ABSTRACT
Electroconvulsive therapy (ECT), the oldest somatic therapy still in use in psychiatry today, remains one of the most effective therapeutic interventions for a wide variety of psychiatric disorders. In this article, we review some of the recent advances in ECT that are currently being researched and implemented in clinical practice. We explore recent studies that point to the potential therapeutic benefit and safety of ECT in COVID-19-related neuropsychiatric complications and special populations (such as the elderly and pregnant persons) that are generally at higher risk of having adverse effects from psychotropic medications. We highlight studies that performed a head-to-head comparison of ECT and ketamine, which has shown promise for treatment-resistant depression and acute suicidality. Researchers continue to explore different ways of using ECT by modifying the treatment parameters to maintain efficacy and decrease side effects. Neurocognitive side effects remain one of the major drawbacks to its use and contribute to the negative stigma of this highly effective treatment. In this regard, we describe attempts to improve the safety of ECT by modifying dosing parameters, novel electrode placements, and the addition of augmenting agents with the aim of decreasing side effects and improving efficacy. This review identifies some of the recent advances in the last few years in ECT research while also highlighting areas where further research is needed.
ABSTRACT
The following paper described two cases of patients with catatonic depression in bipolar disorder (BD) referred to our electroconvulsive therapy (ECT) service. Both were deemed not medically fit for ECT, and were, instead, treated with intravenous (IV) ketamine. Both responded with a resolution of symptoms, returning to baseline level of functioning. During the COVID-19 pandemic, given the risks associated with providing ECT (an aerosol generating procedure) and, in the context of limited resources, ketamine therapy for catatonia is a potentially beneficial alternative or supportive treatment to ECT that merits additional research.
ABSTRACT
This case report highlights the use of ECT in an adolescent patient with a COVID-19 infection, which is an area of limited data. The patient received a full course of bitemporal ECT, with a total of 15 treatments administered over four months. The patient responded robustly, with a complete return to her pre-infection baseline mental status, and response has remained durable for one-year post continuation phase ECT taper. Maintenance ECT considerations for catatonia should be determined on a case-by-case basis but was not needed for our patient, given the durability of the response to ECT.
ABSTRACT
During the COVID-19 pandemic era that began in 2020, there has been a growing trend in the literature to tackle the problem of health stress (HS) for promoting a sense of public health. In turn, this developing area of research has a high level of relevancy linked to business and economic recovery (Cvirik, 2020). Since HS has increased sharply during the COVID-19 pandemic era, there has been a need to further investigate the balance between coping with HS and the positive continuous intention to use mobile health applications (mHealth apps) among the public. This is the first study that takes the Asia-Pacific region as its case study and empirically investigates the validity of extensions based on the theories of expectation confirmation theory (ECT) (Bhattacherjee, 2001) on user continuous behavior relating to mHealth apps during the COVID-19 pandemic. Results reveal that HS as an emotion can positively affect perceived usefulness and satisfaction in relation to the continuous intention to use mHealth apps. The differences between new and frequent users are confirmed. Discussion and implications for practices are provided in the end. (c) 2022 The Authors. Published by Elsevier B.V. on behalf of College of Management, National Cheng Kung University.
ABSTRACT
Background: There is growing concern about the psychopathological consequences of the COVID-19 pandemic. The prolonged stress due to the spreading fear of the contagion and to the enforced containment measures are deemed to trigger recurrences of preexisting mental disorders as well as the onset of new ones. From such perspective, clinical cases may be of primary ground to identify individual features and pandemic-related factors predisposing to the development of serious psychiatric symptoms. Case presentation: Mr. R. is a 64-year-old, married, unemployed man, whose premorbid personality was characterized by relevant autistic traits. The patient developed catatonia in the context of the COVID-19 pandemic. We aimed at discussing the role of both preexisting and precipitating factors. Conclusions: Autism spectrum could represent a predisposing factor for severe psychopathological outcome and catatonia. Furthermore, the present clinical case highlights the role of COVID-19 pandemic in influencing physical and mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
The tourism industry has dynamized the economy of the countries by offering places, as well as related tourism experiences, products, and services. In the context of the COVID-19 pandemic, some of these tourist destinations were affected by subjective perceptions of users on social networks, within stands out Twitter. To achieve an objective perception from user comments posted on Twitter in front of a tourist destination, we propose a PANAS-tDL (Positive and Negative Affect Schedule - Deep Learning) model which integrates into a single structure a neural model inspired by a Stacked neural deep learning model (SDL), as well as the PANAS-t methodology. For this process, a database of comments was available for four destinations (Colombia, Italy, Spain, USA), and its tourist's products and services, before and in the context of COVID-19 pandemic throughout the year 2020. The proposed model made it possible to generate objective perceptions of the tourist destinations and their products and services using an automatic classification of comments in each category defined by the PANAS-t methodology (11-sentiments). The results show how users' perceptions were towards the negative sentiment zone defined by this methodology, according to the evolution of the COVID-19 pandemic worldwide throughout the year 2020. The proposed model also integrated an automatic process of normalisation, lemmatisation and tokenisation (Natural language process - NLP) for the objective characterization of perceptions, and due to its capacity for adaption and learning, it can be extended for the evaluation of new tourist destinations, products or services using comments from different social networks. Copyright © 2021 by Author/s and Licensed by Veritas Publications Ltd., UK.
