Clinical Neuroscience of ECT (CNECT)

Out on PubMed, in JECT, from clinicians in Izumo, Japan, is this case report: Favorable Outcome After Modified Electroconvulsive Therapy in the Perioperative Management of a Patient With Treatment-Resistant Schizophrenia and a Femoral Neck Fracture. Otsuki K, Hayashi S, Nagahama M, Yokoi N, Inagaki M. J ECT. 2021 Apr 9. doi: 10.1097/YCT.0000000000000762. Online ahead of print. PMID:  33840800   This case report reminds us that ECT, with careful attention to good muscle relaxation, can be performed safely in the presence of certain orthopedic injuries. In this case, the patient had ECT with a fresh femoral neck fracture, and then 2 days after surgical repair. This case, with review of the literature, is worth a full read for practitioners, ~5 minutes.

Out on PubMed, from researchers in Korea, is this study: Factors associated with post-electroconvulsive therapy delirium: A retrospective chart review study. Jo YT, Joo SW, Lee J, Joo YH. Medicine (Baltimore). 2021 Apr 9;100(14):e24508. doi: 10.1097/MD.0000000000024508. PMID:  33832062 The abstract is copied below: Although electroconvulsive therapy (ECT) is generally a safe therapeutic method, unexpected adverse effects, such as post-ECT delirium, may occur. Despite its harmful consequences, there has been little discussion about the predictors of post-ECT delirium. Thus, the current study aimed to clarify the factors associated with post-ECT delirium by reviewing electronic medical records of 268 bitemporal ECT sessions from December 2006 to July 2018 in a university hospital.Demographic and clinical characteristics of sessions involving patients with or without post-ECT delirium were compared. Multiple logistic regression analysis was applied to analyze the correlation between v...

"Classics in ECT" brings you this longitudinal study from 1953: Electroconvulsive  therapy; a five-year study of results. ALEXANDER GH. J Nerv Ment Dis. 1953 Mar;117(3):244-50. PMID:  13070038 The pdf is here . And from the text: This is a 5-year longitudinal follow up of patients treated between 1940-1944 at Butler Hospital in Providence, Rhode Island. Half of the patients remained remitted for the 5-year period; patients with diagnoses other than schizophrenia were twice as likely to sustain remission.  (Still, about one third of patients with a diagnosis of schizophrenia remained remitted.) There are many caveats here, including the now-obsolete diagnostic schemas, but the point is that mood disorder patients fared better. This was with unmodified ECT in the very early days of ECT in the US. History buffs will want to read this short paper in full, ~8 minutes.

Out on PubMed is this "news alert" in the Saudi Medical Journal: Study examines the use of  electroconvulsive  therapy in England. [No authors listed] Saudi Med J. 2021 May;42(5):580. PMID:  33896792 With this neutral-sounding title appearing on PubMed,  the Saudi Medical Journal and  Cochrane Library Newsalert (I'm not exactly sure what this alert service is, cannot find it on the Cochrane Library website...)  have spread the anti-ECT propaganda of John Read and colleagues. People who read this article summary "cold", i.e, without knowledge of the backstory, will think the "study" data are reasonably interpreted and that Dr. Read is actually an ECT "expert".  Dr. Read's unwarranted hostility towards ECT and British Psychiatry is cloaked in the guise of academic respectability, with the professed goal of protecting vulnerable patients. His true motive, however, remains open to speculation.  The damage done to potential patients who may n...

 Out on PubMed, from researchers in The Lowcountries, is this paper: The pattern of inflammatory markers during  electroconvulsive  therapy in older depressed patients. Carlier A, Rhebergen D, Schilder F, Bouckaert F, Sienaert P, Veerhuis R, Hoogendoorn AW, Eikelenboom P, Stek ML, Dols A, van Exel E. World J Biol Psychiatry. 2021 Apr 6:1-24. doi: 10.1080/15622975.2021.1907718. Online ahead of print. PMID:  33821774 The abstract is copied below: Objectives: An association is found between changes in cytokine levels and antidepressant treatment outcome. Also, a proinflammatory profile is associated with a favourable electroconvulsive therapy (ECT) outcome. This paper investigates the pattern of inflammatory markers during a course of ECT in older depressed patients and whether this pattern is associated with ECT outcome. We hypothesized that ECT has an anti-inflammatory effect. Methods: The pattern of CRP, IL-6, IL-10, and TNF-α during a course of ECT was examined usin...

