Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from investigators in Japan, is this study: Factors causing a relapse of major depressive disorders following successful  electroconvulsive  therapy: A retrospective cohort study. Kurimoto N, Inagaki T, Aoki T, Kadotani H, Kurimoto F, Kuriyama K, Yamada N, Ozeki Y. World J Psychiatry. 2021 Oct 19;11(10):841-853. doi: 10.5498/wjp.v11.i10.841. eCollection 2021 Oct 19. PMID:  34733646   The abstract is copied below: Background: Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD. Aim: To investigate the diagnostic factors and treatment strategies associated with depression relapse. Methods: We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga ...

 Out on PubMed, from investigators in Spain, is this study: Evaluating maintenance   electroconvulsive  therapy in Bipolar Disorders: 3-year mirror-image study. Madero S, Anmella G, Sagué-Vilavella M, Pons MT, Giménez A, Murru A, Gómez-Ramiro M, Gil-Badenes J, Rios J, Bioque M, Vieta E, Benabarre A. J Affect Disord. 2021 Oct 26:S0165-0327(21)01135-6. doi: 10.1016/j.jad.2021.10.052. Online ahead of print. PMID:  34715196 The abstract is copied below: Background: Maintenance electroconvulsive therapy (mECT) is underused in the treatment of bipolar disorder (BD). We aimed to study the real-life effectiveness of mECT in BD. Methods: Naturalistic 3-year mirror-image study in individuals diagnosed with BD who underwent mECT at a tertiary hospital. Intra-subject comparisons of psychiatric hospitalization were performed using McNemar test. Days and number of psychiatric hospitalizations before and during mECT were compared through wilcoxon signed-rank test. Mean annual days ...

 Out on PubMed, from scientists in Korea, is this study: Electroconvulsive  seizure inhibits the mTOR signaling pathway via AMPK in the rat frontal cortex. Kim SH, Yu HS, Huh S, Kang UG, Kim YS. Psychopharmacology (Berl). 2021 Oct 30. doi: 10.1007/s00213-021-06015-2. Online ahead of print. PMID:  34716784 Psychopharmacology   https://doi.org/10.1007/s00213-021-06015-2  ORIGINAL INVESTIGATION  Electroconvulsive seizure inhibits the mTOR signaling pathway  via AMPK in the rat frontal cortex  Se Hyun Kim 1  · Hyun Sook Yu 2  · Seonghoo Huh 2  · Ung Gu Kang 1,3  · Yong Sik Kim 4   Received: 15 July 2021 / Accepted: 13 October 2021  © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021  The abstract is copied below: Rationale: Accumulating evidence indicates critical involvement of mammalian target of...

  Out on PubMed, from international clinicians , is this case report: New-Onset Catatonia and Delirium in a COVID-Positive Patient. Kaur G, Khavarian Z, Basith SA, Faruki F, Mormando C. Cureus. 2021 Oct 1;13(10):e18422. doi: 10.7759/cureus.18422. eCollection 2021 Oct. PMID:  34729258 The abstract is copied below: Coronavirus disease (COVID-19) is a strain of coronavirus family, which was initially found in China in late 2019 and subsequently spread to rest of the world. COVID-19 has led to physical and mental health complications since its onset. In addition to the pandemic-associated social stresses, biological complications include direct viral encephalitis, autoimmune-mediated responses, medication side effects, hypoxic brain injury, and delirium, which can collectively cause varied presentations of neuropsychiatric symptoms. Neuropsychiatric complications have been reported in the acute stages of COVID-19 and post-infection period. Here we report our experience treating a ...

Out on PubMed, from investigators in the USA, is this epidemiological study:  Effects of  Electroconvulsive  Therapy on Suicidal Behavior and Emergency Department Use Among Homeless Veterans: A Propensity Score-Matched Study. Tsai J, Peltzman T, Watts BV, Shiner B. J Clin Psychiatry. 2021 Oct 26;82(6):21m13935. doi: 10.4088/JCP.21m13935. PMID:  34705349 The abstract is copied below: Objective: This study examined the effects of electroconvulsive therapy (ECT) on suicidal ideation, suicide attempt, and emergency department use among homeless veterans receiving services in the Veterans Affairs (VA) health care system. Methods: National VA administrative data from 2001 to 2017 were analyzed using propensity score matching to compare 1,524 homeless veterans who received ECT and 3,025 homeless veterans discharged from psychiatric inpatient units serving as matched controls. Results: Homeless veterans who received ECT were significantly less likely to have used any ED serv...

