Journal of Ect最新文献

{"title":"Exploring the Decision-Making Process for Electroconvulsive Therapy in Patients With Major Depressive Disorder and Their Relatives After Treatment.","authors":"Jordy Rovers, Lieke Schönberger, Dore Loef, Philip van Eijndhoven, Esmée Verwijk, Metten Somers, Annemiek Dols, Indira Tendolkar","doi":"10.1097/YCT.0000000000001106","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001106","url":null,"abstract":"<p><strong>Objectives: </strong>Shared decision making is used for reaching medical decisions, also in the management of major depressive disorder (MDD). Electroconvulsive therapy (ECT) is an effective treatment option for patients with severe MDD. However, the decision-making process, specifically the exchange of evidence-based information, for ECT may be hampered by the controversy and stigma surrounding ECT. We aim to explore the experiences of the decision-making process of patients and their relatives who have chosen to receive ECT in order to guide optimization of shared decision making in ECT.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with MDD patients and their relatives who had voluntarily received ECT between 2018-2023 at the Radboud University Medical Center, the Netherlands. The interviews were analyzed by thematic analysis.</p><p><strong>Results: </strong>Meaning saturation occurred after 16 interviews. The following 3 major themes emerged: 1) information is key, 2) empowering the decision, and 3) lived experiences with ECT. Participants emphasized the importance of accessible information presented in a calm and stepwise manner. They also identified gaps in desired information, particularly regarding memory loss and difficulty in retaining the given information. Factors empowering the decision included support from family, healthcare professionals, peers, and desperation, while negative factors included stigma, negative images, lack of support, and fear. Lived experiences with ECT might influence a future decision. Positive experiences were improved attitudes, treatment effects, and empathic and involved professionals, while negative aspects included cognitive side effects and lack of follow-up.</p><p><strong>Conclusions: </strong>This study offers insights into factors influencing the decision-making process in patients with MDD that received ECT. It shows possibilities for improving the decision-making process in clinical practice.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494946","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":"Impact of Anesthesia on Electroconvulsive Therapy-Related Impairments in Global Cognitive Function in Patients With Treatment-Resistant Depression.","authors":"Léo Bernardoff, Martin Blay, Dimitri Thellier, Thierry D'Amato, Filipe Galvao, Emmanuel Poulet","doi":"10.1097/YCT.0000000000001119","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001119","url":null,"abstract":"<p><strong>Introduction: </strong>Electroconvulsive therapy (ECT) in patients with treatment-resistant depression frequently leads to impairments in global cognitive function. Propofol and etomidate are the 2 most frequently used drugs for anesthetic induction during ECT. However, only few studies compared their differential impact on ECT-related impairments in global cognitive function.</p><p><strong>Methods: </strong>We studied retrospectively 75 patients hospitalized at Centre Hospitalier Le Vinatier (Bron, France) who met the DSM-V criteria for major depressive disorder and were treated with bilateral ECT to compare the effects of propofol and etomidate on ECT-related cognitive impairment. Global cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), and symptom severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), both before and after treatment. The primary endpoint of the study was the change in MoCA score.</p><p><strong>Results: </strong>We found no significant difference in MoCA score variation between the etomidate and propofol groups. There were also no significant differences in MADRS score variation, responder, remission rate or ECT parameters between the 2 groups (except duration of electroencephalogram crisis).</p><p><strong>Conclusions: </strong>In this retrospective study, choice of etomidate or propofol as anesthetic agent had no impact on the adverse effects associated with ECT on global cognitive function in patients with treatment-resistant depression.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442853","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":"Maintenance Electroconvulsive Therapy for Treatment-Resistant Irritability in Autism Due to Depression in an Adolescent: A Case Study.","authors":"Enes Faruk Altunkilic, Gul Karacetin, Ipek Ege Gurel Ficicioglu, Ezgi Gurtay, Binay Kayan Ocakoglu, Aysegul Tonyali","doi":"10.1097/YCT.0000000000001118","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001118","url":null,"abstract":"<p><strong>Abstract: </strong>Irritability may be seen in patients with autism spectrum disorder, and it may be treated medically. The core features of the ASD diagnosis may confound presumed treatment resistance of irritability in ASD. Mood disorders should be in differential diagnosis if irritability is treatment-resistant in patients with autism. Electroconvulsive therapy (ECT) may be an effective treatment of choice in such patients. In this case report, we present a 16-year-old, 10-month-old male adolescent with autism spectrum disorder who was admitted to our inpatient service due to his self-harming and aggressive behavior with the possibility of severe harm resulting to others. His irritability was resistant to medical treatment; therefore, an underlying mood disorder was considered in the differential diagnosis. This case report presents a patient with treatment-resistant irritability in autism who was treated with fluoxetine and ECT. ECT is being continued as maintenance ECT. While this case is being written, he has received 36th maintenance ECT at a frequency of twice a week. This patient has benefited from a combination of fluoxetine and ECT. In conclusion, in the presence of irritability unresponsive to pharmacological and behavioral treatment in a patient with nonverbal autism spectrum disorder, an underlying mood disorder should be considered, and treatment should be arranged accordingly; ECT and maintenance ECT may be an effective treatment option.