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Endomba FT, Aho Glélé LS, Benkhadra M, Guillet C. Etomidate versus propofol for electroconvulsive therapy: An intraindividual comparative study during the COVID-19 pandemic. L'ENCEPHALE 2024; 50:504-509. [PMID: 38040511 DOI: 10.1016/j.encep.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 09/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES The Coronavirus disease 2019 (COVID-19) pandemic markedly influenced mental health care practices, notably regarding electroconvulsive therapy (ECT). This was due to the redistribution of anesthetic agents used during ECT such as propofol, for intensive care units. Because in our center propofol was switched to etomidate to avoid ECT activity discontinuation, we undertook this study in order to compare Propofol and Etomidate regarding electroencephalographic seizure duration and stimulus intensity. METHODS We performed a retrospective and comparative study, each patient being its own control. We included patients with at least two courses of ECT on propofol and two others with etomidate over the period from September 2019 to April 2021, regardless of the psychiatric diagnosis. Our data collection process notably targeted stimulus intensity, seizure duration recorded using electroencephalography, and medication used for anesthetic induction. RESULTS Overall, we included 18 patients with a male: female ratio of 1:2.6 and a mean (and standard deviation) age of 62.7±13.4 years. We found that the mean intensity of stimulation was significantly lower with etomidate when compared to propofol (425.3±250.0 vs. 658.9±280.2 mC, P=0.001). The mean duration of electroencephalographic seizure was significantly higher with etomidate in comparison to propofol (53.5±16.6 vs. 35.0±12.2seconds, P<0.001). CONCLUSION By using each patient as its own control, our study found that etomidate, while compared to propofol, was related to a lower level of stimulatory intensity and a longer electroencephalographic seizure duration.
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Affiliation(s)
| | - Ludwig Serge Aho Glélé
- Service d'épidémiologie et d'hygiène hospitalière, CHU hôpital d'enfants, 14, rue Paul 10 Gaffarel, 21079 Dijon, France
| | - Mehdi Benkhadra
- Service de Sismothérapie, Centre Hospitalier La Chartreuse, 21000 Dijon, France
| | - Clément Guillet
- La Chartreuse Psychiatric Hospital, Depression Unit, 21000 Dijon, France
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Kronsell A, Nordenskjöld A, Mittendorfer-Rutz E, Tiger M. Long-term follow-up on patient attitudes towards renewed ECT: A register-based cohort study. J Psychiatr Res 2024; 177:24-30. [PMID: 38971053 DOI: 10.1016/j.jpsychires.2024.06.040] [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: 03/15/2024] [Revised: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). After receiving ECT for MDD there is a large risk of relapse within the first year. Patient attitudes towards renewed treatment could impact their decisions regarding future therapy. We conducted a nationwide cohort study, using data from Swedish registers. Patients with MDD who received ECT were followed up to six months after the initial ECT-series. We investigated if certain patient and treatment characteristics during the initial treatment were correlated to their attitude towards renewed ECT at the six-month follow-up. Logistic regression models were used to calculate adjusted odds ratios for predictors. The Bonferroni method was used to adjust significance levels for multiple testing. The study included 1917 patients. 51.1% of patients were positive, 27.6% were undecided and 21.3% were negative towards renewed treatment. Patients with response to treatment were less likely to have a negative attitude towards renewed ECT (odds ratio 0.32, 95% CI 0.25-0.41, P < 0.001). Moreover, patients with experience of ECT prior to the index series were less likely to have a negative attitude towards renewed ECT (odds ratio 0.44, 95% CI 0.34-0.58, P < 0.001). In order to minimize the risk of negative attitudes towards renewed ECT for MDD, treatment should primarily be reserved for patients that are likely to respond to ECT.
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Affiliation(s)
- Alexander Kronsell
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | | | - Mikael Tiger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
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Liu X, Liang S, Liu J, Sha S, Zhang L, Jiang W, Jiang C, Hermida AP, Tang Y, McDonald WM, Ren Y, Wang G. Psychometric Properties of the Chinese Version of the ElectroConvulsive Therapy Cognitive Assessment: An Electroconvulsive Therapy-Specific Cognitive Screening Tool. J ECT 2024; 40:186-193. [PMID: 38009975 DOI: 10.1097/yct.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an effective somatic treatment, but it may be limited by cognitive adverse effects. The existing cognitive screening instruments often lack specificity to ECT-associated cognitive deficits. The ElectroConvulsive Therapy Cognitive Assessment was developed and validated in a clinical setting, but the reliability and validity of the Chinese version of ElectroConvulsive Therapy Cognitive Assessment (ECCA-C) have not been studied in a large clinical sample. METHODS The ECCA-C and the Montreal Cognitive Assessment (MoCA) were administered to patients with major depressive disorder (MDD) undergoing ECT at 3 time points: pretreatment (baseline), before the fifth treatment, and 1 week posttreatment. The instruments were also administered to a sample of healthy subjects. RESULTS Sixty-five patients with MDD and 50 age- and sex-matched healthy controls were recruited in this study. Overall, the patient group had statistically significantly lower MoCA and ECCA-C scores than the control group (both P values <0.001). The Cronbach α of the ECCA-C was 0.88 at baseline. Statistically significant decreases over time were observed in ECCA-C: pre-ECT (23.9 ± 4.0) > mid-ECT (21.3 ± 3.4) > post-ECT (18.7 ± 4.8) (all P values <0.001), whereas no statistically significant changes in MoCA scores were found at these 3 time points ( F = 1.86, P = 0.165). A cutoff score of 26.5 on the ECCA-C was found to best differentiate between MDD patients and healthy controls. CONCLUSIONS The ECCA-C showed satisfactory psychometric properties and may be a more sensitive instrument than the MoCA to assess cognitive impairment associated with ECT.
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Affiliation(s)
| | | | | | | | | | | | | | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
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4
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Loef D, van Eijndhoven PFP, Schouws SNTM, Slooter AJC, Janssen N, Kok RM, Rutten BPF, van Exel E, Rhebergen D, Oudega ML, Mocking RJT, Tendolkar I, Dols A, Verwijk E. The sensitivity of the Mini-Mental State Examination to detect objective cognitive side-effects induced by electroconvulsive therapy, results from the Dutch ECT Consortium. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00236-2. [PMID: 39128496 DOI: 10.1016/j.bpsc.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/19/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Monitoring cognitive side-effects following electroconvulsive therapy (ECT) is crucial for balancing side-effects and clinical effectiveness. Unfortunately, evidence-based guidelines on cognitive testing following ECT are lacking. A frequently used test in global ECT practice is the Mini Mental State Examination (MMSE). We examined the change of the MMSE and its performance in identifying a decline in predefined neuropsychological measures sensitive to ECT-induced cognitive changes: verbal recall and verbal fluency. METHODS The mean MMSE scores pre- and one week post-ECT were compared using a Wilcoxon signed-rank test. The Reliable Change Index was calculated for all cognitive measures to indicate whether an individual's change score from pre- to post-ECT is considered statistically significant. The sensitivity and specificity of the MMSE were calculated. RESULTS 426 patients with depression from five sites were included from the Dutch ECT Consortium. The mean MMSE increased significantly from 26.2 (SD=3.9) pre-ECT to 26.8 (SD=3.8) post-ECT (p=0.002). 36 patients (8.5%) showed a significant decline in MMSE score post-ECT. The sensitivity of the MMSE in identifying patients who experienced a significant decline in verbal recall or verbal fluency ranged from 3.6% to 11.1%. The specificity of the MMSE in identifying patients who did not experience a significant decline in verbal recall or verbal fluency ranged from 95.6% to 96.6%. CONCLUSIONS Given the very low sensitivity of the MMSE, we propose reconsidering the prominence of the MMSE in ECT practice and cognitive monitoring guidelines, advocating for a more comprehensive approach to assess ECT-induced cognitive changes.
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Affiliation(s)
- Dore Loef
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
| | - Philip F P van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Sigfried N T M Schouws
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Arjen J C Slooter
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikki Janssen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands; Donders Centre for Medical Neuroscience, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob M Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eric van Exel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Didi Rhebergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands; Department of Research, GGZ Centraal Mental Health Care, Amersfoort, The Netherlands
| | - Mardien L Oudega
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Roel J T Mocking
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands; Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
| | - Annemiek Dols
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Esmée Verwijk
- University of Amsterdam, Department of Psychology, Brain and Cognition, Amsterdam, The Netherlands; Amsterdam UMC, Department of Medical Psychology, Amsterdam, The Netherlands; ECT department, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Dai X, Zhang R, Deng N, Tang L, Zhao B. Anesthetic Influence on Electroconvulsive Therapy: A Comprehensive Review. Neuropsychiatr Dis Treat 2024; 20:1491-1502. [PMID: 39100572 PMCID: PMC11298179 DOI: 10.2147/ndt.s467695] [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: 03/08/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024] Open
Abstract
The prevalence of severe mental disorders has been rising annually. Electroconvulsive therapy (ECT) is considered a valuable treatment option in psychiatry for conditions such as schizophrenia and medication-resistant depression, especially when other treatments have proven insufficient. ECT rapidly improves patients' mood, alleviates symptoms, and demonstrates significant therapeutic effects. Currently, the form of ECT used in clinical practice is modified electroconvulsive therapy (mECT), which is administered under general anesthesia. Accumulative evidence has confirmed that different anesthetic drugs, anesthetic-ECT time interval, anesthetic depth, and airway management can impact the outcomes of ECT. Therefore, this review aims to summarize the current impact of anesthesia factors on ECT, providing reference for clinical anesthesia during ECT procedures.
