Relative impact of diagnosis and clinical stage on response to electroconvulsive therapy: a retrospective cohort

Objectives: Electroconvulsive therapy (ECT) is commonly indicated for refractory psychiatric disorders. However, little research has compared response across diagnoses. Here, we aimed to evaluate the relative impact of diagnosis and clinical staging as response predictors in a cross-diagnostic sample. Methods: In a retrospective cohort of adult inpatients (n=287) who underwent at least six sessions of ECT, we investigated predictors of complete response (a clinical global impression of 1) to ECT. We use adjusted regression models to estimate the impact of clinical diagnosis and staging on complete response and dominance analysis to assess the relative importance of these predictors. Results: Those for whom a depressive episode was a primary indication for treatment were the most likely to have complete improvement, while those with psychosis were the least likely; clinical stage had a significant influence on outcome in all diagnoses. A diagnosis of psychosis was the strongest predictor of non-response. Conclusions: A diagnosis of psychosis (mainly schizophrenia) was the strongest predictor of non-response. We also found that clinical staging can aggregate information on ECT response that is independent of clinical diagnosis.

Experiencia clínica de la terapia electroconvulsiva con anestesia y relajación en la Clínica Universidad de La Sabana: 2009-2017

Introducción: La terapia electroconvulsiva es un procedimiento efectivo y seguro, el cual se indica principalmente a pacientes con episodios depresivos tanto unipolares como bipolares, manía y esquizofrenia, cuando no responden a otros tratamientos. Objetivo: Describir las propiedades demográficas, sociales y clínicas de un grupo de pacientes tratados con terapia electroconvulsiva con anestesia y relajación (TECAR) en la Clínica Universidad de La Sabana por un periodo de 8 arios. Métodos: Se revisan las bases de datos y los registros de los procedimientos desde el 1 de enero de 2009 hasta el 31 de diciembre de 2017. Se realiza un análisis con estadística descriptiva. Resultados: En este periodo se realizaron 1.322 procedimientos a 143 pacientes, el 54,5% de ellos mujeres, y con diagnóstico asociado de depresión mayor en el 57% de los pacientes. El número de tratamientos por persona fue 9,2 y en el 3,8% se presentaron complicaciones, sin que se requiriese tratamiento invasivo en ninguna de ellas. Conclusiones: La terapia electroconvulsiva se aplica con seguridad a los pacientes y con parámetros diversos en cuanto a edad, sexo y diagnóstico más frecuente, en comparación con otros países de Latinoamérica y el mundo. Es importante sumar esfuerzos en investigación que permitan tener un panorama más completo de las características de su aplicación en el país.

Electroconvulsive therapy is an effective and safe procedure, which is indicated mainly in patients with both unipolar and bipolar depressive episodes, mania and schizophrenia, when they do not respond to other treatments. Objective: To describe the demographic, social and clinical properties of a group of patients treated with electroconvulsive therapy (ECT) with anaesthetic and muscular relaxant at the Universidad de La Sabana Clinic for a period of 8 years. Methods: The databases and records of the procedures were reviewed from 1 January 2009 to 31 December 2017. An analysis was performed with descriptive statistics. Results: In this period, 1,322 procedures were performed on 143 patients (54.5% women) with an associated diagnosis of major depression in 57%. The number of treatments per person was 9.2 and complications occurred in 3.8%, without any of them requiring invasive management. Conclusions: Electroconvulsive therapy is performed safely in patients and with different parameters in terms of age, gender and diagnosis, in comparison to other countries in Latin America and the world. It is important to join efforts in research that allow a more complete overview of the characteristics of its application in the country.

Impacto de la Terapia Electroconvulsiva en el Funcionamiento de la Memoria en Pacientes con Depresión

