Journal of Ect最新文献

Multiple chemical sensitivity is a nociplastic pain syndrome whereby individuals develop adverse somatic symptoms following exposure to various odorants and chemicals. The condition is debilitating, and optimal management is unclear. Electroconvulsive therapy has proven effective for management, but utilization remains low. Here is described a patient with multiple chemical sensitivity who was treated with ultra-brief pulse right unilateral electroconvulsive therapy, who also met Mahgoub's criteria for melancholic depression. The authors suggest that Mahgoub's clinical criteria for melancholia may prove useful for identifying cases of multiple chemical sensitivity that are responsive to electroconvulsive therapy.

Propofol is a short-acting intravenous anesthetic commonly used in electroconvulsive therapy (ECT). Misuse cases have been reported due to the short-lasting euphoric and dissociative effects of propofol. Here, we present a 49-year-old woman with complaints of depression and panic attacks, who underwent ECT because of poor adherence to medication and a previous positive response to the treatment. During ECT, she reported experiencing euphoria and relaxation following propofol administration, which she described as a feeling of "drunkenness" and "narcotic-like" effects. When ECT was discontinued after achieving remission, her anxious-depressive symptoms and panic attacks re-emerged within 1 to 2 months, and she reapplied with an intensive demand for ECT. When ECT was restarted and planned to be tapered gradually, each reduction in session frequency was accompanied by withdrawal-like symptoms such as anticipatory anxiety, tremors, sweating, and an intense desire for ECT, along with a persistent wish to continue treatment. She stated that she wanted to maintain twice-weekly sessions even when her symptoms had improved. Considering this clinical picture, it was suggested that the case might have been ECT misuse secondary to propofol dependence. To our knowledge, this is the first case in the literature highlighting possible ECT dependence or misuse. This report emphasizes the importance of recognizing the misuse potential of anesthetic agents in ECT practice and distinguishing psychological dependence behaviors that may emerge during treatment.

Recently, the effectiveness of noninvasive brain stimulation (NIBS) techniques, such as transcranial direct current stimulation (tDCS), has been shown in psychiatric disorders. Here, a new, intensified protocol has been developed, which is suggested to induce late-phase long-term potentiation (LTP)-like plasticity, and increase efficacy of the intervention. In the present case report, we evaluated the effectiveness of a new intensified tDCS protocol (30 sessions, 2 mA for 20 min, 2 sessions daily with a 20 min interval between daily sessions, for 15 d) applied to the left ventromedial prefrontal cortex (AF3 according to the EEG International 10 to 20 system), which is suggested to induce late-phase plasticity, and therefore is expected to have superior clinical effects, in a girl with severe cockroach phobia. Severity of phobia symptoms, the anxiety level to phobic stimuli (cockroach), general anxiety, depression, and emotional distress were measured before and immediately after intervention and at follow-up (3 wk and 6 wk after the last intervention). The results show a significant improvement in phobia symptoms postintervention, maintained for up to 6 weeks after the last intervention, and side effects, including burning sensations and skin redness, were mild. These findings suggest that an intensified tDCS stimulation protocol over the left vmPFC may effectively improve phobia symptoms. Moreover, the results showed that this intensified protocol is safe and tolerable. To substantiate the effects of the current protocol, further investigations in larger patient groups are required.

Objectives: Dual orexin receptor antagonists (DORAs) are widely used for insomnia treatment; however, their effects on seizure quality during modified electroconvulsive therapy (m-ECT) remain unclear. This study examined whether DORAs influence seizure parameters during m-ECT.

Methods: A total of 239 m-ECT sessions in 54 patients (January 2022 to February 2025) were retrospectively analyzed. Patients were categorized into a DORA group (32 patients, 152 sessions) and a non-DORA group (22 patients, 87 sessions). Seizure quality was assessed using postictal suppression index, seizure duration, electroencephalogram (EEG) coherence, EEG amplitude, and peak heart rate (HR). Linear mixed-effects models evaluated each parameter and a composite Σz score (sum of standardized z-scores) with covariates including age, sex, chlorpromazine-equivalent dose, diagnosis (F2 vs. non-F2), ECT session number, thiopental dose, and percentage energy. Subgroup analyses included patients aged older than or equal to 60 years, within-DORA comparisons (suvorexant vs. lemborexant, dose-adjusted), and dose-response analyses limited to DORA-treated sessions.

