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Uppinkudru C, Pathak H, Kumar K R, S B, Bagali K, Pantoji M, Ezhumalai N, Parlikar R, Shah V, Balachander S, Sreeraj VS, Mehta UM, Sinha P, Arumugham SS, Venkatasubramanian G, Thirthalli J. Development, validation and clinical utility of short-term adverse-effects of electroconvulsive therapy (SAVE) checklist. Psychiatry Res 2024; 335:115839. [PMID: 38503006 DOI: 10.1016/j.psychres.2024.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. However, it has many cognitive and non-cognitive adverse effects (AEs). There are lacunae in the literature on systematic assessment of non-cognitive AEs. There is a need for a standard, comprehensive and specific clinical tool to evaluate this. Hence, a checklist of short-term AEs of ECT (SAVE) with a 2-phase assessment was developed. Content validation was done using 15 experts' ratings and predefined content validity ratio and index (CVR and CVI) in a two-stage modified Delphi method. The checklist had a good CVR and CVI with a final tool of 39 items. The tool was sensitive and identified the non-cognitive AEs after ECT. Cardiovascular and musculoskeletal systems displayed the highest incidence. Many participants exhibited delayed recovery in orientation, gait, and stance, highlighting a necessity for meticulous monitoring. SAVE is the first standardised tool to assess short-term ECT-related AEs systematically. This checklist likely identifies clinically significant incidences of adverse effects. Its regular use may enhance the safety of ECT and patient comfort by supporting early identification and intervention for AEs. However, given the transient nature of AEs, further studies are needed to determine their predictive validity for long-term consequences.
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Affiliation(s)
- Chithra Uppinkudru
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Raj Kumar K
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Bridgit S
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Kiran Bagali
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Makarand Pantoji
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Nathiya Ezhumalai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Vyoma Shah
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
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Tor PC, Barreiros AR, Cao TV, Dong V, Brettell L, Tuneu CM, Galvez V, Waite S, Sarma S, Branjerdporn G, Chatterton ML, Mohan T, Hussain S, Martin D, Loo C. Why You Should Collect Routine Clinical Data for ECT: A Singapore Story From the CARE Network. J ECT 2024:00124509-990000000-00157. [PMID: 38587407 DOI: 10.1097/yct.0000000000001012] [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: 04/09/2024]
Affiliation(s)
- Phern-Chern Tor
- From the Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | | | - Thanh Vinh Cao
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Vanessa Dong
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Louise Brettell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Clara Massaneda Tuneu
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Veronica Galvez
- Mental Health and Addiction Searvice, Parc Tauli University Hospital, I3PT-CERCA, Barcelona, Spain
| | - Sue Waite
- The Queen Elizabeth Hospital, Woodville South
| | | | | | | | | | - Salam Hussain
- Sir Charles Gairdner Hospital, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Royal Australian and New Zealand College of Psychiatrists, Nedlands, Australia
| | - Donel Martin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Colleen Loo
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
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Laurin A, Bonjour M, Galvao F, Dubien Berbey C, Sauvaget A, Bulteau S. The anticholinergic burden is not associated with cognitive impairments in patients treated by electroconvulsive therapy for treatment-resistant depression. J Psychiatr Res 2022; 150:87-95. [PMID: 35366599 DOI: 10.1016/j.jpsychires.2022.03.038] [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: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective non-pharmacological treatment for treatment-resistant depression (TRD) but can expose to transient cognitive impairments. Understanding factors underlying these cognitive side effects is important. This study investigated the impact of anticholinergic treatments on cognitive performances after ECT courses for TRD in naturalistic condition. METHODS Impact of anticholinergic burden (Anticholinergic Impregnation Scale, AIS) on cognitive changes (Montreal Cognitive Assessment, MoCA) adjusted on depression level (Montgomery and Asberg Depression Scale, MADRS) was investigated in 42 patients who received an ECT course between 2017 and 2020 for unipolar or bipolar TRD. Collection of daily treatments given during ECT was carried out via the computerized traceability of treatments validated by nurses. RESULTS Among the 31 treatments identified with an anticholinergic score, which represent only 38% of total treatments, the three most frequently given treatments were Lorazepam (47%), Venlafaxine (36%) and Cyamemazine (26%). Delayed recall was the most frequently impaired cognitive function after ECT courses. Using logistic regression, we found no association between the anticholinergic burden and the decrease in cognitive scores after ECT courses, adjusted on MADRS score evolution (p > 0.1). Conversely, improvement in MADRS scores were correlated with improvement in attention MoCA subscores. LIMITATIONS This is a retrospective monocentric study with a moderate sample size using anticholinergic scales to calculate the anticholinergic burden without plasma dosage. CONCLUSION Anticholinergic treatments did not seem to explain ECT-related cognitive impairments. This warrants further large prospective investigations including different measures of anticholinergic burden.