Introducción: La seguridad de la terapia electroconvulsiva ha mejorado mucho en las últimas décadas, lo que hace que los efectos potencialmente adversos en la memoria y otras funciones neurocognitivas sean el principal aspecto clínico de preocupación en el presente. En Colombia, la población general y los profesionales de la salud (incluso algunos psiquiatras) parecen tener opiniones mayoritariamente negativas sobre el tratamiento electroconvulsivo, pero quizá esto podría reconsiderarse si se brinda más información; por lo tanto, el objetivo del presente estudio es evaluar los cambios en la memoria y la gravedad de los síntomas en un grupo de pacientes con depresión grave antes y después de la terapia electroconvulsiva. Métodos: Se incluyó a 23 pacientes con edades comprendidas entre los 23 y los 70 anos del Servicio de Terapia Electroconvulsiva de la Clínica San Juan de Dios (Manizales, Colombia) para evaluar el efecto de esta terapia en la memoria de pacientes con depresión grave. Los síntomas depresivos y la memoria se evaluaron con la escala de depresión de Hamilton (HAMD) y la prueba de aprendizaje auditivo verbal de Rey (RAVLT) respectivamente. Se evaluó a los participantes antes de la sesión inicial de la serie de terapia electroconvulsiva (0-1 día) y 2 días después de su último tratamiento. Resultados: La terapia electroconvulsiva resultó en una mejora significativa en la puntuación de depresión. No hubo diferencias significativas en las puntuaciones de las 5 pruebas de aprendizaje, recuerdo retardado, aprendizaje y olvido desde antes del tratamiento hasta después de este. Se encontraron diferencias significativas antes y después del tratamiento en la prueba de reconocimiento retardado. Conclusiones: Los problemas de memoria pueden evaluarse y caracterizarse de manera práctica tras la terapia electroconvulsiva. La evaluación cognitiva antes y después de la terapia electroconvulsiva es un procedimiento viable y útil. En general, el rendimiento de la memoria no empeora después de la terapia electroconvulsiva en pacientes con depresión. Solo el reconocimiento retardado se ve afectado unos días después, particularmente en pacientes con bajo nivel educativo y colocación de electrodos bitemporales (BT).

Introduction: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

La terapia electroconvulsiva en el síndrome neuroléptico maligno / Electroconvulsive therapy in neuroleptic malignant syndrome

Resumen: Uno de los efectos adversos más importantes de los neurolépticos es la posibilidad de desencadenar el síndrome neuroléptico maligno (NMS). El diagnóstico se determina por exclusión y el manejo terapéutico inicial será retirado por neurolépticos por la administración de benzodiacepinas y, en casos extremos, el uso de la terapia electroconvulsiva (ECT). La ECT es una opción terapéutica eficaz en estos pacientes y en esos casos se obtiene una mala respuesta a la administración con fármacos antipsicóticos. Basándonos en el caso del artículo «Rocuronium-sugammadex for electroconvulsive therapy management in neuroleptic malignant síndrome. A case report¼ donde se describe el manejo exitoso del uso de relajantes no despolarizantes y su reversor específico en terapias electroconvulsivas en pacientes diagnosticados de síndrome neuroléptico maligno, comentamos la fisiopatología e implicaciones anestésicas además de similitudes con otras entidades hipertérmicas, como es la hipertermia maligna.

Abstract: One of the most important adverse effects of neuroleptics is the possibility of triggering neuroleptic malignant syndrome (NMS). The diagnosis is determined by exclusion and the initial therapeutic management will be withdrawn by neuroleptics by the administration of benzodiazepines and, in extreme cases, the use of electroconvulsive therapy (ECT). ECT is an effective therapeutic option in these patients and in these cases a poor response to administration with antipsychotic drugs is obtained. Based on the case of the article «Rocuronium-sugammadex for the management of electroconvulsive therapy in neuroleptic malignant syndrome. A case report¼ where the successful management of the use of non-depolarizing relaxants and their specific reversal in electroconvulsive therapies in patients diagnosed with of malignant neuroleptic syndrome, we comment on the pathophysiology and anesthetic images as well as similarities with other hyperthermic entities, such as malignant hyperthermia.

Electroconvulsive Therapy in a Patient with Left Main and Triple Vessel Coronary Artery Disease (CAD): Anaesthetic Management

Electroconvulsive therapy (ECT) is a safe and effective treatment for many psychiatric disorders. The passage of electrical current lead to hemodynamic alterations which may be detrimental to patients suffering from severe coronary artery disease. We describe perioperative anesthetic management of a patient having severe left main coronary artery stenosis (LMCAS) with severe triple vessel coronary artery disease (TVD).

Posibles mecanismos de acción de la terapia electroconvulsiva en trastornos afectivos: revisión de la evidencia disponible en investigación con seres humanos

The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. Functioning of the hippocampal serotonin receptor 5-HT1B is associated with the response in patients with major depressive disorder (PMDD), while the striatal dopamine transporter would participate in the response of PMDD and in patients with bipolar disorders (BD). The only neurotrophic factor associated with ECT response was vascular endothelial growth factor. In BD, some oxidative stress metabolites had a clinical correlation, while tryptophan metabolism showed a clinical association in BD and PMDD. Furthermore, in PMDD, some neurodegeneration markers were implicated in the MA of ECT. There were no other biological dimensions associated with BD. In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.

