Clinical Neuroscience of ECT (CNECT)

ECT  and  ethical   psychiatry . Salzman C. Am J Psychiatry. 1977 Sep;134(9):1006-9. doi: 10.1176/ajp.134.9.1006. PMID:  900283 The pdf is here . This article, from the Special Section on ECT in the September, 1977 issue of the American Journal of Psychiatry, is a good review of the ethics of voluntary and involuntary ECT, and informed consent for the procedure. The case vignettes are particularly illustrative and helpful. The issues discussed have continued relevance for ECT practice in 2020.  Definitely worth reading (about 15 minutes).

Combined Use of Thyroid Hormone and ECT. Stern RA, Steketee MC, Durr AL, Prange AJ, Golden RN. Convuls Ther. 1993;9(4):285-292. The pdf is here . PMID:  11941224 This classic paper in Convulsive Therapy reviews animal thyroid studies as well as Stern's patient study published in 1991 in Biological Psychiatry. It contains a fine review of ECT's effects on the HPT axis. In my opinion, there was a real signal here, both for enhanced antidepressant efficacy and cognitive sparing. Why it was never adequately followed up and replicated is a mystery, and a lost opportunity. I believe there will be another review of pharmacologic enhancement of ECT in the near future.

Out on PubMed, from clinicians in Louisiana, is this case report: Treatment of a Complex Case of Catatonia and Conversion Features With Electroconvulsive Therapy in a 14-Year-Old Male. Roi C, Verret L, Peet B, Conrad EJ. Ochsner J. 2020 Fall;20(3):307-310. doi: 10.31486/toj.19.0026. PMID:  33071665 The abstract is copied below: Background: Pediatric catatonia is a rare and poorly understood phenomenon. The majority of reported cases have a psychiatric etiology. Because of the heterogeneous presentation and treatment issues unique to the pediatric population, identification and management can be challenging. Additionally, few definitive guidelines or practice parameters are available for pediatric patients. The first-line treatment for catatonia is pharmacologic, and when treatment fails or is inadequate, electroconvulsive therapy (ECT) has been shown to be safe and effective. Case Report: A previously healthy, 14-year-old male presented with acute onset of catatonia that resolved a...

Out on PubMed, from researchers in Canada and Australia, is this study: Modulation of functional network properties in major depressive disorder following electroconvulsive therapy ( ECT ): a resting-state EEG analysis. Hill AT, Hadas I, Zomorrodi R, Voineskos D, Farzan F, Fitzgerald PB, Blumberger DM, Daskalakis ZJ. Sci Rep. 2020 Oct 13;10(1):17057. doi: 10.1038/s41598-020-74103-y. PMID:  33051528 The abstract is copied below: Electroconvulsive therapy (ECT) is a highly effective neuromodulatory intervention for treatment-resistant major depressive disorder (MDD). Presently, however, understanding of its neurophysiological effects remains incomplete. In the present study, we utilised resting-state electroencephalography (RS-EEG) to explore changes in functional connectivity, network topology, and spectral power elicited by an acute open-label course of ECT in a cohort of 23 patients with treatment-resistant MDD. RS-EEG was recorded prior to commencement of ECT and again within 48 ...

Out on PubMed, from clinicians in Chicago and Austin, is this review: Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives. Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Neuropsychiatr Dis Treat. 2020 Sep 25;16:2191-2208. doi: 10.2147/NDT.S231573. eCollection 2020. PMID:  33061390   The abstract is copied below: Catatonia is a serious, common syndrome of motoric and behavioral dysfunction, which carries high morbidity and mortality. Electroconvulsive therapy (ECT) is the definitive treatment for catatonia, but access to ECT for the treatment of catatonia remains inappropriately limited. Catatonia is observable, detectable, and relevant to various medical specialties, but underdiagnosis impedes the delivery of appropriate treatment and heightens risk of serious complications including iatrogenesis. Current understanding of catatonia's pathophysiology links it to the current understanding of ECT's mechanism of action. Definitive catatonia care requires rec...

