Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from researchers in China, is this study: Real-world evidence from a retrospective study on suicide during depression: clinical characteristics, treatment patterns and disease burden. Wang H, Lyu N, Huang J, Fu B, Shang L, Yang F, Zhao Q, Wang G. BMC Psychiatry. 2024 Apr 19;24(1):300. doi: 10.1186/s12888-024-05726-y. PMID:  38641767 The abstract is copied below: Background: Suicide stands as both a primary symptom and the direst outcome of major depressive disorder (MDD). The scarcity of effective treatment strategies makes managing MDD patients with suicide especially challenging. Hence, it is crucial to investigate disease characteristics and efficacious therapeutic strategies for these patients, drawing insights from disease databases and real-world data. Methods: In this retrospective study, MDD patients hospitalized between January 2013 and December 2020 were investigated using Electronic Health Records (EHR) data from Beijing Anding Hospital. The study en...

 Out on PubMed, from authors in Germany, is this article: [ Electroconvulsive  therapy: what should be done when the needs exceed the treatment capacities?-A medical ethics guidance]. Zilles-Wegner D, Besse M, Methfessel I, Simon A. Nervenarzt. 2024 Apr 15. doi: 10.1007/s00115-024-01663-z. Online ahead of print. PMID:  38619598   German.   No abstract available The pdf is here . And Google translated here: This is a very nice piece about ECT resources and how to fairly and ethically apportion them in Germany. The demand for ECT is greater than the availability; a method of prioritizing patients is suggested. It would be interesting to hear about these issues in other countries as well. Kudos to Dr. Zilles-Wegner and co-authors for this important and thought-provoking article.

 Out on PubMed, from authors in Florida, is this case series: Psychotropic Management in Cotard Syndrome: Case Reports Supporting Dual Medication Management. Fusick AJ, Davis C, Gunther S, Klippel C, Sullivan G. Case Rep Psychiatry. 2024 Apr 9;2024:7630713. doi: 10.1155/2024/7630713. eCollection 2024. PMID:  38633733   The abstract is copied below: Cotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or psychiatric etiology and can be difficult to treat. Recently Couto and Gonçalves purposed that treatment should include an atypical antipsychotic alone or in combination with either a mood stabilizer or antidepressant. Here the authors advocate for a more specific but well-known psychotropic regimen, namely the combination of olanzapine and fluoxetine. We conducted a literature review and of 246 papers identified, only three reported using a combination of fluox...

Out on PubMed, from authors in The Netherlands, is this review: Non-Pharmacological Interventions for Depression and Anxiety in Parkinson's Disease. van Wegen EEH, van Balkom TD, Hirsch MA, Rutten S, van den Heuvel OA. J Parkinsons Dis. 2024 Apr 6. doi: 10.3233/JPD-230228. Online ahead of print. PMID:  38607762   Review. The review is here . And from the text:   ECT gets good coverage in this review of non-pharmacological interventions for depression and anxiety in PD. I am struck by the fact that most authors, as here, immediately need to say we don't know how ECT works, then pick one theory among many and suggest that is exactly how it works. Also, the important issue of ECT as a treatment for the core motor symptoms of PD is mentioned, but downplayed.

 Out on PubMed, from authors in China, is this case report: The abstract is copied below: Backgroud: Catatonia encompasses a group of severe psychomotor syndromes affecting patients' motor, speech, and complex behaviors. Common features include rigidity, reduced mobility, speech, sputum production, defecation, and eating. Risks associated with catatonia, such as increased muscle tension and reduced swallowing and coughing reflexes, along with risks from therapeutic approaches like prolonged bed rest and sedative drugs, can elevate the risk of aspiration pneumonia, severe pneumonia, and acute respiratory failure. These complications significantly impede catatonia treatment, leading to poor prognosis and jeopardizing patient safety. Case description: In this report, we present a case of catatonia complicated by severe pneumonia and respiratory failure, successfully managed with modified electroconvulsive therapy alongside tracheotomy. We hope this case provides valuable insights for...

 Out on PubMed, from clinicians in Japan, is this case report: Effects of right unilateral ultra-brief pulse  electroconvulsive  therapy in a depressed patient with dementia w ith Lewy bodies: a longitudinal case report. Yamaguchi Y, Kobayashi R, Muraosa H, Numazawa T, Morioka D, Sakamoto K, Suzuki A. Psychogeriatrics. 2024 Apr 16. doi: 10.1111/psyg.13127. Online ahead of print. PMID:  38627608   The report is here . And here: Here is a case report to remind us of the anti-Parkinsonian effect of ECT. The case is well presented, but the clinical care was flawed, as the dramatic benefit of the ECT was allowed to wane, since the ECT course was abruptly stopped, and neither tapered, nor followed with continuation ECT. The case also is a reminder of the need to be cautious in ECT technique in this patient population, to avoid delirium. The authors deserve kudos for this addition to the ECT in Parkinson's Disease literature, and hopefully will be more flexible in thei...