Effect of electroconvulsive therapy on brain functional network in major depressive disorder / 生物医学工程学杂志

Electroconvulsive therapy (ECT) is an interventional technique capable of highly effective neuromodulation in major depressive disorder (MDD), but its antidepressant mechanism remains unclear. By recording the resting-state electroencephalogram (RS-EEG) of 19 MDD patients before and after ECT, we analyzed the modulation effect of ECT on the resting-state brain functional network of MDD patients from multiple perspectives: estimating spontaneous EEG activity power spectral density (PSD) using Welch algorithm; constructing brain functional network based on imaginary part coherence (iCoh) and calculate functional connectivity; using minimum spanning tree theory to explore the topological characteristics of brain functional network. The results show that PSD, functional connectivity, and topology in multiple frequency bands were significantly changed after ECT in MDD patients. The results of this study reveal that ECT changes the brain activity of MDD patients, which provides an important reference in the clinical treatment and mechanism analysis of MDD.

Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review / Eletroconvulsoterapia no tratamento de pacientes com agitação e outros distúrbios de comportamento devido à demência: uma revisão sistemática

ABSTRACT Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia. Objective: This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia. Methods: We performed a systematic analysis on the electroconvulsive therapy to treat patients with dementia and coexisting severe agitation. Articles were classified according to the level of evidence based on methodological design. Patients received an acute course of electroconvulsive therapy, often followed by maintenance intervention. Results: We selected 19 studies (156 patients; 64.1% women; 51-98 years old), which met the inclusion criteria: one case-control study by chart analysis (level of evidence 2); one open-label study (level of evidence 3); three historical/retrospective chart analyses (level of evidence 4); and 14 case series/reports (level of evidence 5). No randomized, sham-controlled clinical trials (level of evidence 1) were identified, which represents the main methodological weakness. Some patients had postictal delirium, cardiovascular decompensation and cognitive changes, lasting for a short time. Conclusions: Overall, patients achieved significant improvement in agitation. However, the main finding of the present review was the absence of methodological design based on randomized and sham-controlled clinical trials. Despite methodological limitations and side effects requiring attention, electroconvulsive therapy was considered a safe and effective treatment of patients with severe agitation and related behavioral disorders due to dementia.

RESUMO Distúrbios comportamentais são clinicamente relevantes em pacientes com demência, e regimes farmacológicos para mitigar esses sintomas têm proporcionado resultados limitados. Comprovadamente eficaz em diversas condições psiquiátricas, a eletroconvulsoterapia é uma estratégia potencialmente benéfica para o tratamento de pacientes com agitação grave na demência. Objetivos: Esta revisão examina as publicações sobre eficácia, segurança e tolerabilidade da eletroconvulsoterapia no tratamento de pacientes com agitação na demência. Métodos: Realizamos uma análise sistemática da eletroconvulsoterapia no tratamento de pacientes com demência e agitação grave. Os artigos foram classificados quanto ao nível de evidência com base no delineamento metodológico. Os pacientes receberam um curso agudo de eletroconvulsoterapia, frequentemente seguido de manutenção. Resultados: Foram selecionados 19 estudos (156 pacientes; 64,1% mulheres; 51-98 anos): um estudo caso-controle desenvolvido com base na análise de prontuários (nível de evidência 2); um estudo aberto (nível de evidência 3); três estudos de análise retrospectiva de prontuários (nível de evidência 4); e 14 séries/relatos de casos (nível de evidência 5). Não foram identificados ensaios clínicos randomizados e controlados com placebo (nível de evidência 1), fator que representa a principal fragilidade metodológica. No entanto, o principal achado da presente revisão consistiu na ausência de desenho metodológico baseado em ensaios clínicos randomizados e controlados com placebo. Em geral, os efeitos colaterais foram transitórios e bem tolerados. Alguns pacientes apresentaram delirium pós-ictal, descompensação cardiovascular e alterações cognitivas por períodos breves. Conclusões: No geral, os pacientes obtiveram melhora significativa na agitação. No entanto, o principal achado da presente revisão foi a ausência de delineamento metodológico baseado em ensaios clínicos randomizados e controlados com placebo. Apesar das limitações metodológicas e dos efeitos adversos, a eletroconvulsoterapia foi considerada um tratamento seguro e eficaz em pacientes com agitação grave e com outros distúrbios comportamentais clinicamente relevantes na demência.

