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Qubad M, Dupont G, Hahn M, Martin SS, Puntmann V, Nagel E, Reif A, Bittner RA. When, Why and How to Re-challenge Clozapine in Schizophrenia Following Myocarditis. CNS Drugs 2024; 38:671-696. [PMID: 38951464 PMCID: PMC11316720 DOI: 10.1007/s40263-024-01100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
Clozapine-induced myocarditis (CIM) is among the most important adverse events limiting the use of clozapine as the most effective treatment for schizophrenia. CIM necessitates the immediate termination of clozapine, often resulting in its permanent discontinuation with considerable detrimental effects on patients' psychopathology and long-term outcome. Consequently, a clozapine re-challenge after CIM is increasingly regarded as a viable alternative, with published reports indicating a success rate of approximately 60%. However, published cases of re-challenges after CIM remain limited. Here, we provide a narrative review of the current state of research regarding the epidemiology, pathophysiology, risk factors, diagnosis and clinical management of CIM as well as a synthesis of current recommendations for re-challenging patients after CIM. This includes a step-by-step guide for this crucial procedure based on the current evidence regarding the pathophysiology and risk factors for CIM. Slow dose titration regimes and addressing risk factors including concomitant valproate and olanzapine are crucial both to prevent CIM and to ensure a safe and successful re-challenge. Furthermore, we discuss the utility of C-reactive protein, troponin, N-terminal-pro hormone and brain natriuretic peptide, therapeutic drug-monitoring and cardiac magnetic resonance imaging for CIM screening and diagnosis as well as for post-CIM re-challenges.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
| | - Gabriele Dupont
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Martina Hahn
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, Germany
| | - Simon S Martin
- Department of Radiology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Valentina Puntmann
- Department of Cardiology, Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Eike Nagel
- Department of Cardiology, Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Robert A Bittner
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
- Ernst Strüngmann Institute for Neuroscience (ESI) in Cooperation with Max Planck Society, Frankfurt, Germany.
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Iliuta FP, Manea M, Mares AM, Varlam CI, Lacau RM, Stefanescu A, Ciobanu CA, Ciobanu AM, Manea MC. Understanding the Patient Landscape: A Ten-Year Retrospective Examination of Electroconvulsive Therapy in Romania's Largest Psychiatric Hospital. Biomedicines 2024; 12:1028. [PMID: 38790990 PMCID: PMC11117559 DOI: 10.3390/biomedicines12051028] [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: 04/11/2024] [Revised: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
The aim of this analysis was to investigate the socio-demographic and clinical profile, the effectiveness, and the association of pharmacological treatment in patients who underwent electroconvulsive therapy during the last 10 years in the largest psychiatric hospital in Romania. This study includes 249 patients aged between 18 and 73 years old. Recurrent depression was the most frequent diagnosis for which ECT was performed (T = 96, 38.55%), followed by schizophrenia (T = 72, 28.91%). The most frequent indication for ECT was treatment resistance (T = 154, 61.84%), followed by persistent suicidal ideation (T = 54, 21.68%) and catatonia (T = 42, 16.86%). In 111 (44.60%) cases included in this study, re-hospitalization was required after performing ECT, while 138 (55.40%) participants did not require any further hospital readmissions. Significant differences were found between these groups in terms of socio-demographic data, diagnosis, number of ECT sessions performed, and association of psychotropic medication during and after the procedure, therefore two separate patient profiles were found based on these characteristics. Patients necessitating re-hospitalization post-ECT were mainly males aged 25-44 diagnosed with schizophrenia and underwent a greater number of ECT sessions (7-12), whereas those not requiring re-hospitalization were predominantly females aged 45-64 with recurrent depressive disorder for which 4-6 ECT sessions were performed.
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Affiliation(s)
- Floris Petru Iliuta
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
- Department of Psychiatry and Psychology, Discipline of Psychiatry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Mirela Manea
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
- Department of Psychiatry and Psychology, Discipline of Psychiatry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Aliss Madalina Mares
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
- Department of Psychiatry and Psychology, Discipline of Psychiatry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Corina Ioana Varlam
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
| | - Radu Mihail Lacau
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
| | - Andreea Stefanescu
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
| | | | - Adela Magdalena Ciobanu
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
- Neurosciences Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihnea Costin Manea
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (F.P.I.)
- Department of Psychiatry and Psychology, Discipline of Psychiatry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 010221 Bucharest, Romania
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George R, Krishnan V, Talbot D, Elhindi J, Mayur P, Harris A. Examining the clinical effectiveness of continuation and maintenance electroconvulsive therapy in schizophrenia. Asian J Psychiatr 2024; 92:103895. [PMID: 38157717 DOI: 10.1016/j.ajp.2023.103895] [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: 09/05/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE There are few studies that examine the effectiveness of Continuation/Maintenance Electroconvulsive Therapy (C/M-ECT) in schizophrenia, despite the documented effectiveness of acute ECT treatment. We aimed to investigate the clinical effectiveness of C/M-ECT for in-patients with Schizophrenia in a naturalistic setting. We examined the medical records of 46 in-patients who were diagnosed with Schizophrenia and had received C/M-ECT belonging to non-acute extended care service in a public psychiatry hospital in Sydney, Australia. The focus of analysis was on 138 treatment cycles (71 acute only cycles and 67 acute-continuation/maintenance cycles) across 45 subjects. A linear mixed effects model was used to describe the change in clinical global impression-severity (CGI-S) over time 4 time points viz., pre-post acute and pre-post continuation/maintenance ECT. RESULTS Acute-only cycles and acute-continuation/maintenance cycles had identical pre- (M = 5, C.I. = 4-6), post-cycle CGI-S scores, and identical CGI-S difference scores (M = 0, C.I. = -1 - 1). Broadly in each continuation/maintenance cycle, we observed an initial sharp decrease in CGI-S scores followed by a logarithmic increase in scores over time, with satisfactory CGI-S score maintenance observed for approximately 6 months. Bitemporal ECT influenced CGI-S across maintenance ECT (p < 0.05) indicating smaller declines in CGI-S scores over time. CONCLUSION In schizophrenia, C/M ECT preserves effects on illness severity for at least upto 6 months following an acute course of ECT. Bitemporal ECT vis a vis other electrode positions differentiated clinical severity over time.
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Affiliation(s)
- Rachna George
- Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | - Vijay Krishnan
- Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | | | - James Elhindi
- University of Sydney, Australia; Western Sydney Local Health District, Westmead, NSW 2145, Australia; Statistician
| | - Prashanth Mayur
- University of Sydney, Australia; Western Sydney Local Health District, Westmead, NSW 2145, Australia.
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Caroff SN, Ungvari GS, Gazdag G. Treatment of schizophrenia with catatonic symptoms: A narrative review. Schizophr Res 2024; 263:265-274. [PMID: 36404216 DOI: 10.1016/j.schres.2022.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
Catatonia is a neuropsychiatric syndrome consisting of psychomotor abnormalities caused by a broad range of disorders affecting brain function. While the nosological status of catatonia is no longer restricted to a subtype of schizophrenia in standardized diagnostic systems, the character, course, and clinical significance of catatonia in people with schizophrenia remain unclear. Evidence suggests that catatonia could be a nonspecific state-related phenomenon, a fundamental core symptom dimension of schizophrenia, or a subcortical variant of schizophrenia. Either way, the validity of catatonia in schizophrenia is clinically significant only insofar as it predicts prognosis and response to treatment. Most contemporary clinical trials of antipsychotics have targeted schizophrenia as an overly broad unitary psychosis neglecting any differential response defined by phenomenology or course. However, early naturalistic studies showed that catatonia predicted poor response to first-generation antipsychotics in chronic schizophrenia and case reports cautioned against the risk of triggering neuroleptic malignant syndrome. More recent studies suggest that second-generation antipsychotics, particularly clozapine, may be effective in schizophrenia with catatonic symptoms, while small randomized controlled trials have found that the short-term response to ECT may be faster and more significant. Based on available data, conclusions are limited as to whether antipsychotics are as effective and safe in acute and chronic schizophrenia with catatonic symptoms compared to other treatments and compared to schizophrenia without catatonia. Further studies of the pathophysiology, phenomenology, course and predictive value of catatonia in schizophrenia are worthwhile.