Out on Pubmed, from investigators in Kyoto, Japan, is this study: Early and late effects of electroconvulsive therapy associated with different temporal lobe structures. Yamasaki S, Aso T, Miyata J, Sugihara G, Hazama M, Nemoto K, Yoshihara Y, Matsumoto Y, Okada T, Togashi K, Murai T, Takahashi H, Suwa T. Transl Psychiatry. 2020 Oct 13;10(1):344. doi: 10.1038/s41398-020-01025-8. PMID:  33051437   The abstract is copied below: Recent studies examining electroconvulsive therapy (ECT) have reported that early sessions can induce rapid antidepressant and antipsychotic effects, and the early termination of ECT was reported to increase the risk of relapse. We hypothesized that different neural mechanisms associated with the therapeutic effects of ECT may be involved in the different responses observed during the early and late periods of ECT treatment. We investigated whether these antidepressant and antipsychotic effects were associated with temporally and spatially different regio...

Out on PubMed, from the Medical University of Silesia in Katowice, Poland, is this survey study: Does pop-culture affect perception of medical procedures? Report on knowledge and attitude towards electroconvulsive therapy among Polish students. Kramarczyk K, Ćwiek A, Kurczab B, Czok M, Bratek A, Kucia K. Psychiatr Pol. 2020 Jun 30;54(3):603-612. doi: 10.12740/PP/109157. Epub 2020 Jun 30. PMID:  33038890 The abstract is copied below: Objectives: The aim of the study was to investigate the general knowledge and attitudes towards ECT among Polish students, including students of medical faculties. Furthermore, the influence of pop-culture on society's opinion about ECT was investigated. Methods: For this purpose, 1,370 students have been examined with the usage of the author's questionnaire, which consisted of questions about socio-demographic data, detailed questions about ECT as well as questions about their opinion about influence of pop-culture on the reception of this procedur...

Out on PubMed is this study from Hefei, China: Bifrontal electroconvulsive therapy changed regional homogeneity and functional connectivity of left angular gyrus in major depressive disorder. Mo Y, Wei Q, Bai T, Zhang T, Lv H, Zhang L, Ji G, Yu F, Tian Y, Wang K. Psychiatry Res. 2020 Sep 20;294:113461. doi: 10.1016/j.psychres.2020.113461. Online ahead of print. PMID:  33038791 The abstract is copied below: Electroconvulsive therapy (ECT) is a rapid and effective treatment for MDD. However, the mechanism of ECT for MDD has not been clarified. In this study, we used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the mechanism of ECT. Two groups of subjects were recruited: healthy controls (HCs) and MDD patients who received bifrontal ECT. MDD patients and HCs underwent rs-fMRI scans and clinical assessments (Hamilton Depression Rating Scale, Rey-Auditory Verbal Learning Test (RAVLT), and the verbal fluency test). Regional homogeneity (ReHo) and functional co...

The pdf is here . This review of the status of ECT in the United States in 1991, was occasioned by the 1990 APA Task Force Report on ECT. It is a concise, but comprehensive, review of the history of ECT in the USA, contemporary practice methods and research findings. The history section is particularly informative. Many of the clinical issues discussed in this 1991 paper are relevant for today's practice. This is definitely worth a careful read (about 15 minutes).

Out on PubMed is this editorial from clinicians in Rio de Janeiro , Brazil: Anesthesia for  Electroconvulsive  Therapy during the COVID-19 pandemic. Pereira-Soares EL, Nascimento AL, da Silva JA, Nardi AE. Expert Rev Neurother. 2020 Oct 12. doi: 10.1080/14737175.2020.1835471. Online ahead of print. PMID:   33043717 From the text: ...the anesthesia procedure should be adjusted for avoiding the contamination of patients and healthcare professionals, following the recently published consensus guidelines. Aerosol-generating procedures, such as high-flow nasal oxygen, MV, and tracheal suction, should be avoided [14]. It can often be difficult to identify and isolate infected patients; therefore, it is recommended to take precautions during airway management of all patients [4]. Ideally, patients should be treated in rooms with negative pressure, if available [4,8,10,14]. It is recommended to use glycopyrrolate for minimizing salivation [15] and remifentanil and lidocaine for ...

