Clinical Neuroscience of ECT (CNECT)

  Dear Blog readers, I will be on hiatus for the rest of the month, planning to resume sometime in early January. In the meantime, I encourage you to keep searching PubMed and asking questions of OpenEvidence about ECT. Happy Holidays to all! CK

Out on PubMed, from authors in India, is this article: Experience of using electroconvulsive therapy for bipolar disorder: A retrospective study from North India. Grover S, Sharma N, Chakrabarti S. Indian J Psychiatry. 2024 Oct;66(10):973-977. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_222_24. Epub 2024 Oct 17. PMID:  39668879   The abstract is copied below: Background: Little information is available on response to electroconvulsive therapy (ECT) in patients with bipolar disorder (BD) from India. Aim: T his exploratory study aims to evaluate and compare the sociodemographic and clinical profiles, treatment outcomes of BD patients with depression and mania/mixed episode who received ECT and to evaluate the predictors of response to ECT. Results: Data of 278 BD patients who received 325 ECT courses were extracted from the ECT register. The number courses of ECT for bipolar depression (n = 202) exceeded those for mania/mixed episodes (n = 123). In terms of response to ECT...

 In the Indian Journal of Psychiatry is this LTE case report: The pdf is here . I blog about this LTE purely to revisit the issue of ECT in postpartum psychosis. The report is flawed (no ECT details, no discussion of why the patient's blood pressure could not be managed), but is yet another example of the remarkable efficacy of ECT in severe postpartum psychiatric illness.

 Out on PubMed, from authors in China, is this paper: Association of the neutrophil-to-platelet ratio with response to electroconvulsive therapy in adolescents with major depressive disorder. Geng D, Wang W, Du N, Niwenahisemo LC, Xu H, Wang Y, Kuang L. Front Psychiatry. 2024 Nov 25;15:1413608. doi: 10.3389/fpsyt.2024.1413608. eCollection 2024. PMID:  39655209   The abstract is copied below: Background: Major depressive disorder (MDD) is one of the most serious mental disorders affecting adolescents worldwide. Electroconvulsive therapy (ECT) is widely acknowledged as a first-line treatment for severe depression, but the clinical response varies. Neutrophils and platelets are both related to the progression of MDD. The aim of this study was to investigate the correlation between the neutrophil-to-platelet ratio (NPR) during the acute phase and the effectiveness of ECT treatment. Methods: A total of 138 adolescent MDD patients who received ECT were included in the study. Ne...

 Out on PubMed, from clinicians at Duke, is this case report: Misdiagnosis of Primary Eating Disorder in an Individual With Major Depressive Disorder and Comorbid Catatonic Syndrome. Howard A, Robbins-Welty G, Schindler NJ, Kincaid B, Komisar J. J Psychiatr Pract. 2024 Nov 1;30(6):447-448. doi: 10.1097/PRA.0000000000000825. PMID:  39655974 The abstract is copied below: Catatonia is a neuropsychiatric syndrome affecting movement, emotion, speech, and behavior, which commonly occurs secondary to medical or psychiatric disorders and with comorbid illnesses. We report the case of an 18-year-old male with a history of depression, anxiety, attention-deficit/hyperactivity disorder, polysubstance use, and previous suicide attempts who presented to the hospital from a residential eating disorders treatment facility, due to psychomotor slowing. The patient scored 3 or lower on the Bush-Francis Catatonia Rating Scale (BFCRS), but he showed marked improvement following 2 mg of intravenou...

  Palliative Electroconvulsive Therapy: A Descriptive Cohort Study. Robbins-Welty GA, Slauer RD, Brown MM, Nakatani MM, Shalev D, Feigal J. J Acad Consult Liaison Psychiatry. 2024 Dec 9:S2667-2960(24)00134-4. doi: 10.1016/j.jaclp.2024.12.001. Online ahead of print. PMID:  39662871 The abstract is copied below: Introduction: Palliative care ( PC ) is the standard of care for patients with serious medical illnesses, or those conditions associated with high risk of mortality and negative impact on quality of life (QOL). Electroconvulsive therapy (ECT) is the gold standard treatment for certain psychiatric conditions, which may co-occur with serious medical illnesses. However, the use of "palliative ECT" (PECT) in this context is understudied. Methods: We conducted a descriptive retrospective cohort study reviewing the indications, outcomes, and regimens of PECT. We included patients who had an ECT consultation, in addition to either a PC consultation or a do-not-attempt-resusci...

 Out on PubMed, from clinicians in Texas, in JECT, is this case report; Clinical Response to Electroconvulsive Therapy in a Young Adult With Down Syndrome Regression Disorder. Kelley BJ, Bailey KJ, Hubregsen JJ. J ECT. 2024 Dec 3. doi: 10.1097/YCT.0000000000001093. Online ahead of print. PMID:  39652068 The abstract is copied below: Down syndrome regression disorder (DSRD) is a condition in which individuals with Down syndrome experience a decline in social and adaptive functioning in adolescence to early adulthood. Initially described as catatonic psychosis and later designated Down syndrome disintegrative disorder (DSDD), the etiology for DSRD remains unclear but has been hypothesized to relate to autoimmune function, stress, and psychiatric disease. DSRD presents heterogeneously and has no clearly established diagnostic criteria, which can complicate treatment recommendations. ECT has been used to successfully treat DSRD, but the number of reported cases remains low, espec...

