Journal of Ect最新文献

Background: Electroconvulsive therapy (ECT) is a highly effective treatment for schizophrenia and mood disorders; however, most evidence is derived from the adult population, with less evidence in adolescents. We sought to determine the use of ECT in adolescents in the Institute of Mental Health (IMH) and evaluate the treatment outcome.

Methods: We conducted a retrospective naturalistic analysis of ECT registry data of patients aged from 10 to 19 years from March 2017 to March 2023. Descriptive analysis was used to analyze the demographics and clinical characteristics. Paired t tests were used to compare the change in clinical outcome scores, including the Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impressions Scale - Severity (CGI-S), and Montreal Cognitive Assessment (MoCA) before and after 2 weeks of ECT treatment.

Results: Fifty-five patients were included for analysis. There was a significant improvement in BPRS (P < 0.001), MADRS (P = 0.005), and CGI-S (P < 0.001), and the average CGI-I score was 2.275 (SD, 0.81), which is equivalent to "much improved" after 6 sessions of treatment. Of all patients, 48.5% showed significant clinical improvement. There was no significant change in MoCA scores (P = 0.218).

Conclusions: Our preliminary findings show that ECT is a safe, rapid, and effective treatment for psychotic and mood disorders in adolescents. Further studies with a larger sample size and specific subgroup analysis are needed to establish the effectiveness of ECT and identify predictors of response in this population.

Objectives: We studied the acceptability, feasibility, tolerability, and preliminary effectiveness of combined cue exposure and anodal high-definition transcranial direct current stimulation (HD-tDCS) on the right dorsolateral prefrontal cortex (DLPFC) on cannabis craving in cannabis use disorder (CUD).

Methods: We randomly assigned 48 participants equally in 4 groups: A, tDCS and cannabis cue exposure; B, tDCS and neutral image; C, sham tDCS and cue exposure; and D, sham tDCS and neutral image. The images were validated by Delphi consensus. All participants received 6 sessions. We explored the acceptance, protocol completion, and follow-up rates. We assessed cannabis cravings twice, at the end of sessions and 4 weeks after intervention; change in frequency and amount of cannabis and other substance use were assessed at 4 weeks after intervention; working memory and executive functions were tested at the end of sessions. We performed an intention-to-treat analysis.

Results: We observed low acceptance (19.6%) but high completion (91.7%) and follow-up rates. There were motivational and logistical reasons for low acceptance; monetary compensation improved treatment acceptance. Participants in all groups showed significant reductions in cannabis cravings at the end of sessions, except for group C, the reduction in cravings sustained at the follow-up. Frequency and amount of cannabis use reduced, and cognitive outcomes improved in all 4 groups; however, there was no between-group difference, and changes were higher in groups B and D. Adverse effects and attrition were not different between HD-tDCS and sham treatment.

Conclusions: Anodal right DLPFC HD-tDCS is a safe and promising treatment for CUD. Cue exposure does not add to its effect.

Abstract: Although electroconvulsive therapy (ECT) is effective for treating depression, schizophrenia, and mania, cognitive adverse effects may limit use. One possible mechanism for these effects includes cholinergic transmission alterations, supporting potential use of cholinesterase inhibitors for prevention and treatment of these cognitive deficits. The objective of this review is to determine efficacy and safety of cholinesterase inhibitors clinically used for dementia in reducing ECT cognitive adverse effects. PubMed, EMBASE, and CENTRAL were searched in August 2024 for randomized controlled trials using terms and keywords related to cholinesterase inhibitors (acetylcholinesterase inhibitor, cholinesterase inhibitor, donepezil, galantamine, or rivastigmine) and ECT (electroconvulsive therapy, electroconvulsive, electroshock therapy, or ECT). A total of 8 randomized controlled trials were reviewed with mean patient ages ranging from 28.6 to 59.33 years and most common diagnoses including depressive disorders, schizophrenia/psychosis, and bipolar disorder. Six of the 8 trials showed benefits of using cholinesterase inhibitors in patients undergoing ECT. Significant improvements were found in immediate memory after ECT and recovery of personal memory, repetition, alertness, orientation, and impersonal memory compared with placebo. Trials varied in cognitive assessment scales, length of therapy, dosing strategy, ECT schedule, and ECT type/parameters. Cholinesterase inhibitors may be effective for reducing cognitive adverse effects of ECT and appear safe and well tolerated. The most commonly studied medication was donepezil 5 mg daily started shortly before and continued throughout ECT. Additional studies are needed to clarify optimal dosing, titration, duration of therapy, and the role of treatment for older adults, preexisting cognitive impairment, and neurologic comorbidities.

