First Acute-Course Electroconvulsive Therapy for Moderate-to-Severe Depression Benefits Patients With or Without Accompanying Baseline Cognitive Impairment

Cerebral amyloid angiopathy (CAA) is a condition characterised by accumulation of amyloid beta protein (Aβ) in the wall of cerebral blood vessels which increases the risk of intracranial haemorrhage and contributes to cognitive impairment. We describe the case of a man around the age of 70 with ‘probable’ CAA according to the modified Boston criteria and severe depression whose depression was treated successfully with electroconvulsive therapy (ECT). To the best of our knowledge, there are no earlier published reports of ECT in a patient with CAA. We briefly discuss possible safety measures for these patients, the impact of ECT on cognition in CAA and a possible influence of ECT on Aβ clearance.

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332 - Electroconvulsive therapy in older adults with major depression was not associated with cognitive decline during a 15-year follow-up

International Psychogeriatrics ◽

10.1017/s104161022000232x ◽

2020 ◽

Vol 32 (S1) ◽

pp. 91-91

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Major Depression ◽

Cognitive Decline ◽

Electroconvulsive Therapy ◽

Antidepressant Treatment ◽

Community Sample ◽

Control Group

AUTHORS:Kerstin Johansson, Karolina Thömkvist, Ingmar Skoog and Sacuiu SF* (*presenter)OBJECTIVE:To determine the effects of electroconvulsive therapy (ECT) in major depression in relation to the development of dementia during long-term follow-up.METHOD:In an observational clinical prospective study of consecutive patients 70 years and older diagnosed with major depression at baseline 2000-2004 (n=1090), who were free of dementia and received antidepressant treatment, with or without ECT, we sought to determine if cognitive decline (mild cognitive impairment and dementia) during 15 -year follow-up was associated with receiving ECT at baseline. The control group was selected among the participants in the Gothenburg H70 Birth Cohort Studies matched by age group and sex 1:1.RESULTS:Among patients with affective syndromes 7% received ECT. During follow-up, 157 patients were diagnosed with dementia, equal proportions among those who received ECT (14.5%) and those who did not receive ECT (14.5%). The relation between ECT and cognitive decline remained non-significant irrespective antidepressive medication or presence of mild cognitive impairment at baseline.CONCLUSION:Preliminary results indicate that ECT was not associated with the development of cognitive decline in the long-term in a hospital-based cohort of 70+ year-olds. The results remain to verify against controls from a representative community sample.

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Electrode Placement, Stimulus Dosing and Seizure Monitoring during ECT

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048679409080791 ◽

1994 ◽

Vol 28 (4) ◽

pp. 675-683 ◽

Cited By ~ 5

Author(s):

G. Murugesan

Keyword(s):

Cognitive Impairment ◽

Electroconvulsive Therapy ◽

Electrical Stimulus ◽

Electrode Placement ◽

Treatment Modalities ◽

Points Of View ◽

Bilateral Treatment

Electroconvulsive therapy is one of the most useful, safe and predictable treatment modalities in psychiatry. For optimal results proper application of the procedure is essential. Over the years the procedure has undergone considerable refinement, yet not all those who administer the treatment are fully conversant with this. This paper addresses issues relating to electrode placement, stimulus dosing and seizure monitoring from practical and clinical points of view. Right unilateral ECT, if administered with high electrical stimulus, produces results close to bilateral treatment with substantially less cognitive impairment. However, certain patients may only respond to bilateral ECT. Adequate training for clinicians administering ECT is recommended.

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Electroconvulsive therapy awareness as approach for psychology students

Journal of Educational Sciences & Psychology ◽

10.51865/jesp.2021.1.20 ◽

2021 ◽

Vol 11 (73) (1) ◽

pp. 226-233

Author(s):

Simona Trifu ◽

Elena Mănicu ◽

Milu Petruţ ◽

Adrian Nicu Lupu

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Side Effects ◽

Electroconvulsive Therapy ◽

Psychology Students ◽

Epidemiological Evidence ◽

Clinical Literature ◽

Growing Body ◽

Current Guidelines ◽

Over Time

Electroconvulsive therapy (ECT) generated many controversies over time. The clinical literature establishing the efficacy of ECT is among the most solid for any medical treatment, and has been extensively reviewed; however, both practitioners and patients seem to be still reluctant on this issue. In the following review we are aiming at raising the level of awareness among the interested parties regarding ECT. Epidemiological evidence shows that there are a growing number of cases in which ECT has a great benefit, among the most notable being pharmacological resistant depressive disorder, bipolar disorder, schizophrenia, catatonia and others. Current guidelines seem to be overly-prudent regarding ECT indications, in spite of a growing body of research attesting to its importance. Side effects of ECT range from somatic to cognitive and, with a careful prior examination, most are acute and can be managed in a few minutes. An exception to this is the cognitive impairment, which can last from a few hours to a few weeks and presents a reason to reconsider ECT in elderly patients with an important preexisting cognitive impairment.