In the JAMA Patient Page feature, in the March 12, 2024 issue is this mention of ECT: The page is also here . This is actually a surprising and important recognition of ECT in one of the world's leading medical journals. Unfortunately, in last week's JAMA Patient Page on perinatal (postpartum) depression, there was no mention of ECT. The inclusion of ECT here is commendable, despite the description of electric "shocks." Kudos to the editors of JAMA for the accurate list of treatment options for severe bipolar disorder.

Out on PubMed, from authors mainly in South America, is this article: Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD). Corral R, Bojórquez E, Cetkovich-Bakmas M, Córdoba R, Chestaro J, Gama C, Bonetto GG, Jaramillo CL, Moreno RA, Ng B, de Leon EP, Risco L, Silva H, Vazquez G. Span J Psychiatry Ment Health. 2023 Sep 22:S2950-2853(23)00013-3. doi: 10.1016/j.sjpmh.2023.06.001. Online ahead of print. PMID:  38592432 The abstract is copied below: Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. Methods: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psyc...

 Out on PubMed, from authors in Turkey, in JECT, is this case report: Letter to the Editor: Declaration of a Case of Mutism Who Started to Speak After 16 Years With Electroconvulsive Therapy. Engel FN, Balaban ÖD, Caglar N. J ECT. 2024 Apr 10. doi: 10.1097/YCT.0000000000001013. Online ahead of print. PMID:  38595208 The LTE is here . And here: This is not really a case report, it is just a "declaration" that ECT allowed a patient to speak after 16 years of mutism. There are no details of the case or the ECT. The discussion of the differential diagnosis of mutism is good, as is the literature review. The authors' main point is the reminder that sometimes it is not catatonia.

 Out on PubMed, from authors in Brazil, in JECT, is this case report: Extreme Agitation in Mania Treated With Intravenous Continuous Infusion of Dexmedetomidine and  ECT . Tolentino A, Santaella F, Barros FMR, Barnes L, Torre OD, Schlittler L, Oliveira KD, Dos Santos Junior A, Dalgalarrondo P, Banzato CEM. J ECT. 2024 Apr 8. doi: 10.1097/YCT.0000000000001007. Online ahead of print. PMID:  38587401 The report is here . And here: This is a very interesting case report describing the use of IV dexmedetomidine to treat pre-ECT agitation in mania. It would have been helpful to have the details of the anesthetic management and something about the ECT parameters. Dexmedetomidine is an up-and-comer in the ECT world; I'm predicting much more common use in conjunction with ECT in the future...

 Here is a link to a video produced by Dr. Michael Grozinger and colleagues in Germany: https://www.youtube.com/watch?v=nEVAjMncCQo Another screen shot: This is an excellent addition to the patient information video resources available online. It is narrated by the patient, Thomas, and covers his ECT experience in 15 minutes. Its low key approach should make it very approachable for patients. Kudos to Dr. Grozinger and colleagues for producing this.

 Out on PubMed, from authors in Pisa, Italy, is this reiew: Pseudodementia in Patients with Unipolar and Bipolar Disorders: A Case Series and Literature Review. Elefante C, Brancati GE, Acierno D, Pistolesi G, Ricciardulli S, Weiss F, Romeo F, Lattanzi L, Maremmani I, Perugi G. J Clin Med. 2024 Mar 19;13(6):1763. doi: 10.3390/jcm13061763. PMID:  38541988   Free PMC article Review. The abstract is copied below: Even though pseudodementia has been historically linked to depression, other psychiatric conditions may cause reversible cognitive alterations. The purpose of this study is to improve our understanding of pseudodementia occurring throughout the entire bipolar spectrum. A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched up to March 2023. Fifteen articles on patients with pseudodementia and bipolar disorder (BD), mania, hypomania, or mixed depression have been included. Moreover, seven female pa...

 Out on PubMed, from authors in Boston, is this article: Epigenome  Defines Aberrant Brain  Laterality  in Major Mental Illnesses. Abdolmaleky HM, Nohesara S, Thiagalingam S. Brain Sci. 2024 Mar 7;14(3):261. doi: 10.3390/brainsci14030261. PMID:  38539649 The abstract is copied below: Brain-hemisphere asymmetry/laterality is a well-conserved biological feature of normal brain development. Several lines of evidence, confirmed by the meta-analysis of different studies, support the disruption of brain laterality in mental illnesses such as schizophrenia (SCZ), bipolar disorder (BD), attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and autism. Furthermore, as abnormal brain lateralization in the planum temporale (a critical structure in auditory language processing) has been reported in patients with SCZ, it has been considered a major cause for the onset of auditory verbal hallucinations. Interestingly, the peripheral counterpar...