Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from researchers in Spain, Australia and the USA, is this review article: A multimetric systematic review of fMRI findings in patients with MDD receiving ECT. Porta-Casteràs D, Cano M, Camprodon JA, Loo C, Palao D, Soriano-Mas C, Cardoner N. Prog Neuropsychopharmacol Biol Psychiatry. 2020 Nov 13:110178. doi: 10.1016/j.pnpbp.2020.110178. Online ahead of print.  PMID:  33197507   The abstract is copied below: And from the text: [Of the 34 articles]...the resting-state fMRI metrics employed included: seed-based resting-state functional connectivity (n=17), resting-state network connectivity (n=10), ReHo (n=3), ALFF (n=4), and fALFF (n=5). Moreover, regarding the number of results per metric, resting-state functional connectivity studies seem to capture more ECT-related changes than task-based and/or resting-state activity. Although this finding may be partially accounted for the fact that resting-state connectivity (across 2 different metrics) was more frequen...

Out on PubMed, from researchers at McLean Hospital and the Massachusetts General Hospital,  is this study:   Rate of continuing acute course treatment using right unilateral ultrabrief pulse  electroconvulsive  therapy at a large academic medical center. Luccarelli J, McCoy TH Jr, Shannon AP, Forester BP, Seiner SJ, Henry ME. Eur Arch Psychiatry Clin Neurosci. 2020 Nov 16. doi: 10.1007/s00406-020-01202-2. Online ahead of print.  PMID:   33196856 The abstract is copied below: And from the text: ...perhaps the most favorable interpretation of these results from the perspective of RUL-UBP ECT is that the method achieves remission in fewer than 12 treatments in approximately 1/3 of patients (reflecting the 571 who discontinue treatment), is unsuccessful in 1/3 of patients (the 616 who require alternative treatment parameters), and is tolerable and partially effective in the remaining 1/3 (the 606 receiving twelve RUL-UBP treatments). A worst-case interpretation...

Out on Pubmed, from clinicians in Belo Horizonte, Brazil, is this LTE: The pdf (in Portuguese) is here . Some of the translated text is below: Electroconvulsive therapy (ECT) is a procedure indicated for the treatment of various neuropsychiatric disorders, including life-threatening disorders and situations, such as depression with risk of suicide or malnutrition, catatonia, refractory schizophrenia, mania with psycho agitation -serious motor and epilepticus.1 Although it is a life-saving treatment, continuing ECT services during the COVID-19 pandemic has been a challenge due to the intrinsic risks of anesthesia and approaching the airways during the procedure.2 it consists in the use of a short acting hypnotic agent (propofol, etomidate or thiopental) followed by a neuromuscular blocker, the most used being succinylcholine due to the rapid onset and termination of action. Oxygen supply is provided through non-invasive balloon-mask ventilation.3 This is the critical point in the proced...

This letter is interesting from two points of view: the phenomenon of relief of depression with a single ECT and the correlation with dexamethasone suppression test results. In the intervening years, additional similar case reports have been published and various physiological changes after a single ECT have been reported. It seems unlikely that this is a placebo effect, and Dr. Rich's suggestion of a subgroup of  patients who are "exquisitely sensitive" to ECT seems likely to be true.

Out on Pubmed, from clinicians in Japan, is this case report:  Case of Prolonged Catatonia Caused by Sjögren's Syndrome. Inagaki T, Kudo K, Kurimoto N, Aoki T, Kuriyama K. Case Reports Immunol. 2020 Nov 3;2020:8881503. doi: 10.1155/2020/8881503. eCollection 2020. PMID:  33204547   The pdf is here . And from the text: [This 58-year old woman]...received a 20-session course of ECT within a period of 10 weeks. (there were no adverse effects that interfered with the treatment, except for minor temporal delirium. Her catatonia was obviously improved along with the other depressive symptoms, including appetite loss and decline in locomotor activity. One week after the final ECT session, her pressure sores had completely resolved, and we were able to collect cerebrospinal fluid through a lumbar puncture for cytological examination. (results showed an increased cell count (10/μL), elevated IgG levels (14.3 mg/dL), and elevated interleukin-6 levels (5.14 pg/mL). (specific gravity ...

