The Journal of ECT最新文献

{"title":"Electroconvulsive Therapy (ECT) in the News: \"Balance\" Leads to Bias.","authors":"Melissa Choy, Kate G. Farber, C. Kellner","doi":"10.1097/YCT.0000000000000376","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000376","url":null,"abstract":"M any reports of electroconvulsive therapy (ECT) in the news media try to achieve journalistic balance by dedicating a sizable portion of their content to anti-ECT views.We suggest that such practice is, in fact, biased, and effectively perpetuates misinformation and stigma about ECT. Recently, Nicholas Kristof of the New York Times argued that uncritically presenting both sides of an issue for the sake of journalistic “balance” can lead to distortion rather than an accurate portrayal of truth. His examplewas the current US presidential election in which unchecked news reporting on a candidate has led to “normalizing lies and extremism.” Kristof's argument applies equally to news reporting on electroconvulsive therapy (ECT). Despite its widespread acceptance in the medical community, ECT remains surrounded by “controversy.” For years, journalists have paired factual reporting on ECTwith sensationalized anecdotes and unsubstantiated claims. In an attempt to intrigue readers and avoid partisanship, many news outlets have inadvertently given a sizable, unchecked platform to antipsychiatry proponents. For example, 2013 BBC Health News coverage on ECT included a patient success story, a history of the procedure, and potential theories ofmechanism of action. However, it paired thesewith the story of a patient who blamed ECT for erasing years of her memory, with no discussion of her psychiatric condition or response to treatment, and quotes from a psychologist comparing ECTwith “lobotomies and surprise baths.”A2016 article in STAT gave equal weight to a patient narrative on how ECT resolved her severe depression and claims from an anti-ECT proponent, who blamed ECT for ending her marriage. A 2016 New Scientist article discussing the efficacy of ECT still included terminology such as “tainted treatment” and “brutal and archaic.” In their effort to capture readers' attention, all of these articles referenced the movieOne Flew Over the Cuckoo's Nest, the ubiquitous archaic image of ECT that is conflatedwithmodern practice. Even informationalmaterial from the psychiatric profession includes language promulgated by the antipsychiatry movement. For example, the ECT informational leaflet from the Royal College of Psychiatrists has a section entitled “what do those against ECT say,” which states that “some see ECTas a treatment that belongs to the past...permanently damages both the brain and mind...[and] would want to see it banned.” An article that presents one success story and one patient who reports catastrophic memory loss implies that both outcomes are equally likely. This is not an accurate portrayal of the clinical reality; approximately three quarters of patients have a good response to ECT and a positive attitude about it. Inaccurate or overblown statements without adequate commentary perpetuate the apprehension and stigma surrounding ECT. By presenting dramatized memory loss claims side by side with physician expertise and factual studies, the media","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124093558","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":"Reply to Dr Martin's Letter Regarding Differences in Cognitive Outcomes After ECT Depending on BDNF and COMT Polymorphisms.","authors":"Daniel M. Bennett, J. Perrin, Gordon Fernie","doi":"10.1097/YCT.0000000000000397","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000397","url":null,"abstract":"To the Editor: B ennett and colleagues recently examined the effects of both the brain-derived neurotrophic factor (BDNF) Val66Met singlenucleotide polymorphism and catecholO-methyltransferase (COMT) Val158Met single-nucleotide polymorphism cognitive and mood outcomes after electroconvulsive therapy (ECT). Their study included 87 depressed patients, and cognitive functioning was tested at multiple time points (preECT, after 4 treatments, post-ECT, 1 month post-ECT, and 3 months post-ECT) with 2 tasks, the Mini-Mental State Examination and Spatial Recognition Memory from the CANTAB computerized battery. The authors suggested that assessing either of these polymorphisms will not be helpful for predicting cognitive outcomes after ECT in clinical practice. In a larger sample, we similarly had investigated the effects of both these polymorphisms, in addition to other potentially relevant genes, for predicting cognitive and mood outcomes after ECT. However, in contrast to Bennett et al, we administered a comprehensive neuropsychological battery, which included measures of both anterograde memory (learning and delayed recall) and retrograde autobiographical memory, the cognitive functions most affected by ECT. Our results showed effects ofCOMTVal158Met on change in retrograde autobiographical memory (P = 0.048, η = 0.055) and BDNF Val66Met on change in anterograde memory functioning (P = 0.026, η = 0.043) from preto post-ECT in unadjusted models. However, these effects were no longer statistically significant after adjustment for relevant covariates. Notwithstanding, it is possible that these effects may still hold true in a larger sample because our sample (N = 117) was modest for a gene association study, a limitation we acknowledged. Although the Spatial Recognition Memory test used by Bennett and colleagues also assessed anterograde memory (visuospatial), it did not assess delayed recall,","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128146083","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":"Concomitant Anticonvulsants With Bitemporal Electroconvulsive Therapy: A Randomized Controlled Trial With Clinical and Neurobiological Application","authors":"G. Rakesh, J. Thirthalli, C. Kumar, K. Muralidharan, V. Phutane, B. Gangadhar","doi":"10.1097/YCT.0000000000000357","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000357","url":null,"abstract":"Background Electroconvulsive therapy (ECT) is an effective treatment for major affective disorders. The combined use of ECT and anticonvulsant mood stabilizers is a common clinical scenario. There is dearth of systematic studies on the use of this combination with regard to clinical or cognitive outcomes. Objective/Hypothesis We aimed to compare clinical improvement and cognitive adverse effects between patients who received only ECT versus those who received ECT and anticonvulsants. We hypothesized that improvement would be fastest in patients who received only ECT. Methods We conducted a randomized controlled trial in which patients prescribed ECT while being treated with anticonvulsants were randomized into 3 groups: full-dose (FD), half-dose (HD), and stop anticonvulsant. A blind rater assessed clinical improvement in patients using rating scales [Young’s Mania Rating Scale (YMRS) and Clinical Global Impression] for clinical improvement and cognitive adverse effects (Postgraduate Institute memory scale). Analysis was done using mixed-effects modeling to delineate differences in clinical and cognitive outcomes across the 3 arms of the study over the course of ECT. Results Of the 54 patients recruited, 36 patients went into treatment allocation arms per the initial randomization plan. The main anticonvulsants prescribed were sodium valproate and carbamazepine. Patients in the 3 groups were comparable on clinical features. The most common diagnosis was bipolar affective disorder—with current episode of mania. Overall, there was no difference across the 3 groups in final clinical outcome scores (YMRS and Clinical Global Impression) when analyzed as intention to treat (ITT) or “as treated.” In both analyses, group × time interaction was significant when comparing trend of YMRS scores between the FD anticonvulsant group and the HD group from baseline to last ECT (P = 0.0435 in ITT and P = 0.0055 in as treated). Patients in the FD group improved faster than those in the HD group. There were no differences across the 3 groups with regard to their cognitive adverse effects in the ITT analysis; “as-treated analysis” showed the HD patients to have performed poorly on some domains. Seizure parameters showed no significant difference across the 3 groups. Conclusion This is a preliminary prospective study examining whether coprescription of anticonvulsants with ECT affected clinical or cognitive outcomes. The most important takeaway point from this study is the significant reduction in YMRS scores when ECT was given with FD anticonvulsant compared with halving the dose (HD) of anticonvulsant. This difference was shown in both ITT and as-treated analysis. There is a need for more prospective studies to examine this clinical question.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124950284","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 Comparison of Right Unilateral and Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Major Depression: A Naturalistic Clinical Australian Study","authors":"C. Galletly, Benjamin L. Carnell, P. Clarke, S. Gill","doi":"10.1097/YCT.0000000000000359","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000359","url":null,"abstract":"Background A great deal of research has established the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. However, questions remain about the optimal method to deliver treatment. One area requiring consideration is the difference in efficacy between bilateral and unilateral treatment protocols. Objective This study aimed to compare the effectiveness of sequential bilateral rTMS and right unilateral rTMS. Methods A total of 135 patients participated in the study, receiving either bilateral rTMS (N = 57) or right unilateral rTMS (N = 78). Treatment response was assessed using the Hamilton depression rating scale. Results Sequential bilateral rTMS had a higher response rate than right unilateral (43.9% vs 30.8%), but this difference was not statistically significant. This was also the case for remission rates (33.3% vs 21.8%, respectively). Controlling for pretreatment severity of depression, the results did not indicate a significant difference between the protocols with regard to posttreatment Hamilton depression rating scale scores. Conclusions The current study found no statistically significant differences in response and remission rates between sequential bilateral rTMS and right unilateral rTMS. Given the shorter treatment time and the greater safety and tolerability of right unilateral rTMS, this may be a better choice than bilateral treatment in clinical settings.