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Affiliation(s)
- Stanley N Caroff
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center and the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, Australia; Section of Psychiatry, University of Notre Dame, Fremantle, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest, Hungary; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Dynamic impedance is correlated with static impedance and seizure quality parameters in bifrontal electroconvulsive therapy. Acta Neuropsychiatr 2023; 35:177-185. [PMID: 36803888 DOI: 10.1017/neu.2023.10] [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: 02/23/2023]
Abstract
BACKGROUND To evoke a therapeutically effective seizure, electrical stimulation in electroconvulsive therapy (ECT) has to overcome the combined resistivity of scalp, skull and other tissues. Static impedances are measured prior to stimulation using high-frequency electrical alternating pulses, dynamic impedances during passage of the stimulation current. Static impedance can partially be influenced by skin preparation techniques. Earlier studies showed a correlation between dynamic and static impedance in bitemporal and right unilateral ECT. OBJECTIVE This study aims at assessing the correlation of dynamic and static impedance with patient characteristics and seizure quality criteria in bifrontal ECT. METHODS We performed a cross-sectional single-centre retrospective analysis of ECT treatments at the Psychiatric University Hospital Zurich between May 2012 and March 2020 and used linear mixed-effects regression models in 78 patients with a total of 1757 ECT sessions. RESULTS Dynamic and static impedance were strongly correlated. Dynamic impedance was significantly correlated with age and higher in women. Energy set and factors positively (caffeine) and negatively (propofol) affecting seizure at the neuronal level were not associated with dynamic impedance. For secondary outcomes, dynamic impedance was significantly related to Maximum Sustained Power and Average Seizure Energy Index. Other seizure quality criteria showed no significant correlation with dynamic impedance. CONCLUSION Aiming for low static impedance might reduce dynamic impedance, which is correlated with positive seizure quality parameters. Therefore, good skin preparation to achieve low static impedance is recommended.
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Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022; 7:212. [PMID: 37953926 PMCID: PMC10636350 DOI: 10.12688/wellcomeopenres.18028.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/14/2023] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24 th May 2021.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Vanteemar S. Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Chandramouli Roy
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Uppinkudru Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kiran Basawaraj Bagali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Sudhir Venkataramaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Gopala Krishna Kadarapura Nanjundaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
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Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24th May 2021.
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Sugita K, Mori Y, Kanemoto K, Sugita S. Long-lasting leukocytosis in patients with schizophrenia treated with clozapine after electroconvulsive therapy : ECT stabilizes white blood cell count. Sci Prog 2022; 105:368504221117067. [PMID: 36000301 PMCID: PMC10358617 DOI: 10.1177/00368504221117067] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The present study was conducted to investigate the possible hematologic impact of long-term electroconvulsive therapy (ECT) in patients with drug-resistant schizophrenia and receiving clozapine therapy. SUBJECTS AND METHODS In this retrospective study, clinical charts of 57 hospitalized patients with schizophrenia who required clozapine therapy because of active psychotic symptoms resistant to other antipsychotics were examined. For 18 who underwent ECT, the first assessment was conducted at the end of that therapy (average two months after start, 7.68 sessions) and the second two months later. As for the 39 patients who did not undergo ECT, the first and second assessment points were at two and four months, respectively, after a randomly chosen time point. RESULTS Multiple regression analysis revealed that modified ECT (m-ECT) (ß = 0.346, p = 0.005), gender (males showed greater increase) (ß = 0.273, p = 0.023), and disease duration (longer associated with greater increase) (ß = 0.258, p = 0.033) were correlated with a change in white blood cell (WBC) count (ΔR2 = 0.277, p < 0.001) at the first assessment point. At the second assessment point, multiple regression analysis showed that m-ECT (ß = 0.262, p = 0.039), gender (males showed greater increase) (ß = 0.264, p = 0.036), and disease duration (longer associated with greater increase) (ß = 0.234, p = 0.068) were again correlated with changed WBC count (ΔR2 = 0.203, p < 0.007). DISCUSSION An increase in leukocytes may have a protective influence against the adverse myelosuppressive effects of clozapine. However, a simple mobilization of leukocytes from bone marrow to peripheral circulation may not enhance the immune system, leading to only a masking of the effects of a potential immuno-insufficient state in the treated patient. In either case, should leukocytosis be induced and then remain for an extended period, hematologists, as well as psychiatrists involved in electroconvulsive intervention for clozapine-treated patients, must keep this factor in mind.
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Affiliation(s)
- Kotaro Sugita
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
| | - Yasuhiro Mori
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
| | - Kousuke Kanemoto
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
| | - Sotaro Sugita
- Department of Neruro-Psychiatry, Achi Medical University, Nagakute city, Aichi, Japan
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Jo YT, Lee J, Joo YH. Fever as a Side Effect after Electroconvulsive Therapy. Neuropsychobiology 2022; 81:19-27. [PMID: 34233323 DOI: 10.1159/000511542] [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: 03/17/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most important and safe nonpharmacological treatment for psychiatric disorders. Some patients experience unexplained fever after ECT, but only a few studies have reported on this. METHOD We investigated fever after ECT by retrospectively reviewing the medical records of patients. Patients treated at the ECT unit of the Department of Psychiatry at Asan Medical Center, Seoul, South Korea, between 30 June 2004 and 30 June 2019, were included. Differences in variables were compared between groups with or without fever after ECT sessions. RESULT There were 28 patients (8.8%) in the fever group. Forty-three ECT sessions (1.5%) resulted in fever after treatment. The female-to-male ratio was higher in the fever group than in the control group, and the mean number of total ECT sessions was also higher in the fever group than in the control group, but there were no other differences between the 2 groups. CONCLUSION Comparing fever and control sessions, fever sessions relatively preceded control sessions and had a longer seizure duration. Postictal delirium occurred more often in the fever sessions than in control sessions. Fever sessions had a higher white blood cell count and lower concomitant quetiapine dosage than control sessions. Because 8.8% of patients who received ECT experienced fever after treatment more than once, fever after ECT is considered to be a common side effect.
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Affiliation(s)
- Young Tak Jo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Ho Joo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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de Mangoux GC, Amad A, Quilès C, Schürhoff F, Pignon B. History of ECT in Schizophrenia: From Discovery to Current Use. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac053. [PMID: 39144764 PMCID: PMC11205978 DOI: 10.1093/schizbullopen/sgac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Eighty years ago, schizophrenia was the first indication for electroconulsive therapy (ECT), and likewise ECT was one of the first treatments used for schizophrenia. This paper presents the history of ECT in the treatment of schizophrenia and its evolution, from it's discovery in the 20th century, which is an example of empiricism with a sequence of "shock" therapies. Following this discovery, the use ECT in schizophrenia has been in expansion during several decades, in a context of lack of efficacy of the treatment in schizophrenia. Then, after World War II and the derivative use of ECT in Germany, the use of ECT has decline during several decades. However, in the last decades, the use of ECT in schizophrenia has reemerged. Indeed, among patients in schizophrenia, rates of resistance to treatment have always been and still are high. In 2017, the concept of "ultra-treatment resistant schizophrenia" was defined when clozapine was tried and failed; and ECT, that had been long since abandoned in the treatment of schizophrenia until recent renewed interest, has emerged especially concerning the add-on of ECT to clozapine. However, ECT remains highly stigmatized and underutilized. This article looks at the history of the practice of ECT in schizophrenia with a historical and clinical approach and makes connections between the history of the treatment and its influence on its current recommendation and practice.