Out on PubMed, from clinicians at NYU, is this case report: Successful Use of  Electroconvulsive  Therapy for Catatonia After Hypoxic-Ischemic Brain Injury. Kim K, Anbarasan D, Caravella RA, Nally E, Ying P, Gurin L. Psychosomatics. 2020 Sep 2:S0033-3182(20)30243-7. doi: 10.1016/j.psym.2020.08.009. Online ahead of print. PMID:  33023757   A small portion of the text of the case report is excerpted below (the pdf is not available without permission): This is an interesting and well-written case report. The theoretical discussion about the medical/neuropsychiatric contexts in which catatonia may appear is thoughtful. What is distressing is the tentative and ineffectual ECT that was initially prescribed for the patient, and the obsessional, repetitive exaggeration of the risks of cognitive adverse effects in the text, thinking that also seemed to drive the clinical decisions. Mature clinical decision-making involves carefully balancing risks and benefits, but also under...

Out on Pubmed, from researchers in Montreal, Quebec, Canada is this systematic review: The clinical relevance of dose titration in  electroconvulsive  therapy: A systematic review of the literature. Landry M, Lafrenière S, Patry S, Potvin S, Lemasson M. Psychiatry Res. 2020 Oct 3;294:113497. doi: 10.1016/j.psychres.2020.113497. Online ahead of print. PMID:  33039882 The abstract is copied below: Electroconvulsive therapy is a highly effective treatment of several psychiatric disorders. The debate regarding which charge dosing method offers the most favorable risk-benefit ratio remains. Our objective was to review the comparative evidence regarding efficacy and tolerability of dose titration (DT) vs other charge dosing methods, such as the age-based method (ABM) and the fixed dose method. Our secondary objective was to examine which populations would most benefit from DT. We conducted a systematic review of the literature in March 2020. Studies comparing DT to another char...

Out on Pubmed, from researchers in France and Canada, is this study: The Combination of Propofol and Ketamine Does Not Enhance Clinical Responses to Electroconvulsive Therapy in Major Depression-The Results From the KEOpS Study. Brunelin J, Iceta S, Plaze M, Gaillard R, Simon L, Suaud-Chagny MF, Galvao F, Poulet E. Front Pharmacol. 2020 Sep 15;11:562137. doi: 10.3389/fphar.2020.562137. eCollection 2020. PMID:  33041803 The abstract is copied below: Objective: We investigated the clinical effects of the combination of ketamine and propofol as anesthetic agents during electroconvulsive therapy (ECT) in patients with uni- or bipolar major depressive episodes. We hypothesized that ketamine may confer short- and long- term advantages in improving depressive symptoms at the early stages of ECT. Methods: In a randomized placebo-controlled trial, remission rates after 4 and 8 weeks of ECT were compared between patients who were randomly allocated to receive either the combination of ketami...

Out on PubMed, from researchers in Hungary, is this article: [The public's attitudes towards electroconvulsive therapy in Hungary]. Asztalos M, Könye P, Gazdag G. Ideggyogy Sz. 2020 Sep 30;73(9-10):311-316. doi: 10.18071/isz.73.0311. PMID:  33035417 The abstract is copied below: Background and purpose: This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public's attitude towards ECT, and no such study has been published from Hungary. Methods: Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers. Results: The result showed a si...

The pdf is here . This is a fascinating report of the early use of barbiturate anesthesia for ECT. It has both archaic and modern features, and is very well written. Note the reference to trying to use the initial phase of barbiturate hypnosis to obtain "psychogenic material" through "narcoanalysis," as in an amytal interview. Also, the discussion of maintenance ECT is surprisingly au courant.

The pdf is here . This is Dr. Frankel's (Chair of the 1978 APA Task Force on ECT) thoughtful discussion of the five articles that comprise the Special Section on ECT in the September, 1977 issue of the American Journal of Psychiatry. Particularly good reading is his scathing rebuke of the anti-ECT neurologist, John Friedberg. The critiques of the other four papers are also definitely worth reading (20 minutes). (Please see also blog post of October 9, 2010)

Out on PubMed, from clinicians in Lisbon, Portugal, is this case report: Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report. Maia A, Cotovio G, Barahona-Corrêa B, Oliveira-Maia AJ. Acta Med Port. 2020 Sep 30. doi: 10.20344/amp.13019. Online ahead of print. PMID:  32997617 From the text: CASE REPORT A 66-year-old man with prior diagnosis of schizophrenia was admitted to an ICU due to respiratory infection and septic shock syndrome, evolving rapidly to stupor and respiratory failure, and requiring sustained sedation for orotracheal intubation. At admission, all psychiatric medication was discontinued, and a course of empirical antibiotic treatment was started. Three days later, upon improvement of respiratory function and laboratory parameters, propofol was interrupted and the patient was extubated. However, leukocytosis and mild elevations of lactate dehydrogenase and liver transaminases persisted, despite normal creatine kinase level...

