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Ong MJY, Lee VLL, Teo SL, Tan HJ, Trinka E, Khoo CS. Electroconvulsive Therapy in Refractory and Super-Refractory Status Epilepticus in Adults: A Scoping Review. Neurocrit Care 2024; 41:681-690. [PMID: 38769254 DOI: 10.1007/s12028-024-02003-4] [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: 12/11/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has been suggested as a treatment option for refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). OBJECTIVE The objective of this scoping review was to conduct an extensive literature review on the role of ECT as a treatment option for RSE and SRSE. METHODS We searched Ovid MEDLINE and Scopus for journal articles from database inception until February 2024. Articles were then selected based on predetermined inclusion and exclusion criteria. RESULTS We identified five retrospective case series with 28 adult patients receiving ECT for RSE or SRSE. ECT was administered within 3-70 days (mean 20 days) after the development of SE, and the mean number of ECT courses ranged from 1 to 12 sessions for each patient. ECT was administered in fixed or titrated doses. A total of 20 out of 28 patients (71%) showed clinical improvement, with two (7%) having complete cessation of seizures. It is essential to note that given the lack of control, there could be overreporting of clinical improvement in these studies. 11 patients (39%) were reported as deceased due to causes that were not directly related to ECT treatment. Four patients (14%) reported adverse effects of ECT, including memory, concentration, and/or cognitive impairment. CONCLUSIONS There are level-4 Oxford Centre for Evidence-Based Medicine evidence and low-level Grading of Recommendations Assessment Development and Education evidence that suggest ECT as a treatment option for RSE and SRSE. In light of the limitations of the existing evidence, clinicians should carefully consider individual patients' clinical contexts when deciding on the appropriateness of ECT as a treatment option. Further research, including prospective studies with controlled designs, is needed to elucidate the efficacy, safety, and optimal regime of ECT in the management of RSE and SRSE.
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Affiliation(s)
- Marjorie Jia Yi Ong
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Vanessa Lin Lin Lee
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Sze Lynn Teo
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Eugen Trinka
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Ching Soong Khoo
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
- Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
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Lanni I, Chiacchierini G, Papagno C, Santangelo V, Campolongo P. Treating Alzheimer's disease with brain stimulation: From preclinical models to non-invasive stimulation in humans. Neurosci Biobehav Rev 2024; 165:105831. [PMID: 39074672 DOI: 10.1016/j.neubiorev.2024.105831] [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: 05/20/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
Alzheimer's disease (AD) is a severe and progressive neurodegenerative condition that exerts detrimental effects on brain function. As of now, there is no effective treatment for AD patients. This review explores two distinct avenues of research. The first revolves around the use of animal studies and preclinical models to gain insights into AD's underlying mechanisms and potential treatment strategies. Specifically, it delves into the effectiveness of interventions such as Optogenetics and Chemogenetics, shedding light on their implications for understanding pathophysiological mechanisms and potential therapeutic applications. The second avenue focuses on non-invasive brain stimulation (NiBS) techniques in the context of AD. Evidence suggests that NiBS can successfully modulate cognitive functions associated with various neurological and neuropsychiatric disorders, including AD, as demonstrated by promising findings. Here, we critically assessed recent findings in AD research belonging to these lines of research and discuss their potential impact on the clinical horizon of AD treatment. These multifaceted approaches offer hope for advancing our comprehension of AD pathology and developing novel therapeutic interventions.
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Affiliation(s)
- Ilenia Lanni
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy; Behavioral Neuropharmacology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giulia Chiacchierini
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy; Behavioral Neuropharmacology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Costanza Papagno
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Valerio Santangelo
- Functional Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Philosophy, Social Sciences & Education, University of Perugia, Perugia, Italy
| | - Patrizia Campolongo
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy; Behavioral Neuropharmacology Unit, IRCCS Santa Lucia Foundation, Rome, Italy.
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3
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Wilson MG, Riis TS, Kubanek J. Controlled ultrasonic interventions through the human skull. Front Hum Neurosci 2024; 18:1412921. [PMID: 38979100 PMCID: PMC11228146 DOI: 10.3389/fnhum.2024.1412921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024] Open
Abstract
Transcranial focused ultrasound enables precise and non-invasive manipulations of deep brain circuits in humans, promising to provide safe and effective treatments of various neurological and mental health conditions. Ultrasound focused to deep brain targets can be used to modulate neural activity directly or localize the release of psychoactive drugs. However, these applications have been impeded by a key barrier-the human skull, which attenuates ultrasound strongly and unpredictably. To address this issue, we have developed an ultrasound-based approach that directly measures and compensates for the ultrasound attenuation by the skull. No additional skull imaging, simulations, assumptions, or free parameters are necessary; the method measures the attenuation directly by emitting a pulse of ultrasound from an array on one side of the head and measuring with an array on the opposite side. Here, we apply this emerging method to two primary future uses-neuromodulation and local drug release. Specifically, we show that the correction enables effective stimulation of peripheral nerves and effective release of propofol from nanoparticle carriers through an ex vivo human skull. Neither application was effective without the correction. Moreover, the effects show the expected dose-response relationship and targeting specificity. This article highlights the need for precise control of ultrasound intensity within the skull and provides a direct and practical approach for addressing this lingering barrier.
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Affiliation(s)
- Matthew G Wilson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Thomas S Riis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Jan Kubanek
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
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4
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Stuiver S, Pottkämper JCM, Verdijk JPAJ, Ten Doesschate F, van Putten MJAM, Hofmeijer J, van Waarde JA. Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time. Eur Psychiatry 2024; 67:e16. [PMID: 38351599 DOI: 10.1192/j.eurpsy.2024.10] [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] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT. METHODS We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha-delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration. RESULTS In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored. CONCLUSIONS We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures.
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Affiliation(s)
- Sven Stuiver
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
| | - Julia C M Pottkämper
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Joey P A J Verdijk
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Jeannette Hofmeijer
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, Arnhem, The Netherlands
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Miyako K, Kajitani N, Koga Y, Takizawa H, Boku S, Takebayashi M. Identification of the antidepressant effect of electroconvulsive stimulation-related genes in hippocampal astrocyte. J Psychiatr Res 2024; 170:318-327. [PMID: 38194849 DOI: 10.1016/j.jpsychires.2024.01.004] [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: 10/25/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
Major depressive disorder (MDD) remains a significant global health concern, with limited and slow efficacy of existing antidepressants. Electroconvulsive therapy (ECT) has superior and immediate efficacy for MDD, but its action mechanism remains elusive. Therefore, the elucidation of the action mechanism of ECT is expected to lead to the development of novel antidepressants with superior and immediate efficacy. Recent studies suggest a potential role of hippocampal astrocyte in MDD and ECT. Hence, we investigated antidepressant effect of electroconvulsive stimulation (ECS), an animal model of ECT, -related genes in hippocampal astrocyte with a mouse model of MDD, in which corticosterone (CORT)-induced depression-like behaviors were recovered by ECS. In this model, both of CORT-induced depression-like behaviors and the reduction of hippocampal astrocyte were recovered by ECS. Following it, astrocytes were isolated from the hippocampus of this model and RNA-seq was performed with these isolated astrocytes. Interestingly, gene expression patterns altered by CORT were reversed by ECS. Additionally, cell proliferation-related signaling pathways were inhibited by CORT and recovered by ECS. Finally, serum and glucocorticoid kinase-1 (SGK1), a multi-functional protein kinase, was identified as a candidate gene reciprocally regulated by CORT and ECS in hippocampal astrocyte. Our findings suggest a potential role of SGK1 in the antidepressant effect of ECS via the regulation of the proliferation of astrocyte and provide new insights into the involvement of hippocampal astrocyte in MDD and ECT. Targeting SGK1 may offer a novel approach to the development of new antidepressants which can replicate superior and immediate efficacy of ECT.
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Affiliation(s)
- Kotaro Miyako
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoto Kajitani
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusaku Koga
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hitoshi Takizawa
- International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shuken Boku
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
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Goodman MS, Vila-Rodriguez F, Barwick M, Burke MJ, Downar J, Hunter J, Kaster TS, Knyahnytska Y, Kurdyak P, Maunder R, Thorpe K, Trevizol AP, Voineskos D, Zhang W, Blumberger DM. A randomized sham-controlled trial of high-dosage accelerated intermittent theta burst rTMS in major depression: study protocol. BMC Psychiatry 2024; 24:28. [PMID: 38191370 PMCID: PMC10773082 DOI: 10.1186/s12888-023-05470-9] [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: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS), a novel form of repetitive transcranial magnetic stimulation (rTMS), can be administered in 1/10th of the time of standard rTMS (~ 3 min vs. 37.5 min) yet achieves similar outcomes in depression. The brief nature of the iTBS protocol allows for the administration of multiple iTBS sessions per day, thus reducing the overall course length to days rather than weeks. This study aims to compare the efficacy and tolerability of active versus sham iTBS using an accelerated regimen in patients with treatment-resistant depression (TRD). As a secondary objective, we aim to assess the safety, tolerability, and treatment response to open-label low-frequency right-sided (1 Hz) stimulation using an accelerated regimen in those who do not respond to the initial week of treatment. METHODS Over three years, approximately 230 outpatients at the Centre for Addiction and Mental Health and University of British Columbia Hospital, meeting diagnostic criteria for unipolar MDD, will be recruited and randomized to a triple blind sham-controlled trial. Patients will receive five consecutive days of active or sham iTBS, administered eight times daily at 1-hour intervals, with each session delivering 600 pulses of iTBS. Those who have not achieved response by the week four follow-up visit will be offered a second course of treatment, regardless of whether they initially received active or sham stimulation. DISCUSSION Broader implementation of conventional iTBS is limited by the logistical demands of the current standard course consisting of 4-6 weeks of daily treatment. If our proposed accelerated iTBS protocol enables patients to achieve remission more rapidly, this would offer major benefits in terms of cost and capacity as well as the time required to achieve clinical response. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04255784.
