Clinical Neuroscience of ECT (CNECT)

Out on Pubmed, from authors in the UK and Germany, is this paper: Fronto-medial electrode placement for electroconvulsive treatment of depression. Steele JD, Farnan T, Semple DM, Bai S. Front Neurosci. 2022 Oct 20;16:1029683. doi: 10.3389/fnins.2022.1029683. eCollection 2022. PMID:  36340770 The abstract is copied below: Electroconvulsive therapy (ECT) is the most effective treatment for severe treatment-resistant depression but concern about cognitive side-effects, particularly memory loss, limits its use. Recent observational studies on large groups of patients who have received ECT report that cognitive side-effects were associated with electric field (EF) induced increases in hippocampal volume, whereas therapeutic efficacy was associated with EF induced increases in sagittal brain structures. The aim in the present study was to determine whether a novel fronto-medial (FM) ECT electrode placement would minimize electric fields in bilateral hippocampi (HIP) whilst maximizing ele...

Out on PubMed, from investigators in Denmark and the USA is this study: The use of  electroconvulsive  therapy (ECT) en bloc in Denmark: a nationwide register-based study. Pedersen MI, Salagre E, Kellner CH, Rohde C, Østergaard SD. Nord J Psychiatry. 2022 Nov 7:1-7. doi: 10.1080/08039488.2022.2142279. Online ahead of print. PMID:  36344233 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) en bloc is defined as ECT administered on 2-3 consecutive days. In Denmark, ECT en bloc is recommended for severe conditions such as catatonia, treatment-resistant mania/psychosis, or imminent risk of suicide. To our knowledge, there are no recent reports on the use of ECT en bloc in clinical practice. Here, we provide such a report. Methods: We characterized the use of ECT en bloc in the period from 2006-2019 based on data from Danish national registers. Furthermore, we compared mortality rates between patients receiving ECT en bloc and patients receiving standard...

Out on PubMed, from authors in Thailand, is this article: Electroconvulsive Therapy Practice in Thailand: A Nationwide Survey. Kittayarak K, Ittasakul P. Neuropsychiatr Dis Treat. 2022 Oct 31;18:2477-2484. doi: 10.2147/NDT.S385598. eCollection 2022. PMID:  36338515 The abstract is copied below: Objective: To determine the characteristics of electroconvulsive therapy (ECT) practice in Thailand. Methods: A cross-sectional survey of ECT practice in Thailand was conducted. A questionnaire was sent to all 34 hospitals providing ECT services nationwide. ECT staff of each hospital were asked to complete the questionnaire. Results: All 34 hospitals responded to the survey. The most common diagnosis was schizophrenia (5,958 patients/year), followed by bipolar disorder (982 patients/year) and major depressive disorder (869 patients/year). Brief pulse device was used in all hospitals. Bitemporal ECT was the most common type of electrode placement (88.2%), followed by bifrontal (44.1%) and rig...

I   will be on  hiatus  from November 23-28, resuming on the 29th. Please feel free to review prior blog posts, and don't forget to check PubMed.

Out on PubMed, from investigators in Denmark, is this study: Cerebral perfusion is related to antidepressant effect and cognitive side effects of  Electroconvulsive  Therapy. Gbyl K, Lindberg U, Wiberg Larsson HB, Rostrup E, Videbech P. Brain Stimul. 2022 Nov 1:S1935-861X(22)00230-3. doi: 10.1016/j.brs.2022.10.007. Online ahead of print. PMID:  36332891 The abstract is copied below: Background: The mechanisms underlying the antidepressant effect and cognitive side effects of Electroconvulsive Therapy (ECT) remain elusive. The measurement of cerebral perfusion provides an insight into brain physiology. Objective: We investigated ECT-related perfusion changes in depressed patients and tested whether these changes correlate with clinical effects. Methods: A sample of 22 in-patients was examined at three time points: 1) within two days before, 2) within one week after, and 3) six months after an ECT series. Cerebral perfusion was quantified using arterial spin labeling magnet...

Out on PubMed, from an anesthesiologist in Seattle, is this review: Contemporary Anesthetic Evaluation and Management for Electroconvulsive Therapy. Salinas FV. Adv Anesth. 2022 Dec;40(1):201-221. doi: 10.1016/j.aan.2022.07.005. PMID:  36333048   Review. The abstract is copied below: Electroconvulsive therapy (ECT) is a medical treatment most often used in patients with severe major depression that has not responded to other treatments. ECT is also indicated for patients with other severe psychiatric conditions, including bipolar disorder, schizophrenia, schizoaffective disorders, catatonia, and neuroleptic malignant syndrome. Contemporary "modified ECT" involves inducing general anesthesia with neuromuscular blockade before inducing the therapeutic seizure. The goal of this review is to combine an evidence-based update with the experience of the author's institution to provide a practical approach to anesthetic care for the patient undergoing ECT. Keywords: Electroconvul...