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Affiliation(s)
- Xinyu Dai
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Rui Zhang
- Department of Neurosurgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Nan Deng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Le Tang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Bangshu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Ren L, Yu J, Chen H, Luo J, Lv F, Min S. Alteration of hyperpolarization-activated cation current-mediated metaplasticity contributes to electroconvulsive shock-induced learning and memory impairment in depressed rats. Front Psychiatry 2024; 15:1365119. [PMID: 38911706 PMCID: PMC11190359 DOI: 10.3389/fpsyt.2024.1365119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Background Accompanied by a rapid and effective antidepressant effect, electroconvulsive shock (ECS) can also induce learning and memory impairment. Our previous research reported that metaplasticity is involved in this process. However, the mechanisms still remain unclear. This study investigated the role of I h current in the metaplastic changes and learning and memory impairment induced by ECS in depressive rats. Methods Depressive rats received ECS after modelling using chronic unpredictable. ZD7288, a type of I h current inhibitor was used to verify the effect of I h current. The sucrose preference test and Morris water maze were used for behavior testing. Changes in metaplasticity was assessed with the LTD/LTP threshold by stimulation at different frequencies. Spontaneous and evoked action potentials (APs) were measured to confirm difference of neuronal excitability. Additionally, the amplitude of I h current was analyzed. Results ECS exerts antidepressant effect, but also induce spatial learning and memory dysfunction. ECS up-regulates the LTD/LTP threshold. In rats treated with ECS, the frequency of spontaneous and evoked APs is significantly reduced. In addition, ECS induces changes in the intrinsic properties of AP, including a decrease of AP-half width and peak amplitude, and an increase in AP time to peak and post-hyperpolarization potential amplitude. In particular, ECS increases both instantaneous and steady-state I h currents. However, Inhibition of I h current with ZD7288 results in a relief of learning and memory impairment and a decrease in threshold, as well as a significant reversal of whole-cell electrophysiological changes. Conclusion ECS-induced learning and memory impairment is caused by neuronal hypoexcitability mediated metaplasticity, and upregulation of LTD/LTP threshold by an increase in I h current.
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Affiliation(s)
- Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yu
- Department of Psychiatry, Shanghai 10th People’s Hospital, Anesthesia and Brain Research Institute, Tongji University, Shanghai, China
| | - Hengsheng Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jie Luo
- 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
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ren L, Chen Q, Gao J, Liu Y, Tao Y, Li X, Luo Q, Lv F, Min S. Clinical efficacy of adjunctive esketamine anesthesia in electroconvulsive therapy for major depressive disorders: A pragmatic, randomized, controlled trial. Psychiatry Res 2024; 335:115843. [PMID: 38461645 DOI: 10.1016/j.psychres.2024.115843] [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: 11/01/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for depression, and esketamine has been shown to have antidepressant effects. However, it is currently unclear whether adjunctive esketamine can enhance the clinical efficacy of ECT in real-world clinical practice. In this pragmatic clinical trial, patients with major depression were randomly assigned into two groups: patients received 0.25 mg/kg esketamine plus propofol (esketamine group) or the same volume of saline (control group) plus propofol. Results indicated that there was no difference in response and remission rates between the two groups. However, patients receiving esketamine had a higher remission rate of SI and lower psychotic scores. Patients receiving esketamine also required a lower electric dose, but the seizure duration and cognitive function were comparable between the two groups. Diastolic blood pressure increased after esketamine injection, but there was no increased risk of hypertension. Furthermore, incidence of delirium and confusion were comparable between the groups. Conclusively, adjunctive esketamine anesthesia does not provide any advantage in improving the response and remission rates of ECT. However, it can improve remission of SI and alleviate accompanying psychotic symptoms in depressive patients. With adjunctive usage, the adverse cardiovascular and neuropsychiatric events associated with esketamine appear to be tolerable.
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Affiliation(s)
- Li Ren
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Qibin Chen
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Jin Gao
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yuanyuan Liu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yi Tao
- Department of Phase I Clinical Trial Ward, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Xiao Li
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Qinghua Luo
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Feng Lv
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
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Fan S, Zhang J, Wu Y, Yu Y, Zheng H, Guo YY, Ji Y, Pang X, Tian Y. Changed brain entropy and functional connectivity patterns induced by electroconvulsive therapy in majoy depression disorder. Psychiatry Res Neuroimaging 2024; 339:111788. [PMID: 38335560 DOI: 10.1016/j.pscychresns.2024.111788] [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: 07/10/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Our objective is to innovatively integrate both linear and nonlinear characteristics of brain signals in Electroconvulsive Therapy (ECT) research, with the goal of uncovering deeper insights into the pathogenesis of Major Depressive Disorder (MDD) and identifying novel targets for other physical intervention therapies. METHODS We measured brain entropy (BEN) in 42 MDD patients and 42 matched healthy controls (HC) using rs-fMRI data. Brain regions that differed significantly in patients with MDD before and after ECT were extracted. Then, we use these brain regions as seed points to investigate the differences in whole-brain resting-state functional connectivity (RSFC) patterns before and after ECT. RESULTS Compared to HCs, patients had higher BEN levels in the right precuneus (PCUN.R) and right angular gyrus (ANG.R). After ECT, patients had lower BEN levels in the PCUN.R and ANG.R. Compared with before ECT, patients showed significantly increased RSFC after ECT between the PCUN.R and right middle temporal gyrus and ANG.R. Significantly increased RSFC was observed between the ANG.R and right middle frontal gyrus and right supramarginal gyrus after ECT. CONCLUSION Combining the linear and nonlinear characteristics of brain signals can effectively explore the pathogenesis of depression and provide new targets for ECT.
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Affiliation(s)
- Siyu Fan
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Jiahua Zhang
- The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, PR China
| | - Yue Wu
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei,. 230601, PR China
| | - Yue Yu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Hao Zheng
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Yuan Yuan Guo
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Yang Ji
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Xiaonan Pang
- Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China.
| | - Yanghua Tian
- The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, PR China; Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230032, PR China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, PR China; Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei,. 230601, PR China.
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9
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Loef D, van Eijndhoven P, van den Munckhof E, Hoogendoorn A, Manten R, Spaans HP, Tendolkar I, Rutten B, Nuninga J, Somers M, van Dellen E, van Exel E, Schouws S, Dols A, Verwijk E. Pre-treatment predictors of cognitive side-effects after treatment with electroconvulsive therapy in patients with depression: A multicenter study. J Affect Disord 2024; 349:321-331. [PMID: 38195009 DOI: 10.1016/j.jad.2024.01.049] [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: 08/28/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive episodes (MDE). However, ECT-induced cognitive side-effects remain a concern. Identification of pre-treatment predictors that contribute to these side-effects remain unclear. We examined cognitive performance and individual cognitive profiles over time (up to six months) following ECT and investigated possible pre-treatment clinical and demographic predictors of cognitive decline shortly after ECT. METHODS 634 patients with MDE from five sites were included with recruitment periods between 2001 and 2020. Linear mixed models were used to examine how cognitive performance, assessed with an extensive neuropsychological test battery, evolved over time following ECT. Next, possible pre-treatment predictors of cognitive side-effects directly after ECT were examined using linear regression. RESULTS Directly after ECT, only verbal fluency (animal and letter; p < 0.0001; Cohen's d: -0.25 and -0.29 respectively) and verbal recall (p < 0.0001; Cohen's d: -0.26) significantly declined. However, during three and six months of follow-up, cognitive performance across all domains significantly improved, even outperforming baseline levels. No other pre-treatment factor than a younger age predicted a larger deterioration in cognitive performance shortly after ECT. LIMITATIONS There was a substantial amount of missing data especially at 6 months follow-up. CONCLUSIONS Our findings show that verbal fluency and memory retention are temporarily affected immediately after ECT. Younger patients may be more susceptible to experiencing these acute cognitive side-effects, which seems to be mostly due to a more intact cognitive functioning prior to ECT. These findings could contribute to decision-making regarding treatment selection, psychoeducation, and guidance during an ECT course.
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Affiliation(s)
- Dore Loef
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands.
| | | | | | - Adriaan Hoogendoorn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Ruby Manten
- GGZ Noord-Holland-Noord Mental Health Care, Alkmaar, the Netherlands
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud umc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Bart Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jasper Nuninga
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Metten Somers
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels, Belgium
| | - Eric van Exel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Sigfried Schouws
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Annemiek Dols
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Esmée Verwijk
- Parnassia Psychiatric Institute, The Hague, the Netherlands; University of Amsterdam, Department of Psychology, Amsterdam, the Netherlands; Amsterdam UMC, AMC, Department of Medical Psychology, Amsterdam, the Netherlands
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Saini A, Begum N, Matti J, Ghanem DA, Fripp L, Pollak TA, Zandi MS, David A, Lewis G, Rogers J. Clozapine as a treatment for catatonia: A systematic review. Schizophr Res 2024; 263:275-281. [PMID: 36117082 DOI: 10.1016/j.schres.2022.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022]
Abstract
Catatonia is a neuropsychiatric disorder characterised by altered movement, speech, and behaviour. Clozapine is an established therapy for treatment-resistant schizophrenia, but its role in catatonia has not been systematically examined. In this systematic review, we aimed to assess the evidence for clozapine as a treatment for catatonia. Full text original research articles in English where at least one patient with catatonia was treated with clozapine were included, provided catatonia did not occur solely in the context of neuroleptic malignant syndrome. Results were tabulated with calculations of summary statistics presented. Risk of bias was assessed with the Tool for Evaluating the Methodological Quality of Case Reports and Case Series. 182 patients were included, 81 from cohort studies and 101 from case reports or case series. 119/182 patients (65 %) had a specified underlying diagnosis of schizophrenia. Over 80 % of reported patients with catatonia had at least partial remission following treatment with clozapine across both cohort studies and case reports and case series. Among the case reports and series, 24/101 patients (23.8 %) followed clozapine withdrawal. Overall, 25 studies were of low quality, 60 of moderate quality and 8 of high quality. Our findings should be interpreted with caution, as the reliance on case reports, case series and small cohort studies is susceptible to reporting biases, regression to the mean and confounding by other treatments. Future research could use large healthcare databases to ascertain outcomes in those on clozapine with a history of catatonia given the difficulty and expense of conducting randomised controlled trials.