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Affiliation(s)
- Michelle S Goodman
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Barwick
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Hunter
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Robert Maunder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Zhang
- Centre for Advancing Health Outcomes, St Paul's Hospital, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Deng ZD, Robins PL, Regenold W, Rohde P, Dannhauer M, Lisanby SH. How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both? Neuropsychopharmacology 2024; 49:150-162. [PMID: 37488281 PMCID: PMC10700353 DOI: 10.1038/s41386-023-01677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
We have known for nearly a century that triggering seizures can treat serious mental illness, but what we do not know is why. Electroconvulsive Therapy (ECT) works faster and better than conventional pharmacological interventions; however, those benefits come with a burden of side effects, most notably memory loss. Disentangling the mechanisms by which ECT exerts rapid therapeutic benefit from the mechanisms driving adverse effects could enable the development of the next generation of seizure therapies that lack the downside of ECT. The latest research suggests that this goal may be attainable because modifications of ECT technique have already yielded improvements in cognitive outcomes without sacrificing efficacy. These modifications involve changes in how the electricity is administered (both where in the brain, and how much), which in turn impacts the characteristics of the resulting seizure. What we do not completely understand is whether it is the changes in the applied electricity, or in the resulting seizure, or both, that are responsible for improved safety. Answering this question may be key to developing the next generation of seizure therapies that lack these adverse side effects, and ushering in novel interventions that are better, faster, and safer than ECT.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Pei L Robins
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - William Regenold
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Paul Rohde
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Moritz Dannhauer
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA.
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Belge JB, Mulders P, Van Diermen L, Sienaert P, Sabbe B, Abbott CC, Tendolkar I, Schrijvers D, van Eijndhoven P. Reviewing the neurobiology of electroconvulsive therapy on a micro- meso- and macro-level. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110809. [PMID: 37331685 DOI: 10.1016/j.pnpbp.2023.110809] [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: 01/22/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysis METHODS: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro- (molecular), meso- (structural) and macro- (network) level. RESULTS ECT impacts both peripheral and central inflammatory processes, triggers neuroplastic mechanisms and modulates large scale neural network connectivity. CONCLUSIONS Integrating this vast body of existing evidence, we are tempted to speculate that ECT may have neuroplastic effects resulting in the modulation of connectivity between and among specific large-scale networks that are altered in depression. These effects could be mediated by the immunomodulatory properties of the treatment. A better understanding of the complex interactions between the micro-, meso- and macro- level might further specify the mechanisms of action of ECT.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Peter Mulders
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Linda Van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, Zoersel 2980, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Leuvensesteenweg 517, Kortenberg 3010, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, University Psychiatric Center Duffel, Stationstraat 22, Duffel 2570, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
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Webb T, Cheeniyil R, Wilson M, Kubanek J. Remote targeted electrical stimulation. J Neural Eng 2023; 20:036030. [PMID: 37236172 PMCID: PMC10251736 DOI: 10.1088/1741-2552/acd95c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 05/28/2023]
Abstract
Objective:The ability to generate electric fields in specific targets remotely would transform manipulations of processes that rest on electrical signaling.Approach:This article shows that focal electric fields are generated from distance by combining two orthogonal, remotely applied energies-magnetic and focused ultrasonic fields. The effect derives from the Lorentz force equation applied to magnetic and ultrasonic fields.Main results:We elicited this effect using standard hardware and confirmed that the generated electric fields align with the Lorentz equation. The effect significantly and safely modulated human peripheral nerves and deep brain regions of non-human primates.Significance:This approach opens a new set of applications in which electric fields are generated at high spatiotemporal resolution within intact biological tissues or materials, thus circumventing the limitations of traditional electrode-based procedures.
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Affiliation(s)
- Taylor Webb
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| | - Rahul Cheeniyil
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| | - Matthew Wilson
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| | - Jan Kubanek
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
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10
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Chen L, Lv F, Min S, Yang Y, Liu D. Roles of prokineticin 2 in electroconvulsive shock-induced memory impairment via regulation of phenotype polarization in astrocytes. Behav Brain Res 2023; 446:114350. [PMID: 36804440 DOI: 10.1016/j.bbr.2023.114350] [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: 09/14/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
Electroconvulsive shock (ECT) is the most effective treatment for depression but can impair learning and memory. ECT is increasingly being shown to activate astrocytes and induce neuroinflammation, resulting in cognitive decline. Activated astrocytes can differentiate into two subtypes, A1-type astrocytes and A2-type astrocytes. Regarding cognitive function, neurotoxic A1 astrocytes and neuroprotective A2 astrocytes may exhibit opposite effects. Specifically, prokineticin 2 (PK2) functions as an essential mediator of inflammation and induces a selective A2-protective phenotype in astrocytes. This study aimed to clarify how PK2 promotes improved learning memory following electroconvulsive shock (ECS). As part of the study, rats were modeled using chronic unpredictable mild stress. Behavioral experiments were conducted to assess their cognitive abilities and depression-like behaviors. Western blot was used to determine the expression of PK2. Immunohistochemical and electron microscopy analyses of the hippocampal CA1 region were conducted to study the activation of astrocyte subtypes and synaptic ultrastructure, respectively. In this study, rats' spatial learning and memory impairment began to improve as activated A1-subtype astrocytes gradually decreased, and PK2 and A2 phenotype activation peaked on the third day after ECS. PKRA7 (PK2 antagonist) inhibits A2-type astrocyte activation partially and suppresses spatial learning and memory improvement. Collectively, our findings support that PK2 may induce a selective modulation of astrocytic polarization to a protective phenotype to promote learning and memory improvement after ECS.
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Affiliation(s)
- Lihao Chen
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Feng Lv
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - You Yang
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Di Liu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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11
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Rajagopalan A, Lim KWK, Tan XW, Martin D, Lee J, Tor PC. Predictors of cognitive changes in patients with schizophrenia undergoing electroconvulsive therapy. PLoS One 2023; 18:e0284579. [PMID: 37159469 PMCID: PMC10168561 DOI: 10.1371/journal.pone.0284579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/02/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Previous studies on the effects of electroconvulsive therapy (ECT) on cognition in schizophrenia have been inconclusive. This study aimed to identify factors that may predict cognitive improvement or deterioration in patients with schizophrenia after-ECT. MATERIALS & METHODS Patients with schizophrenia or schizoaffective disorder with predominantly positive psychotic symptoms, who were treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and January 2018, were assessed. Montreal Cognitive Assessment (MoCA), Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) were performed before and after ECT. Patients with clinically significant improvement, deterioration or no change in MoCA scores were compared on demographics, concurrent clinical treatment and ECT parameters. RESULTS Of the 125 patients analysed, 57 (45.6%), 36 (28.8%) and 32 (25.6%) showed improvements, deterioration and no change in cognition respectively. Age and voluntary admission predicted MoCA deterioration. Lower pre-ECT MoCA and female sex predicted MoCA improvement. Patients showed improvements in GAF, BPRS and BPRS subscale scores on average, except for the MoCA deterioration group, who did not show statistically significant improvement in negative symptom scores. Sensitivity analysis showed that nearly half the patients (48.3%) who were initially unable to complete MoCA pre-ECT were able to complete MoCA post-ECT. CONCLUSIONS The majority of patients with schizophrenia demonstrate improved cognition with ECT. Patients with poor cognition pre-ECT are more likely to see improvement post-ECT. Advanced age may be a risk factor for cognitive deterioration. Finally, improvements in cognition may be associated with improvements in negative symptoms.
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Affiliation(s)
- Arvind Rajagopalan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Kenny Wai Kwong Lim
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Donel Martin
- School of Psychiatry, Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jimmy Lee
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Phern-Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
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12
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Nikolin S, Owens K, Francis-Taylor R, Chaimani A, Martin DM, Bull M, Sackeim HA, McLoughlin DM, Sienaert P, Kellner CH, Loo C. Comparative efficacy, cognitive effects and acceptability of electroconvulsive therapies for the treatment of depression: protocol for a systematic review and network meta-analysis. BMJ Open 2022; 12:e068313. [PMID: 36549738 PMCID: PMC9772645 DOI: 10.1136/bmjopen-2022-068313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There have been important advances in the use of electroconvulsive therapy (ECT) to treat major depressive episodes. These include variations to the type of stimulus the brain regions stimulated, and the stimulus parameters (eg, stimulus duration/pulse width). Our aim is to investigate ECT types using a network meta-analysis (NMA) approach and report on comparative treatment efficacy, cognitive side effects and acceptability. METHOD We will conduct a systematic review to identify randomised controlled trials that compared two or more ECT protocols to treat depression. This will be done using the following databases: Embase, MEDLINE PubMed, Web of Science, Scopus, PsycINFO, Cochrane CENTRAL and will be supplemented by personal contacts with researchers in the field. All authors will be contacted to provide missing information. Primary outcomes will be symptom severity on a validated continuous clinician-rated scale of depression, cognitive functioning measured using anterograde verbal recall, and acceptability calculated using all-cause drop-outs. Secondary outcomes will include response and remission rates, autobiographical memory following a course of ECT, and anterograde visuospatial recall.Bayesian random effects hierarchical models will compare ECT types. Additional meta-regressions may be conducted to determine the impact of effect modifiers and patient-specific prognostic factors if sufficient data are available. DISCUSSION This NMA will facilitate clinician decision making and allow more sophisticated selection of ECT type according to the balance of efficacy, cognitive side effects and acceptability. ETHICS This systematic review and NMA does not require research ethics approval as it will use published aggregate data and will not collect nor disclose individually identifiable participant data. PROSPERO REGISTRATION NUMBER CRD42022357098.
