Clinical Neuroscience of ECT (CNECT)

Out on PubMed from colleagues in Barcelona, Spain, published in the Journal of Affective Disorders , is this commentary: Electroconvulsive  therapy protocol adaptation during the COVID-19 pandemic. Gil-Badenes J, Valero R, Valentí M, Macau E, Bertran MJ, Claver G, Bioque M, Baeza I, Bastidas Salvadó A, Lombraña Mencia M, Pacchiarotti I, Bernardo M, Vieta E. J Affect Disord. 2020 Jul 15;276:241-248. doi: 10.1016/j.jad.2020.06.051. Online ahead of print. PMID:  32697705 The abstract is copied here: Background:  During the COVID-19 pandemic, electroconvulsive therapy units have had to confront challenges such as the infectious hazard due to aerosol-generating ventilation, or the lack of staff and material resources. Our objective was to elaborate a protocol to make ECT during the COVID-19 pandemic a safer procedure for patients and professionals. Methods:  A multidisciplinary workgroup (including mental health, anesthesia, preventive medicine, and occupational risk prof...

Out on PubMed, from investigators at Yale University  and Groningen, The Netherlands, is this study: Addressing Electroconvulsive Therapy Knowledge Gaps and Stigmatized Views Among Nursing Students Through a Psychiatrist-APRN Didactic Partnership. Kitay BM, Walde T, Robertson D, Cohen T, Duvivier R, Martin A. J Am Psychiatr Nurses Assoc. 2020 Jul 29:1078390320945778. doi: 10.1177/1078390320945778. Online ahead of print. PMID:  The abstract is copied below: BACKGROUND:  Knowledge gaps and stigmatized perceptions regarding electroconvulsive therapy (ECT) among patients and health providers contribute to the underutilization of an important therapeutic modality. The proactive education of future advanced practice registered nurses (APRNs) provides an opportunity to optimize the use of this evidence-based clinical practice.  AIMS:  As part of a general course in psychiatry during the first year of nursing school, we dedicated 1 hour to treatment-refractory depressio...

Out on PubMed, from investigators in Aarhus and Glostrup, Denmark is this pilot clinical trial Low frequency rTMS, inhibits the antidepressive effect of ECT. A pilot study. Buchholtz PE, Ashkanian M, Hjerrild S, Hauptmann LK, Devantier T, Jensen P, Wissing S, Thorgaard M, Speed M, Brund RBK, Videbech P. Acta Neuropsychiatr. 2020 Jul 27:1-27. doi: 10.1017/neu.2020.28. Online ahead of print. PMID:  32713367 The abstract is copied below: Objective: Low frequency rTMS of the prefrontal cortex have been shown to have a statistically and clinically significant antidepressant effect. The present pilot study was carried out to investigate if right prefrontal low frequency rTMS as an add-on to ECT accelerates the antidepressant effect and reduces cognitive side effects. Methods: In this randomized, controlled, double blind study thirty-five patients with major depression were allocated to ECT+placebo or ECT+ low frequency right prefrontal rTMS. The severity of depression was evaluated durin...

Out on PubMed from investigators Alexander (Sascha) Sartorius and colleagues in Germany is this study: Empirical ratio of the combined use of S-ketamine and propofol in  electroconvulsive  therapy and its impact on seizure quality. Sartorius A, Beuschlein J, Remennik D, Pfeifer AM, Karl S, Bumb JM, Aksay SS, Kranaster L, Janke C. Eur Arch Psychiatry Clin Neurosci. 2020 Jul 22. doi: 10.1007/s00406-020-01170-7. Online ahead of print. PMID:  32699969 The abstract is copied below: Electroconvulsive therapy (ECT) is an effective treatment for depressive disorders. In certain cases, ECT-associated anaesthesia can be improved by the use of ketofol (i.e., S-ketamine + propofol). We aimed to evaluate the empirical mixing ratio of ketofol in these cases for better clinical implementation. We retrospectively investigated n = 52 patients who received 919 ECT sessions with S-ketamine plus propofol as anaesthetic agents. Several anaesthesia and ECT-related parameters including doses of...

