Geriatric Telepsychiatry: Promoting Access to Geriatric Mental Health Care Beyond the Physical Barriers.

Psychiatric illnesses are an important contributor of morbidity and mortality in older adults. There is increase in older adults with psychiatric disorders paralleling their growth in absolute numbers. This leads to challenges in mental health care and service delivery. Several barriers that exists in our community hinder older adults from receiving mental health care. Additionally, lack of adequate human resources in geriatric mental health care compounds the problem. Telemedicine, though not new in other fields of medicine, is relatively new in the practice of psychiatry in India. This is probably due to lack of clear guidelines and regulations regarding the same in India. There is a recent increase in teleconsultations in India similar to other developed countries due to ongoing COVID-19 pandemic. The recent telepsychiatry operational guidelines have made telepsychiatry a legitimate and official practice in India. Challenges specific to older adults in the form of low digital literacy, sensory issues, and cognitive impairment can be overcome by adopting telepsychiatry services in coming years. Concerns related to security and safety of telepsychiatry require further evaluation.

Resolution of Cognitive Adverse Effects of Electroconvulsive Therapy in Persons with Schizophrenia: A Prospective Study.

BACKGROUND: Cognitive impairments are among the most important adverse effects of electroconvulsive therapy (ECT). Although much is known about them in patients with depression, there is very little information about these in persons with schizophrenia. METHODS: In this study, we examined the persistence of cognitive impairments in a subsample of patients (n = 49) with schizophrenia who had earlier participated in a clinical trial comparing the therapeutic and cognitive efficacy of bifrontal ECT (BFECT; n = 23) and bitemporal ECT (BTECT; n = 29) electrode placements. Total scores on Hindi Mental State Examination, processing speed, working memory, and verbal fluency were assessed in these patients at two points: first, at the end of their respective ECT course and at the follow-up (mean [standard deviation] = 98.7 [38.3] days). The course of cognitive impairments was assessed in all patients (n = 49) as a single group. Further, BFECT and BTECT patients were also compared with one another. RESULTS: ECT-induced acute cognitive impairments in patients with schizophrenia had normalized by the end of 3 months' follow-up post-ECT. All the tested parameters in the realm of Hindi Mental Status Examination, speed of processing, sequencing, spatial and working memory and verbal fluency showed recovery. Further, across all tests, BFECT and BTECT ultimately had similar scores at the follow-up though BFECT performed relatively better with regards to the acute effects. In fact, worst performing BTECT group caught up to recover to comparable levels of performance by the end of follow-up. CONCLUSIONS: In patients with schizophrenia, most of acute ECT-induced cognitive impairments recover by the end of 3 months' post-ECT. Further, different electrode placements do not seem to make any difference regarding ultimate recovery of cognitive deficits. Future prospective studies are needed that could address the limitations of this study.

Battery for ECT Related Cognitive Deficits (B4ECT-ReCoDe): development and validation.

BACKGROUND: The use of electroconvulsive therapy (ECT) in treatment of psychiatric disorders is associated with adverse cognitive effects. There is a need to develop a short assessment tool of cognitive functions during the course of ECT. OBJECTIVE: This study aimed at developing and validating a short, sensitive battery to assess cognitive deficits associated with ECT in India. METHODS: Battery for ECT Related Cognitive Deficits (B4ECT-ReCoDe), a brief cognitive battery (20-30 min) to assess verbal, visual, working and autobiographic memory, sustained attention, psychomotor speed and subjective memory impairment, was administered to 30 in-patients receiving bilateral ECT, one day after the 1st, 3rd and 6th ECT. Data was analysed using repeated measures analysis of variance and Pearson's correlation. RESULTS: Significant deficits were found in verbal, visual and autobiographic memory, psychomotor speed. Subjective experience of memory loss correlated positively with verbal memory impairment. CONCLUSIONS: B4ECT-ReCoDe, a brief, sensitive measure of cognitive impairments associated with ECT can be used in routine clinical practice.

Double-blind randomized controlled study showing symptomatic and cognitive superiority of bifrontal over bitemporal electrode placement during electroconvulsive therapy for schizophrenia.

BACKGROUND: Several studies show that bifrontal electrode placement produces relatively fewer cognitive adverse effects than bitemporal placement during electroconvulsive therapy (ECT) in depression. There are no reports comparing these electrode placements in schizophrenia. OBJECTIVES: This study compared the clinical and cognitive effects of bifrontal and bitemporal electrode placements in schizophrenia patients referred for electroconvulsive therapy (ECT). METHODS: 122 schizophrenia patients who were prescribed ECT were randomized to receive ECT with either bifrontal (BFECT; n = 62) or bitemporal (BTECT; n = 60) placement. Their concomitant anti-psychotic medications and the number of ECT sessions were not controlled. Psychopathology was assessed using the Brief Psychiatric Rating Scale (BPRS), Bush-Francis Catatonia Rating Scale (BFCRS), and the Nurse Observation Scale for Inpatient Evaluation (NOSIE). Cognitive functions were assessed 24-h after the final ECT using a battery of tests. Clinical improvement was compared using chi-square test, repeated measures ANOVA and analysis of covariance (ANCOVA). Cognitive adverse effects were compared using t-test. RESULTS: At the end of 2 weeks (after 6 ECT sessions) 63% and 13.2% of BFECT and BTECT patients respectively had met the response criterion for BPRS (40% reduction in total score; OR = 20.8; 95% CI = 3.61-34.33). BFECT patients showed significantly faster clinical response on BPRS (Time × Group interaction effect: P = 0.001), BFCRS (P < 0.001) and the NOSIE total assets score (P = 0.003). ANCOVA using baseline scores as covariates and treatment-resistance status as between-subject factor showed that BFECT patients had significantly greater improvement in all measures. BFECT patients had significantly higher PGI-memory-scale total score than BTECT patients (t = 5.16; P < 0.001). They also showed superior performance in other cognitive measures. CONCLUSIONS: BFECT results in superior clinical and cognitive outcomes than BTECT in schizophrenia patients referred for ECT.