Clinical Neuroscience of ECT (CNECT)

A recent addition to Pubmed citations from J ECT is this literature review of the incidence of headache after ECT, from Dutch investigators: The Incidence of Post-Electroconvulsive Therapy Headache: A Systematic Review Laura Aleida Christina Mulder   1 ,  Koen Pieter Grootens J ECT 2020 Mar 20[Online ahead of print] PMID:  32205737 The pdf is here . The results show that about a third of patients experience headache after ECT, and that, overall, it occurs in about one in ten ECT sessions. The article really focuses on incidence of headache, not etiology nor treatment. Our goal as ECT practitioners is to make ECT as safe and comfortable as possible for patients; to that end, treatment of post-ECT headache is an important feature of good ECT practice. Typically, simple analgesics are effective.  A common treatment strategy to prevent headache (in patients who have previously experienced it) is pre-procedural administration of 15-30 mg intravenous ...

Out on PubMed today is a reprint of a review article that originally appeared in Psychiatric Clinics in 2018: Electroconvulsive Therapy in Geriatric Psychiatry: A Selective Review Justin P Meyer   1 ,  Samantha K Swetter   2 ,  Charles H Kellner   3 Clin Geriatr Med, 36 (2), 265-279  PMID:  32222301 The pdf is here . Thanks to my colleagues Justin and Samantha for their excellent work in compiling and interpreting the literature on ECT in geriatric psychiatry. Key Points from the article are: •   Electroconvulsive therapy (ECT) is a safe and effective treatment of geriatric patients with severe depressive illness, mania, schizophrenia, catatonia and some other neuropsychiatric conditions.  •   The cognitive effects of ECT are largely transient, even in elderly patients with premorbid impairment.  •   ECT does not worsen the course of dementia, and is indicated for comorbid depression and agitation ...

Out on PubMed today is this article from Adriana Hermida of Emory University and colleagues, describing a new bedside assessment of cognitive functioning for use in ECT services: ElectroConvulsive Therapy Cognitive Assessment (ECCA) Tool: A New Instrument to Monitor Cognitive Function in Patients Undergoing ECT Adriana P Hermida   1 ,  Felicia C Goldstein   2 ,  David W Loring   2 ,  Shawn M McClintock   3 ,  Richard D Weiner   4 ,  Irving M Reti   5 ,  A Umair Janjua   6 ,  Zixun Ye   7 ,  Limin Peng   7 ,  Yi-Lang Tang   6 ,  Gail C Galendez   6 ,  Mustafa M Husain   3 ,  Daniel F Maixner   8 ,  Patricio Riva-Posse   6 ,  William M McDonald   6 ,  National Network of Depression Centers ECT Task Group J Affect Disord, 269, 36-42 2020 Mar4[Online ahead of print] PMID:  32217341 The pdf is here . The ECCA is offered a...

Recently out on PubMed is this important animal study from a highly respected group of investigators at Aarhus University in Denmark: Sustained Ultrastructural Changes in Rat Hippocampal Formation After Repeated Electroconvulsive Seizures Fenghua Chen   1   2 ,  Jibrin Danladi   1 ,  Gregers Wegener   2   3   4 ,  Torsten M Madsen   1 ,  Jens R Nyengaard   1   5 Affiliations  expand Int J Neuropsychopharmacol 2020 Mar 26[Online ahead of print]  PMID:  32215561 The pdf is here . In a genetic animal model of depression,  this study demonstrated increased synaptic plasticity (and increases in BDNF and VEGF) after a single ECS, as well as sustained changes (at 3 months) in "the efficacy of synaptic plasticity and non-neuronal plasticity [vascular and mitochondrial]" after 10 ECS. The importance  of these findings is that they begin to explain both the rapid and sustained antide...

Today's post is meant as a shout-out to our colleagues in Italy, during the terrible pandemic which has caused such suffering there. This new  article from JECT articulately and comprehensively describes the state of ECT in Italy: Electroconvulsive Therapy in Italy-Current Dissemination of Treatment and Determining Factors of the Past Saskia Wilhelmy   1 ,  Michael Grözinger   2 ,  Dominik Groß   1 ,  Andreas Conca   3 J ECT 2020 Mar 20[Online ahead of print] PMID:  32205733 The pdf is here . This article presents a survey of ECT practice in Italy in 2017, comparing it to 2009. Only 9/145 mental health facilities offered ECT in 2017 (5 public, 4 private), down from 14 in 2009. Only 293 patients were treated in Italy in one year, this out of a population of 60 million. There was no outpatient ECT at all.  The historical context of the reasons for the near-absence of ECT in Italy are well presented here. Some hope is o...