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Affiliation(s)
- Andrew Laurin
- CHU de Nantes, F-44000, Nantes, France; Laboratoire 'Mouvement, Interactions, Performance' (MIP), EA 4334, Nantes Université, F-44000, Nantes, France.
| | - Maxime Bonjour
- Hospices Civils de Lyon, F-69000, Lyon, France; Université Claude Bernard Lyon 1, F-69000, Lyon, France
| | - Filipe Galvao
- Centre Hospitalier Le Vinatier, F-69678, Bron, France
| | | | - Anne Sauvaget
- CHU de Nantes, F-44000, Nantes, France; Laboratoire 'Mouvement, Interactions, Performance' (MIP), EA 4334, Nantes Université, F-44000, Nantes, France
| | - Samuel Bulteau
- CHU de Nantes, F-44000, Nantes, France; INSERM U1246 SPHERE 'methodS in Patient-centered outcomes and Health ResEarch', Nantes Université, F-44000, Nantes, France
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Tripathi C, Khan B, Youssef NA. Need for Standardization of Measurement of Time to Reorientation as a Predictor of Cognitive Adverse Effects of Electroconvulsive Therapy. J ECT 2021; 37:13-17. [PMID: 33600117 DOI: 10.1097/yct.0000000000000703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT Testing for time to reorientation (TRO) after electroconvulsive therapy (ECT) has been one of the most predictive measures for cognitive adverse effects of ECT. However, measuring TRO varies between clinical trials, and there is no standardized approach on its measurement between studies. The objective of this report is to systematically review the literature on the different ways of measuring TRO. This would be a first step to establish a consensus on a standard method for TRO. We performed a systematic literature review from 1968 to October 2019 for clinical trials with a sample size of more than 50 and published in English that describe measures of TRO. We searched both PubMed and Web of Science databases. The literature search generated 12 clinical trials, which met the inclusion criteria. Studies measured TRO using 3-, 5-, or 10-item questionnaires. Most studies measured full orientation as answering 4/5 questions. Other studies smaller than 50 required 14/14 items to be answered correctly. There was wide variation between studies on how often and when orientation questions were initiated. These factors have obvious implications to the results and interpretation of the ECT literature.There was no clear consensus on measuring TRO in a uniform fashion. Research and clinical care would benefit from a standardized approach to measuring TRO. Measuring TRO using a 4/5 method seems the most common and quickest way, whereas using a 14/14 method seems to be the most rigorous and sensitive to change in trials.
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Affiliation(s)
| | - Bilal Khan
- From the Department of Psychiatry and Health Behavior
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A Comparison of Computerized Versus Pen-and-Paper Cognitive Tests for Monitoring Electroconvulsive Therapy-Related Cognitive Side Effects. J ECT 2020; 36:260-264. [PMID: 32453186 DOI: 10.1097/yct.0000000000000687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cognitive side effects are a common unintended outcome of electroconvulsive therapy (ECT). Routine cognitive assessment is important for monitoring patient outcomes, although it can pose challenges in busy clinical settings. Computerized cognitive testing has advantages that can facilitate routine monitoring. This study explored the construct and criterion validity of computerized cognitive testing compared with standard pen-and-paper tests for monitoring cognition in ECT patients. METHODS The study included 24 participants with major depression who received an acute course of ECT. Cognition was assessed at pretreatment and at posttreatment with 3 computerized tests from the CogState battery (International Shopping List task, One-Card Learning, and One-Back Task) and 3 conceptually matched pen-and-paper-administered neuropsychological tests. RESULTS At pretreatment, only performance on the computer-administered test of verbal anterograde memory (International Shopping List task) was significantly correlated with the analogous pen-and-paper measure, whereas the other computerized tests were not. Of the computerized measures, only the International Shopping List task showed significant changes from pretreatment to posttreatment (P < 0.01, Cohen d > 1.0). In contrast, all the pen-and-paper-administered tests showed significant changes from pretreatment to posttreatment (P < 0.01, Cohen d range, 0.8-1.2). Pretreatment to posttreatment cognitive changes on the computerized measures were not correlated with changes on the pen-and-paper-administered tests. CONCLUSION Construct and criterion validity and tolerability varied between the computerized measures. The results highlighted potentially important issues related to the interpretation and utility of computerized tests in this patient population.
