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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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Laroy M, Bouckaert F, Ousdal OT, Dols A, Rhebergen D, van Exel E, van Wingen G, van Waarde J, Verdijk J, Kessler U, Bartsch H, Jorgensen MB, Paulson OB, Nordanskog P, Prudic J, Sienaert P, Vandenbulcke M, Oltedal L, Emsell L. Characterization of gray matter volume changes from one week to 6 months after termination of electroconvulsive therapy in depressed patients. Brain Stimul 2024; 17:876-886. [PMID: 39059711 DOI: 10.1016/j.brs.2024.07.015] [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: 04/09/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Increased gray matter volume (GMV) following electroconvulsive therapy (ECT) has been well-documented, with limited studies reporting a subsequent decrease in GMV afterwards. OBJECTIVE This study characterized the reversion pattern of GMV after ECT and its association with clinical depression outcome, using multi-site triple time-point data from the Global ECT-MRI Research Collaboration (GEMRIC). METHODS 86 subjects from the GEMRIC database were included, and GMV in 84 regions-of-interest (ROI) was obtained from automatic segmentation of T1 MRI images at three timepoints: pre-ECT (T0), within one-week post-ECT (T1), and one to six months post-ECT (T2). RM-ANOVAs were used to assess longitudinal changes and LMM analyses explored associations between GMV changes and demographical and clinical characteristics. RESULTS 63 of the 84 ROIs showed a significant increase-and-decrease pattern (RM-ANOVA, Bonferroni corrected p < 0.00059). Post hoc tests indicated a consistent pattern in each of these 63 ROIs: significant increase from T0 to T1inGMV, followed by significant decrease from T1 to T2 and no difference between T0 and T2, except for both amygdalae, right hippocampus and pars triangularis, which showed the same increase and decrease but GMV at T2 remained higher compared to T0. No consistent relationship was found between GMV change pattern and clinical status. CONCLUSION The GEMRIC cohort confirmed a rapid increase of GMV after ECT followed by reversion of GMV one to six months thereafter. The lack of association between the GMV change pattern and depression outcome scores implies a transient neurobiological effect of ECT unrelated to clinical improvement.
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Affiliation(s)
- Maarten Laroy
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium.
| | - Filip Bouckaert
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, B-3000, Leuven, Belgium
| | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Annemieke Dols
- Department of Psychiatry, UMC Utrecht, Division Brain, Utrecht, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Didi Rhebergen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands; Mental Health Institute, GGZ Centraal, Amersfoort, the Netherlands
| | - Eric van Exel
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jeroen van Waarde
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands
| | - Joey Verdijk
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Martin Balslev Jorgensen
- Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Joan Prudic
- Department of Psychiatry, Columbia University Irving Medical Center, USA
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Academic Centre for ECT and Neuromodulation, B-3000, Leuven, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, B-3000, Leuven, Belgium
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Louise Emsell
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, B-3000, Leuven, Belgium; KU Leuven, Leuven Brain Institute, Department of Imaging and Pathology, Translational MRI, B-3000, Leuven, Belgium
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3
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Kellner CH. JAMA Patient Page on Perinatal Depression: No Mention of ECT. J ECT 2024:00124509-990000000-00192. [PMID: 39024195 DOI: 10.1097/yct.0000000000001055] [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: 07/20/2024]
Affiliation(s)
- Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Abe Y, Yokoyama K, Kato T, Yagishita S, Tanaka KF, Takamiya A. Neurogenesis-independent mechanisms of MRI-detectable hippocampal volume increase following electroconvulsive stimulation. Neuropsychopharmacology 2024; 49:1236-1245. [PMID: 38195908 PMCID: PMC11224397 DOI: 10.1038/s41386-023-01791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/15/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective psychiatric treatments but the underlying mechanisms are still unclear. In vivo human magnetic resonance imaging (MRI) studies have consistently reported ECT-induced transient hippocampal volume increases, and an animal model of ECT (electroconvulsive stimulation: ECS) was shown to increase neurogenesis. However, a causal relationship between neurogenesis and MRI-detectable hippocampal volume increases following ECT has not been verified. In this study, mice were randomly allocated into four groups, each undergoing a different number of ECS sessions (e.g., 0, 3, 6, 9). T2-weighted images were acquired using 11.7-tesla MRI. A whole brain voxel-based morphometry analysis was conducted to identify any ECS-induced brain volume changes. Additionally, a histological examination with super-resolution microscopy was conducted to investigate microstructural changes in the brain regions that showed volume changes following ECS. Furthermore, parallel experiments were performed on X-ray-irradiated mice to investigate the causal relationship between neurogenesis and ECS-related volume changes. As a result, we revealed for the first time that ECS induced MRI-detectable, dose-dependent hippocampal volume increase in mice. Furthermore, increased hippocampal volumes following ECS were seen even in mice lacking neurogenesis, suggesting that neurogenesis is not required for the increase. The comprehensive histological analyses identified an increase in excitatory synaptic density in the ventral CA1 as the major contributor to the observed hippocampal volume increase following ECS. Our findings demonstrate that modification of synaptic structures rather than neurogenesis may be the underlying biological mechanism of ECT/ECS-induced hippocampal volume increase.
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Affiliation(s)
- Yoshifumi Abe
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Tokyo, Shinju-ku, 160-8582, Japan
| | - Kiichi Yokoyama
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Tokyo, Shinju-ku, 160-8582, Japan
| | - Tomonobu Kato
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Tokyo, Shinju-ku, 160-8582, Japan
| | - Sho Yagishita
- Laboratory of Structural Physiology, Center for Disease Biology and Integrative Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenji F Tanaka
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Tokyo, Shinju-ku, 160-8582, Japan
| | - Akihiro Takamiya
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan.
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Lee SH, Hyung WSW, Youn CE, Chi S, Youn H, Lee MS, Han C, Jeong HG. Trends in Electroconvulsive Therapy Utilization in South Korea: Health Insurance Review Data From 2008 to 2018. Psychiatry Investig 2024; 21:691-700. [PMID: 39089694 PMCID: PMC11298272 DOI: 10.30773/pi.2024.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE The study aimed to analyze and clinically correlate 10-year trends in the demographic characteristics of patients receiving electroconvulsive therapy (ECT) to provide an overview of ECT utilization in South Korea. METHODS Using health insurance claims data from 2008 to 2018 retrieved from Health Insurance Review and Assessment Service database in South Korea, we identified individuals undergoing ECT based on procedural codes. Descriptive analysis evaluated baseline clinical characteristics, and trend analysis used a linear regression model. RESULTS The prevalence of ECT increased by 240.49% (0.405/105 inhabitants in 2008 to 0.974/105 inhabitants in 2018). The increasing trend was more pronounced in younger and older patients. The proportion of women consistently exceeded that of men. A rise in the proportion of patients with affective disorders, and a decrease in the proportion of psychotic disorders was observed. More antidepressants and atypical antipsychotics were prescribed to patients undergoing ECT. The proportion of ECT sessions conducted in large hospital inpatient settings also decreased during the observation period. Despite increasing global trends, ECT prevalence in South Korea remains significantly lower than worldwide rates. CONCLUSION This study demonstrated an increasing trend of ECT across a wide range of population demographics and in more accessible settings. The comparatively low prevalence of ECT in Korea compared to other countries might be attributed to insufficient mental health literacy and the stigma associated with ECT. Given the elevated suicide rates in Korea, more extensive adoption of ECT appears imperative.
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Won Seok William Hyung
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chae En Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Suhyuk Chi
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
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Baroni M, Albaba D, Ngo A, Livingston RK. Atrial Fibrillation Following Electroconvulsive Therapy: A Systematic Review and Case Report. J ECT 2024:00124509-990000000-00164. [PMID: 38830193 DOI: 10.1097/yct.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is considered the gold standard treatment for many psychiatric illnesses; however, it is not without risk. There have been no systematic reviews to date on new-onset atrial fibrillation following ECT. Thus, the aim of this study is to identify reported occurrences of new-onset atrial fibrillation following ECT and the ability to safely resume ECT thereafter.A case pertaining to the development of atrial fibrillation after ECT in a young healthy male is presented. In addition, a systematic review of the literature pertaining to atrial fibrillation after ECT was conducted through PubMed, PsycInfo, and EMBASE. Of the 233 articles screened, 15 articles were selected for in-depth review. Of the 15 articles, only 10 articles met inclusion criteria. These articles included 9 case reports and 1 retrospective review. The retrospective review included 1 patient that developed atrial fibrillation out of 13 patients receiving ECT at the site. The 10 patients included varied in age, risk factors, type of ECT conducted, and treatment of the atrial fibrillation. Of the 4 articles that discussed outcomes, all patients were able to return to ECT without further complications.There are many potential reasons ECT may induce atrial fibrillation, and there are additional treatment considerations for atrial fibrillation in patients receiving ECT. Notably, our results indicate that many have been able to continue ECT without further complications; however, more research is needed to identify the frequency of this adverse reaction.
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Affiliation(s)
| | - Dania Albaba
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College Medicine, Houston, TX
| | - Alexandra Ngo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College Medicine, Houston, TX
| | - Robin K Livingston
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College Medicine, Houston, TX
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Krarup M, Kellner CH, Østergaard SD. Clinical and Legal Differences in the Use of Involuntary Electroconvulsive Therapy for Life-Threatening Illness Across European Countries. J ECT 2024; 40:105-110. [PMID: 38194602 DOI: 10.1097/yct.0000000000000984] [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: 01/11/2024]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) can be life-saving in situations where patients are at risk of dying from severe manifestations of psychiatric illness. In some of these cases, patients are unwilling/unable to consent to ECT, and involuntary ECT is required. Such use of involuntary ECT varies substantially across European countries for unclear reasons. The aim of this study was to examine clinical and legal differences in this use of involuntary ECT across European countries. METHODS A questionnaire based on a case vignette (a 55-year-old female inpatient with psychotic depression at imminent risk of dying from metabolic derangement because of refusal to eat and drink) was sent to an ECT practitioner in each of 31 European countries. RESULTS We received responses from ECT practitioners in 18 countries. In 7 of these countries, involuntary ECT could be carried out without approval from others and/or involvement of the court system in the case described in the vignette. Practitioners in the remaining 11 countries responded that they either could not carry out involuntary ECT or would have to meet certain requirements before initiating involuntary ECT (e.g., approval from medical/ethics committee and second opinion from an independent psychiatrist). Notably, the rules regarding involuntary ECT differed for adults and minors (more restrictive for the latter) in 6 of the 18 countries. CONCLUSIONS In many European countries, legislation precludes or delays the use of involuntary ECT. Harmonization of the legislation on involuntary ECT across European countries to allow for better access to this potentially life-saving treatment seems warranted.
