Clinical Neuroscience of ECT (CNECT)

 "Classics in ECT" brings you this study from 1973, in Acta Psychiatrica Scandinavica: The prophylactic value of extra  ECT  in depressive illness. Barton JL, Mehta S, Snaith RP. Acta Psychiatr Scand. 1973;49(4):386-92. doi: 10.1111/j.1600-0447.1973.tb04432.x. PMID:  4746007 The pdf is here . And from the text: Here is a classic that is good to know about, but to not give much credence to. Despite the data being the data, this study just plain got it wrong, as decades of subsequent experience have show. C/M ECT has since been convincingly proven to be effective; this study was flawed in many ways... One interesting finding in these data is the variable speed of response to ECT, with some patients achieving remission with a very small number of treatments. Students/scholars of ECT will want to be familiar with this "two for the road" study, as a reminder that progress in ECT research is sometimes not linear...

 Out on PubMed, from investigators at Washington University in St. Louis and elsewhere, is this paper: Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity. Kafashan M, Brian Hickman L, Labonte AK, Huels ER, Maybrier H, Guay CS, Subramanian S, Farber NB, Ching S, Hogan RE, Kelz MB, Avidan MS, Mashour GA, Palanca BJA. Clin Neurophysiol. 2022 Jul 30;142:125-132. doi: 10.1016/j.clinph.2022.07.493. Online ahead of print. PMID:  36030576 The abstract is copied below: Objective: Periods of low-amplitude electroencephalographic (EEG) signal (quiescence) are present during both anesthetic-induced burst suppression (BS) and postictal generalized electroencephalographic suppression (PGES). PGES following generalized seizures induced by electroconvulsive therapy (ECT) has been previously linked to antidepressant response. The commonality of quiescence during both BS and PGES motivated trials to recapitulate the antidepressant ef...

Out on PubMed, from clinicians in Japan, is this case report: Successful  electroconvulsive   therapy for 22q11.2 deletion syndrome with Schizophrenia and Parkinson's disease. Tanifuji T, Otsuka I, Kimura A, Horai T, Okazaki S, Satake W, Hishimoto A. Psychiatry Clin Neurosci. 2022 Sep 3. doi: 10.1111/pcn.13467. Online ahead of print. PMID:  36057137 The report is here . And here is the text: This is a least-publishable unit (publishable only because of the genetic syndrome) that nonetheless is helpful to have in the literature. No surprise that ECT benefits both the psychotic symptoms of schizophrenia and the motor symptoms of Parkinson's Disease. Any addition to the evidence base for the use of ECT in these "orphan" indications (yes, schizophrenia is still such in the USA, at least) is most welcome. Kudos to our Japanese colleagues!

 Out on PubMed, from researchers in Australia and Singapore, is this study: The utility of the Sydney Melancholia Prototype Index (SMPI) for predicting response to electroconvulsive therapy in depression: A CARE Network study. Waite S, Tor PC, Mohan T, Davidson D, Hussain S, Dong V, Loo CK, Martin DM. J Psychiatr Res. 2022 Aug 19;155:180-185. doi: 10.1016/j.jpsychires.2022.08.011. Online ahead of print. PMID:  36054966 The abstract is copied below: An enhanced understanding of clinical predictors of positive ECT outcome could assist with the decision to prescribe ECT for select patients. Reliable predictors of ECT response such as psychotic symptoms and age have been identified, however, studies of melancholia and ECT response have been inconsistent. The Sydney Melancholia Prototype Index (SMPI) is a clinical measure designed to differentiate melancholic and non-melancholic depression. This study aimed to investigate whether melancholic depression (as measured by the clinician...

I   will be on hiatus from September 21-27, resuming on the 28th. Please feel free to review prior blog posts, and don't forget to check PubMed.  

 Out on PubMed, from Canadian researchers, is this study: Impact of medications, mood state, and electrode placement on  ECT  outcomes in treatment-refractory psychosis. Ainsworth NJ, Avina-Galindo AM, White RF, Zhan D, Gregory EC, Honer WG, Vila-Rodriguez F. Brain Stimul. 2022 Aug 24;15(5):1184-1191. doi: 10.1016/j.brs.2022.08.012. Online ahead of print. PMID:  36028155 The abstract is copied below: Background: Treatment-refractory psychosis (TRP) is a significant clinical challenge. While clozapine is frequently effective, alternate or augmentation strategies are often necessary. Evidence supports effectiveness of electroconvulsive therapy (ECT), but questions remain about optimal treatment parameters and impacts of concomitant pharmacotherapy. Objective: /Hypothesis: To analyze the impact of clozapine, anticonvulsant medication, mood state, and ECT electrode placement on outcomes in TRP. We hypothesized that ECT would lead to greater reduction in positive symptoms...

Out on PubMed, from researchers in Germany, is this LTE: Hippocampal neuroplasticity, major depression and, not to forget:  ECT . Sartorius A, Karl S, Zilles-Wegner D. Mol Psychiatry. 2022 Aug 29. doi: 10.1038/s41380-022-01746-w. Online ahead of print. PMID:  36038727   The letter is here . And here: Nicely dividing the evidence between animal and human studies, the authors make the case for the centrality of ECT in elucidating the etiopathogenesis of depression. They call out a prior publication in Molecular Psychiatry for having overlooked ECT. Kudos to Drs. Sartorius, Karl, and Zilles-Wegner for standing up for the scientific and clinical importance of ECT. 

