The Journal of ECT最新文献

{"title":"Safety of Electroconvulsive Therapy in Treatment-Refractory Depression in the Setting of Multiple Sclerosis: Erratum.","authors":"","doi":"10.1097/YCT.0000000000000640","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000640","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128508846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Scar","authors":"C. Kellner","doi":"10.2307/3850205","DOIUrl":"https://doi.org/10.2307/3850205","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124119123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pragmatic Guidance for EEG Interpretation","authors":"M. Fink","doi":"10.1097/YCT.0000000000000604","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000604","url":null,"abstract":"E ach patient's induced seizure in electroshock therapy is a controlled experiment. Clinicians apply scalp electrodes, ventilate with oxygen, sedate, paralyze muscles, select energy parameters on the device, stimulate, and expectantly watch unfolding events. Motor movements assure us that the stimulus affected the patient. Facial color changes, heart rate increases, and the monitoring electroencephalogram (EEG) tape shows changing rhythms.After 20 to 100 seconds, the body suddenly relaxes, the auditory warble ends, and oxygenation continues until breathing is assured. We look at the clock or the EEG tape—How long was the seizure? Is the seizure over? The treatment adequate? Is restimulation needed? We selected the stimulus parameters arbitrarily: electrode placement by concerns about cognitive effects, stimulus energy by age and prior experience with this patient, severity of illness, and our understanding of an “effective” treatment. Seizure length is our principal outcome criterion; if very short, we nod to the anesthetist to keep the patient asleep and relaxed, check the electrodes, change energy parameters in the device, and restimulate. We need more reliable criteria that assure that each session is effective in relieving the patient's syndrome. Electroconvulsive therapy (ECT) devices provide a running tape of EEG activity. The rhythms are complex—some are derived from the brain, but many are artifacts of movement or poor electrode placement. Occasionally, the rhythms sufficiently simulate a seizure to be puzzling. Because few psychiatrists are trained in interpreting EEG recordings, how is the clinician to learn? David Semple, an experienced clinician therapist in Edinburgh, offers a well-illustrated guide to seizure patterns, successful seizures, artifacts, anomalies, and EEG terminology. Did a seizure occur? Did it end? Was it adequate? An induced seizure follows a defined pattern. The rhythm starts with low-voltage fast frequencies, amplitudes increase, frequencies slow, and become intermixed with sharp rapid frequency spikes. Slow waves intermixed with spikes appear in multisecond bursts that suddenly end in a flat line. After","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114786809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study Comparing Effects of Bifrontal Versus Bitemporal Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Mild Alzheimer Disease","authors":"Celina S. Liu, N. Herrmann, D. Gallagher, T. Rajji, A. Kiss, D. Vieira, K. Lanctôt","doi":"10.1097/YCT.0000000000000639","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000639","url":null,"abstract":"Objective While transcranial direct current stimulation (tDCS) can enhance aspects of memory in patients with mild cognitive impairment (MCI) and Alzheimer disease (AD), there has been wide variability in both the placement of tDCS electrodes and treatment response. This study compared the effects of bifrontal (anodal stimulation over the dorsolateral prefrontal cortices), bitemporal (anodal stimulation over the temporal cortices), and sham tDCS on cognitive performance in MCI and AD. Methods Seventeen patients diagnosed with MCI or mild AD received 3 sessions of anodal tDCS (bifrontal, bitemporal, 2 mA for 20 minutes; and sham) in random order. Sessions were separated by 1 week. The Alzheimer's Disease Assessment Scale–Cognitive Word Recognition Task, Alzheimer's Disease Assessment Scale–Cognitive Word Recall Task, 2-back, and Montreal Cognitive Assessment were used to assess cognition. Results There was a significant effect of stimulation condition on 2-back accuracy (F2,28 = 5.28 P = 0.01, η2p = 0.27), with greater improvements following bitemporal tDCS compared with both bifrontal and sham stimulations. There were no significant changes on other outcome measures following any stimulation. Adverse effects from stimulation were mild and temporary. Conclusions These findings demonstrate that improvements in specific memory tasks can be safely achieved after a single session of bitemporal tDCS in MCI and mild AD patients.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"350 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125630020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Circulating Levels of GR, FKBP5, and SGK1 in Medicated Patients With Depression Are Not Altered by Electroconvulsive Therapy","authors":"K. Ryan, Lena Poelz, D. McLoughlin","doi":"10.1097/YCT.0000000000000633","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000633","url":null,"abstract":"Supplemental digital content is available in the text. Objectives Hypothalamic-pituitary-adrenal axis dysregulation is frequently observed in patients with depression, with increased levels of the glucocorticoid (GC) cortisol commonly reported. Hypothalamic-pituitary-adrenal axis dysregulation may be a consequence of impaired feedback inhibition due to GC receptor (GR) impairments or dysfunction, termed “glucocorticoid resistance.” Here, our objective was to assess mRNA levels of GC-related markers (GR, FKBP5, serum glucocorticoid kinase 1 [SGK1]) in patients with depression versus controls and in patient samples after electroconvulsive therapy (ECT). We also examined the relationship