 Out on PubMed, in JECT, from clinicians in Mumbai, India, is this report: Electroconvulsive Therapy Administered During the COVID-19 Pandemic. Yeole S, Kapri P, Karia S, Merchant H, Shah N, de Sousa A. J ECT. 2020 Nov 9.  Online ahead of print.  PMID:   33181562 The pdf is here . And from the text: This LTE is a compelling account of dedicated healthcare teamwork during the pandemic, a wonderful addition to ECT/COVID literature. I recommend a full read of the pdf (5 minutes). An interesting detail is that 75% of their ECT patients are diagnosed with schizophrenia. Happy Thanksgiving!

Out on PubMed, in JECT, from clinicians in Portugal, is this case report: Electroconvulsive  Therapy in Refractory Obsessive-Compulsive Disorder: A Case Report. Martins-Correia J, Rodrigues-Silva N, Nunes S. J ECT. 2020 Nov 9. doi: 10.1097/YCT.0000000000000731. Online ahead of print. PMID:  33181561 The abstract is copied below: Electroconvulsive therapy (ECT) is a treatment of undisputed efficacy for severe and treatment-resistant psychiatric disorders. Notwithstanding extensive data on efficacy and safety, it is significantly underused, corresponding to one of the most stigmatized approaches in psychiatry. The list of problems for which ECT is potentially effective does not include obsessive-compulsive disorder (OCD), resulting in only a few available case reports in the literature in which OCD is the target of this specific therapeutic strategy. The authors describe a patient with refractory OCD for whom ECT was prescribed, with remarkable clinical response and functional i...

Out on PubMed, from clinicians in Roanoke, Virginia, is this case report: ElectroconvulsiveTherapy in a Renal Transplantation Patient: A Rare Combination of Disease and Treatment. Malaty G, Godbe K, Elmouchtari M, Malhi G, White J, Bankole A, Criss T. Case Rep Psychiatry. 2020 Oct 30;2020:8889883. doi: 10.1155/2020/8889883. eCollection 2020. PMID:  33178474 The abstract is copied below: The safety and efficacy of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders have been demonstrated in a wide variety of patients, including postoperative patients and those who are pregnant. While several reports highlight the safety of this treatment in heart and liver transplantation patients, there is a relative lack of literature detailing the safety profile of ECT in an individual with recent kidney transplantation. Here, we explore the case of a patient with a recent renal transplant secondary to diabetes-related end-stage renal disease (ESRD) who underwent a successf...

Out on PubMed, from a retired clinician, is this commentary: My Benefits From  Electroconvulsive  Therapy-What a Psychiatrist Learned by Being a Patient. Barchas RE. Psychiatr Serv. 2020 Nov 10:appips72301. doi: 10.1176/appi.ps.72301. Online ahead of print. PMID:  33167818   The pdf is here . The text begins: I always thought of myself as a good psychiatrist, actually a very good psychiatrist. I saw much improvement in almost all of my patients and could control each person’s symptoms with psychopharmacological medications and with psychotherapy, which I loved to do. I never had to refer more than about 1% of my large patient population to hospitals, even though some of my patients were very ill. I could maintain treatment on an outpatient basis, and, in my 34 years of private practice, I never had a patient commit suicide. Now I am 71 years old and have been retired 8 years. Yet I realize now that despite having been a board-certified psychiatrist and a Life Fellow ...

Out on Pubmed, from researchers in Melbourne, Australia, is this responsive LTE:: The Mental Health Act (MHA) 2014 and the use of electroconvulsive therapy (ECT) in Victoria. Das P, Jagadheesan K, Lakra V.Australas Psychiatry. 2020 Nov 9:1039856220970074. doi: 10.1177/1039856220970074. Online ahead of print. The LTE is in response to: Lee J, George K, Price L, et al. An evaluation of the practice of electroconvulsive therapy (ECT) in a Victorian health service before and after the Mental Health Act 2014 . Australas Psychiatry 2020; 28: 279–285 From the text of the LTE: A key finding of Lee et al. was a significant reduction in the total number of patients per month with the MHA 2014.1 We found a similar decline in ECT use, i.e. 14.83% reduction in ECT use per 1000 admissions and 19.91% reduction in the ECT of utilisation per 100,000 persons.2 Also, we found this reduction only in adult patients.2 Lee et al. wondered whether the mental health tribunal (MHT) process could have contribute...