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Martin DM, McClintock SM, Loo CK. Brief cognitive screening instruments for electroconvulsive therapy: Which one should I use? Aust N Z J Psychiatry 2020; 54:867-873. [PMID: 32436734 DOI: 10.1177/0004867420924093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To review brief cognitive screening instruments for routine clinical monitoring in electroconvulsive therapy. METHODS Brief cognitive screening instruments specifically developed for electroconvulsive therapy and commonly used brief generalised cognitive screening instruments were reviewed with relative advantages and disadvantages highlighted. RESULTS Several brief cognitive screening tests designed for use in electroconvulsive therapy have been found sensitive for monitoring electroconvulsive therapy-related cognitive side effects. The choice of a brief generalised cognitive screening instrument for use in an electroconvulsive therapy clinical context comes with several pertinent considerations. CONCLUSION Electroconvulsive therapy is a highly effective treatment for pharmacoresistant and severe neuropsychiatric illness although cognitive side effects can be a barrier for treatment. Routine monitoring using brief cognitive screening instruments has advantages in busy clinical settings and can assist with optimising patient outcomes. More detailed neuropsychological assessment is recommended if the results from brief cognitive screening raise concerns.
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Affiliation(s)
- Donel M Martin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia.,St George Hospital, Sydney, NSW, Australia
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Porter RJ, Baune BT, Morris G, Hamilton A, Bassett D, Boyce P, Hopwood MJ, Mulder R, Parker G, Singh AB, Outhred T, Das P, Malhi GS. Cognitive side-effects of electroconvulsive therapy: what are they, how to monitor them and what to tell patients. BJPsych Open 2020; 6:e40. [PMID: 32301408 PMCID: PMC7191622 DOI: 10.1192/bjo.2020.17] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning. AIMS To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data. METHOD A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors. RESULTS Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience. CONCLUSIONS Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
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Affiliation(s)
- Richard J Porter
- Treatment Algorithm Group; and Department of Psychological Medicine, University of Otago - Christchurch, New Zealand
| | - Bernhard T Baune
- Treatment Algorithm Group; and Department of Psychiatry, University of Melbourne, Australia
| | - Grace Morris
- Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Amber Hamilton
- Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Darryl Bassett
- Treatment Algorithm Group; and Private Practice in Psychiatry and Division of Psychiatry, the University of Western Australia, Australia
| | - Philip Boyce
- Treatment Algorithm Group; and Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Australia
| | - Malcolm J Hopwood
- Treatment Algorithm Group; and Department of Psychiatry, University of Melbourne, Australia
| | - Roger Mulder
- Treatment Algorithm Group; and Department of Psychological Medicine, University of Otago - Christchurch, New Zealand
| | - Gordon Parker
- Treatment Algorithm Group; School of Psychiatry, University of New South Wales; andBlack Dog Institute, Australia
| | - Ajeet B Singh
- Treatment Algorithm Group; and School of Medicine, IMPACT Strategic Research Centre, Deakin University, Australia
| | - Tim Outhred
- Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Pritha Das
- Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Gin S Malhi
- Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
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Systematic Monitoring of Cognitive Function During Electroconvulsive Therapy: A Retrospective Analysis of Data From a Service Using a Short Cognitive Testing Battery. J ECT 2020; 36:10-17. [PMID: 31990736 DOI: 10.1097/yct.0000000000000659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE International guidelines suggest repeating cognitive testing at intervals throughout a course of electroconvulsive therapy (ECT) to monitor its effects on cognitive function. However, it is apparent that few services do this, and an optimal battery of testing has not yet been established. We aimed to evaluate the utility of such routine cognitive testing in a clinic where patients had been routinely tested at intervals throughout a course of ECT. METHODS All patients referred for ECT at a public ECT clinic were offered routine cognitive testing to monitor cognitive function during their course of ECT. Testing was conducted at baseline and after 3, 6, and 9 treatments. Analyses examined whether change in individual measures predicted reduction in autobiographical memory at subsequent measures and whether the results that were given to clinicians informed treatment decisions. RESULTS Changes in cognitive test results were not associated with clinician decisions to change treatment parameters. Only change in digit span forwards after 3 treatments was associated with later reduction in Colombia University Autobiographical Interview - Short Form (CUAMI-SF) of greater than 25%, with a larger improvement in digit span forwards being associated with greater chance of having a 25% reduction in CUAMI-SF. CONCLUSIONS There was no evidence that the screening undertaken in this clinic had been helpful in determining treatment decisions or that changes in cognitive tests predicted in a reliable way who would later experience changes in autobiographical memory. However, follow-up testing was not completed reliably, and longer-term data regarding autobiographical memory were not collected.