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Electroconvulsive therapy, depression severity and mortality: Data from the Danish National Patient Registry

Journal of Psychopharmacology ◽

10.1177/0269881119895518 ◽

2020 ◽

Vol 34 (3) ◽

pp. 273-279 ◽

Cited By ~ 2

Author(s):

Martin Balslev Jørgensen ◽

Maarten Pieter Rozing ◽

Charles H Kellner ◽

Merete Osler

Keyword(s):

Electroconvulsive Therapy ◽

Cox Regression ◽

Severe Depression ◽

Patient Registry ◽

Psychotic Symptoms ◽

Mortality Data ◽

Depression Severity ◽

National Patient Registry ◽

Danish National Patient Registry ◽

National Patient

Background: The effects of electroconvulsive therapy are usually estimated from changes in depression scales from studies with relatively small patient samples. Larger patient samples can be achieved from epidemiological registers, which provide information on other social and clinical predictors, results and risks. Aims: To examine whether depression severity predicts the use of electroconvulsive therapy, risk of re-hospitalization, suicidal behaviour and mortality following electroconvulsive therapy in patients with major depression. Methods: A cohort of 92,895 patients diagnosed with single or recurrent depression between 2005 and 2016 in the Danish National Patient Registry was followed for electroconvulsive therapy and adverse outcomes. Associations between electroconvulsive therapy and outcomes were analysed using Cox regression. Results: A total of 5004 (5.4%) patients were treated with electroconvulsive therapy. Depression severity was the strongest predictor of electroconvulsive therapy. Electroconvulsive therapy was used more frequently above age 70, in those better educated or married, whereas comorbid alcohol abuse or history of prior stroke at study entry were associated with lower rates. Electroconvulsive therapy was associated with lower mortality. The adjusted hazard ratio for the association between electroconvulsive therapy and suicide in patients with mild depression was 6.99 (3.30–14.43), whereas it was 1.10 (0.55–2.20) in those with severe depression and psychotic symptoms. A similar pattern was seen for emergency contacts and attempted suicide. Conclusions: Electroconvulsive therapy was associated with lower all-cause mortality and the relative risk for re-hospitalization and attempted and committed suicide was lowest in patients with the most severe depression. Electroconvulsive therapy is an important treatment, with significant public health benefits, for patients with severe depression.

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Prevalence and correlates of parkinsonism in patients with primary depression

Neurology ◽

10.1212/wnl.57.3.553 ◽

2001 ◽

Vol 57 (3) ◽

pp. 553-555 ◽

Cited By ~ 10

Author(s):

Sergio E. Starkstein ◽

Gustavo Petracca ◽

Eran Chemerinski ◽

Marcelo Merello

Keyword(s):

Cognitive Impairment ◽

Mood Disorder ◽

Severe Depression ◽

Older Age ◽

Longitudinal Changes ◽

Clinical Correlates ◽

Severe Cognitive Impairment ◽

Control Subjects ◽

Depressed Patients ◽

Healthy Control

The authors examined the prevalence, clinical correlates, and longitudinal changes of parkinsonism in 94 patients with primary depression and 20 healthy control subjects. Parkinsonism was present in 20% of patients with primary depression. This syndrome was significantly associated with older age, more severe depression, and more severe cognitive impairment. In a subgroup of depressed patients, parkinsonism was reversible upon recovery from the mood disorder.

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Electroconvulsive therapy in schizophrenia – where do we stand?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.671 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s262-s263

Author(s):

J. Silva ◽

J. Mota ◽

P. Azevedo

Keyword(s):

Side Effects ◽

Electroconvulsive Therapy ◽

Severe Depression ◽

Psychotic Symptoms ◽

Drug Intolerance ◽

Rapid Control ◽

Practice Of Medicine ◽

Nice Guidance ◽

Schizophrenic Patients ◽

Competing Interest

IntroductionElectroconvulsive therapy is currently used in the management of severe depression, long-term mania and catatonia. Regarding schizophrenia-related psychosis ECT is also an option, but the indication is restrictive to severe cases, drug intolerance or resistant ones. Lack of evidence of cost-effectiveness compared to clozapine, and side effects of ECT techniques before 2003, influenced NICE guidance to not recommend ECT in schizophrenia, but modern ECT machines and procedures are subsequent to 2003. ECT is often performed when clozapine fails to respond in monotherapy or if there is intolerance to antipsychotic side effects. ECT in combination with clozapine seems to have significant results allowing the patients to achieve rapid control of psychotic symptoms with fewer side effects, comparing with antipsychotics-association strategies.ObjectivesTo summarized the latest literature about this field and to present recent data from the Electrovulsivetherapy Unit, in Hospital de Magalhães Lemos, Portugal.AimTo explore and critically review the controversies of electroconvulsive therapy in the management of drug-resistant schizophrenia.MethodsRetrospective data of an Electroconvulsive Therapy Unit during 2006–2015 was review.Results198 ECT treatments in schizophrenic patients were performed in our unit, during 2006–2007, in a total of 647 ECT (30,6%). In 2014–2015, 945 schizophrenic patients received ECT treatment, in a total of 2149 performed ECT (43,9%).ConclusionsAlthough guidelines are crucial for the uniform practice of medicine, sometimes is important to be critical about them. The use of ECT in schizophrenia is safe and effective and further research is needed to continue to support this treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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