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Affiliation(s)
- Stevan Nikolin
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Kieran Owens
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohan Francis-Taylor
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Anna Chaimani
- Research Center of Epidemiology (CRESS-UMR1153), INSERM, INRA, Universite de Paris, Paris, France
| | - Donel M Martin
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Michael Bull
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Harold A Sackeim
- Department of Psychiatry, Columbia University, New York, New York, USA
| | | | - Pascal Sienaert
- Department of Neurosciences, KU Leuven Psychiatric University Hospital KU Leuven, Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen Loo
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
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13
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Schauder BA, Malcolm TA, Tan A, Dave D, Peterkin AL, Taylor KL. Correlates of electroconvulsive therapy with neurocognitive functioning, subjective memory and depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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14
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Cognitive trajectories during and after electroconvulsive therapy in patients with MDE: Taking different perspectives. J Psychiatr Res 2022; 156:132-140. [PMID: 36252342 DOI: 10.1016/j.jpsychires.2022.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022]
Abstract
Cognitive function during an ECT care pathway is mainly investigated at the group level by analyzing mean cognitive test scores over time. However, there are important inter-individual differences, with some patients experiencing residual invalidating cognitive deficits. This study provides a nuanced examination of cognitive functioning during and after ECT by combining three approaches for data analysis. A cognitive test battery was assessed in seventy-three ECT-treated patients with a Major Depressive Episode (MDE) at up to five time points (baseline, immediately prior to the third session and 1 week, 3 months and 6 months after completion of the index course). Group-level changes in cognitive function were investigated using linear mixed models and individual-level changes were examined using Reliable Change Indices (RCI). The presence of patient subgroups with similar cognitive trajectories was explored using Latent Class Growth Analysis (LCGA). At the group level, there was a temporary deterioration in processing speed, verbal memory and retrograde amnesia during and after index course of ECT. Individual-level analyses revealed considerable variability in cognitive effects of ECT. Three patient classes with a similar cognitive trajectory could be identified, all with a rather parallel courses over time, thus mainly differing in terms of pre-ECT cognitive functioning.
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15
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Liu H, Lan X, Wang C, Zhang F, Fu L, Li W, Ye Y, Hu Z, Chao Z, Ning Y, Zhou Y. The efficacy and safety of esketamine in the treatment of major depressive disorder with suicidal ideation: study protocol for a randomized controlled trial. BMC Psychiatry 2022; 22:744. [PMID: 36451150 PMCID: PMC9710171 DOI: 10.1186/s12888-022-04388-y] [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: 09/23/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a high risk factor for suicide, with up to 20% of MDD patients attempting suicide during their lifetime. Current treatments for MDD are slow onset of action, low efficiency, and the inability to control suicidal behaviors quickly and effectively. Intravenous ketamine has been shown to have a rapid but transient antidepressant effect, but there is still lack evidence on the efficacy and safety of intravenous esketamine in reducing suicidal ideation and depressive symptoms in MDD patients with suicidal ideation. We designed a study to investigate the effect of short-term repeated intravenous infusion of esketamine three times in MDD patients with suicidal ideation. METHODS This study features a randomized, double-blind, placebo-controlled trial (RCT) comparing short-term repeated intravenous infusions of esketamine with placebo as a supplement to conventional antidepressants with an intervention period of 6 days and one infusion every other day, followed by 4 weeks of follow-up. These methods support the examination of the efficacy, safety, tolerability, and mechanism of action of short-term repeated intravenous infusions of esketamine in MDD patients with suicidal ideation. DISCUSSION This is the first RCT to explore the efficacy and safety of short-term repeated infusion of esketamine on suicidal ideation and depressive symptoms in MDD patients with suicidal ideation. If proven effective and tolerated, it will provide evidence for rapid and effective treatment of suicidal ideation and depressive symptoms in MDD individuals with suicidal ideation. TRIAL REGISTRATION Chinese Clinical Trial Register, ChiCTR2000041232 . Registered 22 December 2020.
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Affiliation(s)
- Haiyan Liu
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China ,grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaofeng Lan
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China ,grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chengyu Wang
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China ,grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fan Zhang
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China ,grid.284723.80000 0000 8877 7471The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ling Fu
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China ,grid.284723.80000 0000 8877 7471The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weicheng Li
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China ,grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China ,grid.284723.80000 0000 8877 7471The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanxiang Ye
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China ,grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Zhibo Hu
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China ,grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ziyuan Chao
- grid.410737.60000 0000 8653 1072The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuping Ning
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China. .,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China. .,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Yanling Zhou
- Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China. .,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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16
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Lu Y, Tian Y, Gan Y, Fu Y, Chen Q, Zou L, Zhao B, Yan Y, Liu S, Chen X, Li X. The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study. Brain Sci 2022; 12:brainsci12101393. [PMID: 36291326 PMCID: PMC9599128 DOI: 10.3390/brainsci12101393] [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: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bipolar disorder). The side effect was assessed by TESS. Significant differences were shown in the reduced scores of the CGI-S between patients who underwent ECT and those who did not (p = 0.001), while, at the same time, there was no significant difference in their TESS score (p = 0.297). The current study found that ECT is an effective and tolerable therapy for psychiatric patients with arachnoid cysts.
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Affiliation(s)
- Ying Lu
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Tian
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Gan
- Department of Psychiatry, Chongqing Eleventh People’s, Chongqing 400038, China
| | - Yixiao Fu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bangshu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu Yan
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shudong Liu
- Department of Clinical Psychology II, Chongqing Mental Health Center, Chongqing 400030, China
| | - Xiaolu Chen
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400015, China
- Correspondence: (X.C.); (X.L.)
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Correspondence: (X.C.); (X.L.)
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17
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Carrier SL, Ponsford J, Phyland RK, Hicks AJ, McKay A. Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review. Neuropsychol Rev 2022; 33:374-392. [PMID: 35687261 PMCID: PMC10148768 DOI: 10.1007/s11065-022-09544-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 05/15/2022] [Indexed: 02/03/2023]
Abstract
Agitation is common in the early recovery period following traumatic brain injury (TBI), known as post-traumatic amnesia (PTA). Non-pharmacological interventions are frequently used to manage agitation, yet their efficacy is largely unknown. This systematic review aims to synthesize current evidence on the effectiveness of non-pharmacological interventions for agitation during PTA in adults with TBI. Key databases searched included MEDLINE Ovid SP interface, PubMed, CINAHL, Excerpta Medica Database, PsycINFO and CENTRAL, with additional online reviewing of key journals and clinical trial registries to identify published or unpublished studies up to May 2020. Eligible studies included participants aged 16 years and older, showing agitated behaviours during PTA. Any non-pharmacological interventions for reducing agitation were considered, with any comparator accepted. Eligible studies were critically appraised for methodological quality using Joanna Briggs Institute Critical Appraisal Instruments and findings were reported in narrative form. Twelve studies were included in the review: two randomized cross-over trials, three quasi-experimental studies, four cases series and three case reports. Non-pharmacological interventions were music therapy, behavioural strategies and environmental modifications, physical restraints and electroconvulsive therapy. Key methodological concerns included absence of a control group, a lack of formalised agitation measurement and inconsistent concomitant use of pharmacology. Interventions involving music therapy had the highest level of evidence, although study quality was generally low to moderate. Further research is needed to evaluate non-pharmacological interventions for reducing agitation during PTA after TBI.Systematic review registration number: PROSPERO (CRD42020186802), registered May 2020.
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Affiliation(s)
- Sarah L Carrier
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia. .,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Rehabilitation and Mental Health Division, Epworth Healthcare, Melbourne, Australia
| | - Ruby K Phyland
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Amelia J Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Rehabilitation and Mental Health Division, Epworth Healthcare, Melbourne, Australia
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18
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Carrier SL, Ponsford J, Phyland RK, Hicks AJ, McKay A. Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review. Neuropsychol Rev 2022. [DOI: https://doi:10.1007/s11065-022-09544-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractAgitation is common in the early recovery period following traumatic brain injury (TBI), known as post-traumatic amnesia (PTA). Non-pharmacological interventions are frequently used to manage agitation, yet their efficacy is largely unknown. This systematic review aims to synthesize current evidence on the effectiveness of non-pharmacological interventions for agitation during PTA in adults with TBI. Key databases searched included MEDLINE Ovid SP interface, PubMed, CINAHL, Excerpta Medica Database, PsycINFO and CENTRAL, with additional online reviewing of key journals and clinical trial registries to identify published or unpublished studies up to May 2020. Eligible studies included participants aged 16 years and older, showing agitated behaviours during PTA. Any non-pharmacological interventions for reducing agitation were considered, with any comparator accepted. Eligible studies were critically appraised for methodological quality using Joanna Briggs Institute Critical Appraisal Instruments and findings were reported in narrative form. Twelve studies were included in the review: two randomized cross-over trials, three quasi-experimental studies, four cases series and three case reports. Non-pharmacological interventions were music therapy, behavioural strategies and environmental modifications, physical restraints and electroconvulsive therapy. Key methodological concerns included absence of a control group, a lack of formalised agitation measurement and inconsistent concomitant use of pharmacology. Interventions involving music therapy had the highest level of evidence, although study quality was generally low to moderate. Further research is needed to evaluate non-pharmacological interventions for reducing agitation during PTA after TBI.Systematic review registration number: PROSPERO (CRD42020186802), registered May 2020.
