Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, in JECT, from authors in Germany and the US, is this LTE: The Trigeminocardiac Reflex in Electroconvulsive Therapy. Sartorius A, Kellner CH, Karl S. J ECT. 2022 May 5. doi: 10.1097/YCT.0000000000000859. Online ahead of print. PMID:35536986 The letter is here: I am indebted to my German colleagues for their collaboration on this LTE. While it is hypothetical, it poses a plausible explanation for asystole/bradycardia in ECT. Let us not forget the trigeminal nerve! I hope that all ECT practitioners and researchers who are interested in the physiology of ECT will read this, think about it, and comment, thanks.

Not yet on Pubmed (because it's an abstract only so far) are these study results from The Netherlands: These results, in abstract form, are very important, as the evidence base for post-mortem brain findings after ECT is very limited.  Here, both findings (increased DCX in hippocampus, and no evidence of brain damage, inflammatory or immune response) are very salutary. I am looking forward to the publication of the full study results in a paper.

 Out on PubMed, from authors in India, is this case series: Efficacy and safety of maintenance electroconvulsive therapy (M- ECT ) in treatment-resistant schizophrenia: A case series. Purohith AN, Chatorikar SA, Praharaj SK, Bhandary RP, Sharma PSVN. Asian J Psychiatr. 2022 Apr 25;73:103132. doi: 10.1016/j.ajp.2022.103132. Online ahead of print.  PMID:  35533602 The abstract is copied below: Background: Treatment-resistant schizophrenia (TRS) is a substantial burden to patients, caregivers, and the treating team. There is a lack of robust evidence to support the efficacy of various pharmacological and non-pharmacological measures to augment clozapine in this population. When used in conjunction with clozapine or other combination antipsychotic regimens, maintenance electroconvulsive therapy (M-ECT) can be a potential therapeutic option in preventing symptom exacerbation in TRS. However, there is limited evidence supporting the role of M-ECT in TRS. Aim: To evaluate the ef...

 Out on PubMed, from researchers in Boston and Los Angeles, is this study: Longitudinal trajectory of response to electroconvulsive therapy associated with transient immune response & white matter alteration post-stimulation. Andreou B, Reid B, Lyall AE, Cetin-Karayumak S, Kubicki A, Espinoza R, Kruse J, Narr KL, Kubicki M. Transl Psychiatry. 2022 May 7;12(1):191. doi: 10.1038/s41398-022-01960-8. PMID:  35523776 The abstract is copied below: Research suggests electroconvulsive therapy (ECT) induces an acute neuroinflammatory response and changes in white matter (WM) structural connectivity. However, whether these processes are related, either to each other or to eventual treatment outcomes, has yet to be determined. We examined the relationship between levels of peripheral pro-inflammatory cytokines and diffusion imaging-indexed changes in WM microstructure in individuals with treatment-resistant depression (TRD) who underwent ECT. Forty-two patients were assessed at basel...

 "Classics in ECT" (or in this case, "EST") brings you this LTE from the Green Journal in 1964: EST FOLLOWING A SELF-INFLICTED SKULL AND DURAL LESION. SELIG JW Jr. Am J Psychiatry. 1964 Nov;121:503. doi: 10.1176/ajp.121.5.503. PMID:  14218409 The letter is here: Here's a quick classic read about risk-benefit calculations with ECT in patients with "complicating physical problems." The assessment of the lethality of the the suicide attempt by gunshot wound to the head ("It was felt that her suicidal attempt was genuine") is so laconic, it is dryly humorous. The consultation with a neurosurgeon shows collaborative care, and the patient recovered from her severe depression with ECT.

 "Classics in ECT" brings you this review from 1991: Electroconvulsive therapy in Parkinson's disease and other movement disorders. Faber R, Trimble MR. Mov Disord. 1991;6(4):293-303. doi: 10.1002/mds.870060405. PMID:  1758447   Review The abstract is copied below: Early case reports note marked improvements in the signs of Parkinson's disease (PD) in several patients with coexisting psychiatric disorders after treatment with electroconvulsive therapy (ECT). Studies since 1959 reveal improvement of parkinsonism in over half of PD patients receiving ECT, regardless of the presence or absence of psychiatric comorbidity. Drug-induced parkinsonism, tardive dystonia, and tardive dyskinesia have also been shown to improve with ECT administration ; tic syndromes have achieved mixed results. In animals, ECT enhances dopamine-mediated effects and increases GABA concentrations in the CNS. Optimal parameters relevant to the antiparkinsonism effects of ECT require further study. ...

