citations of 153 previously identified retracted non-Cochrane SRs. We calculated the numbers of citations before and after retraction separately. We also described how the citation addressed the retraction and how it was used in the article. RESULTS A We identified 954 citations of 128 retracted SRs. The number of retracted SRs and citations reached the peak in 2014 and 2016, respectively, and the majority of the citations (n=580, 60.8%) were in articles published after the SR was retracted. The mean number of citation per retracted SRs was 7.5. 2.6 before and 4.5 after the publication of the retraction notice. Twenty-nine (5.0%) citations indicated the retraction of the SRs in the reference section. Nine of these citations supported the retracted SR's results, and 15 disagreed with them. CONCLUSION Retracted SRs continue to be cited after the publication of the retraction notice. Standardized methods are needed to guide the management of retractions and avoid inappropriate citations of retracted articles.
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Affiliation(s)
- Zijun Wang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Qi Zhou
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Siya Zhao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Ruizhen Hou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Shuya Lu
- Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xia Gao
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China; Guideline International Network Asia, Lanzhou, China; Chinese GRADE Center, Lanzhou, China.
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25
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Holden J, Begum M. Successful rechallenge after clozapine-associated myocarditis. BMJ Case Rep 2022; 15:e248909. [PMID: 35550318 PMCID: PMC9109022 DOI: 10.1136/bcr-2022-248909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/03/2022] Open
Abstract
Clozapine is a highly effective medication used in management of treatment-resistant schizophrenia. Clozapine-associated myocarditis (CAM) is a rare but increasingly recognised complication of clozapine titration. Following an episode of CAM, clinicians can face a challenging dilemma of balancing the risks of recurrent myocarditis against the harms of ongoing psychosis. We describe the case of a woman in her 60s who developed acute myocarditis during clozapine titration and was then cautiously rechallenged with a successful outcome.
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Affiliation(s)
- John Holden
- Psychiatry, NHS Ayrshire and Arran Woodland View, Irvine, UK
| | - Milia Begum
- Psychiatry, NHS Ayrshire and Arran Woodland View, Irvine, UK
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26
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Liu Y, Jia LN, Wu H, Jiang W, Wang Q, Wang D, Xiong YB, Ren YP, Ma X, Tang YL. Adjuvant electroconvulsive therapy with antipsychotics is associated with improvement in auditory mismatch negativity in schizophrenia. Psychiatry Res 2022; 311:114484. [PMID: 35245745 DOI: 10.1016/j.psychres.2022.114484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Yi Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li-Na Jia
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Han Wu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wei Jiang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qian Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dan Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yan-Bing Xiong
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yan-Ping Ren
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Xin Ma
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Deshengmenwai Avenue, Xicheng District, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, United States; Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA 30033, United States
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27
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Gong J, Cui LB, Zhao YS, Liu ZW, Yang XJ, Xi YB, Liu L, Liu P, Sun JB, Zhao SW, Liu XF, Jia J, Li P, Yin H, Qin W. The correlation between dynamic functional architecture and response to electroconvulsive therapy combined with antipsychotics in schizophrenia. Eur J Neurosci 2022; 55:2024-2036. [PMID: 35388553 DOI: 10.1111/ejn.15664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
Attempts to determine why some patients respond to electroconvulsive therapy (ECT) are valuable in schizophrenia. Schizophrenia is associated with aberrant dynamic functional architecture, which might impact the efficacy of ECT. We aimed to explore the relationship between pre-treatment temporal variability and ECT acute efficacy. Forty-eight patients with schizophrenia and thirty healthy controls underwent functional magnetic resonance imaging to examine whether patterns of temporary variability of functional architecture differ between high responders (HR) and low responders (LR) at baseline. Compared with LR, HR exhibited significantly abnormal temporal variability in right inferior front gyrus (IFGtriang.R), left temporal pole (TPOsup.L) and right middle temporal gyrus (MTG.R). In the pooled patient group, ∆PANSS was correlated with the temporal variability of these regions. Patients with schizophrenia with a distinct dynamic functional architecture appear to reveal differential response to ECT. Our findings provide not only an understanding of the neural functional architecture patterns that are found in schizophrenia but also the possibility of using these measures as moderators for ECT selection.