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442858","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":"The \"Learned Intermediary\": The Role of the Psychiatric Interventionist in Product Liability Lawsuits.","authors":"William V McCall, Rebecca E Strickland","doi":"10.1097/YCT.0000000000001122","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001122","url":null,"abstract":"<p><strong>Abstract: </strong>Malpractice lawsuits brought by patient-plaintiffs alleging damages from medications or medical devices may entangle both the prescriber and the biomedical manufacturer. In this scenario, the prescriber may be viewed as a defendant, or alternatively as a \"learned intermediary\" (LI) between the patient and biomedical company. Recent legal actions in the United States involving manufacturers of electroconvulsive therapy devices have invoked the principle of the LI in the arguments. The plaintiff argued that the manufacturer held a major responsibility for providing to device operators warnings which lack scientific basis. This commentary will describe the legal concepts of the LI, and we will argue that the prescriber's duty to the patient is to provide relevant warnings with a scientific grounding, based upon the sum total of the prescriber's education. The courts opined that the conveyance of benefit and risk information to the patient should reflect what is \"known or knowable in light of the generally recognized and prevailing best scientific and medical knowledge available.\" Himes v. Somatics, LLC, 16 Cal. 5th 209, 222, 549 P.3d 916, 923 (2024) (emphasis added).</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384137","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":"Effectiveness of Switching to Right Unilateral From Bilateral Stimulation in Patients With Inadequate Seizures During Acute Electroconvulsive Therapy.","authors":"Ken Wada, Yoshikazu Masuda, Kei Itagaki, Atsuto Fujii, Ryo Ishikawa, Hisato Sangawa, Tatsunori Nagao","doi":"10.1097/YCT.0000000000001051","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001051","url":null,"abstract":"<p><strong>Aim: </strong>To determine the effectiveness of switching to right unilateral (RUL) from bilateral (BL) stimulation in patients with inadequate seizures during acute electroconvulsive therapy (ECT).</p><p><strong>Methods: </strong>A retrospective review of medical records was conducted of patients admitted to the Department of Psychiatry, Hiroshima Citizens Hospital, who received acute ECT from January 2019 to December 2021. Clinical characteristics including ECT procedures and adverse events were examined in patients who switched to RUL from BL.</p><p><strong>Results: </strong>Thirteen patients (7 male and 6 female patients, 66-89 years old) underwent switching to RUL from BL. The total number of ECT sessions including those for seizure titration per patient ranged from 10 to 31, whereas after switching, the number of RUL ECT sessions ranged from 2 to 18. Adequate seizure stimulation was observed from 0 to 11 sessions in patients who underwent RUL. The titrated seizure threshold for RUL was 25.2 mC in 3, 50.4 mC in 8, 75.6 mC, and 100.8 mC in 1. Clinical improvement, assessed by Clinical Global Impressions-Improvement score, was noted in all patients after switching. At the end of the acute ECT course, which included concurrent oral theophylline augmentation in 4 and shortened pulse width in 1 patient, the Clinical Global Impressions-Improvement score was very much improved in 9 and much improved in 3. All 13 patients finished the scheduled ECT course.</p><p><strong>Conclusion: </strong>Switching to RUL from BL can be considered as an effective treatment option for patients undergoing ECT with inadequate seizures.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366602","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":"Is There an Optimal Electrode Placement for Patients With Schizophrenia Undergoing Electroconvulsive Therapy?","authors":"Weng Jun Tan, Kimberly Wan Xin Choo, Jenies Hui Xin Foo, Phern Chern Tor","doi":"10.1097/YCT.0000000000001108","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001108","url":null,"abstract":"<p><strong>Abstract: </strong>Electroconvulsive therapy (ECT) is a recognized treatment option for patients with schizophrenia, especially when patients do not respond adequately to antipsychotic medication or when rapid response is needed in severe cases. The 3 common electrode placements, namely, bitemporal, bifrontal and right unilateral (RUL) modalities, have all been described by various studies to be efficacious in symptom reduction. However, the optimal electrode placement with the greatest success rate in the treatment of schizophrenia has yet to be ascertained. Furthermore, the benefit of switching ECT modalities after poor response to the initial electrode placement has not been well studied. Hence, to illustrate the twin issues of the optimal ECT modality as well as the effect of switching ECT modalities after initial nonresponse in patients with schizophrenia, we describe 2 distinct patients who underwent multiple courses of bifrontal and RUL ECT, but only responded well to bifrontal ECT. This is possibly due to the patients' anatomical differences as well as varying brain stimulation patterns produced by the different electrode placements. Thus, we believe that the prescription of ECT in patients with schizophrenia should be individualized, and a switch to a different ECT modality should be strongly considered if there is a lack of response to a particular modality.