 Out on PubMed, from authors in the UK is this article: Long-Term Adverse Effects After Electroconvulsive Therapy ( ECT ): A Narrative Analysis Exploring People's Experiences, Meaning-Making, and Coping. Shipwright E, Murphy D. Qual Health Res. 2024 Dec 9:10497323241303391. doi: 10.1177/10497323241303391. Online ahead of print. PMID:  39652673 The article is here . And from the text: And if you Google the first author: I don't want to give this too much oxygen, but feel it is important for you to know it is out there. The "study" involves active recruitment of only people with an "adverse long term effect after ECT." References from John Read. The "brain damage" refrain. Very redolent of the tactics of the Church of Scientology and CCHR... Sad to see these probably intelligent and well-meaning British citizens doing such harm to seriously ill patients who may need ECT and be scared off.

  Out on PubMed, from authors in Sweden, is this study: Who is at risk of long-term subjective memory impairment after electroconvulsive therapy? Tornhamre E, Hammar Å, Nordanskog P, Nordenskjöld A. J Affect Disord. 2024 Dec 5:S0165-0327(24)02007-X. doi: 10.1016/j.jad.2024.12.028. Online ahead of print. PMID:  39644929 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is an effective treatment for depression with potential transient cognitive side effects. However, subjective memory impairment can extend over a long period after ECT. Objectives: This study aimed to assess potential risk factors for long-term subjective memory impairment 6 months after ECT and to explore if the associations are mediated by depressive symptoms. Methods: This registry-based study used the Swedish National Quality Register for ECT and other national registers. Long-term subjective memory worsening was defined as a minimum 2-step worsening on the memory item from the compreh...

 Out on PubMed, from investigators in Norway and Sweden, is this study: Persistent pro-inflammatory trait in elderly patients following treatment-resistant major depressive disorder: a longitudinal exploratory study. Gaarden TL, Engedal K, Benth JŠ, Larsen M, Lorentzen B, Mollnes TE, Bjølseth TM, Gyllencreutz Castellheim A. Nord J Psychiatry. 2024 Dec 3:1-10. doi: 10.1080/08039488.2024.2432981. Online ahead of print. PMID:  39624907 The abstract is copied below Objectives: Considering that the remission rate for major depressive disorder (MDD) in elderly patients is below 50%, there is a compelling requirement for an enhanced comprehension of the underlying mechanisms. Chronic low-grade inflammation has been posited as one potential contributor to treatment-resistant MDD in the elderly. Accordingly, the objective of our study was to explore the longitudinal trends of systemic immune markers in elderly inpatients referred to electroconvulsive therapy due to an episode of treat...

Out on PubMed, from clinicians in Mississippi, is this case report: An Abnormal Case of Malignant Catatonia in a Previously Healthy Young Female With Unexplained Neurological Symptoms. Kothari S, Khan BA, Nguyen M, Gleason SH. J Med Cases. 2024 Dec;15(12):382-386. doi: 10.14740/jmc4327. Epub 2024 Oct 30. PMID:  39610913   The abstract is copied below: This is a case report of a previously healthy 26-year-old female with unexplained neurological symptoms that eventually developed malignant catatonia. Because malignant catatonia has a range of clinical manifestations, making prompt diagnosis a challenging task. Due to her relapsing symptoms, the patient was admitted to the inpatient psychiatric unit three times in less than 2 months, and eventually recovered with high doses of lorazepam and several electroconvulsive therapy (ECT) treatments after a stay in the intensive care unit (ICU). This case highlights the importance of avoiding of antipsychotics with dopamine blockade pri...

Out on PubMed, from clinicians at Yale, is this case report in JECT:  Safe Delivery of  Electroconvulsive   Therapy in a Patient With Obstructive Sleep Apnea and a Hypoglossal Nerve Stimulator: A Case Report. Hughes M, Cohen T, Ostroff R, Katz R. J ECT. 2024 Nov 26. doi: 10.1097/YCT.0000000000001089. Online ahead of print. PMID:  39589131   The case report is here . And here: This case report in JECT documents the safe application of ECT in a patient with a hypoglossal nerve stimulator for obstructive sleep apnea. It is helpful to know about this device. We shall see how commonly ECT practitioners have patients with it. Here are links to info about this implant/procedure. from Johns Hopkins: https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea/hypoglossal-nerve-stimulation Video: https://www.google.com/search?q=hypoglossal+nerve+stimulator&oq=hypoglossal+nerve+stimulator&gs_lcrp=EgZjaHJvbWUyCQgAEEUYORiABDIHCAEQABiABDIHCA...

 Out on PubMed, from authors in Denmark, is this study: Exploring the effects of erythropoietin treatment on cortical thickness and hippocampal volume in patients with mood disorders undergoing electroconvulsive therapy: A randomized, placebo-controlled trial. Macoveanu J, Zarp J, Vinberg M, Brendstrup-Brix K, Kessing LV, Jørgensen MB, Miskowiak KW. J Psychopharmacol. 2024 Nov 28:2698811241301224. doi: 10.1177/02698811241301224. Online ahead of print. PMID:  39609686 The abstract is copied here. Background: Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, its utilization is limited to the most severely ill patients due to stigma, healthcare provider unfamiliarity, and concerns regarding cognitive side effects. Erythropoietin (EPO) is a promising add-on treatment during ECT due to its potential to increase neuroplasticity and cognition. Aims: To explore the effects of EPO administration on cortical thickness and hippocampal volumes...