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De Schuyteneer E, Dewachter B, Vansteelandt K, Pilato E, Crauwels B, Lambrichts S, Verspecht S, Hebbrecht K, Obbels J, Sienaert P. Knowledge and Attitudes of First- and Final-Year Medical Students about Electroconvulsive Therapy: The Impact of Media. Acad Psychiatry 2023:10.1007/s40596-023-01779-5. [PMID: 37058205 DOI: 10.1007/s40596-023-01779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate medical students' knowledge about and attitudes towards electroconvulsive therapy (ECT) and to assess the impact of information sources (including those within and outside the curriculum) on knowledge and attitudes by comparing first- and final-year medical students. METHODS Two hundred and ninety-five first-year and one hundred forty-nine final-year medical students of the University of Leuven (KU Leuven) in Belgium responded to an anonymous self-administered survey which consisted of questions about sociodemographic background, self-perceived knowledge about medicine, psychiatry and ECT, interest in psychiatry, experience with psychiatric disorders, information sources of ECT, and knowledge about and attitudes towards ECT. RESULTS Compared to first-year medical students, final-year students had better knowledge about and more positive attitudes towards ECT, partially explained by differences in information sources. Nevertheless, both student groups showed an average knowledge score below 50%. Whereas freshmen attributed their knowledge to movies or documentaries, senior students gained knowledge mainly at university courses, scientific journals, and attending live ECT sessions. A significant positive correlation was found between knowledge about and positive attitudes towards ECT. CONCLUSIONS The knowledge of first- and final-year medical students remains limited, potentially due to limited instruction about ECT in medical courses. The use of media as an information source predicted negative attitudes towards ECT. Therefore, the stigma and misinformation provided in the media need to be addressed in the medical curriculum.
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Affiliation(s)
| | - Bram Dewachter
- KU Leuven, University Hospital KU Leuven, Leuven, Belgium
| | | | - Eva Pilato
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Bo Crauwels
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Simon Lambrichts
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Shauni Verspecht
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium.
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Lambrichts S, Wagenmakers MJ, Vansteelandt K, Obbels J, Schouws SNTM, Verwijk E, van Exel E, Bouckaert F, Vandenbulcke M, Schrijvers D, Veltman DJ, Beekman ATF, Oudega ML, Sienaert P, Dols A. Long-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study. Am J Geriatr Psychiatry 2022; 30:1283-1294. [PMID: 35667960 DOI: 10.1016/j.jagp.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures. METHODS This cohort study was part of the Mood Disorders in Elderly treated with ECT (MODECT) study, which included patients aged 55 years and older with major depressive disorder. Data regarding clinical course, cognitive impairment and mortality were collected 5 years after the index ECT course. We used multivariable Cox proportional hazards models and logistic regression models to assess the association of clinical characteristics with relapse and survival, and cognitive impairment, respectively. RESULTS We studied 110 patients with a mean age of 72.9 years. 67.1% of patients who showed response at the end of the index ECT course relapsed, and the included clinical characteristics were not significantly associated with the risk of relapse. 38.8% of patients with available data showed cognitive impairment at five-year follow-up. 27.5% were deceased; higher age and a higher number of previous psychiatric admissions were significantly associated with increased risk of mortality. CONCLUSIONS Five-year outcome after a course of ECT for severe LLD seems to be in line with long-term outcome following other acute treatments for severe LLD in terms of relapse, cognitive impairment and survival. Additional studies aimed at improving long-term outcome in severe LLD are warranted.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium.
| | - Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Amsterdam UMC location University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), and Leuven Brain Institute, KU Leuven
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), and Leuven Brain Institute, KU Leuven
| | - Didier Schrijvers
- UAntwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Psychiatric Hospital Duffel, Duffel, Belgium
| | - Dick J Veltman
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Annemiek Dols
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands
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Obbels J, Gijsbregts E, Verwijk E, Verspecht S, Lambrichts S, Vansteelandt K, Sienaert P. ECT-related anxiety during maintenance ECT: A prospective study. Acta Psychiatr Scand 2022; 146:604-612. [PMID: 36081255 DOI: 10.1111/acps.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/11/2022] [Revised: 06/14/2022] [Accepted: 08/28/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Despite the established safety of electroconvulsive therapy (ECT), ECT-related anxiety (ERA) remains one of the most distressing complications of ECT. ERA is reported to diminish during an acute course of ECT, but it was never studied during maintenance ECT (M-ECT). Our aim was to study the trajectories of ERA during M-ECT and how they differ from trajectories during the acute course. METHODS Thirty-nine patients with unipolar or bipolar depression, retained for M-ECT after an acute ECT course, were included. ERA was assessed the morning before each ECT session using the ECT-related Anxiety Questionnaire (ERAQ). RESULTS ERA remained stable during M-ECT (RC = -0.05 (SE = 0.06), t(8.35) = -0.86, p = 0.42), while ERA declined significantly during the acute course (RC = -0.85 (SE = 0.30), t(33.6) = -2.81, p = 0.0082). During the acute course, patients with a psychotic depression were more anxious at baseline (t(32)= -2.42, p = 0.02), and showed a significant decline in ERAQ scores (RC = -1.65 (SE = 0.46), t(31.6) = -3.56, p = 0.0012), whereas patients with a non-psychotic depression were less anxious at baseline and retained stable ERAQ scores during the acute course (RC = -0.06 (SE = 0.41), t(32.1) = -0.14, p = 0.89). Whereas a correlation (r = 0.48) was noticed between the decline of depression severity and ERA during the acute course, this was not the case during M-ECT. CONCLUSION ERA runs a stable course during M-ECT, after having decreased during the acute course. During the acute course, ERA trajectories differed significantly between patients with a psychotic and non-psychotic depression. Decline of depression severity and ERA are significantly connected during the acute course of ECT. Both depression severity and ERA remain stable during M-ECT.
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Affiliation(s)
- Jasmien Obbels
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Els Gijsbregts
- Department of Psychiatry, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Esmée Verwijk
- Department of Medical Psychology, Neuropsychology Department, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands.,Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Shauni Verspecht
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Simon Lambrichts
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Kristof Vansteelandt
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
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Lambrichts S, Vansteelandt K, Hebbrecht K, Wagenmakers MJ, Oudega ML, Obbels J, van Exel E, Dols A, Bouckaert F, Schrijvers D, Verwijk E, Sienaert P. Which residual symptoms predict relapse after successful electroconvulsive therapy for late-life depression? J Psychiatr Res 2022; 154:111-116. [PMID: 35933854 DOI: 10.1016/j.jpsychires.2022.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/27/2022] [Revised: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
The risk of relapse following successful acute-phase treatment of late-life depression (LLD), including electroconvulsive therapy (ECT), is substantial. In order to improve reliable prediction of individuals' risk of relapse, we assessed the association between individual residual symptoms following a successful acute course of ECT for LLD and relapse at six-month follow-up. This prospective cohort study was part of the MODECT study, which included 110 patients aged 55 years and older with major depressive disorder. Participants who showed response to the index ECT course were monitored for relapse for six months. We used multivariable stepwise logistic regression models to assess the association between the scores on the 10 individual Montgomery-Åsberg Depression Rating Scale (MADRS) items at the end of the acute ECT course and relapse at six-month follow-up. Of the 80 responders with available six-month follow-up data (58.75% of which had psychotic features at baseline), 36.25% had relapsed. Higher scores on the MADRS items 'reduced sleep' (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.11-3.69, p = 0.0214) and 'lassitude' (OR = 1.62, 95% CI = 1.00-2.62, p = 0.0497) at the end of the acute ECT course were significantly associated with increased risk of relapse at six-month follow-up. In conclusion, some residual depressive symptoms, including sleep disturbance and lassitude, may help better identify patients vulnerable to relapse following a successful acute course of ECT for LLD. If these findings can be replicated, studies assessing interventions that target specific residual symptoms may further reduce post-ECT depressive relapse rates.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium.
