Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, in JECT, from authors in Germany, is this case report: Electroconvulsive Therapy in a Patient With Cerebral Aneurysm, Normal Pressure Hydrocephalus With Ventriculoperitoneal Shunt, and Severe Acquired Pyloric Stenosis. Jacob T, Grözinger M, Papenfuß T, Mai M, Gahr M. J ECT. 2024 Aug 26. doi: 10.1097/YCT.0000000000001070. Online ahead of print. PMID:  39185885 The abstract is copied below: Cerebral aneurysm (CA), normal pressure hydrocephalus (NPH) with ventriculoperitoneal shunt (VPS), and pyloric stenosis increase the risk of complications related to electroconvulsive therapy (ECT). Whereas there is some evidence for the safety of ECT in patients with CA and NPH with VPS, there is none in patients with pyloric stenosis that increases the risk of aspiration during short anesthesia. A 67-year-old female patient with a small and stable aneurysm of the right anterior cerebral artery, NPH with VPS, and severe pyloric stenosis (as a result of suicidal ingestion of p...

Out on PubMed, from authors in Belgium, is this review:  The Role of Electroconvulsive Therapy in Posttraumatic Stress Disorder: A Systematic Review. Callens L, Sienaert P. J ECT. 2024 Aug 26. doi: 10.1097/YCT.0000000000001063. Online ahead of print. PMID:  39178058 The abstract is copied below: Posttraumatic stress disorder (PTSD) is associated with a high burden of disability and mortality. Despite standard treatments with antidepressants and/or psychotherapy, remission is often difficult to achieve. Electroconvulsive therapy (ECT) is an effective treatment for mood disorders but is currently not recognized as a treatment modality for PTSD. The literature about its potential role in the management of PTSD is growing. Thus, we aim to systematically review the available evidence for the role of ECT in PTSD. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines, we performed a systematic literature search from 1958 to December 2023 ...

 Out onPubMed, in JECT, is this LTE: Sylvia Plath and  ECT  Once Again, Now in the Theater. Bergsholm P. J ECT. 2024 Jul 16. doi: 10.1097/YCT.0000000000001040. Online ahead of print. PMID:  39012153 The letter is here: The great poet Sylvia Plath is among the famous people who have had ECT. As Dr. Bergsholm notes, her second course of ECT, described in The Bell Jar,  was successful. He also surmises, as have others, that if ECT had again been prescribed in in timely manner, her suicide in 1963 (not 1953) might have been prevented.

 Out on PubMed, from authors in Maine, in JECT, is this LTE: Refractory Pediatric Catatonia Following Treatment for an Intracranial Mass: Safe and Effective Use of Electroconvulsive Therapy. Moss J, Kastle N, Wolfrum L, Bokat P, Perry E, Gerwin R. J ECT. 2024 Aug 23. doi: 10.1097/YCT.0000000000001066. Online ahead of print. PMID:  39178059  The LTE is here: This is a nicely presented report of a complicated case of recurrent medulloblastoma in an adolescent patient. The patient had successful ECT twice, both times remote from resection of the brain tumor. The rapid response of catatonic symptoms to the ECT is again noteworthy. Kudos to these clinicians for the excellent care and for sharing their experience.

Out on PubMed, from authors at the Mayo Clinic, is this "research letter": Urinary Retention Following Electro-Convulsive Therapy Under General Mask Anesthesia. Stephenson AA, Abel MD, Sprung J, Morgan RJ 3rd, Schroeder DR, Weingarten TN. Can J Psychiatry. 2024 Aug 21:7067437241271738. doi: 10.1177/07067437241271738. Online ahead of print. PMID:  39166343    The article is here . And here: This is a well conducted retrospective chart review of about 10,000 ECT treatments at the Mayo Clinic. Not surprisingly, post-ECT urinary retention is associated with anticholinergic use and older age.  My experience is that use of anticholinergic medication (either for preventing bradycardia or decreasing airway secretions) was much more common, even frequently routine, in the past. Now, it seems to be more targeted use, which makes sense, in order to avoid urinary retention, tachycardia, and the unnecessary use of an additional medication. (If I am reading the table correctly, th...

 Out on PubMed, from the Netherlands, is this article: [Development and learning outcomes of an e-learning  ECT  for psychiatry residents]. Dijkstra EM, J Duvivier R, van Waarde JA. Tijdschr Psychiatr. 2024;66(5):252-258. PMID:  39162165   Dutch. The abstract is copied below: Background: Education in electroconvulsive therapy (ECT) has become mandatory in the Dutch psychiatry training. ECT is still relatively rarely used. To increase knowledge about ECT, we have developed a training module about ECT for psychiatrist training. To promote flexible learning, we opted for e-learning, where educational principles have been applied in the design. Aim: In this article we discuss how this e-learning ECT was developed and analyze the learning outcomes for psychiatry residents. Method: The e-learning has been developed based on the ADDIE model and consists of an entrance test, various assignments and a final test. The learning outcomes of the first 216 residents have been...