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"210 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113997850","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":"Left Anterior Right Temporal Electrode Placement in Maintenance Electroconvulsive Therapy.","authors":"J. Sendra, O. Alcoverro","doi":"10.1097/YCT.0000000000000367","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000367","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129510875","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 Case of Anesthesia Mumps with Electroconvulsive Therapy.","authors":"R. Katz, L. Helgeson, R. Ostroff","doi":"10.1097/YCT.0000000000000370","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000370","url":null,"abstract":"","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134395866","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":"Serum Oxytocin Concentration in Patients Receiving Electroconvulsive Therapy: An Exploratory Study and Review of Literature","authors":"Chinmay Barhale, M. Raju, Alka V. Pawar, K. Kadam, A. De Sousa, C. Andrade","doi":"10.1097/YCT.0000000000000388","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000388","url":null,"abstract":"Background Neuroendocrine biomarkers have long been studied in the context of electroconvulsive therapy (ECT). We prospectively assessed serum oxytocin change and moderators thereof in an exploratory study of patients receiving ECT. Methods Serum oxytocin concentrations were assessed immediately before and 1 to 3 minutes after the first ECT in 33 patients with schizophrenia (n = 14), other nonaffective psychosis (n = 6), mania (n = 10), and depression (n = 3) who received 6 to 7 bitemporal, brief-pulse ECTs. Change in serum oxytocin was assessed in the sample as a whole, and as a function of age, sex, diagnosis, and treatment response. The primary outcome was change in serum oxytocin in the overall sample. Results There was much variation across patients; oxytocin concentrations increased marginally by a mean (standard deviation) (M [SD]) of 6.4 (82.7) pg/mL (P = 0.43). The M (SD) change was −8.2 (85.0) pg/mL in patients with schizophrenia and other nonaffective psychoses (P = 0.84). There was no significant correlation between change in Brief Psychiatric Rating Scale scores and change in oxytocin concentrations in patients with schizophrenia, other nonaffective psychoses, and mania (&rgr; = 0.10, P = 0.61). Serum oxytocin rose in men, after ECT, and fell in women (P = 0.01). Conclusions Change in serum oxytocin immediately after the first ECT in a course may not be a useful biomarker of ECT action. This is the first report on the subject in a sample comprising mostly patients with nonaffective psychosis and mania rather than depression. We discuss our findings in the light of previous research and offer general conclusions about the field.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124626761","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 Trend of Adding Remifentanil in ECT Anesthesia: What Are We Doing?","authors":"Albert Bortolotti","doi":"10.1097/YCT.0000000000000360","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000360","url":null,"abstract":"To the Editor: T he use of remifentanil in electroconvulsive therapy (ECT) has been supported in the literature for more than 10 years. It is used as part of anesthesia for the procedure. It is considered beneficial because it has been shown to prolong seizure duration, improve recovery time, and better modulate blood pressure. Remifentanil has also been shown to attenuate the acute hemodynamic response to ECT. This has been demonstrated with electroencephalographic (EEG) readings and blood pressure responses at the time of the ECT procedure. Thus, immediate benefits of remifentanil are well supported. Remifentanil augmentation is thought to enable a smaller dose of anesthetic agent to be used, thus increasing the chance of a successful seizure. Despite no known direct proconvulsant effects, the addition of remifentanil allows a reduced dose of other anesthetic agents, particularly those that are anticonvulsant. Common anesthetic agents used in ECT, such as propofol and thiopentone, potentially raise seizure thresholds, potentially creating an antiseizure effect. This has implications for reducing the effectiveness of ECT. Benefits have been shown whether remifentanil has been used to augment the other agents or as a sole induction agent. When remifentanil-supplemented anesthesia is reserved for patients with refractory depression, that is, after they do not respond to standard treatment, it may be assumed that these patients will require more ECT treatments to achieve a therapeutic response to ECT. Remifentanil is typically used for cases of high seizure threshold resulting in too short or missed seizures. Remifentanil is also given routinely to all ECT patients in many institutions.Whether remifentanil-supplemented anesthesia affects the number of treatments needed, if given routinely, is not known. Although no actual adverse effect from the use of remifentanil for ECT has been reported to date, the risk profile associated with remifentanil use suggests that caution should be exercised. Both profound respiratory depression and severe cardiovascular depression have been described.