 Out on PubMed, from investigators in Denmark, in JECT, is this study: Cognitive Adverse Effects of  Electroconvulsive  Therapy: A Discrepancy Between Subjective and Objective Measures? Hammershøj LG, Petersen JZ, Jensen HM, Jørgensen MB, Miskowiak KW. J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000797. Online ahead of print. PMID:  34699394 The abstract is copied below: Objectives: The character and duration of cognitive adverse effects of electroconvulsive therapy (ECT) are unclear. This study investigated (1) the sensitivity of a short cognitive test battery to cognitive adverse effects of ECT, (2) the relation between subjective and objective cognitive adverse effects, and (3) patient characteristics associated with more subjective than objective adverse effects. Methods: Forty-one patients with unipolar or bipolar depression referred to ECT underwent assessments at baseline, 5 to 7 days post-ECT, and 3 months post-ECT. Patients rated their fear of various asp...

Out on Pubmed, from investigators in Spain, is this LTE: Here is a link to the supplementary information: pcn13308-sup-0001-supinfo.docx This is a good faith attempt to try to make some sense of a small amount of retrospectively collected clinical data on pulse width. There are too many uncontrolled variables to make much of this, other than to note that, for some patients, increasing stimulus pulse width, may potentiate the treatment. Our field still could benefit from more systematized knowledge of how to to best proceed from from less intense to more intense forms of ECT. That will come in due course from adequately powered studies. In the meantime, thanks to our Spanish colleagues for raising these issues in their LTE.  

Out on PubMed, from investigators in Ireland, in JECT, is this study: Decision-making Capacity for Treatment After  Electroconvulsive   Therapy  for Depression. Loughran O, Finnegan M, Dud I, Galligan T, Kennedy M, McLoughlin DM. J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000804. Online ahead of print. PMID:  34699391 The abstract is copied below: Objectives: Depression can impair decision-making capacity (DMC) for health care decisions. However, it is unclear whether DMC improves after treatments for depression such as electroconvulsive therapy (ECT). There is limited evidence available on DMC for treatment in patients with depression referred for ECT, and it is unknown whether ECT has any impact on DMC. We hypothesized that ECT will improve DMC in severely depressed patients and that this change will be associated with reduced depressive symptom severity. Methods: Using the MacArthur Competence Assessment Tool-Treatment, 4 abilities related to DMC were evaluate...

 Out on PubMed, from investigators at Emory University, in JECT, is this review: The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management. Hermida AP, Mohsin M, Marques Pinheiro AP, McCord E, Lisko JC, Head LW. J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000802. Online ahead of print. PMID:  3469939 The abstract is copied below: Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community because of misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Electroconvulsive therapy causes periprocedural hemodynamic variability because of the surges in parasympathetic and sympathetic nervous systems after the administration of the electrical charge. Patients experience an increase in cardiac workload, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest that cardiac complications occur most frequently in patients with underlying cardiovascul...

Out on PubMed, from colleagues in Belgium, in JECT, is this case report: Delusional Infestation Treated With Electroconvulsive Therapy. Tu H, Sienaert P. J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000799. Online ahead of print. PMID:  34699393 This is a very nicely presented case report of a rare type of somatic delusion. The literature review is helpful, as well. Practitioners who encounter similar patients should be encouraged to consider ECT. A full read is worthwhile for all ECT practitioners, ~5 minutes.

 Out on PubMed, in JECT,  from clinicians in Australia, is this case report: Remission of Somatic Symptom Disorder With Comorbid Severe Major Depressive Disorder After Treatment With Electroconvulsive Therapy. Sarma S, Ranjith S, Abeysundera H. J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000795. Online ahead of print. PMID:  34699390   This is a useful case report of successful treatment of somatic symptom disorder (formerly somatization disorder) and psychotic depression with ECT. The clinical vignette is remarkable for the patient's suicide attempt by jumping, while on a pass from the hospital. It would be instructive to know how soon after that event (with multiple fractures) the ECT was initiated. Also, the timing of, and rationale for, the "second course" of ECT is not clear. This is a worthwhile read for all ECT practitioners, ~5 minutes.