between these GC-related markers and 24-item Hamilton Depression Rating Scale (HAM-D24) scores to assess the utility of using them as biological markers for depression or the therapeutic response to ECT. Methods GR, FKBP5, and SGK1 mRNA levels were examined in whole blood samples from 88 medicated patients with depression pre-/post-ECT and 63 controls using quantitative real-time polymerase chain reaction. Exploratory subgroup correlational analyses were performed to determine the relationship between GR, FKBP5, and SGK1 and 24-item Hamilton Depression Rating Scale scores. Results GR, FKBP5, and SGK1 mRNA levels were significantly lower in medicated patients with depression compared with controls (P < 0.001, P = 0.03, P < 0.001, respectively), but ECT did not alter their levels (all P > 0.05). There was no relationship between GR, FKBP5, or SGK1 and 24-item Hamilton Depression Rating Scale scores. Conclusions GR, FKBP5, and SGK1 do not seem to be involved in the peripheral molecular response to ECT and do not represent useful biomarkers for predicting the therapeutic response to ECT in a real-world clinical setting.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130437533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Ketamine Anesthesia on Efficacy, Tolerability, Seizure Response, and Neurocognitive Outcomes in Electroconvulsive Therapy","authors":"N. Ainsworth, Amir Ali Sepehry, F. Vila-Rodriguez","doi":"10.1097/YCT.0000000000000632","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000632","url":null,"abstract":"Supplemental digital content is available in the text. Abstract Electroconvulsive therapy (ECT) remains the most effective treatment for major depressive disorder. Ketamine is an anesthetic gaining attention for its rapid antidepressant effect. Numerous randomized controlled trials have investigated the effect of ketamine anesthesia in ECT on various clinical outcomes. Previous systematic reviews have not found benefit for overall depression response, although some have found evidence of benefit early in the ECT course. Clear quantitative conclusions have not been established regarding other outcomes, particularly while only using data from high-quality studies. We aimed to examine all data from double-blind randomized controlled trials comparing ketamine to other anesthetics via meta-analysis, to make recommendations regarding ECT practice and future research. Data were extracted for depressive symptoms, seizure duration and electrical dose, neuropsychological performance, and adverse effects. Effect sizes were calculated using Hedge's g and odds ratios. Eighteen studies (n = 915) were included in the meta-analysis. Ketamine was not found to enhance improvement of depressive symptoms, either early in ECT course or at end of study. Ketamine had a large effect on increasing seizure duration both overall (Hedge's g = 0.71, P = 0.038) and in the subgroup receiving ketamine in combination with another anesthetic (Hedge's g = 0.78, P < 0.01), and on decreasing electrical dose (Hedge's g = 1.98, P = 0.039). There was no significant effect of ketamine on any individual neuropsychological domain. Ketamine was not associated with increased adverse effects, except for hypertension in patients receiving ketamine monotherapy. Significant heterogeneity was present for many outcomes, and sensitivity analyses suggested a relation to methodological variation in most cases. This study supports the finding that ketamine does not enhance ECT's antidepressant effect, including on early improvement, but provides substantial evidence for enhancing seizure duration and reducing electrical dose. No significant benefit was found on neurocognitive outcomes, but analysis was limited by small sample sizes and high heterogeneity. Ketamine is generally safe in ECT, particularly as a coanesthetic. Our findings provide meta-analytic support to the recommendations in ECT clinical guidelines for use of coadjuvant ketamine in ECT where seizures are suboptimal. Further studies targeting neurocognitive outcomes are encouraged.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121186337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on the Role of Transcranial Direct Current Stimulation in Substance Use Disorders.","authors":"W. Jacobs, W. McCall","doi":"10.1097/YCT.0000000000000622","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000622","url":null,"abstract":"We read with interest the 2 related articles in this issue of The Journal of ECT: “The effect of transcranial direct current stimulation on opium craving, depression and anxiety: a preliminary study” by Taremian et al and “Transcranial direct current stimulation reduces craving in substance use disorders: a doubleblind placebo-controlled study” by Martinotti et al. Both these studies use transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex treatment (right anodal/left cathodal) for treatment of a fundamental feature of addiction—craving, which was added to theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition, substance use disorder criteria. Both also investigate the effects of this treatment on co-occurring psychiatric symptoms. Both studies correctly recognize that the above issues, especially craving, are significant factors in continued use/relapse and that current interventions, whether behavioral or pharmacologic, are only moderately successful in addressing craving and are also relatively slow in reducing craving level. Interventions that can increase the power and speed with which craving and co-occurring psychiatric symptoms can be reduced could have significant benefits, including increased retention in treatment, reduction in against medical/clinical advice discharges, and earlier and more substantial engagement in treatment. Transcranial direct current stimulation as used in both studies showed significant rapid reductions in craving and co-occurring psychiatric symptoms (depression and anxiety in the study by Taremian et al as well