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Affiliation(s)
- Aman Saini
- Medical School, University College London, London, UK.
| | | | - James Matti
- Medical School, University College London, London, UK
| | | | - Laurie Fripp
- Medical School, University College London, London, UK
| | - Thomas A Pollak
- Department of Psychosis Studies, King's College London, London, UK
| | - Michael S Zandi
- UCL Queen Square Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Anthony David
- Institute of Mental Health, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Jonathan Rogers
- Division of Psychiatry, University College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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11
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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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12
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Frid LM, Kessler U, Ousdal OT, Hammar Å, Haavik J, Riemer F, Hirnstein M, Ersland L, Erchinger VJ, Ronold EH, Nygaard G, Jakobsen P, Craven AR, Osnes B, Alisauskiene R, Bartsch H, Le Hellard S, Stavrum AK, Oedegaard KJ, Oltedal L. Neurobiological mechanisms of ECT and TMS treatment in depression: study protocol of a multimodal magnetic resonance investigation. BMC Psychiatry 2023; 23:791. [PMID: 37904091 PMCID: PMC10617235 DOI: 10.1186/s12888-023-05239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Noninvasive neurostimulation treatments are increasingly being used to treat major depression, which is a common cause of disability worldwide. While electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are both effective in treating depressive episodes, their mechanisms of action are, however, not completely understood. ECT is given under general anesthesia, where an electrical pulse is administered through electrodes placed on the patient's head to trigger a seizure. ECT is used for the most severe cases of depression and is usually not prescribed before other options have failed. With TMS, brain stimulation is achieved through rapidly changing magnetic fields that induce electric currents underneath a ferromagnetic coil. Its efficacy in depressive episodes has been well documented. This project aims to identify the neurobiological underpinnings of both the effects and side effects of the neurostimulation techniques ECT and TMS. METHODS The study will utilize a pre-post case control longitudinal design. The sample will consist of 150 subjects: 100 patients (bipolar and major depressive disorder) who are treated with either ECT (N = 50) or TMS (N = 50) and matched healthy controls (N = 50) not receiving any treatment. All participants will undergo multimodal magnetic resonance imaging (MRI) as well as neuropsychological and clinical assessments at multiple time points before, during and after treatment. Arterial spin labeling MRI at baseline will be used to test whether brain perfusion can predict outcomes. Signs of brain disruption, potentiation and rewiring will be explored with resting-state functional MRI, magnetic resonance spectroscopy and multishell diffusion weighted imaging (DWI). Clinical outcome will be measured by clinician assessed and patient reported outcome measures. Memory-related side effects will be investigated, and specific tests of spatial navigation to test hippocampal function will be administered both before and after treatment. Blood samples will be stored in a biobank for future analyses. The observation time is 6 months. Data will be explored in light of the recently proposed disrupt, potentiate and rewire (DPR) hypothesis. DISCUSSION The study will contribute data and novel analyses important for our understanding of neurostimulation as well as for the development of enhanced and more personalized treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05135897.
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Affiliation(s)
- Leila Marie Frid
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, , Psychiatry Research Skåne, Region Skåne, Sweden
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Vera Jane Erchinger
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Gyrid Nygaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Petter Jakobsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Berge Osnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Stephanie Le Hellard
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kristin Stavrum
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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13
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Corral R, Bojórquez E, Cetkovich-Bakmas M, Córdoba R, Chestaro J, Gama C, Bonetto GG, Jaramillo CL, Moreno RA, Ng B, de Leon EP, Risco L, Silva H, Vazquez G. Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD). SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00013-3. [PMID: 38592432 DOI: 10.1016/j.sjpmh.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 04/10/2024]
Abstract
Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.
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Affiliation(s)
- Ricardo Corral
- Department of Psychiatry, Jose T. Borda Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Marcelo Cetkovich-Bakmas
- Institute of Cognitive and Translational Neurosciences (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Rodrigo Córdoba
- UR Center for Mental Health - CeRSaME, School of Medicine and Health Sciences - EMCS, University of Rosario, Bogotá, Colombia
| | - Julio Chestaro
- Catholic University of Cibao, La Vega, Dominican Republic; Traumatological Hospital Juan Bosch, La Vega, Dominican Republic
| | - Clarissa Gama
- Department of Psychiatry and Legal Medicine, UFRGS, Research Unit, HCPA, Porto Alegre, Brazil
| | | | - Carlos López Jaramillo
- Department of Psychiatry, School of Medicine, University of Antioquia, Medellin, Colombia
| | | | - Bernardo Ng
- Geriatric Center Nuevo Atardecer and Department of Psychiatry, University of California San Diego, Sun Valley Behavioral and Research Centers, California, USA
| | | | - Luis Risco
- Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gustavo Vazquez
- Research Center on Neurosciences, University of Palermo, Buenos Aires, Argentina; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
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14
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Bellini H, Cretaz E, Carneiro AM, da Silva PHR, dos Santos LA, Gallucci-Neto J, Brunoni AR. Magnetic Waves vs. Electric Shocks: A Non-Inferiority Study of Magnetic Seizure Therapy and Electroconvulsive Therapy in Treatment-Resistant Depression. Biomedicines 2023; 11:2150. [PMID: 37626647 PMCID: PMC10452083 DOI: 10.3390/biomedicines11082150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Treatment-resistant depression (TRD), characterized by the failure to achieve symptomatic remission despite multiple pharmacotherapeutic treatments, poses a significant challenge for clinicians. Electroconvulsive therapy (ECT) is an effective but limited option due to its cognitive side effects. In this context, magnetic seizure therapy (MST) has emerged as a promising alternative, offering comparable antidepressant efficacy with better cognitive outcomes. However, the clinical outcomes and cognitive effects of MST require further investigation. This double-blinded, randomized, non-inferiority study aims to compare the efficacy, tolerability, cognitive adverse effects, and neurophysiological biomarkers of MST with bilateral ECT (BT ECT) in patients with TRD. This study will employ multimodal nuclear magnetic resonance imaging (MRI) and serum neurotrophic markers to gain insight into the neurobiological basis of seizure therapy. Additionally, neurophysiological biomarkers will be evaluated as secondary outcomes to predict the antidepressant and cognitive effects of both techniques. The study design, recruitment methods, ethical considerations, eligibility criteria, interventions, and blinding procedures are described. The expected outcomes will advance the field by offering a potential alternative to ECT with improved cognitive outcomes and a better understanding of the underlying pathophysiology of depression and antidepressant therapies.
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Affiliation(s)
- Helena Bellini
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Eric Cretaz
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Adriana Munhoz Carneiro
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Pedro Henrique Rodrigues da Silva
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Leonardo Afonso dos Santos
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - José Gallucci-Neto
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - André Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
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15
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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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16
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Semkovska M, Knittle H, Leahy J, Rasmussen JR. Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis. Aust N Z J Psychiatry 2023; 57:21-33. [PMID: 35362328 DOI: 10.1177/00048674221089231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subjective cognitive complaints represent a leading reason for suboptimal prescription of electroconvulsive therapy, the most acutely effective treatment for depression. However, research findings regarding their presentation are conflicting. OBJECTIVE To describe, quantify and explain the variability in subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression. METHODS We searched systematically PubMed, Embase, PsycARTICLES, CINAHL and relevant reviews for research published from 1 January 1972 to 31 August 2020. We included all independent studies of patients whose subjective cognition was assessed following brief-pulse electroconvulsive therapy for depression. Three meta-analyses were conducted to quantify: (1) the prevalence of patients presenting with cognitive complaints following electroconvulsive therapy; (2) the pre-post electroconvulsive therapy change in subjective cognition and (3) the association between change in depressive symptoms and change in cognitive complaints. Effect sizes were calculated using random-effects models. Eight prespecified demographic and clinical moderators of between-study variability were assessed using sub-group analyses and meta-regressions. RESULTS Data from 72 studies including 5699 participants were meta-analysed. Weighted mean prevalence of patients with cognitive complaints was 48.1% (95% confidence interval = [42.3%, 53.9%]). The type of subjective measure used significantly impacted the pre-post electroconvulsive therapy change in subjective cognition, showing, respectively, large improvement (g = 0.81; 95% confidence interval = [0.59, 1.03]) after electroconvulsive therapy with the Squire Self-Rating Scale of Memory and small worsening (g = -0.48; 95% confidence interval = [-0.70, -0.26]) with 1-item memory scales. The strongest predictors of improved post-electroconvulsive therapy subjective cognition were increased age and larger post-electroconvulsive therapy decrease in depressive symptoms. The weighted mean correlation between pre-post electroconvulsive therapy decrease in depressive symptoms and pre-post electroconvulsive therapy decrease in cognitive complaints was 0.46 (95% confidence interval = [0.39, 0.53]). CONCLUSION Variability in subjective cognition following electroconvulsive therapy is mostly explained by the degree of post-treatment persisting depression and by the subjective assessment used. Scales measuring exclusively subjective worsening present limited clinical utility and instruments allowing the detection of both improvement and worsening in subjective cognition should be preferred.
