Clinical Neuroscience of ECT (CNECT)

 I will be on hiatus for about a week, for the Thanksgiving break. I look forward to blogging in December. In the meantime, please be sure to check PubMed,  when you can.

Out on PubMed, from clinicians at Duke, is this case series: Catatonia in anti-NMDA receptor encephalitis: a case series and approach to improve outcomes with electroconvulsive therapy. Kraiter FG, May DT, Slauer RD, Abburi N, Eckstein C, Shah S, Komisar JR, Feigal JP. BMJ Neurol Open. 2024 Nov 12;6(2):e000812. doi: 10.1136/bmjno-2024-000812. eCollection 2024.  PMID:   39564516 The abstract is copied below: Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been recognised to present with the syndrome of catatonia. In severe cases dysautonomia is representative of malignant catatonia. The treatment with benzodiazepines (BZDs) and electroconvulsive therapy (ECT) may decrease morbidity and mortality in patients presenting with anti-NMDA receptor encephalitis and catatonia. Methods: This is a retrospective case series of eight patients with anti-NMDA receptor encephalitis treated with ECT . We use clinical prediction scores (Clinical Assessment Scale for Autoi...

Last week, on local news in Seattle, was this brief piece on ECT: https://komonews.com/news/local/modern-shock-therapy-university-of-washington-ect-treatment-electroconvulsive-therapy-uw-northwest-hospital-seizure-neuromodulation-severe-depression-tms- currents Thanks to Dr. Randall Espinoza for doing, and alerting me to, this news story. Dr. Espinoza is  Medical Director, Garvey Institute Center for Neuromodulation, Professor of Psychiatry at the University of Washington, and Editor-in-Chief of The Journal of ECT . This is an authoritative and real depiction of ECT that should be helpful to many patients. Kudos to Dr. Espinoza.

 Out on PubMed, from researchers in Norway and Sweden, is this study: Improvement of persistent impairments in executive functions and attention following electroconvulsive therapy in a case control longitudinal follow up study. Hammar Å, Ronold EH, Spurkeland MA, Ueland R, Kessler U, Oedegaard KJ, Oltedal L. BMC Psychiatry. 2024 Nov 20;24(1):832. doi: 10.1186/s12888-024-06270-5. PMID:  39567961 The abstract is copied below: Background: How cognition is influenced by electroconvulsive treatment (ECT) and major depressive disorder (MDD) is still debated. The development and etiology of neurocognitive impairment in MDD were examined by investigating the cognitive profile following ECT related to the state, scar, and trait perspectives, with the former predicting improvements parallel with depressive symptoms, while the two latter expected persisting impairments. Executive functions (EF) and attention are central to cognition and alterations in these functions could influence oth...

On PubMed, from a few months ago, in Am J Psych, is this editorial: Using Medical Records to Investigate the Genetics of Treatment-Resistant Depression Across Health Care Systems. Polimanti R. Am J Psychiatry. 2024 Jul 1;181(7):569-571. doi: 10.1176/appi.ajp.20240377. PMID:   38946279   The editorial is here . And here: This editorial accompanied the Kang study that I I blogged about in May. It is dense and complicated, mainly about the methodology of psychiatric genetic studies. For us, the importance is that it recognizes ECT use as a way to define a subpopulation of depressed patients with a more "biological" and heritable illness. I do wish they had used a "severity" marker, rather than the fraught concept of TRD, but there is much overlap. The editorial also notes the problem of underuse of ECT.

 Out on PubMed, from authors in Nova Scotia, is this case series Identifying and treating catatonia in children with neurodevelopmental disorders: A case series. Nejati N, Etches S. J Can Acad Child Adolesc Psychiatry. 2024 Nov;33(3):215-222. Epub 2024 Nov 1. PMID:  39534778 The abstract is copied below: Catatonia is a neuropsychiatric syndrome that is an increasingly recognized cause of acute behavioural changes in children and adolescents with neurodevelopmental disorders (NDD). Literature suggests that catatonia can present differently in this population and can be missed due to diagnostic overshadowing. Catatonia is a treatable condition, and management strategies in children with NDD include benzodiazepines and electroconvulsive therapy (ECT). Untreated, it can cause significant morbidity including severe medical complications, and therefore timely recognition and management of catatonia in children and adolescents with NDD is essential. In this case series, we present th...