 Out on PubMed, from researchers in Quebec, Canada, is this meta-analysis: Current Practices of Electroconvulsive Therapy in Mental Disorders: A Systematic Review and Meta-Analysis of Short and Long-Term Cognitive Effects. Landry M, Moreno A, Patry S, Potvin S, Lemasson M. J ECT. 2020 Oct 1. doi: 10.1097/YCT.0000000000000723. Online ahead of print. PMID:  33009218 The abstract is copied below: Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depressive disorder, but uncertainties persist regarding the cognitive tests to include in ECT follow-up. The current study is a systematic review and meta-analysis of the most frequent cognitive side effects after ECT. We also discuss the most common cognitive tests in ECT follow-up. We searched studies published from 2000 to 2017 in English and French language in Pubmed, EBM Reviews, EMBASE, and PsycINFO. Standardized cognitive tests were separated into 11 cognitive domains. Comparisons between cogni...

 Out on PubMed, from researchers in Toronto, Canada, is this survey study: Interventional Psychiatry: An Idea Whose Time Has Come? Giacobbe P, Ng E, Blumberger DM, Daskalakis ZJ, Downar J, Garcia C, Hamani C, Lipsman N, Vila-Rodriguez F, Watling M. Can J Psychiatry. 2020 Oct 5:706743720963887. doi: 10.1177/0706743720963887. Online ahead of print. PMID:  33016106 From the text: The rates of competency in ECT have been stagnant over the past 3 decades. 2 , 3  Given the established efficacy of ECT as the gold-standard approach in treating acute depression, perceived ECT competency in just under a quarter of the emerging psychiatric workforce is particularly concerning. The results of this study suggest a way forward from the learners’ perspective, with more opportunities to receive supervision being especially valued. Additionally, this survey indicates that directly administering ECT at least 10 times may be considered a minimum benchmark to achieve self-perceived competenc...

 Out on PubMed, from clinicians in New York, is this case report: COVID-19-Induced Psychosis and Suicidal Behavior: Case Report. Chacko M, Job A, Caston F 3rd, George P, Yacoub A, Cáceda R. SN Compr Clin Med. 2020 Sep 26:1-5. doi: 10.1007/s42399-020-00530-7. Online ahead of print. PMID:  33015547   The abstract is copied below: The COVID-19 pandemic is associated with different types of stressors: fear of infection, financial burden, and social isolation. Additionally, COVID-19 infection seems to increase the risk for neuropsychiatric symptoms including psychosis. We present a case of a 52-year-old male with no previous psychiatric history who developed severe paranoia leading to a suicide attempt. He was successfully treated with a combination of milieu treatment, pharmacotherapy, and electroconvulsive therapy. We add to the nascent literature that COVID-19, as other coronaviruses, can increase the risk for severe psychosis and suicidal behavior. The pdf is here . The ti...

 Out on PubMed, from clinicians at the University of Toledo Medical Center, Toledo, Ohio, is this case report: Use of Nitrous Oxide to Facilitate Induction for Electroconvulsive Therapy: A Case Report. Lee K, Sparkle T. Am J Case Rep. 2020 Oct 5;21:e925883. doi: 10.12659/AJCR.925883. PMID:  33012778 The abstract is copied below: BACKGROUND The choice of pharmacologic agents used for electroconvulsive therapy (ECT) is critical as this can affect seizure duration and, ultimately, the effectiveness of ECT for the underlying condition. We report the use of nitrous oxide (N2O) to sedate and place an intravenous (IV) catheter in a combative patient for the induction of anesthesia. We found no significant clinical effect on seizure duration while using N2O in the pre- and intra-procedural period. CASE REPORT We present the case of a 48-year-old woman with a history of major depressive disorder scheduled for electroconvulsive therapy (ECT). We used 50% nitrous oxide (N2O) to sedate he...