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The Change in Facial Emotion Recognition Ability in Inpatients with Treatment Resistant Schizophrenia After Electroconvulsive Therapy. Psychiatr Q 2017; 88:535-543. [PMID: 27663585 DOI: 10.1007/s11126-016-9466-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with schizophrenia have impairments in emotion recognition along with other social cognitive deficits. In the current study, we aimed to investigate the immediate benefits of ECT on facial emotion recognition ability. Thirty-two treatment resistant patients with schizophrenia who have been indicated for ECT enrolled in the study. Facial emotion stimuli were a set of 56 photographs that depicted seven basic emotions: sadness, anger, happiness, disgust, surprise, fear, and neutral faces. The average age of the participants was 33.4 ± 10.5 years. The rate of recognizing the disgusted facial expression increased significantly after ECT (p < 0.05) and no significant changes were found in the rest of the facial expressions (p > 0.05). After the ECT, the time period of responding to the fear and happy facial expressions were significantly shorter (p < 0.05). Facial emotion recognition ability is an important social cognitive skill for social harmony, proper relation and living independently. At least, the ECT sessions do not seem to affect facial emotion recognition ability negatively and seem to improve identifying disgusted facial emotion which is related with dopamine enriched regions in brain.
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A comparative study of the cognitive side effects of bitemporal and bifrontal electroconvulsive therapy. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000516721.16137.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Müller HHO, Reike M, Grosse-Holz S, Röther M, Lücke C, Philipsen A, Kornhuber J, Grömer TW. Electroconvulsive Therapy Hasn't Negative Effects on Short-Term Memory Function, as Assessed Using a Bedside Hand-Held Device. Ment Illn 2017; 9:7093. [PMID: 28748058 PMCID: PMC5509960 DOI: 10.4081/mi.2017.7093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022] Open
Abstract
Electroconvulsive therapy (ECT) is effective in the treatment of treatment-resistant major depression. The fear of cognitive impairment after ECT often deters patients from choosing this treatment option. There is little reliable information regarding the effects of ECT on overall cognitive performance, while short-term memory deficits are well known but not easy to measure within clinical routines. In this pilot study, we examined ECT recipients' pre- and post-treatment performances on a digital ascending number tapping test. We found that cognitive performance measures exhibited good reproducibility in individual patients and that ECT did not significantly alter cognitive performance up to 2 hours after this therapy was applied. Our results can help patients and physicians make decisions regarding the administration of ECT. Digital measurements are recommended, especially when screening for the most common side effects on cognitive performance and short-term memory.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen.,Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Mareen Reike
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Simon Grosse-Holz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Mareike Röther
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Teja W Grömer
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
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Cognitive Effects of Bifrontal Versus Right Unilateral Electroconvulsive Therapy in the Treatment of Major Depression in Elderly Patients: A Randomized, Controlled Trial. J ECT 2016; 32:151-8. [PMID: 26909824 DOI: 10.1097/yct.0000000000000310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Bifrontal (BF) electrode placement has been explored to refine the electroconvulsive therapy (ECT) technique. No previous study has compared the cognitive effects of BF versus right unilateral (RUL) ECT by only including the subgroup that is most likely to receive it: elderly patients with major depression. METHODS Nondemented patients (n = 65) with major depression, aged 60 to 85 years, were randomly allocated to BF ECT and RUL formula-based ECT. Cognitive function was assessed at baseline (T1), within 1 week after a course of ECT (T2), and 3 months after T2 (T3). Six neuropsychological test measures of memory, 5 of executive function, and 3 of information-processing speed were administered. RESULTS According to linear mixed models, there were no significant differences between the BF and RUL groups at any time. The retrograde memory score for public facts declined more for the RUL group (P < 0.001) than the BF group (P = 0.005) from baseline to the first retest and remained stable for both groups from T2 to T3. A rapid improvement in selective attention was observed in the RUL group from T1 to T2, but the scores remained stable from T2 to T3 (P < 0.001). This measure remained stable in the BF group from T1 to T3. CONCLUSIONS Our findings indicate that there were negligible differences in the cognitive effects of formula-based BF or RUL ECT. The overall cognitive effects of ECT were equally favorable for each of the groups.