ABSTRACT
Introduction: The Department of Psychiatry at Semmelweis University is the largest electroconvulsive therapy (ECT) centre in Hungary, where a total number of around 300 treatments are conducted every year. Certain changes were administered in 2018 and 2019 in our logistics and internal protocols that helped to increase the number of treated patients and improve quality of care. The COVID-19 pandemic caused serious disruptions in the Hungarian mental health care system , therefore there was a realistic fear that many patients who required ECT would not receive this form of tretament. Objective(s): Our goal was to assess the effects of the pandemic on our ECT service, and to analyse whether patients were able to receive treatment, despite the logistical difficulties. Method(s): We retrospectively gathered data from our internal documentation to compare the number of ECT treatments with the previous years. We also had to take into account the fluctuation in our general caseload of psychiatric patients, since our Department acted as a COVID-19 treatment centre for several months. Result(s): Total number of ECT treatments decreased in 2020 after a peak in 2019, however the numbers were not much lower compared to the years before changes in 2018. Unfortunately, we see a more direct effect of the 3rd wave of the pandemic. Conclusion(s): We can conlude that there is a decrease in the number of ECT treatments due to the pandemic, however, the fact that we still provided service in most parts of 2020 and 2021 for patients with the most severe conditions is a serious achivement.
ABSTRACT
Introduction: Covid-19 was declared a global pandemic by the WHO on 11 March 2020. From the beginning, the pandemic posed a challenge to the different health systems around the world, which were forced to prioritise and distribute their resources as efficiently as possible. During the period between 11 March 2020 and 28 April 2021, the Regional ECT Unit of the Region of Murcia remained closed. Objective(s): - Determine the clinical status of patients on maintenance ECT in the Regional ECT Unit during the Covid-19 pandemic. - Prioritise resumption of treatment in those who were clinically decompensated or at risk - Understand the consequences of discontinuation of maintenance ECT for these patients. Method(s): A longitudinal descriptive study was conducted during the month of May 2020. Result(s): Thirty-seven patients were contacted by telephone. On the first call, a total of 15 patients were unstable or at risk of decompensation. Prior to the second call, CT was administered preferentially to a total of 8 patients and programmed to 2. On the second call, a total of 11 patients were at risk of decompensation. Conclusion(s): The closure of the Regional ECT Unit had negative consequences for patients undergoing maintenance treatment. Electroconvulsive therapy is an essential part of the treatment of psychiatric patients both in acute episodes and in relapse prevention.
ABSTRACT
Introduction: COVID-19 infection may lead to encephalopathy and various neurotrophic effects which can result in neuropsychiatric complications. Here, an asymptomatic adolescent female developed acute onset catatonia and psychosis manifesting during the resolution of Covid-19 infection. Objective(s): Discuss differential diagnosis, medical workup, and initial treatment optimization for acute stabilization. Method(s): This 15-year-old female with no previous psychiatric history nor prodromal symptomatology was hospitalized secondary to Covid -19. During the immediate three-month recovery phase following resolution of Covid-19, the patient exhibited gradually increasing anxiety, paranoia, delusions, disorganized behavior, and weight loss leading to re-hospitalization secondary to catatonia. Negative workup included rapid strep test, urinalysis, chest and abdominal x-ray, EEG, and brain MRI. Lumbar puncture revealed elevated WBC of 18 but was unremarkable for NDMA receptor antibodies, CSF HSV, and encephalitis panel. IV steroids, IVIG, and Anakinra were all given without benefit. Inadequate response to olanzapine, clonidine, and lorazepam led to an Index Series of bilateral electroconvulsive therapy (ECT). Result(s): The provisional diagnosis of psychotic disorder secondary to COVID-19 infection responded robustly regarding sleep, behavior, and affect by session #6, yet positive symptoms of psychosis persist. Ongoing ECT, psychopharmacology, and narrowing of the differential diagnosis continue. Conclusion(s): As more COVID-19 cases evolve during the pandemic, potential post-infectious neuropsychiatric complications should be considered as potentially contributory and kept in a thoughtful differential diagnosis. Regardless of ultimate causation, the acute symptom profile responded robustly to an initial Index Series of ECT.