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Affiliation(s)
- Gonzague Corbin de Mangoux
- GHU Paris psychiatrie et neurosciences, Site Sainte-Anne, Service de psychiatrie adultes 17 and 18, Pôle 16, Université de Paris, 1 Rue Cabanis, 75014 Paris, France
| | - Ali Amad
- University of Lille, Inserm, CHU Lille, U1172, LilNcog, Lille Neuroscience and Cognition, F-59000 Lille, France
- Fédération régionale de recherche en psychiatrie et santé mentale, Hauts-de-France, France
| | - Clélia Quilès
- Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, TeamPharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Franck Schürhoff
- University Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Créteil, France
| | - Baptiste Pignon
- University Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Créteil, France
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Lappin JM, Davies K, O'Donnell M, Walpola IC. Underuse of recommended treatments among people living with treatment-resistant psychosis. Front Psychiatry 2022; 13:987468. [PMID: 36147973 PMCID: PMC9485552 DOI: 10.3389/fpsyt.2022.987468] [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: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND International guidelines recommend that individuals with treatment-resistant psychosis must be treated with clozapine. ECT has also been reported to improve symptom profiles. Identification of clozapine and/or ECT use in real-world practice enables understanding of the extent to which this evidence-base is implemented. SETTING Statewide public health tertiary referral service, the Tertiary Referral Service for Psychosis (TRSP), NSW, Australia. OBJECTIVES To (i) describe clinical characteristics of individuals with treatment-resistant psychosis and to detail the proportion who had received a trial of clozapine or ECT at any point during their illness course; (ii) describe the characteristics of the treatment trials in both those currently on clozapine and those previously on clozapine; (iii) document reasons in relevant individuals why clozapine had never been used. METHODS All TRSP clients who met the criteria for treatment resistance (TR) were included. A detailed casenote review was conducted to examine whether clozapine and/or ECT had ever been prescribed. Characteristics of clozapine and ECT trials were documented. Tertiary service treatment recommendations are described. FINDINGS Thirty-six of 48 individuals had TR. They had marked clinical and functional impairment. A minority were currently receiving clozapine (n = 14/36). Most had received a clozapine trial at some point (n = 32/36). Most experienced persistent clinical symptoms while on clozapine (n = 29/32). Clozapine plasma levels were very rarely reported (4/32). Augmentation and antipsychotic polypharmacy were common among those currently on clozapine. The median clozapine trial duration was 4.0 (IQR: 3.0-20.3) months in individuals previously prescribed clozapine. Reasons for clozapine discontinuation included intolerable side effects (n = 10/18) and poor adherence (n = 7/18). One-quarter of TR individuals had trialed ECT (n = 9/36). Tertiary service recommendations included routine plasma monitoring to optimize dose among people currently on clozapine; clozapine retrial in those previously treated; and clozapine initiation for those who had never received clozapine. ECT was recommended to augment clozapine and as an alternative where clozapine trial/retrial was not feasible. CONCLUSION Among people with TR referred to a tertiary service, clozapine and ECT were underutilized. Clozapine trials are typically terminated without an adequate trial. Strategies to optimize the use of clozapine therapy and ECT in clinical settings are needed to increase the therapeutic effectiveness of evidence-based therapies for treatment-resistant psychosis.
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Affiliation(s)
- Julia M Lappin
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
| | - Kimberley Davies
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
| | - Maryanne O'Donnell
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
| | - Ishan C Walpola
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
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12
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Stippl A, Kirkgöze FN, Bajbouj M, Grimm S. Differential Effects of Electroconvulsive Therapy in the Treatment of Major Depressive Disorder. Neuropsychobiology 2021; 79:408-416. [PMID: 32344410 DOI: 10.1159/000505553] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS/METHODS Electroconvulsive therapy (ECT) is still one of the most potent treatments in the acute phase of major depressive disorder (MDD) and particularly applied in patients considered treatment resistant. However, despite the frequent and widespread use of ECT for >70 years, the exact neurobiological mechanisms underlying its efficacy remain unclear. The present review aims to describe differential antidepressant and cognitive effects of ECT as well as effects on markers of neural activity and connectivity, neurochemistry, and inflammation that might underlie the treatment response and remission. RESULTS Region- specific changes in brain function and volume along with changes in concentrations of neurotransmitters and neuroinflammatory cytokines might serve as potential biomarkers for ECT outcomes. CONCLUSIONS However, as current data is not consistent, future longitudinal investigations should combine modalities such as MRI, MR spectroscopy, and peripheral physiological measures to gain a deeper insight into interconnected time- and modality-specific changes in response to ECT.
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Affiliation(s)
- Anna Stippl
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Fatma Nur Kirkgöze
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Simone Grimm
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany, .,MSB Medical School Berlin, Berlin, Germany, .,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Psychiatric Hospital, Zurich, Switzerland,
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13
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Sackeim HA. Staging and Combining Brain Stimulation Interventions: Vagus Nerve Stimulation and Electroconvulsive Therapy. J ECT 2021; 37:80-83. [PMID: 34029304 DOI: 10.1097/yct.0000000000000745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Harold A Sackeim
- From the Departments of Psychiatry and Radiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
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14
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Black Parker C, McCall WV, Spearman-McCarthy EV, Rosenquist P, Cortese N. Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups. Psychiatr Serv 2021; 72:684-690. [PMID: 33730880 DOI: 10.1176/appi.ps.202000142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients from racial-ethnic minority groups undergo disparate electroconvulsive therapy (ECT) treatment compared with Caucasian peers. One leading hypothesis is that clinicians may unknowingly display racial bias when considering ECT for patients of color. Studies have consistently shown that patients of color face numerous racially driven, provider-level interpersonal and perceptual biases that contribute to clinicians incorrectly overdiagnosing them as having a psychotic-spectrum illness rather than correctly diagnosing a severe affective disorder. A patient's diagnosis marks the entry to evidence-based service delivery, and ECT is best indicated for severe affective disorders rather than for psychotic disorders. As a consequence of racially influenced clinician misdiagnosis, patients from racial-ethnic minority groups are underrepresented among those given severe affective diagnoses, which are most indicated for ECT referral. Evidence also suggests that clinicians may use racially biased treatment rationales when considering ECT after they have given a diagnosis of a severe affective or psychotic disorder, thereby producing secondary inequities in ECT referral. Increasing the use of gold-standard treatment algorithms when considering ECT for patients of color is contingent on clinicians transcending the limitations posed by aversive racism to develop culturally unbiased, clinically indicated diagnostic and treatment rationales.
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Affiliation(s)
- Carmen Black Parker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - William V McCall
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - E Vanessa Spearman-McCarthy
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - Peter Rosenquist
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - Niayesh Cortese
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
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15
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Maruyama S, Boku S, Okazaki S, Kikuyama H, Mizoguchi Y, Monji A, Otsuka I, Sora I, Kanazawa T, Hishimoto A, Yoneda H. ATP and repetitive electric stimulation increases leukemia inhibitory factor expression in astrocytes: A potential role for astrocytes in the action mechanism of electroconvulsive therapy. Psychiatry Clin Neurosci 2020; 74:311-317. [PMID: 32022358 DOI: 10.1111/pcn.12986] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
AIM Electroconvulsive therapy (ECT) is effective for psychiatric disorders. However, its action mechanism remains unclear. We previously reported that transcription factor 7 (TCF7) was increased in patients successfully treated with ECT. TCF7 regulates Wnt pathway, which regulates adult hippocampal neurogenesis. Adult hippocampal neurogenesis is involved in the pathophysiology of psychiatric disorders. Astrocytes play a role in adult hippocampal neurogenesis via neurogenic factors. Of astrocyte-derived neurogenic factors, leukemia inhibitory factor (LIF) and fibroblast growth factor 2 (FGF2) activate Wnt pathway. In addition, adenosine triphosphate (ATP), released from excited neurons, activates astrocytes. Therefore, we hypothesized that ECT might increase LIF and/or FGF2 in astrocytes. To test this, we investigated the effects of ATP and electric stimulation (ES) on LIF and FGF2 expressions in astrocytes. METHODS Astrocytes were derived from neonatal mouse forebrain and administered ATP and ES. The mRNA expression was estimated with quantitative reverse-transcription polymerase chain reaction. Protein concentration was measured with ELISA. RESULTS ATP increased LIF, but not FGF2, expression. Multiple ES, but not single, increased LIF expression. Knockdown of P2X2 receptor (P2X2R) attenuated ATP-induced increase of LIF mRNA expression. In contrast, P2X3 and P2X4 receptors intensified it. CONCLUSION P2X2R may mediate ATP-induced LIF expression in astrocytes and multiple ES directly increases LIF expression in astrocytes. Therefore, both ATP/P2X2R and multiple ES-induced increases of LIF expression in astrocytes might mediate the efficacy of ECT on psychiatric disorders. Elucidating detailed mechanisms of ATP/P2X2R and multiple ES-induced LIF expression is expected to result in the identification of new therapeutic targets for psychiatric disorders.