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Sanz-Fuentenebro FJ. Stimulus characteristics in electroconvulsive therapy. A pragmatic review. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 11:36-47. [PMID: 27569402 DOI: 10.1016/j.rpsm.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
The process of normalization electroconvulsive therapy (ECT) requires, among other actions, disseminating the latest information on this technique. One of the most complex aspects is the electrical stimulus, whose knowledge should be spread and put into practice. In this paper we review the available information about frequency and number of ECT sessions, and efficacy of each electrode placement. We also present two approaches to determine the ECT charge: stimulus titration versus age-based method; and the limitations of the summary metrics of charge, being necessary to expand our knowledge of the parameters that configure the stimulus: duration, current amplitude frequency and pulse width.
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Affiliation(s)
- Francisco Javier Sanz-Fuentenebro
- Hospital Universitario-Instituto de Investigación Hospital 12 de Octubre, Madrid, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España.
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Song GM, Tian X, Shuai T, Yi LJ, Zeng Z, Liu S, Zhou JG, Wang Y. Treatment of Adults With Treatment-Resistant Depression: Electroconvulsive Therapy Plus Antidepressant or Electroconvulsive Therapy Alone? Evidence From an Indirect Comparison Meta-Analysis. Medicine (Baltimore) 2015; 94:e1052. [PMID: 26131818 PMCID: PMC4504538 DOI: 10.1097/md.0000000000001052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Electroconvulsive therapy (ECT) and antidepressant are the effective treatment alternatives for patients with treatment-resistant depression (TRD); however, the effects and safety of the ECT plus antidepressant relative to ECT alone remain controversial. We decide to assess the potential of ECT plus antidepressant compared with ECT alone by undertaking an indirect comparison meta-analysis.Databases from PubMed, ISI Web of Science, CENTRAL, Clinicaltrials.gov, EMBASE, CBM (China Biomediccal Literatures Database), and CNKI (China National Knowledge Infrastructure) were searched for relevant studies through November 21, 2014. Literature was screened, data were extracted and methodological quality of the eligible trial was assessed by 2 independent reviewers accordingly. Then, head-to-head and indirect comparison meta-analyses were carried out.A total of 17 studies which including 13 studies regarding ECT plus antidepressant versus antidepressant alone and 4 studies concerning ECT versus antidepressant alone containing a total of 1098 patients were incorporated into this meta-analysis. The head-to-head comparison suggested that response rate can be improved in the ECT plus antidepressant (RR, 1.82; 95% CI, 1.55-2.14) and ECT alone group (RR, 2.24, 95% CI, 1.51-3.33) compared with antidepressant alone, respectively; adverse complications including memory deterioration and somatization were not significantly increased except incidence of memory deterioration in ECT plus antidepressant in the 4th weeks after treatment (RR, 0.09, 95% CI, 0.02-0.49). Indirect comparison meta-analysis showed that no significant differences were detected in response rate and memory deterioration between ECT plus antidepressant and ECT alone. However, ECT plus antidepressant increased the incidence of memory deterioration relative to ECT alone.With present evidence, the regime of ECT plus antidepressant should not be preferentially recommended to treat the patients with TRD relative to ECT alone.