ABSTRACT
Purpose: Infection with COVID-19 has presented diversely in patients, including neuropsychiatric symptoms such as akinetic mutism. Most of these cases involve patients of middle-to-late age or with other health comorbidities. This is a unique case of a long hospitalization for severe catatonic symptoms in a patient with covid-19 infection in which ultimately, ECT helped produce rapid improvements in catatonia. Access to prompt ECT has been limited during the ongoing pandemic, and this case illustrates the importance of managing contamination risk and maintaining access to psychiatric treatment resources. Copyright © 2022
ABSTRACT
Delirious mania has been described as a state of acute excitement, fluctuating sensorium, affective and catatonic symptoms. Electroconvulsive therapy (ECT) despite being an effective treatment modality in such cases, has been under-utilised during pregnancy, mainly due to safety concerns. Here, we report the effectiveness of ECT in acute management of delirious mania in a 24 weeks pregnant woman who also tested COVID-19 positive during hospitalisation. Patient presented with three weeks history of acute manic excitement with period of altered sensorium and catatonic symptoms with no response to trials of two antipsychotic agents. After organic causes ruled out, patient was planned for ECT while ongoing antipsychotic was continued. After the first ECT session, patient tested positive for COVID-19, though asymptomatic and had to be shifted to COVID-19 isolation facility. Complete resolution of psychiatric symptoms occurred after fifth ECT. All five ECT sessions, including those in COVID-19 isolation facility were carried out under supervision of a multidisciplinary team. None of the ECT sessions had any major adverse event. Symptom remission sustained even following ECT discontinuation. No neonatal or maternal adverse effects observed after an uneventful delivery at 35 weeks. Both mother and child continued to maintain well in follow-up period of one year on oral olanzapine. In this unusual concurrent presentation of mania, delirium and catatonic symptoms during second trimester pregnancy, we highlighted the effectiveness and safety of ECT as a viable treatment modality. Additionally, management challenges posed by patient testing COVID-19 positive and then, administering ECT in COVID-19 isolation facility using personal protective equipment by multidisciplinary team has been highlighted.
Subject(s)
Antipsychotic Agents , Bipolar Disorder , COVID-19 , Catatonia , Electroconvulsive Therapy , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , COVID-19/therapy , Catatonia/etiology , Female , Humans , Mania , Pregnancy , Pregnancy Trimester, Second , Treatment OutcomeABSTRACT
PURPOSE OF REVIEW: We reviewed recent evidence on the use of electroconvulsive therapy (ECT) in the geriatric population. This review looked at the literature on depression, for which there is a breadth of data, as well as other conditions that have historically not been as well studied, as well as attempting to provide practical recommendations for ECT practitioners. This review also examined the impact of the COVID-19 pandemic on ECT in the elderly. RECENT FINDINGS: ECT shows robust efficacy across many psychiatric diseases, from depression and bipolar disorder to psychosis and catatonia. It has also shown positive results at improving behavioral symptoms of dementia, as well as improving motor symptoms seen in Parkinson's disease. It is routinely found to be a safe treatment as well, generally with only minimal transient side effects. ECT should not be considered a "last-resort" treatment for geriatric patients suffering from psychiatric disorders. It has historical and recent literature supporting its use in many psychiatric disorders and has been shown to be safe with minimal side effects when appropriate considerations are taken for the elderly population.