"Classics in ECT" today brings you this clinical trial from 1983, authored by noted ECT researcher and scholar, Richard (Dick) Abrams and colleagues including Mickey Taylor and Ray Faber: Bilateral versus unilateral electroconvulsive therapy: efficacy in melancholia. Abrams R, Taylor MA, Faber R, Ts'o TO, Williams RA, Almy G. Am J Psychiatry. 1983 Apr;140(4):463-5. doi: 10.1176/ajp.140.4.463. PMID:  6837786   The abstract is at the above link and copied here: The authors compared the therapeutic efficacy of bilateral and unilateral electroconvulsive therapy (ECT) in 51 patients with endogenous depression who were randomly assigned to bilateral (N = 24) or unilateral (N = 27) ECT. Seizures were monitored by oscilloscope. After 6 treatments blind assessment on a modified Hamilton depression scale showed an 81.1% improvement in the bilateral group compared with a 55.5% improvement in the unilateral group. Additional treatments were prescribed ad libitum by a hospital ps...

Out on PubMed recently is this expert consensus algorithm: Korean Medication Algorithm for Schizophrenia 2019, Second Revision: Treatment of Psychotic Symptoms. Lee JS, Yun JY, Kang SH, Lee SJ, Choi JH, Nam B, Lee SH, Chung YC, Kim CH. Clin Psychopharmacol Neurosci. 2020 Aug 31;18(3):386-394. doi: 10.9758/cpn.2020.18.3.386. PMID:  32702217 The abstract is copied below: Objective: In 2001, the Korean College of Neuropsychopharmacology and the Korean Society for Schizophrenia Research developed the Korean Medication Algorithm Project for Schizophrenia (KMAP-SPR 2001, revised 2006) through a consensus of expert opinion. The present study was carried out to support the second revision of the KMAP-SPR. Methods: Based on clinical guidelines and studies on the treatment of psychotic symptoms in schizophrenia, the Executive committee completed a draft of KMAP-SPR 2019. To obtain an expert consensus, a Review committee of 100 Korean psychiatrists was formed and 69 responded to a 30-item que...

Out on PubMed form investigators in India, Australia and England, with Jagadisha Thirthalli as senior author is this study: Antidepressant effects of ketamine and ECT: A pilot comparison. Sharma RK, Kulkarni G, Kumar CN, Arumugham SS, Sudhir V, Mehta UM, Mitra S, Thanki MV, Thirthalli J. J Affect Disord. 2020 Jul 18;276:260-266. doi: 10.1016/j.jad.2020.07.066. Online ahead of print. PMID:  32697707 The abstract is copied below: Background:  To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes. Methods:  This assessor-blinded randomized control trial included 25 patients (either sex; 18-65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severi...

Out on PubMed, from psychiatrists in Portugal, is this letter-to-the-editor: [ Electroconvulsive  Therapy: A Health Literacy Problem]. Pereira D, Ferreira L, Mendes M, Fernandes R, Viveiros V. Acta Med Port. 2020 Jul 1;33(7-8):529. doi: 10.20344/amp.13865. Epub 2020 Jul 1. PMID:  32669191   The pdf, in Portuguese, is here . The letter discusses the fact that both the lay population and the medical profession have misconceptions and very limited knowledge of ECT. I particularly like referring to this as a "health literacy problem." I totally agree with these colleagues and applaud them for their efforts to get more appropriate recognition/understanding of ECT in Portuguese medicine.

Out on PubMed is this case report written by a medical student and 2 attendings from the University of South Florida: Diagnostic Challenges and Treatment of the Neuropsychiatric Symptoms of Adult-Onset Niemann-Pick Type C With  Electroconvulsive  Therapy. Foels R, Hartney K, Cohen-Oram A. Psychosomatics. 2020 Jun 21:S0033-3182(20)30197-3. doi: 10.1016/j.psym.2020.06.011. Online ahead of print. PMID:  32680690 From the text: We present a novel case in which treatment with ECT resulted in symptomatic improvement in a patient with adult-onset NPC. Our patient presented initially with mild attention problems and eventual progressed to an episode of acute psychosis followed by encephalopathy with alternating catatonic and hyperactive features. She was trialed on multiple medications in an attempt to manage her psychiatric symptoms including risperidone, lurasidone, lamotrigine, trazodone, and lorazepam with minimal-to-no benefits in alleviation of her symptoms and increased ca...