What was learned: studies by the consortium for research in ECT ( CORE ) 1997-2011. Fink M. Acta Psychiatr Scand. 2014 Jun;129(6):417-26. doi: 10.1111/acps.12251. Epub 2014 Feb 12. PMID:  24571807   The abstract is copied below: Objective: To review the findings of the four-hospital collaborative studies of electroconvulsive therapy (ECT) in unipolar depressed patients known as CORE between 1997 and 2011. Unipolar depressed patients were treated with bilateral ECT, and on remission were randomly assigned to a fixed schedule continuation ECT or to combined lithium and nortriptyline for 6 months. A second study compared three electrode placements in unipolar and bipolar depressed patients. Method: Nineteen published reports were reviewed. The findings are compared with those of a parallel multi-hospital study of ECT led by a Columbia University Collaboration (CUC) team that studied right unilateral ECT in a similar population with similar inclusion/exclusion and remission criter...

Out on PubMed, from researchers in Australia and the USA, is this review: Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience. Elias A, Thomas N, Sackeim HA. Am J Psychiatry. 2020 Nov 10:appiajp202020030238. doi: 10.1176/appi.ajp.2020.20030238. Online ahead of print. PMID:  33167675 The abstract is copied below: Resistance to pharmacological agents is commonly encountered in the treatment of acute episodes of mania. In contemporary practice guidelines, electroconvulsive therapy (ECT), once a widely used standalone intervention for mania, is no longer considered a first-line treatment. Stigma, logistics, and ethical factors constrain ECT administration in this condition and lead to its underutilization. However, the past three decades have produced promising research regarding the use of ECT in mania. Randomized controlled trials, albeit in limited numbers, the adoption of ultrabrief ECT, examination of the safety and efficacy of combining ECT with pharma...

 Out on PubMed, from colleagues in Chandigarh, India, is this article: Does electroconvulsive therapy cause brain damage: An update. Jolly AJ, Singh SM. Indian J Psychiatry. 2020 Jul-Aug;62(4):339-353. doi: 10.4103/psychiatry.IndianJPsychiatry_239_19. Epub 2020 Jul 27. PMID:  33165343   The abstract is copied below: Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage. This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technologi...

Out on PubMed, from researchers in Toronto, Canada, is this study: Treatment Capacity and Clinical Outcomes for Patients With Schizophrenia Who Were Treated With Electroconvulsive Therapy: A Retrospective Cohort Study. Plahouras JE, Konstantinou G, Kaster TS, Buchman DZ, Foussias G, Daskalakis ZJ, Blumberger DM. Schizophr Bull. 2020 Nov 4:sbaa144. doi: 10.1093/schbul/sbaa144. Online ahead of print. PMID:  33145601 The abstract is copied below: Background: Patients with schizophrenia are often found incapable to consent to psychiatric treatment. We evaluated clinical outcomes for incapable and capable patients with schizophrenia treated with electroconvulsive therapy (ECT). Methods: We conducted a chart review of all inpatients treated with an acute course of ECT between 2010 and 2018 at the Centre for Addiction and Mental Health, Toronto, Canada. Short-term outcomes included treatment response and cognitive impairment. We assessed whether incapable patients regained the capacity to...

Neurocognitive functioning after  electroconvulsive  therapy in late-life depression: a four-year prospective study. Obbels J, Vansteelandt K, Bouckaert F, Dols A, Stek M, Verwijk E, Sienaert P. Acta Psychiatr Scand. 2020 Nov 4. doi: 10.1111/acps.13252. Online ahead of print. PMID:  33150605 The abstract is copied below: Objective: Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side-effects of ECT in older patients. In this study we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression (LLD) from before the start until four years after the index ECT course. Methods: 41 patients aged 55 years and older with a unipolar depression, referred for ECT were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years and 4 years after the last ECT session. Results: We did not find any statistically significant cognitive changes from befo...

Out on PubMed, from researchers in India and Australia, is this LTE : Comparable effects of 0.5 ms and 1.5 ms pulse-widths on cardiovascular response in schizophrenia patients receiving electroconvulsive therapy. Ithal D, Mitra S, Nallur SV, Arumugham SS, Kumar CN, Ramesh VJ, Thirthalli J, Gangadhar BN. J Psychiatr Res. 2020 Oct 16;132:195-197. doi: 10.1016/j.jpsychires.2020.10.013. Online ahead of print. PMID:  33126013 The pdf is here . And from the text: ...For the mean charge of 110 mC observed in the 0.5 ms PW (Table- 1) group, the stimulus train would last for about double the duration (2.2s) as compared to 163 mC at 1.5 ms PW (1.04s) - the stimulus frequency and stimulus amplitude were kept constant. Thus, despite the lower charge of stimulus in the 0.5 ms group, the group received longer train of stimulus. However, no differences were observed in cardiovascular response. Although the 0.5 ms group had a lower seizure threshold, both groups received similar electrical dosage...