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19
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Fu Z, Sui J, Espinoza R, Narr K, Qi S, Sendi MSE, Abbot CC, Calhoun VD. Whole-Brain Functional Connectivity Dynamics Associated With Electroconvulsive Therapy Treatment Response. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:312-322. [PMID: 34303848 PMCID: PMC8783932 DOI: 10.1016/j.bpsc.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Depressive episodes (DEPs), characterized by abnormalities in cognitive functions and mood, are a leading cause of disability. Electroconvulsive therapy (ECT), which involves a brief electrical stimulation of the anesthetized brain, is one of the most effective treatments used in patients with DEP due to its rapid efficacy. METHODS In this work, we investigated how dynamic brain functional connectivity responds to ECT and whether the dynamic responses are associated with treatment outcomes and side effects in patients. We applied a fully automated independent component analysis-based pipeline to 110 patients with DEP (including diagnosis of unipolar depression or bipolar depression) and 60 healthy control subjects. The dynamic functional connectivity was analyzed by a combination of the sliding window approach and clustering analysis. RESULTS Five recurring connectivity states were identified, and patients with DEPs had fewer occurrences in one brain state (state 1) with strong positive and negative connectivity. Patients with DEP changed the occupancy of two states (states 3 and 4) after ECT, resulting in significantly different occurrences of one additional state (state 3) compared with healthy control subjects. We further found that patients with DEP had diminished global metastate dynamism, two of which recovered to normal after ECT. The changes in dynamic connectivity characteristics were associated with the changes in memory recall and Hamilton Depression Rating Scale of DEP after ECT. CONCLUSIONS These converging results extend current findings on subcortical-cortical dysfunction and dysrhythmia in DEP and demonstrate that ECT might cause remodeling of brain functional dynamics that enhance the neuroplasticity of the diseased brain.
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Affiliation(s)
- Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, United States
| | - Jing Sui
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, United States,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China,University of Chinese Academy of Sciences, Beijing, China
| | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Katherine Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Shile Qi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, United States
| | - Mohammad S. E. Sendi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, United States,Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Christopher C. Abbot
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States,Corresponding author: Dr. Christopher C. Abbott, Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States, , Phone: 505-272-0406
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, United States,Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, United States,Department of Psychology, Computer Science, Neuroscience Institute, and Physics, Georgia State University, Atlanta, Georgia, United States
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20
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Ong Y, Chan LG. A Systematic Review on Cognitive Effects of Electroconvulsive Therapy in Asian Patients. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:1-16. [PMID: 35078944 PMCID: PMC8813321 DOI: 10.9758/cpn.2022.20.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022]
Abstract
Objective Electroconvulsive therapy (ECT) is the most efficacious treatment for many major mental illnesses but is limited by cognitive side effects. However, research on the pattern and severity of ECT-related cognitive side effects is inconsistent. Furthermore, little is known about the cognitive effects of ECT in Asian populations. A systematic review was conducted to examine objective cognitive performance following ECT in the Asian context. Methods This review systematically identified studies assessing ECT-related cognitive effects in PubMED, PsychINFO, The Cochrane Library, Journal of ECT and major databases in Asian countries. The search included publications from peer-reviewed journals of languages other than English. Results A total of 6,322 studies were identified; 823 were assessed for eligibility, of which 16 studies met the search criteria and were included in this review. Majority used high dose Bitemporal ECT for Depression and/or Schizophrenia. Cognitive impairment, which could occur immediate to the first ECT session, was reported in only 9 out of the 16 studies. However, deficits were observed to resolve as early as 3 weeks after the initiation of ECT. The remaining studies reported no impairment or even improvement after ECT. Conclusion There is no consistent evidence that suggests ECT causes cognitive deficits in patients, despite the widespread use of high dose Bitemporal ECT. This review suggests that Asian patients, presenting with a different psychiatric profile, may respond to high-dose Bitemporal ECT differently from Western samples.
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Affiliation(s)
- Yining Ong
- Department of Psychiatry, Tan Tock Seng Hospital, Singapore
| | - Lai Gwen Chan
- Department of Psychiatry, Tan Tock Seng Hospital, Singapore
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21
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Belge JB, Diermen LV, Sabbe B, Morrens M, Coppens V, de Timary P, Constant E, Sienaert P, Schrijvers D. Inflammatory Markers May Inform the Effects of Electroconvulsive Therapy on Cognition in Patients with Depression. Neuropsychobiology 2022; 80:493-501. [PMID: 33910216 DOI: 10.1159/000515931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The neurobiological mechanisms underlying the acute cognitive effects of electroconvulsive therapy (ECT) remain poorly understood. Prior research has shown that proinflammatory cytokines such as IL-6, TNF-α, IL1-β, and IL-10 may interfere with cognitive functioning. Interestingly, immunomodulation is one of the proposed modes of action of ECT. This study investigates whether changes of peripheral levels of IL-6, TNF-α, IL1-β, and IL-10 are related to changes in cognitive functioning following ECT. METHODS In the week before and 1 week after an acute course of ECT, 62 patients suffering from depression underwent a neuropsychological evaluation to assess their processing speed using the Symbol Digit Substitution Test (SDST), verbal episodic memory using the Hopkins Verbal Learning Test-Revised (HVLT-R), and their retrospective autobiographic memory using the Autobiographical Memory Interview (AMI) with the peripheral inflammatory markers being measured at the same 2 time points. RESULTS Patients improved drastically following ECT, while their main performance on both the HVLT-R and AMI declined and their SDST scores remained stable. The levels of IL-6 and IL1-β had both decreased, where the decrease in IL-6 was related to the decrease in HVLT-R scores. Higher baseline IL-10 levels were associated with a more limited decrease of the HVLT-R scores. CONCLUSION Our findings tentatively suggest that the effects of ECT on verbal episodic memory may be related to the treatment's immunomodulatory properties, most notably due to decreased IL-6 levels. Moreover, baseline IL-10 appears to be a potential biomarker to predict the effects of ECT on verbal episodic memory. Whilst compelling, the results of this study should be interpreted with caution as, due to its exploratory nature, no correction for multiple comparisons was made. Further, a replication in larger cohorts is warranted.
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Affiliation(s)
- Jan-Baptist Belge
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium.,Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Linda Van Diermen
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium.,Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Psychiatric Center Bethanië, Zoersel, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium.,Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Manuel Morrens
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium.,Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Violette Coppens
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium.,Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe de Timary
- Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Eric Constant
- Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Didier Schrijvers
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium.,Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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22
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Henstra MJ, Feenstra TC, Kok RM, Spaans HP, van Exel E, Dols A, Oudega M, Vergouwen ACM, van der Loo A, Bet PM, Loer SA, Eikelenboom M, Sienaert P, Lambrichts S, Bouckaert F, Bosmans JE, van der Velde N, Beekman ATF, Stek ML, Rhebergen D. Rivastigmine for ECT-induced cognitive adverse effects in late life depression (RECALL study): A multicenter, randomized, double blind, placebo-controlled, cross-over trial in patients with depression aged 55 years or older: Rationale, objectives and methods. Front Psychiatry 2022; 13:953686. [PMID: 35911242 PMCID: PMC9334653 DOI: 10.3389/fpsyt.2022.953686] [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: 05/26/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive side-effects are an important reason for the limited use of electroconvulsive therapy (ECT). Cognitive side-effects are heterogeneous and occur frequently in older persons. To date, insight into these side-effects is hampered due to inconsistencies in study designs and small sample sizes. Among all cognitive side-effects, confusion and delirious states are especially troublesome for patients, relatives and clinicians. In particular inter-ictal delirium-like states are worrisome, since they may lead to premature treatment discontinuation. Besides a need for further insight into determinants of cognitive side-effects of ECT, there is a great need for treatment options. METHODS AND DESIGN The Rivastigmine for ECT-induced Cognitive Adverse effects in Late Life depression (RECALL) study combines a multicenter, prospective cohort study on older patients with depression, treated with ECT, with an embedded randomized, placebo-controlled cross-over trial to examine the effect of rivastigmine on inter-ictal delirium. Patients are recruited in four centers across the Netherlands and Belgium. We aim to include 150 patients into the cohort study, in order to be able to subsequently include 30 patients into the trial. Patients are included in the trial when inter-ictal delirium, assessed by the Confusion Assessment method (CAM), or a drop in Mini Mental State Examination (MMSE) score of ≥4 during ECT, develops. In the cohort study, comprehensive measurements of ECT-related cognitive side-effects-and their putative determinants-are done at baseline and during the ECT-course. The primary outcome of the clinical trial is the effectiveness of rivastigmine on inter-ictal delirium-severity, assessed with a change in the Delirium Rating Scale-Revised-98. Secondary outcomes of the clinical trial are several ECT-characteristics and side-effects of rivastigmine. DISCUSSION This study is the first clinical trial with a focus on ECT-induced, inter-ictal delirium. The cohort provides the basis for recruitment of patients for the cross-over trial and additionally provides an excellent opportunity to unravel cognitive side-effects of ECT and identify putative determinants. This paper describes the rationale and study protocol. CLINICAL TRIAL REGISTRATION EudraCT 2014-003385-24.
