Clinical Neuroscience of ECT (CNECT)

Out on Pubmed, from researchers in Warsaw, Poland, is this study: Right unilateral versus bilateral formula-based  electroconvulsive   therapy  in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial. Dominiak M, Goetz Z, Antosik-Wojcinska AZ, Swiecicki L. Psychogeriatrics. 2021 Jan 13. doi: 10.1111/psyg.12652. Online ahead of print. PMID:  33442924 The abstract is copied below: Background: Electroconvulsive therapy (ECT) remains the most effective treatment of depression in the elderly population; however, it is still unclear which type of ECT is most beneficial in this population. The aims of this study were: (i) to assess the feasibility of a randomised controlled trial in elderly depressed patients treated with right unilateral (RUL) or fronto-temporal bilateral (BT) formula-based ECT; (ii) to compare formula-based RUL and BT ECT in terms of efficacy, safety and tolerability in this population. Methods: The study...

"Classics in ECT" brings you this review from Australian colleagues: Half a century of  ECT  use in young people. Rey JM,  Walter G. Am J Psychiatry. 1997 May;154(5):595-602. doi: 10.1176/ajp.154.5.595. PMID:  9137112 The abstract is copied below: Objective: Pharmacological treatments for certain psychiatric disorders in young people are often ineffective and may cause major side effects; thus, it is important to investigate other treatments. This article reviews the literature on the efficacy and safety of ECT in this age group and examines the evidence for the suggestion that it may be used inappropriately. Method: All studies published in English and other languages on the use of ECT in persons 18 years of age or younger were obtained. The reports were systematically reviewed and rated according to the quality of the information in several domains, yielding an overall quality score for each study. Individual cases from each report were then examined and grouped ac...

"Classics in ECT" brings you this case series from the British Medical Journal in 1977: The pdf is here . And from the text: We considered the possibility that our patients were in a depressive stupor. Catatonic stupor and the psychomotor retardation seen in severe depressive illnesses may be difficult to distinguish, and the response to ECT was similar to what might be expected in depression.There was, however, a striking lack of evidence of prior psychiatric illness in these patients and their families, and there was no evidence of any primary disturbance of mood. It would be of great theoretical interest if we could document a "symptomatic schizophrenia" related to typhoid. Eugen Bleuler described the condition of his patient, referred to above, as acute schizophrenia, but he included in this category many patients whom other psychiatrists would not call schizophrenic. In some ways our patients resembled schizophrenics: they were young, and their catatonic syndro...

Out on PubMed is this study from clinicians in Nigeria: Modified electroconvulsive therapy in a resource-challenged setting: Comparison of two doses (0.5 mg/kg and 1 mg/kg) of suxamethonium chloride. Aaron OI, Faponle AF, Bolaji BO, Mosaku SK, Adenekan AT, Oginni OA. Saudi J Anaesth. 2020 Oct-Dec;14(4):487-492. doi: 10.4103/sja.SJA_147_20. Epub 2020 Sep 24. PMID:  33447191 The abstract is copied below: Background:  Suxamethonium has been shown to have a superior modification of the convulsion associated with ECT compared to other muscle relaxants. The dosage of suxamethonium used in ECT varies widely based on the experiences of practitioners. The study aimed to determine and compare the effectiveness and side effect profile of 0.5 mg/kg and 1 mg/kg in modified ECT. Subjects and Methods:  This was a prospective randomized crossover study, comparing the effects of suxamethonium at a dose of 0.5 mg/kg, and 1.0 mg/kg in 27 patients who had a total of 54 sessions of modified E...

Out on PubMed, from clinicians in Groningen, The Netherlands, is this case report and literature review: [Electroconvulsive therapy in a 12-year-old boy with a severe depression]. Smith-Apeldoorn SY, Haarman BCM, Schuppert HM. Tijdschr Psychiatr. 2020;62(12):1080-1085. PMID:  33443762   Dutch The abstract is copied below: Electroconvulsive therapy (ect) is an uncommon treatment in children and adolescents. This could partially be explained by the fact that a large proportion of the (child and adolescent) psychiatrists have little knowledge on ect in youths. We describe a case of a 12-year-old boy with a severe depression refractory to pharmacotherapy and psychotherapy, in which ect treatment was successful, including six years follow-up. Additionally, this report represents the state of the art concerning the efficacy and safety of ect in youths. The text of this case report is in Dutch; the gist of the case is that the child had a severe depression with prominent weight loss,...

Out on Pubmed, from clinicians at the University of Arkansas, is this study: Continuous Fetal Monitoring During Electroconvulsive Therapy: A Prospective Observation Study. Rabie N, Shah R, Ray-Griffith S, Coker JL, Magann EF, Stowe ZN. Int J Womens Health. 2021 Jan 6;13:1-7. doi: 10.2147/IJWH.S290934. eCollection 2021.  PMID:  33442300   The abstract is copied below: Objective : The use of electroconvulsive therapy in pregnancy has been limited by concerns about its effects on fetal well-being, despite limited evidence that suggests it is safe and effective. No studies have utilized continuous fetal heart rate monitoring during electroconvulsive therapy sessions. We aimed to describe the fetal heart rate patterns of patients undergoing electroconvulsive therapy. Design : This study is a prospective case series of pregnant patients undergoing electroconvulsive therapy with continuous fetal heart rate monitoring. Setting : University-based hospital. Population: Pregnant pat...