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Weiss A, Hussain S, Ng B, Sarma S, Tiller J, Waite S, Loo C. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Aust N Z J Psychiatry 2019; 53:609-623. [PMID: 30966782 DOI: 10.1177/0004867419839139] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide guidance for the optimal administration of electroconvulsive therapy, in particular maintaining the high efficacy of electroconvulsive therapy while minimising cognitive side-effects, based on scientific evidence and supplemented by expert clinical consensus. METHODS Articles and information were sourced from existing guidelines and the published literature. Information was revised and discussed by members of the working group of the Royal Australian and New Zealand College of Psychiatrists' Section for Electroconvulsive Therapy and Neurostimulation, and findings were then formulated into consensus-based recommendations and guidance. The guidelines were subjected to rigorous successive consultation and external review within the Royal Australian and New Zealand College of Psychiatrists, involving the full Section for Electroconvulsive Therapy and Neurostimulation membership, and expert and clinical advisors and professional bodies with an interest in electroconvulsive therapy administration. RESULTS The Royal Australian and New Zealand College of Psychiatrists' professional practice guidelines for the administration of electroconvulsive therapy provide up-to-date advice regarding the use of electroconvulsive therapy in clinical practice and are informed by evidence and clinical experience. The guidelines are intended for use by psychiatrists and also others with an interest in the administration of electroconvulsive therapy. The guidelines are not intended as a directive about clinical practice or instructions as to what must be done for a given patient, but provide guidance to facilitate best practice to help optimise outcomes for patients. The outcome is guidelines that strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that electroconvulsive therapy is a continually evolving practice. CONCLUSION The guidelines provide up-to-date advice for psychiatrists to promote optimal standards of electroconvulsive therapy practice.
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Affiliation(s)
- Alan Weiss
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Salam Hussain
- 2 School of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- 3 Sir Charles Gairdner Hospital Mental Health Service, Perth, WA, Australia
| | - Bradley Ng
- 4 Mental Health and Specialist Services, Robina Hospital, Robina, QLD, Australia
| | - Shanthi Sarma
- 5 Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - John Tiller
- 6 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- 7 Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Susan Waite
- 8 Department of Mental Health Services, The Queen Elizabeth Hospital, Adelaide, SA, Australia
- 9 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Colleen Loo
- 10 School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
- 11 Sydney Neurostimulation Centre, Black Dog Institute, Randwick, NSW, Australia
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The anaesthetic-ECT time interval with thiopentone-Impact on seizure quality. J Affect Disord 2019; 252:135-140. [PMID: 30981950 DOI: 10.1016/j.jad.2019.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/06/2019] [Accepted: 04/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The time between anaesthetic induction and ECT stimulus administration has been hypothesised to significantly impact ictal EEG quality. In this study, our aim was to examine the effect of the time interval between anaesthetic induction and the ECT stimulus for ictal seizure quality in ECT sessions utilising thiopentone anaesthesia. METHODS 413 EEG traces from 42 patients, collected retrospectively, were manually rated using a quantitative-qualitative structured rating scale (indices including seizure amplitude, regularity, post-ictal suppression and general seizure quality). Linear Mixed Effects Models were used to analyse the effect of the anaesthetic-ECT time interval on seizure quality indices, seizure duration and orientation scores after ECT, controlling for patient and ECT treatment factors. RESULTS The anaesthetic-ECT time interval had a significant impact on ictal EEG quality indices (p < 0.05), with longer times producing higher quality seizures. Seizure duration and orientation scores after ECT were not significantly influenced by the anaesthetic-ECT time interval. Age, anaesthetic dose, ECT type and ECT treatment number also had a significant impact on measures of seizure quality (p < 0.05). LIMITATIONS The effect of ventilation technique was not explicitly measured. Only manual ratings of ictal quality were analysed. CONCLUSIONS The time between anaesthetic induction and ECT stimulus administration has a significant impact on the ictal EEG seizure quality observed, with thiopentone anaesthetic. These results are consistent with prior findings with propofol anaesthesia, and suggest a need for routine clinical monitoring of this time interval. This variable warrants consideration when interpreting ictal EEGs, which often informs subsequent dosing decisions.
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