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Affiliation(s)
- Jie Gong
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Long-Biao Cui
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, China.,Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China
| | - Ying-Song Zhao
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Zhao-Wen Liu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Xue-Juan Yang
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Yi-Bin Xi
- Department of Radiology, Xi'an People's Hospital, Xi'an, China
| | - Lin Liu
- Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Peng Liu
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Jin-Bo Sun
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Shu-Wan Zhao
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao-Fan Liu
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Jia
- Department of Early Intervention, Xi'an Mental Health Center, Xi'an, Shaanxi, China
| | - Ping Li
- Department of Medical Imaging, Xi'an Mental Health Center, Xi'an, Shaanxi, China
| | - Hong Yin
- Department of Radiology, Xi'an People's Hospital, Xi'an, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Qin
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
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28
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Joo SW, Kim H, Jo YT, Ahn S, Choi YJ, Choi W, Park S, Lee J. One-Year Clinical Outcomes Following Electroconvulsive Therapy for Patients with Schizophrenia: A Nationwide Health Insurance Data-Based Study. Neuropsychiatr Dis Treat 2022; 18:1645-1652. [PMID: 35968513 PMCID: PMC9374090 DOI: 10.2147/ndt.s373222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although the use of electroconvulsive therapy (ECT) in the treatment of schizophrenia has decreased since the advent of antipsychotic drugs, ECT is still implemented in several clinical indications. However, a few population-based studies have examined its real-world effectiveness in schizophrenia. METHODS We used data from 2010 to 2019 from the Health Insurance Review and Assessment Service database in the Republic of Korea. We selected 380 schizophrenia patients having more than six ECT sessions and 1140 patient controls matched for age, sex, calendar year at entry, and the number of psychiatric hospitalizations before the time point of start of psychiatric hospitalization for ECT. Antipsychotic treatment discontinuation, psychiatric hospitalization, and direct medical costs were used as measures of clinical outcomes. Multiple regression analysis was used for any group-by-time interaction effect, and 1-year pre- and post-ECT periods were compared within and between the groups. RESULTS We found a significantly lower number of antipsychotic treatment discontinuations in the ECT group during the 1-year post-ECT period (t=2.195, p=0.028). A larger decrease was found in the number of psychiatric hospitalizations in the ECT group, with a group-by-time interaction effect (p=0.043). The direct medical costs in the 1-year pre- (t=-8.782, p<0.001) and post-ECT periods (t=-9.107, p<0.001) were higher in the ECT group than in the control group, with no significant change across both periods. CONCLUSION We found that the ECT group had a larger decrease in the number of psychiatric hospitalizations in the 1-year post-ECT period than the control group.
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Affiliation(s)
- Sung Woo Joo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Tak Jo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soojin Ahn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jae Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woohyeok Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soyeon Park
- Department of Psychiatry, Medical Foundation Yongin Mental Hospital, Yongin, Republic of Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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29
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Yang Y, Kong D, Li Q, Chen W, Zhao G, Tan X, Huang X, Zhang Z, Feng C, Xu M, Wan Y, Yang M. Non-antipsychotic medicines and modified electroconvulsive therapy are risk factors for hospital-acquired pneumonia in schizophrenia patients. Front Psychiatry 2022; 13:1071079. [PMID: 36713903 PMCID: PMC9880231 DOI: 10.3389/fpsyt.2022.1071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) has a significant and detrimental impact on schizophrenia patients. Non-antipsychotic medicines and modified electroconvulsive therapy (MECT) are frequently used in conjunction with antipsychotics to treat schizophrenia. Whether non-antipsychotic medicines or MECT are risk factors for HAP in schizophrenia treated with antipsychotics is still unknown. METHODS Patients with schizophrenia who were admitted to the Fourth People's Hospital of Chengdu between January 2015 and April 2022 were included in this retrospective cohort study. Individuals with HAP were 1:1 matched to individuals without HAP (non-HAP) using propensity score matching (PSM). The risk factors for HAP were analyzed by comparing the two groups. RESULTS A total of 7,085 schizophrenia patients were included in this study, with a mean age of 39.77 ± 14.45 years. 193 patients developed HAP on an average of 22.26 ± 21.68 days after admission with an incidence of 2.73%. After 1:1 PSM, 192 patients from each group (HAP and non-HAP) were included. The HAP group had significantly more patients with MECT and taking benzodiazepines, antidepressants, mood stabilizers, and anti-parkinsonians both before and after PSM by Bonferroni correction (P < 0.001). Multivariate logistic regression analysis showed that, combined with antipsychotics, non-antipsychotic medicines including benzodiazepines (OR = 3.13, 95%CI = 1.95-5.03, P < 0.001), mood stabilizers (OR =3.33, 95%CI =1.79-6.20, P < 0.001) and MECT (OR =2.58, 95%CI =1.49-4.46, P = 0.001) were associated with a significantly increased incidence of HAP. CONCLUSION The incidence of HAP in schizophrenia patients in our cohort was 2.73%. MECT and non-antipsychotic medicines, including benzodiazepines and mood stabilizers were risk factors for HAP in schizophrenia patients treated with antipsychotics.
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Affiliation(s)
- Yan Yang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Di Kong
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qiwen Li
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Wei Chen
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Guocheng Zhao
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xi Tan
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xincheng Huang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zipeng Zhang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Can Feng
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Min Xu
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Ying Wan
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Mi Yang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China.,MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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Zhou J, Li J, Zhao Q, Ou P, Zhao W. Working memory deficits in children with schizophrenia and its mechanism, susceptibility genes, and improvement: A literature review. Front Psychiatry 2022; 13:899344. [PMID: 35990059 PMCID: PMC9389215 DOI: 10.3389/fpsyt.2022.899344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
The negative influence on the cognitive ability of schizophrenia is one of the issues widely discussed in recent years. Working memory deficits are thought to be a core cognitive symptom of schizophrenia and lead to poorer social functions and worse academic performance. Previous studies have confirmed that working memory deficits tend to appear in the prodromal phase of schizophrenia. Therefore, considering that children with schizophrenia have better brain plasticity, it is critical to explore the development of their working memory. Although the research in this field developed gradually in recent years, few researchers have summarized these findings. The current study aims to review the recent studies from both behavior and neuroimaging aspects to summarize the working memory deficits of children with schizophrenia and to discuss the pathogenic factors such as genetic susceptibility. In addition, this study put forward some practicable interventions to improve cognitive symptoms of schizophrenia from psychological and neural perspectives.
