Journal of Ect最新文献

Introduction: Electroconvulsive therapy (ECT) in patients with treatment-resistant depression frequently leads to impairments in global cognitive function. Propofol and etomidate are the 2 most frequently used drugs for anesthetic induction during ECT. However, only few studies compared their differential impact on ECT-related impairments in global cognitive function.

Methods: We studied retrospectively 75 patients hospitalized at Centre Hospitalier Le Vinatier (Bron, France) who met the DSM-V criteria for major depressive disorder and were treated with bilateral ECT to compare the effects of propofol and etomidate on ECT-related cognitive impairment. Global cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), and symptom severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), both before and after treatment. The primary endpoint of the study was the change in MoCA score.

Results: We found no significant difference in MoCA score variation between the etomidate and propofol groups. There were also no significant differences in MADRS score variation, responder, remission rate or ECT parameters between the 2 groups (except duration of electroencephalogram crisis).

Conclusions: In this retrospective study, choice of etomidate or propofol as anesthetic agent had no impact on the adverse effects associated with ECT on global cognitive function in patients with treatment-resistant depression.

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.

Abstract: This case report describes an instance of aspiration in a 50-year-old male who surreptitiously broke his fast before his second Electroconvulsive therapy despite multiple fasting confirmations and strict food security measures, leading to subsequent necessitating intensive care unit management. Although not confirmed, there was high suspicion of intentional sabotage. This case highlights the importance of ensuring fasting compliance in psychiatric patients and encourages clinicians to practice vigilance in patients who may be considered high risk and falsify fasting adherence.

Objectives: This study was carried out with a descriptive design to evaluate the performance, comprehensiveness, reliability, and quality of Turkish YouTube videos addressing ECT.

Methods: The Turkish keywords "Elektrokonvülsif Terapi, Elektrokonvülsif Tedavi" and EKT [Electroconvulsive Therapy, Electroconvulsive Treatment and ECT] were searched on September 15, 2023, and the first 30 for each keyword and total 90 YouTube videos were examined. A form developed by the researchers was used for comprehensiveness, DISCERN for reliability, and Global Quality Scale for quality.

Results: The videos' (N = 27) average "number of views" was 546881.3 ± 1754392.2, the average "comprehensiveness score" was 4.8 ± 3.0, the average "reliability score" was 3.1 ± 2.2, and the average "quality score" was 2.6 ± 1.5. When the videos were examined for reliability, 55.6% contained good and useful information for the audience, whereas only 33.3% were of high quality. There was a significant positive correlation between comprehensiveness, reliability, and quality ( P  = 0.000).

Conclusions: People with psychiatric problems or their relatives resort to the Internet and platforms such as YouTube on topics for some information they are unfamiliar with, it is recommended that the content prepared in these areas be comprehensive, reliable, and of high quality.

Objectives: Modification of the electrode placement with electroconvulsive therapy (ECT) impacts on patient outcomes, including cognitive effects. The investigation of alternative right unilateral placements (RUL) has the potential to further improve ECT outcomes by reducing cognitive side effects.

Methods: This study investigated differences in the intracerebral distribution of current density comparing the standard d'Elia right unilateral positioning (temporoparietal [TP]) with two recently developed RUL placements, focal electrically administered seizure therapy (FEAST) and frontoparietal (FP) stimulation. The strength of the electrical fields (E-fields) was compared in brain regions of interest (ROIs) implicated in both clinical and cognitive outcomes. Computational modeling was conducted in the head models of five participants with major depression who had received RUL ECT.

Results: Results showed that the FEAST and FP placements were associated with significantly less bilateral stimulation effects in regions hypothesized to be associated with memory, whereas the FP and TP placements produced significantly greater bilateral stimulation effects in some regions hypothesized to be associated with efficacy. FEAST, using a smaller anterior electrode, produced significantly greater E-fields in some ROIs associated with memory and efficacy, although those differences were much smaller in magnitude.

Conclusions: These findings suggest that both FEAST and FP may result in a superior clinical profile relative to TP. Future clinical studies are required to confirm the differences in clinical outcomes associated with the novel RUL placements.