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Affiliation(s)
- Mette Krarup
- From the Horsens Regional Psychiatric Hospital, Horsens, Denmark
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Wang X, Ren H, Zhang Z, Zhong X, Luo Q, Huang Y, Qiu H. The efficacy of electroconvulsive therapy in adolescent major depressive disorder with suicidal ideation: A propensity score-matched, retrospective cohort study. Asian J Psychiatr 2024; 95:103998. [PMID: 38493750 DOI: 10.1016/j.ajp.2024.103998] [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: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND More evidence is needed to validate the use of ECT in adolescent depression. This study aims to compare the effectiveness of electroconvulsive therapy (ECT) to conventional medication therapy for adolescents with major depression with suicidal ideation. METHODS In this retrospective cohort study, we reviewed inpatient records from the First Affiliated Hospital of Chongqing Medical University spanning December 2016 to June 2021. We focused on adolescents diagnosed with severe depression presenting with suicidal tendencies. To equalize baseline differences between patients, we used the one-to-one propensity score matching to match patients who received ECT treatment with those who did not. Multivariate regression analysis was utilized to adjust for potential confounders, and subgroup analyses and sensitivity analyses were conducted to verify the robustness of our findings. RESULTS Of the 626 patients in this study, 474 underwent ECT treatment while 152 received medication treatment, all aged between 10 and 18 years. Once matched, each group contained 143 patients. The ECT group demonstrated a significantly higher response rate and greater reductions in both Hamilton Depression Rating Scale and Hamilton Anxiety Scale scores (all P < 0.001). Additionally, the ECT group was more effective in reducing suicidal ideation, with fewer individuals retaining such ideation at discharge. In the multivariable regression analysis, both ECT treatment and shorter disease duration were independently linked to enhanced antidepressant efficacy. Subgroup analyses and sensitivity analyses verified the robustness of the main study effect. CONCLUSIONS For adolescents with major depressive disorder and suicidal ideation, combining ECT with pharmacotherapy is more effective than pharmacotherapy alone before medications reach full effect.
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Affiliation(s)
- Xinglian Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Ren
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Changshou District Third People's Hospital, Chongqing, China
| | - Zheng Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiufen Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Mental Health Center, Chongqing, China
| | - Qinghua Luo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Huang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
| | - Haitang Qiu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Baldinger-Melich P, Spies M, Bozic I, Kasper S, Rujescu D, Frey R. Perspectives in treatment-resistant depression: esketamine and electroconvulsive therapy. Wien Klin Wochenschr 2024:10.1007/s00508-024-02358-w. [PMID: 38662240 DOI: 10.1007/s00508-024-02358-w] [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: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024]
Abstract
Modern electroconvulsive therapy (ECT) and the approval of nasal esketamine for clinical use have significantly improved the approach to treatment-resistant depression (TRD), which is defined as non-response to at least two different courses of antidepressants with verified adherence to treatment, adequate dosage, and duration of treatment. The goal of this literature review is to present the newest evidence regarding efficacy and safety. Furthermore, we aim to provide an overview of future perspectives in this field of research, for example, regarding structural and molecular effects. Both treatment methods will be critically evaluated for their individual advantages, disadvantages, and response rates. Firstly, we will discuss the well-established method of ECT and its different treatment modalities. Secondly, we will discuss the properties of ketamine, the discovery of its antidepressive effects and the route to clinical approval of the esketamine nasal spray. We will comment on research settings which have evaluated intravenous ketamine against ECT. The decision-making process between esketamine nasal spray or ECT should include the assessment of contraindications, age, severity of disease, presence of psychotic symptoms, patient preference and treatment accessibility. We conclude that both treatment options are highly effective in TRD. If both are indicated, pragmatically esketamine will be chosen before ECT; however, ECT studies in ketamine non-responders are missing.
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Affiliation(s)
- Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Ina Bozic
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Siegfried Kasper
- Department of Molecular Neurosciences, Center for Brain Research, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria.
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Fusick AJ, Davis C, Gunther S, Klippel C, Sullivan G. Psychotropic Management in Cotard Syndrome: Case Reports Supporting Dual Medication Management. Case Rep Psychiatry 2024; 2024:7630713. [PMID: 38633733 PMCID: PMC11022521 DOI: 10.1155/2024/7630713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
Cotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or psychiatric etiology and can be difficult to treat. Recently Couto and Gonçalves purposed that treatment should include an atypical antipsychotic alone or in combination with either a mood stabilizer or antidepressant. Here the authors advocate for a more specific but well-known psychotropic regimen, namely the combination of olanzapine and fluoxetine. We conducted a literature review and of 246 papers identified, only three reported using a combination of fluoxetine and olanzapine with many of them having limited or confounding information that make it difficult for us to comment on the historically efficacy of this medication combination. Therefore, the authors provide two case examples of patients being treated successfully with olanzapine and fluoxetine. One, a 66-year-old male veteran and another 76-year-old male veteran. Both of these cases hold significance as the patient's psychotic depression was so severe as to warrant ECT as a possible treatment. In both cases, this medication combination was able to avoid the procedure. Overall, with the addition of our cases and the sparse information available in the literature, we propose the combination of fluoxetine and olanzapine as an effective Cotard syndrome treatment.
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Affiliation(s)
- Adam J. Fusick
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
| | - Chemar Davis
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Steven Gunther
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
| | - Cory Klippel
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
| | - Gregory Sullivan
- Mental Health and Behavioral Sciences Service, Department of Psychiatry and Behavioral Neurosciences, James A Haley Veterans Hospital, Tampa, Florida, USA
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Badinier J, Lopes R, Mastellari T, Fovet T, Williams SCR, Pruvo JP, Amad A. Clinical and neuroimaging predictors of benzodiazepine response in catatonia: A machine learning approach. J Psychiatr Res 2024; 172:300-306. [PMID: 38430659 DOI: 10.1016/j.jpsychires.2024.02.039] [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: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
Catatonia is a well characterized psychomotor syndrome combining motor, behavioural and neurovegetative signs. Benzodiazepines are the first-choice treatment, effective in 70 % of cases. Currently, the factors associated with benzodiazepine resistance remain unknown. We aimed to develop machine learning models using clinical and neuroimaging data to predict benzodiazepine response in catatonic patients. This study examined a cohort of catatonic patients who underwent standardized clinical evaluation, 3 T brain MRI, and benzodiazepine trial. Based on clinical response, patients were classified as benzodiazepine responders or non-responders. Cortical thickness and regional brain volumes were measured. Two machine learning models (linear model and gradient boosting tree model) were developed to identify predictors of treatment response using clinical, demographic, and neuroimaging data. The cohort included 65 catatonic patients, comprising 30 benzodiazepine responders and 35 non-responders. Using clinical data alone, the linear model achieved 63% precision, 51% recall, a specificity of 61%, and 58% AUC, while the gradient boosting tree (GBT) model attained 46% precision, 60% recall, a specificity of 62% and 64% AUC. Incorporating neuroimaging data improved model performance, with the linear model achieving 66% precision, 57% recall, a specificity of 67%, and 70% AUC, and the GBT model attaining 50% precision, 50% recall, a specificity of 62% and 70% AUC. The integration of imaging data with demographic and clinical information significantly enhanced the predictive performance of the models. The duration of the catatonic syndrome, along with the presence of mitgehen (passive obedience) and immobility/stupor, and the volume of the right medial orbito-frontal cortex emerged as important factors in predicting non-response to benzodiazepines.
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Affiliation(s)
- Jane Badinier
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Renaud Lopes
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Tomas Mastellari
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Steven C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jean-Pierre Pruvo
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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12
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De Marco G, Simons J, Forsberg L, Douglas T. What makes a medical intervention invasive? JOURNAL OF MEDICAL ETHICS 2024; 50:226-233. [PMID: 37722810 DOI: 10.1136/jme-2023-109301] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 09/20/2023]
Abstract
The classification of medical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, a medical intervention is invasive if and only if it involves either breaking the skin ('incision') or inserting an object into the body ('insertion'). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in relation to medical interventions-namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of an intervention can depend on the characteristics of the salient alternative interventions, and (3) that medical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account.
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Affiliation(s)
- Gabriel De Marco
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Jannieke Simons
- Julius Centre for Health Sciences and Primary Care, Department of Bioethics and Health Humanities, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lisa Forsberg
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Somerville College, University of Oxford, Oxford, UK
| | - Thomas Douglas
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Jesus College, University of Oxford, Oxford, UK
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13
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Vreijling SR, Chin Fatt CR, Williams LM, Schatzberg AF, Usherwood T, Nemeroff CB, Rush AJ, Uher R, Aitchison KJ, Köhler-Forsberg O, Rietschel M, Trivedi MH, Jha MK, Penninx BWJH, Beekman ATF, Jansen R, Lamers F. Features of immunometabolic depression as predictors of antidepressant treatment outcomes: pooled analysis of four clinical trials. Br J Psychiatry 2024; 224:89-97. [PMID: 38130122 PMCID: PMC10884825 DOI: 10.1192/bjp.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Profiling patients on a proposed 'immunometabolic depression' (IMD) dimension, described as a cluster of atypical depressive symptoms related to energy regulation and immunometabolic dysregulations, may optimise personalised treatment. AIMS To test the hypothesis that baseline IMD features predict poorer treatment outcomes with antidepressants. METHOD Data on 2551 individuals with depression across the iSPOT-D (n = 967), CO-MED (n = 665), GENDEP (n = 773) and EMBARC (n = 146) clinical trials were used. Predictors included baseline severity of atypical energy-related symptoms (AES), body mass index (BMI) and C-reactive protein levels (CRP, three trials only) separately and aggregated into an IMD index. Mixed models on the primary outcome (change in depressive symptom severity) and logistic regressions on secondary outcomes (response and remission) were conducted for the individual trial data-sets and pooled using random-effects meta-analyses. RESULTS Although AES severity and BMI did not predict changes in depressive symptom severity, higher baseline CRP predicted smaller reductions in depressive symptoms (n = 376, βpooled = 0.06, P = 0.049, 95% CI 0.0001-0.12, I2 = 3.61%); this was also found for an IMD index combining these features (n = 372, βpooled = 0.12, s.e. = 0.12, P = 0.031, 95% CI 0.01-0.22, I2= 23.91%), with a higher - but still small - effect size compared with CRP. Confining analyses to selective serotonin reuptake inhibitor users indicated larger effects of CRP (βpooled = 0.16) and the IMD index (βpooled = 0.20). Baseline IMD features, both separately and combined, did not predict response or remission. CONCLUSIONS Depressive symptoms of people with more IMD features improved less when treated with antidepressants. However, clinical relevance is limited owing to small effect sizes in inconsistent associations. Whether these patients would benefit more from treatments targeting immunometabolic pathways remains to be investigated.