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Affiliation(s)
- Jintao Zhou
- School of Psychology, Nanjing Normal University, Nanjing, China.,Department of Psychology, Fudan University, Shanghai, China
| | - Jingfangzhou Li
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Qi Zhao
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, Macao SAR, China
| | - Peixin Ou
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, Macao SAR, China
| | - Wan Zhao
- School of Psychology, Nanjing Normal University, Nanjing, China
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Lecarpentier P, Gandré C, Coldefy M, Ellini A, Trichard C. Use of electroconvulsive therapy for individuals receiving inpatient psychiatric care on a nationwide scale in France: Variations linked to health care supply. Brain Stimul 2021; 15:201-210. [PMID: 34954085 DOI: 10.1016/j.brs.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A comprehensive understanding of variations in the use of electroconvulsive therapy (ECT) among health care providers in charge of ECT referrals is lacking. OBJECTIVE Our objectives were to document ECT use and its variations on a nationwide scale in France and to identify the factors that were significantly associated with these variations. METHODS Administrative health claims data on hospitalization were used to perform a descriptive analysis of ECT use for adult patients receiving inpatient psychiatric care in mainland France in 2019 and its variations across hospitals in charge of ECT referrals. Based on a conceptual framework drawn from the literature on medical practice variations, a multilevel logistic regression was then conducted to identify patients, hospitals and contextual characteristics that were significantly associated with ECT treatment using non-ECT-treated patients receiving inpatient psychiatric care as the reference population. RESULTS Patients receiving ECT (n = 3288) were older, more frequently female and had more severe diagnoses than other patients seen in inpatient care (n = 295,678). Significant variations were observed in the rate of ECT use across hospitals (n = 468), with a coefficient of variation largely above one. In the multivariable analysis, ECT treatment was associated with patient characteristics (which accounted for 6% of the variations) but also with characteristics of the hospitals and their environments (44% of the variations), including the type of hospital and its distance to the closest facility providing ECT. CONCLUSIONS Variations in ECT use were strongly linked to health care supply characteristics, which raises questions about access to quality mental health care.
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Affiliation(s)
- Pierre Lecarpentier
- EPS Barthélémy Durand, Psychiatry Department, Avenue Du 8 Mai 1945, 91150, Etampes, France; Institut de Recherche et Documentation en économie de la santé (IRDES), 117 bis Rue Manin, 75019, Paris, France
| | - Coralie Gandré
- Institut de Recherche et Documentation en économie de la santé (IRDES), 117 bis Rue Manin, 75019, Paris, France.
| | - Magali Coldefy
- Institut de Recherche et Documentation en économie de la santé (IRDES), 117 bis Rue Manin, 75019, Paris, France
| | - Anis Ellini
- Agence technique de l'information sur l'hospitalisation (ATIH), 13 Rue Moreau, 75012, Paris, France
| | - Christian Trichard
- EPS Barthélémy Durand, Psychiatry Department, Avenue Du 8 Mai 1945, 91150, Etampes, France
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Hajak VL, Hajak G, Ziegelmayer C, Grimm S, Trapp W. Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions. Front Psychol 2021; 12:767915. [PMID: 34887815 PMCID: PMC8650631 DOI: 10.3389/fpsyg.2021.767915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT. Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs. Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments. Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.
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Affiliation(s)
- Vivien L Hajak
- Department of Psychology, Medical School Berlin, Berlin, Germany.,Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Christoph Ziegelmayer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Simone Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany.,Department of Psychiatry, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Wolfgang Trapp
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany.,Department of Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.,Department of Psychology, University of Applied Sciences, Bamberg, Germany
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Iwanaga H, Ueno T, Oribe N, Hashimoto M, Nishimura J, Nakayama N, Haraguchi N, Tateishi H, Kunitake Y, Mizoguchi Y, Monji A. Correlation between Post-Acute Electroconvulsive Therapy Alpha-Band Spectrum Power Increase and Improvement of Psychiatric Symptoms. J Pers Med 2021; 11:jpm11121315. [PMID: 34945787 PMCID: PMC8703644 DOI: 10.3390/jpm11121315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
The results of quantitative electroencephalography (qEEG) studies on electroconvulsive therapy (ECT) have been inconsistent, and indicators of the efficacy of ECT have not been clearly identified. In this study, we examined whether qEEG could be used as an indicator of the effect of ECT by measuring it during the course of treatment. We analyzed qEEG data before and after acute-phase ECT in 18 patients with schizophrenia, mood disorders, and other psychiatric disorders. We processed the qEEG data and compared the spectral power between the data acquired before and after ECT. The spectral power increased significantly after ECT in the delta, theta, and alpha bands. There was a strong significant correlation between the increase in the spectral power of the alpha band after acute ECT and improvement in the Brief Psychiatric Rating Scale score. Our results suggest that an increase in the alpha-band spectral power may be useful as an objective indicator of the treatment effect of acute ECT.