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Affiliation(s)
- Marieke J Henstra
- Department of Internal Medicine and Geriatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Aging and Later Life Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas C Feenstra
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ Centraal Mental Health Care, Amersfoort, Netherlands
| | - Rob M Kok
- Department of Old Age Psychiatry and ECT Center Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Harm-Pieter Spaans
- Department of Old Age Psychiatry and ECT Center Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Eric van Exel
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Annemiek Dols
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands.,Amsterdam Neuroscience, Neurodegeneration Program, Amsterdam, Netherlands
| | - Mardien Oudega
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Anton C M Vergouwen
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, Netherlands
| | - Adriano van der Loo
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Stephan A Loer
- Department of Anesthesiology, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Merijn Eikelenboom
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Simon Lambrichts
- Department of Neurosciences, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium
| | - Judith E Bosmans
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine and Geriatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Aging and Later Life Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Max L Stek
- Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Didi Rhebergen
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ Centraal Mental Health Care, Amersfoort, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands
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23
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Chen X, Zhang T, Shan X, Yang Q, Zhang P, Zhu H, Jiang F, Liu C, Li Y, Li W, Xu J, Shen H. High-frequency repetitive transcranial magnetic stimulation alleviates the cognitive side effects of electroconvulsive therapy in major depression. Front Psychiatry 2022; 13:1002809. [PMID: 36262627 PMCID: PMC9575950 DOI: 10.3389/fpsyt.2022.1002809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The retrospective study aimed to explore the difference in mood outcomes and cognitive function between high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over dorsolateral prefrontal cortex (DLPFC) and electroconvulsive therapy in major depression disorder (MDD) patients and to examine the improvement of HF-rTMS on cognitive impairment evoked by electroconvulsive therapy (ECT). MATERIALS AND METHODS A total of 116 participants with MDD, who completed a 4-week follow-up assessment, were enrolled. The cohort consisted of 26 cases classed as control, 46 participants administrated with HF-rTMS (HF-rTMS group), 22 patients treated with ECT (ECT group), and 23 cases treated with HF-rTMS and ECT at the course of hospitalization (HF-rTMS + ECT group). Medication was kept constant as well in all participants. The 17-item Hamilton Depression Rating Scale for Depression (HAMD-17) and 14-item Hamilton Anxiety Rating Scale (HAMA-14) were used to assess depression and anxiety, respectively. Montreal Cognitive Assessment (MoCA) was to elevate cognitive function. RESULTS No statistical significance was found for baseline in sociodemographic, characteristics of depression, anxiety and cognition, and psychopharmaceutic dosages among control, HF-rTMS, ECT, and HF-rTMS + ECT groups (p > 0.05). Compared with baseline level, total scores of HAMD-17 and HAMA-14 significantly decreased at the end of 4 weeks after treatment (p < 0.001). Furthermore, the decline in scores of HAMD-17 and its sleep disorder and retardation factors from baseline to post-treatment was greater in HF-rTMS, ECT, and HF-rTMS + ECT group than in control (p < 0.05), and there was a significant difference between control and HF-rTMS group in the decline of psychological factor of HAMA-14 (p < 0.01). ECT treatment evoked total score of MoCA to decrease significantly at the end of 4-week after intervention (p < 0.001), and the decline in scores of MoCA and its delayed recall and language performances from baseline to post-treatment was greater in ECT than control, HF-rTMS, and HF-rTMS + ECT (p < 0.05). CONCLUSION High-frequency repetitive transcranial magnetic stimulation improved psychological anxiety and ameliorated the cognition impairment evoked by ECT though it had the same anti-depressant efficacy as ECT.
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Affiliation(s)
- Xing Chen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Tongtong Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Xiaoyan Shan
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Qun Yang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Peiyun Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Haijiao Zhu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Fei Jiang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Chao Liu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Yanzhong Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Weijun Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Jian Xu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Hongmei Shen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China.,Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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24
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Wagenmakers MJ, Vansteelandt K, van Exel E, Postma R, Schouws SNTM, Obbels J, Rhebergen D, Bouckaert F, Stek ML, Barkhof F, Beekman ATF, Veltman DJ, Sienaert P, Dols A, Oudega ML. Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy. Am J Geriatr Psychiatry 2021; 29:1117-1128. [PMID: 33454176 DOI: 10.1016/j.jagp.2020.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT. METHODS A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyze the association between structural brain alterations and cognitive functioning over time. RESULTS Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA). CONCLUSION All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations.
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Affiliation(s)
- Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Rein Postma
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium; University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Didi Rhebergen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Filip Bouckaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Max L Stek
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Frederik Barkhof
- Institute of Healthcare Engineering, University College London, London, UK; Institute of Neurology, University College London, London, UK; Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Dick J Veltman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
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25
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Argyelan M, Lencz T, Kang S, Ali S, Masi PJ, Moyett E, Joanlanne A, Watson P, Sanghani S, Petrides G, Malhotra AK. ECT-induced cognitive side effects are associated with hippocampal enlargement. Transl Psychiatry 2021; 11:516. [PMID: 34625534 PMCID: PMC8501017 DOI: 10.1038/s41398-021-01641-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Electroconvulsive therapy (ECT) is of the most effective treatments available for treatment-resistant depression, yet it is underutilized in part due to its reputation of causing cognitive side effects in a significant number of patients. Despite intensive neuroimaging research on ECT in the past two decades, the underlying neurobiological correlates of cognitive side effects remain elusive. Because the primary ECT-related cognitive deficit is memory impairment, it has been suggested that the hippocampus may play a crucial role. In the current study, we investigated 29 subjects with longitudinal MRI and detailed neuropsychological testing in two independent cohorts (N = 15/14) to test if volume changes were associated with cognitive side effects. The two cohorts underwent somewhat different ECT study protocols reflected in electrode placements and the number of treatments. We used longitudinal freesurfer algorithms (6.0) to obtain a bias-free estimate of volume changes in the hippocampus and tested its relationship with neurocognitive score changes. As an exploratory analysis and to evaluate how specific the effects were to the hippocampus, we also calculated this relationship in 41 other areas. In addition, we also analyzed cognitive data from a group of healthy volunteers (N = 29) to assess practice effects. Our results supported the hypothesis that hippocampus enlargement was associated with worse cognitive outcomes, and this result was generalizable across two independent cohorts with different diagnoses, different electrode placements, and a different number of ECT sessions. We found, in both cohorts, that treatment robustly increased the volume size of the hippocampus (Cohort 1: t = 5.07, Cohort 2: t = 4.82; p < 0.001), and the volume increase correlated with the neurocognitive T-score change. (Cohort 1: r = -0.68, p = 0.005; Cohort 2: r = -0.58; p = 0.04). Overall, our research indicates that novel treatment methods serving to avoid hippocampal volume increase may result in a better side effect profile.
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Affiliation(s)
- Miklos Argyelan
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA.
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Todd Lencz
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Simran Kang
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Sana Ali
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Paul J Masi
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Emily Moyett
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Andrea Joanlanne
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Philip Watson
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Sohag Sanghani
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Georgios Petrides
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anil K Malhotra
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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26
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Zhang Y, Ren L, Min S, Lv F, Yu J. Effects of N-Methyl-D-aspartate receptor (NMDAR) and Ca 2+/calmodulin-dependent protein kinase IIα (CaMKIIα) on learning and memory impairment in depressed rats with different charge by modified electroconvulsive shock. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1320. [PMID: 34532457 PMCID: PMC8422109 DOI: 10.21037/atm-21-3690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Background With the development of modified electroshock therapy (MECT), it has become necessary to increase the electric quantity in order to achieve a good antidepressant effect, but this increase will lead to more serious learning and memory impairment. The purpose of this study was to investigate the intrinsic mechanism of cognitive impairment induced by high-energy electroconvulsive shock (MECS, an animal model of MECT). Methods Rats were randomly divided into 6 groups: control (C, n=6), M0, M60, M120, M180, and M240 groups (MECS at 0, 60, 120, 180, and 240 mC stimulation intensity after 80 mg/kg propofol, with 12 rats in each group). Their depression-like behavior and learning and memory ability were evaluated by sucrose preference test (SPT), open field test (OFT), and Morris water maze test (MWM). The expression of phospho-NMDA receptor 1 (GluN1), GluN2A, GluN2B, Ca2+/calmodulin-dependent protein kinase IIα (CaMKIIα), p-T305-CaMKII, and postsynaptic densities-95 (PSD-95) in hippocampus were detected by western blot. The co-expression of CaMKIIα and GluN2B subunit was detected by co-immunoprecipitation (CO-IP). Results The chronic unpredictable mild stresses (CUMS) procedure successfully induced depression-like behavior in rats, which was improved in varying degrees after MECS. The results showed that the expression of GluN1, GluN2A, GluN2B, and PSD-95 decreased with the increase of charge, while p-T305-CaMKII increased, which led to the deterioration of learning and memory ability, but the expression change of CaMKIIα was not statistically significant. Conclusions Increase in the MECS charge adjusts the synaptic plasticity by changing the binding amount of CaMKIIα and its subunit GluN2B and the level of CaMKII autophosphorylation, thereby impairing learning and memory functions.
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Affiliation(s)
- Yuxi Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Lv
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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27
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The effect of electroconvulsive therapy on neuroinflammation, behavior and amyloid plaques in the 5xFAD mouse model of Alzheimer's disease. Sci Rep 2021; 11:4910. [PMID: 33649346 PMCID: PMC7921388 DOI: 10.1038/s41598-021-83998-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
Microglial cells are affected in Alzheimer’s disease (AD) and interact with amyloid-beta (Aβ) plaques. Apart from memory loss, depression is common in patients with AD. Electroconvulsive therapy (ECT) is an anti-depressive treatment that may stimulate microglia, induce neuroinflammation and alter the levels of soluble Aβ, but the effects of ECT on microglia and Aβ aggregation in AD are not known. We investigated the short- and long-term effects of ECT on neuroinflammation and Aβ accumulation. 5xFAD mice received either electroconvulsive stimulation (ECS n = 26) or sham treatment (n = 25) for 3 weeks. Microglia and Aβ were analyzed in samples collected 24 h, 5 weeks, or 9 weeks after the last treatment. Aβ plaques and microglia were quantified using immunohistochemistry. The concentration of soluble Aβ and cytokines was quantified using ELISA and levels of Aβ aggregates were measured with Western Blot. Microglial phagocytosis of Aβ in the hippocampus was evaluated by flow cytometry in Methoxy-X04 injected mice 24 h following the last ECS treatment. Y-maze and Elevated plus maze were performed to study behavior after 5 weeks. We could not detect any significant short- or long-term effects of ECS on Aβ pathology or neuroinflammation, but ECS reduced abnormal behavior in the Elevated Plus maze.