Background: Electroconvulsive therapy (ECT) is a medical procedure for treating severe depression and other mental health disorders, with anesthesia management being crucial for patient safety. Despite extensive research on factors influencing seizure quality during ECT, the impact of pre-ECT anxiety remains insufficiently explored.

Methods: This prospective observational study aimed to investigate the influence of pre-ECT anxiety, as measured by the Amsterdam Preoperative Anxiety and Information Scale, on electroencephalogram ictal characteristics during ECT and to explore anesthesia-related factors that may enhance seizure quality.

Results: A total of 38 patients participated in 168 documented ECT sessions over a 2-month period. Data analysis revealed a significant association between higher levels of pre-ECT anxiety, lidocaine doses exceeding 0.36 mg/kg, and decreased seizure quality during ECT sessions.

Conclusion: These findings suggest an association between pre-ECT anxiety, lidocaine dosage, and decreased seizure quality during ECT. Further research, including interventional studies, is required to better understand the causal factors.

Abstract: Electroconvulsive therapy (ECT) effectively treats severe psychiatric disorders such as depression, mania, catatonia, and schizophrenia. Although its exact mechanism remains unclear, ECT is thought to induce neurochemical and neuroendocrine changes. Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have provided vital insights into ECT's neurobiological effects. This scoping review investigates the role of molecular imaging in understanding these effects. A systematic search across PubMed, EMBASE, Web of Science, Cochrane, and Scopus databases yielded 857 unique records, from which 45 peer-reviewed articles in English with longitudinal PET or SPECT measures in ECT patients were included. The review identifies 2 main research directions: ECT's impact on brain activity and neurotransmitters. Initial research assessed regional cerebral blood flow and regional glucose metabolism during ictal (during ECT), postictal (within 24 hours), short-term (within a week), and long-term (beyond a week) follow-up as markers of brain activity. Initial findings showed an anterior-posterior regional cerebral blood flow gradient during the ictal phase, with subsequent normalization of hypoperfusion in frontal and parietal regions, and persistent long-term effects. Later, research shifted to the monoamine hypothesis of depression, examining ECT's impact on serotonin and dopamine systems via PET imaging. Results on receptor availability post-ECT were mixed, showing both reductions and no significant changes, indicating variable effects. This scoping review further highlights the need to explore new targets, tailor methodologies for patient populations, and foster multicenter studies. Although SPECT has been valuable, advances in PET imaging now make it preferable, offering unparalleled insights into ECT's molecular and neurobiological mechanisms.

Background: Computational modeling is used to optimize transcranial electrical stimulation (tES) approaches, and the precision of these models is dependent on their anatomical accuracy. We are unaware of any computational modeling of tES that has included cranial sutures.

Objectives: The aims of the study were to review the literature on the timing of closure of the coronal and squamous sutures, which are situated under electrode placements used in tES; to review the literature regarding differences in skull and suture conductivity and to determine a more accurate conductivity for sutures; and to identify magnetic resonance image (MRI) techniques that could be used to detect cranial sutures.

Methods: A scoping review of medical literature was conducted. We conducted computational modeling of a cranial bone plug using COMSOL Multiphysics finite element software, utilizing methodology and results from a previous study. We assessed use of the "3D Slicer" software to identify sutures in routine T1-weighted MRI scans.

Results: Reports from forensic examinations and computed tomography (CT) scans showed suture closure does not correlate with age. Our computational modeling determined a cranial suture conductivity of 0.32 S/m, which is much higher than for skull (compact skull 0.004 S/m, standard trilayer 0.013 S/m). 3D slicer enabled rapid and precise identification of the anatomy and location of cranial sutures.