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Affiliation(s)
- Guo-Min Song
- From Department of Nursing, Tianjin Hospital, Tianjin, Peoples' Republic of China (G-MS); Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, Peoples' Republic of China (XT, TS, L-JY, ZZ); School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, Peoples' Republic of China (XT, TS, L-JY, ZZ, YW); School of Nursing, Peking Union Medical College, Beijing, Peoples' Republic of China (SL); and Department of Oncology, Affiliated Hospital of Zunyi Medical College, Zunyi, Peoples' Republic of China (J-GP)
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Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial. J Affect Disord 2015; 175:8-17. [PMID: 25590761 DOI: 10.1016/j.jad.2014.12.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/26/2014] [Accepted: 12/24/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND No prior study has compared the efficacy of bifrontal (BF) vs right unilateral (RUL) electroconvulsive therapy (ECT) by including the subgroup that is most likely to receive it: only elderly patients with major depression (MD). METHODS This single-site, randomized, assessor-blinded, controlled trial was conducted from 2009 to 2013. Seventy-three elderly patients with MD, unipolar and bipolar, were treated with a course of formula-based BF ECT or RUL ECT. The 17-item Hamilton Rating Scale for Depression (HRSD17) was used to measure efficacy. Safety was assessed with the Mini Mental State Examination (MMSE). RESULTS Both electrode placements resulted in highly significant downward trends in symptom severity (all p<0.001), with a non-significant difference between methods (p=0.703). At the end of the ECT course, response rates for the BF and RUL group were 63.9% and 67.6%, respectively. Short-term remission, defined as an HRSD17 score≤7, was achieved in 14 (38.9%) patients in the BF group and 19 (51.4%) patients in the RUL group. Global cognitive function, as measured by the MMSE, did not deteriorate in the two treatment groups. LIMITATIONS The small number of subjects may have led to reduced power to detect real differences. The MMSE is not sufficient to ascertain the negative effect of ECT on cognition. CONCLUSIONS This study indicates that formula-based BF and RUL ECT are equally efficacious, and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing, in a clinical sample of elderly patients with MD. TRIAL REGISTRATION ClinicalTrials.gov NCT01559324.
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Wei Q, Tian Y, Yu Y, Zhang F, Hu X, Dong Y, Chen Y, Hu P, Hu X, Wang K. Modulation of interhemispheric functional coordination in electroconvulsive therapy for depression. Transl Psychiatry 2014; 4:e453. [PMID: 25268257 PMCID: PMC4202999 DOI: 10.1038/tp.2014.101] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/15/2022] Open
Abstract
Considerable evidence suggests that depression is related to interhemispheric functional coordination deficits. For depression, electroconvulsive therapy (ECT) is the most rapid and effective therapy, but its underlying mechanism remains unknown. The aim of this study was to explore the impact of ECT on the interhemispheric functional coordination in depression patients. We used resting-state functional magnetic resonance imaging to observe the change of interhemispheric functional coordination with the method of voxel-mirrored homotopic connectivity (VMHC) in 11 depressed patients before and after ECT, compared with 15 healthy controls. The results showed that, compared with depression patients before ECT, VMHC was significantly increased in superior frontal gyri (BA 8), middle frontal gyri (two clusters: BA 8/9 and BA 10) and angular gyri (BA 39) in depression patients after ECT. Compared with healthy controls, VMHC in those areas was significantly lower in the middle frontal gyri (BA 8/9) and angular gyri (BA 39) in depression patients before ECT, but no significant difference was observed in the superior frontal gyri (BA 8) and middle frontal gyri (BA 10). There was no significant correlation between the changes of Hamilton Depression Rating Scale scores and changed VMHC values in those four areas in depression patients. The results suggest that ECT selectively modulated interhemispheric functional coordination in depression patients. Such may play an important mechanistic role in the treatment of depression, and may afford a useful avenue for optimizing treatment.
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Affiliation(s)
- Q Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Y Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Y Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - F Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - X Hu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Y Dong
- Anhui Mental Health Center, Hefei, China
| | - Y Chen
- Anhui Mental Health Center, Hefei, China
| | - P Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - X Hu
- Anhui Mental Health Center, Hefei, China
| | - K Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China. E-mail:
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Kayser S, Bewernick BH, Hurlemann R, Soehle M, Schlaepfer TE. Comparable seizure characteristics in magnetic seizure therapy and electroconvulsive therapy for major depression. Eur Neuropsychopharmacol 2013; 23:1541-50. [PMID: 23820052 DOI: 10.1016/j.euroneuro.2013.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/20/2012] [Accepted: 04/20/2013] [Indexed: 12/28/2022]
Abstract
Electroconvulsive therapy (ECT) is highly effective for treatment-resistant depression (TRD); however, its use for less severe forms of depression is somewhat limited by a lack of control over current spreading to medial temporal lobe memory structures, resulting in various cognitive side effects. In contrast, magnetic seizure therapy (MST), which uses high frequency repetitive transcranial magnetic stimulation (rTMS) for local seizure induction, has been associated with reduced cognitive side effects. To assess whether different characteristics of seizures induced by both methods are responsible for the differences in neuropsychological side-effect profile, we studied seven TRD-patients undergoing both MST and ECT in an open-label, within subject, controlled crossover pilot study. Comparison parameters included seizure-related ictal characteristics, including motor activity, electromyogram (EMG), electroencephalogram (EEG), and postictal recovery and reorientation times.Our results showed no differences in motor activity or EMG and EEG characteristics, thus implicating similar electrophysiological processes in seizure induction with MST and ECT. In line with previous studies, we observed shorter postictal recovery and reorientation times following MST.The ictal characteristics of induced seizures were found similar with ECT and MST suggesting that the more focal seizure induction associated with MST may account for the more beneficial neuropsychological side effect profile of MST.