Out on PubMed, in JECT, from researchers in Boston, is this study: Duration of Treatment in Electroconvulsive Therapy Among Patients Beginning With Acute Course Right Unilateral Brief Pulse Stimuli. Luccarelli J, McCoy TH Jr, Shannon AP, Forester BP, Seiner SJ, Henry ME. J ECT. 2021 Apr 9. doi: 10.1097/YCT.0000000000000768. Online ahead of print. PMID:  33840804 The abstract is copied below: Objectives: Right unilateral brief pulse (RUL-BP) electroconvulsive therapy (ECT) has been adopted as a technique for reducing the cognitive side effects of ECT relative to sine wave or bilateral treatments, but it is unknown how often patients are transitioned to alternative electrode placements. This study analyzes time in first lifetime acute course RUL-BP ECT. Methods: A single-center retrospective chart review was conducted of adult patients receiving a first lifetime course of ECT from 2000 to 2017 beginning with individualized seizure threshold determination using RUL-BP treatment parame...

"Classics in ECT" brings you this article from 1947: Ambulatory  electroconvulsive therapy. FELDMAN F , GOMBERT E, BARRERA SE. J Nerv Ment Dis. 1947 Feb;105(2):171-90. doi: 10.1097/00005053-194702000-00007. PMID:  20284376   The pdf is here . And from the text: This classic article is a description of a busy outpatient ECT practice in upstate New York in the early years after World War II. I feature it mainly as a reminder that ambulatory ECT is not new, although it almost disappeared in later decades, only to be revived starting in the 1980s. Much of what is described in this 20-page essay rings true today, but much of it is also totally archaic, including the paternalistic, patriarchal tone, some of the diagnostic categories, and, of course, the fact that this is about unmodified ECT. The themes of the importance of family involvement and the need to have ongoing treatment to decrease relapse  still ring true. For history buffs, a full read (~30 minutes) ...

Out on Pubmed is this study from clinicians in Tabriz, Iran: The Effect of Foot Reflexology on Amnesia in Patients Undergoing Electroconvulsive Therapy: A Randomized Clinical Trial. Alinejad Machiani S, Namdar Areshtanab H, Ebrahimi H, Sarbakhsh P, Noorazar SG, Goljarian S. J Caring Sci. 2021 Mar 1;10(1):15-21. doi: 10.34172/jcs.2021.004. eCollection 2021 Mar. PMID:  33816380 The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is the oldest procedure among the early biological treatments introduced in psychiatry. However, the most debated and treatment-limiting adverse effect of ECT is amnesia. Therefore, due to the restriction of the use of drugs to manage amnesia in patients undergoing ECT, the present study investigated the effect of reflexology on amnesia. Methods: In this randomized controlled trial, 68 patients who met the inclusion criteria were randomly allocated to intervention and control groups. The intervention group received foot reflexology wit...

Out on PubMed from researchers in China and France is this review: Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review. Chen Y, Magnin C, Brunelin J, Leaune E, Fang Y, Poulet E. Brain Behav. 2021 Apr 10:e02144. doi: 10.1002/brb3.2144. Online ahead of print. PMID:  33838000   The abstract is copied below: Background: Suicide is a major public health issue and the majority of those who attempt suicide suffer from mental disorders. Beyond psychopharmacotherapy, seizure therapies and noninvasive brain stimulation interventions have been used to treat such patients. However, the effect of these nonpharmacological treatments on the suicidal ideation and incidence of suicidality remains unclear. Here, we aimed to provide an update on the effects of seizure therapies and noninvasive brain stimulation on suicidality. Methods: We conducted a systematic review of the literature in the PubMed, EMBASE, Cochrane Central Register of Controlled Tr...