Conclusions: Cranial sutures persist throughout the lifespan and have a far higher conductivity than skull bone. Cranial sutures can be localized quickly and precisely using a combination of MRI and readily available modeling software. Sutures should be included in tES computational modeling and electroencephalography source imaging to improve the accuracy of results.

Introduction: Assessment of autobiographical memory following electroconvulsive therapy is lacking multilingual options. We therefore developed the Dutch translation of the Columbia University Autobiographical Memory Interview-Short Form (CUAMI-SF). We aimed to assess its practical use and identify segments for potential revision to improve the interview's applicability.

Methods: The CUAMI-SF comprises 30 questions asking details about 6 segments (eg, last trip, last birthday) and 7 question categories (eg, dates, list of persons present). The interview was translated to Dutch using blind back-translation principles. We evaluated practicality and potential redundancy, through surveying a focus group and quantitative analyses of 60 participants, including depressed patients treated with electroconvulsive therapy (n = 14) or deep brain stimulation (n = 25) and healthy controls (n = 21). For the quantitative analyses, we compared the average percentage of nonanswered questions at baseline between groups. The average consistency scores after a follow-up of approximately 6 weeks were also calculated and compared for each segment between the groups.

Results: The focus group mostly found the CUAMI-SF easy to use and to score, but argued redundancy in specific questions asking for dates, numbers, and addresses. The largest differences in consistency scores between the groups were present for the segments "travel," "birthdays," "New Year's Eve," and "doctor's visits," indicating higher sensitivity compared with "family member" and "job."

Discussion: The CUAMI-SF was found easy to use by administrators. The segments "family member" and "job" emerged as less sensitive. Therefore, removal might maintain sensitivity while reducing administration time, which could prove beneficial in clinical and research settings.

Abstract: Electroconvulsive therapy (ECT) is a therapeutic intervention that induces generalized seizures under general anesthesia. This case report compares the efficacy of dexmedetomidine (DEX) and nitrous oxide (N2O) to that of propofol during ECT procedures. A 33-year-old woman with a 15-year history of schizophrenia and recurrent psychotic episodes underwent ECT. During a previous hospitalization, she underwent 14 ECT sessions using propofol and succinylcholine. The mean electrical stimulation dose was 598.9 ± 237.6 mC, with mean motor and electroencephalogram seizure durations of 23.8 ± 8.0 and 34.9 ± 8.3 seconds, respectively. During her current hospitalization, she underwent an additional 14 ECT sessions using DEX and N2O. The mean electrical stimulation dose was significantly lower, at 239.4 ± 54.7 mC, with comparable motor and electroencephalogram seizure durations of 34.6 ± 11.6 and 36.3 ± 12.5 seconds, respectively. Our case report emphasizes the effectiveness of using DEX and N2O for ECT anesthesia compared to propofol. Despite a significantly lower mean electrical stimulation dose requirement with DEX and N2O (t = 5.5155, P < 0.00001), no significant differences were observed in electroencephalogram seizure duration between the groups.

Introduction: The practice of electroconvulsive therapy (ECT) exhibits variability across various domains, both between regions, and between centers within the same region. The ECT Working Group of the Catalan Society of Psychiatry conducted a comprehensive survey in Catalonia, Spain, to assess the current status of those variables essential in the clinical practice of ECT.

Materials and methods: The survey comprised 50 items, including various question types such as multiple-choice, numerical response, and open-ended questions. It was administered to the 20 public hospitals that currently provide ECT in Catalonia during the year 2022. Information was gathered on 4 main areas: Organization of the ECT Unit, Specific Technique of ECT Application, Strategies and Organization of the Therapeutic Plan, and Epidemiological Data, Training, and Healthcare Resource Management.

Results: Some notable findings include an application rate of 1.1 per 10,000 inhabitants, major depression diagnosis as the primary indication for ECT in 80% of the centers, and the ability to perform maintenance ECT in 100% of centers.

Conclusions: Following the survey and analysis, 3 main findings emerged: minimal variation in ECT application rates compared to the previous decade, increased complexity in current ECT practices with a focus on quality and patient safety, and identified areas for improvement in resource management and the necessity for a well-trained and stable multidisciplinary team.