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Affiliation(s)
- Sarah R. Vreijling
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Cherise R. Chin Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Alan F. Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Tim Usherwood
- Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; and George Institute for Global Health, Sydney, Australia
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, Texas, USA
| | - A. John Rush
- Department of Psychiatry and Behavioral Health, Duke School of Medicine, Durham, North Carolina, USA; and Duke-National University of Singapore, Singapore, Singapore
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katherine J. Aitchison
- Departments of Psychiatry & Medical Genetics, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada; and Women and Children's Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K. Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Rick Jansen
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
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14
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Ledesma-Corvi S, Jornet-Plaza J, Gálvez-Melero L, García-Fuster MJ. Novel rapid treatment options for adolescent depression. Pharmacol Res 2024; 201:107085. [PMID: 38309382 DOI: 10.1016/j.phrs.2024.107085] [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: 08/01/2023] [Revised: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
There is an urgent need for novel fast-acting antidepressants for adolescent treatment-resistant depression and/or suicidal risk, since the selective serotonin reuptake inhibitors that are clinically approved for that age (i.e., fluoxetine or escitalopram) take weeks to work. In this context, one of the main research lines of our group is to characterize at the preclinical level novel approaches for rapid-acting antidepressants for adolescence. The present review summarizes the potential use in adolescence of non-pharmacological options, such as neuromodulators (electroconvulsive therapy and other innovative types of brain stimulation), as well as pharmacological options, including consciousness-altering drugs (mainly ketamine but also classical psychedelics) and cannabinoids (i.e., cannabidiol), with promising fast-acting responses. Following a brief analytical explanation of adolescent depression, we present a general introduction for each therapeutical approach together with the clinical evidence supporting its potential beneficial use in adolescence (mainly extrapolated from prior successful examples for adults), to then report recent and/or ongoing preclinical studies that will aid in improving the inclusion of these therapies in the clinic, by considering potential sex-, age-, and dose-related differences, and/or other factors that might affect efficacy or long-term safety. Finally, we conclude the review by providing future avenues to maximize treatment response, including the need for more clinical studies and the importance of designing and/or testing novel treatment options that are safe and fast-acting for adolescent depression.
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Affiliation(s)
- Sandra Ledesma-Corvi
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Jordi Jornet-Plaza
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Laura Gálvez-Melero
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - M Julia García-Fuster
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Medicine, University of the Balearic Islands, Palma, Spain.
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15
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Gil-Badenes J, Giménez-Palomo A, Duque L, Pujol-Fontrodona G, Martínez-Amorós E, Bioque M. Maintenance Electroconvulsive Therapy in Catatonia: Clinical Profiles From a Case Series. J ECT 2024:00124509-990000000-00150. [PMID: 38412188 DOI: 10.1097/yct.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES This study aims to conduct a descriptive analysis of the clinical features and treatment responses in 6 patients with catatonia who received maintenance electroconvulsive therapy (ECT). METHODS Our study included all patients who underwent maintenance ECT (mECT) at the Hospital Clínic de Barcelona between September 2020 and September 2022 following a catatonic episode. RESULTS The study cohort comprised 5 patients with schizophrenia and 1 patient with major depressive disorder. Among patients with schizophrenia, the first catatonic episode occurred several years after their initial paranoid psychotic episode, whereas the patient with depression experienced a rapid progression from the first depressive episode to catatonia. After acute ECT, 4 patients achieved complete symptomatic remission, 1 patient exhibited a partial response, and another maintained a severe catatonic state. Maintenance ECT was indicated because of the high risk of severe relapses. The mean frequency of mECT sessions was 9.83 (SD, 5.60) days. Notably, 66.67% of the patients were concurrently receiving clozapine as part of their pharmacological treatment. Among patients with schizophrenia, mECT sessions could not be extended beyond 7 to 10 days, whereas the depressed patient could space ECT sessions up to 21 days without experiencing a relapse. CONCLUSIONS Maintenance ECT proves to be a safe and well-tolerated strategy for preventing relapses in severe catatonic patients who have previously stabilized with acute ECT. Further research is needed to develop clinical guidelines that define optimal application strategies for mECT in catatonia.
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Affiliation(s)
| | | | - Lucía Duque
- Psychiatry Department, Hospital Universitario Juan Ramón Jiménez, Huelva
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16
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Migchels C, Obbels J, McAllister-Williams H, Demyttenaere K, Sienaert P. Vagus Nerve Stimulation as an Alternative to Maintenance Electroconvulsive Therapy for Difficult-to-Treat Depression. J ECT 2024:00124509-990000000-00144. [PMID: 38373170 DOI: 10.1097/yct.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
ABSTRACT Vagus nerve stimulation (VNS), an implantable neurostimulator, provides a valuable long-term treatment option for patients with difficult-to-treat depression. It has been reported that previous response to electroconvulsive therapy (ECT) might predict a better response to VNS and that VNS could reduce or eliminate the need for maintenance ECT in some patients. We present the case of a patient who received a total of more than 120 sessions of ECT over the course of 13 years because of a major depressive disorder, with favorable response but without achieving full remission. After implantation of VNS, ECT was discontinued, and her depressive symptoms improved, achieving remission within 12 months. This case supports VNS as an alternative to maintenance ECT in patients with difficult-to-treat depression who have shown previous response to ECT treatment.
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Affiliation(s)
- Charlotte Migchels
- From the Department of Psychiatry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
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Toffanin T, Cattarinussi G, Ghiotto N, Lussignoli M, Pavan C, Pieri L, Schiff S, Finatti F, Romagnolo F, Folesani F, Nanni MG, Caruso R, Zerbinati L, Belvederi Murri M, Ferrara M, Pigato G, Grassi L, Sambataro F. Effects of electroconvulsive therapy on cortical thickness in depression: a systematic review. Acta Neuropsychiatr 2024:1-15. [PMID: 38343196 DOI: 10.1017/neu.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is one of the most studied and validated available treatments for severe or treatment-resistant depression. However, little is known about the neural mechanisms underlying ECT. This systematic review aims to critically review all structural magnetic resonance imaging studies investigating longitudinal cortical thickness (CT) changes after ECT in patients with unipolar or bipolar depression. METHODS We performed a search on PubMed, Medline, and Embase to identify all available studies published before April 20, 2023. A total of 10 studies were included. RESULTS The investigations showed widespread increases in CT after ECT in depressed patients, involving mainly the temporal, insular, and frontal regions. In five studies, CT increases in a non-overlapping set of brain areas correlated with the clinical efficacy of ECT. The small sample size, heterogeneity in terms of populations, comorbidities, and ECT protocols, and the lack of a control group in some investigations limit the generalisability of the results. CONCLUSIONS Our findings support the idea that ECT can increase CT in patients with unipolar and bipolar depression. It remains unclear whether these changes are related to the clinical response. Future larger studies with longer follow-up are warranted to thoroughly address the potential role of CT as a biomarker of clinical response after ECT.
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Affiliation(s)
- Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Niccolò Ghiotto
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Chiara Pavan
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Luca Pieri
- Department of Medicine, University of Padova, Padua, Italy
| | - Sami Schiff
- Department of Medicine, University of Padova, Padua, Italy
| | - Francesco Finatti
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Francesca Romagnolo
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giorgio Pigato
- Department of Psychiatry, Padova University Hospital, Padua, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
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18
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Oflezer C, Oflezer Ö, Canbek Ö, Eskil Çiçek Ö, Bahadir H. Oral Complications in Patients With Psychiatric Illness Undergoing Electroconvulsive Therapy in Istanbul, Turkey. J ECT 2024:00124509-990000000-00136. [PMID: 38227895 DOI: 10.1097/yct.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Despite advances in pharmacotherapy, electroconvulsive therapy (ECT) remains a mainstay treatment option in psychiatry. This study aims to determine the occurrence of oral injury from ECT modified with the use of an inexpensive, disposable, hand-made oral protector customized to the dental needs of the individual patient. METHOD Based on data collected between January 1, 2013, and December 31, 2018, registered patients who had received ECT were evaluated retrospectively. We investigated the incidence of oral complications such as dental fractures, dental avulsion, temporomandibular joint dislocation, jaw pain, and soft tissue, lip, and tongue injuries in a single center. RESULTS There were 1750 male patients (59.6%) and 1187 female patients (40.4%), with a mean age of 35.20 ± 11.59 years. The incidence of oral injury was 0.1% per patient (4/2937) and 0.01% per session (4/22135). Oral complication characteristics included mucosal abrasion in 2 patients, dental fracture in 1 patient, and tooth avulsion in one. No dental fracture or avulsion in our patient population has resulted in aspiration. We found no evidence of jaw pain, temporomandibular joint dislocation, or injury to the lip or tongue. CONCLUSION Our results demonstrate a minimum risk of oral complications during ECT and also provide additional justification for an adequate oral assessment by the ECT team before the procedure.
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Affiliation(s)
- Ceyhan Oflezer
- From the Department of Anesthesiology, Bakirkoy Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery
| | - Özlem Oflezer
- Department of Prosthodontics, Istanbul Provincial Health Directorate
| | - Özge Canbek
- Department of Psychiatry, Bakirkoy Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery
| | - Özlem Eskil Çiçek
- Department of Health Management, Istanbul University, Cerrahpasa Faculty
| | - Hakan Bahadir
- Department of Radiology, Private Practice, Istanbul Provincial Health Directorate, Istanbul, Turkey
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19
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Wadi L, Mandge V. Electroconvulsive therapy for catatonia in anti-NMDA receptor encephalitis: A case series. J Neuroimmunol 2024; 386:578271. [PMID: 38155066 DOI: 10.1016/j.jneuroim.2023.578271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Anti-NMDAR encephalitis is the most common cause of immune-mediated catatonia. CASE SERIES Three females presented with neuropsychiatric symptoms and were empirically treated with first-line immunotherapy and ovarian teratoma resection for suspected autoimmune encephalitis, preceding diagnostic confirmation via NMDAR antibody positivity. They required escalating large doses of benzodiazepines for refractory malignant catatonia resulting in ICU level care. ECT treatments were initiated, and patients were gradually noted to have clinical improvement as was measured by the Bush-Francis Catatonia Rating Scale. CONCLUSIONS Clinicians should recognize catatonia among patients with suspected anti-NMDAR encephalitis and consider the early implementation of ECT into treatment algorithms.
