Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from investigators in Germany, is this review: Treatment of bipolar disorders in older adults: a review. Ljubic N, Ueberberg B, Grunze H, Assion HJ. Ann Gen Psychiatry. 2021 Sep 21;20(1):45. doi: 10.1186/s12991-021-00367-x. PMID:  34548077 The abstract is copied below: Background: Old age bipolar disorder has been an orphan of psychiatric research for a long time despite the fact that bipolar disorder (BD)-I and II together may affect 0.5-1.0% of the elderly. It is also unclear whether aetiology, course of illness and treatment should differ in patients with a first manifestation in older age and patients suffering from a recurrence of a BD known for decades. This narrative review will summarize the current state of knowledge about the epidemiology, clinical features, and treatment of BD in the elderly. Methods: We conducted a Medline literature search from 1970 to 2021 using MeSH terms "Bipolar Disorder" × "Aged" or "Geriatric" or "Eld...

Out on PubMed, from researchers in the Netherlands, is this study: Shape and volume changes of the superior lateral ventricle after  electroconvulsive  therapy measured with ultra-high field MRI. Nuninga JO, Mandl RCW, Siero J, Nieuwdorp W, Heringa SM, Boks MP, Somers M, Sommer IEC. Psychiatry Res Neuroimaging. 2021 Sep 3;317:111384. doi: 10.1016/j.pscychresns.2021.111384. Online ahead of print The abstract  is copied below: The subventricular zone (SVZ) of the lateral ventricles harbors neuronal stem cells in adult mammals. Rodent studies report neurogenic effects in the SVZ of electroconvulsive stimulation. We hypothesize that if this finding translates to depressed patients undergoing electroconvulsive therapy (ECT), this would be reflected in shape changes at the SVZ. Using T1-weighted MR images acquired at ultra-high field strength (7T), the shape and volume of the ventricles were compared from pre to post ECT after 10 ECT sessions (in patients twice weekly) or 5 wee...

"Classics in ECT" brings you this commentary from 1983: Consent , competency and ECT: some critical suggestions. Sherlock R. J Med Ethics. 1983 Sep;9(3):141-3. doi: 10.1136/jme.9.3.141. PMID:  6620317 The pdf is here . This is one of four related pieces in this 1983 issue of the Journal of Medical Ethics. I blog about it so that you know it exists; those particularly interested in the ethics of ECT, ECT informed consent, and involuntary ECT may already be aware of it, but still might appreciate a reminder. While I am no ethicist, the view expressed by Sherlock here seems very reasonable to me. If one understands severe depressive illness, it is not hard to see how a patient may lack autonomy and be less than fully competent; better to err on the side of treatment and risk being called "paternalistic" than lose a life. Perhaps the other pieces in this series will be subjects for the blog, as well... I recommend a full read of this commentary, ~10 minutes. (Please se...

Out on PubMed, from investigators in Germany and Switzerland, is this study: EffECTively Treating Depression: A Pilot Study Examining Manualized Group CBT as Follow-Up Treatment After  ECT . Carstens L, Hartling C, Aust S, Domke AK, Stippl A, Spies J, Brakemeier EL, Bajbouj M, Grimm S. Front Psychol. 2021 Sep 3;12:723977. doi: 10.3389/fpsyg.2021.723977. eCollection 2021. PMID:  34539527   The abstract is copied below: Background: There is an urgent need for effective follow-up treatments after acute electroconvulsive therapy (ECT) in depressed patients. Preliminary evidence suggests psychotherapeutic interventions to be a feasible and efficacious follow-up treatment. However, there is a need for research on the long-term usefulness of such psychotherapeutic offers in a naturalistic setting that is more representative of routine clinical practice. Therefore, the aim of the current pilot study was to investigate the effects of a half-open continuous group cognitive behavior...

Out on PubMed,  in JECT, from senior author Soren Ostergaard, is this Danish  register study: Self-Harm and Suicide Attempts Preceding and  Following  Electroconvulsive  Therapy: A Population-Based Study. Salagre E, Rohde C, Østergaard SD. J ECT. 2021 Sep 13. doi: 10.1097/YCT.0000000000000790. Online ahead of print. PMID:  34519684 The abstract is copied below: Objective: The beneficial effect of electroconvulsive therapy (ECT) on suicidality has been documented in clinical trials, whereas naturalistic studies on the topic are scarce and restricted to individuals with mood disorders. Here, based on population-based data from Danish registers, we aimed to investigate the course of self-harm and suicide attempts preceding and following ECT across 4 major mental disorders. This was done to examine whether data from the real-world clinical setting are compatible with the positive results from clinical trials. Methods: We identified all patients diagnosed with u...

"Classics in ECT" brings you this commentary from 1980: ECT and special problems of informed consent. Culver CM , Ferrell RB, Green RM. Am J Psychiatry. 1980 May;137(5):586-91. doi: 10.1176/ajp.137.5.586. PMID:  7369404 The abstract is copied below: The authors examine the question of whether severely depressed patients can validly consent to ECT, indeed whether anyone should be asked to consent to a treatment that some have held is disabling and beyond the range of rational choice. They suggest some clarification in the use of the terms "competent" and "rational." The authors present examples of cases where ECT may appropriately be used with and without a patient's consent. They conclude that except in cases in which patients may die without ECT, physicians will not err morally by respecting patients' informed decisions about treatment. The pdf is here . This is the piece that was the seed for the four subsequent articles in the Journal of Medical...