Out on PubMed, from researchers in Belgium and the Netherlands, is this study: A longitudinal study of the association between basal ganglia volumes and psychomotor symptoms in subjects with late life depression undergoing  ECT . Van Cauwenberge MGA, Bouckaert F, Vansteelandt K, Adamson C, De Winter FL, Sienaert P, Van den Stock J, Dols A, Rhebergen D, Stek ML, Emsell L, Vandenbulcke M. Transl Psychiatry. 2021 Apr 1;11(1):199. doi: 10.1038/s41398-021-01314-w. PMID:  33795659 The abstract is copied below: Psychomotor dysfunction (PMD) is a core element and key contributor to disability in late life depression (LLD), which responds well to electroconvulsive therapy (ECT). The neurobiology of PMD and its response to ECT are not well understood. We hypothesized that PMD in LLD is associated with lower striatal volume, and that striatal volume increase following ECT explains PMD improvement. We analyzed data from a two-center prospective cohort study of 110 LLD subjects (>55 yea...

Today's blog post is about: https://www.pbs.org/video/hemingway-episode-3-blank-page/ I am writing about the portrayal of ECT in the Ken Burns three-episode biography of Ernest Hemingway on CNN. The handling of ECT is....amazingly fair! It is not blamed for his suicide, and shows that his depression was helped by both courses, albeit transiently, because he had inadequate aftercare. The latter is blamed on his celebrity, the phenomenon of VIPs getting inferior medical care. Hemingway's history of repeated brain trauma and severe alcoholism, complicating the psychiatric diagnosis, is also well described.  There is mention of the successful ECT given to Hemingway's son for a psychotic episode in his young adulthood. And, best of all, no repetition of the famous sentence...

Out on Pubmed, from researchers in Switzerland and Germany, is this paper: Gradient of electro-convulsive therapy's antidepressant effects along the longitudinal hippocampal axis. Gyger L, Regen F, Ramponi C, Marquis R, Mall JF, Swierkosz-Lenart K, von Gunten A, Toni N, Kherif F, Heuser I, Draganski B. Transl Psychiatry. 2021 Mar 29;11(1):191. doi: 10.1038/s41398-021-01310-0. PMID:  33782387 The abstract is copied below: Despite decades of successful treatment of therapy-resistant depression and major scientific advances in the field, our knowledge about electro-convulsive therapy's (ECT) mechanisms of action is still scarce. Building on strong empirical evidence for ECT-induced hippocampus anatomy changes, we sought to test the hypothesis that ECT has a differential impact along the hippocampus longitudinal axis. We acquired behavioural and brain anatomy magnetic resonance imaging (MRI) data in patients with depressive episode undergoing ECT (n = 9) or pharmacotherapy (n = 24)...

Out on PubMed, from researchers in Sweden, is this study: The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: nationwide register-based cohort study. Kronsell A, Nordenskjöld A, Bell M, Amin R, Mittendorfer-Rutz E, Tiger M. BJPsych Open. 2021 Mar 23;7(2):e71. doi: 10.1192/bjo.2021.31. PMID:  33752777 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). ECT treatment effect relies on induced generalised seizures. Most anaesthetics raise the seizure threshold and shorten seizure duration. There are no conclusive studies on the effect of anaesthetic dose on response and remission rates with ECT for MDD. Aims: We aimed to examine the effect of different dose intervals of anaesthetics on response and remission after ECT for MDD. Method: We conducted a nationwide cohort study, using data from Swedish registers. Low-, medium- and...

[S2k guidelines: status epilepticus in adulthood : Guidelines of the German Society for Neurology]. Rosenow F, Weber J; Deutsche Gesellschaft für Neurologie (DGN); Österreichische Gesellschaft für Neurologie (ÖGN). Nervenarzt. 2021 Mar 22. doi: 10.1007/s00115-020-01036-2. Online ahead of print. PMID:  33751150   Review.   German. The abstract is copied below: in English, German This S2k guideline on diagnosis and treatment of status epilepticus (SE) in adults is based on the last published version from 2021. New definitions and evidence were included in the guideline and the clinical pathway. A seizures lasting longer than 5 minutes (or ≥ 2 seizures over more than 5 mins without intermittend recovery to the preictal neurological state. Initial diagnosis should include a cCT or, if possible, an MRI. The EEG is highly relevant for diagnosis and treatment-monitoring of non-convulsive SE and for the exclusion or diagnosis of psychogenic non-epileptic seizures. As the increasi...