Out on PubMed, from authors in China, is this review: Anesthetic Influence on Electroconvulsive Therapy: A Comprehensive Review. Dai X, Zhang R, Deng N, Tang L, Zhao B. Neuropsychiatr Dis Treat. 2024 Jul 31;20:1491-1502. doi: 10.2147/NDT.S467695. eCollection 2024. PMID:  39100572     The abstract is copied below: The prevalence of severe mental disorders has been rising annually. Electroconvulsive therapy (ECT) is considered a valuable treatment option in psychiatry for conditions such as schizophrenia and medication-resistant depression, especially when other treatments have proven insufficient. ECT rapidly improves patients' mood, alleviates symptoms, and demonstrates significant therapeutic effects. Currently, the form of ECT used in clinical practice is modified electroconvulsive therapy (mECT), which is administered under general anesthesia. Accumulative evidence has confirmed that different anesthetic drugs, anesthetic-ECT time interval, anesthetic depth, and airway...

 I will be on hiatus for the next couple of weeks, resuming towards the end of the month. In the meantime, here are some PubMed search statistics: "ECT": 11,867 "Electroconvulsive Therapy": 17,533 "Electroconvulsive": 19,0210 I hope you are all having a good summer. CK

 Out on PubMed, from authors in India, is this paper: Use of  electroconvulsive  therapy during postpartum: A retrospective chart review. Grover S, Sharma P, Chakrabarti S. Indian J Psychiatry. 2024 Jun;66(6):572-575. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_165_24. Epub 2024 Jun 19. PMID:  39100373   The abstract is copied below: Background: There is limited data on use of electroconvulsive therapy (ECT) for management of psychiatric disorders during the postpartum period from India. Aim: We aimed to assess the demographic and clinical profile of patients receiving ECT during the postpartum period for various psychiatric disorders using a retrospective study design. Methods: ECT register of the department was reviewed for the period of January 2019 to December 2023 to identify the patients who received ECT during the postpartum period. The treatment records of these patients were evaluated to extract the demographic and clinical profile. Results: During...

 Out on Pubmed, from authors in China, is this study: Efficacy and Side Effects of Mixed-Strategy Electroconvulsive Therapy: A Proof-of-Concept Randomized Clinical Trial on Late Life Depression. Lv SW, Sun Y, Chen Y, Wang C, Xie XH, Hu XM, Hong H, Zhang LF, Zhu NN, Xie PY, Zhang L, Chen L, Kong XM. Psychiatry Investig. 2024 Jul;21(7):772-781. doi: 10.30773/pi.2023.0198. Epub 2024 Jul 24. PMID:  39089703   The abstract is copied below: Objective: Patients with late life depression sometimes refuse to receive electroconvulsive therapy (ECT) owing to its adverse reactions. To alleviate patient's resistance, a novel ECT stimulation strategy named mixed-strategy ECT (msECT) was designed in which patients are administered conventional ECT during the first three sessions, followed by low energy stimulation during the subsequent sessions. However, whether low energy electrical stimulation in the subsequent stage of therapy affect its efficacy and reduce adverse reactions in pati...

 Out on PubMed, from clinicians at Vanderbilt University, is this case report: Electroconvulsive  Therapy in Managing Intractable Psychosis in Hereditary Aceruloplasminemia-Associated Neurodegeneration: A Case Report. Wang V, Chew H, Niu K. J Acad Consult Liaison Psychiatry. 2024 Jul 27:S2667-2960(24)00074-0. doi: 10.1016/j.jaclp.2024.07.006. Online ahead of print. PMID:  39074778 The report is here . And from the text: Here is a very nicely reported case of the successful use of ECT in a rare disease. I particularly like the phrase, "ECT's mechanism of action is multifaceted..." Kudos to these authors for teaching us some internal medicine and neurology  and sharing their clinical experience.

 Out on PubMed, from an author in Korea, is this case report: Alteration of Functional Connectivity before and after  Electroconvulsive  Therapy in a Single Patient with Depression and Catatonia. Park YM. Clin Psychopharmacol Neurosci. 2024 Aug 31;22(3):537-540. doi: 10.9758/cpn.23.1096. Epub 2023 Jul 12. PMID:  39069694 The abstract is copied below: Catatonia, a severe neuropsychiatric condition, is distinguished by a range of prominent motor features such as immobility, mutism, negativism, rigidity, posturing, staring, stereotypy, automatic obedience, echolalia, and mannerism. A female patient of middle age was admitted to the open psychiatric ward of a hospital after exhibiting suicidal ideation, delusions, depression, insomnia, refusal to eat, difficulty in swallowing, and decreased motivation for four months prior to admission. Following 14 electroconvulsive therapy (ECT) sessions, her symptoms improved in the order of appetite, immobility, speech volume, mood, ...

 Out on PubMed, from GEMRIC, is this paper: Characterization of gray matter volume changes from one week to 6 months after termination of  electroconvulsive  therapy in depressed patients. Laroy M, Bouckaert F, Ousdal OT, Dols A, Rhebergen D, van Exel E, van Wingen G, van Waarde J, Verdijk J, Kessler U, Bartsch H, Jorgensen MB, Paulson OB, Nordanskog P, Prudic J, Sienaert P, Vandenbulcke M, Oltedal L, Emsell L; for GEMRIC. Brain Stimul. 2024 Jul 24;17(4):876-886. doi: 10.1016/j.brs.2024.07.015. Online ahead of print. PMID:  39059711   The paper is here . And from the text: This GEMRIC report (n=86) confirms that GMV reverts to baseline in most, but not all, brain regions months after ECT. The speculation about underlying neuroplastic mechanisms is interesting. Further elucidation of those mechanisms and the correlation with efficacy and side effects awaits.