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191166","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":"Electroconvulsive Therapy for Treatment-Resistant Depression in a Patient With Wolff-Parkinson-White Syndrome: A Case Report and Literature Review.","authors":"María Paula Gutiérrez-Alzate, Sebastián López-Ospino, Andrea Marcela Suárez-Chacón, Gina Tatiana Coral-Sánchez, Ángela R Acero-González","doi":"10.1097/YCT.0000000000001107","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001107","url":null,"abstract":"<p><strong>Abstract: </strong>Electroconvulsive therapy (ECT) has been recognized as an effective treatment option in severe major depression and treatment-resistant depression. However, its use has been associated with an initial increase in parasympathetic and subsequently sympathetic tone; this has relevance in the context of patients with arrhythmias or pre-excitation syndromes in which some adverse effects have been reported. We present the case of a young female with treatment-resistant depression and a history of Wolff Parkinson White Syndrome admitted for modified ECT. To date, there is no evidence of the anesthetic management of patients with pre-excitation syndromes who require ECT treatment. Therefore, doubts arose regarding the management prior to the procedure. After performing 12 modified ECT sessions an improvement in depressive symptoms was evidenced without any adverse event.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124129","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":"DBS Artifact During Postictal Generalized EEG Suppression After ECT.","authors":"Benjamin Nazif, Foroogh Najafi, Andrew Howard, Stefan Lang, Evan Shao, Chantelle Hrazdil, Fidel Vila-Rodriguez","doi":"10.1097/YCT.0000000000001114","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001114","url":null,"abstract":"","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124110","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":"Optimizing Electroconvulsive Therapy With E-Field Modeling: A Narrative Review.","authors":"Caili Ren, Simon Kung, Paul E Croarkin, Alexander Opitz, Brent P Forester, Adriana P Hermida, Martina Mueller, Sandeep R Pagali, Georgios Petrides, Stephen J Seiner, Isabel A Yoon, Maria I Lapid","doi":"10.1097/YCT.0000000000001111","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001111","url":null,"abstract":"<p><strong>Abstract: </strong>Electroconvulsive therapy (ECT) is an effective treatment for severe depression, especially in treatment-resistant cases. However, its potential cognitive side effects necessitate careful dosing to balance therapeutic benefits and cognitive stability. Recent advances in electric field (E-field) modeling offer promising avenues to optimize ECT dosing. This review synthesizes current knowledge on E-field modeling in ECT and explores its clinical applications. It examines the variability in E-field strengths and distributions induced by ECT and their impact on clinical outcomes. Additionally, the relationship between E-field strengths, neuroplasticity, and therapeutic efficacy is discussed. Translational studies of E-field-informed ECT are highlighted, emphasizing individualized optimal amplitude dosing and potential clinical applications. This review provides useful insights into how E-field modeling can improve the effectiveness of ECT while minimizing adverse effects, helping guide future research and clinical practice.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034843","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 Retrospective Analysis of the Impact of Electroconvulsive Therapy on Anxiety Symptoms in Patients With Treatment-Resistant Depression.","authors":"Julia Laszcz, Chenyang Wang, Patricio Riva-Posse, Jonathan Kim, Valeriya Tsygankova, Ally Mandell, Hanna Rice, Adriana Hermida, Brandon M Kitay, Andrea Crowell, William M McDonald, Rachel Hershenberg","doi":"10.1097/YCT.0000000000001113","DOIUrl":"https://doi.org/10.1097/YCT.0000000000001113","url":null,"abstract":"<p><strong>Background: </strong>Electroconvulsive therapy (ECT) is an effective treatment for treatment-resistant depression (TRD). There are limited data on the improvement of anxiety symptoms in patients receiving ECT for TRD.</p><p><strong>Objective: </strong>The aim of the study was to examine the extent to which anxiety symptom severity improves, relative to improvements in depressive symptoms, in TRD patients receiving an acute course of ECT.</p><p><strong>Methods: </strong>A retrospective chart review of 117 TRD patients who received an acute ECT course in a naturalistic outpatient setting was conducted. Symptomatic response was measured using the Beck Depression Inventory II and Generalized Anxiety Disorder 7 Scale. Two generalized estimating equation models assessed the degree of change in anxious symptoms relative to the change in depressive symptoms.</p><p><strong>Results: </strong>Both depression (-0.09, P < 0.001) and anxiety (-0.08, P < 0.001) improved after ECT treatment, with a greater standardized decrease for symptoms of depression. Higher levels of anxiety over the treatment (-0.42, P < 0.001) were associated with smaller antidepressant improvements.</p><p><strong>Conclusions: </strong>ECT may improve symptoms of anxiety in patients with TRD. Anxiety symptoms show a favorable trajectory of improvement, though to a lesser extent, relative to changes in symptoms of depression. Higher symptoms of anxiety throughout the treatment course may be a negative predictor of antidepressant response in ECT.</p>","PeriodicalId":54844,"journal":{"name":"Journal of Ect","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034825","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}