Journal of Ect最新文献

{"title":"Dose-Dependent Effects of Benzodiazepines and Other Psychotropic Drugs on Seizure Duration in Electroconvulsive Therapy.","authors":"Pornjira Pariwatcharakul, Patipon Homhual, Punyisa Prachgosin, Naratip Sa-Nguanpanich, Lakkana Thongchot, Pitchaporn Liao, Thanarat Suansanae","doi":"10.1097/YCT.0000000000001189","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001189","url":null,"abstract":"<p><strong>Objective: </strong>To examine the effects of psychotropic drugs on the seizure duration in patients receiving electroconvulsive therapy (ECT).</p><p><strong>Materials and methods: </strong>Medical records of patients receiving ECT at a university hospital in Bangkok from March 2014 to February 2017 were retrospectively reviewed. Demographics, psychotropic drug use, ECT parameters, and motor seizure duration were recorded. Daily doses of drugs with antipsychotic properties and benzodiazepines were converted to risperidone and diazepam equivalent doses, respectively. Besides descriptive statistics, logistic regression analyses were performed using the linear quantile mixed model analysis to examine the association between seizure duration and the use and daily dose of psychotropic drugs.</p><p><strong>Results: </strong>Data from 249 inpatients were analyzed. Seizure duration was inversely associated with benzodiazepine dosage (β=-0.070, P=0.026), especially at diazepam-equivalent dose ≥20 mg (β=-5.303, P=0.031). After adjustment for thiopental dose, charges, age, and sex, this association remained significant (β=-5.321, P=0.033). Antipsychotic use (P=0.672) and risperidone-equivalent daily dose (P=0.996), as well as clozapine use (P=0.395) and dose (P=0.733), were not associated with seizure duration. The use of anticonvulsants (P=0.989), including valproate (P=0.500), and antidepressants (P=0.649), including SSRIs (P=0.666), SNRIs (P=0.713), and trazodone (P=0.249), also showed no significant associations. After adjusting for thiopental dose, charge, age, sex, and BZD dose, other psychotropic medications showed no significant association with seizure duration.</p><p><strong>Conclusions: </strong>Benzodiazepine doses at diazepam equivalents of ≥20 mg were associated with shorter seizure duration. If patients benefit from benzodiazepine use during ECT, clinicians may consider prescribing it at a diazepam-equivalent dose of <20 mg/d if necessary.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report on the Role of Continuous Theta Burst Stimulation in Managing Dystonia in a Patient With Wilson's Disease.","authors":"Ankita Saroj, Sandhya Verma, Mohita Joshi, Praveen Kumar Sharma, Sujita Kumar Kar","doi":"10.1097/YCT.0000000000001186","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001186","url":null,"abstract":"","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Intracranial Pressure Change Through Optic Nerve Sheath Ultrasound During Electroconvulsive Therapy.","authors":"Irem Aksoy, Demet Lafli Tunay, Mustafa Aksoy","doi":"10.1097/YCT.0000000000001187","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001187","url":null,"abstract":"<p><strong>Objectives: </strong>Electroconvulsive therapy (ECT), which is applied by producing a seizure with an electrical current under general anesthesia, is an effective and reliable method in the treatment of most psychiatric diseases. Nevertheless, how the treatment affects intracranial pressure and other neuronal mechanisms is uncertain. This prospective observational study evaluated the effects of ECT on intracranial pressure by measuring the optic nerve sheath diameter (ONSD) using ultrasonography.</p><p><strong>Methods: </strong>Thirty-nine patients undergoing their first ECT session were included in the study, and ONSD measurements were performed on all patients at 4 time points: before and after anesthesia induction, after ECT (post-ictal), and during the recovery phase. Age, weight, height, psychiatric diagnoses, medications and comorbidities, blood pressure and heart rate values, and motor seizure durations were recorded.</p><p><strong>Results: </strong>Post-ictal ONSD (5.47 ± 0.40 mm) was significantly higher than preinduction (4.89 ± 0.33 mm), postinduction (4.90 ± 0.35 mm), and recovery (4.96 ± 0.38 mm) measurements (P < 0.001). The change in ONSD during ECT was significantly higher in patients with preexisting hypertension (P = 0.001) and correlated positively with blood pressure.</p><p><strong>Conclusions: </strong>In patients with an indication for ECT and without an intracranial space-occupying lesion, ECT procedure may cause a transient increase in intracranial pressure (ICP). This change in ICP may be more pronounced in patients with a diagnosis of hypertension. These findings highlight the need for careful monitoring of ICP in hypertensive patients undergoing ECT.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Cognitive Screening Tools Used to Assess Neurocognitive Side Effects of Electroconvulsive Therapy: A Systematic Review.","authors":"Jeremy Dodd, Emma Brown, Lars Eriksson, Simone Garrett-Walcott, Subramanian Purushothaman, Donel Martin, Stephen Parker, Mark Vickers","doi":"10.1097/YCT.0000000000001181","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001181","url":null,"abstract":"<p><p>This systematic review identified and critically appraised existing research comparing cognitive screening tools used to assess neurocognitive side effects of electroconvulsive therapy (ECT). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and the Synthesis Without Meta-analysis (SWiM) reporting guideline. A protocol was registered with the Open Sciences Network (OSF) registry, and critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal tool for Diagnostic Test Accuracy Studies. Pragmatic criteria were applied to assess relative strengths and weaknesses of the identified cognitive screening tools for application to clinical practice. Nine studies met the inclusion criteria; 2 ECT-specific cognitive screening tools, 2 generalised cognitive screening tools, 4 neurocognitive batteries, and 1 brief memory scale. The ECT-specific cognitive screening tools were the Brief ECT Cognitive Screen (BECS) and the ElectroConvulsive Therapy Cognitive Assessment (ECCA). The Montreal Cognitive Assessment (MoCA) was the most common generalised cognitive screening tool used. The BECS and ECCA scored the highest using our specific pragmatic criteria. Key limitations across the included studies were the lack of a suitable gold standard comparator and inadequate blinding of assessors. There is limited evidence to support the superiority of one cognitive tool over another for assessing neurocognitive side effects associated with ECT. The primary limitations across the current literature base are the lack of a gold standard reference tool and heterogeneity of included populations. There is a need for further research to validate the sensitivity and specificity of tools such as the BECS and ECCA.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Variations in Access: Investigating Time-to-Electroconvulsive Therapy (ECT) Utilization Among Inpatients Using the National Inpatient Sample.","authors":"Anisha Kohli, Haley Schuster, Ryan W Walters, Imad Alsakaf","doi":"10.1097/YCT.0000000000001180","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001180","url":null,"abstract":"<p><strong>Objectives: </strong>This study examined temporal trends and sociodemographic variations in time-to-electroconvulsive therapy (ECT) administration among inpatients with psychiatric conditions for which ECT is indicated.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the National Inpatient Sample database from 2016 to 2021. Hospitalizations of adults with a primary diagnosis of major depressive disorder, bipolar disorder, schizoaffective disorder, noncatatonic schizophrenia, or catatonia who received ECT were included. Outcomes assessed included time to first ECT session, hospitalization length, discharge disposition, costs, and complications. Mixed-effects negative binomial regression was used to evaluate differences in time-to-ECT by age, biological sex, primary insurance, income quartile, and health-related social needs.</p><p><strong>Results: </strong>From 2016 to 2021, ECT-utilizing hospitalizations declined, while the time to first ECT session increased by 24.6% from 7.3 days in 2016 to 9.1 days in 2021. Delays were longest for noncatatonic schizophrenia and catatonia. Sociodemographic variations included significantly longer wait times for Blacks and Hispanics, Medicaid beneficiaries, and those with housing insecurity or unemployment. Hospitalizations that included older patients experienced longer delays, whereas rural hospitals reported shorter wait times.</p><p><strong>Conclusions: </strong>Significant delays in ECT administration exist, particularly for vulnerable populations and less common indications. These findings underscore the need for interventions to address systemic barriers and improve equitable access to timely ECT.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Disparities in Electroconvulsive Therapy: A Study From Singapore.","authors":"Crystal Yun See Lee, Jiaqian Sun, Birong Chen, Xiaowei Tan, Phern Chern Tor","doi":"10.1097/YCT.0000000000001183","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001183","url":null,"abstract":"<p><strong>Background: </strong>Electroconvulsive therapy (ECT) has been a key treatment for various psychiatric disorders. Prior research has indicated racial disparities in ECT utilization, particularly in Western populations. This study examines racial differences in ECT use and outcomes in Singapore, a multiracial Asian context, focusing on Chinese, Malay, and Indian patients.</p><p><strong>Methods: </strong>A retrospective analysis of medical records from the Singapore Institute of Mental Health (IMH) was conducted for patients who underwent ECT between 2017 and 2023. Data on sociodemographic profiles, clinical characteristics, pre-ECT clinical data, and post-ECT outcomes were collected.</p><p><strong>Results: </strong>The final sample consisted of 1091 participants: 79.6% Chinese, 10.3% Malay, and 5.8% Indian. Chinese participants were older and more likely to be female. There were no differences between races in terms of primary psychiatric diagnosis, number of failed medications, or previous ECT use. There were no significant racial differences in ECT response rates, which were 48.3% for Chinese, 40.4% for Indian, and 42.7% for Malay participants. Cognitive outcomes also did not differ significantly by race. However, results showed that being Chinese was a significant predictor of better post-ECT utility scores.</p><p><strong>Conclusions: </strong>These findings align with literature suggesting that ECT's efficacy is generally unaffected by race. Chinese participants were found to have higher post-ECT quality of life measure scores, which may reflect potential differences in the subjective experiences and perceived utility of ECT between races. The results provide valuable insights into ECT practices in a non-Western context and suggest that ECT is equally effective and safe across different racial groups in Singapore.