Today's post features a classic ECT article: Antidepressant effects of high-dose  right   unilateral  electroconvulsive therapy. Abrams R , Swartz CM, Vedak C. Arch Gen Psychiatry. 1991 Aug;48(8):746-8. doi: 10.1001/archpsyc.1991.01810320070010. PMID:  1883258 The pdf is here This is a departure from the usual purpose of this blog, which is to report on the newest literature. But a second function could be a series, "Classics in ECT," to refresh our memories about the best in past ECT articles. I admire this article for several reasons: it is the harbinger of many clinical trials to follow in the subsequent decades, it is concise and clearly written, and even mentions left unilateral ECT! In my opinion it forms the basis of our modern belief that high-dose RUL ECT is a good, go-to technique for many patients. Definitely worth reading in full.

There is a lot to choose from this morning, with 8 new citations from JECT having been uploaded to PubMed. I have chosen a case report of the treatment of a catatonic patient to highlight a technical anesthesia issue: Repeated Sugammadex Administration in a Catatonic Patient for Electroconvulsive Therapy Predrag Gligorovic   1 ,  Jacob Matthews J ECT Mar 20[Online ahead of print] PMID:  32205735 The pdf is here . This case is noteworthy for documenting the safe use of sugammadex 15 times during an acute course of ECT. Sugammadex simplifies the reversal of non-depolarizing muscle relaxants (used in certain situations in ECT, included prolonged immobilization due to catatonia, with resultant risk of hyperkalemia from succinylcholine) and is considered a boon, by anesthesiologists. This case reports also documents a common issue of inconsistent drug dosing when different anesthesiologists (14 in this case!) attend the patient at different ECT sessions.

  Covid-19 has severely impacted all health system resources,  including ECT services, which have the difficult responsibility of  deciding when ECT can be postponed or avoided, versus when it is  urgently or emergently needed.   The below two articles discuss this issue of how "elective" a procedure ECT is: Is Maintenance Electroconvulsive Therapy Always an Elective Procedure?: Weighing Medical Versus Psychiatric Risk Isobel A Rosenthal   1 ,  Charles H Kellner J ECT, 34 (1), 5-6 PMID:  28658009 The pdf is here . Kellner, CH.   ECT Today: The Good It Can Do .   Psychiatric Times, Sep 15, 2010.   Accessed on Mar 22, 2020. https://www.psychiatrictimes.com/electroconvulsive-therapy/ect-today-good-it-can-do

Autoimmume encephalitis is an important new potential indication for ECT. This recent review article is worth reading carefully: Anti-N-Methyl d-Aspartate Receptor Encephalitis and Electroconvulsive Therapy: Literature Review and Future Directions Yasas Chandra Tanguturi   1 ,  Allyson Witters Cundiff   1 ,  Catherine Fuchs   2 Child Adolesc Psychiatr Clin N Am, 28 (1), 79-89  Jan 2019 PMID:  30389078 The pdf is here . This review might have escaped your attention because it appears in the child and adolescent psychiatry literature.  The article has a comprehensive literature review of reported cases of ECT use in autoimmune encephalitis. It also has an excellent review of catatonia (which occurs in the vast majority of these patients) and a discussion of the potential mechanism of action of ECT in autoimmune encephalitis. Please see also bog posts of 2/8 and 3/23 on this topic.

Out on Pubmed today is a case report of NMS: Neuroleptic Malignant Syndrome: A Case Report Lisa A Ruth-Sahd   1 ,  Darris Rodrigues ,  Elizabeth Shreve Nursing, 50 (4), 32-38 PMID:  32195873 The pdf is here . The report is a reminder of the use of ECT for this rare and dangerous condition. It is written from the nursing perspective and is a welcome addition to the literature.  The discussion is mostly accurate, but does not mention the diagnostic overlap with catatonia. The case report itself provides no details of the ECT course; the fatal outcome is testament to the potential lethality of the illness, despite the use of ECT.