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Affiliation(s)
| | - Shuken Boku
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Okazaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Kikuyama
- Department of Psychiatry, Osaka Medical College, Takatsuki, Japan
| | - Yoshito Mizoguchi
- Department of Psychiatry, Saga University Faculty of Medicine, Saga, Japan
| | - Akira Monji
- Department of Psychiatry, Saga University Faculty of Medicine, Saga, Japan
| | - Ikuo Otsuka
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiro Sora
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsufumi Kanazawa
- Department of Psychiatry, Osaka Medical College, Takatsuki, Japan.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Yoneda
- Department of Psychiatry, Osaka Medical College, Takatsuki, Japan
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16
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Janjua AU, Dhingra AL, Greenberg R, McDonald WM. The Efficacy and Safety of Concomitant Psychotropic Medication and Electroconvulsive Therapy (ECT). CNS Drugs 2020; 34:509-520. [PMID: 32342484 DOI: 10.1007/s40263-020-00729-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders. Patients referred to ECT are often taking multiple medications, many of which can potentially affect the safety and efficacy of their course of ECT. This review evaluates the impact of a variety of psychotropic medications often used in conjunction with ECT and examines strategies to optimize their management. The review encompasses mood stabilizers, antidepressants, benzodiazepines, antiepileptics, antipsychotics, and other commonly used psychotropics.
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Affiliation(s)
- A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA.
| | - Amitha L Dhingra
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA
| | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA
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17
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Kumagaya DY. Acute electroconvulsive therapy in the elderly with schizophrenia and schizoaffective disorder: A case series. Asia Pac Psychiatry 2019; 11:e12361. [PMID: 31106956 DOI: 10.1111/appy.12361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/26/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION There is a paucity of evidence regarding the use of electroconvulsive therapy (ECT) in the elderly with primary psychotic conditions, such as schizophrenia and schizoaffective disorder. This study examined the efficacy and safety of acute ECT treatment in late-life patients with primary psychotic conditions. METHODS A retrospective chart review was conducted on all patients aged 60 and above, who received ECT within a large metropolitan psychiatric facility in Australia between 2012 and 2018, and who were diagnosed with a primary psychotic condition. Information regarding demographic data, illness correlates, ECT treatment, treatment outcomes, and adverse effects was collected. RESULTS A total of 20 patients met inclusion into the study, 35% of whom were diagnosed with schizophrenia and 65% with schizoaffective disorder. The average age was 69 years. Patients had been trialed on an average of seven distinct antipsychotic agents prior to acute ECT treatment; 50% had been trialed on clozapine. ECT was associated with full (60%) or partial remission (35%) of psychotic illness in 95% (n = 19) of patients. No ECT-related fatalities were encountered. Adverse effects were experienced in 20% of patients, although none precluded the continuation of treatment. DISCUSSION This study found ECT to be a highly effective and safe treatment in the elderly with schizophrenia and schizoaffective disorder, who had not responded adequately to psychotropic medications.
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18
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Clinical outcome after discontinuation of maintenance Electroconvulsive Therapy. A retrospective follow-up study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 13:5-10. [PMID: 31473181 DOI: 10.1016/j.rpsm.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse.
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19
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Abstract
Electroconvulsive therapy (ECT) was initially used for the treatment of schizophrenia, but over the years with the advent of antipsychotics, its use in schizophrenia has been limited. Treatment guidelines vary in their recommendations for the use of ECT in schizophrenia. The usual indications of its use among patients with schizophrenia include treatment resistance, to augment pharmacotherapy, to manage catatonia, suicidal behaviour, severe agitation and clozapine-resistant schizophrenia. Available literature, including meta-analysis and systematic reviews, suggest that ECT is a safe and effective treatment in patients with schizophrenia. However, despite the available evidence, it is highly underutilised and is often used as one of the last resort among patients with schizophrenia. This review focuses on the indications of use of ECT in schizophrenia, studies evaluating its effectiveness, efficacy in certain special situations like first episode schizophrenia, adolescents, catatonia etc., predictors of response to ECT in schizophrenia and influence of various ECT-related parameters on efficacy/effectiveness among patients with schizophrenia. From the review, it can be concluded that ECT is not only is beneficial as an augmenting strategy in treatment-resistant schizophrenia but also can be used effectively in patients with schizophrenia in various other situations.
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20
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Ivanov MV, Zubov DS. [Electroconvulsive therapy in treatment of resistant schizophrenia: biological markers of efficacy and safety]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:92-97. [PMID: 31089103 DOI: 10.17116/jnevro201911903192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To evaluate clinical and biological efficacy and safety of electroconvulsive therapy (ECT) in patients with treatment-resistant paranoid schizophrenia. MATERIAL AND METHODS Determination of CNS specific biological markers (BDNF, NSE, S100B), together with markers of inflammation and CNS alteration (IL-2, CPK, CPK-MB), and clinical evaluation were performed in two groups of patients: the ECT + antipsychotic treatment group (n=66) and the antipsychotic treatment group (n=32). RESULTS AND CONCLUSION In the ECT + antipsychotic treatment group, the more pronounced reduction of psychotic symptoms has been revealed compared with subjects on antipsychotic treatment as monotherapy. Patients receiving ECT showed no increase in plasma levels of inflammation and CNS alteration biomarkers (NSE, S100B, CPK, CPK-MB, IL-2). The plasma level of BDNF, capable to characterize both the efficacy and safety of antipsychotic therapy, had a more pronounced upward trend in subjects with combined electroconvulsive and antipsychotic treatment, which may indicate good tolerability and high effectiveness of ECT.
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Affiliation(s)
- M V Ivanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, St.-Petersburg, Russia
| | - D S Zubov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, St.-Petersburg, Russia
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21
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Kanahara N, Hirabayashi M, Mamada T, Nishimoto M, Iyo M. Combination therapy of electroconvulsive therapy and aripiprazole for dopamine supersensitivity psychosis. Schizophr Res 2018; 202:398-400. [PMID: 29937327 DOI: 10.1016/j.schres.2018.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
| | - Makihiko Hirabayashi
- Department of Psychiatry, Shinwa-kai Yachiyo Hospital, 549 Shimotakano, Yachiyo City, Chiba 276-0021, Japan
| | - Takashi Mamada
- Department of Psychiatry, Seiwa-kai Asai Hospital, 38-1 Ietoku, Togane City, Chiba 283-8650, Japan
| | - Masahiko Nishimoto
- Department of Psychiatry, Aokisuejiroukinen-kai Sousyu Hospital, 1682-3 Kamiogino, Atsugi City, Kanagawa 243-0201, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan
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22
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Ungvari GS, Gerevich J, Takács R, Gazdag G. Schizophrenia with prominent catatonic features: A selective review. Schizophr Res 2018; 200:77-84. [PMID: 28818505 DOI: 10.1016/j.schres.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
Abstract
A widely accepted consensus holds that a variety of motor symptoms subsumed under the term 'catatonia' have been an integral part of the symptomatology of schizophrenia since 1896, when Kraepelin proposed the concept of dementia praecox (schizophrenia). Until recently, psychiatric classifications included catatonic schizophrenia mainly through tradition, without compelling evidence of its validity as a schizophrenia subtype. This selective review briefly summarizes the history, psychopathology, demographic and epidemiological data, and treatment options for schizophrenia with prominent catatonic features. Although most catatonic signs and symptoms are easy to observe and measure, the lack of conceptual clarity of catatonia and consensus about the threshold and criteria for its diagnosis have hampered our understanding of how catatonia contributes to the pathophysiology of schizophrenic psychoses. Diverse study samples and methodologies have further hindered research on schizophrenia with prominent catatonic features. A focus on the motor aspects of broadly defined schizophrenia using modern methods of detecting and quantifying catatonic signs and symptoms coupled with sophisticated neuroimaging techniques offers a new approach to research in this long-overlooked field.
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Affiliation(s)
- Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre, 200 Cambridge Street, Perth 6014, Australia
| | - Jozsef Gerevich
- Addiction Research Institute, Remete u 12, Budapest, Hungary.
| | - Rozália Takács
- Psychiatric Outpatient Service, Toth Ilona Medical Service, Csiko setany 9, 1214 Budapest, Hungary; School of Doctoral Studies, Semmelweis University, Ulloi ut 85, 1085 Budapest, Hungary
| | - Gábor Gazdag
- 1st Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc Hospital, Koves ut 1, 1204 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa u 6, Budapest, Hungary.
