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Le Droguene E, Bulteau S, Deschamps T, Thomas-Ollivier V, Brichant-Petitjean C, Guitteny M, Laurin A, Sauvaget A. Dynamics of Depressive and Psychomotor Symptoms During Electroconvulsive Therapy in Older Depressive Patients: A Case Series. J ECT 2023; 39:255-262. [PMID: 37310091 DOI: 10.1097/yct.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment for patients experiencing a major depressive episode, especially older ones. Identification of specific responses within early ECT sessions remains an issue of debate, however. Hence, this pilot study prospectively examined the outcome in terms of depressive signs, symptom by symptom, throughout a course of ECT, concentrating particularly on psychomotor retardation symptoms. METHODS Nine patients were clinically evaluated several times during the ECT course, before the first session and then weekly (over 3-6 weeks, according to their evolution), by completing the Montgomery-Åsberg Depression Rating Scale (MADRS), the Mini-Mental State Examination test, and the French Retardation Rating Scale for Depression for assessing the severity of psychomotor retardation. RESULTS Nonparametric Friedman tests showed significant positive changes in mood disorders during ECT in older depressive patients (mean, -27.3% of initial MADRS total score). Fast improvement in French Retardation Rating Scale for Depression score was observed at t1 (ie, after 3-4 ECT sessions), whereas a slightly delayed improvement in the MADRS scores was found at t2 (ie, after 5-6 ECT sessions). Moreover, the scores for items linked to the motor component of psychomotor retardation (eg, gait, postural control, fatigability) were the first to significantly decrease during the first 2 weeks of the ECT course compared with the cognitive component. CONCLUSIONS Interestingly, participants' concentration on daily functional activities, their interest and fatigability, and their reported state of sadness were the first to progress, representing possible precursor signs of positive patient outcomes after ECT.
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Affiliation(s)
| | - Samuel Bulteau
- Nantes Université, CHU Nantes, INSERM, Methods in Patients-Centered Outcomes and Health Research
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| | | | | | - Marie Guitteny
- CHU de Nantes, Service d'Addictologie et Psychiatrie de Liaison, Nantes, France
| | - Andrew Laurin
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
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Sauvaget A, Dumont R, Bukowski N, Bonnot O, Auffret R, Poulet E, Szekely D, Quiles C, Yrondi A, Plaze M, de Carvalho W, Amad A, Bulteau S. [Recommendations for a gradual and controlled resumption of electroconvulsive therapy in France during the period of lifting of the containment and of the COVID-19 pandemic linked to SARS-CoV-2]. L'ENCEPHALE 2020; 46:S119-S122. [PMID: 32507557 PMCID: PMC7271849 DOI: 10.1016/j.encep.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
La pandémie du COVID-19 a des conséquences majeures sur l’organisation des soins. En France et dans le monde, les centres pratiquant l’électroconvulsivothérapie (ECT) ont vu leur activité diminuer, voire s’arrêter, pour de diverses raisons. Dans ce contexte, le maintien ou la reprise de cette activité thérapeutique essentielle pour de nombreux patients souffrant de troubles psychiatriques nécessite des adaptations matérielles, humaines et logistiques qu’il convient d’encadrer. L’objectif de ce travail collectif et national est de proposer des recommandations simples et applicables immédiatement par tout établissement de santé, public ou privé, pratiquant les ECT. Elles sont issues d’un retour d’expériences pluriprofessionnelles et interétablissements. Déclinées en trois étapes, ces recommandations sont accompagnées d’une fiche pratique qui décrit, de façon précise, les conditions nécessaires et préalables à toute reprise d’activité ECT.
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Affiliation(s)
- A Sauvaget
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; Nantes Université, CHU Nantes, Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France.
| | - R Dumont
- CHU de Nantes, Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu-PTMC, Nantes, France
| | - N Bukowski
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - O Bonnot
- Child and Adolescent Psychiatry Department, CHU and University of Nantes, Nantes, France
| | - R Auffret
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - E Poulet
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; Centre hospitalier Le Vinatier, Bron, France; Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Department of Emergency Psychiatry, hospices civils de Lyon, University Hospital Edouard-Herriot, Lyon, France
| | - D Szekely
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; Department of psychiatry, centre hospitalier Princesse-Grace, 98000 Monaco, France
| | - C Quiles
- Centre hospitalier Charles-Perrens, 33000 Bordeaux, France
| | - A Yrondi
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; Service de psychiatrie et de psychologie médicale, centre expert dépression résistante fondamental, CHU de Toulouse, Toulouse, France; Inserm, UPS, ToNIC Toulouse NeuroImaging Center, hôpital Purpan, université de Toulouse, Toulouse, France
| | - M Plaze
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; Université de Paris, 75005 Paris, France; Service hospitalo-universitaire, GHU de Paris psychiatrie & neurosciences, 75014 Paris, France
| | - W de Carvalho
- Pôle ECT - groupe SINOUÉ, clinique BELLEVUE, 92190 Meudon, France
| | - A Amad
- Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, CHU de Lille, université de Lille, 59000 Lille, France
| | - S Bulteau
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation transcrânienne en psychiatrie), Saint-Germain-en-Laye, France; CHU Nantes, Department of Addictology and Psychiatry, Nantes, France; Inserm-U1246 SPHERE University of Nantes and University of Tours, Nantes, France
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Abstract
PURPOSE OF REVIEW To summarize the differential diagnosis and diagnostic approach of sudden unresponsiveness with normal vital signs in various settings, including the ICU. RECENT FINDINGS Sudden unresponsiveness may be either transient or persistent, and may result from primary brain diseases or nonstructural systemic conditions. Life-threatening causes should always be discriminated from those more benign. Regional epidemiology, for example regarding intoxications, and evolving therapeutic management, for example for ischemic stroke, should always be taken into account for optimal opportunity for rapid diagnosis and best management. SUMMARY Sudden unresponsiveness with normal vital signs should trigger immediate and focused diagnostic evaluation to find or exclude those conditions requiring urgent, and possibly life-saving, management.
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