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Lomas M, Rickard V, Milton F, Savage S, Weir A, Zeman A. Electroconvulsive therapy related autobiographical amnesia: a review and case report. Cogn Neuropsychiatry 2021; 26:107-121. [PMID: 33467984 DOI: 10.1080/13546805.2021.1871889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: While short-term cognitive impairment following electroconvulsive therapy (ECT) is well described and acknowledged, the relationship between ECT and persistent memory impairment, particularly of autobiographical memory, has been controversial. Methods: We describe the case of a 70-year-old consultant neurophysiologist, AW, who developed prominent, selective autobiographical memory loss following two courses of ECT for treatment-resistant depression. Results: His performance on standard measures of IQ, semantic and episodic memory, executive function and mood was normal, while he performed significantly below controls on measures of episodic autobiographical memory. Conclusions: Explanations in terms of mood-related memory loss and somatoform disorder appear unlikely. We relate AW's autobiographical memory impairment, following his ECT, to reports of similar autobiographical memory impairment occurring in the context of epilepsy, and emphasise the importance of using sensitive approaches to AbM assessment.
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Affiliation(s)
- Matthew Lomas
- College of Medicine and Health, College House, University of Exeter, Exeter, UK
| | - Victoria Rickard
- College of Medicine and Health, College House, University of Exeter, Exeter, UK
| | - Fraser Milton
- School of Psychology, College of Life and Environmental Sciences, Washington Singer, University of Exeter, Exeter, UK
| | - Sharon Savage
- School of Psychology, College of Life and Environmental Sciences, Washington Singer, University of Exeter, Exeter, UK
| | - Andrew Weir
- Institute of Neurological Sciences, Langlands Drive, University of Glasgow, Glasgow, UK
| | - Adam Zeman
- College of Medicine and Health, College House, University of Exeter, Exeter, UK
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Gbyl K, Støttrup MM, Mitta Raghava J, Xue Jie S, Videbech P. Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression. Acta Psychiatr Scand 2021; 143:238-252. [PMID: 33251575 DOI: 10.1111/acps.13259] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/21/2020] [Accepted: 11/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Patients hesitate to consent to electroconvulsive therapy (ECT) because of the fear of memory impairment. The mechanisms underlying this impairment are unclear, but several observations suggest hippocampal alterations may be involved. We investigated whether ECT-induced change in hippocampal volume correlates with memory impairment. METHODS Using a 3 T MRI scanner, we acquired brain images and assessed cognitive performance in 22 severely depressed patients at three time points: (1) before ECT series, (2) within one week after the series, and (3) at six-month follow-up. The hippocampus was segmented into subregions using FreeSurfer. The dentate gyri (DG) were the primary regions of interest (ROIs) and major hippocampal subregions secondary ROIs. Cognitive performance was assessed using the Screen for Cognitive Impairment in Psychiatry and verbal memory using the Verbal Learning subtest. The linear mixed model and the repeated-measures correlation were used for statistical analyses. RESULTS ECT induced an increase in the right and left DG volume with co-occurring worsening in verbal memory, and these changes were within-patients negatively correlated (right DG, rrm = -0.85, df = 18, p = 0.0000002; left DG, rrm = -0.58, df = 18, p = 0.008). At a six-month follow-up, the volume of both DG decreased with a co-occurring improvement in verbal memory, and these changes were negatively correlated in the right DG (rrm = -0.64, df = 15, p = 0.005). Volume increases in 14 secondary ROIs were also negatively correlated with memory impairment. CONCLUSION ECT-related transient increases in the volume of major hippocampal subregions within-patients are associated with memory impairment. Hippocampal alterations following ECT should be the focus in searching for causes of the cognitive side effects.
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Affiliation(s)
- Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Mette Marie Støttrup
- Center for Neuropsychiatric Depression Research, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Jayachandra Mitta Raghava
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Center Glostrup, Glostrup, Denmark.,Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Glostrup, Denmark
| | - Song Xue Jie
- Department of Clinical Psychiatry, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Psychiatric Center Glostrup, Glostrup, Denmark
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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: 2] [Impact Index Per Article: 0.5] [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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Hebbrecht K, Giltay EJ, Birkenhäger TK, Sabbe B, Verwijk E, Obbels J, Roelant E, Schrijvers D, Van Diermen L. Cognitive change after electroconvulsive therapy in mood disorders measured with the Montreal Cognitive Assessment. Acta Psychiatr Scand 2020; 142:413-422. [PMID: 32895922 DOI: 10.1111/acps.13231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) is a sensitive and clinically practical test but its usefulness in measuring long-term cognitive effects of ECT is unclear. Using the MoCA, we investigated short- and long-term global cognitive change in ECT-treated patients with a Major Depressive Episode (MDE). METHOD We included 65 consecutive ECT-treated patients with MDE, in whom global cognitive functioning was assessed at baseline (T0); during ECT (before the third session; T1); and 1 week (T2), 3 months (T3), and 6 months (T4) after completion of the index course. Changes in MoCA (sub)scores were analyzed using linear mixed models and reliable change indices were computed to investigate individual changes in MoCA total scores. RESULTS There was a significant effect of time on MoCA scores (F(4, 230.5) = 4.14, P = 0.003), with an improvement in global cognitive functioning from T3 compared to T1 and T2. At the individual level, 26% (n = 17) of patients showed a significantly worse cognitive functioning at T2 and 12% (n = 8) an improved cognitive functioning compared to T0. For T4, these percentages ameliorated to 8% and 18% respectively. CONCLUSION No persistent global cognitive impairment induced by ECT was found at the group level using the MoCA. At the individual level, however, there was clear heterogeneity in the effects of ECT on cognitive functioning. The MoCA is a suitable tool to monitor short- and long-term global cognitive functioning in ECT-treated patients with MDE but in younger patients, potential ceiling effects must be taken into account.
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Affiliation(s)
- K Hebbrecht
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,VZW Emmaüs, University Psychiatric Hospital Duffel, Duffel, Belgium
| | - E J Giltay
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - T K Birkenhäger
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B Sabbe
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium
| | - E Verwijk
- Department of Medical Psychology (EV), Neuropsychology Department, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychology (EV), Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department Haaglanden (EV), Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT) University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - E Roelant
- StatUa, Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - D Schrijvers
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,VZW Emmaüs, University Psychiatric Hospital Duffel, Duffel, Belgium
| | - L Van Diermen
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,VZW Emmaüs, University Psychiatric Hospital Duffel, Duffel, Belgium.,Psychiatric Hospital Bethanië, Zoersel, Belgium
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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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Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
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Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
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Feasibility of the Audio Recorded Cognitive Screen in the Assessment of Individuals Undergoing Electroconvulsive Therapy. J ECT 2020; 36:4-9. [PMID: 31913926 DOI: 10.1097/yct.0000000000000637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Monitoring for cognitive deficits during a course of electroconvulsive therapy (ECT) is recommended, but cognitive assessment can be time consuming. The Audio Recorded Cognitive Screen (ARCS) is a cognitive test instrument with good psychometric properties that places minimal demands on clinicians' time, but until now, it has not been formally evaluated for monitoring cognition in the context of ECT treatment. OBJECTIVES This study aimed to assess the feasibility/utility of using the ARCS in the assessment of depressed patients undergoing ECT. METHODS Depressed patients undergoing ECT were tested with the ARCS and a comparison instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), in counterbalance order immediately before any ECT and after the sixth ECT treatment episode. Apathy (Apathy Scale) and depression (Profile of Mood states Short Form) were measured on both occasions. Analyses compared performances on the 2 cognitive instruments and examined for associations with the measures of apathy or depression. RESULTS Twenty-eight individuals (9 male, 19 female) aged 19 to 84 years underwent testing. Performances on the total ARCS were similar to those on the total RBANS, and both showed decline from baseline to follow-up. The total ARCS and RBANS measures correlated well (r = 0.75, P < 0.001). Neither apathy nor depression scores were significantly associated with scores on either the RBANS or ARCS. CONCLUSIONS The ARCS was acceptable and convenient in the assessment of cognition in patients undergoing treatment with ECT. In light of its practical advantages, further evaluation of the ARCS for detecting cognitive impairment and tracking cognitive changes during ECT seems warranted.
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Preventive effect of dexmedetomidine on postictal delirium after electroconvulsive therapy. Eur J Anaesthesiol 2020; 37:5-13. [DOI: 10.1097/eja.0000000000001113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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van Diermen L, Vanmarcke S, Walther S, Moens H, Veltman E, Fransen E, Sabbe B, van der Mast R, Birkenhäger T, Schrijvers D. Can psychomotor disturbance predict ect outcome in depression? J Psychiatr Res 2019; 117:122-128. [PMID: 31382133 DOI: 10.1016/j.jpsychires.2019.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE ≥ 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment.
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Affiliation(s)
- Linda van Diermen
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Simon Vanmarcke
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Herman Moens
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium
| | - Eveline Veltman
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Bernard Sabbe
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roos van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Didier Schrijvers
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Abstract
OBJECTIVES Findings on the cognitive effect of electroconvulsive therapy (ECT) in individuals with schizophrenia have brought mixed results, with few recent studies beginning to report cognitive improvements after treatment. Cognitive change in inpatients with schizophrenia who were referred for an acute course of ECT was examined in the current study. Furthermore, the study aimed to determine the profile of patients who experience cognitive improvement and the potential use of a brief cognitive battery to detect this positive cognitive change, if any. METHODS Montreal Cognitive Assessment (MoCA) was conducted at baseline and posttreatment after 6 sessions of ECT. The Brief ECT Cognitive Screen was also administered to determine its predictive ability on cognitive gain of 2 points or higher in MoCA total scores for the 2 consecutive time points. RESULTS A total of 81 inpatients were included in the study. Retrospective analysis revealed significant improvements in MoCA total score and domains of visuospatial/executive function and attention. Cognitive improvement was more pronounced among those who had worse pre-MoCA score before ECT. CONCLUSIONS The study provided support to the existing literature where cognitive improvement has been reported among individuals with schizophrenia after ECT. Future studies should consider the use of randomized controlled trials to examine the possible cognitive benefits of ECT. In a setting where there is a high volume of patients receiving ECT, the monitoring of patients' cognitive status through the course of ECT continues to be warranted and the Brief ECT Cognitive Screen may be useful as a quick measure to detect such ECT-related cognitive change.