Subject(s)
COVID-19 , Catatonia , Electroconvulsive Therapy , Aged , Catatonia/therapy , Depression/therapy , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/methods , Humans , Pandemics , Treatment OutcomeABSTRACT
Catatonia is an undertreated and underdiagnosed neuropsychiatric syndrome whose prognosis is benign if treated early, thus avoiding possible complications and compromising the health of patients. The latest epidemiological studies indicate a prevalence of catatonia of 9.2%, being frequent in medical pathologies (especially neurological ones), as well as in psychiatric pathologies. The use of validated scales is recommended for its diagnosis, to be able to measure the severity and response to treatment. Once catatonia has been identified, it is necessary to perform a protocolized diagnostic study of the underlying aetiology («Catatonia Workup»). Treatment of choice is benzodiazepines and electroconvulsive therapy. In recent years, new therapeutic alternatives such as non-invasive transcranial magnetic stimulation have emerged. In this review we propose several initiatives to promote the dissemination and knowledge of catatonia in the clinical setting. Resumen La catatonia es un síndrome neuropsiquiátrico infratratado e infradiagnósticado cuyo pronóstico es benigno si se trata de forma precoz, evitando así posibles complicaciones y el compromiso de la salud de los pacientes. Los últimos estudios epidemiológicos señalan una prevalencia de catatonia del 9,2%, siendo frecuente tanto en las enfermedades médicas (especialmente en las neurológicas), como en las psiquiátricas. Es recomendable el uso de escalas validadas para su diagnóstico y poder medir la gravedad y la respuesta al tratamiento. Una vez identificada la catatonia, es necesario realizar un estudio diagnóstico protocolizado de la etiología subyacente («Catatonia Workup»). El tratamiento de elección son las benzodiacepinas y la terapia electroconvulsiva. En los últimos años, han surgido nuevas alternativas terapéuticas no invasivas, tales como la estimulación magnética transcraneal. En esta revisión, proponemos varias iniciativas para fomentar la difusión y el conocimiento de la catatonia en el ámbito clínico.
ABSTRACT
Interest in mobile short-video platforms (MSVP) as a new social network service tool has surged in recent years. However, only a few studies have focused on MSVP users’ post-acceptance behavior. To clarify this issue of sustainable usage, this study analyzed users’ post-acceptance habit formation by incorporating perceived interactivity and perceived enjoyment into the expectation-confirmation theory of the information system continuance (ECT-IS) model using structural equation modelling. We developed and distributed an online questionnaire and collected 219 valid responses from Chinese MSVP users. Our results show that satisfaction is the foremost factor in determining users’ habit formation as it completely mediates the influence of confirmation and perceived interactivity. We also show that perceived enjoyment positively influences habit formation directly and indirectly. Nonetheless, we note that sustainable usage should form the basis of continuous satisfaction from user experience due to a few missing links with regard to modulation in habitual usage. Therefore, we suggest that MSVPs should enhance their content recommendation algorithms using technologies such as deep-learning forecasting to improve users’ satisfaction by increasing perceived enjoyment. We also show that the influence of perceived interactivity on habit formation is effective only when fully mediated by satisfaction. Thus, we recommend that MSVPs should diversify their interaction mechanisms, for instance, by introducing mass creators that promote users’ habit formation by enhancing their satisfaction on the platform.
ABSTRACT
Ketamine, a non-competitive N-methyl-d-aspartate receptor antagonist, is commonly used as an anesthetic and analgesic but has recently shown promising research in treating certain psychiatric conditions such as depression, post-traumatic stress disorder (PTSD), suicidal ideation, and substance use disorder. Due to its euphoric, dissociative, and hallucinogenic properties, ketamine has been abused as a recreational drug, which has led to rigid regulation of medication. The COVID-19 pandemic has been an unprecedented challenge for the American population which was reflected in increased reports of problems regarding their mental health. Mood disorders have dramatically increased in the past two years. Approximately one in ten people stated that they had started or increased substance use because of the COVID-19 pandemic. Furthermore, rates of suicidal ideation have significantly increased when compared to pre-pandemic levels, with more than twice the number of adults surveyed in 2018 indicating suicidal thoughts "within the last 30 days" at the time they were surveyed. Moreover, many responders indicated they had symptoms of PTSD. The PubMed database was searched using the keyword "ketamine," in conjunction with "depression," "suicidal ideation," "substance use disorder," and "post-traumatic stress disorder." The inclusion criteria encompassed articles from 2017 to 2022 published in the English language that addressed the relationship between ketamine and mental health disorders. With this sharp increase in the prevalence of psychiatric disorders and an increased public interest in mental health combined with the promise of the therapeutic value of ketamine for certain mental health conditions, including suicidal ideation, this narrative review sought to identify recently published studies that describe the therapeutic uses of ketamine for mental health. Results of this review indicate that ketamine's therapeutic effects offer a potential alternative treatment for depression, suicidal ideation, substance use disorders, and PTSD.