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Margot J Wagenmakers
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Mardien L Oudega
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Eric van Exel
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Annemiek Dols
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
| | - Filip Bouckaert
- KU Leuven, University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Didier Schrijvers
- UAntwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Esmée Verwijk
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
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Sienaert P, Brus O, Lambrichts S, Lundberg J, Nordanskog P, Obbels J, Verspecht S, Vansteelandt K, Nordenskjöld A. Suicidal ideation and ECT, ECT and suicidal ideation: A register study. Acta Psychiatr Scand 2022; 146:74-84. [PMID: 35279825 PMCID: PMC9313798 DOI: 10.1111/acps.13425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although electroconvulsive therapy (ECT) is anti-suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT. METHODS This population-based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥4 on the last item of the Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline. RESULTS In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre-treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS-S-score, and younger age were associated with persistent SI. CONCLUSION The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non-psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.
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Affiliation(s)
- Pascal Sienaert
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Ole Brus
- Clinical Epidemiology and BiostatisticsFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Simon Lambrichts
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Johan Lundberg
- Department of Clinical NeuroscienceCenter for Psychiatry ResearchKarolinska Institute and Stockholm County CouncilSweden
| | - Pia Nordanskog
- Center for Social and Affective NeuroscienceDepartment of Clinical and Experimental MedicineFaculty of Health SciencesLinköping University and Department of PsychiatryRegion ÖstergötlandSweden
| | - Jasmien Obbels
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Shauni Verspecht
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Kristof Vansteelandt
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Axel Nordenskjöld
- University Health Care Research CentreFaculty of Health and Medical SciencesÖrebro UniversityÖrebroSweden
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6
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Crauwels B, Vansteelandt K, Obbels J, Lambrichts S, Pilato E, Demyttenaere K, Sienaert P. The Effect of Electroconvulsive Therapy on Positive Affect and Hedonism in Patients With Depression: A Prospective Study. J ECT 2022; 38:110-116. [PMID: 34966039 DOI: 10.1097/yct.0000000000000818] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The outcome of antidepressant treatments is generally assessed with standardized symptom scales such as the Quick Inventory of Depressive Symptomatology-Clinician Rating (QIDS-C). These scales, however, might not reflect patients' expectations for treatment, including a recovery of positive affect (PA) and hedonism. The Leuven Affect and Pleasure Scale (LAPS) was developed to better reflect patients' expectations for treatment. We used the LAPS to investigate changes in PA and hedonism alongside depressive symptoms during electroconvulsive therapy (ECT) and over 12 weeks after treatment. METHODS Fifty-three patients with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, depressive episode, referred for ECT, were included in this prospective study. The LAPS and QIDS-C were administered before and 1 and 12 weeks after the ECT course. LAPS normative levels were obtained in 149 healthy controls. RESULTS Pearson correlations revealed only moderate overlap of the QIDS-C with PA and hedonism. Piecewise linear mixed models indicated significant improvements in depressive symptoms (QIDS-C and LAPS negative affect), PA, and hedonism during ECT. In the 12 weeks after ECT treatment, negative affect and QIDS-C further improved, but PA and hedonism plateaued. Exploratory analyses indicated that only fully remitted patients (QIDS-C) attained normative levels on PA and hedonism at 12 weeks after ECT. CONCLUSIONS Standardized symptom scales (QIDS-C) may incompletely reflect clinical change in ECT treatment for depression. Although ECT improved depressive symptoms, PA, and hedonism in patients with depression, only fully remitted patients attained normative levels of PA and hedonism, due to plateaus in improvement. These plateaus were not observed for depressive symptoms, which further improved after ECT discontinuation.
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Affiliation(s)
- Bo Crauwels
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Kristof Vansteelandt
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Jasmien Obbels
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Simon Lambrichts
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Eva Pilato
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Koen Demyttenaere
- Department of Neurosciences, University Psychiatric Center KU Leuven and Research Group Psychiatry, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
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Lambrichts S, Vansteelandt K, Wagenmakers M, Oudega M, Obbels J, Dols A, Bouckaert F, Sienaert P. Which residual symptoms predict relapse after successful electroconvulsive therapy for late-life depression? Eur Psychiatry 2022. [PMCID: PMC9563668 DOI: 10.1192/j.eurpsy.2022.460] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Introduction: Residual depressive symptoms are common after a successful acute treatment of late-life depression (LLD), and their presence predicts increased risk of relapse. While electroconvulsive therapy (ECT) is the most effective treatment for LLD, little is known about which particular symptoms remain and impact long-term outcome after a successful acute ECT course.