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Affiliation(s)
- Lara Wadi
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27705, United States of America.
| | - Vishal Mandge
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27705, United States of America; Duke Regional Hospital, 3643 N Roxboro St, Durham, NC 27704, United States of America.
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20
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Belge JB, van Eijndhoven P, Mulders PCR. Mechanism of Action of ECT in Depression. Curr Top Behav Neurosci 2024; 66:279-295. [PMID: 37962811 DOI: 10.1007/7854_2023_450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Electroconvulsive therapy (ECT) remains the most potent antidepressant treatment available for patients with major depressive disorder (MDD). ECT is highly effective, achieving a response rate of 70-80% and a remission rate of 50-60% even in treatment-resistant patients. The underlying mechanisms of ECT are not fully understood, although several hypotheses have been proposed, including the monoamine hypothesis, anticonvulsive hypothesis, neuroplastic effects, and immunomodulatory properties. In this paper, we provide an overview of magnetic resonance imaging evidence that addresses the neuroplastic changes that occur after ECT at the human systems level and elaborate further on ECTs potent immunomodulatory properties. Despite a growing body of evidence that suggests ECT may normalize many of the structural and functional changes in the brain associated with severe depression, there is a lack of convergence between neurobiological changes and the robust clinical effects observed in depression. This may be due to sample sizes used in ECT studies being generally small and differences in data processing and analysis pipelines. Collaborations that acquire large datasets, such as the GEMRIC consortium, can help translate ECT's clinical efficacy into a better understanding of its mechanisms of action.
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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, Wilrijk, Belgium.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
| | - Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
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21
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Verledens C, Obbels J, Van den Eynde L, Pilato E, Verspecht S, Hebbrecht K, De Schuyteneer E, Vansteelandt K, Sienaert P. Electroconvulsive therapy related anxiety in patients with depression: The influence of cognitive coping styles. Acta Psychiatr Scand 2024; 149:33-40. [PMID: 37986171 DOI: 10.1111/acps.13637] [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: 06/23/2023] [Revised: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) related anxiety (ERA) is a common phenomenon with high individual variability. The way patients cognitively cope with the prospects of receiving ECT could be a mechanism explaining individual differences in ERA. Cognitive coping like monitoring (information seeking, paying attention to consequences) and blunting (seeking distraction and reassurance) has been linked to anxiety in various medical settings, with monitoring leading to more and blunting to less anxiety. How cognitive coping is related to ERA, is unknown. METHODS The sample consisted of 71 patients with unipolar or bipolar depression referred for ECT. Cognitive coping was assessed at baseline, while ERA was measured each morning before the ECT session. Using a Linear Mixed Model, the influence of cognitive coping styles on ERA was investigated. RESULTS Blunting was associated with lower levels of ERA (p = 0.037) and monitoring tended to be associated with higher levels of ERA (p = 0.057) throughout the ECT course. Patients with a depression with psychotic features scored significantly higher on monitoring, but even after controlling for monitoring they showed a stronger decline in ERA during treatment compared to patients without psychotic features. CONCLUSION Cognitive coping style contributes to individual differences in ERA. Blunting is a protective factor, leading to lower levels of ERA throughout the ECT course. On the contrary, patients with a higher monitoring style tend to experience higher levels of ERA. Further insights in these coping mechanisms may help to tailor future treatment to individual patients and reduce ERA before and during ECT treatment.
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Affiliation(s)
- Chelsea Verledens
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Liese Van den Eynde
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Eva Pilato
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Shauni Verspecht
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Emma De Schuyteneer
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
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22
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Karl S, Sartorius A, Aksay SS. Catatonia and ECT across the lifespan. Schizophr Res 2024; 263:246-251. [PMID: 37087393 DOI: 10.1016/j.schres.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia with high response rates. Although empirical data suggest that tolerability and efficacy are at least as good as in adults, ECT treatment of children, adolescents, and geriatric patients seems to pose a specific challenge for many practitioners. This article intends to explore and discuss reasons hindering the use of ECT in these patient groups, give an overview on the use of ECT to treat catatonia and provide practical advice on ECT in children, adolescents, and geriatric patients for the treatment of catatonia. Classification of catatonia as a subform of schizophrenia and a diagnostic overlap with other common conditions in children, adolescents, and geriatric patients might lead to underdiagnosis of catatonia. Concerns about the mechanism of action and about a lack of controlled studies as well as general concerns about the use of ECT in children and adolescents might lead to underutilization of ECT. However, studies of ECT to treat catatonia in children, adolescents, and geriatric patients consistently show its safety and effectiveness. Administration of ECT needs to consider some specific characteristics of children, adolescents, and geriatric patients. In conclusion, ECT is a safe and highly effective treatment for catatonia across the lifespan. Existing evidence does not warrant restrictions of its use in certain age groups.
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Affiliation(s)
- Sebastian Karl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
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23
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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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24
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Villiger D, Trachsel M. With great power comes great vulnerability: an ethical analysis of psychedelics' therapeutic mechanisms proposed by the REBUS hypothesis. JOURNAL OF MEDICAL ETHICS 2023; 49:826-832. [PMID: 37045591 DOI: 10.1136/jme-2022-108816] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics' mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy.
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Affiliation(s)
- Daniel Villiger
- Department of Philosophy, University of Zurich, Zurich, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit of University Hospital Basel and Psychiatric University Clinics, Basel, Switzerland
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25
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Goh SE, Tan XW, Tor PC. Effect of early electroconvulsive therapy on length of stay in patients with bipolar, depressive and psychotic disorders. Schizophr Res 2023; 261:139-144. [PMID: 37722210 DOI: 10.1016/j.schres.2023.09.022] [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: 03/29/2023] [Revised: 07/21/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE There is limited literature examining the effect of early electroconvulsive therapy(ECT) on the length of stay(LOS), especially for psychotic disorders. This study aimed to evaluate the association between early ECT and LOS in three main groups of patients with bipolar, depressive and primary psychotic disorders. METHOD A retrospective descriptive analysis of 464 patients who received inpatient ECT from May 2017 to March 2021 in a large tertiary psychiatric institution was conducted. Early ECT was defined as ECT done before the mean number of days from admission to initiation of ECT by diagnosis. The main outcome measure was LOS, which was examined by diagnosis between the early and late ECT groups, using a linear regression model with adjustment factors chosen based on univariate analysis. RESULTS A strong, significant association was found between early ECT and a shorter LOS (β -28.3, 95 % CI -33.6 to -23.0, p < 0.001), even after accounting for adjustment factors. This association was consistent in all three diagnosis groups: bipolar disorders (β -14.5, 95 % CI -20.1 to -9.0, p < 0.001), major depressive disorder (β -18.2, 95 % CI -27.1 to -9.3, p < 0.001) and psychotic disorders (β -39.0, 95 % CI -46.8 to -31.2, p < 0.001). There was no significant difference in the 30-day readmission rates between the early and late ECT groups trans-diagnostically. CONCLUSION Early ECT is strongly associated with a shorter LOS across a range of diagnostic indications including major depressive disorder, bipolar disorder and schizophrenia. ECT can be considered earlier in treatment-decision algorithms and may offer a reduction in LOS.
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Affiliation(s)
- Shih Ee Goh
- Department of Mood & Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
| | - Xiao Wei Tan
- Department of Mood & Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
| | - Phern Chern Tor
- Department of Mood & Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
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26
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Gędek A, Materna M, Majewski P, Antosik AZ, Dominiak M. Electrolyte Disturbances Related to Sodium and Potassium and Electroconvulsive Therapy: A Systematic Review. J Clin Med 2023; 12:6677. [PMID: 37892815 PMCID: PMC10606982 DOI: 10.3390/jcm12206677] [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: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Electrolyte disturbances related to sodium and potassium affect patients with mental disorders undergoing electroconvulsive therapy (ECT). The objective of this study was to systematically summarize the data regarding ECT and electrolyte disturbances related to sodium and potassium. MATERIALS AND METHODS A systematic literature review in accordance with PRISMA guidelines was conducted. Clinical studies of patients receiving ECT with electrolyte disturbances reported before or after treatment were included. RESULTS We identified nine case reports and two retrospective studies describing electrolyte abnormalities occurring before or after ECT. ECT was effective and safe in patients with hyponatremia and hypernatremia, including the elderly patient population. This treatment was also effective in treating psychiatric symptoms that may persist after ionic equalization. Electrolyte disturbances after ECT were rare. Reports have suggested that succinylcholine used as a muscle relaxant was the main cause of hyperkalemia after ECT. CONCLUSIONS Electrolyte control is a crucial aspect of guiding ECT therapy. In the context of sodium-related disorders, it is critical to control patient hydration as part of therapy. In addition, succinylcholine should not be used in patients with immobilization, such as catatonia or neuroleptic malignant syndrome. It is necessary to conduct further studies to clarify whether electrolyte concentration affects ECT parameters and clinical efficacy. In addition, it is necessary to assess the influence of various anesthetics on these conditions during ECT. The result of this review should be interpreted bearing in mind the small number of studies conducted to date and the low quality of the evidence they provide.
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Affiliation(s)
- Adam Gędek
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
- Praski Hospital, Aleja Solidarności 67, 03-401 Warsaw, Poland
| | | | - Paweł Majewski
- Stefan Cardinal Wyszynski Regional Specialist Hospital, Aleja Kraśnicka 100, 20-718 Lublin, Poland
| | - Anna Z. Antosik
- Department of Psychiatry, Faculty of Medicine, Collegium Medicum, Cardinal Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland
| | - Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
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27
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Lundsgaard CC, Gbyl K, Videbech P. Blood-brain barrier permeability and electroconvulsive therapy: a systematic review. Acta Neuropsychiatr 2023:1-8. [PMID: 37842858 DOI: 10.1017/neu.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The cause of cognitive side effects after electroconvulsive therapy (ECT) is largely unknown. Alterations in the blood-brain barrier (BBB) have been considered in several recent ECT studies. We therefore found it worthwhile to perform a systematic review of the literature to examine if electrically induced seizures affect the permeability of the BBB. METHODS PubMed/MEDLINE and Embase were searched 16 November 2022. Studies with a direct measurement of BBB permeability in animals treated with modified electroconvulsive stimulation (ECS) and in humans treated with ECT were included. Synthesis of results was narrative due to the low number of studies and differences in study designs. RESULTS Four animal and two human (31 participants) studies were included. In animals, two studies found increased BBB permeability to some smaller molecules after modified ECS, while the two other studies found marginally increased or unchanged permeability to albumin after treatment. In contrast, the human studies did not find increased BBB permeability to smaller molecules or albumin after ECT. CONCLUSION Animal but not human studies support increased BBB permeability to some smaller molecules after electrically induced seizures. However, this conclusion is confined by the low number of studies and the lack of studies applying state-of-the-art methods. More studies using modern approaches to measuring of BBB permeability are warranted. FUNDING AND REGISTRATION The study was founded by Mental Health Services in the Capital Region of Denmark (grant number 61151-05) and was registered on PROSPERO before data extraction was initiated (CRD42022331385).