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Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is effective in the treatment of severe psychiatric disorders. Electroconvulsive therapy is applied to almost 1 million patients every year around the world. The aim of this study was to monitor the use of ECT in psychiatric facilities for adults in the Czech Republic (CR) in 2014 and to describe the national practice. METHODS A 14-item questionnaire was sent to all Czech inpatient psychiatric facilities that provide ECT, with the aim of getting a detailed picture of the use of ECT in the CR. The questionnaire assessed the technical background for using ECT in each center, along with indications for the treatment, the procedure, and the manner of documenting and monitoring adverse effects. The data obtained were supplemented with information about national legal and ethical regulations as well as historical background. RESULTS Electroconvulsive therapy is used in 26 centers across the CR. More than 1000 patients were treated with ECT in 2014. All centers use instruments delivering brief pulse stimuli, monitoring electroencephalogram and electrocardiogram. All patients have to be indicated for this treatment, which is a decision the patient's psychiatrist makes. All patients have to sign an informed consent form, excluding a situation where the patient's life is endangered. Somatic state is assessed in all patients. Bitemporal electrode placement is the preferred option in all centers. CONCLUSIONS This article covers detailed information about the use of ECT in the CR. The results will be used to harmonize national practice and reduce the stigma associated with this method in the CR.
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Ipekcioglu D, Yazar MS, Canbek O, Yuksel O, Meterelliyoz KS, Ilnem MC. Electroconvulsive therapy combined with antipsychotic therapy in the treatment of acute schizophrenia inpatients: symptom profile of the clinical response. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1446729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Derya Ipekcioglu
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Menekse Sıla Yazar
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ozge Canbek
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ozge Yuksel
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | | | - Mehmet Cem Ilnem
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Abstract
OBJECTIVE Little is known about electroconvulsive therapy (ECT) use in the treatment of schizophrenia in China. This study examined the frequency of ECT use, its trend between 2006 and 2012, and its independent demographic and clinical correlates in a nationwide survey in China. METHODS A total of 5162 inpatients in 45 Chinese psychiatric hospitals/centers were interviewed (2696 in 2006 and 2466 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. RESULTS Electroconvulsive therapy was used in 6.1% of the whole sample; 4.7% in 2006 and 7.7% in 2012 (P < 0.001) with wide interprovince variations. Multiple logistic regression analyses of the whole sample revealed that patients receiving ECT were more likely to be women, receive second-generation antipsychotics, treated in tertiary referral centers (level III hospitals), had a shorter illness duration, and more positive and depressive symptoms (R = 0.181; P < 0.001). CONCLUSIONS Electroconvulsive therapy for schizophrenia has increased between 2006 and 2012 in China. Its percentage was higher than the figures reported in most other countries. Reasons for the substantial variations in the frequency of ECT across different provinces in China require further investigations.
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Thomann PA, Wolf RC, Nolte HM, Hirjak D, Hofer S, Seidl U, Depping MS, Stieltjes B, Maier-Hein K, Sambataro F, Wüstenberg T. Neuromodulation in response to electroconvulsive therapy in schizophrenia and major depression. Brain Stimul 2017; 10:637-644. [DOI: 10.1016/j.brs.2017.01.578] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 01/18/2023] Open
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Abstract
ECT is the oldest and most effective therapy available for the treatment of severe major depression. It is highly effective in individuals with treatment resistance and when a rapid response is required. However, ECT is associated with memory impairment that is the most concerning side-effect of the treatment, substantially contributing to the controversy and stigmatization surrounding this highly effective treatment. There is overwhelming evidence for the efficacy and safety of an acute course of ECT for the treatment of a severe major depressive episode, as reflected by the recent FDA advisory panel recommendation to reclassify ECT devices from Class III to the lower risk category Class II. However, its application for other indications remains controversial, despite strong evidence to the contrary. This article reviews the indication of ECT for major depression, as well as for other conditions, including catatonia, mania, and acute episodes of schizophrenia. This study also reviews the growing evidence supporting the use of maintenance ECT to prevent relapse after an acute successful course of treatment. Although ECT is administered uncommonly to patients under the age of 18, the evidence supporting its use is also reviewed in this patient population. Finally, memory loss associated with ECT and efforts at more effectively monitoring and reducing it are reviewed.
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Affiliation(s)
- Richard D Weiner
- a Department of Psychiatry and Behavioral Sciences , Duke University School of Medicine , Durham , NC , USA
| | - Irving M Reti
- b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Effectiveness of electroconvulsive therapy in patients with treatment resistant schizophrenia: A retrospective study. Psychiatry Res 2017; 249:349-353. [PMID: 28152470 DOI: 10.1016/j.psychres.2017.01.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 11/05/2016] [Accepted: 01/17/2017] [Indexed: 02/08/2023]
Abstract
This study aimed to evaluate the effectiveness of electroconvulsive therapy (ECT) among patients with treatment resistant schizophrenia (TRS). Records of patients who had received ECT were reviewed to identify patients with TRS who were administered ECT in combination with clozapine. Socio-demographic, clinical data and ECT details were extracted. The most common diagnosis was of paranoid schizophrenia (49%) followed by undifferentiated schizophrenia (36%). A-fifth (22%) of the patients were judged to have poor response to clozapine. The mean number of ECTs given were 13.97 (SD-7.67) and mean clozapine dose was 287.5mgs/day (SD-100.1). About two-thirds (63%) of the patients showed >30% reduction in scores on different symptom-rating scales with combined use of clozapine and ECT. Among clozapine non-responders, approximately 69% responded to the combination. Post-ECT rise in blood pressure was the most common side effect (16.9%) followed by prolonged seizures (7%). Long-term follow-up data was available for 47 out of the 59 patients. More than two-third (N=34; 72%) followed-up for an average of 30 months (SD 32.3; range: 1-120), maintained well with continued clozapine treatment. To conclude, results of this study further endorse the effectiveness, safety and long-term benefits of the clozapine-ECT combination in TRS and clozapine-refractory schizophrenia.
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González-Valderrama A, Castañeda CP, Mena C, Undurraga J, Mondaca P, Yañez M, Bedregal P, Nachar R. Duration of untreated psychosis and acute remission of negative symptoms in a South American first-episode psychosis cohort. Early Interv Psychiatry 2017; 11:77-82. [PMID: 26256570 DOI: 10.1111/eip.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022]
Abstract
AIM To determine the association between duration of untreated psychosis (DUP) and symptoms remission in a hospitalized first-episode psychosis cohort. METHODS Inpatients with a first-episode non-affective psychosis were recruited. Subjects were divided into two groups of long and short DUP using a 3-month cut-off point, and this was related to remission at 10 weeks of treatment. Multivariate analyses were performed. RESULTS Fifty-five inpatients were included. There were no differences in remission rates of positive symptoms. Up to 76.5% of the patients with a short DUP (<3 months) achieved remission of negative symptoms versus 31.6% in the DUP ≥ 3 months group (P = 0.003). After controlling for relevant factors, patients with a shorter DUP were still three times more likely to achieve negative symptoms remission (HR: 3.04, 95% CI 1.2-7.5). CONCLUSIONS DUP is a prognostic factor that should be considered at an early stage to identify a 'high risk' subgroup of persistent negative symptoms.
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Affiliation(s)
- Alfonso González-Valderrama
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile.,Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile
| | - Carmen Paz Castañeda
- Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile
| | - Cristián Mena
- Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile
| | - Juan Undurraga
- Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile.,Department of Psychiatry, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Pilar Mondaca
- Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile
| | - Matías Yañez
- Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile
| | - Paula Bedregal
- Departamento de Salud Publica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ruben Nachar
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile.,Early Intervention in Psychosis Program, Instituto Psiquiátrico 'Dr José Horwitz Barak', Santiago, Chile
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Abstract
The aim was to evaluate the clinical profile and effectiveness of ECT in women. A retrospective chart review was carried out to identify female patients who had received ECT during the period September 2013-February 2015. Details regarding their sociodemographic, clinical, and treatment data were extracted from these records for the present study. The total number of patients, admitted to our psychiatry inpatient clinic during the survey period, was 802. During this period, 26 (3.24 %) female patients received ECT. Patients who received ECT were mostly in age group of 25-44 years (76.9 %). Twenty percent of patients were in the postpartum period. Psychotic disorders (46.1 %) was the most common diagnosis for which ECT was used, followed by bipolar affective disorder, current episode manic (19.2 %). At the end of ECT courses, 70 % of the patients showed good response with a CGI-I of 1 or 2, and 30 % showed minimal response with a CGI-I score of 3. The most common side effects were post-ECT confusion (15.4 %) and prolonged seizure (11.5 %). This rate of prolonged seizure was higher the rates reported in the literature. The bronchospasm related with remifentanil, post-ECT bradycardia, hypertensive crisis and oligohydramnios were also reported in one case each. ECT is a safe and effective treatment option in women with severe psychiatric disorders and disorders in the perinatal/postpartum period are a major area of ECT use. The female gender may be a contributing factor for the higher rates of prolonged seizure.