Out on PubMed from researchers in the Netherlands is this study: A randomized controlled trial of a standard 4-week protocol of repetitive transcranial magnetic stimulation in severe treatment resistant depression P F P van Eijndhoven   1 ,  J Bartholomeus   2 ,  M Möbius   3 ,  A de Bruijn   4 ,  G R A Ferrari   3 ,  P Mulders   5 ,  A H Schene   5 ,  D J L G Schutter   6 ,  J Spijker   7 ,  I Tendolkar   5 PMID:  32663974 The abstract is copied here: Background:  Treatment options for major depressive disorder (MDD) in individuals who are depressed for at least 2 years and failed two or more different types of therapeutic intervention, remain scarce. Being less invasive than electroconvulsive therapy, repetitive transcranial magnetic stimulation (rTMS) might be an alternative treatment option. Research question:  Does high frequency rTMS applied over the left prefrontal cortex...

Out on PubMed, from clinicians in  Göttingen, Germany is this case report and review: [Electroconvulsive therapy in pregnancy: case report and interdisciplinary treatment suggestions]. Zilles-Wegner D, Trost S, Walliser K, Saager L, Horn S, Ernst M. Nervenarzt. 2020 Jul 17. doi: 10.1007/s00115-020-00960-7. Online ahead of print. PMID:  32681216   The abstract is copied here: Background:  Psychiatric disorders during pregnancy are common. Electroconvulsive therapy (ECT) can be indicated in severely affective or psychotic disorders with the necessity of a rapid response. Currently available review articles greatly differ in the methodology, leading to divergent conclusions concerning the use of ECT during pregnancy. Objective:  Description of a new clinical case and interdisciplinary treatment suggestions for the safe application of ECT in pregnancy. Methods:  Clinical case report and selective review of the literature with special consideration of existing s...

Out on PubMed in Acta Psychiatrica Scandinavica is this literature review from investigators in Germany, with Sascha Sartorius as senior author: The Neuroleptic Malignant Syndrome - A systematic case series analysis focusing on therapy regimes and outcome. Kuhlwilm L, Schönfeldt-Lecuona C, Gahr M, Connemann BJ, Keller F, Sartorius A. Acta Psychiatr Scand. 2020 Jul 13. doi: 10.1111/acps.13215. Online ahead of print. PMID:  32659853   The abstract is here: Introduction:  Neuroleptic Malignant Syndrome (NMS) is a rare, potentially life-threatening antipsychotic-associated disorder that requires an efficient and timely therapy. The aim of the study was to compare the effectiveness of different NMS therapies and to analyze its outcome depending on NMS severity. Method:  Systematic search for NMS cases in biomedical databases. The focus of the analysis was on therapy with dantrolene, bromocriptine and electroconvulsive therapy (ECT) when each was compared with symptomatic ...

Out on PubMed this week is this epidemiological study of ECT: Characterization of the Quality of Electroconvulsive Therapy Among Older Medicare Beneficiaries. Rhee TG, Olfson M, Sint K, Wilkinson ST. J Clin Psychiatry. 2020 Jul 7;81(4):19m13186. doi: 10.4088/JCP.19m13186. PMID:  32659875 The abstract is here: Background:  Electroconvulsive therapy (ECT) is an important therapy for treatment-resistant depression and is especially effective for elderly individuals with depression. This is the first US nationally representative description of ECT in the elderly. Methods:  Using 2014-2015 Medicare claims data, we compared elderly individuals with major depressive disorder (using ICD-9 and ICD-10 codes) who received ECT with those who did not on demographic and clinical measures. We characterized treatment patterns by setting and the proportion of individuals receiving index and continuation/maintenance courses, subtherapeutic courses of ECT, and post-ECT follow-up care. Resul...