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Cardinale KM, Bocharnikov A, Hart SJ, Baker JA, Eckstein C, Jasien JM, Gallentine W, Worley G, Kishnani PS, Van Mater H. Immunotherapy in selected patients with Down syndrome disintegrative disorder. Dev Med Child Neurol 2019; 61:847-851. [PMID: 30548468 DOI: 10.1111/dmcn.14127] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 12/14/2022]
Abstract
Down syndrome disintegrative disorder (DSDD) is an increasingly identified condition characterized by cognitive decline, autistic characteristics, insomnia, catatonia, and psychosis in adolescents and young adults with Down syndrome. Previously we reported a higher rate of autoimmune thyroid disease in these patients compared with unaffected individuals with Down syndrome. We therefore hypothesized DSDD may in some cases be immune-mediated. Here we report four cases of DSDD treated with immunotherapy. Families were interviewed retrospectively for symptoms of cognitive decline, autism, catatonia, psychosis, and insomnia before and after treatment, using established scales where possible. Medical records were reviewed for evaluations and treatment. All four patients received intravenous immunoglobulin with or without additional immunotherapy. Significant improvements were seen in catatonia, insomnia, autistic features, cognition, and psychosis. In this small case series of patients with autoimmunity, core symptoms of DSDD improved significantly after immunotherapy. This supports the hypothesis that, in some patients, DSDD is immune-mediated. Immunotherapy should be considered in the treatment of DSDD, particularly in patients with a history of autoimmunity. WHAT THIS PAPER ADDS: Immunotherapy may improve symptoms of catatonia, insomnia, autism severity, cognitive decline, and psychosis in Down syndrome disintegrative disorder.
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Affiliation(s)
| | | | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Jane Ann Baker
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | | | - Joan M Jasien
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - William Gallentine
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Gordon Worley
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Heather Van Mater
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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Alcoverro-Fortuny Ò, Alarcón BG, Usan FV, Ruíz DS, Oscoz-Irurozqui M, Señé GM. Etomidate improves seizure adequacy during electroconvulsive therapy. Psychiatry Res 2019; 273:350-354. [PMID: 30682556 DOI: 10.1016/j.psychres.2019.01.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess whether switching propofol to etomidate during an electroconvulsive therapy course improves seizure quality in convulsion-resistant patients. A retrospective study of paired cases included thirty-three patients. Seizure variables for each agent were assessed. A generalized linear mixed model (GLMM) for repeated measures was used for the analysis. Anesthesia with etomidate leads to greater seizure duration, improved seizure quality in the EEG register, and prevents further need for restimulation; although did not differ from propofol in the amount of energy delivered or in other automated parameters. These results suggest that this procedure appears to be an adequate strategy to improve seizure quality.
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Affiliation(s)
- Òscar Alcoverro-Fortuny
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Granollers, Barcelona, Spain.
| | - Belén García Alarcón
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Ferran Viñas Usan
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Granollers, Barcelona, Spain
| | - David Suárez Ruíz
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Maitane Oscoz-Irurozqui
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Gemma Molist Señé
- Research and Innovation area, Hospital General de Granollers, Granollers, Barcelona, Spain
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Kiebs M, Hurlemann R, Mutz J. Cognitive effects of non-surgical brain stimulation for major depressive disorder: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e023796. [PMID: 30782887 PMCID: PMC6377555 DOI: 10.1136/bmjopen-2018-023796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/28/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Non-surgical brain stimulation techniques may be considered as alternative or add-on treatments for patients with major depressive disorder who failed to respond to pharmacological interventions. Electroconvulsive therapy has been shown to be highly effective in reducing depressive symptoms but stakeholders remain concerned about adverse cognitive effects. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may be associated with more benign adverse effect profiles and may indeed improve certain cognitive functions such as memory and attention. To guide clinical decision-making, we will carry out a systematic review and meta-analysis of the cognitive effects of eight non-surgical brain stimulation techniques. METHODS AND ANALYSIS A systematic literature search of the Embase, PubMed/MEDLINE and PsycINFO databases, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and OpenGrey will be performed. We will include both randomised clinical trials which report on at least one cognitive measure post treatment as well as non-randomised trials and pre-post intervention studies. There are no restrictions to the type of cognitive outcome measures, except that the tests are standardised and psychometrically validated. The Revised Cochrane tool for assessing risk of bias in randomised trials (RoB 2.0) will be used to evaluate included trials. Pre-post studies will be evaluated using the quality assessment tool developed by the US National Heart, Lung and Blood Institute. Meta-analysis, meta-regression, subgroup and sensitivity analyses will be conducted where sufficient data are available. ETHICS AND DISSEMINATION No ethical approval is needed to conduct this work. The findings will be submitted for publication in peer-reviewed journals and presented at scientific meetings. PROSPERO REGISTRATION NUMBER CRD42018118850.
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Affiliation(s)
- Maximilian Kiebs
- Department of Psychiatry and Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Julian Mutz
- Faculty of Medicine, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK
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Combining attentional bias modification with dorsolateral prefrontal rTMS does not attenuate maladaptive attentional processing. Sci Rep 2019; 9:1168. [PMID: 30718539 PMCID: PMC6362221 DOI: 10.1038/s41598-018-37308-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/22/2018] [Indexed: 11/08/2022] Open
Abstract
High frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce depressive symptoms and improve cognitive biases such as attentional bias. One promising technique that may complement rTMS treatment is attentional bias modification (ABM) training, given the similarity in modulating attentional bias and affecting neuronal activity. We tested whether the combination of rTMS treatment and ABM training in a single session would attenuate maladaptive attentional processing and improve mood in participants with subclinical depressive symptoms. To this end, 122 healthy participants were randomly assigned to one of four groups, receiving either a single rTMS treatment, a single ABM treatment, a combination of rTMS and ABM or a sham treatment. Of these 122 participants, 72 showed a heightened BDI-II score (between 9 and 25) and were included in our main analyses. In our subclinical (≥9 and ≤25 BDI-II) sample, a single combination treatment of rTMS and ABM training induced no significant changes in attentional bias, attentional control or mood, nor did rTMS alone affect attentional bias systematically. We discuss these null findings in light of the task specifics and relate them to the ongoing discussion on ABM training in depression.
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Chen P, Hei M, Kong L, Liu Y, Yang Y, Mu H, Zhang X, Zhao S, Duan J. One water-soluble polysaccharide from Ginkgo biloba leaves with antidepressant activities via modulation of the gut microbiome. Food Funct 2019; 10:8161-8171. [DOI: 10.1039/c9fo01178a] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
By performing a pyrosequencing-based analysis of bacterial community, we detected that one Ginkgo biloba polysaccharide reversed depression-associated gut dysbiosis and increased the richness of Lactobacillus species which has been proven to be a path to relieve depression.
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Affiliation(s)
- Peng Chen
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
| | - Maofang Hei
- State Key Laboratory of Crop Stress Biology for Arid Areas
- College of Veterinary Medicine
- Northwest A&F University
- Yangling 712100
- China
| | - Lili Kong
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
| | - Yinyin Liu
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
| | - Yu Yang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
| | - Haibo Mu
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
| | - Xiuyun Zhang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
| | - Shanting Zhao
- State Key Laboratory of Crop Stress Biology for Arid Areas
- College of Veterinary Medicine
- Northwest A&F University
- Yangling 712100
- China
| | - Jinyou Duan
- Shaanxi Key Laboratory of Natural Products & Chemical Biology
- College of Chemistry & Pharmacy
- Northwest A&F University
- Yangling 712100
- China
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Abstract
BACKGROUND Treatment-resistant depression (TRD) is a serious chronic condition disabling patients functionally and cognitively. Chronic vagus nerve stimulation (VNS) is recognized for the management of TRD, but few studies have examined its long-term effects on cognitive dysfunction in unipolar and bipolar resistant depression. OBJECTIVE The purpose of this study was to assess the course of cognitive functions and clinical symptoms in a cohort of patients treated with VNS for TRD. METHODS In 14 TRD patients with VNS, standardized clinical and neuropsychological measures covering memory, attention/executive functions, and psychomotor speed were analyzed prestimulation and up to 2 years poststimulation. RESULTS Vagus nerve stimulation patients significantly improved on cognitive and clinical measures. Learning and memory improved rapidly after 1 month of stimulation, and other cognitive functions improved gradually over time. Cognitive improvements were sustained up to 2 years of treatment. At 1 month, improvement in Montgomery-Åsberg Depression Rating Scale scores was not correlated with changes in any of the cognitive scores, whereas at 12 months, the change in Montgomery-Åsberg Depression Rating Scale score was significantly correlated with several measures (Stroop interference, verbal fluency, and Rey-Osterrieth Complex Figure delayed recall). CONCLUSIONS In recent years, a growing interest in cognitive dysfunction in depression has emerged. Our results suggest that chronic VNS produces sustained clinical and cognitive improvements in TRD patients, with some mental functions improving as soon as 1 month after the initiation of the VNS therapy. Vagus nerve stimulation seems a very promising adjunctive therapy for TRD patients with cognitive impairment.