ABSTRACT
Most nations across the world are actively pursuing equal access to healthcare services. Teleconsultation technology is a substantial improvement in terms of an effective framework for the provision of healthcare services. However, a lack of understanding of people's willingness towards the use of this technology has been observed. The goal of this study is to investigate the factors affecting the post-acceptance of teleconsultation services in Malaysia. This study developed a theoretical model which involves the combination of the second generation of Unified Theory of Acceptance and Use of Technology (UTAUT2) and Expectation Confirmation Theory (ECT), with the inclusion of several other constructs. An online survey was used to collect data from 154 university students and partial least squares (PLS) approach was used for data analysis. The research findings indicate that confirmation, performance, effort expectancy, usefulness, and satisfaction were the key factors that affect the post-acceptance of teleconsultation services. Furthermore, actual use, ease of use, technology readiness, and facilitating conditions did not impact participants' post intention in the continuous usage of teleconsultation facilities.
ABSTRACT
During the COVID-19 pandemic era that began in 2020, there has been a growing trend in the literature to tackle the problem of health stress (HS) for promoting a sense of public health. In turn, this developing area of research has a high level of relevancy linked to business and economic recovery (Čvirik, 2020). Since HS has increased sharply during the COVID-19 pandemic era, there has been a need to further investigate the balance between coping with HS and the positive continuous intention to use mobile health applications (mHealth apps) among the public. This is the first study that takes the Asia-Pacific region as its case study and empirically investigates the validity of extensions based on the theories of expectation confirmation theory (ECT) (Bhattacherjee, 2001) on user continuous behavior relating to mHealth apps during the COVID-19 pandemic. Results reveal that HS as an emotion can positively affect perceived usefulness and satisfaction in relation to the continuous intention to use mHealth apps. The differences between new and frequent users are confirmed. Discussion and implications for practices are provided in the end.
ABSTRACT
Catatonia has been reported as one among many neuropsychiatric manifestations associated with COVID-19 infection. Catatonia and COVID-19 co-occurrence remain clinical concerns, often posing challenges pertaining to diagnosis, and especially management. Limited information is available regarding the appropriate approaches to the management of catatonia in COVID-19 infection, particularly with reference to the safety and efficacy of benzodiazepines and Electro-convulsive therapy (ECT). We present our experience of five patients with catatonia consequent to heterogeneous underlying causes and concurrent COVID-19 infection, who received care at the psychiatric COVID unit of our tertiary care psychiatric hospital. An interesting observation included varying underlying causes for catatonia and the potential role that COVID-19 infection may have played in the manifestation of catatonia. In our experience, new-onset catatonia with or without pre-existing psychiatric illness and concurrent COVID-19 can be safely and effectively managed with lorazepam and/or ECTs. However, critical to the same is the need to implement modified protocols that integrate pre-emptive evaluation for COVID-19 disease and proactive monitoring of its relevant clinical parameters, thereby permitting judicious and timely implementation of catatonia-specific treatment options.
Subject(s)
COVID-19 , Catatonia , Electroconvulsive Therapy , Catatonia/diagnosis , Catatonia/etiology , Catatonia/therapy , Hospitals, Psychiatric , Humans , SARS-CoV-2 , Tertiary HealthcareABSTRACT
BACKGROUND: There is growing concern about the psychopathological consequences of the COVID-19 pandemic. The prolonged stress due to the spreading fear of the contagion and to the enforced containment measures are deemed to trigger recurrences of preexisting mental disorders as well as the onset of new ones. From such perspective, clinical cases may be of primary ground to identify individual features and pandemic-related factors predisposing to the development of serious psychiatric symptoms. CASE PRESENTATION: Mr. R. is a 64-year-old, married, unemployed man, whose premorbid personality was characterized by relevant autistic traits. The patient developed catatonia in the context of the COVID-19 pandemic. We aimed at discussing the role of both preexisting and precipitating factors. CONCLUSIONS: Autism spectrum could represent a predisposing factor for severe psychopathological outcome and catatonia. Furthermore, the present clinical case highlights the role of COVID-19 pandemic in influencing physical and mental health.