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Arumugham SS, Thirthalli J, Andrade C. Efficacy and safety of combining clozapine with electrical or magnetic brain stimulation in treatment-refractory schizophrenia. Expert Rev Clin Pharmacol 2016; 9:1245-52. [DOI: 10.1080/17512433.2016.1200971] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is currently regarded as a significant treatment option for intractable psychiatric disorders, such as catatonic schizophrenia or treatment-resistant depression; however, the underlying molecular mechanism for its therapeutic effect remains obscure. METHODS Employing microarray analysis (Human Genome U133 Plus 2.0 Array; Affymetrix, United States) of cDNA derived from the peripheral blood of patients with catatonic schizophrenia (n = 5), we detected a significant change in 145 genes (0.68%) before and after modified ECT (mECT). Moreover, we performed quantitative polymerase chain reaction validation of genes that had previously been suggested to be functionally related to schizophrenia. RESULTS Of 4 genes examined (AKT3, TCF7, PPP3R1, and GADD45B), only TCF7 was increased during the mECT procedure (P = 0.0025). DISCUSSION This study describes the first attempt to uncover the molecular mechanism of mECT using a microarray assay of mRNA derived from peripheral blood, and our results suggest that the TCF family may play a role in the functional mechanism of mECT.
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Hoirisch-Clapauch S, Nardi AE. Improvement of Psychotic Symptoms and the Role of Tissue Plasminogen Activator. Int J Mol Sci 2015; 16:27550-60. [PMID: 26593907 PMCID: PMC4661911 DOI: 10.3390/ijms161126053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 01/17/2023] Open
Abstract
Tissue plasminogen activator (tPA) mediates a number of processes that are pivotal for synaptogenesis and remodeling of synapses, including proteolysis of the brain extracellular matrix, degradation of adhesion molecules, activation of neurotrophins, and activation of the N-methyl-d-aspartate receptor. Abnormalities in these processes have been consistently described in psychotic disorders. In this paper, we review the physiological roles of tPA, focusing on conditions characterized by low tPA activity, which are prevalent in schizophrenia. We then describe how tPA activity is influenced by lifestyle interventions and nutritional supplements that may ameliorate psychotic symptoms. Next, we analyze the role of tPA in the mechanism of action of hormones and medications effective in mitigating psychotic symptoms, such as pregnenolone, estrogen, oxytocin, dopamine D3 receptor antagonists, retinoic acid, valproic acid, cannabidiol, sodium nitroprusside, N-acetyl cysteine, and warfarin. We also review evidence that tPA participates in the mechanism by which electroconvulsive therapy and cigarette smoking may reduce psychotic symptoms.
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Affiliation(s)
- Silvia Hoirisch-Clapauch
- Department of Hematology, Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro CEP 20221-903, Brazil.
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, and National Institute for Translational Medicine, INCT-TM CEP 22290-140, Brazil.
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Nishiguchi M, Kikuyama H, Kanazawa T, Tsutsumi A, Kaneko T, Uenishi H, Kawabata Y, Kawashige S, Koh J, Yoneda H. Increases in iPS Transcription Factor (Oct4, Sox2, c-Myc, and Klf4) Gene Expression after Modified Electroconvulsive Therapy. Psychiatry Investig 2015; 12:532-7. [PMID: 26508965 PMCID: PMC4620311 DOI: 10.4306/pi.2015.12.4.532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/27/2014] [Accepted: 01/27/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is a reasonable option for intractable depression or schizophrenia, but a mechanism of action has not been established. One credible hypothesis is related to neural plasticity. Three genes (Oct4, Sox2, c-Myc) involved in the induction of induced pluripotent stem (iPS) cells are Wnt-target genes, which constitute a key gene group involved in neural plasticity through the TCF family. Klf4 is the other gene among Yamanaka's four transcription factors, and increases in its expression are induced by stimulation of the canonical Wnt pathway. METHODS We compared the peripheral blood gene expression of the four iPS genes (Oct4, Sox2, c-Myc, and Klf4) before and after modified ECT (specifically ECT with general anesthesia) of patients with intractable depression (n=6) or schizophrenia (n=6). Using Thymatron ten times the total bilateral electrical stimulation was evoked. RESULTS Both assessments of the symptoms demonstrated significant improvement after mECT stimulation. Expression of all four genes was confirmed to increase after initial stimulation. The gene expression levels after treatment were significantly different from the initial gene expression in all twelve cases at the following treatment stages: at the 3rd mECT for Oct4; at the 6th and 10th mECT for Sox2; and at the 3rd, 6th and 10th mECT for c-Myc. CONCLUSION These significant differences were not present after correction for multiple testing; however, our data have the potential to explain the molecular mechanisms of mECT from a unique perspective. Further studie should be conducted to clarify the pathophysiological involvement of iPS-inducing genes in ECT.
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Affiliation(s)
- Masaki Nishiguchi
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroki Kikuyama
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tetsufumi Kanazawa
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Atsushi Tsutsumi
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takao Kaneko
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroyuki Uenishi
- Psychological Service and Counseling Center, Kansai University, Suita, Osaka, Japan
| | - Yasuo Kawabata
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Seiya Kawashige
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Jun Koh
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroshi Yoneda
- Department of Neropsychiatry, Osaka Medical College, Takatsuki, Osaka, Japan
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Dokucu ME. Neuromodulation Treatments for Schizophrenia. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2015; 2:339-348. [PMID: 28713665 DOI: 10.1007/s40501-015-0055-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Schizophrenia is a psychiatric disorder that causes great suffering and debilitation worldwide. We have a multitude of medications that are effective for psychosis. However, these have not been successful in treating the negative and cognitive symptom domains of schizophrenia. These symptoms are responsible for the larger part of functional impairments that result from schizophrenia. In addition, there are many patients for whom no significant improvement is achieved even in the positive symptom domain. Hence, other treatment modalities have been explored to help these patients. Electroconvulsive therapy and transcranial magnetic stimulation are two of the most promising adjunct treatment methods for medication resistant schizophrenia. Electroconvulsive therapy is the gold standard treatment for catatonias whether associated with schizophrenia, mood disorders or other non-psychiatric disorders. Although not effective for negative symptoms, electroconvulsive therapy provides substantial augmentation to antipsychotic medications in improving positive symptoms and overall severity. Electroconvulsive therapy should be considered more often in patients with inadequate response to antipsychotic medications even when they do not have prominent affective symptoms. Transcranial magnetic stimulation has emerged as a promising useful therapeutic tool in targeting medication resistant auditory hallucinations and negative symptoms. Transcranial magnetic stimulation has proven to be very safe and well-tolerated by the patients in spite of its labor intensiveness. The incorporation of transcranial magnetic stimulation to routine clinical use awaits further studies to substantiate its efficacy and to optimize and customize treatment parameters to individual patients and their symptom patterns. Moreover, combining transcranial magnetic stimulation with electroconvulsive therapy to synergize their likely different mechanisms of action is another exciting possibility.
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Affiliation(s)
- Mehmet E Dokucu
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences 710 North Lake Shore Drive #1324, Chicago, Illinois 60611,
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36
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Hagen E, Shprung D, Minakova E, Washington J, Kumar U, Shin D, Sankar R, Mazarati A. Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy. Neurotherapeutics 2015; 12:657-66. [PMID: 25916397 PMCID: PMC4489959 DOI: 10.1007/s13311-015-0357-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Autism is a developmental disorder characterized by impairments in social and communication abilities, as well as by restricted and repetitive behaviors. Incidence of autism is higher than earlier estimates, and treatments have limited efficacy and are costly. Limited clinical and experimental evidence suggest that patients with autism may benefit from electroconvulsive therapy (ECT). We examined the therapeutic potential of ECT in BTBR T+ tf/j mice, which represent a validated model of autism. A series of 13 electroconvulsive shocks (ECS) delivered twice a day over 7 days reversed core autism-like behavioral abnormalities-impaired sociability, social novelty, and repetitive behavior-when the animals were tested 24 h after the last ECS. The effect lasted up to 2 weeks after ECT. Neither single ECS nor a series of 6 ECS modified animals' behavior. Chronic infusion into the lateral brain ventricle of a preferential oxytocin receptor blocker (2S)-2-Amino-N-[(1S,2S,4R)-7,7-dimethyl-1-[[[4-(2-methylphenyl)-1-piperazinyl]sulfonyl]methyl]bicyclo[2.2.1]hept-2-yl]-4-(methylsulfonyl)butanamide hydrochloride abolished ECT-induced improvement of sociability and mitigated improvement of social novelty but did not affect ECT-induced reversal of repetitive behavior. These proof-of-principle experiments suggest that ECT may, indeed, be useful in the treatment of autism, and that its therapeutic effects may be mediated, in part, by central oxytocin signaling.