Objectives
Objectives: We aimed to assess the association between specific residual depressive symptoms after an effective acute ECT course for LLD and relapse at six-month follow-up.
Methods
Methods: In this prospective cohort study, including 110 patients aged 55 years and older with LLD, information about relapse was collected six months after the acute ECT course. Relapse was defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score >15, hospital admission or restart of ECT. We used multivariable stepwise logistic regression models including the scores on the 10 individual MADRS items at the end of the acute ECT course to predict relapse.
Results
Results: Of the 80 responders with available six-month follow-up data, 29 patients (36.25%) had suffered relapse. Higher scores on the MADRS items ‘reduced sleep’ (odds ratio (OR)=2.03, 95% confidence interval (CI)=1.11-3.69, p=0.0214) and ‘lassitude’ (OR=1.62, 95% CI=1.00-2.62, p=0.0497) at the end of the acute ECT course were significantly associated with increased risk of relapse at six-month follow-up.
Conclusions
Conclusions: Some residual depressive symptoms, including sleep disturbance and fatigue, may help better identify patients vulnerable to relapse following a successful acute ECT course for LLD. Future studies assessing interventions that target specific residual symptoms may further reduce post-ECT depressive relapse.
Disclosure
No significant relationships.
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Henstra MJ, Feenstra TC, Kok RM, Spaans HP, van Exel E, Dols A, Oudega M, Vergouwen ACM, van der Loo A, Bet PM, Loer SA, Eikelenboom M, Sienaert P, Lambrichts S, Bouckaert F, Bosmans JE, van der Velde N, Beekman ATF, Stek ML, Rhebergen D. Rivastigmine for ECT-induced cognitive adverse effects in late life depression (RECALL study): A multicenter, randomized, double blind, placebo-controlled, cross-over trial in patients with depression aged 55 years or older: Rationale, objectives and methods. Front Psychiatry 2022; 13:953686. [PMID: 35911242 PMCID: PMC9334653 DOI: 10.3389/fpsyt.2022.953686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive side-effects are an important reason for the limited use of electroconvulsive therapy (ECT). Cognitive side-effects are heterogeneous and occur frequently in older persons. To date, insight into these side-effects is hampered due to inconsistencies in study designs and small sample sizes. Among all cognitive side-effects, confusion and delirious states are especially troublesome for patients, relatives and clinicians. In particular inter-ictal delirium-like states are worrisome, since they may lead to premature treatment discontinuation. Besides a need for further insight into determinants of cognitive side-effects of ECT, there is a great need for treatment options. METHODS AND DESIGN The Rivastigmine for ECT-induced Cognitive Adverse effects in Late Life depression (RECALL) study combines a multicenter, prospective cohort study on older patients with depression, treated with ECT, with an embedded randomized, placebo-controlled cross-over trial to examine the effect of rivastigmine on inter-ictal delirium. Patients are recruited in four centers across the Netherlands and Belgium. We aim to include 150 patients into the cohort study, in order to be able to subsequently include 30 patients into the trial. Patients are included in the trial when inter-ictal delirium, assessed by the Confusion Assessment method (CAM), or a drop in Mini Mental State Examination (MMSE) score of ≥4 during ECT, develops. In the cohort study, comprehensive measurements of ECT-related cognitive side-effects-and their putative determinants-are done at baseline and during the ECT-course. The primary outcome of the clinical trial is the effectiveness of rivastigmine on inter-ictal delirium-severity, assessed with a change in the Delirium Rating Scale-Revised-98. Secondary outcomes of the clinical trial are several ECT-characteristics and side-effects of rivastigmine. DISCUSSION This study is the first clinical trial with a focus on ECT-induced, inter-ictal delirium. The cohort provides the basis for recruitment of patients for the cross-over trial and additionally provides an excellent opportunity to unravel cognitive side-effects of ECT and identify putative determinants. This paper describes the rationale and study protocol. CLINICAL TRIAL REGISTRATION EudraCT 2014-003385-24.