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Affiliation(s)
- Christoffer C Lundsgaard
- Center for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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28
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Schuurmans RGM, Krijnen de Bruin E, van Asperen GCR, Poslawsky IE, Hafsteinsdóttir TB, van Meijel B. Factors influencing motivation of patients diagnosed with depression to have electroconvulsive therapy. J Psychiatr Ment Health Nurs 2023; 30:1019-1026. [PMID: 36998159 DOI: 10.1111/jpm.12925] [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: 07/04/2022] [Revised: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The clinical effect of electroconvulsive therapy (ECT) has been confirmed for a majority of patients with several psychiatric disorders. ECT is mostly used in patients with severe depression. Choosing, persevering with and completing ECT depends on the patients' motivation for undergoing this therapy. However, the factors influencing patients' motivation for ECT have not yet been studied. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Four important factors that influence the motivation of patients diagnosed with major depression to have ECT were identified: (1) psychological pain and distress; (2) perceived need for treatment; (3) perception of ECT as an effective treatment; (4) influence of the environment. The first factor, psychological pain and distress, was perceived as the primary motivator for starting and continuing ECT. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professionals should be aware of the factors that influence patients to have electroconvulsive therapy and their own role in the decision-making process and during treatment. As patients are susceptible to emotional support and as the motivation of patients for starting and continuing ECT is positively influenced by the advice and support of mental health professionals, these professionals have a key role in motivating patients for ECT. When the patient has decided to start ECT, mental health professionals should explore the factors that influence their motivation and regularly assess these factors so that they can guide the patient in their process. The professional should have an overview of these factors and investigate how they can be positively influenced to help patients keep their motivation during the treatment process. This will contribute to person-centred care and could lead to better treatment outcomes. ABSTRACT: Introduction The factors influencing patients' motivation for undergoing electroconvulsive therapy (ECT) have not yet been subjected to a thorough study. Knowledge of these factors could improve the quality of care for patients with depression recommended to have ECT. Aim To identify the factors that influence the motivation of patients diagnosed with depression to have ECT. Method This qualitative study followed a grounded theory approach in which semi-structured interviews were conducted with 18 patients from four different psychiatric hospitals to study their perspectives on factors influencing their motivation to have ECT. Results The explanatory framework of factors influencing motivation for ECT comprises four main categories, starting with the most important category, psychological pain and distress, and continuing with the following categories: perceived need for treatment; perception of ECT as an effective treatment; environmental influences. Discussion In this study, we found that the psychological pain and distress of depression, and their consequences in daily life, had been the primary experiences that motivated patients to start and continue ECT. Implications for Practice This is the first study that has examined motivational factors for patients with severe depression to participate in ECT. Professionals appear to have a key role in motivating patients for ECT. They should explore factors that influence motivation for ECT, regularly assess their motivation and intervene on influential factors.
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Affiliation(s)
| | | | | | - Irina E Poslawsky
- Department of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Department of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (location VUmc), Amsterdam, The Netherlands
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29
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Koh AHK, Tan XW, Tor PC, Chatterton ML, Martin DM, Loo CK. The association between outpatient continuation/maintenance electroconvulsive therapy, readmission risk and total direct cost in patients with depressive, bipolar and psychotic disorders: A naturalistic retrospective cohort study. J Affect Disord 2023; 338:289-298. [PMID: 37295655 DOI: 10.1016/j.jad.2023.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The transdiagnostic effect of continuation/maintenance ECT (CM-ECT) across mood and psychotic disorders on hospital psychiatric readmission risk and total direct cost remains unclear. METHODS A naturalistic retrospective analysis of 540 patients who received inpatient acute ECT treatment from May 2017 to Mar 2021 in a tertiary psychiatric institution. Patients were assessed with validated clinical rating scales pre-ECT and after the first 6 treatments of a course of inpatient acute ECT. After discharge, patients who continued with CM-ECT were compared with those not receiving CM-ECT using survival analysis of hospital readmission. Total direct cost (hospitalisation and ECT treatment cost) was also analysed. All patients were subjected to a standard post-discharge monitoring program with case managers checking in on the patients regularly after discharge and ensuring they were given an outpatient appointment within a month of discharge. RESULTS Both cohorts had significant improvement in their rating scales scores after their first six 6 sessions of inpatient acute ECT. Patients who continued with CM-ECT after completing their inpatient acute ECT (mean number of acute ECT: N = 9.9, SD 5.3), had a significantly lower risk of readmission [adjusted hazard ratio of 0.68 (95 % CI: 0.49-0.94, p = 0.020)]. Patients who received CM-ECT also had a significantly lower average total direct cost compared to those who did not (SGD$35,259 vs SGD$61,337). For patients with mood disorders, the CM-ECT group had a significantly lower inpatient ECT cost, hospitalisation cost and total direct costs compared to those without CM-ECT. LIMITATIONS The naturalistic study cannot prove a causal relationship between CM-ECT and reduced readmission and lower healthcare costs. CONCLUSION CM-ECT is associated with lower readmission risks and lower total direct healthcare costs for the treatment of mood and psychotic disorders, especially for mood disorders.
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Affiliation(s)
- Azriel H K Koh
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore
| | - Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore
| | - Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore.
| | - Mary Lou Chatterton
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Donel M Martin
- Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, Sydney, New South Wales, Australia
| | - Colleen K Loo
- Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, Sydney, New South Wales, Australia
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30
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Permoda-Pachuta A, Malewska-Kasprzak M, Skibińska M, Rzepski K, Dmitrzak-Węglarz M. Changes in Adipokine, Resitin, and BDNF Concentrations in Treatment-Resistant Depression after Electroconvulsive Therapy. Brain Sci 2023; 13:1358. [PMID: 37891727 PMCID: PMC10605107 DOI: 10.3390/brainsci13101358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES One of the current challenges in psychiatry is the search for answers on how to effectively manage drug-resistant depression. The occurrence of drug resistance in patients is an indication for the use of electroconvulsive therapy (ECT). This method is highly effective and usually results in relatively quick health improvement. Despite the knowledge of how ECT works, not all of the biological pathways activated during its use have been identified. Hence, based on the neuroinflammatory hypothesis of depression, we investigated the concentration of two opposite-acting adipokines (anti-inflammatory adiponectin and proinflammatory resistin) and BDNF in antidepressant-resistant patients undergoing ECT. METHODS The study group comprised 52 patients hospitalized due to episodes of depression in the course of unipolar and bipolar affective disorder. The serum concentration of adipokines and BDNF was determined before and after the therapeutic intervention using an ELISA method. In the analyses, we also included comparisons considering the type of depression, sex, and achieving remission. RESULTS Adiponectin, resistin, and BDNF concentrations change after ECT treatment. These changes are correlated with an improvement in the severity of depressive symptoms and are more or less pronounced depending on the type of depression. CONCLUSIONS Although not all observed changes reach statistical significance, adipokines in particular remain exciting candidates for biomarkers in assessing the course of the disease and response to ECT treatment.
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Affiliation(s)
| | | | - Maria Skibińska
- Department of Psychiatric Genetics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Krzysztof Rzepski
- Mental Health Center at the HCP Medical Center, 61-485 Poznan, Poland
| | - Monika Dmitrzak-Węglarz
- Department of Psychiatric Genetics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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31
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Wang K, Li X, Wang X, Hommel B, Xia X, Qiu J, Fu Y, Zhou Z. In vivo analyses reveal hippocampal subfield volume reductions in adolescents with schizophrenia, but not with major depressive disorder. J Psychiatr Res 2023; 165:56-63. [PMID: 37459779 DOI: 10.1016/j.jpsychires.2023.07.012] [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: 02/28/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Adult studies have reported atypicalities in the hippocampus and subfields in patients with schizophrenia (SCZ) and major depressive disorder (MDD). Both affective and psychotic disorders typically onset in adolescence, when human brain develops rapidly and shows increased susceptibility to adverse environments. However, few in vivo studies have investigated whether hippocampus subfield abnormalities occur in adolescence and whether they differ between SCZ and MDD cases. METHODS We recruited 150 adolescents (49 SCZ patients, 67 MDD patients, and 34 healthy controls) and obtained their structural images. We used FreeSurfer to automatically segment hippocampus into 12 subfields and analyzed subfield volumetric differences between groups by analysis of covariance, covarying for age, sex, and intracranial volume. Composite measures by summing subfield volumes were further compared across groups and analyzed in relation to clinical characteristic. RESULTS SCZ adolescents showed significant volume reductions in subfields of CA1, molecular layer, subiculum, parasubiculum, dentate gyrus and CA4 than healthy controls, and almost significant reductions, as compared to the MDD group, in left molecular layer, dentate gyrus, CA2/3 and CA4. Composite analyses showed smaller volumes in SCZ group than in healthy controls in all bilateral composite measures, and reduced volumes in comparison to MDD group in all left composite measures only. CONCLUSIONS SCZ adolescents exhibited both hippocampal subfield and composite volumes reduction, and also showed greater magnitude of deviance than those diagnosed with MDD, particularly in core CA regions. These results indicate a hippocampal disease process, suggesting a potential intervention marker of early psychotic patients and risk youths.
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Affiliation(s)
- Kangcheng Wang
- School of Psychology, Shandong Normal University, Jinan, 250358, China; Shandong Mental Health Center, Shandong University, Jinan, 250014, China
| | - Xingyan Li
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Xiaotong Wang
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Bernhard Hommel
- School of Psychology, Shandong Normal University, Jinan, 250358, China
| | - Xiaodi Xia
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jiang Qiu
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Yixiao Fu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Zheyi Zhou
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China.