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Affiliation(s)
- Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Hannah Knittle
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Janet Leahy
- Department of Psychology, University of Limerick, Limerick, Ireland
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17
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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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18
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Phillips JL, Van Geel A, Burhunduli P, Vasudev D, Batten LA, Norris S, Talbot J, Ortiz A, Owoeye O, Blier P. Assessment of Objective and Subjective Cognitive Function in Patients With Treatment-Resistant Depression Undergoing Repeated Ketamine Infusions. Int J Neuropsychopharmacol 2022; 25:992-1002. [PMID: 35931041 PMCID: PMC9743964 DOI: 10.1093/ijnp/pyac045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/20/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Subanesthetic ketamine infusions can elicit rapid and sustained antidepressant effects, yet the potential cognitive impact of ketamine has not been thoroughly examined. This study measured changes in objective and subjective cognitive function following repeated ketamine treatment. METHODS Thirty-eight patients with treatment-resistant depression were administered cognitive assessments before and after undergoing 7 i.v. ketamine infusions (0.5 mg/kg over 40 minutes) within a clinical trial examining the efficacy of single and repeated administrations. Depression severity and perceived concentration were evaluated with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptoms Self-Report. RESULTS Twenty-three participants (60.5%) responded after repeated infusions (≥50% decrease in MADRS total scores). We measured significant improvements in several cognitive domains, including attention, working memory, verbal, and visuospatial memory (effect sizes ranging from Cohen d = 0.37-0.79). Cognitive changes were attributed to reduction in depressive symptoms except for improvement in verbal memory, which remained significant after adjustment for change in MADRS total score (P = .029, η p2 = 0.13). Only responders reported improvement in subjective cognitive function with repeated ketamine administration (MADRS item 6, P < .001, d = 2.00; Quick Inventory of Depressive Symptoms Self-Report item 10, P < .001, d = 1.36). CONCLUSION A short course of repeated ketamine infusions did not impair neurocognitive function in patients with treatment-resistant depression. Further research is required to understand the potential mediating role of response and remission on improved cognitive function accompanying ketamine treatment as well as to examine longer-term safety outcomes. ClinicalTrials.gov identifier NCT01945047.
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Affiliation(s)
- Jennifer L Phillips
- Correspondence: Jennifer L. Phillips, PhD, University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z7K4, Canada ()
| | - Amanda Van Geel
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Patricia Burhunduli
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dominique Vasudev
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Lisa A Batten
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada
| | - Sandhaya Norris
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Jeanne Talbot
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Abigail Ortiz
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada,Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Olabisi Owoeye
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Pierre Blier
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Is repetitive transcranial magnetic stimulation (rTMS) an effective and safe treatment option for postpartum and peripartum depression? A Systematic Review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Ansariniaki M, Behnam B, Keyghobady S, Izadisabet F, Mirmohammadkhani M, Abdollahi M, Soleimani M. The effects of aromatherapy with clove essential oil on memory function of patients during electroconvulsive therapy: A randomized controlled trial. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:348-367. [PMID: 35317341 PMCID: PMC8900590 DOI: 10.5498/wjp.v12.i2.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/27/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated, even though its classification has evolved in recent years. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. The underrecognition of catatonia in older patients is also frequent, and research in this population is scarce.
AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings.
METHODS Following the PRISMA guidelines, MEDLINE, EMBASE, and PsycINFO databases were searched from inception to December 2021, with a strategy aimed at identifying all articles published on catatonia in older adults. Titles and abstracts were scanned and selected independently by two authors. Papers investigating issues related to catatonia and/or catatonic symptoms in older people, with English abstracts available, were included. References of selected articles were revised to identify other relevant studies.
RESULTS In total, 1355 articles were retrieved. After removing duplicates, 879 remained. Of the 879 identified abstracts, 669 were excluded because they did not meet the inclusion criteria. A total of 210 articles underwent full text review, and 51 were eliminated for various reasons. Fourteen more articles were selected from the references. Overall, 173 articles were reviewed: 108 case reports, 35 case series, 11 prospective cohort studies, 6 case-control studies, 3 retrospective cohort studies and 10 reviews. We found several particular aspects of catatonia in this population. Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. Older patients, compared to younger patients, have a higher risk of developing catatonia with benzodiazepine (BZD) withdrawal, in bipolar disorder, and in the general hospital. Age, together with other risk factors, was significantly associated with the incidence of deep venous thrombosis, neuroleptic malignant syndrome poor outcome, other complications and mortality. Treatment with BZDs and electroconvulsive therapy is safe and effective. Prompt treatment of its cause is essential to ensure a good prognosis.
CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. The risk of developing catatonia in some settings and conditions, as well as of developing complications, is high in this population. Symptomatic treatment is safe and effective, and timely etiologic treatment is fundamental.
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Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Angel Ruiz de Pellon-Santamaria
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Ayar Nizama-Vía
- Psychiatry Service “Virgen del Cisne” Mental Health Community Center, Regional Health Directorate, Tumbes 24002, Peru
| | - Marco Isetta
- Library and Knowledge Services, Central & North West London NHS Foundation Trust, St Charles’ Hospital, London W10 6DZ, United Kingdom
| | - Ines Albajar
- Neurology Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Jordi Serra-Mestres
- Old Age Psychiatry Service, Cardinal Clinic, Windsor SL4 5UL, United Kingdom
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22
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Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:359-381. [DOI: 10.5498/wjp.v12.i2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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23
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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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24
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in people with depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [DOI: 10.1002/14651858.cd015164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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25
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Adverse effects of electroconvulsive therapy. Hippokratia 2021. [DOI: 10.1002/14651858.cd014995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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26
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Daskalakis ZJ, Tamminga C, Throop A, Palmer L, Dimitrova J, Farzan F, Thorpe KE, McClintock SM, Blumberger DM. Confirmatory Efficacy and Safety Trial of Magnetic Seizure Therapy for Depression (CREST-MST): study protocol for a randomized non-inferiority trial of magnetic seizure therapy versus electroconvulsive therapy. Trials 2021; 22:786. [PMID: 34749782 PMCID: PMC8576983 DOI: 10.1186/s13063-021-05730-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is well-established and effective for treatment-resistant depression (TRD), but in Canada and the USA, less than 1% of patients with TRD receive ECT mainly due to its cognitive adverse effects (i.e. amnesia). Thus, new treatment alternatives for TRD are urgently needed. One such treatment is magnetic seizure therapy (MST). ECT involves applying a train of high-frequency electrical stimuli to induce a seizure, whereas MST involves applying a train of high-frequency magnetic stimuli to induce a seizure. METHODS In this manuscript, we introduce our international, two-site, double-blinded, randomized, non-inferiority clinical trial to develop MST as an effective and safe treatment for TRD. This trial will compare the efficacy of MST to right unilateral ultra-brief pulse width electroconvulsive therapy (RUL-UB-ECT) with a combined primary endpoint of remission of depression and superior cognitive adverse effects in 260 patients with TRD. Amelioration of suicidal ideation will be assessed as a secondary endpoint. Inpatients or outpatients, over 18 years of age with a MINI International Neuropsychiatric Interview (MINI) diagnosis of non-psychotic major depressive disorder (MDD) can be enrolled in the study provided that they meet illness severity and full eligibility criteria. Participants are randomized to receive MST or RUL-UB ECT, 2-3 days per week over seven weeks, or a maximum of 21 treatments. The study will involve before-, during-, and after-treatment assessments of depression severity, suicidal ideation, subjective side-effects, and cognitive performance consistent with an intent-to-treat study design approach. DISCUSSION Positive results from this trial could have an immediate and tremendous impact for patients with TRD. If MST demonstrates comparable antidepressant treatment efficacy to ECT, but with greater cognitive safety, it could rapidly be adopted into clinical practice. Indeed, given that the administration of MST is nearly identical to ECT, the majority of ECT facilities in North America could readily adopt MST. Furthermore, the potential for cognitive safety could lead to improved treatment acceptability. Healthcare providers, patients and care partners, and policymakers would therefore demand this form of convulsive therapy. TRIAL STATUS Enrollment for this study began on June 26, 2018, and is estimated to complete recruitment by July 2024. At the time of submission, we have enrolled and randomized 117 participants. TRIAL REGISTRATION ClinicalTrials.gov NCT03191058 , Registered on June 19, 2017. Primary sponsor: Daniel Blumberger (DMB), Principal Investigator Daniel.Blumberger@camh.ca , 416-535-8501 x 33662 Contact for public queries: DMB, Daniel.Blumberger@camh.ca Contact for scientific queries: ZJD, Zdaskalakis@health.ucsd.edu.