 "Classics in ECT" brings you this case report: The pdf is here . This is an ole timey case report filled with internal medicine "classics" that we are lucky to have left behind. But the main point, to never overlook medical causes of psychiatric presentations, is well taken. In another blog post, I poo pooed the mention of acute intermittent porphyria as a complication of ECT because it is so rare, but here is just such a case caused by the barbiturate induction agent. I hope history of medicine and ECT history fans will enjoy reading this, ~5 minutes.

Out on PubMed, in JECT, is this case report: Electroconvulsive Therapy in a Patient With Psychotic Depression and Recent Subarachnoid Hemorrhage. Wechsler B, Desai MS, Khurshid KA. J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000794. Online ahead of print. PMID:  34699389 This is a useful case report that documents the safety of ECT one week after a traumatic subarachnoid hemorrhage. It would have been helpful to have the exact doses of labetalol used. The dramatic resolution of psychotic depression seen here with ECT is, of course, typical. I recommend a full read to all ECT practitioners, ~5 minutes. 

Out on PubMed, from investigators in Chicago, is this study: Characterizing Seizure-Induced Changes in the Glioma Microenvironment. Sita T, Hurley L, Dussold C, Sachdev S, Stupp R, Stegh A. Int J Radiat Oncol Biol Phys. 2021 Nov 1;111(3S):e599-e600. doi: 10.1016/j.ijrobp.2021.07.1601. PMID The abstract is copied below: Purpose/objective(s): Growing evidence indicates that the neurotransmitters dysregulated in psychiatric disorders are similarly dysregulated in glioblastoma (GBM) biology. Patients with psychiatric disorders are classically thought of having excessive glutamate (major depression, bipolar depression), excessive dopamine (mania, psychosis), and/or insufficient serotonin (major depression, anxiety). Analogously, GBM cells are dependent on bountiful neuronal glutamate, utilize elevated dopamine receptor expression to activate the hypoxic response and augment progression, and catabolize serotonin to drive proliferation. The clinical induction of seizure, known as electroconvu...

 Out on PubMed, from investigators in Portugal, is this study: Absence of Longer Reorientation Times in Patients Undergoing Electroconvulsive Therapy and Concomitant Treatment with Lithium. Martins-Ascencao R, Rodrigues-Silva N, Trovão N. Clin Psychopharmacol Neurosci. 2021 Nov 30;19(4):695-704. doi: 10.9758/cpn.2021.19.4.695. PMID:  34690124 The abstract is copied below: Objective: Lithium is a drug of choice in the treatment of bipolar disorder and refractory depressive disorders. However, previous research suggests lithium has a negative cognitive impact in recovery from electroconvulsive therapy (ECT) and a higher risk of delirium, so patients are often required to stop taking lithium before ECT, despite risk of relapse. We studied the cognitive impact of serum lithium levels in patients undergoing ECT. Methods: This was an observational prospective study. Serum lithium levels, thyroid and biochemical parameters were measured prior to each ECT session. Time elapsed from th...

 Out on PubMed, from investigators in Poland, is this study: Neurobiological Basis of Increased Risk for Suicidal Behaviour. Wisłowska-Stanek A, Kołosowska K, Maciejak P. Cells. 2021 Sep 23;10(10):2519. doi: 10.3390/cells10102519. PMID:  34685499 The abstract is copied below: According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus-pi...

 Out on PubMed, from investigators in Spain, is this study: The abstract is below: Abstract: Few systematic evaluations have been performed of the efficacy of electroconvulsive therapy (ECT) as a relapse prevention strategy in major depressive disorder (MDD). This is a single-blind, multicenter, randomized controlled trial to compare the efficacy and tolerability of pharmacotherapy plus maintenance ECT (M-Pharm/ECT) versus pharmacotherapy alone (M-Pharm) in the prevention of MDD relapse. Subjects with MDD who had remitted with bilateral acute ECT (n = 37) were randomly assigned to receive M-Pharm/ECT (n = 19, 14 treatments) or M-Pharm (n = 18) for nine months. The subjects were followed up for 15 months. The main outcome was relapse of depression, defined as a score of 18 or more on the Hamilton Depression Rating Scale. At nine months, 35% of the subjects treated with M-Pharm/ECT relapsed as compared with 61% of the patients treated with M-Ph...