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Affiliation(s)
- Hideyuki Iwanaga
- Department of Psychiatry, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (H.I.); (N.O.); (M.H.); (J.N.)
| | - Takefumi Ueno
- Department of Psychiatry, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (H.I.); (N.O.); (M.H.); (J.N.)
- Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (N.N.); (N.H.)
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Correspondence: ; Tel.: +81-952-52-3231
| | - Naoya Oribe
- Department of Psychiatry, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (H.I.); (N.O.); (M.H.); (J.N.)
- Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (N.N.); (N.H.)
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Manabu Hashimoto
- Department of Psychiatry, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (H.I.); (N.O.); (M.H.); (J.N.)
- Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (N.N.); (N.H.)
| | - Jun Nishimura
- Department of Psychiatry, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (H.I.); (N.O.); (M.H.); (J.N.)
| | - Naho Nakayama
- Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (N.N.); (N.H.)
| | - Nami Haraguchi
- Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, 160 Mitsu, Yoshinogari, Kanzaki, Saga 842-0192, Japan; (N.N.); (N.H.)
| | - Hiroshi Tateishi
- Department of Psychiatry, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan; (H.T.); (Y.K.); (Y.M.); (A.M.)
| | - Yutaka Kunitake
- Department of Psychiatry, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan; (H.T.); (Y.K.); (Y.M.); (A.M.)
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan; (H.T.); (Y.K.); (Y.M.); (A.M.)
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan; (H.T.); (Y.K.); (Y.M.); (A.M.)
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Possible Hypothetical Mode of Action of ECT (Electroconvulsive Therapy) Based on DNA Dipole Character and Epigenetics. ACTA MEDICA BULGARICA 2021. [DOI: 10.2478/amb-2021-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The human genome consists of roughly 23000 genes which cannot explain the enormous diversity of proteins or behavior. A second epigenetic code warrants adaptive variation of gene expression. The rationale of this variation are transfer reactions such as methylation, acetylation or phosphorylation of DNA or histones including reverse reactions which are supposed to be altered by electroconvulsive therapy (ECT). The method has been successfully used since the 1930ies but the underlying molecular mechanism of action has not been elucidated yet. The paper discusses the theoretical involvement of epigenetic gene expression as an adaptive process to explain biochemical changes after ECT administration.
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Døssing E, Pagsberg AK. Electroconvulsive Therapy in Children and Adolescents: A Systematic Review of Current Literature and Guidelines. J ECT 2021; 37:158-170. [PMID: 34424874 DOI: 10.1097/yct.0000000000000761] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACT There is a lack of studies regarding the efficacy of electroconvulsive therapy (ECT) in children and adolescents. In this study, we aimed to assess benefits and harms of ECT in children and adolescents with major psychiatric diseases. We conducted a systematic search in PubMed, EMBASE, and PsycINFO for peer-reviewed articles written in English regarding the use of ECT as treatment for major psychiatric diseases in children and adolescents. This study consists of 192 articles, mostly case studies (n = 50), reviews and overview articles (n = 52), and retrospective studies (n = 30). We present an overview of evidence for ECT in children and adolescents with mood disorders, catatonia, schizophrenia, intellectual disability, self-injurious behavior, and other indications. This article is also a summary of international guidelines regarding the use of ECT in children and adolescents. We evaluated the overall quality of evidence by using Grading of Recommendations, Assessment, Development and Evaluations and found the overall level of evidence to be of low quality. There are no absolute contra indications for ECT in children and adolescents. Fears regarding cognitive dysfunction have not been reproduced in studies. Electroconvulsive therapy should be considered in severe, treatment-resistant mood disorders, catatonia, and schizophrenia, especially in older adolescents. High-quality studies are warranted to assess the efficacy of ECT, especially in these potentially life-threatening diseases.