"Classics in ECT" brings you this anonymous commentary: Effects of electric convulsion therapy. [No authors listed] Br Med J. 1980 Dec 13;281(6255):1588. PMID:  7448526   The pdf is here . The conclusion, "ECT remains a safe and effective treatment for this morbid melancholia," says it all.  Forty years later, this is a remarkably au courant assessment of ECT-it could have been written about the recently published revival of the "controversy" surrounding ECT. The summary of the patient attitudes studies by the late CP Freeman (with the famous, "less upsetting than a visit to the dentist") is a nice reminder of that work. Much of what this says about cognitive issues has been proven true in subsequent research. I recommend a full read of this commentary by all ECT healthcare professionals, ~5 minutes.

Out on PubMed, from investigators in Austria, is this study: Relationship Between Anesthesia Depth and Quality of Seizures in Patients Undergoing  Electroconvulsive  Therapy: A Prospective Observational Study. Gasteiger L, Heil M, Hörner E, Andexer J, Kemmler G, Hausmann A, Lederer W. J ECT. 2021 Sep 13. doi: 10.1097/YCT.0000000000000792. Online ahead of print. PMID:  34519686 The abstract is copied below: Objectives: Electroconvulsive therapy under general anesthesia is an established treatment for mood disorders, such as therapy-resistant depression. As most anesthetic drugs used for induction of anesthesia increase the seizure threshold, adequate depth of anesthesia without diminishing the therapeutic efficacy of interventions is crucial. The aim of this study was to investigate whether anesthesia depth as assessed by Narcotrend (NCT) monitoring correlates with maximum seizure quality. Methods: An observational study was performed in psychiatric patients undergoing mul...

Out on PubMed, in Acta Psychiatrica Scandinavica, is this study: Electroconvulsive  Therapy and Psychiatric Readmission in Major Depressive Disorder - A Population-Based Register Study. Stenmark L, Kellner CH, Landén M, Larsson I, Msghina M, Nordenskjöld A. Acta Psychiatr Scand. 2021 Sep 15. doi: 10.1111/acps.13373. Online ahead of print. PMID:  34523119 The abstract is copied below: Objective: The primary aim was to determine whether electroconvulsive therapy (ECT) is associated with reduced risk of psychiatric readmission in major depressive disorder (MDD). Methods: This study was based on data from multiple Swedish population-based registries. All adult patients admitted to any Swedish hospital for moderate-to-severe MDD between 2012-2018 were included. Participants were divided into two groups depending on whether they received ECT during inpatient care. Follow-up was set at 30 and 90 days from discharge. Data were analyzed using logistic regression and matching was conduc...

 Out on PubMed, from the Harvard ECT group, is this study: The effects of  electroconvulsive  therapy on depression and Suicidality in transgender and gender diverse individuals. Luccarelli J, Crall C, Hart KL, Seiner SJ, Henry ME. Gen Hosp Psychiatry. 2021 Aug 14:S0163-8343(21)00115-8. doi: 10.1016/j.genhosppsych.2021.08.006. Online ahead of print. PMID:  34518020 And from the text: A total of 19 patients met inclusion criteria. Mean age was 24.1 ± 5.5 years, and primary clinical diagnoses were major depressive disorder (13; 68.4%), bipolar disorder (5; 26.3%), and other (1; 5.3) (Table S1). Patients self-reported a range of gender identities, with 9 (47.3%) identifying as gender non-binary (Table S2). At baseline patients had severe-range depression on the QIDS, with a mean score of 17.0 ± 4.9. Median BASIS-24 SI subscale was 1.25 (IQR 0.42 to 3.00) (Fig. 1). At treatment #5, mean QIDS was 11.2 ± 4.5, with a median SI subscale of 0.58 (IQR 0.00 to 1.79). At treatm...

 Out on PubMed, from researchers at Yale , Columbia, and Rutgers, is this study: Association of ECT With Risks of All-Cause Mortality and Suicide in Older Medicare Patients. Rhee TG, Sint K, Olfson M, Gerhard T, H Busch S, Wilkinson ST. Am J Psychiatry. 2021 Sep 10:appiajp202121040351. doi: 10.1176/appi.ajp.2021.21040351. Online ahead of print. PMID:  34503341 The abstract is copied below: Objective: This observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in older psychiatric patients. Methods: Participants were Medicare-insured psychiatric inpatients age 65 or older. Patients receiving ECT were exact-matched to control subjects (in a 1:3 ratio) on age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts, and Elixhauser comorbidity index. Cox proportional hazard models were risk-adjusted for race, year of hospitalization, rural-urban continuum code, year of ind...

Out on PubMed, from clinicians in England, is this case report: Refractory catatonia in old age: a case report. Bean E, Findlay C, Gee C, Amin J. J Med Case Rep. 2021 Aug 14;15(1):406. doi: 10.1186/s13256-021-03000-3. PMID:  34389061 The abstract is copied below: Background: Catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in old age are poorly understood. We present a report of an older person whose catatonia was refractory to extensive treatment, and we identify important implications for the management of catatonia in old age. Case presentation: We describe a 73-year-old white man with longstanding autistic spectrum disorder who presented with symptoms of depression. Following a period of diagnostic uncertainty and failure to improve with antidepressant med...