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Affiliation(s)
- Sarah Kayser
- Department of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany
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10
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Xie J, Chen J, Wei Q. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a meta-analysis of stimulus parameter effects. Neurol Res 2013; 35:1084-91. [PMID: 23889926 DOI: 10.1179/1743132813y.0000000245] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Studies comparing the antidepressant effects of electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have reported mixed results, as the choice of rTMS stimulus parameters is essential to its antidepressive effect. This meta-analysis aimed at assessing how rTMS stimulus parameters influence the efficacy of rTMS relative to ECT in treating major depression. METHODS A comprehensive literature search (including PubMed, CCTR, Web of Science, Embase, EAGLE, NTIS, CBM-disc, CNKI, Current Controlled Trials, Clinical Trials, International Clinical Trials Registry, and Internet Stroke Center) was conducted dating until December 2012. After exclusion of low-quality studies, the key search terms ('depressive', 'depression', 'transcranial magnetic stimulation', 'TMS', 'repetitive TMS', 'electroconvulsive therapy', and 'ECT') produced nine high-quality randomized controlled trials (RCTs) of rTMS versus ECT. RESULTS These nine studies, composed of 395 patients, were meta-analyzed through assessment of odds of remission, response, and drop-out. Two rTMS subgroups displayed non-significant superiority to ECT: 20 Hz (odds ratio (OR) = 1·20; P > 0·05) and ≥ 1200 daily stimuli (OR = 1·06; P > 0·05). One rTMS subgroup displayed non-significant inferiority to ECT: four-week treatment period (OR = 0·65; P > 0·05). The other rTMS subgroups were significantly inferior to ECT. Repetitive transcranial magnetic stimulation was associated with a 30% relative reduction in the odds of drop-out, however non-significantly (95% confidence interval (CI), 0·36-1·39). DISCUSSION The results indicate that the efficacy of rTMS is tied to its stimulus parameters. Varying stimulus parameters can result in varying antidepressive effects. Consequently, future research on rTMS or rTMS versus ECT should take the influence of rTMS stimulus parameters into consideration.
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Affiliation(s)
- Jing Xie
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Al-Harbi KS, Qureshi NA. Neuromodulation therapies and treatment-resistant depression. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012; 5:53-65. [PMID: 23152710 PMCID: PMC3496963 DOI: 10.2147/mder.s33198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective This paper aims to review evidence-based data on the use of NTs in TRD. Method Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000–2012). Those papers that addressed NTs in TRD were retained for extensive review. Results Despite methodological challenges, a range of 30%–93% of TRD patients showed substantial improvement to one of the NTs. One hundred–percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. Conclusion NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.
