Journal of Ect最新文献

Objectives: To investigate the effects of transcranial direct current stimulation (tDCS) on brain-derived neurotrophic factor (BDNF) levels, craving, and executive functions in individuals on maintenance treatment for opioid use.

Methods: We randomized 70 right-handed men aged 18-55 years into 2 groups: the intervention group and the sham group. The intervention was 10 sessions of 2 mA stimulation over 5 days. Each session in the sham group ended after 30 seconds. Craving was measured using the Desire for Drug Questionnaire (DDQ), Obsessive Compulsive Drug Use Scale (OCDUS), and visual analog scale (VAS). The measurements were taken before and after the intervention, as well as 2 months later. BDNF was measured before and after the intervention. Repeated-measures analysis of variance, the generalized estimating equation model, and independent t test were used for data analysis.

Results: The mean differences (95% confidence intervals) in pre and post craving scores in the intervention group were (12.71 [9.10 to 16.32], P = 0.167) for VAS, (1.54 [1.12 to 1.96], P = 0.012) for OCDUS, and (1.71 [1.27 to 2.15], P = 0.125) for DDQ. These measures in the control group were -0.44 (-1.19 to 0.30), 0.01 (-0.21 to 0.23), and 0.126 (-0.11 to 0.36), respectively. BDNF serum levels significantly increased after the intervention (difference, 0.84 [0.69 to 0.99], P < 0.001); however, this change was not significant in the generalized estimating equation model. The effect of tDCS on craving was significant in OCDUS, but not significant in VAS and DDQ.

Conclusions: The tDCS reduces craving and improves executive functions in the short term. BDNF serum level was not associated with tDCS.

Objectives: Electroconvulsive therapy (ECT) can be effective for a variety of psychiatric conditions, including for some patients who are very psychotic or agitated. Transferring such patients from the psychiatric ward to the ECT clinic can pose significant challenges for treating teams, as they try to minimize the use of restraint.

Methods: We developed a protocol for safe transfer of such patients using sedation with ketamine. An intravenous cannula is inserted on the ward in a low stimulus environment with gentle supportive holds. Intravenous ketamine is given in a bolus at 0.5-2.0 mg/kg. The patient is transported on a transfer bed to the ECT clinic within a few minutes, and usual ECT process is immediately followed.

Results: We describe 6 patients who were given between 1 and 11 ECT treatments using this method. All of them finished ECT courses without the need for ketamine sedation. Five of them regained capacity, provided informed consent for further ECTs, and eventually reached remission.

Conclusions: Ketamine can be used to manage risk and transfer agitated patients to an ECT clinic for treatment.

Objective: The aim of the study is to characterize geographic variation in electroconvulsive therapy (ECT) receipt across the United States (US) Veterans Administration (VA) healthcare system and explore potential explanatory variables.

Background: ECT is a highly effective and rapidly acting treatment for multiple mental disorders. However, there may be geographic disparities in access to ECT across the US.

Methods: We conducted a retrospective, cross-sectional study of all VA patients from 2003 to 2019 to describe rates of ECT within previously defined mental health referral regions (MHRRs). We investigated differences between the population that received ECT and other patients with a mental health condition severe enough to warrant inpatient hospitalization. We analyzed crude as well as age, sex, race, and ethnicity-adjusted ECT rates and explored potential explanatory variables. We compared MHRRs in the highest and lowest tertiles of ECT receipt.

Results: The rate of ECT receipt among VA patients was 1.7 individuals per 10,000 (SD = 1.6) annually. Among 115 MHRRs, the rate ranged from a minimum of 0 (effectively no utilization in some areas) to a maximum of 8.9. Regression analysis revealed few significant explanatory variables.

Conclusions: There is significant geographic variation in ECT receipt among VA patients that is not well explained by population characteristics and may be indicative of suboptimal treatment for several mental health conditions.

Abstract: Patients with bipolar I disorder who develop major depressive episodes with psychotic features and suicide ideations following severe episodes of mania can be difficult to treat with medications alone. Electroconvulsive therapy (ECT) is a treatment modality that can be quite helpful to these patients and lead to remission of depressive symptoms also while providing protection against mania. However the literature about using ECT in medically complex patients is sparse, which can limit guidance and knowledge on the specific risks of the procedure in specialized patient populations. We report in our own case the use of ECT to treat a major depressive episode in a young adult with bipolar I disorder who also has a history of 3 liver transplants in his childhood due to primary sclerosing cholangitis. Despite prior case reports relating the safety of ECT in liver transplant recipients, we discuss that our patient had a large intracranial hemorrhage during his first ECT that required 2 decompressive craniotomies and extensive physical rehabilitation. This case serves to expand the limited literature on the use of ECT in patients with history of liver transplants and to increase understanding of risks of the procedure in his specialized patient population.