Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from authors in India, is this LTE: Should We Re-estimate the Seizure Threshold during Maintenance  ECT ? Purohith AN, Jammigumpula A, Praharaj SK. Indian J Psychol Med. 2023 Nov;45(6):658-659. doi: 10.1177/02537176231172309. Epub 2023 Jun 11. PMID:  38545525 The LTE is here . And here: While the overall premise of this letter is reasonable, the case details are so random and meagre, that not much can be gleaned from them.  There is no mention that the parameters of the stimulus package influence ST, there is no mention of the original ST, and EEG was not recorded. Yes, ST increases with ongoing treatment, and it decrements over time. Reasonable stimulus doses should be administered in both the acute series and during continuation/maintenance ECT. Re-titration in the transition to C/MECT is usually not necessary. Kudos to these authors for bringing readers attention to the issue of appropriate stimulus dosing in all phases of ECT care.

Out on PubMed, from authors in Romania, is this review: Neurobiological mechanisms and therapeutic impact of electroconvulsive therapy ( ECT ). Cojocaru AM, Vasile AI, Trifu SC. Rom J Morphol Embryol. 2024 Jan-Mar;65(1):13-17. doi: 10.47162/RJME.65.1.02. PMID:  38527979 The abstract is copied below: Electroconvulsive therapy (ECT) is an efficient therapeutic resource for psycho-pharmacotherapeutic resistant forms of depression. ECT is a form of electrical brain stimulation involving the induction of a controlled seizure, clinically similar to an epileptic seizure, that is initiated in the prefrontal region of the brain and spreads to the cortex and subcortex, including the diencephalic structures. This is achieved by creating a transcranial electric field and synchronously depolarizing neuronal membranes. The mechanisms of action of ECT are not yet fully understood, but several hypotheses have been proposed to explain how it affects the brain: neurotransmitter changes, neuroplastic...

Out on PubMed, in JECT, from authors in Australia, is this case report: Safe Delivery of Electroconvulsive Therapy in Postpartum Depression Patient With Type 1 Chiari Malformation: A Case Study. Sarma S, Quinn E, Branjerdporn G. J ECT. 2024 Mar 26. doi: 10.1097/YCT.0000000000000999. Online ahead of print. PMID:  38530929   The case report is here . And here: Here is a nicely presented case report adding to the evidence base of the safety of ECT in patients with Chiari Type 1 malformations. Seems like this is turning out to be a situation where theoretical risks are not likely to be born out in practice; of course, caution and prudence are still indicated. Beyond the neurological/neurosurgical implications, this case reminds us of the importance of ECT in the treatment of postpartum depression and postpartum psychosis. Kudos to our Australian colleagues for this contribution to the ECT literature.

I'm sure some people will misconstrue this, either by accident, or purposefully. I wonder if APA could choose a more informative, instructive headline, in order to preclude any confusion? 

 Out on PubMed, from authors in Turkey, is this paper: Effect of Different Doses of Sugammadex on Recovery and Hemodynamic Parameters in Reversing Neuromuscular Blockade in Patients Undergoing Electroconvulsive Therapy. Arslan K, Kucuksarac G, Cetin Arslan H, Aydin E, Sahin AS. Medeni Med J. 2024 Mar 21;39(1):16-23. doi: 10.4274/MMJ.galenos.2024.60052. PMID:  38511727 The abstract is copied below: Objective: This retrospective observational study aimed to investigate the effect of different doses of sugammadex used in reversing neuromuscular blockade in electroconvulsive therapy (ECT) procedures on patient recovery and hemodynamic measurements. Methods: Anesthesia induction was performed using propofol (1 mg/kg) and rocuronium (0.4 mg/kg). Patients were classified into group 2 (2 mg/kg) and group 3 (3 mg/kg) according to the dose of sugammadex used to reverse neuromuscular blockade. The patient's spontaneous breathing time, eye-opening time, time to comply with voluntary comma...