 "Classics in ECT" brings you this case report from 1972: Combined cardioversion and ECT in chronic atrial fibrillation. Report of a case. Moriarty JD. Psychosomatics. 1972 Nov-Dec;13(6):388-9. doi: 10.1016/S0033-3182(72)71389-4. PMID:  4671887   The article is here . And here: This is an interesting classic case in which two procedures were done in close temporal proximity under the same anesthesia. That anesthesia happened to be high dose diazepam, and yet seizures were elicited. The excellent results, both psychiatric and cardiologic, are gratifying.

Out on PubMed, from investigators in India, is this study: Can yoga practise prevent electro-convulsive therapy induced neurocognitive deficits? - Findings from a pilot randomised controlled trial. Sudheer N, Kumar V, Bhide SR, Naik SS, Baliga S, Varambally S, Thirthalli J, Gangadhar BN. Asian J Psychiatr. 2022 Aug 15;76:103244. doi: 10.1016/j.ajp.2022.103244. Online ahead of print. PMID:  36037698 The abstract is copied below: Despite decades of experience with ECT, no single agent has emerged as a suitable strategy to mitigate the associated neuro-cognitive deficits. In this first of its kind pilot randomised controlled trial, we sought to demonstrate the effect of yoga on neurocognitive deficits. We found a favourable effect of Yoga in the domain of verbal fluency, however our study did not reveal significant differences in other cognitive domains. Future studies could look to build on this study while addressing the limitations cited. Keywords: ECT neurocognitive deficits yoga....

Out on PubMed, from authors in Japan, is this paper: Long-lasting leukocytosis in patients with schizophrenia treated with clozapine after  electroconvulsive  therapy : ECT stabilizes white blood cell count. Sugita K, Mori Y, Kanemoto K, Sugita S. Sci Prog. 2022 Jul-Sep;105(3):368504221117067. doi: 10.1177/00368504221117067. PMID:  36000301 The abstract is copied below: Introduction: The present study was conducted to investigate the possible hematologic impact of long-term electroconvulsive therapy (ECT) in patients with drug-resistant schizophrenia and receiving clozapine therapy. Subjects and methods: In this retrospective study, clinical charts of 57 hospitalized patients with schizophrenia who required clozapine therapy because of active psychotic symptoms resistant to other antipsychotics were examined. For 18 who underwent ECT, the first assessment was conducted at the end of that therapy (average two months after start, 7.68 sessions) and the second two months lat...

Out on PubMed, from authors in Australia, is this review: A systematic review of modified Electroconvulsive Therapy ( ECT ) to treat delirium. Lupke K, Warren N, Teodorczuk A, Steele S, Kolur U, Wand A, Robinson G, Parker S. Acta Psychiatr Scand. 2022 Aug 22. doi: 10.1111/acps.13492. Online ahead of print. PMID:  35996219   Review. The abstract is copied below: Background: Delirium is costly for patients, carers, and healthcare systems. In addition, non-pharmacological and pharmacological management of delirium is challenging. ECT has been proposed and used as an anecdotal treatment of delirium in clinical practice. However, the efficacy and safety of this approach are not well understood. Objective: To synthesise and review the evidence relating to the safety and efficacy of ECT as a treatment for delirium. Methods: A systematic review was completed according to PRISMA guidelines using the PubMed, CINAHL, Cochrane Library, and PsycINFO databases. Studies were eligible for inc...

 Out on PubMed, from clinicians in New Delhi, India, is this LTE case report: Effectiveness of electroconvulsive therapy in acute management of delirious mania in COVID-19 positive woman in second trimester pregnancy. Bhasin A, Saini R, Verma R, Rajkumar TS, Singh A, Singh AK, Tousifullah M. Asian J Psychiatr. 2022 Aug 9;76:103230. doi: 10.1016/j.ajp.2022.103230. Online ahead of print. PMID:  35994926 The abstract is copied below: Delirious mania has been described as a state of acute excitement, fluctuating sensorium, affective and catatonic symptoms. Electroconvulsive therapy (ECT) despite being an effective treatment modality in such cases, has been under-utilised during pregnancy, mainly due to safety concerns. Here, we report the effectiveness of ECT in acute management of delirious mania in a 24 weeks pregnant woman who also tested COVID-19 positive during hospitalisation. Patient presented with three weeks history of acute manic excitement with period of altered sensori...

 Out on PubMed, from researchers in Belgium, is this case report in JECT: Lateralized Raise in Intraocular Pressure During  Electroconvulsive  Therapy: A Tonometry Pilot Study. Vandeurzen J, Vansteelandt K, Lemmens S, Sienaert P. J ECT. 2022 Aug 9. doi: 10.1097/YCT.0000000000000879. Online ahead of print. PMID:  35969842 The abstract is copied below: Objective: The aim of this study was to evaluate intraocular pressure (IOP) changes during and after electroconvulsive therapy. Methods: In 20 patients, IOP was measured using a handheld iCare tonometer before, during, and up to 15 minutes after the seizure. Electrode placement was either right unilateral (RUL) or bilateral (BL). Statistical analyses were done at baseline, during, and 15 minutes after the seizure. Results: In the RUL group (n = 14), the IOP in the left eye increased from 14.8 mm Hg before the seizure to 27.8 mm Hg during the seizure (P = 0.0001) and decreased to 14.0 mm Hg after the seizure (P = 0.0002)....