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32
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Kroll T, Grözinger M, Matusch A, Elmenhorst D, Novakovic A, Schneider F, Bauer A. Effects of electroconvulsive therapy on cerebral A 1 adenosine receptor availability: a PET study in patients suffering from treatment-resistant major depressive disorder. Front Psychiatry 2023; 14:1228438. [PMID: 37520217 PMCID: PMC10380952 DOI: 10.3389/fpsyt.2023.1228438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Sleep deprivation and electroconvulsive therapy (ECT) effectively ameliorate symptoms in major depressive disorder (MDD). In rodents, both are associated with an enhancement of cerebral adenosine levels, which in turn likely influence adenosinergic receptor expression. The aim of the current study was to investigate cerebral A1 adenosine receptor (A1AR) availability in patients with MDD as a potential mediating factor of antidepressant effects of ECT using [18F]CPFPX and positron emission tomography (PET). Methods Regional A1AR availability was determined before and after a series of ECT applications (mean number ± SD 10.4 ± 1.2) in 14 subjects (4 males, mean age 49.5 ± 11.8 years). Clinical outcome, measured by neuropsychological testing, and ECT parameters were correlated with changes in A1AR availability. Results ECT had a strong antidepressive effect (p < 0.01) while on average cerebral A1AR availability remained unaltered between pre-and post-ECT conditions (F = 0.65, p = 0.42, mean difference ± SD 3.93% ± 22.7%). There was no correlation between changes in clinical outcome parameters and regional A1AR availability, although individual patients showed striking bidirectional alterations of up to 30-40% in A1AR availability after ECT. Solely, for the mean seizure quality index of the applied ECTs a significant association with changes in A1AR availability was found (rs = -0.6, p = 0.02). Discussion In the present study, therapeutically effective ECT treatment did not result in coherent changes of A1AR availability after a series of ECT treatments. These findings do not exclude a potential role for cerebral A1ARs in ECT, but shift attention to rather short-termed and adaptive mechanisms during ECT-related convulsive effects.
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Affiliation(s)
- Tina Kroll
- Institute of Neuroscience and Medicine (INM-2), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Andreas Matusch
- Institute of Neuroscience and Medicine (INM-2), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - David Elmenhorst
- Institute of Neuroscience and Medicine (INM-2), Forschungszentrum Jülich GmbH, Jülich, Germany
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Ana Novakovic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Frank Schneider
- University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andreas Bauer
- Institute of Neuroscience and Medicine (INM-2), Forschungszentrum Jülich GmbH, Jülich, Germany
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Pape A, Kittel-Schneider S. [Practice of anaesthesia for electroconvulsive therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:422-435. [PMID: 37582353 DOI: 10.1055/a-1925-6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Electroconvulsive therapy (ECT) is an established therapeutic method for the treatment of severe mental disorders refractory to pharmaco- and psychotherapy. ECT is a first-line treatment option in delusional disorders, severe depression with acute suicidal tendency or life-threatening catatonia. Usually, ECT is performed as a treatment series. Under short-term anaesthesia and muscle relaxation, tonic-clonic seizures are induced using an external stimulation electrode. Convulsion can be exerted by uni- or bipolar stimulation using an electric charge up to 1000 millicoulomb (mC) with an amperage of 900 mA. Muscular relaxation is necessary to prevent injuries caused by uncontrolled movements during convulsion. During paralysis, consciousness is blocked by general anaesthesia, although ECT is associated with antegrade amnesia for seizure induction and the seizure itself. In the context of ECT, the ideal hypnotic should be characterised by rapid onset, short duration of action and negligible anticonvulsive effects (i.e., least possible impact on seizure quality and duration). As mutual awareness of psychiatric and anaesthesiologic techniques is essential for safe and effective conduction of ECT, this article presents ECT both from the psychiatrist's and the anaesthesiologist's perspective.
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de A Simoes Moreira D, Gauer LE, Teixeira G, Fonseca da Silva AC, Cavalcanti S, Quevedo J. Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis. J Affect Disord 2023; 330:227-238. [PMID: 36907464 PMCID: PMC10497186 DOI: 10.1016/j.jad.2023.02.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND ECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220). METHODS We searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform, without restrictions on publication date. SELECTION CRITERIA randomized controlled trials or cohorts comparing ketamine versus ECT in patients with TRD. RESULTS Eight studies met the inclusion criteria (of 2875 retrieved). Random-effects models comparing ketamine and ECT regarding the following outcomes were conducted: a) reduction of depressive symptoms severity through scales, g = -0.12, p = 0.68; b) response to therapy, RR = 0.89, p = 0.51; c) reported side-effects: dissociative symptoms, RR = 5.41, p = 0.06; nausea, RR = 0.73, p = 0.47; muscle pain, RR = 0.25, p = 0.02; and headache, RR = 0.39, p = 0.08. Influential & subgroup analyses were performed. LIMITATIONS Methodological issues with high risk of bias in some of the source material, reduced number of eligible studies with high in-between heterogeneity and small sample sizes. CONCLUSION Our study showed no evidence to support the superiority of ketamine over ECT for severity of depressive symptoms and response to therapy. Regarding side effects, there was a statistically significant decreased risk of muscle pain in patients treated with ketamine compared to ECT.
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Affiliation(s)
| | | | | | | | - Stefanie Cavalcanti
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA; Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Jhaveri V, Martinez R, Trippensee A, Roussos-Ross K, Brennan M, Wendling A. Airway Complications in Pregnant Patients Undergoing Electroconvulsive Therapy: A Retrospective Case-Control Study. J ECT 2023; 39:81-83. [PMID: 36095090 DOI: 10.1097/yct.0000000000000882] [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: 11/26/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an evidence-based treatment for severe depression and bipolar disorder in pregnant women. Electroconvulsive therapy involves induction of general anesthesia, muscle relaxation, and positive-pressure ventilation. Airway manipulation may lead to complications such as vocal cord injury, aspiration, inability to ventilate, and death. The purpose of this study was to determine whether there were differences in the incidence of airway complications in pregnant patients who underwent mask ventilation (MV) versus endotracheal intubation (ETI) compared with nonpregnant control subjects. METHODS We conducted a single-center retrospective chart review of all adult pregnant patients who underwent anesthesia for ECT from June 1, 2011, to June 30, 2020. Each ECT treatment delivered to a pregnant patient was matched with 2 ECT treatments delivered to a nonpregnant female control subject. Charts were queried for airway management (MV vs ETI), gestational age, and airway complications. Each ECT treatment was considered an independent event. RESULTS Seventy-six ECT treatments from 11 pregnant patients were matched with 154 ECT treatments from 13 nonpregnant patients. In pregnant patients, airway management consisted of MV in 57 of the 76 treatments: 12 of 12 in the first trimester, 33 of 44 in the second trimester, and 12 of 20 in the third trimester. All 154 ECT treatments in the control group used MV. No airway complications were experienced in pregnant or nonpregnant patients with MV or ETI. CONCLUSIONS No airway complications were observed in pregnant patients undergoing MV or ETI regardless of gestational age.
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Affiliation(s)
| | | | - Arvin Trippensee
- Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | | | - Meghan Brennan
- Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Adam Wendling
- Anesthesiology, University of Florida College of Medicine, Gainesville, FL
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De Schuyteneer E, Dewachter B, Vansteelandt K, Pilato E, Crauwels B, Lambrichts S, Verspecht S, Hebbrecht K, Obbels J, Sienaert P. Knowledge and Attitudes of First- and Final-Year Medical Students about Electroconvulsive Therapy: The Impact of Media. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01779-5. [PMID: 37058205 DOI: 10.1007/s40596-023-01779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate medical students' knowledge about and attitudes towards electroconvulsive therapy (ECT) and to assess the impact of information sources (including those within and outside the curriculum) on knowledge and attitudes by comparing first- and final-year medical students. METHODS Two hundred and ninety-five first-year and one hundred forty-nine final-year medical students of the University of Leuven (KU Leuven) in Belgium responded to an anonymous self-administered survey which consisted of questions about sociodemographic background, self-perceived knowledge about medicine, psychiatry and ECT, interest in psychiatry, experience with psychiatric disorders, information sources of ECT, and knowledge about and attitudes towards ECT. RESULTS Compared to first-year medical students, final-year students had better knowledge about and more positive attitudes towards ECT, partially explained by differences in information sources. Nevertheless, both student groups showed an average knowledge score below 50%. Whereas freshmen attributed their knowledge to movies or documentaries, senior students gained knowledge mainly at university courses, scientific journals, and attending live ECT sessions. A significant positive correlation was found between knowledge about and positive attitudes towards ECT. CONCLUSIONS The knowledge of first- and final-year medical students remains limited, potentially due to limited instruction about ECT in medical courses. The use of media as an information source predicted negative attitudes towards ECT. Therefore, the stigma and misinformation provided in the media need to be addressed in the medical curriculum.
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Affiliation(s)
| | - Bram Dewachter
- KU Leuven, University Hospital KU Leuven, Leuven, Belgium
| | | | - Eva Pilato
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Bo Crauwels
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Simon Lambrichts
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Shauni Verspecht
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium.
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Spanggård A, Rohde C, Østergaard SD. Risk factors for suicide among patients having received treatment with electroconvulsive therapy: A nationwide study of 11,780 patients. Acta Psychiatr Scand 2023; 147:333-344. [PMID: 36744379 DOI: 10.1111/acps.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/30/2022] [Accepted: 01/29/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite the putative anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide due to the severity of their underlying mental illness. We aimed to quantify this risk and to identify risk factors for suicide among patients receiving ECT. METHODS Using nationwide Danish registers, we identified all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. Firstly, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Secondly, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional hazards regression. RESULTS A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients having received ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR) = 44.48, 95%CI = 31.12-63.59). Among those having received ECT, the following characteristics were associated with suicide: Male sex (adjusted HRR (AHRR) = 2.32, 95%CI = 1.63-3.30), medium-term higher education (AHRR = 2.64, 95%CI = 1.57-4.44); long-term higher education (AHRR = 3.16, 95%CI = 1.68-5.94), history of substance use disorder (AHRR = 1.51, 95%CI = 1.01-2.26) and history of intentional self-harm/suicide attempt (AHRR = 4.18, 95%CI = 2.76-6.32). CONCLUSIONS Those who are male, have obtained medium-/long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide following ECT. These findings may guide clinical initiatives to reduce suicides.
