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Gil-Badenes J, Giménez-Palomo A, Duque L, Pujol-Fontrodona G, Martínez-Amorós E, Bioque M. Maintenance Electroconvulsive Therapy in Catatonia: Clinical Profiles From a Case Series. J ECT 2024:00124509-990000000-00150. [PMID: 38412188 DOI: 10.1097/yct.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES This study aims to conduct a descriptive analysis of the clinical features and treatment responses in 6 patients with catatonia who received maintenance electroconvulsive therapy (ECT). METHODS Our study included all patients who underwent maintenance ECT (mECT) at the Hospital Clínic de Barcelona between September 2020 and September 2022 following a catatonic episode. RESULTS The study cohort comprised 5 patients with schizophrenia and 1 patient with major depressive disorder. Among patients with schizophrenia, the first catatonic episode occurred several years after their initial paranoid psychotic episode, whereas the patient with depression experienced a rapid progression from the first depressive episode to catatonia. After acute ECT, 4 patients achieved complete symptomatic remission, 1 patient exhibited a partial response, and another maintained a severe catatonic state. Maintenance ECT was indicated because of the high risk of severe relapses. The mean frequency of mECT sessions was 9.83 (SD, 5.60) days. Notably, 66.67% of the patients were concurrently receiving clozapine as part of their pharmacological treatment. Among patients with schizophrenia, mECT sessions could not be extended beyond 7 to 10 days, whereas the depressed patient could space ECT sessions up to 21 days without experiencing a relapse. CONCLUSIONS Maintenance ECT proves to be a safe and well-tolerated strategy for preventing relapses in severe catatonic patients who have previously stabilized with acute ECT. Further research is needed to develop clinical guidelines that define optimal application strategies for mECT in catatonia.
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Affiliation(s)
| | | | - Lucía Duque
- Psychiatry Department, Hospital Universitario Juan Ramón Jiménez, Huelva
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Martínez-Amorós E, Serra P, Bassa A, Palao DJ, Cardoner N. Discontinuation of maintenance electroconvulsive therapy: Lessons learned from the COVID-19 pandemic. Revista de Psiquiatría y Salud Mental (English Edition) 2022; 15:154-155. [PMID: 35840284 PMCID: PMC9274262 DOI: 10.1016/j.rpsmen.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Erika Martínez-Amorós
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Pilar Serra
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Adriana Bassa
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Diego J Palao
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Narcís Cardoner
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
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Martínez-Amorós E, Cardoner N, Gálvez V, de Arriba-Arnau A, Soria V, Palao DJ, Menchón JM, Urretavizcaya M. Can the Addition of Maintenance Electroconvulsive Therapy to Pharmacotherapy Improve Relapse Prevention in Severe Major Depressive Disorder? A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11101340. [PMID: 34679404 PMCID: PMC8534103 DOI: 10.3390/brainsci11101340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 12/22/2022] Open
Abstract
Few systematic evaluations have been performed of the efficacy of electroconvulsive therapy (ECT) as a relapse prevention strategy in major depressive disorder (MDD). This is a single-blind, multicenter, randomized controlled trial to compare the efficacy and tolerability of pharmacotherapy plus maintenance ECT (M-Pharm/ECT) versus pharmacotherapy alone (M-Pharm) in the prevention of MDD relapse. Subjects with MDD who had remitted with bilateral acute ECT (n = 37) were randomly assigned to receive M-Pharm/ECT (n = 19, 14 treatments) or M-Pharm (n = 18) for nine months. The subjects were followed up for 15 months. The main outcome was relapse of depression, defined as a score of 18 or more on the Hamilton Depression Rating Scale. At nine months, 35% of the subjects treated with M-Pharm/ECT relapsed as compared with 61% of the patients treated with M-Pharm. No statistically significant differences between groups were indicated by either Kaplan–Meier or Cox proportional hazards regression analyses. The subjects without psychotic features were at higher risk of relapse. There were no statistically significant differences in the MMSE scores of the two groups at the end of the study. Further studies are needed to better define the indications for M-ECT in order to improve its efficacy as a relapse prevention strategy.
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Affiliation(s)
- Erika Martínez-Amorós
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
| | - Narcís Cardoner
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Correspondence: (N.C.); (M.U.)
| | - Verònica Gálvez
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Diego J. Palao
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
| | - José M. Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
- Correspondence: (N.C.); (M.U.)