Out on PubMed is this case report from clinicians in Portugal: Bottom-up neuroanatomical pattern of symptom remission in melancholic depression after  electroconvulsive  therapy: a case report and literature review. Silva-Dos-Santos A, Venda D, Sales MB, Velho MV, Gracias MJ. Psychogeriatrics. 2021 Jan 12. doi: 10.1111/psyg.12654.   PMID:  33438326   And from the text: ...we hypothesize that the amelioration of symptoms occurs, preferentially, from the reptilian to the mammalian and finally to the neomammalian brain (Topic S9), according to a phylogenetic viewpoint This is straightforward, typical case presentation of psychotic depression, but the analysis of the time course of resolution of different symptoms is particularly interesting. The above graphic (Figure 1) shows this extremely clearly. The idea that certain symptoms resolve quickly with ECT, while others lag, is, of course nothing new. This clinical wisdom is reflected in the saying, "the patient is t...

Out on PubMed are these three articles: Effects of repeated  electroconvulsive  shocks on dopamine supersensitivity psychosis model rats. Kimura M, Oda Y, Oishi K, Yoshino K, Kimura H, Niitsu T, Kanahara N, Shirayama Y, Hashimoto K, Iyo M. Schizophr Res. 2021 Jan 8;228:1-6. doi: 10.1016/j.schres.2020.11.062. Online ahead of print. PMID:  33429150 The abstract is copied below: While the long-term administration of antipsychotics is known to cause dopamine supersensitivity psychosis (DSP), recent studies revealed that DSP helps form the foundation of treatment resistance. Electroconvulsive shock (ES) is one of the more effective treatments for treatment-resistant schizophrenia. The objective of this study was to examine whether repeated ES can release rats from dopamine supersensitivity states such as striatal dopamine D2 receptor (DRD2) up-regulation and voluntary hyperlocomotion following chronic administration of haloperidol (HAL). HAL (0.75 mg/kg/day) was administered f...

"Classics in ECT" brings you this LTE from the Green Journal in 1993: This LTE, by noted ECT researcher Conrad Swartz, forms part of the literature reflecting on the unfortunate name of our procedure. While "programmed seizures" is accurate, it sounds stilted and pedantic to me. My naive call for no more "ECT" (reference #2, above) was, likewise, ill-advised, but I still wish (without much hope) for "ECT" as stand-alone letters, fully decoupled from the words "electroconvulsive therapy."  ECT will stand on its own merits, and the name is but a minor part of the stigma problem.

"Classics in ECT" brings you this paper from the British Journal of Psychiatry in 1994: The pdf is here . This short paper describes a small retrospective clinical chart review to look at speed of response to ECT. Apparently, there was clinical lore that the first treatments in a series have little antidepressant effect. In fact, just the opposite is true, as this and many subsequent studies (including the CORE studies) have shown. The first treatments in an ECT course are typically the most powerful, and early response is a good predictor (but not perfect) of ultimate response. Allan Scott is a well-known ECT practitioner and researcher who has contributed much to the ECT literature over the years. This is not the only paper he and colleagues wrote on this topic... This 1994 paper is definitely worth a full read, only ~10 minutes.

Out on PubMed, from clinicians at Penn State Medical School, is this LTE: Electroconvulsive  Therapy for Catatonia with mTOR Mutation. Mormando CB, Garman JC, Mikoluk C, Francis A. J Autism Dev Disord. 2021 Jan 4. doi: 10.1007/s10803-020-04815-7. Online ahead of print. PMID:  33394247   Excerpts (partial) from the text of the LTE: An adopted 19-year-old developmentally-delayed Caucasian male with ASD and past aggressive behaviors was referred to our ECT service for treatment of catatonia. He had presumptive absence seizures in childhood with normal non-contrast brain magnetic resonance imaging at age 16 and a normal electroencephalogram at age 18. Prior medication trials for aggressive behaviors were minimally effective and poorly tolerated, and included risperidone, olanzapine, valproate, and lorazepam. Four months prior to referral he began to refuse most oral intake resulting in a >30 lbs weight loss. He stopped communicating at home and at school, and his parents b...

"Classics in ECT" brings you this English study from 1975: The pdf is here . The Tables are here: From the Methods : Verbal memory was tested after each of the first two ECTs. The interval between treatments was two or three days during which any medication was unchanged. Theratronic's Transpsycon machine was used. The dose in joules was the same (usually 25) for each treatment; likewise the doses of anaesthetic methohexitone sodium and the muscle relaxant succinylcholine.  And from the Discussion : Of our 12 left-handed writers, eight (67%) had scores suggesting left-sided dominance on a single pair of tests. Left dominance was indicated in five of eight sinistrals and in seven of 10 with mixed handedness. Thus, 12 of 18 (67%) of our non-dextral patients were left dominant onthis assessment. This finding is in line with 28 of44 (64%) left and mixed-handed patients in whom the intracarotid amylobarbitone test showed left speech dominance(Milner et al., 1964), and we cons...