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Affiliation(s)
- Anders Spanggård
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hsieh MH. Electroconvulsive therapy for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:69-90. [PMID: 37806717 DOI: 10.1016/bs.pbr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Electroconvulsive therapy (ECT), the oldest brain stimulation procedure in psychiatry, is associated with rapid response and remission in majority of patients with resistant, severe, and sometimes life-threatening depression. ECT has been included as an essential component in the definition of treatment-resistant depression (TRD) to display the course and diversification of TRD. On the other hand, ECT remains the treatment of choice for the most severe incapacitating forms of TRD and is a cost-effective treatment. In this chapter, we reviewed some essential studies, meta-analysis, and expert guidelines regarding ECT in TRD. ECT should not be considered as a treatment of last resort, and its administration should be considered on the basis of individual patient and illness factors. The clinical role of ECT vs other neurostimulation treatments for TRD, that is, repetitive transcranial magnetic stimulation, were also explored. Much effort has been directed toward the clinical and basic research about mechanisms of action of ECT in depression. A thorough understanding of the neurobiological effects of ECT may increase our understanding of its therapeutic effects, ultimately leading to improved patient care. We also showed that the distinct mechanisms of ECT in biological treatments of major depressive disorder (MDD) and some recent approaches to understand this most common psychiatric disorder. ECT should remain a standard part of modern psychiatric medicine. We recommend a more careful and thoughtful application of this traditional but effective technology.
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Affiliation(s)
- Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Salani D, Goldin D, Valdes B, DeSantis J. Electroconvulsive Therapy for Treatment-Resistant Depression: Dispelling the Stigma. J Psychosoc Nurs Ment Health Serv 2023:1-7. [PMID: 36853035 DOI: 10.3928/02793695-20230222-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The current article is a comprehensive overview of electroconvulsive therapy (ECT) for treatment-resistant depression (TRD), especially with suicidality and psychosis. Common misconceptions and stigma associated with ECT are discussed. Major depressive disorder, one of the most prevalent lifetime mental disorders, is often associated with significant impairments that impacts one's ability to function. Antidepressants may be efficacious in treating depression; however, approximately one third of individuals do not respond to psychotropic medications. Therefore, other treatment options, such as ECT, must be considered for those who do not respond to medications, have psychosis, or are suicidal. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Hjerrild S, Jørgensen MB, Dam OH, Tehrani E, Videbech P, Osler M. Electroconvulsive Therapy and Risk of Road Traffic Accidents: A Danish Register-Based Cohort Study. J ECT 2023; 39:10-14. [PMID: 36095094 DOI: 10.1097/yct.0000000000000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study is to examine whether electroconvulsive therapy (ECT) was associated with the subsequent risk of being involved in a road traffic accident. METHODS A cohort of all 375,435 patients older than 18 years with their first psychiatric hospital contact between 2003 and 2017 in the Danish National Patient Registry was followed for road traffic accidents until December 2018. Associations between ECT and road traffic accidents were examined using Cox regression analyses with multiple adjustments and using propensity score matching on sociodemographic and clinical variables. RESULTS A total of 8486 patients (0.2%) were treated with ECT. During the median follow-up of 5.9 years, 778 of these patients (12.5%) were involved in a road traffic accident and the unadjusted incidence of road traffic accidents was lower among these patients (incidence rate, 15.5 per 1000 patient-years; 95% confidence interval [CI], 14.5-16.7) compared with patients not treated with ECT (incidence rate, 20.0 per 1000 patient-years; 95% CI, 20.0-20.3). Electroconvulsive therapy was not associated with road traffic accidents in the Cox regression models after adjustment for all covariables (hazard ratio, 1.00; 95% CI, 0.92-1.08) or in the propensity score-matched sample (hazard ratio, 0.91; 95% CI, 0.83-1.08). The HRs did not vary materially with follow-up time or when analyses were stratified on sex, age, or type of hospital contact. CONCLUSIONS The analysis of Danish National registry data indicates that ECT is not associated with the risk of being involved in major road traffic accidents.
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Affiliation(s)
| | | | - Ole Henrik Dam
- Mental Health Center Copenhagen, Rigshospitalet, Affective Outpatient Clinic, Copenhagen
| | - Elisabeth Tehrani
- Department for Affective Disorders, Aarhus University Hospital, Aarhus
| | - Poul Videbech
- Centre for Neuropsychiatric Research, Mental Health Centre Glostrup, Institute of Clinical Medicine, University of Copenhagen
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Comparison of Efficacy and Safety of Magnetic Seizure Therapy and Electroconvulsive Therapy for Depression: A Systematic Review. J Pers Med 2023; 13:jpm13030449. [PMID: 36983629 PMCID: PMC10057006 DOI: 10.3390/jpm13030449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
Objectives: As a new physical therapeutic technique, magnetic seizure therapy (MST) has established efficacy in the treatment of depression with few cognitive side effects, and thus appears to be a potential alternative to electroconvulsive therapy (ECT). The findings of randomized controlled trials (RCTs) examining the efficacy and safety of MST versus ECT for depression are inconsistent. This systematic review of RCTs was designed with the aim of assessing the safety and efficacy of MST versus ECT for patients with depression. Methods: The WanFang, Chinese Journal Net (CNKI), EMBASE, PubMed, Cochrane Library, and PsycINFO databases were systematically searched by three independent investigators, from their inceptions to July 24, 2021. Results: In total, four RCTs (n = 86) were included and analyzed. Meta-analyses of study-defined response (risk ratio (RR) = 1.36; 95% CI = 0.78 to 2.36; p = 0.28; I2 = 0%), study-defined remission (RR = 1.17; 95% CI = 0.61 to 2.23; p = 0.64; I2 = 0%), and the improvement in depressive symptoms (standardized mean difference (SMD) = 0.21; 95% CI = −0.29 to 0.71; p = 0.42; I2 = 0%) did not present significant differences between MST and ECT. Three RCTs evaluated the cognitive effects of MST compared with ECT using different cognitive measuring tools, but with mixed findings. Only two RCTs reported adverse drug reactions (ADRs), but these lacked specific data. Only one RCT reported discontinuation due to any reason. Conclusions: This preliminary study suggests that MST appears to have a similar antidepressant effect as ECT for depression, but mixed findings on adverse cognitive effects were reported.
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Li K, Long J, Cao M, Xue R, Chen J, Cheng B, Wang J, Guo W, Deng W, Li T. Thyroid hormone optimize management in electroconvulsive therapy treatment of schizophrenia. Schizophr Res 2023; 252:10-12. [PMID: 36610220 DOI: 10.1016/j.schres.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/11/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Kun Li
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiang Long
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Minne Cao
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Rui Xue
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jianning Chen
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Wanjun Guo
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Tao Li
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Yang M, Yang Y, Liu L, Kong D, Xu M, Huang X, Luo C, Zhao G, Zhang X, Huang Y, Tu Y, Li Z. Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy. Front Psychiatry 2023; 14:1127262. [PMID: 36865072 PMCID: PMC9971594 DOI: 10.3389/fpsyt.2023.1127262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Sex differences may be presented in the clinical features or symptoms of schizophrenia patients but also affect the occurrence of hospital-acquired pneumonia (HAP). Modified electroconvulsive therapy (mECT) is a common treatment method for schizophrenia, used in combination with antipsychotics. This retrospective research explores the sex difference in HAP affecting patients with schizophrenia who have received mECT treatment during hospitalization. METHODS We included schizophrenia inpatients treated with mECT and antipsychotics between January 2015 and April 2022. Blood-related and demographic data collected on admission were analyzed. Influencing factors of HAP in male and female groups were assessed separately. RESULTS A total of 951 schizophrenia patients treated with mECT were enrolled in the study, including 375 males and 576 females, of which 62 patients experienced HAP during hospitalization. The risk period of HAP in these patients was found to be the first day after each mECT treatment and the first three sessions of mECT treatment. Statistically significant differences in the incidence of HAP were identified in male vs. female groups, with an incidence in men about 2.3 times higher than that in women (P < 0.001). Lower total cholesterol (Z = -2.147, P = 0.032) and the use of anti-parkinsonian drugs (χ2 = 17.973, P < 0.001) were found to be independent risk factors of HAP in male patients, while lower lymphocyte count (Z = -2.408, P = 0.016), hypertension (χ2 = 9.096, P = 0.003), and use of sedative-hypnotic drugs (χ2 = 13.636, P < 0.001) were identified in female patients. CONCLUSION Influencing factors of HAP in schizophrenia patients treated with mECT have gender differences. The first day after each mECT treatment and the first three sessions of mECT treatment were identified to have the greatest risk for HAP development. Therefore, it would be imperative to monitor clinical management and medications during this period according to these gender differences.
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Affiliation(s)
- Mi Yang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China.,The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Yang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Liju Liu
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Di Kong
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Min Xu
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xincheng Huang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Cheng Luo
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Guocheng Zhao
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yan Huang
- Department of Psychiatry, Chongqing Mental Health Center, Chongqing, China
| | - Yunzhong Tu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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Obbels J, Gijsbregts E, Verwijk E, Verspecht S, Lambrichts S, Vansteelandt K, Sienaert P. ECT-related anxiety during maintenance ECT: A prospective study. Acta Psychiatr Scand 2022; 146:604-612. [PMID: 36081255 DOI: 10.1111/acps.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 08/28/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Despite the established safety of electroconvulsive therapy (ECT), ECT-related anxiety (ERA) remains one of the most distressing complications of ECT. ERA is reported to diminish during an acute course of ECT, but it was never studied during maintenance ECT (M-ECT). Our aim was to study the trajectories of ERA during M-ECT and how they differ from trajectories during the acute course. METHODS Thirty-nine patients with unipolar or bipolar depression, retained for M-ECT after an acute ECT course, were included. ERA was assessed the morning before each ECT session using the ECT-related Anxiety Questionnaire (ERAQ). RESULTS ERA remained stable during M-ECT (RC = -0.05 (SE = 0.06), t(8.35) = -0.86, p = 0.42), while ERA declined significantly during the acute course (RC = -0.85 (SE = 0.30), t(33.6) = -2.81, p = 0.0082). During the acute course, patients with a psychotic depression were more anxious at baseline (t(32)= -2.42, p = 0.02), and showed a significant decline in ERAQ scores (RC = -1.65 (SE = 0.46), t(31.6) = -3.56, p = 0.0012), whereas patients with a non-psychotic depression were less anxious at baseline and retained stable ERAQ scores during the acute course (RC = -0.06 (SE = 0.41), t(32.1) = -0.14, p = 0.89). Whereas a correlation (r = 0.48) was noticed between the decline of depression severity and ERA during the acute course, this was not the case during M-ECT. CONCLUSION ERA runs a stable course during M-ECT, after having decreased during the acute course. During the acute course, ERA trajectories differed significantly between patients with a psychotic and non-psychotic depression. Decline of depression severity and ERA are significantly connected during the acute course of ECT. Both depression severity and ERA remain stable during M-ECT.
