Clinical Neuroscience of ECT (CNECT)

From authors in Australia, and published in Australasian Psychiatry, is this   contribution: When should we image our patients? Appropriate use of imaging in inpatient psychiatry. Forbes M, Somasundaram A, Jagadheesan K, Stuckey S. Australas Psychiatry. 2020 Jun 25:1039856220934313. doi: 10.1177/1039856220934313. Online ahead of print. PMID:  32586111 The abstract is at the above link and below is the relevant text related to ECT: Chest X-ray for patients undergoing electroconvulsive therapy Background In some inpatient units in Australian and New Zealand, a chest X-ray (CXR) is required for all patients prior to undergoing electroconvulsive therapy (ECT). The RANZCP guidelines recommend that a CXR only be ordered if medically indicated. 6  However, the interpretation of ‘medically indicated’ varies, and some psychiatrists consider a CXR to be part of the pre-ECT evaluation for all patients. 7 , 8  This can result in routine ordering of a CXR before ECT...

Out on PubMed is this literature review and case series from clinician/investigators in Nantes, France: Recurrence After Stopping Maintenance Electroconvulsive Therapy: A Retrospective Case Series. Cabelguen C, Caillet P, Poulet E, Szekely D, Desmidt T, Pichot A, Vanelle JM, Sauvaget A, Bulteau S. J ECT. 2020 Jun 12. doi: 10.1097/YCT.0000000000000693. Online ahead of print. PMID:  32558761 The abstract is at the above link and partially copied here: Methods:  A comprehensive [literature] review was conducted, followed by a retrospective analysis of 18 cases of mECT discontinuation between January 2011 and June 2016 involving patients with affective disorders. Results:  The comprehensive review revealed that only 3 studies have assessed recurrence rate after c/mECT discontinuation. In our retrospective analysis, mean (SD) mECT duration was 12.69 (12.16) months. A new mood event (usually a depressive state) was observed in 50% of the cases, and 44% of those recurren...

Out on PubMed is this study from Harold Sackeim and collaborators: The Benefits and Costs of Changing Treatment Technique in Electroconvulsive Therapy Due to Insufficient Improvement of a Major Depressive Episode. Sackeim HA, Prudic J, Devanand DP, Nobler MS, Haskett RF, Mulsant BH, Rosenquist PB, McCall WV.  Brain Stimul. 2020 Jun 22:S1935-861X(20)30134-0. doi: 10.1016/j.brs.2020.06.016. Online ahead of print.  PMID:   32585354 The abstract is at the above link and copied here: Background : Electroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies.  Objective : To document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received. Methods : Patie...

Out on PubMed is this manuscript  from 2 physicians at the University of North Carolina School of Medicine: Resource Document for Electroconvulsive Therapy in Adult Correctional Settings. Williams JB, Arvidson MM. J ECT. 2020 Jun 12. doi: 10.1097/YCT.0000000000000694. Online ahead of print. PMID:  32558763 The abstract is available at the above link and copied here: Electroconvulsive therapy (ECT) has been used for decades for the treatment of mental illness. Despite its proven efficacy, ECT is rarely offered to individuals with psychiatric disorders who are incarcerated in jails and prisons. There are currently 2.2 million people confined in US correctional facilities. Research has demonstrated that the prevalence of serious mental illness among the US incarcerated population is 4 to 5 times what is observed in the community, and there can be no doubt that individuals currently exist within jails and prisons who would benefit from this treatment modality. One issue ident...

Out on PubMed, from clinicians in Sao Paulo, Brazil is this manuscript in JECT: Images in Clinical Electroconvulsive Therapy: Portable 1-Channel Electroencephalogram Device as Adjunctive Seizure Monitoring. Gallucci-Neto J, Bellini H, Cretaz E. J ECT. 2020 Jun 12. doi: 10.1097/YCT.0000000000000698. Online ahead of print. PMID:  32558764   The image shows an  acceptable, clear EEG of an ECT-induced seizure in 5 panels, from pre-procedural baseline, through the well-developed seizure and postictal suppression. The manuscript reminds us that EEG monitoring is a necessary part of modern ECT practice, but cannot be taken for granted. The authors note that the MECTA Spectrum 4000 series (Q and M) do not come with built in physiological monitoring (the MECTA advertising says, "where alternative monitoring is available"). So, they used this "over the counter" device called the "Heart and Brain Spiker Box" from a company called "Backyard Brains" tha...

Out on PubMed from James Luccarelli and colleagues in Boston is this study: Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic. Luccarelli J, Fernandez-Robles C, Fernandez-Robles C, Horvath RJ, Berg S, McCoy TH, Seiner SJ, Henry ME. Psychother Psychosom. 2020 Jun 18:1-6. doi: 10.1159/000509113. Online ahead of print. PMID:  32554959 The link to the abstract is above; the abstract is copied here: I ntroduction:  Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. Objective:  To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the ap...