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Affiliation(s)
- Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Carol Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alanah Throop
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lucy Palmer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Julia Dimitrova
- Department of Psychology, University at Buffalo, The State University of New York | SUNY Buffalo, Buffalo, USA
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel M Blumberger
- Institute of Medical Science and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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27
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for acute affective episodes in people with bipolar disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd014996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Anderson IM, McAllister-Williams RH, Downey D, Elliott R, Loo C. Cognitive function after electroconvulsive therapy for depression: relationship to clinical response. Psychol Med 2021; 51:1647-1656. [PMID: 32102725 PMCID: PMC8327625 DOI: 10.1017/s0033291720000379] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND As uncertainty remains about whether clinical response influences cognitive function after electroconvulsive therapy (ECT) for depression, we examined the effect of remission status on cognitive function in depressed patients 4 months after a course of ECT. METHOD A secondary analysis was undertaken on participants completing a randomised controlled trial of ketamine augmentation of ECT for depression who were categorised by remission status (MADRS ⩽10 v. >10) 4 months after ECT. Cognition was assessed with self-rated memory and neuropsychological tests of anterograde verbal and visual memory, autobiographical memory, verbal fluency and working memory. Patients were assessed through the study, healthy controls on a single occasion, and compared using analysis of variance. RESULTS At 4-month follow-up, remitted patients (N = 18) had a mean MADRS depression score of 3.8 (95% CI 2.2-5.4) compared with 27.2 (23.0-31.5) in non-remitted patients (N = 19), with no significant baseline differences between the two groups. Patients were impaired on all cognitive measures at baseline. There was no deterioration, with some measures improving, 4-months after ECT, at which time remitted patients had significantly improved self-rated memory, anterograde verbal memory and category verbal fluency compared with those remaining depressed. Self-rated memory correlated with category fluency and autobiographical memory at follow-up. CONCLUSIONS We found no evidence of persistent impairment of cognition after ECT. Achieving remission improved subjective memory and verbal memory recall, but other aspects of cognitive function were not influenced by remission status. Self-rated memory may be useful to monitor the effects of ECT on longer-term memory.
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Affiliation(s)
- Ian M. Anderson
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Darragh Downey
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Colleen Loo
- University of New South Wales, Black Dog Institute & St George Hospital, Sydney, Australia
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Murayama T, Kobayashi S, Matsuoka T, Kigawa Y, Ishida T, Hyakumachi K, Utsumi K, Kawanishi C. Effectiveness of Electroconvulsive Therapy in Patients With Advanced Parkinson Disease. J ECT 2021; 37:88-93. [PMID: 33337651 DOI: 10.1097/yct.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In addition to motor symptoms, patients with Parkinson disease (PD) experience various psychiatric comorbidities, including impulse control disorders (ICDs). Moreover, antiparkinsonian drugs sometimes cause psychiatric symptoms. Antiparkinsonian and antipsychotic drugs are competitive in pharmacodynamics, and psychotropic drugs, including antidepressants, may worsen motor symptoms or induce adverse reactions. Considering this conflicting situation, we examined the effectiveness of electroconvulsive therapy (ECT) on both motor and psychiatric symptoms in PD. METHODS We retrospectively examined 12 PD patients with advanced motor symptoms and drug-resistant psychiatric symptoms, including ICDs, who had undergone ECT. Both before and after ECT, the severity of PD motor symptoms were evaluated using Hoehn and Yahr staging, while psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. The patients' doses of antiparkinsonian and antipsychotic drugs were also assessed before and after ECT. RESULTS Both the mean Hoehn and Yahr and Neuropsychiatric Inventory scores were significantly decreased after ECT. The symptoms of ICDs, which were observed in 5 patients, disappeared following ECT. Improvements in motor symptoms and psychiatric symptoms lasted for more than 1 year in 5 cases and 9 cases, respectively. Furthermore, the daily dose of antiparkinsonian drugs was significantly decreased in 6 cases. CONCLUSIONS Our results demonstrated that ECT was effective for both severe motor symptoms and psychiatric symptoms in advanced PD patients. ECT might be a solution for the conflicting problem of treating both motor and psychiatric symptoms in PD.
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Affiliation(s)
| | | | - Takeshi Matsuoka
- Department of Neurology, Date Red Cross Hospital, Date, Hokkaido
| | - Yoshiyasu Kigawa
- Department of Neuropsychiatry, Sapporo Medical University, Sapporo
| | - Tomotaka Ishida
- Department of Psychiatry, Sunagawa City Medical Center, Sunagawa
| | - Kengo Hyakumachi
- Department of Psychiatry, Iwamizawa Asuka Hospital, Iwamizawa, Hokkaido, Japan
| | - Kumiko Utsumi
- Department of Psychiatry, Sunagawa City Medical Center, Sunagawa
| | - Chiaki Kawanishi
- Department of Neuropsychiatry, Sapporo Medical University, Sapporo
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Landry M, Moreno A, Patry S, Potvin S, Lemasson M. Current Practices of Electroconvulsive Therapy in Mental Disorders: A Systematic Review and Meta-Analysis of Short and Long-Term Cognitive Effects. J ECT 2021; 37:119-127. [PMID: 33009218 DOI: 10.1097/yct.0000000000000723] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depressive disorder, but uncertainties persist regarding the cognitive tests to include in ECT follow-up. The current study is a systematic review and meta-analysis of the most frequent cognitive side effects after ECT. We also discuss the most common cognitive tests in ECT follow-up. We searched studies published from 2000 to 2017 in English and French language in Pubmed, EBM Reviews, EMBASE, and PsycINFO. Standardized cognitive tests were separated into 11 cognitive domains. Comparisons between cognitive measures included pre-ECT baseline with post-ECT measures at 3 times: PO1, immediately post-ECT (within 24 hours after last ECT); PO2, short term (1-28 days); and PO3, long term (more than 1 month). A total of 91 studies were included, with an aggregated sample of 3762 individuals. We found no significant changes in global cognition with Mini-Mental State Examination at PO1. Hedges g revealed small to medium effect sizes at PO2, with individuals presenting a decrease in autobiographical memory, verbal fluency, and verbal memory. Verbal fluency problems showed an inverse correlation with age, with younger adults showing greater deficits. At PO3, there is an improvement on almost all cognitive domains, including verbal fluency and verbal memory. There is a lack of standardization in the choice of cognitive tests and optimal cognitive timing. The Mini-Mental State Examination is the most common screening test used in ECT, but its clinical utility is extremely limited to track post-ECT cognitive changes. Cognitive assessment for ECT purposes should include autobiographical memory, verbal fluency, and verbal memory.
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Baker J, Savage S, Milton F, Butler C, Kapur N, Hodges J, Zeman A. The syndrome of transient epileptic amnesia: a combined series of 115 cases and literature review. Brain Commun 2021; 3:fcab038. [PMID: 33884371 PMCID: PMC8047097 DOI: 10.1093/braincomms/fcab038] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
The term transient epileptic amnesia was coined in 1990 to describe a form of epilepsy causing predominantly amnestic seizures which could be confused with episodes of Transient Global Amnesia. Subsequent descriptions have highlighted its association with ‘atypical’ forms of memory disturbance including accelerated long-term forgetting, disproportionate autobiographical amnesia and topographical amnesia. However, this highly treatment-responsive condition remains under-recognized and undertreated. We describe the clinical and neuropsychological features in 65 consecutive cases of transient epileptic amnesia referred to our study, comparing these to our previous cohort of 50 patients and to those reported in 102 literature cases described since our 2008 review. Findings in our two cohorts are substantially consistent: The onset of transient epileptic amnesia occurs at an average age of 62 years, giving rise to amnestic episodes at a frequency of around 1/month, typically lasting 15–30 min and often occurring on waking. Amnesia is the only manifestation of epilepsy in 24% of patients; olfactory hallucinations occur in 43%, motor automatisms in 41%, brief unresponsiveness in 39%. The majority of patients describe at least one of the atypical forms of memory disturbance mentioned above; easily provoked tearfulness is a common accompanying feature. There is a male predominance (85:30). Epileptiform changes were present in 35% of cases, while suspected causative magnetic resonance imaging abnormalities were detected in only 5%. Seizures ceased with anticonvulsant treatment in 93% of cases. Some clinical features were detected more commonly in the second series than the first, probably as a result of heightened awareness. Neuropsychological testing and comparison to two age and IQ-matched control groups (n = 24 and 22) revealed consistent findings across the two cohorts, namely elevated mean IQ, preserved executive function, mild impairment at the group level on standard measures of memory, with additional evidence for accelerated long-term forgetting and autobiographical amnesia, particularly affecting episodic recollection. Review of the literature cases revealed broadly consistent features except that topographical amnesia, olfactory hallucinations and emotionality have been reported rarely to date by other researchers. We conclude that transient epileptic amnesia is a distinctive syndrome of late-onset limbic epilepsy of unknown cause, typically occurring in late middle age. It is an important, treatable cause of memory loss in older people, often mistaken for dementia, cerebrovascular disease and functional amnesia. Its aetiology, the monthly occurrence of seizures in some patients and the mechanisms and interrelationships of the interictal features—amnestic and affective—all warrant further study.