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Kalisova L, Kubinova M, Michalec J, Albrecht J, Madlova K, Raboch J. Cognitive functioning in patients treated with electroconvulsive therapy. Neuropsychiatr Dis Treat 2018; 14:3025-3031. [PMID: 30510424 PMCID: PMC6231503 DOI: 10.2147/ndt.s182423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective treatment method for severe mental illnesses. ECT has gone through significant modernization. Side effects of ECT have largely decreased. Temporary disturbance of cognitive performance can be still present as a side effect of electroconvulsive treatment. METHODS Cognitive functioning in the sample of patients with severe and acute mental illness treated with electroconvulsive therapy (ECT) was assessed. Basic assessment of cognitive functions was applied in the beginning, in the middle, and at the end of ECT course treatment with the Montreal Cognitive Assessment (MoCA). Complex and detailed testing of cognitive functions using the MATRICS Consensus Cognitive Battery (MCCB) was done at two points in time - within the first week of and then 6 weeks after the end of ECT. RESULTS Participants had cognitive deficits at baseline, which were most likely influenced markedly by the psychopathology of the illness itself. The improvement in cognition came together with the reduction in psychopathology; psychopathology scores were significantly reduced during ECT treatment. Compared to the baseline, all scores for cognitive testing were significantly improved but remained low in comparison with the controls. After 6 weeks, there was further significant improvement. CONCLUSION Our results confirm the safety and efficacy of ECT in the treatment of severe mental disorders.
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Affiliation(s)
- Lucie Kalisova
- Department of Psychiatry, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic,
| | - Marketa Kubinova
- Department of Psychiatry, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic,
| | - Jiri Michalec
- Department of Psychiatry, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic,
| | - Jakub Albrecht
- Department of Psychiatry, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic,
| | - Katerina Madlova
- Department of Psychiatry, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic,
| | - Jiri Raboch
- Department of Psychiatry, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic,
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Nuninga JO, Claessens TFI, Somers M, Mandl R, Nieuwdorp W, Boks MP, Bakker S, Begemann MJH, Heringa S, Sommer IEC. Immediate and long-term effects of bilateral electroconvulsive therapy on cognitive functioning in patients with a depressive disorder. J Affect Disord 2018; 238:659-665. [PMID: 29966930 DOI: 10.1016/j.jad.2018.06.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective treatment for patients suffering from major depression. However, its use is limited due to concerns about negative effects on cognition. Unilateral ECT is associated with transient cognitive side-effects, while case-controlled studies investigating the effect of bilateral ECT on cognition remain scarce. We investigate the effects of bilateral ECT on cognition in depression in a longitudinal case-controlled study. We hypothesize that adverse cognitive effects of bilateral ECT are transient rather than long-term. METHODS A total of 48 depressed patients and 19 controls were included in the study and assessed with a battery of cognitive tests, including tests of: working memory, verbal fluency, visuospatial abilities, verbal/visual memory and learning, processing speed, inhibition, attention and task-switching, and premorbid IQ. Patients underwent three cognitive assessments: at baseline (n = 43), after ten ECT sessions (post-treatment; n = 39) and six months after the tenth ECT session (follow-up; n = 25). Healthy controls underwent the same cognitive assessment at baseline and after five-weeks. RESULTS Within the patient group, transient adverse cognitive side-effects were observed for verbal memory and learning, and verbal fluency. None of the cognitive domains tested in this study showed persisting impairments. LIMITATIONS A relatively high attrition rate is observed and autobiographical memory was not assessed. CONCLUSION This study shows that bilateral ECT has negative cognitive effects on short-term. These effects could be explained by a decrease in cognitive performance, a lack of learning effects or a combination. However, the decrease in cognitive functioning appears to recover after six months.
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Affiliation(s)
- Jasper O Nuninga
- Department of Neuroscience, University Medical Centre Groningen, The Netherlands; Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands.
| | - Thomas F I Claessens
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Metten Somers
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - René Mandl
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Wendy Nieuwdorp
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Marco P Boks
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Steven Bakker
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Marieke J H Begemann
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Sophie Heringa
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
| | - Iris E C Sommer
- Department of Neuroscience, University Medical Centre Groningen, The Netherlands; Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands; Department of Medical and Biological Psychology, University of Bergen, Norway
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Vink JJT, Mandija S, Petrov PI, van den Berg CAT, Sommer IEC, Neggers SFW. A novel concurrent TMS-fMRI method to reveal propagation patterns of prefrontal magnetic brain stimulation. Hum Brain Mapp 2018; 39:4580-4592. [PMID: 30156743 PMCID: PMC6221049 DOI: 10.1002/hbm.24307] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/11/2022] Open
Abstract
Major depressive disorder (MDD) is a severe mental disorder associated with high morbidity and mortality rates, which remains difficult to treat, as both resistance and recurrence rates are high. Repetitive transcranial magnetic stimulation (TMS) of the left dorsolateral prefrontal cortex (DLPFC) provides a safe and effective treatment for selected patients with treatment‐resistant MDD. Little is known about the mechanisms of action of TMS provided to the left DLPFC in MDD and we can currently not predict who will respond to this type of treatment, precluding effective patient selection. In order to shed some light on the mechanism of action, we applied single pulse TMS to the left DLPFC in 10 healthy participants using a unique TMS‐fMRI set‐up, in which we could record the direct effects of TMS. Stimulation of the DLPFC triggered activity in a number of connected brain regions, including the subgenual anterior cingulate cortex (sgACC) in four out of nine participants. The sgACC is of particular interest, because normalization of activity in this region has been associated with relief of depressive symptoms in MDD patients. This is the first direct evidence that TMS pulses delivered to the DLPFC can propagate to the sgACC. The propagation of TMS‐induced activity from the DLPFC to sgACC may be an accurate biomarker for rTMS efficacy. Further research is required to determine whether this method can contribute to the selection of patients with treatment resistant MDD who will respond to rTMS treatment.
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Affiliation(s)
- Jord J T Vink
- Department of Imaging, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefano Mandija
- Department of Imaging, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Petar I Petrov
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornells A T van den Berg
- Department of Imaging, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Iris E C Sommer
- Department of Neuroscience and Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Medical and Biological Psychology, University of Bergen, Bergen, Norway
| | - Sebastiaan F W Neggers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Narchal S, Harris AW, Allen B. A comparison between Right Unilateral Ultrabrief electroconvulsive therapy and bilateral electroconvulsive therapy in the elderly: a pilot naturalistic observational study. Australas Psychiatry 2018; 26:394-397. [PMID: 29609474 DOI: 10.1177/1039856218765898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare clinical outcomes and adverse effects between Bitemporal (BT) and Right Unilateral Ultrabrief (RUL(UB)) electroconvulsive therapy (ECT) in an elderly population. METHODS Patients over the age of 65 years admitted to a tertiary referral hospital over a seven month period requiring ECT received RUL(UB) ECT. They were compared with those who received BT ECT over these and the preceding seven months. RESULTS Twenty-three patients entered the study. No significant differences was observed between the groups in demographic and clinical characteristics or clinical improvement. However, patients who received BT ECT were significantly more likely to be confused post treatment compared with the RUL(UB) group. CONCLUSIONS This pilot study found RUL(UB) ECT to be an effective treatment in elderly patients. These patients also suffered significantly less confusion than patients who received BT ECT.
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Affiliation(s)
- Shalini Narchal
- Staff Specialist, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, and; Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia
| | - Anthony Wf Harris
- Professor of Psychiatry, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, and; Department of Psychiatry, Westmead Hospital, Westmead, NSW, and; Brain Dynamics Centre, Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia
| | - Bruce Allen
- Senior Staff Specialist, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, and; Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) is said to have few adverse effects and among them, cognitive impairment is the most significant side effect limiting its use. However, recent studies have suggested it to be due to illness rather than due to ECT, hence a need to study the memory changes following ECT. AIM This study aimed to assess the memory changes following ECT and subsequent recovery in the short period of 4 weeks. MATERIALS AND METHODS Fifty consecutive first-episode cases of depression requiring ECT and scoring at least 27 on initial Mini-Mental State Examination were studied using Becks Depression Inventory and Wechsler Memory Scale III-Indian adaptation at baseline, after six ECTs, and 4 weeks after last ECT. Findings were analyzed using appropriate statistical methods. RESULTS Memory improved significantly after a course of six ECTs and further 4 weeks after the last ECT. Depression scores had dramatically reduced after a course of six ECTs. Significant correlation was found between baseline depression scores and baseline general (delayed) memory scores. CONCLUSIONS The memory changes seen after ECT were likely to be mediated by changes in depression. Probably, ECT had no deleterious effects on memory or its negative effects were more than balanced by the changes due to improvement of depression.
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Affiliation(s)
| | | | - Jyoti Prakash
- Department of Psychiatry, Command Hospital (EC), Kolkata, West Bengal, India
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Decreased Cognitive Functioning After Electroconvulsive Therapy Is Related to Increased Hippocampal Volume: Exploring the Role of Brain Plasticity. J ECT 2018; 34:117-123. [PMID: 29389676 DOI: 10.1097/yct.0000000000000483] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is still the most effective treatment of severe and therapy-refractory major depressive disorder. Cognitive side effects are the major disadvantage of ECT. Cognitive deficits are generally temporary in nature and may be mediated by the hippocampus. Recent studies have shown a temporary increase in hippocampal volume and a temporary decrease in cognitive functioning post-ECT compared with pre-ECT. This study investigates whether these volumetric changes are related to changes in cognitive functioning after ECT. METHODS Nineteen medication-free patients with treatment-resistant major depressive disorder underwent a whole-brain magnetic resonance imaging scan and a neuropsychological examination (including the Rey auditory verbal learning task, Wechsler Memory Scale Visual Reproduction, fluency, Trail Making Task) within 1 week before and within 1 week after the course of ECT. Electroconvulsive therapy was administered twice a week bitemporally with a brief pulse. A matched healthy control group (n = 18) received the same neuropsychological examination and at a similar interval to that of the patients. RESULTS Hippocampal volumes increased significantly from pretreatment to posttreatment in patients. Mean performance on cognitive tasks declined, or remained stable, whereas performance in controls generally improved because of retesting effects. The increase in hippocampal volume was related to changes in cognitive performance, indicating that this increase co-occurred with a decrease in cognitive functioning. CONCLUSIONS Our findings tentatively suggest that the temporal increase in hippocampal volume after treatment, which may result from neurotrophic processes and is thought to be crucial for the antidepressive effect, is also related to the temporary cognitive side effects of ECT.
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