ECT  non-remitters: prognosis and treatment after 12 unilateral electroconvulsive therapy sessions for major depression. van Duist M, Spaans HP, Verwijk E, Kok RM. J Affect Disord. 2020 Jul 1;272:501-507. doi: 10.1016/j.jad.2020.03.134. Epub 2020 Apr 29. PMID:  32553394 Background:  Depressive disorder causes significant suffering in patients and caregivers worldwide. Electroconvulsive therapy (ECT) is a highly effective antidepressant treatment, but little is known about the prognosis and treatment of patients who do not achieve remission with ECT. We investigated prognosis and treatment of patients with major depression who did not achieve remission after 12 unilateral electroconvulsive therapy sessions. Methods:  We conducted a retrospective, naturalistic follow-up study. Patients who had previously participated in a double-blind randomized controlled trial that compared brief pulse with ultra-brief pulse ECT and who had not achieved remission after 12 rig...

Out on PubMed is this study from investigators in the Netherlands: Psychotic depressive subtype and white mater hyperintensities do not predict cognitive side effects in  ECT : A systematic review of pretreatment predictors. van Kessel MA, van der Vlugt JJB, Spaans HP, Murre JMJ, Verwijk E. J Affect Disord. 2020 Jul 1;272:340-347. doi: 10.1016/j.jad.2020.03.181. Epub 2020 May 4. PMID:  32553376   Review. The abstract is at the above link, and copied here: Background:  Most studies regarding cognitive side-effects following ECT for treating depression report transient forms of cognitive disturbances. However, a growing number of studies also report considerable differences among individual patients. Objective:  The aim of this systematic review was to identify pretreatment patient characteristics for predicting the risk of developing cognitive side-effects following ECT. Methods:  Online databases PubMed/Medline, Embase, and PsycINFO were search...

Out on PubMed is this study from practitioners in Turkey: ECT  augmentation of antipsychotics in severely ill schizophrenia: a naturalistic, observational study. Usta Saglam NG, Aksoy Poyraz C, Yalcin M, Balcioglu I. Int J Psychiatry Clin Pract. 2020 Jun 15:1-6. doi: 10.1080/13651501.2020.1777313. Online ahead of print.  PMID:  32538214 The link to the abstract is above; it is copied here: Objectives:  There is positive evidence to support the role of electroconvulsive therapy (ECT) in the treatment of schizophrenia; however, it is unclear to what extent this growing evidence reflects the actual situation in clinical practice. The aim of this study was to explore the efficacy of ECT augmentation to antipsychotics in individuals with schizophrenia in a naturalistic-observational environment. Methods:   Eighty-one patients diagnosed with schizophrenia, hospitalised due to acute psychotic exacerbation were included in the study. We compared changes in Posi...

Out on PubMed is this study from Turkey, published in an EEG journal: An Observational Retrospective Study Investigating Changes in Seizure Adequacy Parameters of Electroconvulsive Therapy and Their Relationships to Clinical Outcome in Schizophrenia and Schizoaffective Disorder. Durmaz O, Öcek Baş T. Clin EEG Neurosci. 2020 Jun 11:1550059420932076. doi: 10.1177/1550059420932076. Online ahead of print. PMID:  32525703 The abstract is at the above link, and copied here: The aim of the current study was to investigate a possible relationship between electroconvulsive therapy (ECT) seizure adequacy parameters and clinical outcome as well as differences between ECT responders and nonresponders in terms of ECT seizure parameters in patients diagnosed with schizophrenia and schizoaffective disorder. First and last ECT records data, sociodemographic variables, and baseline and post ECT Positive and Negative Syndrome Scale scores were obtained. Maximum sustained power was higher in la...

Recently published by investigators from Sweden and Norway, led by senior author, Axel Nordenskjöld, is this epidemiological study: Predictors of treatment response to electroconvulsive therapy in schizophrenia – a nationwide registry-based study. Linnea Stenmark, BSci, Katarzyna Popiolek, MD, Robert Bodén, MD, PhD, Ole Brus, Msc, Åsa Hammar, PhD, Mikael Landen, MD, PhD, Johan Lundberg, MD, PhD, Pia Nordanskog, MD, PhD, Axel Nordenskjöld, MD, PhD ,  Schizophrenia Bulletin Open ,   https://doi.org/10.1093/schizbullopen/sgaa019 The link to the full text is here . The methods included: All patients admitted to any Swedish hospital for schizophrenia from 2011 to 2017, who were treated with ECT while in inpatient care, were included in the Swedish National Quality Registry for ECT (Q-ECT), and were assessed using the Clinical Global Impression – Improvement (CGI-I) scale after treatment were included . The results were: The study included 285 patients who wer...

Out on PubMed from child psychiatrist and pediatric catatonia expert Dirk Dhossche, myself, and Michael Goetz is this letter-to-the-editor in European Child and Adolescent Psychiatry: Definitive treatment options for pediatric catatonia should include electroconvulsive therapy. Dhossche D, Kellner CH, Goetz M. Eur Child Adolesc Psychiatry. 2020 Jun 13. doi: 10.1007/s00787-020-01576-7. Online ahead of print.PMID: 32535657 Our letter was in response to: Asylum-seeking children with resignation syndrome: catatonia or traumaticwithdrawal syndrome? von Knorring AL, Hultcrantz E.Eur Child Adolesc Psychiatry. 2019 Nov 1. doi: 10.1007/s00787-019-01427-0. Online ahead of print.PMID: 31676913 The pdf is here . These authors wrote: In the beginning of the 2000s, an increasing number of asylum-seeking children in Sweden fell into a stuporous condition. In the present study, we report 46 consecutive children with the most severe form of this illness where the children were unable to giv...