as impulsiveness in the study byMartinotti et al), confirming the trends from the previous scientific","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134061673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing Medical Ethics to Consider Involuntary Administration of Electroconvulsive Therapy.","authors":"S. Surya, R. Bishnoi, R. Shashank","doi":"10.1097/YCT.0000000000000624","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000624","url":null,"abstract":"E lectroconvulsive therapy (ECT) has been used as a treatment modality for psychotic disorders from the times before the advent of pharmacological agents. However, introduction of antipsychotic medications in the 1950s and thereafter has led to a decline in the use of ECT. This decline can be attributed to the convenience of administration and better acceptance of pharmacotherapy. Despite the availability of a basket of pharmacological agents, a large proportion of individuals with psychotic disorders do not achieve significant treatment response. Electroconvulsive therapy is especially beneficial for suicidality and catatonic syndromes, where the need for acute intervention and rapid improvement in symptoms is crucial to prevent dismal outcomes. Despite the robust evidence for the efficacy and safety of ECT in serious mental illnesses like schizophrenia, bipolar disorder, and psychotic depression, some parts of the general public continue to harbor a strong negative perception of ECT. These negative views have been reinforced by the depiction of ECT in films andmedia accounts from self-selected subjects. On the other hand, most patients who have undergone ECT found treatment effective and viewed this modality positively. Partly due to societal stigma, informed consent is an important subject of debate in ECT practice. This is specifically relevant to individuals with serious mental illnesses, where the ability to consent is limited due to poor insight or impaired cognitive functions. In these cases, where principle of autonomy cannot solely guide the treatment, psychiatrists are expected to consider principles of beneficence and nonmaleficence by offering safe and effective treatments. The consent process in individuals who lack capacity or refuse consent is guided by state laws in the United States, ranging from allowing family members to consent to court-ordered treatment. How do individuals receiving ECTwithout or against their consent react once they can acknowledge improvement in their symptoms with ECT? Do they reject their prescribed treatment, or do they agree with the generally favorable view of ECT reported by individuals who receive consensual ECT? Is the risk-benefit ratio of involuntary (without individual consent) treatments similar to that of voluntary treatments (with individual consent). In this context, surveys by Takamiya et al and Besse et al, published in this issue of the journal, make important contribution to the field of ECT. Takamiya et al compared the attitudes toward ECT among participants who received treatments involuntarily and those who","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125192109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive Symptom Dimensions in Treatment-Resistant Major Depression and Their Modulation With Electroconvulsive Therapy","authors":"B. Wade, G. Hellemann, R. Espinoza, R. Woods, Shantanu H. Joshi, R. Redlich, A. Jørgensen, C. Abbott, K. Oedegaard, S. McClintock, L. Oltedal, K. Narr","doi":"10.1097/YCT.0000000000000623","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000623","url":null,"abstract":"Supplemental digital content is available in the text. Objective Symptom heterogeneity in major depressive disorder obscures diagnostic and treatment-responsive biomarker identification. Whether symptom constellations are differentially changed by electroconvulsive therapy (ECT) remains unknown. We investigate the clustering of depressive symptoms over the ECT index and whether ECT differentially influences symptom clusters. Methods The 17-item Hamilton Depression Rating Scale (HDRS-17) was collected from 111 patients with current depressive episode before and after ECT from 4 independent participating sites of the Global ECT-MRI Research Collaboration. Exploratory factor analysis of HDRS-17 items pre- and post-ECT treatment identified depressive symptom dimensions before and after ECT. A 2-way analysis of covariance was used to determine whether baseline symptom clusters were differentially changed by ECT between treatment remitters (defined as patients with posttreatment HDRS-17 total score ≤8) and nonremitters while controlling for pulse width, titration method, concurrent antidepressant treatment, use of benzodiazepine, and demographic variables. Results A 3-factor solution grouped pretreatment HDRS-17 items into core mood/anhedonia, somatic, and insomnia dimensions. A 2-factor solution best described the symptoms at posttreatment despite poorer separation of items. Among remitters, core mood/anhedonia symptoms were significantly more reduced than somatic and insomnia dimensions. No differences in symptom dimension trajectories were observed among nonremitting patients. Conclusions Electroconvulsive therapy targets the underlying source of depressive symptomatology and may confer differential degrees of improvement in certain core depressive symptoms. Our findings of differential trajectories of symptom clusters over the ECT index might help related predictive biomarker studies to refine their approaches by identifying predictors of change along each latent symptom dimension.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125247134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Society for ECT and Neurostimulation Annual Meeting Abstracts 2019","authors":"","doi":"10.1097/yct.0000000000000620","DOIUrl":"https://doi.org/10.1097/yct.0000000000000620","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115508005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}