 Out on PubMed, from authors in North Carolina, in JECT, is this case report: Electroconvulsive   Therapy  in a Left Ventricular Assist Device Recipient With Treatment-Resistant Depression. Nash R, Rosenkrans D, Kolarczyk L, Khan A, Hatch E, Gala G, Laughon SL, McClure RK. J ECT. 2024 Nov 6. doi: 10.1097/YCT.0000000000001080. Online ahead of print. PMID:  39531309 The abstract is copied below: Depression and heart failure are highly comorbid, with up to 35% of heart failure patients suffering from comorbid depression. Left ventricular assist devices (LVADs) serve as a major lifeline for patients with heart failure; however, despite the drastic improvement in cardiac function following LVAD implantation, up to 24% of LVAD recipients suffer from depression. Depression management in LVAD recipients is often complicated by the recipient's increased risk for antidepressant side effects, adverse drug reactions, and inability to safely receive certain interventional psychia...

 Out on PubMed, from clinicians in Japan, is this case report. Remimazolam Anesthesia for Modified Electroconvulsive Therapy Mitigates Postoperative Agitation. Shimono S, Shakuo T, Yamamura A, Hashimoto M, Masuda R, Shida K. Cureus. 2024 Oct 7;16(10):e71037. doi: 10.7759/cureus.71037. eCollection 2024 Oct. PMID:  39525258  The abstract is copied below: Postoperative complications, such as immediate postoperative blood pressure elevation, agitation, and delirium, have been associated with modified electroconvulsive therapy (mECT). Remimazolam may reduce postoperative delirium; however, there are no reports of its use in mECT. Herein, we present a case of effective convulsions and calm arousal with remimazolam in a patient with a history of postoperative agitation. The patient was a 45-year-old man who was diagnosed with severe depression and psychotic symptoms and was treated with electroconvulsive therapy (ECT). Owing to previous episodes of agitation upon awakening, re...

 Out on PubMed, from a researcher at UCLA, is this editorial: Electroconvulsive  Therapy and Brain Network Reorganization: Dynamic Connectivity Insights and Implications for the Treatment of Depression and Suicidal Ideation. Zavaliangos-Petropulu A. Biol Psychiatry. 2024 Dec 15;96(12):e25-e27. doi: 10.1016/j.biopsych.2024.09.007. PMID:  39537268 The editorial is here . And here: Here's a dense but delightful editorial about a resting-state fMRi study in Biological Psychiatry  that I have not yet blogged about. The physics and details are complex, but the overarching themes are clear and encouraging: we may have begun to chip away at an understanding of how ECT works to normalize functional brain networks to alleviate depression and one of its most pernicious symptoms, suicidality. This editorial is worth reading very carefully; I hope to blog about the underlying study in the future.

 Out on PubMed, from researchers in Minnesota, is this study: Self-Rated  ECT  Outcomes in Patients With Depression: A Naturalistic Single-Site Study. Berger SR, Kung S, Lapid MI. J ECT. 2024 Nov 6. doi: 10.1097/YCT.0000000000001081. Online ahead of print. PMID:  39531338 The abstract is copied below: Objectives: Electroconvulsive therapy (ECT) is considered to be the most effective treatment for severe depression. This study investigated recent ECT outcomes for depression at a large tertiary center, which also provides community care. Methods: Data were obtained from Mayo Clinic Rochester patients ages 18 and older who received an acute course of ECT between August 1, 2017 and April 30, 2024. Patients were included if there was a depressive disorder diagnosis (unipolar or bipolar) and a self-rated Patient Health Questionnaire-9 (PHQ-9) within 10 days of the start and end of the acute course. Patients were excluded if the starting PHQ-9 score was less than 10. The ag...