Out on PubMed, from researchers at Vanderbilt University School of Medicine, in Nashville, Tennessee, is this case report: Chronic Electroconvulsive Therapy May Induce Calvarial Hyperemia and Marrow Replacement. Khattab MH, Sherry AD, Aulino JM, Becker JE, Petrie WM, Cmelak AJ. J ECT. 2020 Oct 27. doi: 10.1097/YCT.0000000000000728. Online ahead of print. PMID:  33122499 The abstract is copied below: Electroconvulsive therapy (ECT) is a treatment option for a number of psychiatric disorders, including refractory major depression and obsessive compulsive disorder. There are no known structural sequelae of ECT. Here we present a patient with severe refractory obsessive compulsive disorder and major depression treated over 2 years with ECT every 2 weeks. Planning magnetic resonance imaging intended for a potential procedural intervention for her psychiatric disease incidentally demonstrated a new area of increased enhancement and loss of marrow signal within the right frontal bone. Ima...

Out on PubMed is Dr. Fink's latest review of catatonia: Expanding the Catatonia Tent: Recognizing Electroconvulsive Therapy Responsive Syndromes. Fink M. J ECT. 2020 Oct 27. doi: 10.1097/YCT.0000000000000729. Online ahead of print. PMID:  33122500 From the text: Catatonia is an acute onset systemic behavior syndrome with prominent motor and mood features that is increasingly recognized from 3% to 15% of hospital inpatients, usually in emergency, medical, neurology, and psychiatry units. Stupor, mutism, negativism, rigidity, posturing, staring, and 20 other behaviors are the classical signs described for more than a century. When first delineated in 1874 by the German psychiatrist Karl Kahlbaum, he noted “... the obvious association of this illness with other signs of disease, and its constant occurrence with certain somatic (particular muscular) disorders have been more or less ignored.” Soon recognized by others, Emil Kraepelin placed his catatonia cases within his concept of deme...

Out on PubMed, from clinicians in Japan, is this case report: Severe bradycardia at the termination of seizure during electroconvulsive therapy. Kadoi Y, Michizaki M, Saito T, Ota J, Saito S, Sameshima T. JA Clin Rep. 2020 Oct 16;6(1):83. doi: 10.1186/s40981-020-00389-6. PMID:  33067732 The abstract is copied below: Background: Few cases of asystole or severe bradycardia occurring after the termination of seizure in the third phase with the dominance of parasympathetic nervous system activity during electroconvulsive therapy (ECT) have been reported. We describe a case of severe bradycardia occurring at the termination of seizure. Case presentation: The patient had been diagnosed with bipolar disorder more than 9 years earlier. No adverse hemodynamic events had been observed in over 100 sessions of ECT performed during a 9-year period. ECT was usually induced by propofol and suxamethonium. On this ECT, the heart rate gradually decreased before seizure termination, and severe bradyc...

Out on PubMed, from researchers in Iran, is this study: Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy. Heidarbeigi F, Jamilian H, Alaghemand A, Kamali A. Eur J Transl Myol. 2020 Aug 4;30(3):8877. doi: 10.4081/ejtm.2020.8877. eCollection 2020 Sep 30.PMID: 33117503 The abstract is copied below: Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidi...

Out on PubMed, from clinicians in Rotweil, Germany, is this case report: Electroconvulsive therapy in a female patient with a cavernous malformation in the medulla oblongata. Kozian R, Grözinger M, Graf B. Fortschr Neurol Psychiatr. 2020 Oct 13. doi: 10.1055/a-1167-2952. Online ahead of print. PMID:  33051863 The abstract is copied below: The implementation of ECT treatment should not be ruled out in principle even if there is a cavernoma of the medulla oblongata with previous bleeding, but it requires appropriate conditions such as neurosurgical consultation, strict blood pressure monitoring and special information from the patient. And from a text translation from the German: [74-year old female patient] The neurological findings did not reveal any particularities in the patient. According to her own statements the patient had suffered a cerebral hemorrhage years ago. In fact, 10 years ago, a left-sided hypaesthesia of hand and leg was documented with bleeding from a cavernoma of...