Out on PubMed, from clinicians in Pennsylvania and New Jersey, is this case report: Genesis of Mental Disorders: Could It Be Cavum Septum Pellucidum (CSP) et Vergae? A Case Report of CSP in Schizophrenia with Catatonia. Zuckerberg A, Pothen N, Fitzsimmons A. Innov Clin Neurosci. 2024 Mar 1;21(1-3):63-65. eCollection 2024 Jan-Mar. PMID:  38495604 The abstract is copied below: I n our case report, a 29-year-old male patient with a known history of schizophrenia presented with altered mental status and catatonia and was found to have an enlarged (21mm) cavum septum pellucidum (CSP) on magnetic resonance imaging (MRI). He was subsequently treated with escitalopram, olanzapine, methylphenidate, lorazepam, and eight electroconvulsive therapy (ECT) treatments during his hospital course, after which his catatonia improved . We compared this to other cases in which a large CSP was identified and discussed the possibility of increased susceptibility to psychosis, specifically catatonia, whic...

 Out on PubMed, from American authors, is this paper: Cognitive effects of electroconvulsive therapy in depressed adolescents. Ghaziuddin N , McClintock SM, Maixner DF, Miller LR, Husain M, Wachtel LE, Siddiqi SH, Flood M, Weinstein S, Frye MA, Weiner RD; National Network of Depression Centers (NNDC) Neuromodulation and Children Adolescent Mood Disorders Task Groups. J Affect Disord. 2024 Mar 11:S0165-0327(24)00465-8. doi: 10.1016/j.jad.2024.03.050. Online ahead of print. PMID:  38479508   No abstract available. The article is here . And from the text: This is a brief statement from the NNDC to set the record straight about the clinical importance of ECT for severely psychiatrically ill youth, and the need to keep ECT accessible for this population. I urge all ECT healthcare professionals to read the statement in full. Kudos to Dr. Ghaziuddin and colleagues for this cogent, matter-of-fact, and very important commentary.

Out on PubMed, from authors in India, is this article: Development, validation and clinical utility of short-term adverse-effects of electroconvulsive therapy (SAVE) checklist. Uppinkudru C, Pathak H, Kumar K R, S B, Bagali K, Pantoji M, Ezhumalai N, Parlikar R, Shah V, Balachander S, Sreeraj VS, Mehta UM, Sinha P, Arumugham SS, Venkatasubramanian G, Thirthalli J. Psychiatry Res. 2024 Mar 7;335:115839. doi: 10.1016/j.psychres.2024.115839. Online ahead of print. PMID:  38503006 The abstract is copied below: Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. However, it has many cognitive and non-cognitive adverse effects (AEs). There are lacunae in the literature on systematic assessment of non-cognitive AEs. There is a need for a standard, comprehensive and specific clinical tool to evaluate this. Hence, a checklist of short-term AEs of ECT (SAVE) with a 2-phase assessment was developed. Content validation was done using 15 experts' ratings and p...

 Kindly check PubMed for new ECT articles this week, and feel free to review past topics on this blog. Thanks, CK

Out on PubMed, from researchers in China, is this study: Mechanism of  electroconvulsive  therapy in schizophrenia: a bioinformatics analysis study of RNA-seq data. Wang T, Yu M, Gu X, Liang X, Wang P, Peng W, Liu D, Chen D, Huang C, Tan Y, Liu K, Xiang B. Psychiatr Genet. 2024 Apr 1;34(2):54-60. doi: 10.1097/YPG.0000000000000362. Epub 2024 Mar 1. PMID:  38441120 The abstract is copied below: Objective: The molecular mechanism of electroconvulsive therapy (ECT) for schizophrenia remains unclear. The aim of this study was to uncover the underlying biological mechanisms of ECT in the treatment of schizophrenia using a transcriptional dataset. Methods: The peripheral blood mRNA sequencing data of eight patients (before and after ECT) and eight healthy controls were analyzed by integrated co-expression network analysis and the differentially expressed genes were analyzed by cluster analysis. Gene set overlap analysis was performed using the hypergeometric distribution of phyp...