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Affiliation(s)
- Erik Døssing
- From the Child and Adolescent Mental Health Centre, Mental Health Services, Zealand Region, Roskilde
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36
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Baldaçara L, Grudtner RR, da S. Leite V, Porto DM, Robis KP, Fidalgo TM, Rocha GA, Diaz AP, Meleiro A, Correa H, Tung TC, Malloy-Diniz L, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:538-549. [PMID: 33331533 PMCID: PMC8555636 DOI: 10.1590/1516-4446-2020-1108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022]
Abstract
This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Roberta R. Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Hospital Psiquiátrico São Pedro, Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Verônica da S. Leite
- Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil
- Secretaria de Saúde do Município de Palmas, Palmas, TO, Brazil
| | - Deisy M. Porto
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Associação Catarinense de Psiquiatria, Florianópolis, SC, Brazil
| | - Kelly P. Robis
- Departamento de Psiquiatria, Pontifícia Universidade Católica de Minas Gerais (PUC Minas), Belo Horizonte, MG, Brazil
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Gislene A. Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Hospital Universitário Clemente de Faria, Montes Claros, MG, Brazil
| | - Alexandre P. Diaz
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Humberto Correa
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Teng C. Tung
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Leandro Malloy-Diniz
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Associação Brasileira de Impulsividade e Patologia Dual, Brasília, DF, Brazil
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Antônio G. da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina (APAL)
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Kanemoto K. Psychotic Disorders in Epilepsy: Do They Differ from Primary Psychosis? Curr Top Behav Neurosci 2021; 55:183-208. [PMID: 34426945 DOI: 10.1007/7854_2021_234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Any attempt to compare the definitions of symptoms listed for "primary psychoses" with those adopted in studies of psychoses in patients with epilepsy (PWE) will encounter problems of heterogeneity within both conditions. In this manuscript, five psychotic illnesses listed in Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), that is, brief psychotic illness, schizophreniform disorder, schizophrenia, delusional disorder, and schizoaffective disorder are compared with postictal (or periictal) and interictal psychotic disorders in PWE. After examining definitions of primary psychoses, definitions of psychoses adopted in the papers dealing with postictal and interictal psychoses are summarized. Further, diagnostic criteria of five types of psychotic disorders in PWE proposed in 2007 by Krishnamoorthy et al. are also discussed, which include postictal psychosis, comorbid schizophrenia, iatrogenic psychosis caused by antiepileptic drugs (AEDs) (AED-induced psychotic disorder: AIPD), and forced normalization. Evidently, a comparison between postictal psychosis and schizophrenia is pointless. Likewise, schizophrenia may not be an appropriate counterpart of forced normalization and AIPD, given their acute or subacute course.Based on these preliminary examinations, three questions are selected to compare primary psychoses and psychoses in PWE: Is postictal psychosis different from a brief psychotic disorder? Does epilepsy facilitate or prevent the development of psychosis or vice versa? Is interictal psychosis of epilepsy different from process schizophrenia? In conclusion, antagonism between psychosis and epileptic seizures in a later stage of active epilepsy seems not to be realized without reorganization of the nervous system promoted during an earlier stage. Both genetic predisposition and the summated effects of epileptic activity must be taken into consideration as part of a trial to explain interictal psychosis. Interictal psychosis is an aggregate of miscellaneous disorders, that is, co-morbid schizophrenia, AED-induced psychotic disorders, forced normalization, and "epileptic" interictal psychosis. Data are lacking to conclude whether differences exist between process schizophrenia and "epileptic" interictal psychosis in terms of negative symptoms, specific personal traits, and the "bizarre-ness" of delusory-hallucinatory contents. These discussions may shed light on the essence of process schizophrenia, thus allowing it stand out and receive increased focus.
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Grover S, Shouan A, Chakrabarti S, Sahoo S, Mehra A. Comparative study of effectiveness of augmentation with ECT in clozapine resistant schizophrenia (CRS) and non-clozapine resistant schizophrenia (Non-CRS). Nord J Psychiatry 2021; 75:397-405. [PMID: 33630681 DOI: 10.1080/08039488.2021.1877349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is limited evidence for different treatment strategies in patients with clozapine resistant schizophrenia (CRS). AIM To determine the effectiveness of ECT in patients with clozapine resistant schizophrenia and compare the same with a group of patients with non-clozapine resistant schizophrenia, receiving ECT. RESULTS Out of a total of 68 patients with schizophrenia, 27 (38.66%) of patients had CRS. With 6 ECTs, there was a significant reduction in PANSS positive, negative, general psychopathology, prosocial score and depression symptoms in the CRS (p < 0.001) and Non-CRS group (p < 0.001), but no statistically significant difference was seen between the 2 groups in terms of proportion of patients showing >40% response on PANSS total score. The reduction in PANSS score of >40% in CRS group was seen in 48.1% of patients in the positive symptoms subscale, in 25.9% of patients in negative symptoms subscale, in 46.7% of cases in the general psychopathology subscale, in 44.4% of the patients in Depression subscale, in 29.6% of the patients in the modified prosocialsubscaleand in 29.6% of the patients in total PANSS score. CONCLUSION ECT is an effective augmentation strategy for patients with CRS and it is as effective as when used in patients with non-CRS.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Shouan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gammon D, Cheng C, Volkovinskaia A, Baker GB, Dursun SM. Clozapine: Why Is It So Uniquely Effective in the Treatment of a Range of Neuropsychiatric Disorders? Biomolecules 2021; 11:1030. [PMID: 34356654 PMCID: PMC8301879 DOI: 10.3390/biom11071030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/16/2022] Open
Abstract
Clozapine is superior to other antipsychotics as a therapy for treatment-resistant schizophrenia and schizoaffective disorder with increased risk of suicidal behavior. This drug has also been used in the off-label treatment of bipolar disorder, major depressive disorder (MDD), and Parkinson's disease (PD). Although usually reserved for severe and treatment-refractory cases, it is interesting that electroconvulsive therapy (ECT) has also been used in the treatment of these psychiatric disorders, suggesting some common or related mechanisms. A literature review on the applications of clozapine and electroconvulsive therapy (ECT) to the disorders mentioned above was undertaken, and this narrative review was prepared. Although both treatments have multiple actions, evidence to date suggests that the ability to elicit epileptiform activity and alter EEG activity, to increase neuroplasticity and elevate brain levels of neurotrophic factors, to affect imbalances in the relationship between glutamate and γ-aminobutyric acid (GABA), and to reduce inflammation through effects on neuron-glia interactions are common underlying mechanisms of these two treatments. This evidence may explain why clozapine is effective in a range of neuropsychiatric disorders. Future increased investigations into epigenetic and connectomic changes produced by clozapine and ECT should provide valuable information about these two treatments and the disorders they are used to treat.