Action mechanism of vinpocetine in improving learning and memory disorders in depressive rats after MECT / 西安交通大学学报(医学版)

【Objective】 To explore the action mechanism of vinpocetine in improving learning and memory disorders in depressive rats after modified electroconvulsive therapy (MECT). 【Methods】 The models of depressive rats were constructed by chronic unpredictable mild stress (CUMS) method. A total of 30 rats with depression were randomly divided into depression group, MECT group, and MECT+vinpocetine (10 mg/kg) group, with 10 in each group. A total of 10 untreated healthy rats were enrolled as control group. The learning and memory ability were tested by Morris water maze test and novel object recognition test. The depression state was evaluated by sugar preference test. The brain slices of the hippocampus were prepared for electrophysiological experiments. The density of dendritic spine was detected by Golgi staining. The expressions of endocannabinoids related genes [diacylglycerol lipase (DAGLα), monoacylglycerol lipase (MAGL), and endocannabinoid type-I receptor (CB1R)] were detected by qPCR and Western blotting. The lentivirus was injected to downregulate the expressions of CB1R and DAGLα in the hippocampus. After re-modeling and treatment, behavioral tests were performed. 【Results】 Compared with control group, sugar preference, spatial exploration time, relative discrimination index, long-term potentiation (LTP), density of dendritic spine, expressions of DAGLα and CB1R were decreased, while escape latency and MAGL were increased in depression group (P<0.05). Compared with depression group, sugar preference, escape latency, and MAGL were increased, while spatial exploration time, relative discrimination index, LTP, density of dendritic spine, expressions of DAGLα and CB1R were decreased in MECT group (P<0.05). Compared with depression group, sugar preference, spatial exploration time, relative discrimination index, LTP, density of dendritic spine, expressions of DAGLα and CB1R were increased, while escape latency and MAGL were decreased in MECT+vinpocetine group (P<0.05). Compared with MECT group, sugar preference, spatial exploration time, relative discrimination index, LTP, density of dendritic spine, expressions of DAGLα and CB1R were increased, while escape latency and MAGL were decreased in MECT+vinpocetine group (P<0.05). The down-regulation of DAGLα or CB1R by lentivirus could inhibit the improvement effect of vinpocetine on behavioral performance of depressive rats after MECT. 【Conclusion】 Vinpocetine can significantly improve learning and memory disorders in depressive rats after MECT, which may be related to regulating the expressions of endocannabinoid-related genes and enhancing synaptic plasticity.

Electroconvulsive therapy in schizophrenia: a review of neuroimaging studies / 中华行为医学与脑科学杂志

Electroconvulsive therapy (ECT) is a physical therapy method with rapid onset and remarkable effect for schizophrenia(SZ). It is widely used in patients with agitated impulses, stupor and refractory patients with poor drug treatment effect. The neurophysiological mechanism of ECT effect has not been elucidated. In the past decade, the magnetic resonance imaging (MRI) studies of ECT for SZ have been gradually reported in domestic and international journal, involving magnetic resonance spectroscopy, structural state and resting state analysis, preliminary findings suggest that there may be a correlation between ECT efficacy and structural and functional brain changes, mainly involving morphological changes in brain regions such as the thalamus, hippocampus, insula and left medial prefrontal lobe, as well as functional changes in core resting state networks, particularly the dorsal frontoparietal network, default network and limbic network. More research and exploration are needed in the future to provide valuable clues to further explore the therapeutic mechanism of ECT treatment.

Historia de la terapia electroconvulsiva: ¿cuándo empezó a utilizarse anestesia para este procedimiento? / History of electroconvulsive therapy: when did anesthesia begin to be used for this procedure?

Resumen: La terapia electroconvulsiva consiste en la aplicación de corriente eléctrica a través de electrodos colocados en regiones frontotemporales (bilateral) o unilateral, con el objetivo de inducir una crisis convulsiva, controlada y monitorizada, que se realiza bajo anestesia general con la presencia de un equipo multidisciplinario. En este trabajo, se hace una reseña de la historia de la aplicación de anestésicos y relajantes musculares que se han utilizado para este tratamiento y de cómo el anestesiólogo se ha posicionado como un elemento fundamental para la aplicación del mismo.