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Affiliation(s)
- Jasmien Obbels
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Els Gijsbregts
- Department of Psychiatry, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Esmée Verwijk
- Department of Medical Psychology, Neuropsychology Department, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands.,Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Shauni Verspecht
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Simon Lambrichts
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Kristof Vansteelandt
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
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45
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Qureshi H, Jain L. Late to respond, but early to relapse - An abnormal course of electroconvulsive therapy in treatment-resistant schizophrenia during times of COVID-19. PSYCHIATRY RESEARCH CASE REPORTS 2022; 1:100052. [PMID: 36188755 PMCID: PMC9511015 DOI: 10.1016/j.psycr.2022.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Haris Qureshi
- Department of Psychiatry, UConn School of Medicine, Farmington, CT, United States
| | - Lakshit Jain
- Department of Psychiatry, UConn School of Medicine, Farmington, CT, United States
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46
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Pedersen MI, Salagre E, Kellner CH, Rohde C, Østergaard SD. The use of electroconvulsive therapy (ECT) en bloc in Denmark: a nationwide register-based study. Nord J Psychiatry 2022:1-7. [PMID: 36344233 DOI: 10.1080/08039488.2022.2142279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) en bloc is defined as ECT administered on 2-3 consecutive days. In Denmark, ECT en bloc is recommended for severe conditions such as catatonia, treatment-resistant mania/psychosis, or imminent risk of suicide. To our knowledge, there are no recent reports on the use of ECT en bloc in clinical practice. Here, we provide such a report. METHODS We characterized the use of ECT en bloc in the period from 2006-2019 based on data from Danish national registers. Furthermore, we compared mortality rates between patients receiving ECT en bloc and patients receiving standard regimen ECT (not en bloc). RESULTS We identified 2173 patients who received a total of 2734 ECT en bloc treatment courses in Denmark in the period from 2006 to 2019 (6% of the total number of ECT treatment courses). The use of ECT en bloc was stable over the study period (range: 138-196 patients per year). The most common treatment indications were unipolar depression (41%), psychotic disorder (23%), and bipolar disorder (20%). The vast majority (90%) received ECT en bloc voluntarily. The 1-year mortality rate ratio for ECT en bloc compared to standard regimen ECT was 1.42 (95%CI: 1.03-1.95). CONCLUSION The use of ECT en bloc in Denmark is stable both in terms of the number of patients treated and treatment indications. In keeping with ECT en bloc being used for severe conditions, those receiving this treatment have a higher mortality rate compared to those receiving standard ECT, warranting careful monitoring during follow-up.
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Affiliation(s)
- Marie I Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Estela Salagre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Rohde
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Søren D Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
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47
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Gbyl K, Lindberg U, Wiberg Larsson HB, Rostrup E, Videbech P. Cerebral perfusion is related to antidepressant effect and cognitive side effects of Electroconvulsive Therapy. Brain Stimul 2022; 15:1486-1494. [PMID: 36332891 DOI: 10.1016/j.brs.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The mechanisms underlying the antidepressant effect and cognitive side effects of Electroconvulsive Therapy (ECT) remain elusive. The measurement of cerebral perfusion provides an insight into brain physiology. OBJECTIVE We investigated ECT-related perfusion changes in depressed patients and tested whether these changes correlate with clinical effects. METHODS A sample of 22 in-patients was examined at three time points: 1) within two days before, 2) within one week after, and 3) six months after an ECT series. Cerebral perfusion was quantified using arterial spin labeling magnetic resonance imaging. The primary regions of interest were the bilateral dorsolateral prefrontal cortices (DL-PFC) and hippocampi. The depression severity was assessed by the six-item Hamilton Depression Rating Scale, and cognitive performance by the Screen for Cognitive Impairment in Psychiatry. A linear mixed model and partial correlation were used for statistical analyses. RESULTS Following an ECT series, perfusion decreased in the right (-6.0%, p = .01) and left DL-PFC (-5.6%, p = .001). Perfusion increased in the left hippocampus (4.8%, p = .03), while on the right side the increase was insignificant (2.3%, p = .23). A larger perfusion reduction in the right DL-PFC correlated with a better antidepressant effect, and a larger perfusion increase in the right hippocampus with worse cognitive impairment. CONCLUSION ECT-induced attenuation of prefrontal activity may be related to clinical improvement, whereas a hippocampal process triggered by the treatment is likely associated with cognitive side effects.
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Affiliation(s)
- Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research (CNDR), Mental Health Center Glostrup, Glostrup, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ulrich Lindberg
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Bo Wiberg Larsson
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research (CNDR), Mental Health Center Glostrup, Glostrup, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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48
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Waite S, Tor PC, Mohan T, Davidson D, Hussain S, Dong V, Loo CK, Martin DM. The utility of the Sydney Melancholia Prototype Index (SMPI) for predicting response to electroconvulsive therapy in depression: A CARE Network study. J Psychiatr Res 2022; 155:180-185. [PMID: 36054966 DOI: 10.1016/j.jpsychires.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
An enhanced understanding of clinical predictors of positive ECT outcome could assist with the decision to prescribe ECT for select patients. Reliable predictors of ECT response such as psychotic symptoms and age have been identified, however, studies of melancholia and ECT response have been inconsistent. The Sydney Melancholia Prototype Index (SMPI) is a clinical measure designed to differentiate melancholic and non-melancholic depression. This study aimed to investigate whether melancholic depression (as measured by the clinician rated version of the SMPI) predicted a better response to ECT than non-melancholic depression. The study included data collated from four participating sites in the Clinical Alliance for ECT and Related treatments (CARE) network. The primary outcome was response (>50% improvement) on the Montgomery Asberg Depression Rating Scale (MADRS) and the secondary outcome was raw change in MADRS score. Of the 329 depressed patients included in the study, 81% had melancholic features and 76% met criteria for clinical response. SMPI defined melancholia was associated with older age, higher pre-treatment mood scores and presence of psychosis. Melancholia as defined by the SMPI, however, did not significantly predict either clinical response or overall mood improvement with ECT in multivariate analyses. Instead, older age, greater pre-treatment depression severity and the use of bifrontal compared to right unilateral ultrabrief ECT were significant predictors of mood improvement. Path analysis showed that higher pre-treatment mood score and older age were independently associated with mood improvement with ECT.
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Affiliation(s)
- S Waite
- The Queen Elizabeth Hospital, South Australia, Australia
| | - P C Tor
- Institute of Mental Health, Singapore
| | - T Mohan
- Flinders Medical Centre, South Australia, Australia
| | - D Davidson
- Flinders Medical Centre, South Australia, Australia
| | - S Hussain
- Sir Charles Gairdner Hospital, North Metro Health Service, Western Australia, Australia; Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Australia; Section of ECT and Neurostimulation, Royal Australian and New Zealand College of Psychiatrists, Australia
| | - V Dong
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - C K Loo
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - D M Martin
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
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49
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Lu Y, Tian Y, Gan Y, Fu Y, Chen Q, Zou L, Zhao B, Yan Y, Liu S, Chen X, Li X. The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study. Brain Sci 2022; 12:brainsci12101393. [PMID: 36291326 PMCID: PMC9599128 DOI: 10.3390/brainsci12101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bipolar disorder). The side effect was assessed by TESS. Significant differences were shown in the reduced scores of the CGI-S between patients who underwent ECT and those who did not (p = 0.001), while, at the same time, there was no significant difference in their TESS score (p = 0.297). The current study found that ECT is an effective and tolerable therapy for psychiatric patients with arachnoid cysts.
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Affiliation(s)
- Ying Lu
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Tian
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Gan
- Department of Psychiatry, Chongqing Eleventh People’s, Chongqing 400038, China
| | - Yixiao Fu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bangshu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu Yan
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shudong Liu
- Department of Clinical Psychology II, Chongqing Mental Health Center, Chongqing 400030, China
| | - Xiaolu Chen
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400015, China
- Correspondence: (X.C.); (X.L.)
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Correspondence: (X.C.); (X.L.)
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50
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Schurgers G, Walter S, Pishva E, Guloksuz S, Peerbooms O, Incio LR, Arts BMG, Kenis G, Rutten BPF. Longitudinal alterations in mRNA expression of the BDNF neurotrophin signaling cascade in blood correlate with changes in depression scores in patients undergoing electroconvulsive therapy. Eur Neuropsychopharmacol 2022; 63:60-70. [PMID: 36067540 DOI: 10.1016/j.euroneuro.2022.07.183] [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: 02/09/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/26/2022]
Abstract
Electroconvulsive therapy (ECT) appears to be the most effective treatment for severe depression. However, its mechanisms of action are incompletely understood. Evidence suggests ECT enhances neuroplasticity and neurogenesis. While studies on ECT-induced neuroplasticity focused on brain-derived neurotrophic factor (BDNF), other factors of the BDNF/TrkB signaling cascade remain underinvestigated. We assessed longitudinal changes in depression scores, serum BDNF protein levels, and mRNA expression of BDNF/TrkB related genes (BDNF, AKT1, ERK1, CREB), NR3C1 and IGF1 in peripheral blood in 19 treatment-resistant depressed patients undergoing ECT. We also analysed DNA methylation patterns at various timepoints to explore possible epigenetic regulation of mRNA expression. Using multilevel regression, we found a negative association between depression scores and blood-based mRNA expression of BDNF/TrkB related genes and NR3C1. Expression of BDNF, ERK1 and NR3C1 increased significantly over time (BDNF: β = 0.0295, p = 0.003; ERK1: β = 0.0170, p = 0.034; NR3C1: β = 0.0035, p = 0.050). For these three genes changes in mRNA expression were highly correlated (R = 0.59 - 0.88) with changes in DNA methylation for multiple CpG sites in the respective genes. Also, serum BDNF protein levels increased across the study period (β = 0.11, p = 0.001). Our findings show that the antidepressant effects of ECT are associated with changes in expression of BDNF and its signaling molecules and that these molecular markers can be detected in peripheral blood. Alterations in DNA methylation could be a key mechanism whereby ECT influences gene expression.
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Affiliation(s)
- Geert Schurgers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Sharon Walter
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Ehsan Pishva
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands; University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Odette Peerbooms
- Mutsaersstichting, Pediatric Mental Health Care, Venlo, the Netherlands
| | - Laura Rodriguez Incio
- Psychiatry Outpatient Clinic, Tarragona, Spain; University Hospital Institut Pere Mata, Reus, Spain; University of Rovira i Virgili, Tarragona, Spain
| | - Baer M G Arts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands
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