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Dunne RA, McLoughlin DM. Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression. World J Biol Psychiatry 2012; 13:248-58. [PMID: 22098115 DOI: 10.3109/15622975.2011.615863] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our aim was to perform a meta-analysis of randomized controlled trials comparing efficacy and side effects of bifrontal (BF) ECT to bitemporal (BT) or unilateral (RUL) ECT in depression. METHODS We performed a systematic review of randomized controlled trials comparing BF ECT with RUL or BT ECT in depression. Eight trials (n=617) reported some cognitive outcome. Efficacy was measured by reduction in Hamilton Depression Rating Scale score. Cognitive outcomes were limited to Mini-Mental State Examination (MMSE) in seven studies, with two studies measuring each of: Complex-figure delayed recall, Trail-making tests and verbal learning. RESULTS Efficacy was equal between BF and BT ECT (Hedges's g=0.102, P=0.345, confidence interval (CI): -0.110, 0.313) and BF and RUL ECT (standardized mean difference=-0.12, P=0.365, CI: -0.378, 0.139). Post-treatment MMSE score decline was less for BF than BT ECT (g=0.89, CI: 0.054, 1.724) but not RUL ECT. RUL ECT impaired Complex figure recall more than BF ECT (g=0.76, CI :0.487, 1.035), but BF ECT impaired word recall more than RUL ECT (g=-1.45, CI: -2.75, -0.15). CONCLUSIONS Bifrontal ECT is not more effective than BT or RUL ECT but may have modest short-term benefits for specific memory domains. BF ECT has potential advantages, but given longer experience with BT and RUL, bifrontal ECT requires better characterization.
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Affiliation(s)
- Ross A Dunne
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland.
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Muralidharan K, Thimmaiah R, Chakraborty V, Jain S. Bifrontal ECT for drug-induced psychosis in Parkinson's disease. Indian J Psychiatry 2011; 53:156-8. [PMID: 21772651 PMCID: PMC3136021 DOI: 10.4103/0019-5545.82549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Psychosis has been documented to occur during treatment for idiopathic Parkinson's disease (PD). This case report describes an elderly male who developed psychosis during the course of treatment for idiopathic PD. He was treated with clozapine but experienced significant adverse effects without clinical improvement. He was prescribed bifrontal electroconvulsive therapy (BF-ECT). Here, we report the efficacy of BF-ECT in treating psychosis and motor symptoms in PD, without producing cognitive side effects in an elderly male.
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Affiliation(s)
- K Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Abstract
Electrode placement in electroconvulsive therapy affects both the efficacy and adverse cognitive effect profile of the treatment. For many years, 2 placements, bitemporal (also referred to as "bifrontotemporal" or simply "bilateral") and right unilateral, were the principal placements in widespread clinical use. More recently, bifrontal placement has joined their ranks as a commonly used placement. In this article, we review the evidence base for the efficacy and safety of each of these electrode placements for the indication of depression, describe another novel placement, and then draw conclusions from this available evidence base, pointing out areas in need of further study.
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Quantitative electroencephalographic analysis of bifrontal versus bitemporal electrode placement in a stable maintenance electroconvulsive therapy population. J ECT 2010; 26:98-9. [PMID: 19710621 DOI: 10.1097/yct.0b013e3181b00f45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Electrode placement in electroconvulsive therapy (ECT) is one of the many variables that can influence clinical outcome. Quantitative electroencephalographic (EEG) measures of the ECT-induced seizure have been studied in an attempt to determine differences in various electrode placements. The objective of this study was to evaluate the differences in the EEG between bifrontal (BF) and bitemporal (BT) placement. METHOD Seventeen patients of maintenance ECT (10 males and 7 females) who received both BT and BF ECTs for a 12-month period starting January 2007 were identified through chart review. Patients were included if their medications, dosages and ECT parameters, and clinical condition remained stable during the study period. Each patient received both BF (n = 124) and BT (n = 112) placements. RESULTS We found no significant differences in EEG measures between the 2 placements. We demonstrated that the qualitative EEG measures in both BT and BF electrode placements are similar. CONCLUSIONS Our findings support that BF electrode placement produces similar quality seizures when compared with BT placement and may be a viable alternative placement to BT.