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Martínez-Amorós E, Serra P, Bassa A, Palao DJ, Cardoner N. Discontinuation of maintenance electroconvulsive therapy: Lessons learned from the COVID-19 pandemic. Rev Psiquiatr Salud Ment (Engl Ed) 2021; 15:S1888-9891(21)00090-2. [PMID: 34329756 PMCID: PMC8314863 DOI: 10.1016/j.rpsm.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/30/2021] [Accepted: 07/17/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Erika Martínez-Amorós
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Pilar Serra
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Adriana Bassa
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Diego J Palao
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Narcís Cardoner
- Department of Mental Health, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
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Martínez-Amorós E, Goldberg X, Gálvez V, de Arriba-Arnau A, Soria V, Menchón JM, Palao DJ, Urretavizcaya M, Cardoner N. Early improvement as a predictor of final remission in major depressive disorder: New insights in electroconvulsive therapy. J Affect Disord 2018; 235:169-175. [PMID: 29656263 DOI: 10.1016/j.jad.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/07/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early improvement to antidepressant drugs predicts remission, but the predictive value of early improvement to electroconvulsive therapy (ECT) is still unclear. The main aim of this study was to determine the optimal definition of early improvement in the treatment of major depressive disorder (MDD) with ECT, by analyzing its value as a predictor of remission. METHODS A naturalistic study was conducted in 87 adult MDD patients treated with acute ECT. ROC curves were generated to identify the best time point (week 1 or 2 of treatment) predicted remission. Sensibility, specificity, and predictive values were calculated for several definitions of early improvement previously proposed in the literature (20%, 25%, 30%, and 35%). Complementary, time to remission was analyzed and a logistic regression model was performed to further characterize the impact of the optimal definition of early improvement on remission while adjusting for other clinically relevant variables. RESULTS A 30% reduction in the HAM-D score after 2 weeks was identified as the optimal definition of early improvement, with acceptable sensitivity (76%), and specificity (67%). Complementary analyses provided further support for this definition showing a shorter time to remission and a significant effect adjusted for the rest of variables. LIMITATIONS Relatively small sample size, ECT restricted to brief bilateral treatment. CONCLUSIONS Early improvement, defined as a 30% of reduction in the HAM-D21 score at week 2, is a good predictor of remission in MDD patients treated with bilateral ECT, with potential clinical impact. Lack of early improvement could indicate a need for further changes in treatment strategies.
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Affiliation(s)
- Erika Martínez-Amorós
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Ximena Goldberg
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Verònica Gálvez
- School of Psychiatry, University of NSW. Black Dog Institute, Sydney, Randwick, Australia
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Diego J Palao
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | - Narcís Cardoner
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
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Cosculluela A, Cobo J, Martínez-Amorós E, Paños M, Santiago AM, Crivillés S, Camposo M, Oliva JC, Granero A, Palao DJ. Effectivity and Cost-effectivity of the Maintenance Electroconvulsive Therapy: A mirror naturalistic analysis. Actas Esp Psiquiatr 2017; 45:257-267. [PMID: 29199760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Maintenance Electroconvulsive Therapy (mECT) is a biological long-term treatment in which patients receive ECT on periods from 2 to 4 weeks, during a variable period of time, usually for more than 6 months. Recent studies showed the efficacy of mECT in prevention of relapse and recurrences. Our study wants to demostrate the effectivity and cost-effectivity of this therapy in the naturalistic conditions of our area. DESIGN Retrospective longitudinal study, with mirror analysis in naturalistic conditions. SUBJECTS Patients attended at the Corporació Sanitària Parc Taulí (Sabadell, Catalonia), and included in the mECT program during more than six months. We performed diagnostic following DSM-IV criteria, subdividing the sample in three groups: patients affected of Recurrent Major Depression, Bipolar Disorder and Schizophrenia and Related Disorders. MEASURES Number and duration of hospitalizations for the previous three years before the beginning of mECT, compared with the same data for the next three years following the beginning of mECT. Comparative analysis of direct hospitalization costs, costs of the mECT and pharmacologic costs. Statistic: Descriptive and non- parametric tests. RESULTS Sample of 35 patients (1997-2008). There is a significative reduction the number of hospitalizations and days of hospitalization in the total sample and also in each of the three subgroups. The direct total cost decreased but it was only significant in the Bipolar Disorder subgroup, due to the increased pharmacological costs. CONCLUSIONS mECT in our area is an effective and costeffective treatment with a great impact on the reduction of clinical decline and hospitalizations.