"Classics in ECT" brings you this article by Dr. Fred Frankel in the American Journal of Psychotherapy, in 1984: The use of electroconvulsive therapy in  suicidal  patients. Frankel FH. Am J Psychother. 1984 Jul;38(3):384-91. doi: 10.1176/appi.psychotherapy.1984.38.3.384. PMID:  6486285 The abstract is copied below: Publications on the subjects of ECT and suicide stress the importance of ECT as a valuable treatment in appropriately selected cases of suicidal ideation or attempted suicide. There is no direct correlation between the degree of suicidality and the usefulness of ECT. In the management of cases with major affective disorder, particularly those showing delusions and vegetative signs, ECT should be considered early in the treatment. The presence of the potential for suicide provides an added incentive. However, suicidal threats or attempts on the part of patients with severe personality disorders are not likely to respond to ECT unless the picture is complic...

"Classics in ECT" brings you this study from 1998, in the Indian Journal of Psychiatry: Response to first ect in depression : a predictor of outcome. Gupta N, Avasthi A, Kulhara P. Indian J Psychiatry. 1998 Oct;40(4):322-6. PMID:  21494495   Response to first ECT in depression and its value as a predictor of response to ECT is a poorly researched subject. Twenty-two antidepressant-free patients of severe depression (ICD - 10) were administered a course of 6 ECTs using bilateral sine-wave electrical stimulation with serial assessments on Hamilton Depression Rating Scale (HDRS). Using 'a priori' definition for 'good response' (≥ 60% reduction is baseline HDRS scores) patients were grouped and analysed. The reduction in HDRS scores after first ECT was significantly greater for Good Responders (GR) in comparison to 'Poor responders'. It appeared that ≥ 9% reduction in baseline HDRS scores after the first ECT was associated with 'Good Response'. Th...

 Out on PubMed, from clinicians in Texas, is this report: Safety and efficacy of ketamine-augmented electroconvulsive therapy in third trimester pregnancy complicated by COVID-19. Patel A, Saucier AC, Hobday C, Chacko R. Proc (Bayl Univ Med Cent). 2022 Aug 8;35(6):874-875. doi: 10.1080/08998280.2022.2106415. eCollection 2022. PMID:  36304628   The abstract is copied below: Major depressive disorder during pregnancy can be detrimental to the fetus and patient. Treatments can include electroconvulsive therapy (ECT) for severe cases. The use of ketamine in ECT can provide symptomatic relief as well as induce anesthesia. Here, we describe the case of a 35-year-old gravid woman with a long-standing history of major depressive disorder who presented with treatment-resistant depression with suicidal ideation after an alteration in her antidepressant medication. After psychiatric evaluation, she was deemed to be a good candidate for ECT augmented with ketamine for symptomatic rel...

Out on PubMed, from clinicians in China, is this case report: Electroconvulsive therapy combined with lithium developed reversible pure anomic aphasia: a case report. Yang Q, Cheng X, Su Z, Sun L, Li M. BMC Psychiatry. 2022 Oct 27;22(1):663. doi: 10.1186/s12888-022-04323-1. PMID:  36303177 The abstract is copied below: Background: Electroconvulsive therapy (ECT) combined with mood stabilizers is an effective method of treatment for manic episodes; however, there are controversial views on its side effects. Case presentation: A 53-year-old man was diagnosed with bipolar disorder during a manic episode, and had previous conditions such as hypertension, and diabetes. He developed reversible delirium and anomic aphasia during combined treatment with lithium and ECT (Li-ECT). No other neurological symptoms or signs happened during the one-month follow-up period. Conclusions: The anomic aphasia appeared after ECT was reversible. Li-ECT should be administered with caution to middle- and o...

Out on Pubmed, from authors in China, is this paper: The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study. Lu Y, Tian Y, Gan Y, Fu Y, Chen Q, Zou L, Zhao B, Yan Y, Liu S, Chen X, Li X. Brain Sci. 2022 Oct 15;12(10):1393. doi: 10.3390/brainsci12101393. PMID:  36291326 The abstract is copied below: Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bip...

Out on PubMed, from authors in Japan, is this case series: Electroconvulsive therapy improves psychotic symptoms in patients with dementia with Lewy bodies. Fukatsu T, Kanemoto K. Int J Geriatr Psychiatry. 2022 Nov;37(11). doi: 10.1002/gps.5832. PMID:  36281953 The abstract is copied below: Purpose: The aim of this study was to examine the efficacy and safety of electroconvulsive therapy (ECT) for psychotic symptoms of dementia with Lewy bodies (DLB), and also to determine its use as an adaptive criterion. Methods: Eight patients aged 66-83 years old (mean 75.4 ± 5.9 years) diagnosed with probable DLB based on the criteria for DLB and who received ECT between September 2013 and December 2019 at Aichi Medical University were enrolled. The efficacy and safety of ECT were retrospectively examined. Psychotic symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS), while parkinsonism was evaluated based on Hoehn-Yahr (HY) stage, with both scores analyzed and compar...