Clinical Neuroscience of ECT (CNECT)

  Here is the link to the program: https://nact.se/next-meeting/scientific-programme/ And here is the program: The Nordic Association For Convulsive Therapy (NACT) is one of the biggest ECT societies in the world, and their meetings are among the best. This looks to be an excellent program, as per their usual. I hope to be able to blog about some of these presentations, if the slide sets become available.  I encourage all ECT practitioners to consider going to a future NACT meeting in person; I'm sure you would enjoy it and find it very rewarding.

  Out on PubMed, from Oregon, is this case report: Pharmacologic Treatment of Malignant Catatonia Without Electroconvulsive Therapy: A Case Report. Hegewald C, Guthrie D, LeFay SM. Cureus. 2024 Apr 11;16(4):e58071. doi: 10.7759/cureus.58071. eCollection 2024 Apr. PMID:  38737995 The abstract is copied below: Malignant catatonia is a rare, life-threatening variant of catatonia requiring prompt treatment. Malignant catatonia is characterized by typical catatonia symptoms of psychomotor, neurologic, and behavioral changes complicated by autonomic instability, with an estimated mortality rate of 50% or more when untreated. Electroconvulsive therapy (ECT) is considered the definitive and most effective treatment for malignant catatonia, with minimal literature on the efficacy of pharmacological interventions alone. Timely access to life-saving ECT may be limited in some hospitals due to restrictive laws on the use of ECT when the patient is incapacitated or due to lack of treatment availa

 This story appeared in the Washington Post on May 12, 2024: https://www.washingtonpost.com/wellness/2024/05/12/down-syndrome-regression-disorder-mothers-support/ https://www.washingtonpost.com/wellness/2024/05/12/down-syndrome-regression-disorder-mothers-support/ This article, about Down Syndrome Regression Disorder, mentions in passing that one of the patients was helped by ECT. Nice to see a positve mention and the treatment correctly referred to as "electroconvulsive therapy." Many readers will note the similarities between these patients and those children with autism who regress and exhibit catatonic features with self-injury.

Out on Pubmed, from authors in Japan, is this case report:   Case report: Recurring and treatment-resistant depression in acquired hepatocerebral degeneration due to a congenital portosystemic shunt. Tamura T, Takagi S, Hayakawa A, Oyama J, Fujino J, Shiwaku H, Takahashi H, Sugihara G. Front Psychiatry. 2024 Apr 23;15:1402695. doi: 10.3389/fpsyt.2024.1402695. eCollection 2024. PMID:  38716114   The abstract is copied below: Introduction: Acquired hepatocerebral degeneration (AHD) is a neurological condition associated with cerebral manganese (Mn) accumulation caused by portosystemic shunts (PSS), usually because of advanced liver disease. AHD is diagnosed by the identification of T1-weighted brain magnetic resonance imaging (MRI) hyperintensities coupled with the presence of PSS and neurological symptoms. Clinical presentations primarily involve motor dysfunction and cognitive impairment. As a result of the frequently concurrent hepatic encephalopathy, the psychiatric symptoms of AHD a

 Out on PubMed, from Canadian authors, is this guideline update: Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A, Frey BN, Giacobbe P, Gratzer D, Grigoriadis S, Habert J, Ishrat Husain M, Ismail Z, McGirr A, McIntyre RS, Michalak EE, Müller DJ, Parikh SV, Quilty LS, Ravindran AV, Ravindran N, Renaud J, Rosenblat JD, Samaan Z, Saraf G, Schade K, Schaffer A, Sinyor M, Soares CN, Swainson J, Taylor VH, Tourjman SV, Uher R, van Ameringen M, Vazquez G, Vigod S, Voineskos D, Yatham LN, Milev RV. Can J Psychiatry. 2024 May 6:7067437241245384. doi: 10.1177/07067437241245384. Online a