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Affiliation(s)
- Dara Gammon
- Saba University School of Medicine, Saba, The Netherlands; (D.G.); (A.V.)
| | - Catherine Cheng
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (C.C.); (G.B.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Anna Volkovinskaia
- Saba University School of Medicine, Saba, The Netherlands; (D.G.); (A.V.)
| | - Glen B. Baker
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (C.C.); (G.B.B.)
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Serdar M. Dursun
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (C.C.); (G.B.B.)
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Moon SY, Kim M, Lho SK, Oh S, Kim SH, Kwon JS. Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation. Psychiatry Investig 2021; 18:486-499. [PMID: 34218638 PMCID: PMC8256139 DOI: 10.30773/pi.2020.0438] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/03/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) has been the most potent treatment option for treatment-resistant schizophrenia (TRS). However, the underlying neural mechanisms of ECT in schizophrenia remain largely unclear. This paper examines studies that investigated structural and functional changes after ECT in patients with schizophrenia. METHODS We carried out a systematic review with following terms: 'ECT', 'schizophrenia', and the terms of various neuroimaging modalities. RESULTS Among the 325 records available from the initial search in May 2020, 17 studies were included. Cerebral blood flow in the frontal, temporal, and striatal structures was shown to be modulated (n=3), although the results were divergent. Magnetic resonance spectroscopy (MRS) studies suggested that the ratio of N-acetyl-aspartate/creatinine was increased in the left prefrontal cortex (PFC; n=2) and left thalamus (n=1). The hippocampus and insula (n=6, respectively) were the most common regions of structural/functional modulation, which also showed symptom associations. Functional connectivity of the default mode network (DMN; n=5), PFC (n=4), and thalamostriatal system (n=2) were also commonly modulated. CONCLUSION Despite proven effectiveness, there has been a dearth of studies investigating the neurobiological mechanisms underlying ECT. There is preliminary evidence of structural and functional modulation of the hippocampus and insula, functional changes in the DMN, PFC, and thalamostriatal system after ECT in patients with schizophrenia. We discuss the rationale and implications of these findings and the potential mechanism of action of ECT. More studies evaluating the mechanisms of ECT are needed, which could provide a unique window into what leads to treatment response in the otherwise refractory TRS population.
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Affiliation(s)
- Sun-Young Moon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
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Abstract
PURPOSE OF REVIEW Agitation associated with schizophrenia remains an important clinical concern and if not managed effectively, can escalate into aggressive behavior. This is a review of the recent biomedical literature on agitation in individuals with schizophrenia. RECENT FINDINGS Themes in the recent literature include consideration of comorbidities such as cigarette smoking and cannabis use. Surveys reveal that pharmacological approaches to manage agitation have changed little, with haloperidol remaining in common use and intramuscular administration of antipsychotics and/or benzodiazepines being frequently administered to more severely agitated/aggressive individuals. Of note, ketamine has been recently adopted for use in severe agitation in medical emergency departments, but the risk of this medication for people with schizophrenia is unclear. At present, inhaled loxapine remains the only rapidly acting noninjectable FDA-approved treatment for agitation associated with schizophrenia. In development is an intranasal formulation for olanzapine (a well characterized atypical antipsychotic already approved to treat agitation) and a sublingual film for dexmedetomidine (an α2-adrenergic agonist used as an anesthetic and now being repurposed). SUMMARY Comorbidities can contribute to agitation and can make an accurate differential diagnosis challenging. The ongoing development of rapidly acting novel formulations of antiagitation medications, if successful, may facilitate clinical treatment by providing additional options.
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Abstract
OBJECTIVE We sought to assess the effectiveness of clozapine augmentation with Electroconvulsive therapy (ECT) (C+ECT) in patients with clozapine-resistant schizophrenia. METHODS We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT. RESULTS Forty-two patients were treated with C+ECT over a 10-year period. The mean age of the patients at initiation of ECT was 46.3 (SD = 8.2) years (range 27-62 years). The mean number of ECTs given was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Seventy-six per cent of patients (n = 32) showed a Clinical Global Impression-Improvement (CGI-I) score of ≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Sixty-four per cent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness or duration of clozapine treatment. Seventy-five per cent of responders remained out of hospital over the course of 1-year follow-up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised. CONCLUSION This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine-resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended.