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Affiliation(s)
- Albert Cosculluela
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain
| | - Jesús Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain Departament of Psichiatry and Forensic Medicine. Universitat Autònoma de Barcelona. Bellaterra, Barcelona, Spain Center of Collaborative Biomedical Research in Mental Health (CIBERSAM)
| | - Erika Martínez-Amorós
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain Center of Collaborative Biomedical Research in Mental Health (CIBERSAM)
| | - Montse Paños
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain
| | - Angel M Santiago
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain
| | - Sara Crivillés
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain
| | - María Camposo
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain
| | - Joan C Oliva
- Statistic Unit, Parc Taulí Foundation. Sabadell, Barcelona, Spain
| | - Albert Granero
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain
| | - Diego J Palao
- Mental Health Department, Corporació Sanitària Parc Taulí. Sabadell, Barcelona, Spain Departament of Psichiatry and Forensic Medicine. Universitat Autònoma de Barcelona. Bellaterra, Barcelona, Spain Center of Collaborative Biomedical Research in Mental Health (CIBERSAM)
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Serra-Blasco M, Aguilar E, Vicent M, Navarra G, Portella M, Figuereo I, Crivillés S, Martínez-Amorós E, Lahera G, Monreal J, Cardoner N. Cognitive dysfunction in depression. Is it well detected? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionMajor depression cognitive impairments lasts in remission periods, have an impact on treatment outcome and hamper psychosocial functioning. Thus, its accurate detection and specific treatment has become a crucial step.ObjectivesIn order to assess objective cognitive functioning (OCF), a neuropsychological battery was administered. For subjective cognitive functioning (SCF), cognitive perception was evaluated by clinicians and patients.AimsTo determine the concordance between OCF and SCF.MethodsOne hundred and two patients were grouped according to Hamilton Depressive Rating Scale (HDRS−17): 18 remitters (RE < 7), 40 partly remitters (PR, 7–18) and 44 acutely depressed (AD > 18). OCF was computed combining T-scores of digit symbol substitution test (WAIS-IV) with two RAVLT subtests (learning and memory). SCF was assessed with a CGI adaptation for cognitive disturbances severity.ResultsThe OFC was 41.21(8.49) for all patients and 45.54(6.8), 41.93(6.8) and 38.7 (9.7) for RE, PR, and AD, respectively. Psychiatrist and patients’ SCF had a poor agreement (α=0.518), with Cronbach's alpha for RE, PR and AD of −0.607, 0.518 and 0.404. Concordance between OCF and SCF was calculated for all patients (psychiatrist, r = −0.317, P = 0.002; patient, r = −0.310, P = 0.002), for RE (r = −0.535, P = 0.022; r = 0.395, P = 0.105) for PR (r = −0.013, P = 0.94; r = −0.328, P = 0.045) and for AD (r = −0.252, P = 0.122; r = −0.333, P = 0.033). Patients rated their SFC as more impaired than did clinicians.ConclusionsConcordance between clinicians and patients regarding SCF is very poor, worsening in AD group and being null in remission. This study also points out that CF is best detected by patients in acute episodes and by psychiatrists when patients are in clinical remission.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gálvez V, de Arriba Arnau A, Martínez-Amorós E, Ribes C, Urretavizcaya M, Cardoner N. Acute bilateral ECT in a depressed patient with a hip-aztreonam-spacer and subsequent maintenance ECT after prosthesis collocation. Int Psychogeriatr 2014; 27:1-4. [PMID: 25381759 DOI: 10.1017/s104161021400235x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT Electroconvulsive Therapy (ECT) has been demonstrated to be a safe and effective treatment for geriatric depression, although its application might be challenging when medical comorbidities exist. The present case reports a 78-year-old man diagnosed with recurrent unipolar major depressive disorder (MDD), who presented with a severe depressive episode with psychotic features (DSM IV). He successfully received a course of bitemporal (BT) ECT with a hip-aztreonam-spacer due to a hip fracture that occurred during hospitalization. This was followed by maintenance ECT (M-ECT) with a recent prosthesis collocation. This particular case illustrates the importance of a multidisciplinary approach in geriatric patients with somatic complications receiving ECT.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry,University of New South Wales (UNSW),Sydney,Australia;Therapeutic Neurostimulation Group,Black Dog Institute,Sydney,Australia
| | - Aida de Arriba Arnau
- Psychiatry Department,Bellvitge University Hospital,L'Hospitalet de Llobregat,Barcelona,Spain;Mood Disorders Clinical and Research Unit,Psychiatry Department,Bellvitge University Hospital,Barcelona,Spain
| | - Erika Martínez-Amorós
- Psychiatry Department,Salut Mental Parc Taulí. Corporació Sanitària Universitària Parc Taulí,Sabadell,Spain;Institut Universitari Parc Taulí - UAB (IUFPT-UAB),Sabadell,Spain