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Affiliation(s)
- Marieke J Henstra
- Department of Internal Medicine and Geriatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Aging and Later Life Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas C Feenstra
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ Centraal Mental Health Care, Amersfoort, Netherlands
| | - Rob M Kok
- Department of Old Age Psychiatry and ECT Center Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Harm-Pieter Spaans
- Department of Old Age Psychiatry and ECT Center Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Eric van Exel
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Annemiek Dols
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands.,Amsterdam Neuroscience, Neurodegeneration Program, Amsterdam, Netherlands
| | - Mardien Oudega
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Anton C M Vergouwen
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, Netherlands
| | - Adriano van der Loo
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Stephan A Loer
- Department of Anesthesiology, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Merijn Eikelenboom
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Simon Lambrichts
- Department of Neurosciences, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium
| | - Judith E Bosmans
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine and Geriatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Aging and Later Life Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Max L Stek
- Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Didi Rhebergen
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ Centraal Mental Health Care, Amersfoort, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands
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9
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Lambrichts S, Vansteelandt K, Obbels J, Sienaert P. How to Reliably Predict Relapse After Electroconvulsive Therapy? J Clin Psychiatry 2021; 83. [PMID: 34875148 DOI: 10.4088/jcp.21lr14269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium.,Corresponding author: Simon Lambrichts, MD, University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070 Kortenberg, Belgium
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
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10
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Gilden J, Poels EMP, Lambrichts S, Vreeker A, Boks MPM, Ophoff RA, Kahn RS, Kamperman AM, Bergink V. Bipolar episodes after reproductive events in women with bipolar I disorder, A study of 919 pregnancies. J Affect Disord 2021; 295:72-79. [PMID: 34416620 DOI: 10.1016/j.jad.2021.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/05/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Women with bipolar I disorder are at high risk for severe episodes after childbirth, but there is no study that provides an overview on bipolar episode risk both during pregnancy and after childbirth, miscarriage and induced abortion. The aim of this study was to determine the episode risk during all pregnancy outcomes subdivided by first and subsequent pregnancies. METHODS Participants were 436 women with bipolar I disorder from the Dutch Bipolar Cohort, having 919 pregnancies of which 762 resulted in a live childbirth, 118 ended in a miscarriage and 39 ended in induced abortion. Women reported on the occurrence of manic or depressed episodes during the perinatal period. Information about medication use was obtained by questionnaires. RESULTS Episode risk was 5.2% during pregnancy, and 30.1% in the postpartum period, with a peak in the early postpartum period. Risk of an episode was highest after live birth (34.4%), and lower after miscarriage (15.2%) and induced abortion (27.8%). Women with an episode during pregnancy or postpartum were less likely to have a second child compared to women with an uneventful first pregnancy (cOR=0.34; 95%CI: 0.22-0.51; p<0.001); if they had a second child their risk of an episode was significantly elevated with a subsequent pregnancy (cOR=6.17; 95%CI: 3.64-10.45; p<0.001). LIMITATIONS Retrospective cross-sectional design with assessment (partial) through self-report in a homogeneous population. CONCLUSIONS Women with bipolar I disorder have a six times higher risk of an episode after delivery compared to during pregnancy, therefore preventive strategies are particularly important immediately after delivery.