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Affiliation(s)
- Eunice Hagen
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Dana Shprung
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Elena Minakova
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - James Washington
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Udaya Kumar
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Don Shin
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Raman Sankar
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
- />Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Andrey Mazarati
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
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37
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van Buel EM, Patas K, Peters M, Bosker FJ, Eisel ULM, Klein HC. Immune and neurotrophin stimulation by electroconvulsive therapy: is some inflammation needed after all? Transl Psychiatry 2015; 5. [PMID: 26218851 PMCID: PMC5068722 DOI: 10.1038/tp.2015.100] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A low-grade inflammatory response is commonly seen in the peripheral blood of major depressive disorder (MDD) patients, especially those with refractory and chronic disease courses. However, electroconvulsive therapy (ECT), the most drastic intervention reserved for these patients, is closely associated with an enhanced haematogenous as well as neuroinflammatory immune response, as evidenced by both human and animal studies. A related line of experimental evidence further shows that inflammatory stimulation reinforces neurotrophin expression and may even mediate dramatic neurogenic and antidepressant-like effects following exposure to chronic stress. The current review therefore attempts a synthesis of our knowledge on the neurotrophic and immunological aspects of ECT and other electrically based treatments in psychiatry. Perhaps contrary to contemporary views, we conclude that targeted potentiation, rather than suppression, of inflammatory responses may be of therapeutic relevance to chronically depressed patients or a subgroup thereof.
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Affiliation(s)
- E M van Buel
- Department of Molecular Neurobiology, Center for Life Sciences, University of Groningen, Groningen, The Netherlands,Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Molecular Neurobiology, Center for Life Sciences, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands. E-mail:
| | - K Patas
- Department of Molecular Neurobiology, Center for Life Sciences, University of Groningen, Groningen, The Netherlands,Institute of Neuroimmunology and Multiple Sclerosis, Center for Molecular Neurobiology, University Medical Center Eppendorf, Hamburg, Germany
| | - M Peters
- Department of Molecular Neurobiology, Center for Life Sciences, University of Groningen, Groningen, The Netherlands
| | - F J Bosker
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U L M Eisel
- Department of Molecular Neurobiology, Center for Life Sciences, University of Groningen, Groningen, The Netherlands,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H C Klein
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
OBJECTIVE This paper aims to review the available evidence for the use of clozapine and electroconvulsive therapy (ECT) in combination. METHODOLOGY Electronic searches were carried out to identify reports describing the combined use of clozapine and ECT. RESULTS Forty reports including 208 patients were identified. The majority of reports were in the form of case reports and case series, with few retrospective and open-label studies. The majority of patients were aged between 18 and 65 years and diagnosed with schizophrenia or schizoaffective disorder. Most of the patients refractory to clozapine were started on ECT as an augmentation therapy; however, in some reports, both ECT and clozapine were started concurrently, and in few cases clozapine was started after ECT. In terms of effectiveness, 37.5-100% patients improved in short-term, and sustained long-term improvement (3 weeks to 24 months) was described in few studies. In terms of the side-effect profile, five patients each had delirium and tachycardia and only four patients were described to have prolonged seizures. Overall, the combination was considered effective and safe. CONCLUSION There is evidence for the effectiveness and safety of the clozapine-ECT combination and it should be used in patients with treatment-resistant schizophrenia who do not respond to clozapine.
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Iancu I, Pick N, Seener-Lorsh O, Dannon P. Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results. Neuropsychiatr Dis Treat 2015; 11:853-62. [PMID: 25848283 PMCID: PMC4384746 DOI: 10.2147/ndt.s78919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND While electroconvulsive therapy (ECT) has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M)-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning. METHODS We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years) with schizophrenia (n=16) or schizoaffective disorder (n=4) who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised. RESULTS Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment). We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant. CONCLUSION C/M-ECT is safe and effective for chronically hospitalized patients. It improves general functioning and reduces verbal aggression and self-harm. More research using other aggression tools is needed to determine its effects and to reproduce our findings in prospective and controlled studies.
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Affiliation(s)
- Iulian Iancu
- Be'er Ya'akov Mental Health Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Pick
- Be'er Ya'akov Mental Health Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Seener-Lorsh
- Be'er Ya'akov Mental Health Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pinhas Dannon
- Be'er Ya'akov Mental Health Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Huang C, Kang Y, Zhang B, Li B, Qiu C, Liu S, Ren H, Yang Y, Liu X, Li T, Guo W. Anti-N-methyl-d-aspartate receptor encephalitis in a patient with a 7-year history of being diagnosed as schizophrenia: complexities in diagnosis and treatment. Neuropsychiatr Dis Treat 2015; 11:1437-42. [PMID: 26089673 PMCID: PMC4468991 DOI: 10.2147/ndt.s82930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis associated with antibodies against the NR1 subunits of NMDARs. Although new-onset acute prominent psychotic syndromes in patients with NMDAR encephalitis have been well documented, there is a lack of case studies on differential diagnosis and treatment of anti-NMDAR encephalitis after a long-term diagnostic history of functional psychotic disorders. The present study reports an unusual case of anti-NMDAR encephalitis. The patient had been diagnosed with schizophrenia 7 years earlier, and was currently hospitalized for acute-onset psychiatric symptoms. The diagnosis became unclear when the initial psychosis was confounded with considerations of other neurotoxicities (such as neuroleptic malignant syndrome). Finally, identification of specific immunoglobulin G NR1 autoantibodies in the cerebrospinal fluid and greater effectiveness of immunotherapy over antipsychotics alone (which has been well documented in anti-NMDAR encephalitis) indicated the diagnosis of anti-NMDAR encephalitis in this case. Based on the available evidence, however, the relationship between the newly diagnosed anti-NMDAR encephalitis and the seemingly clear, long-term history of schizophrenia in the preceding 7 years is uncertain. This case report illustrates that psychiatrists should consider anti-NMDAR encephalitis and order tests for specific immunoglobulin G NR1 autoantibodies in patients presenting with disorientation, disturbance of consciousness, cognitive deficit, dyskinesia, autonomic disturbance, or rapid deterioration, even with a seemingly clear history of a psychiatric disorder and no specific findings on routine neuroimaging, electroencephalography, or cerebrospinal fluid tests in the early stage of the illness.
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Affiliation(s)
- Chaohua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; State Key Laboratory of Biotherapy, Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; Mental Health Center, Affiliated Hospital of Luzhou Medical College, Luzhou, People's Republic of China
| | - Yukun Kang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bo Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bin Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Changjian Qiu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shanming Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hongyan Ren
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; State Key Laboratory of Biotherapy, Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yanchun Yang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiehe Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tao Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; State Key Laboratory of Biotherapy, Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; Mental Health Education Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wanjun Guo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; State Key Laboratory of Biotherapy, Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Shibasaki C, Takebayashi M, Fujita Y, Yamawaki S. Factors associated with the risk of relapse in schizophrenic patients after a response to electroconvulsive therapy: a retrospective study. Neuropsychiatr Dis Treat 2015; 11:67-73. [PMID: 25609968 PMCID: PMC4294689 DOI: 10.2147/ndt.s74303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Electroconvulsive therapy (ECT) is an effective treatment for depression and schizophrenia. However, there is a high rate of relapse after an initial response to ECT, even with antidepressant or antipsychotic maintenance therapy. This study was carried out to examine the factors that influence the risk of relapse in schizophrenic patients after a response to ECT. PATIENTS AND METHODS We retrospectively reviewed the records of 43 patients with schizophrenia who received and responded to an acute ECT course. We analyzed the associated clinical variables and relapse after response to the acute ECT. Relapse was defined as a Clinical Global Impressions Improvement score ≥6 or a psychiatric rehospitalization. RESULTS All patients were treated with neuroleptic medication after the acute ECT course. The relapse-free rate of all 43 patients at 1 year was 57.3%, and the median relapse-free period was 21.5 months. Multivariate analysis showed that the number of ECT sessions was associated with a significant increase in the risk of relapse (hazard ratio: 1.159; P=0.033). Patients who were treated with adjunctive mood stabilizers as maintenance pharmacotherapy after the response to the acute ECT course were at a lower risk of relapse than were those treated without mood stabilizers (hazard ratio: 0.257; P=0.047). CONCLUSION Our study on the recurrence of schizophrenia after a response to an acute ECT course suggests that the number of ECT sessions might be related to the risk of relapse and that adjunctive mood stabilizers might be effective in preventing relapse.