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Hu Q, Huang H, Jiang Y, Jiao X, Zhou J, Tang Y, Zhang T, Sun J, Yao D, Luo C, Li C, Wang J. Temporoparietal Connectivity Within Default Mode Network Associates With Clinical Improvements in Schizophrenia Following Modified Electroconvulsive Therapy. Front Psychiatry 2021; 12:768279. [PMID: 35058815 PMCID: PMC8763790 DOI: 10.3389/fpsyt.2021.768279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022] Open
Abstract
Although modified electroconvulsive therapy (ECT) has been reported to be effective for the treatment of schizophrenia (SCZ), its action mechanism is unclear. To elucidate the underlying ECT mechanisms of SCZ, this study used a longitudinal cohort including 21 SCZ patients receiving only antipsychotics (DSZ group) and 21 SCZ patients receiving a regular course of ECT combining with antipsychotics (MSZ group) for 4 weeks. All patients underwent magnetic resonance imaging (MRI) scans at baseline (t1) and follow-up (t2) time points. A matched healthy control (HC) group included 23 individuals who were only scanned at baseline. Functional connectivity (FC) within the default mode network (DMN) was evaluated before and after ECT. Significant interaction of the group over time was found in FC between angular gyrus (AG) and middle temporal gyrus (MTG). Post-hoc analysis showed a significantly enhanced FC of left AG(AG.L) and right MTG (MTG.R) in the MSZ group relative to the DSZ group. In addition, the right AG (AG.R) showed significantly enhanced FC between MTG.R and left MTG (MTG.L) after ECT in the MSZ group, but no in the DSZ group. In particular, the FCs change in AG.L-MTG.R and AG.R-MTG.R were positively correlated with the Positive and Negative Syndrome Scale (PANSS) negative score reduction. Furthermore, the FC change in AG.L-MTG.R was also positively correlated with the PANSS general psychopathology score reduction. These findings confirmed a potential relationship between ECT inducing hyperconnectivity within DMN and improvements in symptomatology of SCZ, suggesting that ECT controls mental symptoms by regulating the temporoparietal connectivity within DMN.
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Affiliation(s)
- Qiang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiong Jiao
- School of BIomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhou
- School of BIomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junfeng Sun
- School of BIomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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44
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Zhang XY, Chen HD, Liang WN, Yang XH, Cai DB, Huang X, Huang XB, Liu CY, Zheng W. Adjunctive Magnetic Seizure Therapy for Schizophrenia: A Systematic Review. Front Psychiatry 2021; 12:813590. [PMID: 35082705 PMCID: PMC8785398 DOI: 10.3389/fpsyt.2021.813590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/10/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: The efficacy and safety of adjunctive magnetic seizure therapy (MST) for patients with schizophrenia are unclear. This systematic review was conducted to examine the efficacy and safety of adjunctive MST for schizophrenia. Methods: Chinese (WanFang and Chinese Journal Net) and English (PubMed, EMBASE, PsycINFO, and the Cochrane Library) databases were systematically searched. Results: Two open-label self-controlled studies (n = 16) were included and analyzed in this review. In these studies, the Positive and Negative Syndrome Scale (PANSS) total scores and Brief Psychiatric Rating Scale (BPRS) total scores significantly decreased from baseline to post-MST (all Ps < 0.05), without serious adverse neurocognitive effects. Mixed findings on the neurocognitive effects of adjunctive MST for schizophrenia were reported in the two studies. A discontinuation rate of treatment of up to 50% (4/8) was reported in both studies. The rate of adverse drug reactions (ADRs) was evaluated in only one study, where the most common ADRs were found to be dizziness (25%, 2/8) and subjective memory loss (12.5%, 1/8). Conclusion: There is inconsistent evidence for MST-related adverse neurocognitive effects and preliminary evidence for the alleviation of psychotic symptoms in schizophrenia.
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Affiliation(s)
- Xin-Yang Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Laser Sports Medicine, School of Sports Science, South China Normal University, Guangzhou, China
| | - Huo-Di Chen
- Guangdong Teachers College of Foreign Language and Arts, Guangzhou, China
| | - Wan-Nian Liang
- Wanke School of Public Health, Tsinghua University, Beijing, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xing-Bing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Cheng-Yi Liu
- Laboratory of Laser Sports Medicine, School of Sports Science, South China Normal University, Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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45
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Flumazenil for Successful Seizure Induction With Electroconvulsive Therapy: Case Report and Literature Review. Clin Neuropharmacol 2020; 44:29-32. [PMID: 33351502 DOI: 10.1097/wnf.0000000000000429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is indicated for various psychiatric situations that are difficult to manage otherwise and may be regarded as a last resort but seizure induction is sometimes difficult, resulting in inadequate trials and futile outcomes. METHOD We report on a 72-year-old female patient with bipolar depression whose seizure induction with ECT was challenging but the use of flumazenil was deemed effective to obtain remission in the end. We also provide a literature review on this topic. RESULTS Seizure induction was managed with the use of flumazenil, a selective GABA-A receptor antagonist to neutralize the effects of benzodiazepine hypnotics, together with decreasing the amount of anesthesia, increasing the pulse width, and adding chlorpromazine. A PubMed search with keywords of flumazenil and ECT yielded only 14 hits (December 2020) and found some indication that flumazenil might be of use for this purpose even in the absence of benzodiazepines, although evidence base has remained very limited. CONCLUSIONS Flumazenil, an antidote of benzodiazepines, may be effective regardless of whether benzodiazepines are in use. Because inefficient ECT is clinically problematic, more studies are necessary to investigate the effectiveness of flumazenil for successful seizure induction with ECT.
