Journal of Ect最新文献

Objective: To present a comparison of pre-neuropsychological and post-neuropsychological test findings in adolescents (aged 11 to 18 y) who were treated with electroconvulsive therapy (ECT) for a severe and/or treatment-resistant psychiatric disorder.

Methods: Forty-five participants (Nfemale=31; 68.9%) received ECT (mean age ± SD at the time of starting ECT=15.9 ±1.4). Comprehensive psychiatric evaluation and standardized neuropsychological assessment were done as part of the clinical protocol.

Results: The most common diagnostic reason for receiving ECT was refractory mood disorder (n=41; 91%). The mean number of ECT treatments in the index course was 20 ±10.8, and the mean number of continuation treatments among 36 participants was 8.5 ± 9.2. The mean interval between the end of ECT and the neuropsychological evaluation was 65.52 days. Analysis showed no statistically significant decline (P >0.08) in intelligence, academic achievement, learning, memory, and executive functioning. Self-ratings of depression measured by the Beck Depression Inventory were reduced at the post-ECT time-point relative to pre-ECT (declined from "severe" to "moderate") (p = 0.019).

Conclusions: Standardized neuropsychological measures did not reveal a significant decline in a range of neurocognitive domains. These findings challenge the notion that adolescents may be more vulnerable to cognitive side effects of ECT. Reduction in self-reported depression symptoms was also found.

Aim: This study examines early ECT response and correlations between repeat ECT courses, focusing on patients whose treatment indications changed between courses.

Methods: Our retrospective observational study included patients from the Institute of Mental Health (Singapore) who underwent at least 2 ECT courses for different indications between March 2017 and May 2023. For each course, the MADRS and BPRS scores were assessed 1 to 2 days before the first ECT session and after the sixth. Pearson correlation and paired t tests were employed to analyze the relationship between responses to the first and second ECT courses, along with 6 additional clinical outcome assessments (GAF, VAS, CGI-S, US, Q-LES-Q-SF, and MoCA) spanning illness severity, quality-of-life, and cognition.

Results: Twenty-five patients were included. Psychosis was the most common indication for the first course and mania for the second. Overall, early response rates were 38.9% for the first course and 42.1% for the second, with no significant correlation between responses across courses ( P = 0.229). Notably, no patients with catatonia responded to acute treatment in the first course, even when indications changed in the second. Strong correlations were found for global illness severity (CGI-S, r = 0.519, P = 0.023) and quality-of-life (US, r = 0.935, P < 0.001) across the 2 courses.

Conclusion: Changes in ECT indications between courses suggested a poorer prognosis, but those who showed improvement in global illness severity and quality-of-life tended to experience similar benefits in subsequent ECT courses. Given the lack of correlation between symptom-specific early response across courses, a poor early response in a previous ECT course should not preclude patients from future ECT when clinically indicated.

We present 2 cases of patients who received electroconvulsive therapy (ECT) for psychotic depression and catatonia, respectively. Both patients had previously been diagnosed with COVID-related anosmia. Following the first ECT session, the patients reported a significant improvement in their sense of smell, preceding the resolution of depressive and catatonic symptoms. There is a growing body of literature regarding the relationship between psychiatric illness and olfactory dysfunction. Furthermore, considering the neurogenesis hypothesis of ECT, the olfactory bulb is the only brain structure aside from the dentate gyrus where neurogenesis is known to occur.

Objectives: During the acute ECT course, physicians may change induction anesthetics when seizure characteristics are suboptimal, particularly with limited clinical response. Although common in practice, anesthetic switching has undergone limited systematic study regarding frequency or effects on seizure characteristics. We examined the prevalence and impact of anesthetic switching to inform clinical care and the neurobiology of electrically induced seizures.

Methods: We conducted a retrospective cohort study of all patients aged 17 years or older undergoing ECT at Albany Medical Center between 2020 and May 2025. Included subjects received at least 2 ECT sessions within an acute ECT course. The research was determined by the Albany Med IRB to be exempt from IRB review and approval.

Results: Seventy-three patients (35 male/38 female) undergoing 82 acute ECT courses were included, 79% for unipolar or bipolar depression. Age (mean±SD) was 56±17 years. An anesthetic was switched in 22/82 (27%) courses. Multivariate logistic regression found no associations between switching and age, sex, or depression diagnosis. The most frequent switch was propofol to methohexital (16/22, 73%). Compared with the prior session, motor seizures were 15 seconds longer (95% CI: 6-25 s, P=0.0038) and EEG seizures were 24 seconds longer (95% CI: 15-33 s, P<0.0001).

Conclusions: Anesthetic switching occurred in over a quarter of acute ECT courses at this site. The predominant change, propofol to methohexital, was associated with markedly longer seizures. Thus, patients clinically identified for a switch to a less anticonvulsant induction agent retain the capacity for longer seizures. Future studies are warranted to clarify how anesthetic switching influences treatment outcomes.

Neuropsychiatric symptoms in dementia can be heterogeneous and hard to treat, though electroconvulsive therapy (ECT) is becoming more widely accepted as a viable treatment option. Here, we describe a patient with Alzheimer disease (AD) who developed Somatic Symptom Disorder as a prodrome to cognitive and functional decline, though atypical, primary affective disorder in AD was also on the differential. This patient further developed debilitating anxiety and agitation that was refractory to multiple behavioral and pharmacological interventions. ECT was able to treat the patient's neuropsychiatric symptoms, resulting in sustained, full remission with minimal transient, cognitive side effects. This case depicts a rare presentation of AD and further adds to the growing body of literature that suggests ECT is safe and effective for treating neuropsychiatric symptoms in dementia.

Background: Electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are widely used neuromodulatory interventions for psychiatric disorders. Despite their clinical effectiveness, perceptions and stigma associated with these therapies among caregivers remain a concern, influencing treatment acceptance. This study aimed to estimate the perception and stigma associated with ECT, rTMS, and tDCS among primary caregivers of patients receiving these therapies.

Methods: A cross-sectional comparative study was conducted at the Department of Psychiatry of a Tertiary Care Centre of North India involving 99 primary caregivers whose ages ranged 18 to 60 years and who are staying with the patient for at least 1 year, equally distributed across the 3 therapy groups (ECT, rTMS, and tDCS). Participants were selected using purposive sampling. Data were collected using validated tools: Brain Stimulation Therapy Perception Questionnaire (BSTPQ) and Brain Stimulation Therapy Stigma Questionnaire (BSTSQ).

Results: Caregivers of patients undergoing rTMS and tDCS reported more favorable perceptions and lower stigma compared with ECT caregivers. Statistically significant differences were found between ECT and rTMS groups. A moderate negative correlation was observed between perception and stigma (r=-0.482, P<0.01).

Conclusions: Newer therapies like rTMS and tDCS are perceived more positively than ECT. Education and awareness play a critical role in reducing stigma and improving acceptance among caregivers.