Abstract: Electroconvulsive therapy consists of the application of electric current, through electrodes placed in frontotemporal regions (bilateral) or unilateral, with the aim of inducing a seizure, controlled and monitored, and performed under general anesthesia, with the presence of a multidisciplinary team. This paper reviews the history of the application of anesthetics and muscle relaxants, which have been used for this treatment and how the anesthesiologist has positioned himself as a fundamental element for its application.

Posibles mecanismos de acción de la terapia electroconvulsiva en esquizofrenia: revisión de la evidencia disponible en investigación con seres humanos / A review about the putative mechanisms of action of electroconvulsive therapy in schizophrenia in human research

Electroconvulsive therapy (ECT) has multiple uses in psychiatry, but its mechanisms of action (MA) in patients with schizophrenia (PS) are poorly understood. We synthesize and discuss the available evidence in this regard. We conducted a search for primary human studies and systematic reviews searching MA of ECT in PS published in PubMed/Medline, SciELO, PsycInfo, and the Cochrane Library, including 24 articles. Genetic findings are scarce and inconsistent. At the molecular level, the dopaminergic and GABAergic role stands out. The increase in brain derived neurotrophic factor (BDNF) after ECT, is a predictor of positive clinical outcomes, while the change in N-acetyl aspartate levels would demonstrate a neuroprotective role for ECT. This intervention would improve inflammatory and oxidative parameters, thereby resulting in a symptomatic improvement. ECT is associated with an increase in functional connectivity in the thalamus, right putamen, prefrontal cortex and left precuneus, structures that play a role in the neural default mode network. A decrease in connectivity between the thalamus and the sensory cortex and an enhanced functional connectivity of the right thalamus to right putamen along with a clinical improvement have been reported after ECT. Moreover a volumetric increase in hippocampus and insula has been reported after ECT. These changes could be associated with the biochemical pathophysiology of schizophrenia. Most of the included studies are observational or quasi-experimental, with small sample sizes. However, they show simultaneous changes at different neurobiological levels, with a pathophysiological and clinical correlation. We propose that the research on ECT should be carried out from neurobiological dimensions, but with a clinical perspective.

Eletroconvulsoterapia: Caracterização dos Pacientes Atendidos em Hospitais no Sul Catarinense / Electroconvulsive therapy: characterization of patients attended in hospitals in the south of Santa Catarina

Introdução: A eletroconvulsoterapia surge em 1938 para tratamento de psicoses graves, desenvolvida por Ugo Cerletti e Lucio Bini. As indicações para o uso da eletroconvulsoterapia são as mais variadas, entre elas podemos citar: depressão refratária aos antidepressivos, transtorno afetivo bipolar, esquizofrenia, psicoses, doença de Parkinson e epilepsia. O procedimento é realizado em ambiente adequado com equipe especializada, incluindo um psiquiatra, um anestesista e um enfermeiro. O procedimento deve ser feito sob anestesia, bloqueadores neuromusculares e medicações coadjuvantes usadas de forma individualizada. O presente estudo objetivou caracterizar o perfil sociodemográfico e clínico dos pacientes submetidos à ECT em dois hospitais situados no município de Tubarão, em Santa Catarina. Métodos: A presente pesquisa trata-se de um estudo epidemiológico com delineamento transversal. A população em estudo consiste em todos os pacientes submetidos à eletroconvulsoterapia no Hospital Nossa Senhora da Conceição e no Hospital e Maternidade Socimed, ambos localizados na cidade de Tubarão/SC. Desta maneira, obteve-se uma população de 82 pacientes. A coleta de dados ocorreu através de prontuários em um período de janeiro de 2013 até março de 2020. Resultados: Foi encontrada uma prevalência de 47,56% quanto ao diagnóstico para indicação da ECT em transtorno depressivo, em que 69,51% usavam algum antidepressivo e uma mediana de nove (9) sessões de eletroconvulsoterapia (P25: 6; P75:11) e variação de uma até 25 sessões. Conclusão: Foi possível caracterizar os pacientes submetidos à eletroconvulsoterapia em um período de 8 anos, com foco no perfil sociodemográfico e clínico dos pacientes.