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46
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Ultrabrief Electroconvulsive Therapy in Schizophrenia-Lessons From History. J ECT 2020; 36:e8-e9. [PMID: 32118685 DOI: 10.1097/yct.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Xi YB, Cui LB, Gong J, Fu YF, Wu XS, Guo F, Yang X, Li C, Wang XR, Li P, Qin W, Yin H. Neuroanatomical Features That Predict Response to Electroconvulsive Therapy Combined With Antipsychotics in Schizophrenia: A Magnetic Resonance Imaging Study Using Radiomics Strategy. Front Psychiatry 2020; 11:456. [PMID: 32528327 PMCID: PMC7253706 DOI: 10.3389/fpsyt.2020.00456] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Neuroimaging-based brain signatures may be informative in identifying patients with psychosis who will respond to antipsychotics. However, signatures that inform the electroconvulsive therapy (ECT) health care professional about the response likelihood remain unclear in psychosis with radiomics strategy. This study investigated whether brain structure-based signature in the prediction of ECT response in a sample of schizophrenia patients using radiomics approach. METHODS This high-resolution structural magnetic resonance imaging study included 57 patients at baseline. After ECT combined with antipsychotics, 28 and 29 patients were classified as responders and non-responders. Features of gray matter were extracted and compared. The logistic regression model/support vector machine (LRM/SVM) analysis was used to explore the predictive performance. RESULTS The regularized multivariate LRM accurately discriminated responders from non-responders, with an accuracy of 90.91%. The structural features were further confirmed in the validating data set, resulting in an accuracy of 87.59%. The accuracy of the SVM in the training set was 90.91%, and the accuracy in the validation set was 91.78%. CONCLUSION Our results support the possible use of structural brain feature-based radiomics as a potential tool for predicting ECT response in patients with schizophrenia undergoing antipsychotics, paving the way for utilization of markers in psychosis.
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Affiliation(s)
- Yi-Bin Xi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Long-Biao Cui
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China
| | - Jie Gong
- School of Life Sciences and Technology, Xidian University, Xi'an, China
| | - Yu-Fei Fu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China
| | - Xu-Sha Wu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xuejuan Yang
- School of Life Sciences and Technology, Xidian University, Xi'an, China
| | - Chen Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xing-Rui Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ping Li
- Department of Radiology, Xi'an Mental Health Center, Xi'an, China
| | - Wei Qin
- School of Life Sciences and Technology, Xidian University, Xi'an, China
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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48
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Yi W, She S, Zhang J, Wu H, Zheng Y, Ning Y. Clozapine Use in Patients with Early-Stage Schizophrenia in a Chinese Psychiatric Hospital. Neuropsychiatr Dis Treat 2020; 16:2827-2836. [PMID: 33262597 PMCID: PMC7699990 DOI: 10.2147/ndt.s261503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Previous studies suggest that clozapine is commonly underutilized and that its initiation is delayed in patients with first-episode schizophrenia. Knowledge regarding clozapine use among Chinese patients with early-stage schizophrenia is limited. The aim of the present study was to investigate the point prevalence of and patterns and factors associated with clozapine use in patients with early-stage schizophrenia discharged from a psychiatric hospital in China. METHODS A retrospective study was conducted to analyze the prescriptions of 867 consecutive patients with early-stage schizophrenia who were admitted to the Affiliated Brain Hospital of Guangzhou Medical University between Jan 1, 2011 and Dec 31, 2016. RESULTS At discharge from the hospital, 114 (13.1%) patients were prescribed clozapine. Among the patients taking clozapine, 93 patients (81.6%) were prescribed clozapine polypharmacy, and only 21 patients (18.4%) were prescribed clozapine monotherapy. None of the patients were prescribed an overdose of clozapine. The mean daily dosage of clozapine was 160.97 mg, 149.05 mg and 213.69 mg among all patients taking clozapine, patients taking clozapine polypharmacy and patients taking clozapine monotherapy, respectively. The antipsychotic most frequently combined with clozapine was risperidone. Logistic regression suggested that the length of hospital stay, high school education, lower benzodiazepine use and antipsychotic polypharmacy were independently and significantly associated with clozapine use (P<0.05). CONCLUSION Although clozapine has been commonly used in China in recent years, the present study found that clozapine was not commonly used in patients with early-stage schizophrenia. An underutilization and delayed initiation of clozapine may exist in a portion of patients with early-stage schizophrenia. Given the unfavorable outcomes of underutilized and delayed clozapine use, future studies may be needed to assess and increase clozapine use in this population.
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Affiliation(s)
- Wenying Yi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Shenglin She
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jie Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Haibo Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yingjun Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yuping Ning
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
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49
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Jia J, Shen J, Liu FH, Wong HK, Yang XJ, Wu QJ, Zhang H, Wang HN, Tan QR, Zhang ZJ. Effectiveness of Electroacupuncture and Electroconvulsive Therapy as Additional Treatment in Hospitalized Patients With Schizophrenia: A Retrospective Controlled Study. Front Psychol 2019; 10:2306. [PMID: 31681100 PMCID: PMC6804524 DOI: 10.3389/fpsyg.2019.02306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/27/2019] [Indexed: 12/18/2022] Open
Abstract
Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA + ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA + ECT groups had markedly greater clinical response rate than controls on SAPS [72.7 and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3 and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% vs. 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. Clinical Trial Registration: http://www.chictr.org.cn/showprojen.aspx?proj=38901, identifier ChiCTR1900023563.
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Affiliation(s)
- Jie Jia
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Jun Shen
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Fei-Hu Liu
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Hei Kiu Wong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xin-Jing Yang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Qiang-Ju Wu
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Hui Zhang
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhang-Jin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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