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Affiliation(s)
- John Baker
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter EX1 2LU, UK
| | - Sharon Savage
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter EX1 2LU, UK.,School of Psychology, University of Newcastle, New South Wales 2308, Australia
| | - Fraser Milton
- Discipline of Psychology, University of Exeter, Washington Singer Laboratories, Exeter EX4 4QG, UK
| | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.,Department of Brain Sciences, Imperial College, London W12 0NN, UK.,Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago 833007, Chile
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - John Hodges
- Brain and Mind Centre, University of Sydney, Sydney 2050, Australia
| | - Adam Zeman
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter EX1 2LU, UK
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32
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Dominiak M, Goetz Z, Antosik-Wojcinska AZ, Swiecicki L. Right unilateral versus bilateral formula-based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial. Psychogeriatrics 2021; 21:175-184. [PMID: 33442924 DOI: 10.1111/psyg.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/27/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the most effective treatment of depression in the elderly population; however, it is still unclear which type of ECT is most beneficial in this population. The aims of this study were: (i) to assess the feasibility of a randomised controlled trial in elderly depressed patients treated with right unilateral (RUL) or fronto-temporal bilateral (BT) formula-based ECT; (ii) to compare formula-based RUL and BT ECT in terms of efficacy, safety and tolerability in this population. METHODS The study lasted 3 years and managed to randomise 29 patients over 65 years old to receive either BT (n = 14) or RUL (n = 15) ECT. Brief pulse width (0.5 ms) and age-based dosing method were applied. The clinical efficacy was assessed using Hamilton Depression Rating Scale, somatic state was monitored throughout the ECT course. In neuropsychological examination general cognitive performance, executive functions, verbal fluency, memory, autobiographical memory were evaluated. RESULTS The recruitment was poor due to small number of patients able to give informed consent. ECT proved to be a highly effective and safe method of treatment among elders. Formula-based RUL ECT did not differ from BT in antidepressant efficacy and had cognitive advantages - the indices of general cognitive performance, verbal fluency and memory were significantly better than before the treatment in the RUL group. Decline in retrieval consistency of autobiographical memory was more pronounced in the BT group, although it was observed across both groups. CONCLUSIONS Formula-based RUL ECT might not differ from BT in antidepressant efficacy and has an advantage in terms of tolerability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Zuzanna Goetz
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Lukasz Swiecicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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33
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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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34
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Danenberg R, Ruimi L, Shelef A, Paleacu Kertesz D. A Pilot Study of Cognitive Impairment in Longstanding Electroconvulsive Therapy-treated Schizophrenia Patients Versus Controls. J ECT 2021; 37:24-29. [PMID: 32658055 DOI: 10.1097/yct.0000000000000710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT), though reliable and effective, is controversial due to its media portrayal as a treatment with severe side effects. Electroconvulsive therapy is mainly given to patients suffering from affective disorders and treatment-resistant schizophrenia. Although past research assessed the amount and duration of memory loss due to ECT, little is known about its influence on cognition for patients suffering from schizophrenia, whose cognitive decline is an inherent part of their illness. We aimed to test whether maintenance ECT causes cognitive decline among elderly schizophrenia patients. METHODS Twenty elderly (age >65 years) patients suffering from schizophrenia and schizoaffective disorder who received maintenance ECT were matched with 20 controls suffering from the same illnesses that have never been treated with ECT. The match was based on age, sex, and illness duration. The participants were evaluated using the Montreal Cognitive Assessment for cognitive decline and a Positive and Negative Syndrome Scale (PANSS) for illness severity. RESULTS A lower score in the abstraction subscale was found in the maintenance ECT population (P = 0.002), without significant differences in the total Montreal Cognitive Assessment and the delayed-recall subscale scores. In the treatment group, a correlation was found between an impairment in naming and positive symptoms in the PANSS score (r = -0.45) and between abstraction impairment and negative symptoms (r = -0.56) and total PANSS score (r = -0.497). CONCLUSIONS Maintenance ECT does not worsen existing global cognitive deficits or delayed recall in elderly schizophrenia patients. The abstraction impairment was possibly due to the higher disease burden of the patients referred to ECT.
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Affiliation(s)
- Renana Danenberg
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv
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35
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Obbels J, Vansteelandt K, Bouckaert F, Dols A, Stek M, Verwijk E, Sienaert P. Neurocognitive functioning after electroconvulsive therapy in late-life depression: A 4-year prospective study. Acta Psychiatr Scand 2021; 143:141-150. [PMID: 33150605 DOI: 10.1111/acps.13252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side effects of ECT in older patients. In this study, we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression (LLD) from before the start until 4 years after the index ECT course. METHODS Fourty one patients aged 55 years and older with a unipolar depression, referred for ECT, were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years, and 4 years after the last ECT session. RESULTS We did not find any statistically significant cognitive changes from before the start to 4 years after ending the ECT course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level. CONCLUSION Cognitive performance in patients with LLD runs a stable course from before the start of ECT until 4 years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long-term cognitive side effects.
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Affiliation(s)
- Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - Filip Bouckaert
- Old-age Psychiatry, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - Annemiek Dols
- Department of Old Age Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, GGZ inGeest/Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, GGZ inGeest/Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Department of Medical Psychology, Neuropsychology Department, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
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36
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for depression. Hippokratia 2021. [DOI: 10.1002/14651858.cd013843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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37
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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38
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Dominiak M, Antosik-Wójcińska AZ, Goetz Z, Sikorska O, Stefanowski B, Gorostiza D, Święcicki Ł. Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: A randomized open label controlled trial. J Psychiatr Res 2021; 133:52-59. [PMID: 33310500 DOI: 10.1016/j.jpsychires.2020.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
Electroconvulsive therapy (ECT) remains the most effective treatment of depression, though it is still unclear which of its type is the most beneficial. The aim of this study was to compare the formula-based right unilateral ECT (RUL) with the fronto-temporal bilateral ECT (BT), in terms of their efficacy, safety and tolerability in patients with bipolar or unipolar depression. Ninety-one patients were randomly assigned to either BT (n = 45) or RUL (n = 46) ECT. Brief pulse width (0.5 ms) and a formula-based dosing method were applied. The clinical efficacy was assessed using the Hamilton Depression Rating Scale (HDRS-21).The somatic state was monitored throughout the ECT course and cognitive examination included: general cognitive performance, executive functions, visual-spatial functions, verbal fluency, verbal memory and autobiographical memory. Efficacy outcomes were not found to be significantly different between groups when using higher doses of energy in RUL ECT. Patients in RUL group were less likely to be confused and experienced increased blood pressure. The indices of general cognitive performance and verbal auditory memory were also significantly better this group, while BT ECT did not change these functions. Both ECT types resulted in a decline in the retrieval consistency of autobiographical memory that persists for at least three months and was significantly more marked in BT group as compared to RUL. In conclusion, formula-based RUL ECT does not differ from BT in antidepressant efficacy and has an advantage in terms of safety (lower incidence of increased blood pressure and fewer disturbances of consciousness) and tolerability (impact on cognitive functions).
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
| | | | - Zuzanna Goetz
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Olga Sikorska
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Bogdan Stefanowski
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Dagny Gorostiza
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Łukasz Święcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
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39
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Steward B, Bakir AA, Martin D, Dokos S, Loo CK. The left anterior right temporal (LART) placement for electroconvulsive therapy: A computational modelling study. Psychiatry Res Neuroimaging 2020; 304:111157. [PMID: 32799057 DOI: 10.1016/j.pscychresns.2020.111157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
Electrode placement in electroconvulsive therapy (ECT) has a major impact on treatment efficacy and cognitive side effects. Left Anterior Right Temporal (LART) is a lesser utilised bilateral montage which may produce more optimal clinical outcomes relative to standard bitemporal ECT. In this study we used computational modelling to explore how stimulation effects from LART and two novel variants (LART - F3 and LART - Frontal) compared to the more common bilateral placements of bitemporal and bifrontal ECT. High resolution finite element human head models were generated from MRI scans of three subjects with Major Depressive Disorder. Differences in regional stimulation were examined through parametric tests for regions of interest and subtraction maps. Compared to bitemporal ECT, LART - Original resulted in significantly greater stimulation of the left cingulate gyrus (hypothesised to be associated with treatment efficacy), and relatively reduced stimulation of the bilateral hippocampi (potentially associated with cognitive side effects). No additional clinical benefit was suggested with the novel LART placements compared to the original LART. The original LART placement is a promising montage for further clinical investigation.
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Affiliation(s)
| | - Azam Ahmad Bakir
- Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia
| | - Donel Martin
- Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia
| | - Colleen K Loo
- Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; St George Hospital, South Eastern Sydney Health, Sydney, NSW, Australia
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40
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Van de Velde N, Kappen M, Koster EHW, Hoorelbeke K, Tandt H, Verslype P, Baeken C, De Raedt R, Lemmens G, Vanderhasselt MA. Cognitive remediation following electroconvulsive therapy in patients with treatment resistant depression: randomized controlled trail of an intervention for relapse prevention - study protocol. BMC Psychiatry 2020; 20:453. [PMID: 32938410 PMCID: PMC7493867 DOI: 10.1186/s12888-020-02856-x] [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: 06/18/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, even though transient, might trigger mechanisms that increase relapse in patients who initially responded to ECT. Among these side effects, reduced cognitive control is an important neurobiological driven vulnerability factor for depression. As such, cognitive control training (CCT) holds promise as a non-pharmacological strategy to improve long-term effects of ECT (i.e., increase remission, and reduce depression relapse). METHOD/DESIGN Eighty-eight patients aged between 18 and 70 years with MDE who start CCT will be included in this randomized controlled trial (RCT). Following (partial) response to ECT treatment (at least a 25% reduction of clinical symptoms), patients will be randomly assigned to a computer based CCT or active placebo control. A first aim of this RCT is to assess the effects of CCT compared to an active placebo condition on depression symptomatology, cognitive complaints, and quality of life. Secondly, we will monitor patients every 2 weeks for a period of 6 months following CCT/active placebo, allowing the detection of potential relapse of depression. Thirdly, we will assess patient evaluation of the addition of cognitive remediation to ECT using qualitative interview methods (satisfaction, acceptability and appropriateness). Finally, in order to further advance our understanding of the mechanisms underlying effects of CCT, exploratory analyses will be conducted using video footage collected during the CCT/active control phase of the study. DISCUSSION Cognitive remediation will be performed following response to ECT, and an extensive follow-up period will be employed. Positive findings would not only benefit patients by decreasing relapse, but also by increasing acceptability of ECT, reducing the burden of cognitive side-effects. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov . Study ID: NCT04383509 Trial registration date: 12.05.2020.