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudocholinesterase Deficiency Uncovered During Electroconvulsive Therapy: Implications for Psychiatric Services.","authors":"Mude Jeevan Naik, Amruta Nirale, Inchara Bhat, Guru S Gowda, Satish Suhas, Deepak Ghadigoankar, Kadarapura Nanjundaiah Gopalakrishna, John P John, Venkata Senthil Kumar Reddi","doi":"10.1097/YCT.0000000000001177","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001177","url":null,"abstract":"<p><strong>Introduction: </strong>Electroconvulsive therapy (ECT) is an effective and safe treatment for mental disorders with acute suicidality. The use of modified ECT with muscle relaxants like succinylcholine or mivacurium can cause prolonged apnea in individuals with pseudocholinesterase deficiency.</p><p><strong>Case description: </strong>This case describes a 24-year-old woman with schizophrenia and body dysmorphic disorder. She developed prolonged apnea following modified ECT with succinylcholine, despite having no identifiable risk factors for pseudocholinesterase deficiency. Subsequent testing confirmed possible inherited pseudocholinesterase deficiency (serum cholinesterase levels: 353.80 U/L). Anesthetic agent modifications, with atracurium replacing succinylcholine, ensured the safe continuation of ECT.</p><p><strong>Discussion: </strong>This case report highlights that although pseudocholinesterase deficiency is rare, it can lead to serious complications and often goes undiagnosed in otherwise healthy individuals. It underscores the need for greater awareness and a clinical decision-making tree on anesthetic agent modifications used to ensure the safe continuation of ECT.</p><p><strong>Conclusion: </strong>A clinical decision-making tree offers a practical approach for clinicians in risk assessment, preanesthetic screening, and anesthetic agent modification. It thereby ensures the safety of modified ECT administration in individuals with undiagnosed pseudocholinesterase deficiency.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Cholinesterase Inhibitors for Treatment and Prevention of Cognitive Adverse Effects of Electroconvulsive Therapy: A Systematic Review.","authors":"Angela Dylewski, Amanda C Holder, Jamie N Brown","doi":"10.1097/YCT.0000000000001095","DOIUrl":"10.1097/YCT.0000000000001095","url":null,"abstract":"<p><strong>Abstract: </strong>Although electroconvulsive therapy (ECT) is effective for treating depression, schizophrenia, and mania, cognitive adverse effects may limit use. One possible mechanism for these effects includes cholinergic transmission alterations, supporting potential use of cholinesterase inhibitors for prevention and treatment of these cognitive deficits. The objective of this review is to determine efficacy and safety of cholinesterase inhibitors clinically used for dementia in reducing ECT cognitive adverse effects. PubMed, EMBASE, and CENTRAL were searched in August 2024 for randomized controlled trials using terms and keywords related to cholinesterase inhibitors ( acetylcholinesterase inhibitor , cholinesterase inhibitor , donepezil, galantamine , or rivastigmine ) and ECT ( electroconvulsive therapy , electroconvulsive , electroshock therapy , or ECT ). A total of 8 randomized controlled trials were reviewed with mean patient ages ranging from 28.6 to 59.33 years and most common diagnoses including depressive disorders, schizophrenia/psychosis, and bipolar disorder. Six of the 8 trials showed benefits of using cholinesterase inhibitors in patients undergoing ECT. Significant improvements were found in immediate memory after ECT and recovery of personal memory, repetition, alertness, orientation, and impersonal memory compared with placebo. Trials varied in cognitive assessment scales, length of therapy, dosing strategy, ECT schedule, and ECT type/parameters. Cholinesterase inhibitors may be effective for reducing cognitive adverse effects of ECT and appear safe and well tolerated. The most commonly studied medication was donepezil 5 mg daily started shortly before and continued throughout ECT. Additional studies are needed to clarify optimal dosing, titration, duration of therapy, and the role of treatment for older adults, preexisting cognitive impairment, and neurologic comorbidities.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":"174-182"},"PeriodicalIF":1.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Than 8 Years of Maintenance Electroconvulsive Therapy Without Antipsychotic Medication for a Deficit Form of Schizophrenia.","authors":"Mounir Jaafari, Youssef Ouazzani Housni Touhami, Imane Boujguenna, Rachid Aalouane, Ismail Rammouz","doi":"10.1097/YCT.0000000000001120","DOIUrl":"10.1097/YCT.0000000000001120","url":null,"abstract":"","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":"e29-e30"},"PeriodicalIF":1.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Max Fink: A Remembrance.","authors":"Randall T Espinoza, William Vaughn McCall, Charles H Kellner","doi":"10.1097/YCT.0000000000001184","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001184","url":null,"abstract":"","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":"41 3","pages":"153-154"},"PeriodicalIF":1.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}