Journal of Ect最新文献

Electroconvulsive therapy (ECT) is a well-established method to treat various psychiatric disorders. However, ECT is not without risk; as such, all patients undergo a thorough workup to ensure appropriate patient selection. An important physiological event during ECT is the transient increase in intracranial pressure (ICP), which raises the question of intracranial contraindications to this treatment modality. A literature review was conducted to explore the safety of ECT in the presence of various intracranial pathologies to establish a summary of recommendations. Neuropathologies considered include malignant or benign brain tumours, arachnoid cysts, neurovascular conditions, neurotrauma, hydrocephalus, idiopathic intracranial hypertension, and Chiari 1 malformations. The literature remains very sparse on this topic, mostly including case series or short retrospective studies. However, there have not been any established absolute contraindications to ECT. Available evidence describes lower risks following ECT in clinically asymptomatic tumors, arachnoid cysts, treated hydrocephalus, and asymptomatic Chiari 1 malformation. Several strategies have been proposed to mitigate the risks of transient rise of intracranial pressure in certain conditions, including the administration of steroid medications and intravenous antihypertensives. The decision to proceed with ECT in the presence of intracranial pathology should be made on a case-by-case basis by a multidisciplinary team involving both psychiatric and neurosurgical teams.

Almost a century after the first experiments with camphor in inducing seizures for the treatment of schizophrenic patients, this past remains present in psychiatry as one of its milestones, being one of the first effective biological approaches conducted for mental illness. In Hungary, László Meduna, a psychiatrist with training in neuropathology, hypothesized that convulsions held therapeutic potential based on a theoretical incompatibility with psychosis and, with firm intellectual dedication, planned and executed a research project that resulted, after generations of improvements, in one of the most effective and timeless treatments in psychiatry. László Meduna entered history. Using the early research methods available at the time, he developed an innovative procedure. Meduna, like many other dedicated scientists throughout history, filled gaps with his research skills. This review situates the work of Meduna within its historical context, examining his development of chemically induced seizures as a treatment for severe psychiatric disorders. This seminal therapeutic advance proved remarkably effective, and its fundamental repercussions continue to resonate in contemporary practice.

We report the case of a 76‑year‑old woman with a 25‑year history of neuropsychiatric symptoms and Moyamoya vasculopathy, first identified in 2016. She presented in March 2025 with severe catatonic excitement and began electroconvulsive therapy (ECT) starting in April, showing marked clinical improvement within 3 sessions. Genetic testing confirmed moyamoya disease (MMD) with a pathogenic RNF213 mutation, associated with increased risk of infarction or hemorrhage. After trials with several anesthetic agents, dexmedetomidine (DEX) combined with remifentanil was selected, enabling stable anesthesia with a consistent electrical dose of 192 mC across 35 sessions over 5 months. The main challenges included hemodynamic stability in MMD, prevention of post‑ictal agitation in advanced age and catatonia, and preservation of seizure quality despite repeated ECT. This case highlights the safe and effective use of ECT with DEX and remifentanil in a patient with genetically confirmed MMD with catatonic symptoms.

Abstract: Autoimmune encephalitis (AE) tends to manifest as a mixture of neuropsychiatric and somatic symptoms, either of which may predominate, and often shows a progressive clinical course sometimes leading to life-threatening conditions. Catatonic and psychotic syndromes, regardless of whether associated with dysautonomia, are common manifestations of AE, especially concerning the anti-NMDAR subtype. Several autoantibodies targeting different neuronal epitopes have been linked to specific clinical manifestations and their detection is embedded in some of the diagnostic criteria for AE. Therapeutical management of AE is challenged by limited diagnostic abilities and poor understanding of the underlying pathophysiology for most of its subtypes. Although the prompt delivery of disease-modifying therapies represents the cornerstone of treatment and primarily affects prognosis, less is known about the role of symptom specific supportive measures like electroconvulsive therapy (ECT). Based on a systematic review of 26 patient-level descriptions of individuals, each with a diagnosis of AE treated with ECT, a favorable clinical response was found in more than ¾ of the revised cases (76.9%). The most common indications for ECT administration were catatonic and psychotic syndromes, often nonresponsive to prior pharmacotherapy with benzodiazepines, antipsychotic, and other psychotropic drugs. Noteworthy side effects were only reported for 3 of 26 patients. Though the low number of cases and publication bias should be considered as major limitations, current available reports are in support of the inclusion of ECT in the integrated therapeutic algorithm of AE to address psychiatric conditions such as severe psychosis and catatonia.

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 (N 2 O) 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 N 2 O. 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 N 2 O for ECT anesthesia compared to propofol. Despite a significantly lower mean electrical stimulation dose requirement with DEX and N 2 O (t = 5.5155, P  < 0.00001), no significant differences were observed in electroencephalogram seizure duration between the groups.

Abstract: Electroconvulsive therapy (ECT) is an effective treatment for severe depression, especially in treatment-resistant cases. However, its potential cognitive side effects necessitate careful dosing to balance therapeutic benefits and cognitive stability. Recent advances in electric field (E-field) modeling offer promising avenues to optimize ECT dosing. This review synthesizes current knowledge on E-field modeling in ECT and explores its clinical applications. It examines the variability in E-field strengths and distributions induced by ECT and their impact on clinical outcomes. Additionally, the relationship between E-field strengths, neuroplasticity, and therapeutic efficacy is discussed. Translational studies of E-field-informed ECT are highlighted, emphasizing individualized optimal amplitude dosing and potential clinical applications. This review provides useful insights into how E-field modeling can improve the effectiveness of ECT while minimizing adverse effects, helping guide future research and clinical practice.

Objectives: This study investigates repeated oral esketamine as a substitution strategy for maintenance electroconvulsive therapy (M-ECT) in eight patients with treatment-resistant depression (TRD).

Methods: In a 6-week dosing phase, esketamine was titrated from 0.5 or 1.0 mg/kg to a maximum of 3.0 mg/kg twice weekly. Outcomes included 6-week change in Inventory of Depressive Symptomatology - Self-rated (IDS-SR), Hamilton Depression Rating Scale - 17 items (HDRS 17 ), and Outcome Questionnaire 45 (OQ-45), along with esketamine treatmentcontinuation.

Results: Depression severity remained stable or improved in five patients, whereas three experienced worsening symptoms and resumed M-ECT. OQ-45 scores were available for five patients, all of whom showed improvement. Currently, four patients are still receiving oral esketamine.

Conclusions: Repeated oral esketamine may be a suitable and patient-friendly alternative to M-ECT. We recommend controlled trials to compare long-term safety and efficacy.

Abstract: Although there is robust evidence of electroconvulsive therapy's (ECT's) efficacy in severe mental illnesses, its use is still constrained by patients' and clinicians' concern about the possibility of cognitive side effects. It is established that anterograde amnesia usually recovers within weeks of the acute ECT treatment course, whereas retrograde memory loss can persist in the long term in some patients. To date, it remains unknown whether retrograde memory loss after ECT can recover and, if so, how.This case report describes a patient who received an acute course of bifrontal 0.5 milliseconds ECT within a time frame of 6 months. The patient initially experienced significant memory loss, including anterograde and retrograde amnesia, the latter including knowledge and skills learnt from more than a decade prior to ECT. During the first year after the patient received ECT, her anterograde memory functioning recovered, but her retrograde memory loss remained. Notably, 2 years after the last ECT treatment, the patient observed an ability to rapidly relearn the material and skills that were lost after ECT. We believe that this case report will offer hope for patients who experience longer-term retrograde memory loss after ECT and stimulate new research on novel interventions for post ECT amnesia.