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Affiliation(s)
- Chiyo Shibasaki
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Minoru Takebayashi
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan ; Department of Psychiatry, NHO Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Yasutaka Fujita
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization (NHO) Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
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Frajo-Apor B, Edinger M, Schmidinger S, Fleischhacker W, Hofer A. Successful Electroconvulsive Therapy in a Clozapine-Refractory Schizophrenia Patient with Meningioma. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2014; 10:225-226. [PMID: 24846879 DOI: 10.3371/csrp.fred.050614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Current and emergent treatments for symptoms and neurocognitive impairment in schizophrenia. ACTA ACUST UNITED AC 2014; 1:107-120. [PMID: 26301175 DOI: 10.1007/s40501-014-0010-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric population. NEUROPSYCHIATRY 2014; 4:33-54. [PMID: 24778709 PMCID: PMC4000084 DOI: 10.2217/npy.14.3] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Electroconvulsive therapy (ECT) is utilized worldwide for various severe and treatment-resistant psychiatric disorders. Research studies have shown that ECT is the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis. For patients who suffer from intractable catatonia and neuroleptic malignant syndrome, ECT can be life saving. For elderly patients who cannot tolerate or respond poorly to medications and who are at a high risk for drug-induced toxicity or toxic drug interactions, ECT is the safest treatment option. Organic causes are frequently associated with late-life onset of neuropsychiatric conditions, such as parkinsonism, dementia and stroke. ECT has proven to be efficacious even when these conditions are present. During the next decade, research studies should focus on the use of ECT as a synergistic therapy, to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence.
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Affiliation(s)
- Nancy Kerner
- Electroconvulsive Therapy Service & the Division of Geriatric Psychiatry, New York State Psychiatric Institute, & the College of Physicians & Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Joan Prudic
- Electroconvulsive Therapy Service & the Division of Geriatric Psychiatry, New York State Psychiatric Institute, & the College of Physicians & Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
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Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res 2013; 146:1-9. [PMID: 23499244 DOI: 10.1016/j.schres.2013.02.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/18/2013] [Accepted: 02/05/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a medical treatment that is most effective for mood disorders (Bipolar Disorder and Major Depression). It has also been shown to be an effective treatment for schizophrenia accompanied by catatonia, extreme depression, mania and other affective components. ECT is currently under-used in many psychiatric settings due to its stigmatized perception by patients and mental health professionals. However, many unanswered questions remain regarding its role in the management of patients with schizophrenia. AIM Evaluate the main indications of ECT in subjects suffering from schizophrenia. OBJECTIVES Investigate the efficacy and the main indications of ECT in the treatment of schizophrenic patients, evaluate its effects in the short-term and the long-term, compare ECT treatment with pharmacotherapy, and assess the effects of treatment with ECT. METHODS A systematic review of the literature was conducted on the use of ECT for schizophrenia. Thirty one articles from peer-reviewed journals were identified, and the most relevant articles were selected for this review. RESULTS The most common indication for using ECT for schizophrenia patients was to augment pharmacotherapy, while the most common accompanying symptoms were, in order, catatonia, aggression and suicide. Catatonic patients responded significantly better to ECT than patients with any other subtype of schizophrenia. The combination of ECT with pharmacotherapy can be useful for drug-resistant patients. The use of an ECT-risperidone combination or ECT-clozapine combination in patients non-responsive to prior pharmacotherapy was found to be most effective. CONCLUSIONS This review indicates that ECT, combined with pharmacotherapy, may be a viable option for a selected group of patients with schizophrenia. In particular, the use of ECT is recommended for drug-resistant patients, for schizophrenic patients with catatonia, aggression or suicidal behavior, and when rapid global improvement and reduction of acute symptomatology are required.
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Comparison of methohexital and etomidate as anesthetic agents for electroconvulsive therapy in affective and psychotic disorders. J Psychiatr Res 2013; 47:686-93. [PMID: 23399487 DOI: 10.1016/j.jpsychires.2012.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 12/03/2012] [Accepted: 12/14/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND ECT is a well-established treatment for severe depression. The available data on psychosis are limited, but reliable. Its therapeutic potential relies on the induction of a generalized seizure. Besides other narcotics, methohexital and etomidate are used for general anesthesia in ECT. Since prolonged seizures have been reported following the use of etomidate, it can be deduced that the substances might differ in their anticonvulsant properties, resulting in a lower increase in stimulus intensity during the course of treatment under etomidate. Besides this hypothesis, we aimed to investigate the differential effects of etomidate and methohexital on clinical features, ECT parameters and side effects of the treatment. METHODS We performed a retrospective analysis of treatment data of patients with affective and psychotic diagnosis who received general anesthesia for ECT either with etomidate or with methohexital. RESULTS ECT with etomidate and methohexital was equally effective. During the course of therapies the administered electric charge increased significantly and equally in both treatment groups. In the methohexital group, but not in the etomidate group, electroencephalographic seizure duration had a declining trend during the course of therapies. We observed more side effects during and immediately after ECT in the methohexital group than in the etomidate group. LIMITATIONS The limitations of this study are that the patients received various psychotropic co-medications, which influence ictal parameters differently, and, secondly, the study is based on a retrospective analysis. CONCLUSION The results of our analysis suggest that etomidate and methohexital affect ictal parameters to different extents. Longer seizure duration and fewer side effects are in favor of etomidate.
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Abstract
OBJECTIVE A comprehensive treatment program for schizophrenia needs to include services to women of childbearing age that address contraception, pregnancy, and postpartum issues, as well as safe and effective parenting. To update knowledge in these areas, a summary of the recent qualitative and quantitative literature was undertaken. METHOD The search terms 'sexuality,''contraception,''pregnancy,''postpartum,''custody,' and 'parenting' were entered into PubMed, PsycINFO, and SOCINDEX along with the terms 'schizophrenia' and 'antipsychotic.' Publications in English for all years subsequent to 2000 were retrieved and their reference lists further searched in an attempt to arrive at a distillation of useful clinical recommendations. RESULTS The main recommendations to care providers are as follows: take a sexual history and initiate discussion about intimate relationships and contraception with all women diagnosed with schizophrenia. During pregnancy, adjust antipsychotic dose to clinical status, link the patient with prenatal care services, and help her prepare for childbirth. There are pros and cons to breastfeeding while on medication, and these need thorough discussion. During the postpartum period, mental health home visits should be provided. Parenting support is critical. CONCLUSION The comprehensive treatment of schizophrenia in women means remembering that all women of childbearing age are potential new mothers.
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Affiliation(s)
- M V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Sadek AR, Knight GE, Burnstock G. Electroconvulsive therapy: a novel hypothesis for the involvement of purinergic signalling. Purinergic Signal 2011; 7:447-52. [PMID: 21695518 DOI: 10.1007/s11302-011-9242-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/02/2011] [Indexed: 01/16/2023] Open
Abstract
It is proposed that ATP is released from both neurons and glia during electroconvulsive therapy (ECT) and that this leads to reduction of depressive behaviour via complex stimulation of neurons and glia directly via P2X and P2Y receptors and also via P1 receptors after extracellular breakdown of ATP to adenosine. In particular, A(1) adenosine receptors inhibit release of excitatory transmitters, and A(2A) and P2Y receptors may modulate the release of dopamine. Sequential ECT may lead to changes in purinoceptor expression in mesolimbic and mesocortical regions of the brain implicated in depression and other mood disorders. In particular, increased expression of P2X7 receptors on glial cells would lead to increased release of cytokines, chemokines and neurotrophins. In summary, we suggest that ATP release following ECT involves neurons, glial cells and neuron-glial interactions acting via both P2 and after breakdown to adenosine via P1 receptors. We suggest that ecto-nucleotidase inhibitors (increasing available amounts of ATP) and purinoceptor agonists may enhance the anti-depressive effect of ECT.
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Affiliation(s)
- Ahmed-Ramadan Sadek
- Wessex Neurological Centre, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, SO16 6YD, UK,
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