| | - Carmina Ribes
- Department of Anesthesiology.Bellvitge University Hospital,L´Hospitalet de Llobregat,Barcelona,Spain
| | - Mikel Urretavizcaya
- ECT Unit,Psychiatry Department,Bellvitge Hospital-ICS,University of Barcelona,Bellvitge Biomedical Research Institute (IDIBELL),CIBERSAM,L'Hospitalet de Llobregat,Barcelona,Spain
| | - Narcís Cardoner
- Psychiatry Department,Bellvitge Hospital-ICS,University of Barcelona,Bellvitge Biomedical Research Institute(IDIBELL),CIBERSAM,L'Hospitalet de Llobregat,Barcelona,Spain
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Martínez-Amorós E, Gálvez Ortiz V, Porter Moli M, Llorens Capdevila M, Cerrillo Albaigés E, Garcia-Parés G, Cardoner Álvarez N, Urretavizcaya Sarachaga M. Propofol and thiopental as anesthetic agents in electroconvulsive therapy: a retrospective study in major depression. Rev Psiquiatr Salud Ment 2013; 7:42-7. [PMID: 23490495 DOI: 10.1016/j.rpsm.2013.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/08/2013] [Accepted: 01/22/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the influence of propofol and thiopental as anesthetics in electroconvulsive therapy (ECT), as regards, seizure duration, electrical charge, clinical efficacy, cardiovascular profile, and presence of adverse cognitive effects. METHODS A retrospective design including 127 patients who received bilateral ECT for the treatment of a major depressive episode. RESULTS The mean seizure duration in the propofol group was significantly shorter than in the thiopental group (21.23±6.09 versus 28.24±6.6 7s, P<.001). The mean stimulus charge was 348.22 mC in the propofol group, and 238 mC in the thiopental group (P<.001). Propofol was associated with a lower increase in blood pressure. There were no differences between groups in treatment response or presence of adverse effects. CONCLUSIONS The anesthetic agent used in ECT might determine differences in parameters such as seizure duration or electrical charge. However, this does not seem to be translated into differences in clinical efficacy or the pattern of adverse effects observed.
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Affiliation(s)
- Erika Martínez-Amorós
- Salut Mental Parc Taulí, Corporació Sanitària Universitària Parc Taulí, Sabadell, Institut Universitari Parc Taulí - UAB (IUFPT-UAB), España.
| | - Verònica Gálvez Ortiz
- Grupo de Neurociencias [Institut Recerca Biomèdica Bellvitge] IDIBELL, Unidad clínica e investigación de trastornos afectivos, Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, España
| | - Montserrat Porter Moli
- Salut Mental Parc Taulí, Corporació Sanitària Universitària Parc Taulí, Sabadell, Institut Universitari Parc Taulí - UAB (IUFPT-UAB), España
| | - Marta Llorens Capdevila
- Salut Mental Parc Taulí, Corporació Sanitària Universitària Parc Taulí, Sabadell, Institut Universitari Parc Taulí - UAB (IUFPT-UAB), España
| | - Ester Cerrillo Albaigés
- Grupo de Neurociencias [Institut Recerca Biomèdica Bellvitge] IDIBELL, Unidad clínica e investigación de trastornos afectivos, Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, España
| | - Gemma Garcia-Parés
- Salut Mental Parc Taulí, Corporació Sanitària Universitària Parc Taulí, Sabadell, Institut Universitari Parc Taulí - UAB (IUFPT-UAB), España
| | - Narcís Cardoner Álvarez
- Grupo de Neurociencias [Institut Recerca Biomèdica Bellvitge] IDIBELL, Unidad clínica e investigación de trastornos afectivos, Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, España; Cibersam (CIBER en Salud Mental), Barcelona, España
| | - Mikel Urretavizcaya Sarachaga
- Grupo de Neurociencias [Institut Recerca Biomèdica Bellvitge] IDIBELL, Unidad clínica e investigación de trastornos afectivos, Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, España; Cibersam (CIBER en Salud Mental), Barcelona, España
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Martínez-Amorós E, Cardoner N, Gálvez V, Urretavizcaya M. Effectiveness and pattern of use of continuation and maintenance electroconvulsive therapy. Rev Psiquiatr Salud Ment 2012; 5:241-53. [PMID: 23021297 DOI: 10.1016/j.rpsm.2012.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 05/29/2012] [Accepted: 06/02/2012] [Indexed: 11/27/2022]
Abstract
Patients with major depressive disorder (MDD) who require an acute course of electroconvulsive therapy (ECT) have high relapse rates. Therefore, an effective maintenance treatment strategy needs to be established. Continuation and maintenance ECT (C/M-ECT) could be an adequate treatment option, although the lack of controlled studies has led to its usefulness being questioned. This review includes a detailed description of studies on the effectiveness/efficacy of ECT in MDD. Despite their methodological limitations, the results appear to support the idea that C/M-ECT would be a safe and effective alternative, especially in patients with severe and recurrent disease. Nevertheless, more controlled studies are needed to provide new evidence and allow a more accurate assessment of the efficacy, safety and pattern of use of C/M-ECT.
