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Karl S, Sartorius A, Aksay SS. Catatonia and ECT across the lifespan. Schizophr Res 2024; 263:246-251. [PMID: 37087393 DOI: 10.1016/j.schres.2023.04.004] [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: 06/22/2022] [Revised: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia with high response rates. Although empirical data suggest that tolerability and efficacy are at least as good as in adults, ECT treatment of children, adolescents, and geriatric patients seems to pose a specific challenge for many practitioners. This article intends to explore and discuss reasons hindering the use of ECT in these patient groups, give an overview on the use of ECT to treat catatonia and provide practical advice on ECT in children, adolescents, and geriatric patients for the treatment of catatonia. Classification of catatonia as a subform of schizophrenia and a diagnostic overlap with other common conditions in children, adolescents, and geriatric patients might lead to underdiagnosis of catatonia. Concerns about the mechanism of action and about a lack of controlled studies as well as general concerns about the use of ECT in children and adolescents might lead to underutilization of ECT. However, studies of ECT to treat catatonia in children, adolescents, and geriatric patients consistently show its safety and effectiveness. Administration of ECT needs to consider some specific characteristics of children, adolescents, and geriatric patients. In conclusion, ECT is a safe and highly effective treatment for catatonia across the lifespan. Existing evidence does not warrant restrictions of its use in certain age groups.
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Affiliation(s)
- Sebastian Karl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
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Lupke K, Warren N, Teodorczuk A, Steele S, Kolur U, Wand A, Robinson G, Parker S. A systematic review of modified electroconvulsive therapy (ECT) to treat delirium. Acta Psychiatr Scand 2022; 147:403-419. [PMID: 35996219 DOI: 10.1111/acps.13492] [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: 04/29/2022] [Revised: 07/30/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delirium is costly for patients, carers, and healthcare systems. In addition, non-pharmacological and pharmacological management of delirium is challenging. Electroconvulsive therapy (ECT) has been proposed and used as an anecdotal treatment of delirium in clinical practice. However, the efficacy and safety of this approach are not well understood. OBJECTIVE To synthesise and review the evidence relating to the safety and efficacy of ECT as a treatment for delirium. METHODS A systematic review was completed according to PRISMA guidelines using the PubMed, CINAHL, Cochrane Library, and PsycINFO databases. Studies were eligible for inclusion if modified ECT was used to treat delirium symptoms. ECT for delirium in people with neuroleptic malignant syndrome, catatonia, or confusional states associated with acute primary psychiatric conditions were excluded. All included records were first ranked using the hierarchy of evidence-based medicine; quality was then assessed using the Joanna Briggs critical appraisal checklists. Pooled data across the cases identified were analysed using descriptive statistics. RESULTS Of 1226 records screened, 10 studies met inclusion criteria: six case reports, three case series, and one quasi-experimental study. The literature base was of mixed quality. A single quasi-experimental study was assessed to be of 'fair' quality, the remainder of the case series and case reports were rated as 'poor' to 'fair' quality. A total of only 40 individual people with delirium who were treated with ECT were identified. In 33/40 cases, the aetiology of delirium was substance withdrawal. The number of ECT treatments administered ranged from 1 to 13. ECT was reported to positively contribute towards treatment of delirium in all cases, although objective measures of improvement were reported in only 6/13 patient cases from case reports and case series (46%). The singular quasi-experimental study reported a statistically significant decrease in duration of delirium, time spent in physical restraint, and in benzodiazepine requirement when ECT was used as an adjunct in benzodiazepine withdrawal delirium. When adverse events were described these included mild confusion and memory deficits; all were reported as time limited and reversible. Considerable limitations in the quality of the evidence base were identified, including the risk of selection, publication and reporting bias. Much data reporting on safety and efficacy of ECT in delirium was missing. CONCLUSION There is insufficient literature to support modified ECT as a clinical treatment for delirium. The few studies identified were generally of weak evidence lacking important data on safety and objective outcome measures, and not including populations with broad delirium aetiologies. Further research using more robust methodologies and broader populations (age, aetiology) of people with delirium treated with ECT is needed.
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Affiliation(s)
- Katie Lupke
- Metro North Mental Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nicola Warren
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Andrew Teodorczuk
- Metro North Mental Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Sarah Steele
- Metro North Mental Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Uday Kolur
- Metro North Mental Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anne Wand
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gail Robinson
- Metro North Mental Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Stephen Parker
- Metro North Mental Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
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Sartorius A, Demirakca T, Böhringer A, Clemm von Hohenberg C, Aksay SS, Bumb JM, Kranaster L, Nickl-Jockschat T, Grözinger M, Thomann PA, Wolf RC, Zwanzger P, Dannlowski U, Redlich R, Zavorotnyy M, Zöllner R, Methfessel I, Besse M, Zilles D, Ende G. Electroconvulsive therapy induced gray matter increase is not necessarily correlated with clinical data in depressed patients. Brain Stimul 2018; 12:335-343. [PMID: 30554869 DOI: 10.1016/j.brs.2018.11.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) and depression have been associated with brain volume changes, especially in the hippocampus and the amygdala. METHODS In this retrospective study we collected data from individual pre-post ECT whole brain magnetic resonance imaging scans of depressed patients from six German university hospitals. Gray matter volume (GMV) changes were quantified via voxel-based morphometry in a total sample of 92 patients with major depressive episodes (MDE). Additionally, 43 healthy controls were scanned twice within a similar time interval. RESULTS Most prominently longitudinal GMV increases occurred in temporal lobe regions. Within specific region of interests we detected significant increases of GMV in the hippocampus and the amygdala. These results were more pronounced in the right hemisphere. Decreases in GMV were not observed. GMV changes did not correlate with psychopathology, age, gender or number of ECT sessions. We ruled out white matter reductions as a possible indirect cause of the detected GMV increase. CONCLUSION The present findings support the notion of hippocampus and amygdala modulation following an acute ECT series in patients with MDE. These results corroborate the hypothesis that ECT enables primarily unspecific and regionally dependent neuroplasticity effects to the brain.
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Affiliation(s)
- Alexander Sartorius
- Research Group Translational Imaging, Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
| | - Traute Demirakca
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Andreas Böhringer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Christian Clemm von Hohenberg
- Research Group Translational Imaging, Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Jan Malte Bumb
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Department of Psychiatry, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Philipp A Thomann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany; Center for Mental Health, Odenwald District Healthcare Center, Uniklinik RWTH, Aachen, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Peter Zwanzger
- kbo-Inn-Salzach-Hospital, Gabersee 7, 83512, Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Germany
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Germany
| | - Maxim Zavorotnyy
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Marburg Center for Mind, Brain and Behavior - MCMBB, University of Marburg, Germany
| | - Rebecca Zöllner
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Isabel Methfessel
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Matthias Besse
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - David Zilles
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
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