 Out on PubMed, from authors in Germany, is this study: Risk Phenotypes, Comorbidities, Pharmacotherapy, and Electroconvulsive Therapy ( ECT ) in a Cohort with Difficult-to-Treat Depression in Comparison to an Unmedicated Control Group. Maier HB, Borchert A, Neyazi A, Moschny N, Schülke R, Bundies GL, Folsche T, Gaspert A, Seifert J, Bleich S, Scherf-Clavel M, Unterecker S, Deckert J, Frieling H, Weber H. Pharmacopsychiatry. 2024 May 2. doi: 10.1055/a-2292-1438. Online ahead of print. PMID:  38698605   The abstract is copied below: Background: Approximately 15-25% of depressed patients suffer from difficult-to-treat depression (DTD). Patients with DTD require a thorough examination to avoid the oversight of treatable (psychiatric/somatic) comorbidities or (pseudo-)resistance to antidepressant drugs (ADs). Polymorphisms of the cytochrome P450 (CYP) enzymes 2D6 and 2C19, which play a major role in the metabolism of ADs, may contribute to resistance to ADs. Patients with DTD might benef

This story appeared in the Washington Post on April 27,2024. The link to the article is here: https://www.washingtonpost.com/nation/interactive/2024/marjorie-taylor-greene-threats/ And from the text: So here is a long article about an incident in the life of a man with severe bipolar disorder; ECT is only a peripheral part of it, but that is what we are here to focus on. There are three issues in my mind. The first is his description of what is certainly an anesthesia awareness event. The suggestion that it was a panic attack is true as far as it goes, but it was caused by the awareness experience. Awareness events related to succinylcholine can occur at either induction or emergence. Unfortunately, even when they occur at induction, the subsequent seizure often does not erase them. The ECT care team should be aware themselves of this potential complication and try to avoid it at all costs. It is terrifying to the patient and, as noted here, may cause them to refuse further treatments.

Out on PubMed, is this responsive LTE: Magnetic Seizure Therapy vs  Electroconvulsive  Therapy for Major Depressive Episode-Reply. Deng ZD, Weiner RD, Lisanby SH. JAMA Psychiatry. 2024 Apr 24. doi: 10.1001/jamapsychiatry.2024.0695. Online ahead of print. PMID:  38656323 The letter is here . And here: Here is the response from Deng et al. to the prior letter from McCall et al. I find these rationales for the surprising weakness of the type of  ECT used, and the weakness of the MST, to be less than convincing. MST may develop into a promising treatment with efficacy that rivals ECT, but the current data show it is not there yet. There will be more on this topic soon...

 Out on PubMed, from American authors, is this LTE: Magnetic Seizure Therapy vs  Electroconvulsive  Therapy for Major Depressive Episode. McCall WV, George MS, Sackeim HA. JAMA Psychiatry. 2024 Apr 24. doi: 10.1001/jamapsychiatry.2024.0692. Online ahead of print. PMID:  38656342   The LTE is here. And here: Here is an LTE from Vaughn McCall and colleagues critiquing the recent Deng et al. study comparing MST to ECT in JAMA Psychiatry . The points made are well taken. Both the Deng et al. and Anand et al. studies were designed with a relatively weak form of ECT. This, of course, has the effect of making the experimental comparator look stronger. ECT endures, and still has a prominent position in the treatment of urgently ill mood and psychotic disorders patients, despite ongoing attempts to downplay its efficacy and safety. Stay tuned to the blog for the response from Deng et al....

 In press in JECT, is this essay by Dr. Max Fink: The essay is here . And here: I am pleased to present Professor Max Fink's essay on resurrecting flurothyl as a method to induce seizures instead of electricity. His arguments are cogent. It would be great to hear from blog readers what they think about the viability of flurothyl as another type of convulsive therapy in contemporary psychiatry. Kudos to Max for his ongoing amazing contributions to the ECT/convulsive therapy literature!

Out on PubMed, from researchers in Arizona and Canada, is this paper: Data on electroconvulsive seizure in mice, effects of anesthesia on immediate early gene expression. Ozols AB, Meyers KT, Damphousse CC, Campbell JM, Khoshaba R, Wallace SG, Hu C, Marrone DF, Gallitano AL. Data Brief. 2024 Mar 27;54:110365. doi: 10.1016/j.dib.2024.110365. eCollection 2024 Jun. PMID:  38646190   The abstract is copied below: Although electroconvulsive therapy (ECT) is one of the most effective treatments for severe mood and psychotic disorders, the mechanisms underlying its therapeutic effects remain unknown. Electroconvulsive stimulation (ECS), the animal model for ECT, can be used to investigate the potential therapeutic mechanisms of ECT in rodents . ECS produces numerous effects in the brain, such as increasing levels of growth factors, inducing dendritic sprouting, and stimulating neurogenesis. It also induces high-level expression of immediate early genes (IEGs) that have been implicated in the