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116005768","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":"Finally, Evidence for Continuation Electroconvulsive Therapy in Major Depressive Disorder.","authors":"W. McCall","doi":"10.1097/YCT.0000000000000368","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000368","url":null,"abstract":"C olleagues in countries outside the United States may be surprised to discover that American psychiatrists must get permission (“authorization”) from commercial (ie, nongovernmental) health insurance companies if they want to be paid for their efforts providing electroconvulsive therapy (ECT) to patients covered by commercial health insurance. In my recent experience, successful authorization of ECT services is handed out in increments of 3 to 6 treatment sessions at a time. After that, additional authorization is required. The same process is followed for continuation ECT following successful acute ECT for major depressive disorder (MDD). The restrictions on payment can be even worse. In my last attempt to obtain authorization for outpatient continuation ECT, the insurance representative denied the request, saying the continuation ECTwas “not a covered service” within that particular patient’s health plan. He was not arguing about the merits or demerits of continuation ECT; hewas simply informing me that his company would not pay for this service. It is easy for the insurance company to deny payment, and difficult for the physician to appeal the denial, when hard evidence is lacking to support continuation ECT as superior to medications alone for MDD. This lack of empirical support for continuation ECTwas also cited as a weakness in the Food and Drug Administration expert panel review of ECT and was also cited by the United Kingdom’s NICE (National Institute for Health and Care Excellence) report on ECT, as summarized elsewhere. Thankfully, the data shortage has now been addressed by Kellner et al, the Prolonging Remission in Depressed Elderly (PRIDE) study. This study recruited 240 elderly MDD patients for an acute course of right unilateral ultrabrief ECT, combined with venlafaxine. Remission of MDD was achieved in 148 (61.7%) of these participants, and 120 of these subsequently consented and were randomized to pharmacotherapy (venlafaxine plus lithium) versus pharmacotherapy accompanied by weekly continuation ECT for 4 weeks with additional ECT after that as needed. The highlights of the randomized phase included the superiority of the continuation ECT arm over the 6 months of follow-up and that only 34.4% of the patients in the ECT group required additional ECT sessions beyond the initial required 4 weekly continuation ECT sessions. Furthermore, the ECT sessions were well tolerated by those assigned in the ECT group, with no meaningful change in Mini Mental State Exam scores. Clinically, the PRIDE study provides guidance for ECT providers and supports offering continuation ECTon a routine basis after successful acute ECT. Apart from the value of the PRIDE study in guiding clinical care, the PRIDE study provides important ammunition for continuation ECT in advocacy with regulatory authorities (ie, NICE) and with payers (ie, commercial insurers). American psychiatrists should have the PRIDE data on the tip of their tonguewhen preparing for a ","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130583951","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":"Cognitive Effects of Bifrontal Versus Right Unilateral Electroconvulsive Therapy in the Treatment of Major Depression in Elderly Patients: A Randomized, Controlled Trial","authors":"Gro Strømnes Dybedal, T. M. Bjølseth, J. Benth, L. Tanum","doi":"10.1097/YCT.0000000000000310","DOIUrl":"https://doi.org/10.1097/YCT.0000000000000310","url":null,"abstract":"Objectives Bifrontal (BF) electrode placement has been explored to refine the electroconvulsive therapy (ECT) technique. No previous study has compared the cognitive effects of BF versus right unilateral (RUL) ECT by only including the subgroup that is most likely to receive it: elderly patients with major depression. Methods Nondemented patients (n = 65) with major depression, aged 60 to 85 years, were randomly allocated to BF ECT and RUL formula-based ECT. Cognitive function was assessed at baseline (T1), within 1 week after a course of ECT (T2), and 3 months after T2 (T3). Six neuropsychological test measures of memory, 5 of executive function, and 3 of information-processing speed were administered. Results According to linear mixed models, there were no significant differences between the BF and RUL groups at any time. The retrograde memory score for public facts declined more for the RUL group (P < 0.001) than the BF group (P = 0.005) from baseline to the first retest and remained stable for both groups from T2 to T3. A rapid improvement in selective attention was observed in the RUL group from T1 to T2, but the scores remained stable from T2 to T3 (P < 0.001). This measure remained stable in the BF group from T1 to T3. Conclusions Our findings indicate that there were negligible differences in the cognitive effects of formula-based BF or RUL ECT. The overall cognitive effects of ECT were equally favorable for each of the groups.","PeriodicalId":287576,"journal":{"name":"The Journal of ECT","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124724296","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}