Neurobiological Basis of Increased Risk for Suicidal Behaviour

According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus–pituitary–adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.

Frequency of Complications after Electroconvulsive Treatment in Patients with Schizophrenia

Objective: To determine the frequency of complications after electroconvulsive treatment in patients with schizophrenia. Study Design: Retrospective study Place and Duration of Study: Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta 1st August 2020 to 31st March 2021. Methodology: One hundred and twenty patients of both genders were presented in this study. Patients were aged between 20-70years. Patient’s detailed demographics age, sex and mean body mass index were recorded after taking informed written consent. Patients of schizophrenia received electroconvulsive treatment. Frequency of immediate complications was observed after each session of electroconvulsive treatment and at the end of electroconvulsive treatment frequency of long term complications were observed. Results: Sixty five (54.17%) were males and 55 (45.83%) were females with mean age were 40.14±3.45 years and mean body mass index 22.14±6.12 kg/m2. Mean electroconvulsive treatment sessions was 88.13±6.87. Mean hospitalization stay was 3.4±2.04 weeks. Frequency of immediate complications were 25 (20.83%) among patients after electroconvulsive treatment session. Among 20.83%, frequency of body aches was 7 (8.83%), headache was in 11 (9.17%), frequency of transient amnesia was among 3 (2.5%) and hypertension was among 4 (3.33%). Significantly no any delay complications were observed in continuously sessions among enrolled cases. Conclusion: The use of electroconvulsive treatment sessions in patients of schizophrenia was effective because no any delay complications were observed in this treatment. Keywords: Schizophrenia, Electroconvulsive treatment (ECT), Treatment sessions

Comparative study of thiopentone sodium, propofol, etomidate for anesthetic efficacy & effect on seizure duration in electroconvulsive therapy

Electroconvulsive treatment (ECT) is an entrenched mental treatment where seizures are electrically actuated in patients for restorative impacts. ECT can deliver extreme unsettling influences in the cardiovascular framework most generally a transient time of hypertension & changes in the pulse and a stamped increment in cerebral blood stream and intracranial weight. These hemodynamics changes might be adjusted utilizing different sedative medications. This investigation was attempted to think about the impacts of propofol, etomidate and thiopentone sodium utilized as IV sedative operators in changed ECT as respects, acceptance time & nature of sedation, adjustment of hemodynamics, seizure length & recuperation time.After authorization acquired from the moral board of trustees for the investigation, composed assent from the patient & family members was taken. This investigation was led in the division of anesthesiology at Civil Hospital, Ahmedabad, which remembered a sum of 90 patients for the 18-60 years age gathering.In our current investigation, we inferred that each of the three instigating operators had sure more than each other when the examination boundaries were individualized. Propofol had the upside of stable hemodynamic boundaries, smooth enlistment & fast recuperation in contrast with etomidate & thiopentone. Nonetheless, it was related with more limited span of seizure. The benefit of thiopentone sodium of having longer seizure length than propofol of having longer seizure span was brought about at the expense of a generally delayed recuperation period. The clear bit of leeway of a more extended seizure length with etomidate could be utilized for better clinical adequacy. Notwithstanding, it was related with myoclonic jerks during the cycle of acceptance. Further examinations ought to be planned to utilize a stage & mix of medications with the goal that the most ideal impacts of each medication can be sensibly utilized.

Incidence and risk factors for postictal delirium in patients after electroconvulsive therapy in China

Aim: This study aimed to elucidate the incidence and risk factors for postictal delirium (PID) among Chinese patients undergoing electroconvulsive therapy (ECT). Methods: In this retrospective study, 203 patients who underwent ECT in the Third Affiliated Hospital of Sun Yat-Sen University from July 2016 to July 2017 had their PID severity measured by a previously developed scale. For data analysis, two groups were created: PID patients and non-PID patients. The groups were analyzed based on three types of independent variables: patient-related, electroconvulsive treatment, and hemodynamic variables. Data analysis was performed through descriptive statistics, Chi-squared tests, Fisher exact tests, and/or independent sampled t-tests. Logistic regression analysis was used to identify independent risk factors for postictal delirium (P < 0.05).Results: Results showed that 81 patients (39.9%) developed moderate to severe PID in their first ECT session. Patients receiving ECT for the first time (P = 0.016), agitation before the ECT (P = 0.028), and high heart rate variances (P = 0.044) were identified as risk factors for PID, and they were significantly correlated with the occurrence of moderate to severe PID (P < 0.01). Conclusion: The patients receiving ECT for the first time, with agitation states before ECT and/or with high heart rate variance during ECT procedures might be at higher risk for moderate to severe PID. The medical staff related to this type of treatment may benefit from detailed knowledge about the aforementioned risk factors for predicting PID and to anticipate the best possible management for these patients.