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Affiliation(s)
- Nele Van de Velde
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Mitchel Kappen
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
| | - Ernst H. W. Koster
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Kristof Hoorelbeke
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Hannelore Tandt
- grid.410566.00000 0004 0626 3303Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Pieter Verslype
- grid.410566.00000 0004 0626 3303Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Chris Baeken
- grid.410566.00000 0004 0626 3303Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium ,grid.5342.00000 0001 2069 7798Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium ,grid.411326.30000 0004 0626 3362Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium ,grid.6852.90000 0004 0398 8763Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rudi De Raedt
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Gilbert Lemmens
- grid.410566.00000 0004 0626 3303Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
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41
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The Tendency of Modified Electroconvulsive Therapy-Related Working Memory and Subjective Memory Deficits in Depression: A Prospective Follow-up Study. J ECT 2020; 36:198-204. [PMID: 32118689 DOI: 10.1097/yct.0000000000000668] [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: 01/14/2023]
Abstract
OBJECTIVE The aim of the study was to explore the tendency of modified electroconvulsive therapy (MECT)-related working memory and subjective memory deficits in depressed patients. METHODS Sixty patients with unipolar/bipolar depression were prepared and enrolled for MECT and 56 subjects were enrolled as healthy controls (HCs). Their demographics (sex, age, body mass index, years of schooling, etc) and clinical characteristics (dosage and number of MECT, etc) were compared. Depression severity, working memory, and subjective memory were measured using the Hamilton Depression Rating Scale 17 (HAMD17), a Digit Span Backwards (DSB), and self-reported assessments, respectively. Measurements were taken at baseline, within 24 hours after each MECT session, and in every month for a 6-month follow-up period. RESULTS (a) The patients had poorer performance than the HCs on DSB and HAMD17 at baseline, and the DSB score and HAMD17 total scores were negatively correlated. However, after the second MECT session, the patients' HAMD17 score was significantly improved compared with that at the baseline (P < 0.05), whereas the DSB score showed no significant difference compared with the HCs (P > 0.05). (b) After the first MECT session, 62% of the patients reported subjective memory deficits, which were exacerbated over the subsequent sessions and relieved with antidepressant treatment during the follow-up period. (c) The risk factors for prolonged subjective memory deficits were overweight and the maximum MECT dosage/age (dosage/age = the percentage of output part of total dosage × 100/age, unit: 1/year) ≥ 1.5/year (odds ratio [OR] = 15.36 and 7.98). CONCLUSIONS Depressed patients showed poorer working memory than the HCs. Such memory deficit may be aggravated by MECT, although it may improve with the relief of depression. Although subjective memory deficits can occur after the first MECT session and gradually recover after the treatment, they may last for 6 months or longer. Persistent deficits may be related to being overweight and having a high MECT dosage.
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Wang D, Tian Y, Li M, Dahmani L, Wei Q, Bai T, Galiè F, Ren J, Farooq RK, Wang K, Lu J, Wang K, Liu H. Functional connectivity underpinnings of electroconvulsive therapy-induced memory impairments in patients with depression. Neuropsychopharmacology 2020; 45:1579-1587. [PMID: 32434212 PMCID: PMC7360738 DOI: 10.1038/s41386-020-0711-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for severe medication-resistant depression. However, ECT frequently results in episodic memory impairments, causing many patients to discontinue treatment. The objective of this study was to explore the functional connectivity underpinnings of ECT-induced episodic memory impairments. We investigated verbal episodic memory and intrinsic functional connectivity in 24 patients with depression (13F, 11M) before and after ECT, and 1 month after treatment. We used a novel individual-oriented approach to examine functional connectivity, and trained a linear support vector regression model to estimate verbal memory performance based on connectivity. The model identified a set of brain connections that can predict baseline verbal memory performance (r = 0.535, p = 0.026). Importantly, we found a nonoverlapping set of brain connections whose changes after ECT can track patients' verbal memory impairments (r = 0.613, p = 0.008). These connections mainly involve the frontoparietal control, default mode, and hippocampal networks, suggesting that ECT affects broad functional networks that are involved in memory performance. In contrast, functional connectivity defined using traditional group-level analyses was unable to estimate either baseline memory performance or post-ECT verbal memory impairments. A parallel analysis using the same strategy did not identify a connectivity marker for overall mood improvement, suggesting that functional connectivity changes related to depressive symptoms may be highly heterogenous. Our findings shed light on the mechanism through which ECT impairs episodic memory, and additionally underline the importance of accounting for interindividual variability in the investigation of functional brain organization in patients with depression.
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Affiliation(s)
- Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
| | - Meiling Li
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Louisa Dahmani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
| | - Franziska Galiè
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jianxun Ren
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Rai Khalid Farooq
- Institute for Research and Medical Consultations, Imam Abdulahman Bin Faisal University, Dammam, Saudi Arabia
| | - Kangcheng Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China.
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA.
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Jolly AJ, Singh SM. Does electroconvulsive therapy cause brain damage: An update. Indian J Psychiatry 2020; 62:339-353. [PMID: 33165343 PMCID: PMC7597699 DOI: 10.4103/psychiatry.indianjpsychiatry_239_19] [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] [Received: 04/09/2019] [Revised: 06/23/2019] [Accepted: 02/08/2020] [Indexed: 12/31/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage. This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods. These include structural, functional, and metabolic neuroimaging; body fluid biochemical marker studies; and follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain. However, there is a lack of evidence at present to suggest that ECT causes brain damage.
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Affiliation(s)
- Amal Joseph Jolly
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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van Rooij SJH, Riva-Posse P, McDonald WM. The Efficacy and Safety of Neuromodulation Treatments in Late-Life Depression. ACTA ACUST UNITED AC 2020; 7:337-348. [PMID: 33585164 DOI: 10.1007/s40501-020-00216-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of review In this review, the efficacy and safety of FDA approved neuromodulation devices (electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS)), as well as emerging neuromodulation treatments currently under investigation. Recent findings ECT is the "gold standard" somatic therapy for treatment resistant depression (TRD). Although the clinical benefits are outweighed by potential cognitive and cardiovascular side effects in majority of cases, it remains unfairly stigmatized. TMS has few cognitive or somatic side effects but is not as effective the treatment of psychotic depression or more treatment resistant depression in elders. VNS has limited data in older patients but has been shown to be effective in chronic, treatment resistant adults. Several investigative neuromodulation treatments including magnetic seizure therapy (MST), focal electrically administered seizure therapy (FEAST), transcutaneous VNS (tVNS), transcranial direct current stimulation (tDCS), and deep brain simulation (DBS) shown promise in geriatric TRD. Summary ECT, TMS and VNS are effective treatment for late-life depression, and research has continued to refine the techniques. Investigative neuromodulation techniques are promising, but evidence for the safety and efficacy of these devices in the geriatric population is needed.
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Affiliation(s)
- Sanne J H van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Patricio Riva-Posse
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - William M McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
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Hermida AP, Goldstein FC, Loring DW, McClintock SM, Weiner RD, Reti IM, Janjua AU, Ye Z, Peng L, Tang YL, Galendez GC, Husain MM, Maixner DF, Riva-Posse P, McDonald WM. ElectroConvulsive therapy Cognitive Assessment (ECCA) tool: A new instrument to monitor cognitive function in patients undergoing ECT. J Affect Disord 2020; 269:36-42. [PMID: 32217341 DOI: 10.1016/j.jad.2020.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a well-established treatment for severe depression but may result in adverse cognitive effects. Available cognitive screening instruments are nonspecific to the cognitive deficits associated with ECT. An ECT-cognitive assessment tool which can be easily administered was developed and validated in a clinical setting. METHODS One hundred and thirty-six participants were enrolled. The ElectroConvulsive therapy Cognitive Assessment (ECCA) and the Montreal Cognitive Assessment (MoCA) were administered prospectively to 55 participants with major depressive disorder (MDD) undergoing ECT at three time points: pre-treatment, before the sixth treatment and one-week post-treatment. The psychometric properties of the total and domain scores were evaluated at all three time points. Forty demographically comparable participants with MDD who did not receive ECT, and 41 healthy, age-matched controls were evaluated at a single time point. RESULTS ECCA and MoCA scores were not statistically different at baseline. Prior to the sixth and final ECT session, total ECCA scores were significantly lower than the MoCA total scores. The ECCA domains of subjective memory, informant-assessed memory, attention, autobiographical memory and delayed verbal recall were significantly lower post-ECT compared to pre-ECT. LIMITATIONS The ECCA was compared only to the MoCA rather than to a more comprehensive neuropsychological testing. This limitation reflected the real-life clinical burden of performing full neuropsychological testing at three time points during the treatment course. CONCLUSIONS The ECCA is a brief, reliable, bedside cognitive screening assessment tool that may be useful to monitor cognitive function in patients treated with ECT. The test can be downloaded from fuquacenter.org/ecca.
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Affiliation(s)
- Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, USA.