Introduction: Electroconvulsive therapy (ECT) emerged in 1938 to treat severe psychoses, developed by Ugo Cerletti and Lucio Bini. The indications for the use of electroconvulsive therapy are the most varied: depression refractory to antidepressants, bipolar affective disorder, schizophrenia, psychoses, Parkinson's disease, and epilepsy. The procedure occurs in an appropriate environment with a specialized team, including a psychiatrist, an anesthesiologist, and a nurse. It must be done under anesthesia, neuromuscular blockers, and adjunctive medications used on an individualized basis. This study aimed to characterize the sociodemographic and clinical profile of patients undergoing ECT in two hospitals located in Tubarão, Santa Catarina. Methods: This research is an epidemiological study with a cross-sectional design. The study population consisted of all patients undergoing electroconvulsive therapy in the Hospital Nossa Senhora da Conceição and the Hospital (HNSC) and Socimed Maternity Hospital (Maternidade Socimed), both located in the city of Tubarão/SC. Thus, the study obtained a population of 82 patients. Data collection occurred through medical records from January 2013 to March 2020. Results: A prevalence of 47.56% was found regarding the diagnosis for the indication of ECT in depressive disorder, in which 69.51% used some antidepressant and a median of nine (9) sessions of electroconvulsive therapy (P25: 6; P75:11) and a variation of one to 25 sessions. Conclusion: It was possible to characterize the patients submitted to electroconvulsive therapy over eight years, focusing on patients' sociodemographic and clinical profiles.

A Eletroconvulsoterapia (ECT) como tratamento em Transtornos Depressivo Maior: revisão integrativa da literatura

Modelo do estudo: Revisão integrativa da literatura. Objetivo: encontrar as melhores evidências disponíveis sobre a eficácia e efetividades da eletroconvulsoterapia(ECT) no tratamento da depressão maior, resistente a psicofármacos Metodologia: A busca foi realizada de outubro a novembro de 2020 nas bases de dados MEDLINE (acessado via PubMed), Register of Controlled Trials (Cochrane CENTRAL), Centre for Reviews and Dissemination (CRD), Web of Science e Scientific Electronic Library Online (SciELO), LILACS (via BVS), Periódicos Capes, e Scholar Google. Resultados: A pesquisa nas diversas bases de dados totalizou 801 citações, das quais 12 foram avaliadas conforme os critérios de inclusão e exclusão. Nos dozes artigos analisados, 11 concluem que a eletroconvulsoterapia é um tratamento eficaz em pacientes com depressão. Conclusa?o: Os estudos analisados mostraram que ha? Poucas evidências sobre o tema investigado. A eletroconvulsoterapia e uma técnica segura, conforme os estudos apresentados, e se mostra eficaz no tratamento de transtorno depressivo grave.

Cotard’s syndrome in the postoperative period following head and neck cancer surgery – A case report

Major head and neck surgery is a known factor for postoperative delirium; however, Cotard’s syndrome (CS) has been rarely reported following head and neck surgery. We report a case of a 51?year?old man who underwent surgery for carcinoma right buccal mucosa and developed agitation and nihilistic delusion after extubation. The patient had a preexisting psychiatric history which is often reported as a risk factor for CS. Of interest, though is that this condition subsided as quickly as it emerged with only supportive counselling and brief pharmacotherapy.

Low-dose ketamine does not improve the speed of recovery from depression in electroconvulsive therapy: a randomized controlled trial

Objective: Electroconvulsive therapy (ECT) is a well-established therapeutic intervention for major depressive disorder. Recent literature has shown that the anesthetic agent ketamine has some antidepressant properties at low doses and may be an alternative therapy for treatment-resistant major depressive disorder. We hypothesized that the use of low-dose ketamine as an anesthetic adjunct in ECT would more rapidly improve depression while maintaining hemodynamic stability than ECT with propofol alone. Methods: Institutional ethics approval was obtained, and the use of ketamine in this study was approved by Health Canada. This is a randomized, double-blinded, placebo-controlled trial that involved ketamine administration at 0.5 mg/kg IV in addition to propofol anesthesia for ECT. The primary outcome was the number of ECT treatments required to achieve a 50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included the number of ECT treatments required to achieve a 25% reduction in MADRS score, as well as any differences in the Clinical Global Impression Scale for Severity, hemodynamic variables, and seizure duration. Adverse events were recorded for safety assessment. Results: A total of 45 patients completed the study. No difference was found between groups with respect to the primary or secondary outcomes. The ketamine group showed a trend towards a decreased dose of propofol required to achieve adequate anesthesia. No adverse events were reported. Conclusion: Low-dose ketamine does not improve psychiatric outcomes in the setting of propofol-based anesthesia for ECT. Specifically, ketamine did not reduce the number of ECT sessions necessary to achieve a 50 or 25% reduction in MADRS scores. Reassuringly, the fact that no differences in hemodynamic variables or unexpected adverse events occurred suggests that low-dose ketamine may be safely used in this setting should clinical indications warrant its use. Clinical trial registration: ClinicalTrials.gov, NCT02579642

