Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from researchers in Brazil, is this study: Relative impact of diagnosis and clinical stage on response to electroconvulsive therapy: a retrospective cohort. Tedeschi E, Hoffmann MS, Magalhaes PVS. Braz J Psychiatry. 2023 May 27. doi: 10.47626/1516-4446-2023-3058. Online ahead of print. PMID:  37243982 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) is commonly indicated for refractory psychiatric disorders. However, response comparison across diagnoses is scantly investigated. Here, we aimed to evaluate the relative impact of diagnosis and clinical staging as response predictors in a cross-diagnostic sample. Methods: We investigate, in a retrospective cohort of adult inpatients (N=287) who underwent at least six sessions of ECT, predictors of complete response (a clinical global impression of 1) to ECT. We use adjusted regression models to estimate the impact of clinical diagnosis and staging on complete response and dominance analysis to as...

Dear Blog Followers, The blog will be on hiatus for much of the rest of the month of May, but with possible sporadic postings. I encourage you to check for new citations on PubMed and to review prior discussions on this blog. I am trying to learn if it is possible to send email notifications to followers whenever a new post is published.  I am aware that there have recently been glitches with posting comments; I will try to see if that can be corrected, as well. Thanks much, CK

 Out on PubMed, from investigators in the Netherlands, is this review: Pharmacological prevention of postictal agitation after electroconvulsive therapy-A systematic review and meta-analysis. Feenstra TC, Blake Y, Hoogendoorn AW, Koekenbier K, Beekman ATF, Rhebergen D. Front Psychiatry. 2023 Apr 20;14:1170931. doi: 10.3389/fpsyt.2023.1170931. eCollection 2023. PMID:  37151968 Background: Postictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7-36% of patients and recur in 19-54% of patients . PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT. Method: A systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception...

Out on PubMed, from clinicians in Japan, in JECT is this LTE: Automatic Change in Pacemaker Mode During Electroconvulsive Therapy in a Patient With an Implantable Cardiac Pacemaker. Kadoi Y, Sano M, Nakano T, Saito S. J ECT. 2023 Apr 24. doi: 10.1097/YCT.0000000000000927. Online ahead of print. PMID:  37145880   The letter is here: This is an interesting letter reporting a rare event with a pacemaker. Scholars of ECT anesthesia will want to read it carefully. There is a typo in the sux dose.

Out on PubMed, from authors in Michigan, is this case report: Efficacious retrial of electroconvulsive therapy for major depressive disorder after a prolonged seizure in an older adult. Kramkowski J, Rath S. BMJ Case Rep. 2023 May 2;16(5):e247633. doi: 10.1136/bcr-2021-247633. PMID:  37130644 The abstract is copied below: This is a case of a woman in her 70s with treatment-resistant major depression who was admitted psychiatrically for the fifth time in 1.5 years. She had a history of intensive psychotherapy and psychotropic medication trials with poor efficacy. She also had a history of adverse complications to electroconvulsive therapy (ECT) with prolonged seizures and postictal confusion during her third hospitalisation. At her fifth hospitalisation, due to poor response to routine psychiatric treatment, ECT was pursued. We discuss challenges in pursuing ECT and the outcome of the retrial of an acute ECT series, in the context of a paucity of similar literature regarding geriatr...

 Out on PubMed, from authors in Chicago, in JECT, is this case report: Challenges to Electroconvulsive Therapy in Pediatric Catatonia: A Case Report. Hua T, Cooper JJ. J ECT. 2023 Apr 24. doi: 10.1097/YCT.0000000000000920. Online ahead of print. PMID:  37125964 The report is here . And here: This is an excellent and instructive case report. "Antibody negative autoimmune encephalitis." Wow, that is right up there with "normal pressure glaucoma." Once again, invasive immunologic therapies are tried, resulting in slight improvement, but long delays before instituting ECT. The thinking is, "of course, ECT cannot be a primary treatment for an immunological or neurological illness." Perhaps this thinking needs to change... Kudos to Drs. Hua and Cooper for their contribution to the catatonia literature.

 Yesterday, Dr. Katarzyna Popiolek from Sweden, reviewed her recent JAMA Network Open article for Dr. George Kirov's monthly journal club. Here are a couple of her slides: I had previously blogged about her paper on July 21,2022, copied below: Out on PubMed, from researchers in Sweden, is this study: Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania. Popiolek K, Bejerot S, Landén M, Nordenskjöld A. JAMA Netw Open. 2022 Jun 1;5(6):e2218330. doi: 10.1001/jamanetworkopen.2022.18330. PMID:  35737387 The abstract is copied below: Importance: Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. Objective: To investigate the response to ECT in patients with manic episodes. Design, setting, and participants: ...

 PubMed citation figures: "ECT" : 11,149 "Electroconvulsive": 18,390 "Electroconvulsive Therapy": 16,921 "Convulsive Therapy": 24,354 Here are the PubMed citation figures as of May 2, 2023 for the several search terms for what we do. "ECT" contains a lot of extraneous stuff: e.g. "extracorporeal therapy," "electrochemotherapy," etc. The bar graphs show that the field is thriving.

 Out on PubMed, from investigators in Germany, is this paper: Effects of Anesthesia Changes During Maintenance  ECT : A Longitudinal Comparison of Seizure Quality Under Anesthesia Using Propofol/Esketamine Versus Methohexital. Methfessel I, Zilles-Wegner D, Kunze-Szikszay N, Belz M. Pharmacopsychiatry. 2023 Apr 28. doi: 10.1055/a-2058-9010. Online ahead of print. PMID:  37116539 The abstract is copied below: Introduction: The effectiveness of ECT relies on the induction of a generalized cerebral seizure. Among others, seizure quality (SQ) is potentially influenced by the anesthetic drug used. Commonly used anesthetics comprise barbiturates, etomidate, propofol, and esketamine, with different characteristics and impacts on seizure parameters. So far, no studies have compared the influence of methohexital vs. a combination of propofol/esketamine on established SQ parameters. Methods: This retrospective longitudinal study compared eight established SQ parameters (PSI, ASEI, ...