 Out on PubMed, from clinicians in Chandigarh, India, is this case report: Pulmonary embolism confounded with COVID-19 suspicion in a catatonic patient presenting to anesthesia for  ECT : a case report. Naik BN, Singh N, Aditya AS, Gupta A, Prabhakar N, Grover S. Braz J Anesthesiol. 2021 Mar 22:S0104-0014(21)00096-8. doi: 10.1016/j.bjane.2021.02.031. Online ahead of print. PMID:  33766683 The abstract is copied below: Catatonic patients may develop deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged periods of immobility. These life-threatening conditions demand prompt recognition and management. We describe the case of a patient with catatonia who presented to anesthesia for electroconvulsive therapy (ECT) at the outset of the current coronavirus disease 2019 pandemic. She complained of breathing difficulty and was suspected to have COVID-19 infection. On further evaluation, she was found to have DVT and PE and required oxygen therapy and intensive ca...

Out on PubMed is this case report from clinicians in Yamagata, Japan: Improvement of Somatic Delusions with Altered Regional Cerebral Blood Flow Following Electroconvulsive Therapy in a Patient with Schizoaffective Disorder. Hayashi H, Kobayashi R, Morioka D, Saito Y, Toyoshima T, Otani K. Am J Case Rep. 2021 Mar 16;22:e929800. doi: 10.12659/AJCR.929800. PMID:  33724980 The abstract is copied below: BACKGROUND Somatic delusions are false and fixed beliefs about health and organ function, which are observed in various psychiatric disorders. Psychotropic drugs such as antipsychotics and antidepressants are effective for some patients, while the efficacy of electroconvulsive therapy (ECT) for pharmacotherapy-resistant cases has been reported. Previous reports suggest that somatic delusions in delusional disorder somatic type are associated with reduced regional cerebral blood flow (rCBF), but it remains unclear whether this association is also observed in other psychiatric disorders. ...

Out on PubMed, from researchers at Yale and the Medical College of Georgia, is this special article: Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups. Black Parker C, McCall WV, Spearman-McCarthy EV, Rosenquist P, Cortese N. Psychiatr Serv. 2021 Mar 18:appips202000142. doi: 10.1176/appi.ps.202000142. Online ahead of print. PMID:  33730880 The abstract is copied below:  and a figure from the text: and the Conclusions section:  Although several theories seek to explain the persistent racial disparities in ECT treatment, racially influenced referral bias is one prominent and probable provider-level factor. Evidence has suggested that both aversive and acknowledged forms of racism among clinicians likely influence cultural diagnostic validity and accuracy, largely through clinician-level interpersonal communication and perceptual deficits, while also influencing how closely decision-making ration...

Out on PubMed, from investigators in Amsterdam, The Netherlands, is this paper: Magnetic resonance imaging for individual prediction of treatment response in major depressive disorder: a systematic review and meta-analysis. Cohen SE, Zantvoord JB, Wezenberg BN, Bockting CLH, van Wingen GA. Transl Psychiatry. 2021 Mar 15;11(1):168. doi: 10.1038/s41398-021-01286-x. PMID:  33723229 The abstract is copied below: No tools are currently available to predict whether a patient suffering from major depressive disorder (MDD) will respond to a certain treatment. Machine learning analysis of magnetic resonance imaging (MRI) data has shown potential in predicting response for individual patients, which may enable personalized treatment decisions and increase treatment efficacy. Here, we evaluated the accuracy of MRI-guided response prediction in MDD. We conducted a systematic review and meta-analysis of all studies using MRI to predict single-subject response to antidepressant treatment in pati...

A second independent audit of electroconvulsive therapy in England, 2019: Usage, demographics, consent, and adherence to guidelines and legislation. Read J, Harrop C, Geekie J, Renton J, Cunliffe S. Psychol Psychother. 2021 Mar 16. doi: 10.1111/papt.12335. Online ahead of print. PMID:  33728773 The abstract is copied below: Objectives: To assess progress towards improving the administering of electroconvulsive therapy (ECT) in England since an audit covering 2011, 2013, and 2015. The same information was gathered, for 2019, on usage, demographics, consent, and adherence to national guidelines and the Mental Health Act. Design and methods: Freedom of Information Act requests were sent to 56 National Health Service Trusts. Results: Thirty-seven trusts (66%) provided data. The gradual decline in the use of ECT in England has levelled off at about 2,500 people per year. There was a 47-fold difference between the Trusts with the highest and lowest rates per capita. Most recipients are s...