Optimization strategy of anesthesia for modified electroconvulsive therapy in patients with major depressive disorder: low-dose esketamine combined with propofol / 中华麻醉学杂志

Objective:To evaluate the optimization efficacy of low-dose esketamine combined with propofol in the patients with major depressive disorder undergoing modified electroconvulsive therapy (MECT).Methods:Fifty-six American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 18-64 yr, scheduled for MECT for the first time, were assigned into esketamine plus propofol group (group EP, n=28) and propofol group (group P, n=28) according to a ratio of 1∶1 by the random number table method.Esketamine 0.25 mg/kg was intravenously injected before anesthesia induction in group EP, while the equal volume of normal saline was given instead in group P. Propofol and succinylcholine were then intravenously injected to perform MECT in two groups.The primary outcomes were the remission rate and response rate, and the secondary outcomes included the number of MECT required for response and remission, the seizure duration, energy inhibition index and consumption of propofol for each MECT, and the occurrence of therapy-related adverse reactions and relapse. Results:Compared with group P, the remission rate and response rate were significantly increased, and the number of MECT required for response and remission was decreased, the seizure duration was prolonged, and energy inhibition index was increased, the consumption of propofol was reduced ( P<0.05), and no significant change was found in the incidence of therapy-related adverse reactions and relapse in group EP ( P>0.05). Conclusions:Low-dose esketamine combined with propofol can enhance the efficacy of MECT and shorten the course of therapy without increasing therapy-related adverse reactions in the patients with major depression.

Efficacy of maintenance electroconvulsive therapy combined with quetiapine treatment for manic episode of bipolar disorder / 中国基层医药

Objective:To investigate the efficacy of maintenance electroconvulsive therapy (MECT) combined with quetiapine treatment for manic episodes of bipolar disorder.Methods:A total of 103 patients with manic episodes of bipolar disorder received treatment in Kangci Hospital of Jiaxing from January 2019 to August 2020 and were included in this study. They were randomly divided into observation ( n = 46) and control groups ( n = 57). The observation group was given MECT combined with quetiapine treatment and the control group was treated with magnesium valproate sustained-release tablets combined with quetiapine. All patients received 4 weeks of treatment. Clinical efficacy, total hospital cost, drug cost during hospitalization, drug proportion, adverse reactions, and scores of the Bech-Rafaelsdn Mania Rating Scale and the Wisconsin Card Sorting Test pre- and post-treatment were compared between the two groups. Results:After 4 weeks of treatment, total response rate was significantly higher in the observation group than in the control group [76.09% (35/46) vs. 56.14% (32/57), χ2 = 4.45, P < 0.05]. In the observation group, total hospital cost, drug cost during hospitalization, and drug proportion were (16074.52 ± 1019.81) yuan, (1374.52 ± 619.81) yuan, and 8.70% respectively, which were not significantly different from those in the control group [(15618.14 ± 1550.34) yuan, (1261.14 ± 750.34) yuan, 10.53%, t = 1.71, 0.82, χ2 = 0.09, all P > 0.05]. After 4 weeks of treatment, Bech-Rafaelsdn Mania Rating score was significantly lower in the observation group than in the control group [(7.36 ± 3.04) points vs. (10.23 ± 2.37) points, t = 5.38, P < 0.001]. The number of wrong responses and the number of perseverative errors in the Wisconsin Card Sorting Test in the observation group were (40.45 ± 3.61) counts and (9.56 ± 1.39) counts, respectively, which were significantly lower than those in the control group [(48.59 ± 4.51) counts, (12.08 ± 1.25) counts, t = 10.17, 9.56, both P < 0.001]. The number of perseverative errors in the Wisconsin Card Sorting Test was significantly higher in the observation group than in the control group [(33.85 ± 2.50) counts vs. (29.71 ± 2.14) counts, t = 8.90, P < 0.001]. There was no significant difference in total incidence of adverse reactions between observation and control groups (21.74% vs. 22.81%, χ2 = 0.01, P > 0.05). Conclusion:MECT combined with quetiapine treatment is highly effective on the manic episodes of bipolar disorder. The combined therapy is worthy of clinical application.