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Affiliation(s)
- Erika Martínez-Amorós
- Salut Mental Parc Taulí, Corporació Sanitària Universitària Parc Taulí, Sabadell. Institut Universitari Parc Taulí - UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
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11
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Martínez-Amorós E, Real E, Barrado PA, Carulla M, Urretavizcaya M, Cardoner N. Optimizing electroconvulsive therapy in non-suspected pseudocholinesterase deficiency: laryngeal mask use and neuromuscular selection. Psychosomatics 2010; 51:537-8. [PMID: 21051690 DOI: 10.1176/appi.psy.51.6.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Martínez-Amorós E, Real E, Barrado PA, Carulla M, Urretavizcaya M, Cardoner N. Optimizing Electroconvulsive Therapy in Non-Suspected Pseudocholinesterase Deficiency: Laryngeal Mask Use and Neuromuscular Selection. Psychosomatics 2010. [DOI: 10.1016/s0033-3182(10)70751-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Soria V, Martínez-Amorós E, Escaramís G, Valero J, Crespo JM, Gutiérrez-Zotes A, Bayés M, Martorell L, Vilella E, Estivill X, Menchón JM, Gratacòs M, Urretavizcaya M. Resequencing and association analysis of arylalkylamine N-acetyltransferase (AANAT) gene and its contribution to major depression susceptibility. J Pineal Res 2010; 49:35-44. [PMID: 20459461 DOI: 10.1111/j.1600-079x.2010.00763.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Circadian rhythms disruptions, including abnormalities of circadian phase position and melatonin secretion, have been described in major depression (MD). Arylalkylamine N-acetyltransferase (AANAT) is a key enzyme of the melatonin pathway involved in circadian oscillations of melatonin levels. We assessed the contribution of AANAT gene variability to susceptibility to MD considering common and rare genetic variations through a sequential sequencing and single nucleotide polymorphism (SNP)-based genotyping approach in a sample of 445 unrelated patients with MD (257 unipolar MD, 188 bipolar depression) and 440 community-based screened control subjects. We identified 17 sequence changes, thirteen of which represented novel sequence variations. We did not observe an over-representation of patients carrying rare variants compared with the healthy controls. Common variants (MAF > 2%) were included in a case-control association analysis that showed significant association after multiple testing correction of two SNPs located in the promoter region of AANAT with MD: rs3760138 (P = 0.00006) and rs4238989 (P = 0.005). Multimarker analysis found significant associations between two three-marker protective haplotypes and a susceptibility three-marker haplotype containing the rare alleles of rs3760138-rs4238989-rs8150 and MD. We present evidence of the association of genetic variability in the AANAT gene with susceptibility to MD. Our results support the hypothesis that the melatonin-signaling pathway and circadian clock mechanisms may contribute to the pathophysiology of MD.
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Affiliation(s)
- Virginia Soria
- CIBERSAM (CIBER en Salud Mental), Mood Disorders Clinical and Research Unit, Psychiatry Department, Bellvitge University Hospital, Idibell, Barcelona, Spain
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14
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Martínez-Amorós E, Real Barrero E, Fuste Fusares C, Hernández-Ribas R, Urretavizcaya Sarachaga M. Bilateral posterior vitreous detachment after electroconvulsive therapy. Gen Hosp Psychiatry 2009; 31:385-7. [PMID: 19555802 DOI: 10.1016/j.genhosppsych.2008.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 09/02/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
Abstract
In this case report, we describe a patient with an acute bilateral posterior detachment of the vitreous, which developed during electroconvulsive therapy (ECT) under general anesthesia. The patient developed symptoms of posterior vitreous detachment immediately after recovery from the eighth ECT session. The ophthalmologist confirmed the clinical diagnosis and ECT was stopped. We review the literature and discuss the ocular side effects of ECT.
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Affiliation(s)
- Erika Martínez-Amorós
- Physical Therapy Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Hospitalet del Llobregat, Barcelona 08907, Spain.
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