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Sienaert P, Vansteelandt K, Demyttenaere K, Peuskens J. Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects. J Affect Disord 2010; 122:60-7. [PMID: 19577808 DOI: 10.1016/j.jad.2009.06.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 06/10/2009] [Accepted: 06/11/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The cognitive side-effects of bifrontal (BF) and right unilateral (UL) ultra-brief pulse (0.3 ms) electroconvulsive therapy (ECT) were compared, in the treatment of patients with a depressive episode. METHOD Neuropsychological functioning in patients with a medication refractory depressive episode, that were treated with a course of BF ultra-brief ECT at 1.5 times seizure threshold (ST) or UL ultra-brief ECT at 6 times ST, by random assignment, was assessed before treatment, and 1 and 6 weeks after the treatment course, by a blinded rater. RESULTS Of the 64 patients that were included, 32 (50%) received BF ECT, and 32 (50%) received UL ECT, by random assignment. Neuropsychological testing 1 and 6 weeks after treatment was performed by 30 (93.75%) and 19 (59.37%) patients, respectively, in the BF-group and 29 (90.62%) and 20 (62.50%), respectively, in the UL-group. There was no deterioration in any of the neuropsychological measures. Patients rated their memory as clearly improved after treatment. There were no significant differences between the patients given BF ECT and those given UL ECT. CONCLUSIONS Ultrabrief pulse ECT, used either in combination with a UL electrode position and a stimulus of 6 times ST, or a BF electrode position with a stimulus of 1.5 times ST, are effective antidepressant techniques, that do not have a deleterious effect on cognitive function.
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Affiliation(s)
- P Sienaert
- ECT Department, University Psychiatric Center, Catholic University of Leuven, campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
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Moreines JL, McClintock SM, Holtzheimer PE. Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: a review. Brain Stimul 2010; 4:17-27. [PMID: 21255751 DOI: 10.1016/j.brs.2010.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/07/2009] [Accepted: 01/14/2010] [Indexed: 12/15/2022] Open
Abstract
Electroconvulsive therapy (ECT) and ablative neurosurgical procedures are established interventions for treatment-resistant depression (TRD), but their use may be limited in part by neuropsychological adverse effects. Additional neuromodulation strategies are being developed that aim to match or exceed the efficacy of ECT/ablative surgery with a better neurocognitive side effect profile. In this review, we briefly discuss the neurocognitive effects of ECT and ablative neurosurgical procedures, then synthesize the available neurocognitive information for emerging neuromodulation therapies, including repetitive transcranial magnetic stimulation, magnetic seizure therapy, transcranial direct current stimulation, vagus nerve stimulation, and deep brain stimulation. The available evidence suggests these procedures may be more cognitively benign relative to ECT or ablative neurosurgical procedures, though further research is clearly needed to fully evaluate the neurocognitive effects, both positive and negative, of these novel neuromodulation interventions.
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Antunes PB, Rosa MA, Belmonte-de-Abreu PS, Lobato MIR, Fleck MP. Eletroconvulsoterapia na depressão maior: aspectos atuais. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31 Suppl 1:S26-33. [DOI: 10.1590/s1516-44462009000500005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: A eficácia da eletroconvulsoterapia em tratar sintomas depressivos está estabelecida por meio de inúmeros estudos desenvolvidos durante as últimas décadas. A eletroconvulsoterapia é o tratamento biológico mais efetivo para depressão atualmente disponível. O objetivo deste estudo foi demonstrar o papel da eletroconvulsoterapia no tratamento da depressão e destacar aspectos atuais relativos à sua prática. MÉTODO: Foram revisados na literatura estudos de eficácia, remissão de sintomas, fatores preditores de resposta, assim como aspectos atuais acerca da qualidade de vida, percepção dos pacientes, mecanismo de ação, técnica e prejuízo cognitivos. RESULTADOS: Os principais achados desta revisão foram: 1) a eletroconvulsoterapia é mais efetiva do que qualquer medicação antidepressiva; 2) a remissão da depressão com a eletroconvulsoterapia varia, em geral, de 50 a 80%; 3) Ainda é controverso o efeito da eletroconvulsoterapia nos níveis de fator neurotrófico derivado do cérebro (acho que aqui pode colocar entre parenteses o "BNDF"); 4) a eletroconvulsoterapia tem efeito positivo na melhora da qualidade de vida; 5) os pacientes submetidos à eletroconvulsoterapia, em geral, têm uma percepção positiva do tratamento. CONCLUSÃO: A eletroconvulsoterapia permanece sendo um tratamento altamente eficaz em pacientes com depressão resistente. Com o avanço da sua técnica, a eletroconvulsoterapia tornou-se um procedimento ainda mais seguro e útil tanto para a fase aguda, quanto para a prevenção de novos episódios depressivos.
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