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shawn M McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Richard D Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Irving M Reti
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, USA
| | - Zixun Ye
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, USA
| | - Gail C Galendez
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, USA
| | - Mustafa M Husain
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel F Maixner
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, USA
| | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Atlanta, GA, USA
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- National Network of Depression Centers, Ann Arbor, Michigan, USA
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a controversial treatment. Research has predominantly focused on clinician assessment of short-term efficacy and, occasionally, on participant experiences of the treatment itself. While service user accounts of the long-term impacts of ECT are reported, they are dispersed throughout the literature and typically tangential to studie's main foci. AIM The aim of this study was to synthesise service-user accounts, within peer-reviewed literature, of long-term impacts of ECT in their daily lives. METHODS A qualitative meta-synthesis was conducted. A systematic literature search identified qualitative articles meeting the inclusion criteria. Results sections of eligible papers were analysed thematically. RESULTS From 16 eligible papers, the review identified 11 long-term impacts, four social influences and five strategies that people employed to navigate these long-term impacts. CONCLUSION Limited research has examined long-term experiences of ECT from service-user perspectives. These lived experience perspectives are required to facilitate peer-to-peer learning and assist future service delivery to align with needs of people living with long-term ECT impacts.
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Affiliation(s)
- K Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - N Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - A Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Sigström R, Nordenskjöld A, Juréus A, Clements C, Joas E, Pålsson E, Landén M. Long-term subjective memory after electroconvulsive therapy. BJPsych Open 2020; 6:e26. [PMID: 32148217 PMCID: PMC7176828 DOI: 10.1192/bjo.2020.9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There have been reports of long-term subjective memory worsening after electroconvulsive therapy (ECT). AIMS To study the prevalence and risk factors of long-term subjective memory worsening among patients receiving ECT in routine clinical practice. METHOD Patients (n = 535, of whom 277 were included in the final analysis) were recruited from eight Swedish hospitals. Participants' subjective memory impairment was assessed before ECT and a median of 73 days after ECT using the memory item from the Comprehensive Psychopathological Rating Scale. Participants also rated their pre-ECT expectations and post-ECT evaluations of the effect of ECT on memory on a 7-point scale. We used ordinal regression to identify variables associated with subjective memory worsening and negative evaluations of the effect of ECT on memory. RESULTS Comparisons of pre- and post-ECT assessments showed that subjective memory worsened in 16.2% of participants, remained unchanged in 52.3% and improved in 31.4%. By contrast, when asked to evaluate the effect of ECT on memory after treatment 54.6% reported a negative effect. Subjective memory worsening was associated with negative expectations before ECT, younger age and shorter duration of follow-up. CONCLUSIONS Although subjective memory improved more often than it worsened when assessed before and after ECT, a majority of patients reported that ECT had negative effects on their memory when retrospectively asked how ECT had affected it. This might suggest that some patients attribute pre-existing subjective memory impairment to ECT. Clinicians should be aware that negative expectations are associated with subjective worsening of memory after ECT.
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Affiliation(s)
- Robert Sigström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Sweden
| | - Anders Juréus
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | | | - Erik Joas
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
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Atay ÖC, Bag S, Usta H, Çetinkaya E, Yanik M. Satisfaction and attitude of bipolar patients regarding electroconvulsive therapy: modified or unmodified. Nord J Psychiatry 2020; 74:131-137. [PMID: 31657256 DOI: 10.1080/08039488.2019.1680730] [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] [Indexed: 01/03/2023]
Abstract
Objective: Ministry of Health of Turkey issued a legislation to use only modified electroconvulsive therapy (ECT) in 2005, and this study aimed to assess satisfaction and attitude of bipolar patients regarding modified and unmodified electroconvulsive therapy.Methods: A total of 100 patients (50 treated with modified electroconvulsive therapy (M-ECT) and 50 treated with unmodified ECT (UM-ECT) with a diagnosis of Bipolar Disorder (depressive or manic episode) were invited to participate in this study. Patients with euthymic mood were included. Satisfaction and attitude towards ECT were evaluated with a structured attitude questionnaire, and M-ECT and UM-ECT patients, and their subgroups (depressive vs. manic) were compared.Results: No significant differences were found between M-ECT and UM-ECT groups regarding age, sex, marital status and occupation. The majority of all patients (78%) were satisfied from treatment with ECT and with the outcome (88%), without significant differences between modified and unmodified groups. Forgetfulness (70%) and headaches (57%) occurred in all groups, with the only significant difference in forgetfulness being reported by more manic patients treated with UM-ECT. Depressive and manic patients treated with UM-ECT reported concerns of brain damage and physical harm significantly more frequently. While 86% of patients treated with M-ECT consented to a future treatment, this was significantly less in patients treated with UM-ECT (50%).Conclusions: Bipolar patients report a high degree of satisfaction treated either with modified or unmodified ECT but there was a significant difference in perception of adverse effects and willingness for receiving ECT in future.
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Affiliation(s)
- Özge Canbek Atay
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, ECT Center, Istanbul, Turkey
| | - Sevda Bag
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Haluk Usta
- Department of Psychiatry, Erenkoy Teaching Hospital for Psychiatry and Neurology, Istanbul, Turkey
| | - Esin Çetinkaya
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, ECT Center, Istanbul, Turkey
| | - Medaim Yanik
- Department of Psychiatry, Bakirkoy Teaching Hospital for Psychiatry, Neurology and Neurosurgery, ECT Center, Istanbul, Turkey
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Kayser S, Bewernick BH, Wagner S, Schlaepfer TE. Effects of magnetic seizure therapy on anterograde and retrograde amnesia in treatment-resistant depression. Depress Anxiety 2020; 37:125-133. [PMID: 31682325 DOI: 10.1002/da.22958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/17/2019] [Accepted: 08/20/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the gold standard for treatment-resistant depression (TRD). However, cognitive side effects, mainly anterograde and retrograde amnesia, frequently occur. Magnetic seizure therapy (MST) is tested using more focal seizure induction. However, the suggestion MST may be more beneficial than ECT because it causes fewer amnesia have not yet been comprehensively investigated using common neuropsychological testing specifically for ECT. We aimed to examine whether MST causes anterograde and retrograde amnesia. METHODS Ten patients with TRD were treated with MST (8.9 [2] treatments) at 100% machine output, a frequency of 100 Hz and 657.4 (62) pulses per train. The short form of the Autobiographical Memory Inventory was administered to test retrograde amnesia. Furthermore, an extended neuropsychological test battery, including verbal and nonverbal recall as well as recognition tasks, was used. RESULTS We observed changes in retrograde amnesia, although they were not clinically relevant (mean: -0.42 ± 0.14). Furthermore, no anterograde amnesia as well as no effects on global cognitive status, attention, language, and executive functions after MST were measured. CONCLUSIONS The cognitive safety and efficacy of MST in patients with TRD were indicated. However, the main limitations of the present study were the small sample and as a consequence, the low statistical power to detect changes after treatment. Therefore, our findings require replication in further studies. In addition, a direct comparison between MST and ECT in a larger sample should be performed before MST can be discussed as an alternative treatment approach to ECT in clinical practice.
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Affiliation(s)
- Sarah Kayser
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Bettina H Bewernick
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Geriatric Psychiatry and Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Thomas E Schlaepfer
- Department of Geriatric Psychiatry and Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Division of Interventional Biological Psychiatry, University Hospital Freiburg, Freiburg, Germany.,Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, Maryland
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50
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Martin D, Lin F, Bai S, Moffa A, Taylor R, Nikolin S, Bull M, Dokos S, Loo CK. A systematic review and computational modelling analysis of unilateral montages in electroconvulsive therapy. Acta Psychiatr Scand 2019; 140:408-425. [PMID: 31419305 DOI: 10.1111/acps.13089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the clinical outcomes of ECT unilateral placements compared in prior studies and apply insights from computational modelling to understand differences between placements. METHODS PubMed, Embase, Scopus and PsycINFO and reference lists were systematically searched for studies of depressed patients where two unilateral placements were compared and clinical outcomes were reported. Computational modelling was done to generate electric field maps for each unilateral placement identified in the systematic review. RESULTS A total of 29 studies met criteria for inclusion. Eight studies reported efficacy outcomes and 23 studies reported cognitive outcomes. Most studies found no significant difference in efficacy between right unilateral (RUL) and left unilateral (LUL) ECT, and no difference was found between temporo-parietal and fronto-temporal ECT. For the majority of studies, RUL placements had better verbal anterograde memory outcomes compared with the LUL placements. There was some evidence suggestive of cognitive advantages for fronto-frontal and fronto-parietal placements relative to temporo-parietal ECT. CONCLUSIONS For efficacy, studies mainly focused on the comparison of right vs. left hemispheric stimulation, with the available evidence suggesting no substantive difference. RUL placements tended to have better verbal anterograde memory outcomes relative to LUL placements, though limited differences were found between the RUL placements.
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Affiliation(s)
- D Martin
- Black Dog Institute, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - F Lin
- Black Dog Institute, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - S Bai
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW, Australia.,Department of Electrical and Computer Engineering, Technical University of Munich (TUM), Munich, Germany.,Munich School of BioEngineering, TUM, Garching, Germany
| | - A Moffa
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - R Taylor
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Concord Centre for Mental Health, Concord, NSW, Australia
| | - S Nikolin
- Black Dog Institute, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - M Bull
- Black Dog Institute, Sydney, NSW, Australia.,HNE Mental Health, Waratah, NSW, Australia
| | - S Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW, Australia
| | - C K Loo
- Black Dog Institute, Sydney, NSW, Australia.,St George Hospital, South Eastern Sydney Health, Sydney, NSW, Australia
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