Application of brain magnetic resonance imaging in electroconvulsive therapy for major depressive disorder / 中国基层医药

Objective:To observe the changes in brain magnetic resonance imaging (MRI) in patients with major depressive disorder (MDD) after modified electroconvulsive therapy (MECT) relative to before treatment.Methods:A total of 105 patients with MDD who received treatment in Hangzhou Seventh People's Hospital and Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2017 to June 2019 were included in this study. The brain MRI data pre- and post-MECT were collected. These patients were divided into study group (abnormal brain structure, n = 51) and control group (normal brain structure; n = 54) according to brain structure pre-treatment as shown on MRI. Clinical efficacy, scores of the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety pre and post-treatment, and the incidence of complications were compared between the two groups. Results:MRI data revealed that 51 patients had abnormal brain structure, including 16 patients with hippocampal atrophy, 18 patients with brain volume reduction, 10 patients with intracranial cyst, and 7 patients with large occipital cistern. These patients had no obvious changes in brain structure after MECT compared with before MECT. The age of onset was lower in the study group than in the control group [(24.15 ± 1.64) years vs. (29.33 ± 2.71) years, t = -7.751, P < 0.05]. The proportion of female patients (57.4% vs. 47.1%), the proportion of patients with a family history of MDD (81.5% vs. 56.9%), and the proportion of patients with psychotic symptoms (55.6% vs. 35.3%) were significantly higher in the study group than in the control group ( χ2 = 4.96, 7.50, 4.33, all P < 0.05). Multivariate logistic regression showed that family history was a factor unrelated to MDD ( P = 0.997). Abnormal brain structure in patients with MDD was negatively correlated with age ( OR = 3.89, 95% CI = 2.083 - 7.281, P < 0.01) and it was positively correlated with sex and psychotic symptoms ( OR = 12.05, 0.08, 95% CI = 2.063 - 70.439, 0.010 - 0.698, both P < 0.05). The Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores decreased after MECT in both groups (both P < 0.05). The proportions of patients having dizziness/headache (50.98% vs. 27.78%), vomiting (43.14% vs. 22.22%), muscle soreness (29.41% vs. 11.11%), delirium (23.53% vs. 7.41%), and memory impairment (64.71% vs. 33.33%) were significantly higher in the study group than in the control group ( χ2 = 5.93, 5.24, 5.49, 5.27, 10.33, all P < 0.05). Conclusion:Most patients with MDD have an abnormal brain structure. Female patients at a low age of onset with psychotic symptoms tend to have an abnormal brain structure. MECT can greatly improve depressive symptoms and has no obvious impact on brain structure. Patients with MDD who have an abnormal brain structure are more likely to have complications.

Effects of cluster nursing program on post-MECT delirium / 四川精神卫生

ObjectiveTo observe the intervention effect of cluster nursing in post-MECT delirium，and explore a new method of post-MECT delirium nursing. MethodsA total of 154 inpatients who met the diagnostic criteria of International Classification of Diseases，tenth edition（ICD-10） and received MECT treatment for the first time were selected and they were randomly divided into control group （n = 77） and study group （n = 77）. The intervention lasted for one course of MECT， 6-12 times MECT as one course. Both groups recieved MECT routine nursing， while the study group was given cluster nursing on the basis of routine nursing. After each treatment， Richmond Agitation Sedation Scale （RASS） and nursing adverse events record form were used to collect data. The incidence and duration of post-MECT delirium and the incidence of nursing adverse events caused by post-MECT delirium were compared between the two groups. ResultsAfter one course of MECT， the incidence of post-MECT delirium was 11.80% in the study group and 16.67% in the control group， the difference was statistically significant （χ2= 6.314， P<0.05）. The duration of post-MECT delirium in the study group was（5.78±2.73）min and（11.20±4.44）min in the control group， the difference was statistically significant （t=3.403， P<0.05）. The incidence of nursing adverse events caused by post-MECT delirium was 7.13% in the study group and 12.70% in the control group， and the difference was statistically significant （χ2=10.940， P<0.01）. ConclusionThe implementation of cluster nursing can reduce the incidence of post-MECT delirium， shorten the duration and reduce the nursing adverse events caused by post-MECT delirium.