Journal of Ect最新文献

Abstract: Down syndrome regression disorder (DSRD) is a condition in which individuals with Down syndrome experience a decline in social and adaptive functioning in adolescence to early adulthood. Initially described as catatonic psychosis and later designated Down syndrome disintegrative disorder (DSDD), the etiology for DSRD remains unclear but has been hypothesized to relate to autoimmune function, stress, and psychiatric disease. DSRD presents heterogeneously and has no clearly established diagnostic criteria, which can complicate treatment recommendations. ECT has been used to successfully treat DSRD, but the number of reported cases remains low, especially when it is unclear whether there are comorbid catatonic features. Here, we present a case of successful use of ECT in an individual with DSRD in which catatonic features were difficult to ascertain, and we make recommendations for the use of ECT in the treatment of DSRD.

Abstract: Electroconvulsive therapy (ECT) is an effective treatment for patients with severe psychiatric disorders. Stigma and lack of knowledge surrounding ECT are major obstacles for both patients and their caregivers, who play an important role as shared decision-makers. Insight in caregivers' perspectives on ECT can support the consent process and patient compliance with ECT. We aimed to review perspectives on knowledge, attitudes, and experiences of caregivers of adult and adolescent patients who received ECT. We performed a computerized search (EMBASE, MEDLINE) for articles meeting the following inclusion criteria: (1) qualitative studies, quantitative studies, or quasi-experimental studies that (2) report on caregiver perspectives of patients who received ECT. We conducted our systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. In total, 29 articles were included. Variation in knowledge about ECT was high among caregivers. Their attitudes were generally positive and most would advise for future ECT if necessary. Psychoeducational tools and ECT experience increased knowledge and attitudes in caregivers. In general, caregivers were satisfied with ECT but wanted more information on risks and side effects before ECT. Caregivers reported more positive attitudes toward and had better experiences with ECT compared with patients. Our systematic review demonstrated moderate knowledge, but overall positive attitudes and experiences on ECT in caregivers. Overall low methodological quality of included studies limits our conclusions. Future research should focus more on qualitative methods and cohort studies.

Abstract: Despite years of research, we are still not able to reliably predict who might benefit from electroconvulsive therapy (ECT) treatment. As we exhaust what is possible using traditional statistical analysis, ECT remains a good candidate for machine learning approaches due to the large data sets with data captured through electroencephalography (EEG) and other objective measures. A systematic review of 6 databases led to the full-text examination of 26 articles using machine learning approaches in examining data predicting response to ECT treatment. The identified articles used a wide variety of data types covering structural and functional imaging data (n = 15), clinical data (n = 5), a combination of clinical and imaging data (n = 2), EEG (n = 3), and social media posts (n = 1). The clinical indications in which response prediction was assessed were depression (n = 21) and psychosis (n = 4). Changes in multiple anatomical regions in the brain were identified as holding a predictive value for response to ECT. These primarily centered on the limbic system and associated networks. Clinical features predicting good response to ECT in depression included shorter duration, lower severity, higher medication dose, psychotic features, low cortisol levels, and positive family history. It has also been possible to predict the likelihood of relapse of readmission with psychosis after ECT treatment, including a better response if higher transfer entropy was calculated from EEG signals. A transdisciplinary approach with an international consortium collecting a wide range of retrospective and prospective data may help to refine and extend these outcomes and translate them into clinical practice.

Objectives: To evaluate the association between 3 ECT quality measures (seizure duration, Postictal Suppression Index [PSI], and heart rate response) and therapeutic compliance as indicated by transitioning from acute to continuation to maintenance phases of ECT.

Methods: This was a retrospective chart review of patients who received ECT between July 2016 and July 2019. ECT quality measures were lagged by 1 ECT session to examine the effect of the prior session's quality measure on progressing to a higher ECT phase at the subsequent ECT session. Associations with therapeutic compliance were analyzed using mixed-effects ordinal regression and mixed-effects partial proportional odds models.

Results: Seizure duration was associated with 8% higher adjusted odds of progressing to out of the acute phase (95% confidence interval [CI]: 2% to 15%, P = 0.007) and 18% higher adjusted odds of progressing to the maintenance phase (95% CI: 10% to 28%, P < 0.001); PSI was associated with 9% higher adjusted odds of progressing out of the acute phase (95% CI: 3% to 16%, P = 0.005), whereas heart rate response was not statistically associated with therapeutic compliance. Greater therapeutic compliance was also associated with bilateral electrode placement and older age.

Conclusions: Longer seizure duration was associated with greater therapeutic compliance across all ECT phases, PSI was associated with progressing out of the acute phase, and heart rate response was not associated with therapeutic compliance. Our findings assist ECT psychiatrists in optimizing ECT quality measures to promote better compliance with ECT.

Objective: GNA13 is an important member of the G protein family, and its coding gene GNA13 has been identified as one of the risk genes for schizophrenia (SCZ). This study aimed to investigate the relationship between GNA13 levels and the clinical symptoms of SCZ following treatment with modified electroconvulsive therapy (MECT).

Methods: This study recruited 82 SCZ patients and 86 healthy controls (HCs). Each SCZ patient received 6 sessions of MECT. The Positive and Negative Syndrome Scale (PANSS) was used to assess SCZ symptom severity. Plasma levels of GNA13 were measured by enzyme-linked immunosorbent assay.

Results: Pretreatment, SCZ patients had a higher GNA13 level than HC ( t = 8.199, P < 0.001). MECT reduced the GNA13 level significantly ( t = 11.13, P < 0.001) and normalized the difference between SCZ and HC ( t = 0.219, P = 0.827). After treatment, the downregulation of GNA13 (ΔGNA13) was negatively correlated with the positive symptoms score reduction rate (ΔP) ( r = -0.379, P = 0.027) and positively correlated with the negative score reduction rate (ΔN) ( r = 0.480, P = 0.004) in females. In both males and females, the receiver operating characteristic curve revealed that the pretreatment GNA13 level could help differentiate SCZ from HC (male: area under the curve = 0.792, P < 0.001; female: area under the curve = 0.814, P < 0.001).

Conclusion: The reduced expression of GNA13 after MECT may be related to the exhibition of both negative and positive symptoms of SCZ in female patients.