Objective: This study aims to explore perspectives of patients, family, and healthcare professionals on feasibility of family presence during electroconvulsive therapy (ECT).

Methods: This qualitative study used semistructured interviews. Eleven patients and 12 healthcare workers participated in small focus groups. Four family members were interviewed individually. All patients and their family members had prior experience with ECT, and all healthcare workers provided care to patients undergoing ECT. Verbatim transcriptions were analyzed using reflexive thematic analysis.

Results: Five main themes emerged. First, family members should be considered as partners in ECT care and their involvement is beneficial for patients, family, and healthcare workers. Second, patients can experience more support through family proximity immediately before and after ECT and during the ECT procedure by providing an added sense of control. Third, family presence can be stressful for family members as witnessing the procedure might be anxiety provoking. In addition, for healthcare workers, increased distress by feeling watched might negatively impact their professional performance. Fourth, all participants express the need for clear guidelines when implementing family presence during ECT. Fifth, more transparency through family presence might be helpful to dispel ECT myths still present in society.

Conclusions: Even though family presence during an ECT procedure can be stressful for healthcare workers and families, it can be feasible when embedded in a broader family-centered ECT care including clear guidelines. Family presence may enhance patients' sense of support, improve understanding of ECT for both patients and family members, and help destigmatize the procedure.

Abstract: The presence of catatonia refractory to routine pharmacologic management is often subsequently managed by electroconvulsive therapy. However, legal obstacles that delay the initiation of electroconvulsive therapy in a timely fashion may be present. This may lead to prolonged risks associated with immobility and result in other procedures such as percutaneous endoscopic gastrostomy (PEG) tube placement. We present a case of successful lysing of catatonia with intravenous ketamine that allowed a patient to avoid potential complications and other procedures prior to definitive treatment with electroconvulsive therapy. Further research of this potential treatment of catatonia is needed as this may change the current approach to refractory catatonia.

Objective: The stigma surrounding electroconvulsive therapy (ECT) among healthcare professionals can lead to a lack of training, limit accessibility to treatment, and introduce variability in its application. The aim of this study was to explore the attitudes and knowledge regarding ECT within healthcare professionals.

Methods: A total of 215 professionals from the Vallès Oriental region (Barcelona) completed the translated version of the Questionnaire on Attitudes and Knowledge of ECT (QuAKE). The relationship between attitude and knowledge scores was analyzed in relation to several demographic variables with bivariate descriptive statistics.

Results: The characteristics associated with a more unfavorable attitude and lower knowledge were being a female professional, aged under 30 years or over 50 years, belonging to the nursing assistant group, working in a setting not related to mental health, and never having witnessed an ECT session. A positive correlation was observed between attitude and knowledge about ECT.

Conclusions: This study identified nursing assistants as the group with the most unfavorable attitudes and lowest knowledge about ECT, and the social workers group had a favorable attitude despite having limited knowledge. The correlation between knowledge and attitude suggests the possibility of improving the latter through appropriate training, although these aspects are not always affected in the same way in all professional groups.

Electroconvulsive therapy (ECT) remains one of the most effective treatments for catatonia, but its use in patients with implantable airway stimulation devices, such as the Inspire device for obstructive sleep apnea (OSA), is very rare, with only 2 prior cases described in the literature: one for major depressive disorder and one without a specified indication. There is no practical guidance for safely administering ECT with an implanted Inspire device. We describe a 32-year-old male with autism spectrum disorder (ASD), epilepsy, and OSA treated with an Inspire device who developed Down syndrome regression disorder (DSRD) and catatonia. DSRD is characterized by the acute loss of previously acquired skills in language, social engagement, and executive functioning. Standard medication approaches were either poorly tolerated or ineffective, leaving ECT as the best remaining option. Following the Inspire manufacturer's safety recommendations, which included turning the device off during each session and carefully positioning electrodes, the patient underwent 30 ECT treatments over 11 months. Gradually, his speech and ability to manage daily activities improved, the aggressive outbursts stopped, and no serious complications occurred. Our experience shows that, with thoughtful planning and precautions, ECT can be delivered safely and effectively for catatonia in DSRD with an implanted Inspire device. As more patients receive implantable airway stimulators, awareness of how to manage these cases will become increasingly important.