Out on PubMed, from authors at UCSF, is this case report: Electroconvulsive therapy use in the adult U.S. correctional setting: A case report and literature review. Martin M, Ureste P. J Forensic Sci. 2021 Jan 4. doi: 10.1111/1556-4029.14652. Online ahead of print. PMID:  33394509 The abstract is copied below: Mr. C is a 45-year-old male inmate who was found in his cell unresponsive and mute. He had poor food and fluid intake for the last four days and was later found standing in place, frozen, and resistant to movement when encouraged by a corrections officer to rest in his bed. His symptoms were consistent with catatonia, a severe motor syndrome that can be life-threatening. The patient had a psychiatric history of bipolar I disorder with multiple past episodes of catatonia. Lorazepam was ineffective at reversing his catatonic symptoms, and his serum creatinine kinase level eventually began to rise, suggestive of muscle breakdown and worsening severity. The treating psychiatrist ...

In the excellent, 1100-page biography of the American poet and novelist, Sylvia Plath, the subject of her ECT treatment is extensively covered, including the below passage about the speed of her response: P.297:      "And yet, those [ECT] treatments administered at McLean seemed to heal-at least in the short term. Dr. Beuscher thought Sylvia made a startlingly quick recovery, as did Sylvia herself. Five years later, Plath was still trying to under-   P.299:     "Psychoanalytic readings of the novel [The Bell Jar ] maintain that Joan's suicide is a symbolic victory for Esther, and even for Plath herself-that by killing Joan, Plath symbolically "killed off" her depressive, life-threatening double. In real life, however, Jane pursued a rigorous course of psychotherapy at McLean, recovered her mental health, and eventually became a successful psychiatrist. Sylvia, who received little real psychotherapy at McLean and was instead prescribed insulin coma therapy a...

Out on PubMed, from clinicians in California, is this case report: New Onset Paroxysmal Atrial Fibrillation After Electroconvulsive Therapy. Hower MR, Yang C. Cureus. 2020 Nov 26;12(11):e11717. doi: 10.7759/cureus.11717. PMID:  33391948 The abstract is copied below: Electroconvulsive therapy (ECT) is a safe treatment for various psychiatric disorders. During an ECT treatment, an electrical stimulus produces a transient sympathetic response leading to changes in the cardiac rate and rhythm. Rarely, ECT treatment may precipitate atrial fibrillation (AF). In this case report, we present a 70-year-old man with schizoaffective disorder who developed paroxysmal AF after his 38th ECT treatment. We review his risk factors for AF and propose a possible mechanism of its development. We also discuss potential treatment options to safely resume ECT treatments. The pdf is here . This case report, first-authored by a medical student, documents the transient emergence of atrial fibrillation after...

 Out on PubMed, from clinicians in Poland, is this review: What exactly is catatonia in children and adolescents. Remberk B, Szostakiewicz Ł, Kałwa A, Bogucka-Bonikowska A, Borowska A, Racicka E. Psychiatr Pol. 2020 Aug 31;54(4):759-775. doi: 10.12740/PP/113013. Epub 2020 Aug 31. PMID:  33386726   Review.   English, Polish. The abstract is copied below: The current study is a review of the literature on catatonia syndrome with focus on children and adolescent's specificity. Previous catatonia conceptualizations were significantly modified in the newest classification systems. Catatonia may be considered either a separate syndrome or a specifier of the course of other psychiatric disorders. Although diagnostic criteria for children and adolescent do not differ from those for adults, the clinical presentation and course may not be the same. In this age group relatively common are somatic conditions taking the form of catatonia. There is agrowing body of literature focu...

"Classics in ECT" brings you this LTE in The Lancet , from 1980: The pdf is here . This LTE, very British and very concise, makes several important points. Dr. Bridges calls for a pragmatic, empirical recognition that ECT works. He decries the influence of psychodynamic psychiatry with its dismissive attitude towards ECT and chides American psychiatry for the use of the term "electroshock." He ends with a sarcastic comment about the ethics of allowing treatment refusal for psychotic patients in the USA. Search of PK Bridges shows over 100 PubMed citations, on a broad range of psychiatric topics, the last from 1997, as well as several textbooks of psychiatry.

From the New York Times on December 28, 2020: https://www.nytimes.com/2020/12/28/health/covid-psychosis-mental.html?smid=em-share Small Number of Covid Patients Develop Severe Psychotic Symptoms - The New York Times Most had no history of mental illness and became psychotic weeks after contracting the virus. Cases are expected to remain rare but are being reported worldwide. By Pam Belluck Almost immediately ... www.nytimes.com This sentence appears near the end of the article: The physical therapist who planned to murder her children had more difficulty. “Every day, she was getting worse,” Dr. Goueli said. “We tried probably eight different medicines,” including antidepressants, antipsychotics and lithium. “She was so ill that we were considering electroconvulsive therapy for her because nothing was working.” I am blogging about this article because whenever ECT is mentioned in the NY Times it is noteworthy. Most such mentions are negative or gratuitously  dismissive; this one is ...