 Out on PubMed, in Dutch, from Belgian clinicians, is this case report: [Rapid remission of psychotic symptoms with electroconvulsive therapy in treatment-resistant schizophrenia]. Damen V, Sienaert P. Tijdschr Psychiatr. 2022;64(4):226-230. PMID:  35506976   Dutch. The abstract is copied below: Electroconvulsive therapy (ECT) has a reputation for rapid alleviation of symptoms, mainly in depressive disorders. In the current literature little attention has been paid to speed of response of psychotic symptoms in schizophrenia. We present the case of a 67-year old woman, diagnosed with schizophrenia and presenting with clozapine-resistant psychotic symptoms that swiftly remitted with ECT. We review the literature on rapid remission of schizophrenic psychosis during a treatment with ECT. The article is here . And from the text: Yes, it is in Dutch, but we know it is good because of who wrote it. A nice contribution to the literature, reminding us that ECT is an antipsych...

 Out on PubMed, In JECT, is this paper: Negative cognitive schema modification as mediator of symptom improvement after electroconvulsive therapy in major depressive disorder. Scheepens DS, van Waarde JA, Ten Doesschate F, Westra M, Kroes MCW, Schene AH, Schoevers RA, Denys D, Ruhé HG, van Wingen GA. J Affect Disord. 2022 Apr 28:S0165-0327(22)00422-0. doi: 10.1016/j.jad.2022.04.088. Online ahead of print. PMID:  35490877 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a potent option for treatment-resistant major depressive disorder (MDD). Cognitive models of depression posit that negative cognitions and underlying all-or-nothing negative schemas contribute to and perpetuate depressed mood. This study investigates whether ECT can modify negative schemas, potentially via memory reactivation, and whether such changes are related to MDD symptom improvement. Method: Seventy-two patients were randomized to either an emotional memory reactivation electro...

Out on PubMed, in JECT,  from clinicians at Stony Brook, is this paper: An Examination of Electroconvulsive Therapy and Delivery of Care in Delirious Mania. Reinfeld S, Yacoub A. J ECT. 2022 Apr 14. doi: 10.1097/YCT.0000000000000844. Online ahead of print. PMID:  35462389 The abstract is copied below: Objectives: Delirious mania is a severe life-threatening syndrome, often misdiagnosed, and eminently treatable as a variant of catatonia. Our aim is to provide a comprehensive examination of electroconvulsive therapy (ECT) parameters and clinical features, as well as describe the delivery of care of the patients with delirious mania. Methods: A retrospective study was conducted of the ECT records at Stony Brook University Hospital from years 2014 to 2021. We characterized demographic and clinical variables, including psychiatric diagnoses and ECT parameters of patients identified with delirious mania. Results: We identified 8 cases (3 women) of delirious mania with 8 correspondin...

 Out on PubMed, from authors in Belgium, in JECT, is this paper: Nonremission After Electroconvulsive Therapy in Individuals With Major Depression: Role of Borderline Personality Disorder. Hein M, Mungo A, Loas G. J ECT. 2022 Apr 29. doi: 10.1097/YCT.0000000000000857. Online ahead of print. PMID:  35482914 The abstract is copied below: Objectives: The aim of the present study was to investigate the risk of nonremission following electroconvulsive therapy (ECT), as associated with borderline personality disorder, in individuals with major depression in the context of the contradictory data available in the literature. Methods: We analyzed demographic and clinical data from 210 individuals with major depression who were treated with ECT. Study participants were recruited from the medical records database of the Psychiatry Department at Erasme Hospital. Only individuals with major depression who were in remission, as demonstrated during the systematic psychiatric interview perfor...

 Out on PubMed, in JECT, from authors in India, is this case report and review: Electroconvulsive Therapy in Patients With Cardiac Implantable Electronic Devices: A Case Report and Systematic Review of Published Cases. Purohith AN, Vaidyanathan S, Udupa ST, Munoli RN, Agarwal S, Prabhu MA, Praharaj SK. J ECT. 2022 Apr 26. doi: 10.1097/YCT.0000000000000851. Online ahead of print. PMID:  35482902 The abstract is copied below: The aims of the study were to report the case of a 54-year-old man with recurrent depressive disorder with multiple medical comorbidities having a dual-chamber pacemaker, treated successfully with 11 sessions of electroconvulsive therapy, and to conduct a systematic review of published cases documenting the use of electroconvulsive therapy (ECT) in patients with cardiac implantable electronic devices (CIEDs) for treating major psychiatric disorders. Methods: We searched electronic databases (MEDLINE, PubMed, Google Scholar, Embase, Cochrane Library, PsycINF...

 "Images in Clinical ECT", in JECT, brings you this image from clinicians in Arizona: An Improvised Bite-Block Apparatus to Prevent Oral Mucosa Damage in Electroconvulsive Therapy. Wiegand CB, Howell S. J ECT. 2022 Apr 26. doi: 10.1097/YCT.0000000000000842. Online ahead of print. PMID:  35482893   This is a useful addition to the literature on oral protection in ECT. Standard bite-blocks are excellent for the vast majority of patients, but innovative solutions for exceptional situations are always welcome, to promote patient safety and comfort.