Out on PubMed, from authors in Australia, is this paper: An audit and analysis of electro convulsive therapy patient information sheets used in local health districts in New South Wales Australia. Wand T, Isobel S, Kemp H. Int J Ment Health Nurs. 2024 Mar 13. doi: 10.1111/inm.13318. Online ahead of print. PMID:  38477074 The abstract is copied below: Electroconvulsive Therapy (ECT) is a widely used psychiatric treatment; however, it remains contentious. It is therefore important that people are provided with accurate and balanced information before consenting to ECT. The aim of this study was to audit and analyse the content and language of ECT information sheets used in local health districts (LHDs) across the state of New South Wales Australia. Descriptive content analysis and evaluative linguistic analysis were used to investigate the information sheets, with findings then considered from a mad studies perspective. Thirteen ECT information sheets were obtained and reviewed, wit...

Out on PubMed, from authors in China, is this paper: Clinical efficacy of adjunctive esketamine anesthesia in electroconvulsive therapy for major depressive disorders: A pragmatic, randomized, controlled trial. Ren L, Chen Q, Gao J, Liu Y, Tao Y, Li X, Luo Q, Lv F, Min S. Psychiatry Res. 2024 Mar 6;335:115843. doi: 10.1016/j.psychres.2024.115843. Online ahead of print. PMID:  38461645 The abstract is copied below: Electroconvulsive therapy (ECT) is an effective treatment for depression, and esketamine has been shown to have antidepressant effects. However, it is currently unclear whether adjunctive esketamine can enhance the clinical efficacy of ECT in real-world clinical practice. In this pragmatic clinical trial, patients with major depression were randomly assigned into two groups: patients received 0.25 mg/kg esketamine plus propofol (esketamine group) or the same volume of saline (control group) plus propofol. Results indicated that there was no difference in response and remi...

 Out on PubMed, from researchers in Sweden, in JECT, is this responsive LTE: Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study. Popiolek K, Arnison T, Boden R, Ekman CJ, Lundberg J, Strandberg P, Nordenskjöld A. J ECT. 2024 Mar 6. doi: 10.1097/YCT.0000000000001005. Online ahead of print. PMID: 38456234 The letter is here . And here: Here is the response of the Swedish researcher team to Pridmore's methodological critique. (Please see yesterday's blog post.) They did the requested re-analysis of the data, and confirmed the original superiority of ECT. There has never been a shortage of people in our field who jump at every opportunity to demean ECT and prematurely tout other treatments as replacements. But the clinical reality remains that ECT is the "gold standard."

 Out on PubMed, in JECT, is this LTE: The Relative Potency of  ECT  and TMS. Pridmore S. J ECT. 2024 Mar 6. doi: 10.1097/YCT.0000000000001006. Online ahead of print. PMID:  38456225 The letter is here . And here: Dr. Pridmore has long been an outspoken booster of rTMS. We will see the response to his methodological critique of the Swedish register study tommorow in the authors' response LTE.

Catatonia Induced by First-Time Use of Synthetic Cannabinoids: A Case Report. Puri A, Costanzo F, Rivera J, Bujdos J. Cureus. 2024 Jan 31;16(1):e53324. doi: 10.7759/cureus.53324. eCollection 2024 Jan. PMID:  38435863 The abstract is copied below: We present the case of a 32-year-old woman who developed life-threatening catatonia in the setting of synthetic cannabis use . She was treated with high doses of lorazepam (up to 26 mg) and eventually transferred to receive electroconvulsive therapy (ECT) . Synthetic cannabis poses a unique risk as it is widely available, difficult to regulate, and with adverse effects that are not well understood due to the presence of ever-changing chemical compounds. In this case report, we present one of the first cases of catatonia induced by first-time synthetic cannabinoids with no previous history of cannabis use disorder. Keywords:  cannabinoids; cannabis-induced catatonia; case report; catatonia; synthetic cannabis. The report is here . And ...