Journal of Ect最新文献

Abstract: Electroconvulsive therapy (ECT) effectively treats severe psychiatric disorders such as depression, mania, catatonia, and schizophrenia. Although its exact mechanism remains unclear, ECT is thought to induce neurochemical and neuroendocrine changes. Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have provided vital insights into ECT's neurobiological effects. This scoping review investigates the role of molecular imaging in understanding these effects. A systematic search across PubMed, EMBASE, Web of Science, Cochrane, and Scopus databases yielded 857 unique records, from which 45 peer-reviewed articles in English with longitudinal PET or SPECT measures in ECT patients were included. The review identifies 2 main research directions: ECT's impact on brain activity and neurotransmitters. Initial research assessed regional cerebral blood flow and regional glucose metabolism during ictal (during ECT), postictal (within 24 hours), short-term (within a week), and long-term (beyond a week) follow-up as markers of brain activity. Initial findings showed an anterior-posterior regional cerebral blood flow gradient during the ictal phase, with subsequent normalization of hypoperfusion in frontal and parietal regions, and persistent long-term effects. Later, research shifted to the monoamine hypothesis of depression, examining ECT's impact on serotonin and dopamine systems via PET imaging. Results on receptor availability post-ECT were mixed, showing both reductions and no significant changes, indicating variable effects. This scoping review further highlights the need to explore new targets, tailor methodologies for patient populations, and foster multicenter studies. Although SPECT has been valuable, advances in PET imaging now make it preferable, offering unparalleled insights into ECT's molecular and neurobiological mechanisms.

Background: Electroconvulsive therapy (ECT) is a widely used treatment for schizophrenia, particularly for acute psychosis, treatment resistance, severe self-harm, and catatonia. Modifying pulse width to a brief pulse (0.5 to 2.0 ms) has emerged as a promising method to minimize adverse cognitive effects traditionally associated with ECT. Newer ECT devices allow shorter stimulus, termed ultra-brief pulse (<0.5 ms). However, the available literature lacks sufficient comparative trials assessing the differences in cognitive adverse effects and clinical efficacy between brief pulse and ultra-brief pulse ECT in patients with schizophrenia.

Aim: To test if there is a significant difference between cognitive adverse effects and efficacy of ultra-brief pulse and brief pulse bitemporal ECT.

Methods: A prospective, hospital-based, randomized single-blind design was used. Forty-two patients diagnosed with schizophrenia were randomly allocated to ultra-brief pulse (0.3 ms) and brief pulse (0.5 ms) bitemporal ECT groups. ECT was administered thrice weekly under anaesthesia, at 2.5 times the seizure threshold. Clinical efficacy and cognitive functioning were assessed using PANSS, CGI, CDSS, MMSE, and Hindi MoCA, both at baseline and following 1 to 2 days after the first and eighth ECT sessions.

Results: Forty patients completed the study. Both groups showed a significant reduction in PANSS subscale scores over time, with no significant difference between them. Similarly, while MoCA and MMSE scores changed significantly within each group, no group-wise difference was found regarding cognitive side effects.

Conclusions: Ultra-brief pulse bitemporal ECT does not confer significant advantages over brief pulse bitemporal ECT in terms of cognitive side effects or efficacy in schizophrenia.

Electroconvulsive therapy (ECT) is an effective, life-saving treatment for catatonia. However, comorbidities of catatonia, such as pneumonia or respiratory failure, can lead to difficulties in ECT. We report the case of a male patient in his 30s with schizophrenia who developed severe catatonia following discontinuation of clozapine. Furthermore, ineffective airway clearance subsequently led to the development of aspiration pneumonia and airway obstruction, which required mechanical ventilation on continuous sedation. During this time, the catatonia improved with high-dose lorazepam and midazolam; however, a spontaneous awakening trial (SAT) revealed that the catatonic symptoms had rapidly recurred following a reduction in the sedative dosage. Based on a discussion of these findings by a multidisciplinary team, ECT was begun while the patient was under mechanical ventilation. Two ECT sessions led to marked improvement in the catatonia, enabling a prolonged SAT to be performed. This confirmed the absence of catatonic symptoms, thereby permitting extubation. After the patient's respiratory status stabilized, 4 additional ECT sessions were administered. Finally, the patient was discharged without any recurrence of the catatonia or medical complications. This case demonstrates the importance of multidisciplinary collaboration in managing catatonia under complicated clinical conditions. Rather than delaying ECT because of its medical conditions, the treatments, including mechanical ventilation to protect the airway, should be carefully coordinated to enable the safe administration of ECT. Furthermore, SAT can serve as a valuable clinical tool for determining the appropriate timing and the need for ECT in catatonic patients under mechanical ventilation.

