Dichotic perception and memory following electroconvulsive treatment for depression

Emotional distress affects attention and concentration: the difference between mountains and valleys

The current study tests the hypothesis that the "mountains and valleys pattern" (MVP) observed within the Attention and Concentration domain of the Meyers Neuropsychological Battery reflects the interference of emotional distress/anxiety on the patient's cognitive test performance. First, the MVP was objectively quantified using a formula that took into account both increased and decreased scores, rather than canceling them out through averaging. Using a total sample of 787 subjects, the Minnesota Multiphasic Personality Inventory-Second Edition Restructured Form (MMPI-2-RF) profile scores of cases with and without this pattern were then compared using an extensive database followed by a smaller, matched-groups design. The presence of the MVP was related to MMPI-2-RF test performance. In particular, this pattern was related to emotional distress/anxiety scales but was not related to scales reflecting neurological or cognitive complaints. The degree of emotional distress experienced may affect attention and concentration test performance in a way that sometimes heightens focus and at other times disrupts focus. The MVP may be used to assess the effects of emotional distress on the consistency of an individual patient's attention and concentration test performance.

Improvement in response times for simple and complex tasks after electroconvulsive therapy

BACKGROUND

Electroconvulsive therapy (ECT) has gone through fundamental changes since its introduction in 1938 and has developed from a frightening and distrusted procedure into an effective and safe treatment for people with severe psychiatric disorders. This study suggests that ECT has an effect on the response times of simple and complex tasks.

METHODS

We had two groups. The first group consisted of eight patients suffering from severe therapy-resistant depression. They were treated with ECT. The second group consisted of eight sex- and age-matched persons who were treated conventionally with antidepressive medication. The authors measured auditory and visual response times of both simple and complex tasks in run A and run B on two different days. In the ECT group, the first measurement took place 1 day before a session of ECT, the second 3 h following a session of ECT. In the depressive control group, the two measurements were performed on two different days but at most within 4 days.

RESULTS

The response times of the depressive subjects treated with ECT are prolonged in both run A and run B compared to those of the depressive control group. The response times in run B are reduced compared to run A on the whole. However the reduction is stronger in the ECT group than the one taking place in the depressive control group between the two runs.

CONCLUSIONS

The considerable decrease of the response times from run A to run B in the ECT group compared to the depressive control group gives further evidence that ECT has a positive effect on important information processing parameters.

Subtypes of memory dysfunction associated with ECT: characteristics and neurobiological bases

Electroconvulsive therapy (ECT) is an effective treatment for a variety of psychiatric syndromes. However, one of its adverse secondary effects is neurocognitive dysfunction. The aim of this paper is to review different subtypes of memory dysfunction associated with ECT from a neuropsychological perspective. Declarative memory is clearly impaired after ECT. Immediate memory, however, is broadly preserved. Few studies have addressed procedural and incidental memory. Selective memory is impaired, probably due to the disruption of specific brain regions. Some of the possible neurobiological bases of ECT memory dysfunction are discussed in this paper. Synaptic plasticity, the cerebral neurotransmission system, and cerebral metabolism are examined in relation to the dysfunction and subsequent recovery of each memory subtype.

Nicardipine improves the antidepressant action of ECT but does not improve cognition

INTRODUCTION

Cognitive impairment, the most important adverse effect of electroconvulsive therapy (ECT), may involve elevated intracellular calcium ion signaling. Animal research suggests that calcium channel-blocking agents, which attenuate excessive intracellular calcium activity, may reduce cognitive dysfunction caused by ECT.

METHOD

The lipid-soluble calcium channel-blocking drug nicardipine or matching placebo were randomly assigned to 26 patients with major depressive disorder receiving ECT. A rater blind to the experimental condition administered the Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale, the Beck Depression Inventory, the Mini-Mental State Examination and a comprehensive battery of neuropsychological tests prior to ECT, at the completion of ECT, and 6 months after ECT completion.

RESULTS

Compared with patients receiving placebo, patients taking nicardipine had significantly lower scores on the Hamilton and Montgomery-Asberg but not the Beck Depression rating scale scores at the completion of ECT. There were no differences between placebo and nicardipine groups in depression scores 6 months after ECT. Cognitive function declined over the course of ECT and improved over the next 6 months in both groups, but changes were statistically significant for only two subtests on the neuropsychological battery. Changes in Mini-Mental State Examination scores were small and were not significant at any point. There were no significant differences between nicardipine and placebo treated groups in any assessment of cognition.

DISCUSSION

Standard approaches to ECT in younger patients without preexisting neurological impairment do not produce cognitive side effects of sufficient severity for calcium channel-blocking agents to reduce these side effects demonstrably. Studies of treatments for cognitive impairment should be conducted in patients with risk factors for more severe cognitive impairment such as geriatric patients or patients with a history of interictal delirium during previous treatment with ECT. A possible effect of nicardipine in enhancing the antidepressant action of ECT requires further investigation in a study designed to test this action.

A preliminary profile of neuropsychological deficits associated with major depression

A profile of neuropsychological deficits of clinically depressed (major depression) but otherwise unimpaired individuals is presented, based on a meta-analysis of all studies published since 1975 and meeting stringent methodological and sample selection criteria. Deficits are discussed separately for different cognitive areas in terms of mean size of deficit, variability between studies, variability of individual scores in depressed populations relative to that of controls, and expected proportion of depressed individuals scoring two standard deviations or more below the mean of controls. The neuropsychological deficits of individuals with major depression are shown to be consistent with a global-diffuse impairment of brain functions with particular involvement of the frontal lobes. Recent neuro-imaging studies also indicating frontal dysfunction in clinical (functional) depression are referred to. Both the severity and the profile of cognitive deficiencies in depression are postulated to be similar to those seen in moderately severe traumatic brain injury.

Memory impairment in schizophrenia: its extent, affiliations and neuropsychological character

In a sample of 60 schizophrenic patients encompassing all grades of severity and chronicity memory impairment was found to be prevalent, often substantial, and disproportionate to the overall level of intellectual impairment. The deficits were not easily attributable to poor cooperation, attention or motivation; nor were they related to neuroleptic or anticholinergic medication. Memory impairment was significantly associated with severity and chronicity of illness and also with negative symptoms and formal thought disorder. There was evidence from the sample as a whole, and from a more detailed examination of five patients with relatively isolated deficits, that schizophrenic memory impairment conformed to the pattern seen in the classical amnesic syndrome. Additionally, there was preliminary evidence for a marked deficit in semantic memory.