Results: No significant differences were observed in seizure quality parameters or the composite Σz score between groups. Among patients aged older than or equal to 60 years, peak HR tended to be lower with DORA exposure, whereas EEG-based seizure measures were maintained. No significant differences were found between suvorexant and lemborexant, and the DORA dose showed no linear relationship with Σz. Sensitivity analyses excluding landiolol, clozapine, or non-F2/F3 diagnoses yielded consistent results.

Conclusions: DORA use during m-ECT did not impair seizure quality, supporting their safe concomitant use. Findings were consistent across subgroup, agent, and dose-response analyses. Larger prospective trials are warranted to confirm these results.

Objective: Catatonia is a complex neuropsychiatric syndrome characterized by marked changes in psychomotor function and behavior. The gold standard for managing catatonia is electroconvulsive therapy. Although bitemporal lead placement is traditionally utilized for management, right unilateral lead placement may offer similar remission rates while offering better cognitive outcomes. Currently, unresolved questions impede utilization of right unilateral electroconvulsive therapy for catatonia, such as its efficacy and durability when managing severe manifestations of the syndrome such as delirious mania and neuroleptic malignant syndrome. Providing answers to these questions may improve utilization of right unilateral electroconvulsive therapy for both acute and chronic management.

Methods: A case series of patients with catatonia was compiled from a retrospective review of all electroconvulsive therapy performed at our institution over the last 7 years. Response and remission rates were determined by a reviewer blinded to treatment modality and hypotheses.

Results: Of patients, 90% with catatonia responded to treatment with right unilateral lead placement, while 70% remitted. All patients with delirious mania and neuroleptic malignant syndrome remitted from treatment with ultrabrief pulse right unilateral electroconvulsive therapy. All patients treated with right unilateral electroconvulsive therapy had stable or improved cognition over the course of their treatments. Over a span of one hundred plus patient-months, no patient treated with continuation or maintenance therapy required rehospitalization within a month of their last treatment.

Conclusions: Right unilateral electroconvulsive therapy provides a rapid, consistent, and durable response for managing a variety of forms of catatonia and should be more readily considered for both acute and chronic management.

Background: This case series describes the combined use of electroconvulsive therapy (ECT) and intranasal esketamine (ESK)-2 rapidly acting, evidence-based options for treatment-resistant depression (TRD). Each can leave residual symptoms or early relapse. Whether concurrent use confers more durable benefit remains unclear.

Methods: We followed 4 adults (50 to 72 y) with severe TRD who had shown partial or waning benefit to ECT or ESK alone. During acute treatment, bilateral ECT (2 to 3 sessions/wk) was paired with ESK (28 to 84 mg, 1 to 2 doses/wk) on non-ECT days. Over 24 weeks, ECT was tapered individually to every 1 to 3 weeks while ESK continued weekly or fortnightly, with schedules adjusted to course and tolerability. MADRS, ECT cadence, and adverse events were documented every 4 weeks.

Results: Two response profiles emerged. In 2 patients, adding the complementary modality to partial monotherapy produced sustained improvement: ESK added to ongoing ECT reduced MADRS from 36→18 (-50%), and ECT during ongoing ESK reduced MADRS from 35→22 (-37%). In 2 maintenance-ECT responders, adding ESK produced improvements from 42→16 (-62%) and 36→6 (-83%), allowing ECT intervals to extend from weekly to every 14 to 21 days. Mean symptom reduction was 58%; no relapses occurred over 24 weeks. Adverse events were mild and transient-brief dissociation (3/4) and post-ictal confusion (2/4); no serious events occurred.

Conclusions: In this naturalistic series, combined ECT+ESK was feasible and associated with sustained symptom improvement, wider ECT spacing, and potentially lower cognitive burden. Findings are hypothesis-generating, support prospective controlled trials to define sequencing, dosing, and safety.