Prolonged seizures (PS), tardive seizures (TS), and status epilepticus (SE) are rare but severe complications related to electroconvulsive therapy (ECT). Factors increasing the risk for these conditions and measures making ECT safe after PS, TS, and SE are insufficiently studied. Therefore, we report and discuss the case of a 43-year-old woman with recurrent major depressive disorder and a history of epilepsy who developed SE during maintenance ECT. Factors possibly associated with SE in the present case were previous PS, discontinuation of oxcarbazepine during ECT, an implanted vagus nerve stimulator, and low stimulus intensity, presumably near the individual seizure threshold. Following comprehensive neurological diagnostics with unremarkable findings, maintenance ECT was resumed with an increased stimulus charge with good efficacy, safety, and tolerability. Based on the present case and the available evidence from the literature, resuming ECT after ECT-associated SE appears to be safe under the following conditions: (1) First, pre-ECT medical history and clinical investigation have to address risk factors for PS, TS, and SE (eg, substance withdrawal and medication/substances lowering seizure threshold). (2) Establishment of an anticonvulsant in order to reduce the risk of PS, TS, and SE cannot be recommended in general. (3) If available, characteristics of previous ECTs regarding charge, type, and dosing of anesthetics, concurrent medication, seizure duration, and tolerability of ECT should be considered. In particular, we recommend an increase in stimulus intensity (charge) to induce robust seizure termination.

Objectives: The goal of this study was to compare the response/remission rates, time to response/remission, and common side effects between treatment-resistant depression (TRD) patients receiving the electroconvulsive therapy (ECT) and those receiving standard repetitive transcranial magnetic stimulation (standard rTMS).

Methods: TRD patients who received ECT or standard rTMS between March 2014 and August 2023 were included. Only patients receiving 20 standard rTMS treatments or at least 6 ECT treatments entered the analysis. Six-item Hamilton Depression Rating Scale (HAMD-6) and common side effects were routinely assessed during the treatment period. Response and remission were defined as a HAMD-6 ≥50% reduction and a HAMD-6 ≤4, respectively. Survival analysis was used to compare the time to response/remission between the two groups.

Results: Compared with the standard rTMS group (N = 96), the ECT group (N = 92) showed a significantly higher treatment completion rate. For completers, the ECT group (N = 74) had significantly higher response rate/remission rate and shorter time to response/remission than the standard rTMS group (N = 63). No patients treated with standard rTMS experienced subjective memory impairment or nausea/vomiting, while 82.4% and 32.4% of patients receiving ECT experienced subjective memory impairment and nausea/vomiting, respectively. The ECT group experienced significantly higher rates of headache and muscle pain than the standard rTMS group.

Conclusions: Compared with the standard rTMS group, the ECT group was more likely to have a higher completion rate, have higher response/remission rates, a short time to response/remission, and experience more side effects during the treatment period.

We report the case of a 26-year-old man with severe obsessive-compulsive disorder (OCD) who developed new-onset psychotic symptoms following neuromodulation therapy. He had a longstanding history of contamination obsessions, "just-right" phenomena, repeating compulsions, and severe avoidance, with minimal response to multiple trials of Serotonin Reuptake Inhibitors (SRIs) including clomipramine. Following initiation of deep transcranial magnetic stimulation (dTMS) using a modified intermittent theta burst (iTBS) protocol, he developed auditory hallucinations and persecutory delusions. Subsequent transcranial direct current stimulation (tDCS), using an adapted protocol targeting both OCD and psychotic symptoms, led to further worsening of the psychosis. Symptoms resolved with antipsychotic treatment. We describe the clinical course and discuss putative mechanisms underlying the emergence of psychosis with neuromodulation in OCD.

Objectives: First aim was to demonstrate feasibility of continuous noninvasive blood pressure monitoring using the ClearSight System (Edwards Lifesciences Corp) in the setting of electroconvulsive therapy (ECT). Second aim was to evaluate the hemodynamic changes over multiple ECT sessions, allowing prediction and preemptive treatment of hemodynamic changes to reduce cardiovascular stress in subsequent sessions.

Methods: In a subset of an ongoing RCT, patients' hemodynamic parameters were recorded using the ClearSight System™ from induction of anesthesia for up to 10 minutes.

Results: One hundred forty-nine sessions in 14 patients were recorded. Hemodynamic monitoring using the ClearSight System was feasible in all patients with limitation of poor peripheral perfusion due to Raynaud syndrome in one patient and recording gaps in case of poor muscle relaxation. Hemodynamic patterns varied widely between individuals, but were comparable over multiple ECT sessions.

Conclusions: Individual hemodynamic reactions can be precisely assessed using the ClearSight System with only minor limitations. Given the similar hemodynamic reaction over repeated sessions, a single measurement can be used to predict subsequent reactions and to preemptively treat cardiovascular changes without the need to use costly consumables over multiple sessions.