 Out on PubMed, in JECT, from clinicians in India, is this case report: Electroconvulsive Therapy in a Patient With Mania and Ventriculoperitoneal Shunt: A Case Report. Karthik N, Jolly AJ, Selvaraj S, Varambally S. J ECT. 2022 Apr 14. doi: 10.1097/YCT.0000000000000849. Online ahead of print. PMID:  35462390 The report is here . And copied below: This is a straightforward case report of safe and effective ECT in a patient with a VP shunt. The clinical details are well presented. A quick check on PubMed shows several additional similar cases not listed in the references. And this is probably more common in clinical practice than suggested by the few reports: I recall a maintenance ECT patient with a VP shunt whom we treated for many years...

 Out on PubMed, in JECT, from European colleagues, is this paper: Preliminary Assessment of Pre-Electroconvulsive Therapy Evaluation Practices in European Countries: The Need for Guidelines. Medved S, Žaja N, Gazdag G, Lengvenyte A, Mörkl S, Mucci F, Ristić I, Jerotić S, Regente JF, Ivanović I, Purišić A, Sasvary F, Sivasanker V, Ziblak A, Lookene M, Sienaert P, Szczegielniak A, Trančik P, Bećirović E, Koutsomitros T, Grech G, Tapoi C, Radmanović B, Ströhle A, Bajs Janović M, Sartorius N. J ECT. 2022 Apr 23. doi: 10.1097/YCT.0000000000000854. Online ahead of print. PMID:  35462388 The abstract is copied below: Objectives: Pre-electroconvulsive therapy (ECT) evaluation is an essential part of ECT preparation, a standard treatment in the psychiatric field. However, no routine pre-ECT evaluation has been published so far. This preliminary study aimed to explore different practices in pre-ECT evaluation across European countries. Methods: The data were collected as a snowball samp...

 Out on PubMed, in JECT, from investigators in Germany, is this paper: Provision of Electroconvulsive Therapy During the COVID-19 Pandemic: A Survey Among Clinics in Germany, Austria, and Switzerland. Karl S, Schönfeldt-Lecuona C, Sartorius A, Grözinger M. J ECT. 2022 Apr 14. doi: 10.1097/YCT.0000000000000846. Online ahead of print. PMID:  35462387 The abstract is copied below: The coronavirus disease 2019 (COVID-19) pandemic has had a marked impact on psychiatry. Capacity reductions also affected electroconvulsive therapy (ECT), even though ECT is an essential rather than an elective procedure. We sent a survey to all 197 clinics in Germany, Austria, and Switzerland with an ECT service between March and May 2021 to provide an overview of the changes made to ECT services in these countries during the acute phase of the COVID-19 pandemic. More than a quarter of the clinics (27.0%) reported a temporary suspension of all ECT treatments, and 28.2% of the clinics reported reduction...

 Out on PubMed, in Lancet Psychiatry, from investigators in Canada, is this study: Risk of suicide death following electroconvulsive therapy treatment for depression: a propensity score-weighted, retrospective cohort study in Canada. Kaster TS , Blumberger DM, Gomes T, Sutradhar R, Wijeysundera DN, Vigod SN. Lancet Psychiatry. 2022 Apr 26:S2215-0366(22)00077-3. doi: 10.1016/S2215-0366(22)00077-3. Online ahead of print. PMID:  35487236 The abstract is copied below: Background: Previous studies examining the risk of suicide death after treatment with electroconvulsive therapy have been confounded and the resulting uncertainty around the risk-benefit profile of electroconvulsive therapy might contribute to its underuse. We aimed to compare the risk of death by suicide after psychiatric hospitalisation among individuals with depression who had been exposed to electroconvulsive therapy with those who had not. Methods: This was a propensity score-weighted, retrospective cohort study...

 Out on PubMed, from academics in Denmark, is this review: [ Electroconvulsive  therapy remains the most effective treatment for depression]. Martens T, Gbyl K. Ugeskr Laeger. 2022 Apr 4;184(14):V11210827. PMID:  35410651   Danish. The abstract is copied below: This review summarises the current knowledge of electroconvulsive therapy (ECT) which is still the most potent and fast-acting antidepressant intervention. The modern procedure is safe when general precautions are taken. Cognitive side effects are transient in most patients, and concerns about side effects should not prevent relevant use. Due to the prognostic benefits of rapid remission, ECT should, in relevant patients, be considered early in the treatment course. Patients should be offered maintenance pharmacotherapy, and, in high-risk cases, tapering of the acute ECT course or maintenance ECT, in order to reduce the risk of relapse. The article is here . And from the text: While most of us do not speak Dan...