 Out on PubMed, from authors in India, is this LTE: Relevance of  electroconvulsive  therapy in acute and maintenance phase management of obsessive-compulsive disorder: A case study. Joshi M, Khan A, Kar SK. Indian J Psychiatry. 2024 Sep;66(9):868-869. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_429_24. Epub 2024 Sep 19. PMID:  39502596 The letter is here . And here: Here's a very interesting case in which a pervasive delusion/obsession/psychotic symptom (the diagnosis seems to cut across various categories) responded well and quickly to ECT. No details of the ECT course are given except # of treatments and that significant response was seen even after ECT #1. I'm going to speculate that it was moderate dose bilateral.  Wouldn't it be nice if there were some simple, standardized dataset to report on a course of ECT? After all, pharmacotherapy trials almost always include dose and duration...

Out on Pubmed, from authors in Michigan and Pennsylvania, is this article: Explaining key stakeholders' preferences for potential policies governing psychiatric electroceutical intervention use. McCright AM, Achtyes ED, Bluhm R, Cabrera LY. Npj Ment Health Res. 2024 Nov 6;3(1):52. doi: 10.1038/s44184-024-00096-5. PMID:  39506102 The abstract is copied below: In recent years, legislators in many states have proposed laws governing the use of psychiatric electroceutical interventions (PEIs), which use electrical or magnetic stimulation to treat mental disorders. To examine how the PEI views of relevant stakeholder groups (e.g., psychiatrists, patients, caregivers, and general public) relate to preferences for proposed policies governing PEI use, we analyze data from a survey on using one of four PEIs to treat major depressive disorder administered to national samples of the stakeholder groups above. We find that the three non-clinician groups' similar PEI policy preferences diffe...

Out on PubMed, from authors in Boston, is this commentary: The US Presidential Election's High Stakes for the Future of Medicine. Huberfeld N, et al.   JAMA. 2024.   PMID:  39302830 The commentary is here . And here: With apologies that this is off topic, but these are no longer normal times. This commentary paints a bleak view of the next few years in American medicine. Hopefully ECT will fly under the radar, but the big picture for our patients looks pretty dire. And what is even more disheartening are the comments to this editorial; physicians taking JAMA to task for publishing this! Sad that many of our colleagues support the authoritarian roadblocks to equitable, affordable healthcare.

Out on PubMed, from researchers in Florida, is this study: Electroconvulsive  therapy (ECT) and Psychiatric rehospitalization rates: a retrospective study. Rahangdale A, Ferraro J. BMC Psychiatry. 2024 Oct 30;24(1):753. doi: 10.1186/s12888-024-06211-2. PMID:  39478522   The abstract is copied below: Background: Electroconvulsive therapy (ECT) induces a generalized seizure under anesthesia with an electrical current for treatment-resistant patients and may be underutilized. To our knowledge, no large-scale, American, nationwide hospital system retrospective study has examined how ECT affects psychiatric rehospitalization chances. Methods: We analyzed initial inpatient encounters for adults aged > 18 years at HCA Healthcare Behavioral Health Units from 2016 to 2021 with diagnoses of major depressive disorder with/without psychosis, bipolar disorder with/without psychosis, schizoaffective disorder, and schizophrenia. Excluding pregnancy and incarceration cases, we compare...

Here's a simple question to OE to remind us of how few ECT practitioners there are in the US. (Even 8% of 50,000 = 4000 seems high, and there are likely even fewer than that.) Another important, and probably unknown number, is what percentage of psychiatrists refer patients for ECT. And fewer than 2%of hospitalized depressed patients receive ECT, as we will see tomorrow.

 Out on PubMed, from authors in China, is this paper: EEG Temporal-Spatial Feature Learning for Automated Selection of Stimulus Parameters in Electroconvulsive Therapy. Wang F, Chen D, Weng S, Gao T, Zuo Y, Zheng Y. IEEE J Biomed Health Inform. 2024 Oct 31;PP. doi: 10.1109/JBHI.2024.3489221. Online ahead of print. PMID:  39480724 The abstract is copied below: The risk of adverse effects in Electroconvulsive Therapy (ECT), such as cognitive impairment, can be high if an excessive stimulus is applied to induce the necessary generalized seizure (GS); Conversely, inadequate stimulus results in failure. Recent efforts to automate this task can facilitate statistical analyses on individual parameters or qualitative predictions. However, this automation still significantly lags behind the requirements in clinical practices. This study addresses this issue by predicting the probability of GS induction under the joint restriction of a patient's EEG (electroencephalogram) and the stimul...