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Affiliation(s)
- Janneke Gilden
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
| | - Eline M P Poels
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Simon Lambrichts
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Annabel Vreeker
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Marco P M Boks
- Department of Psychiatry, Utrecht Medical Center, 3508 GA Utrecht, the Netherlands
| | - Roel A Ophoff
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of obstetrics, gynecology and reproductive science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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11
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Lambrichts S, Vansteelandt K, Crauwels B, Obbels J, Pilato E, Denduyver J, Ernes K, Maebe P, Migchels C, Roosen L, Buggenhout S, Bouckaert F, Schrijvers D, Sienaert P. Relapse after abrupt discontinuation of maintenance electroconvulsive therapy during the COVID-19 pandemic. Acta Psychiatr Scand 2021; 144:230-237. [PMID: 34086984 PMCID: PMC8212096 DOI: 10.1111/acps.13334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Maintenance electroconvulsive therapy (M-ECT) is considered an effective relapse prevention strategy in severe mood and psychotic disorders. How long M-ECT should be continued, and what the outcome is after its discontinuation has not been adequately studied. In our tertiary psychiatric hospital, M-ECT treatments were suspended at the start of the COVID-19 pandemic. We aimed to determine the 6-month relapse rate and time to relapse after abrupt discontinuation of M-ECT and to assess the impact of patient and treatment characteristics on the risk of relapse. METHODS Eighty-one patients whose M-ECT was discontinued abruptly were followed up prospectively for 6 months, or until relapse (i.e., hospital admission, restart of ECT, change of pharmacotherapy, or suicide (attempt)). We used multivariable Cox proportional hazards models to assess the impact of patient and treatment characteristics on the risk of relapse. RESULTS Thirty-six patients (44.44%) relapsed within 6 months following abrupt discontinuation of M-ECT. A greater number of previous acute ECT courses, a diagnosis of psychotic disorder (compared with major depressive disorder or bipolar disorder), and a shorter interval between M-ECT treatments at the time of discontinuation were significantly associated with increased risk of relapse. CONCLUSION Almost half of the patients relapsed, similar to the relapse rate after a successful acute course of ECT. Patients with a shorter interval between M-ECT treatments at the time of discontinuation seem to be at increased risk, as well as patients with a diagnosis of psychotic disorder, compared to patients with mood disorders.
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Affiliation(s)
- Simon Lambrichts
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Kristof Vansteelandt
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Bo Crauwels
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Jasmien Obbels
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Eva Pilato
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Jonas Denduyver
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Katrien Ernes
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Pieter‐Paul Maebe
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Charlotte Migchels
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Lore Roosen
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Satya Buggenhout
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Filip Bouckaert
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI)UAntwerpAntwerpBelgium
| | - Pascal Sienaert
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
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12
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Lambrichts S, Detraux J, Vansteelandt K, Nordenskjöld A, Obbels J, Schrijvers D, Sienaert P. Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:294-306. [PMID: 33506961 DOI: 10.1111/acps.13277] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/28/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The risk of relapse following successful antidepressant treatment, including electroconvulsive therapy (ECT), is substantial. Lithium has been suggested to effectively prevent relapse, yet data remain limited and inconclusive. We performed a systematic review and meta-analysis to examine the efficacy of continuation treatment with lithium in preventing relapse following a successful acute course of ECT in patients with major depression, in comparison to continuation treatment without lithium. We also assessed the role of several study characteristics, possibly impacting the treatment effect. METHODS A systematic literature search, using the PubMed, Embase, Web of Science, and Cochrane Library databases (up to June 2020), was conducted for prospective and retrospective studies, including patients with unipolar or bipolar depression, that assessed the efficacy of lithium for post-ECT depressive relapse prevention. RESULTS Of 2556 records screened, 14 articles reporting on 9748 participants who received continuation treatment either with (N = 1571) or without lithium (N = 8177) were included in the meta-analysis. Patients receiving lithium were less likely to experience depressive relapse after a successful acute course of ECT, compared to patients receiving post-ECT prophylaxis without lithium (weighted odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.34, 0.82), with a number needed to treat (NNT) of 7 (95% CI = 4, 21). We found some limited evidence that older patients may benefit more from continuation treatment with lithium, compared to younger patients. Using the GRADE criteria, the quality of evidence for our outcome measure (i.e., relapse rate) was rated as very low. CONCLUSION Continuation treatment with lithium may have superior efficacy in reducing the risk of relapse after a successful acute ECT course for major depression, in comparison to continuation treatment without lithium. High-quality studies are needed to confirm this finding.
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Affiliation(s)
- Simon Lambrichts
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Johan Detraux
- Department of Neurosciences, Research Group Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Kristof Vansteelandt
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Axel Nordenskjöld
- Faculty of Health and Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Jasmien Obbels
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Pascal Sienaert
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
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13
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Obbels J, Vansteelandt K, Verwijk E, Lambrichts S, Bouckaert F, Sienaert P. Understanding electroconvulsive therapy-related anxiety: a prospective study. Acta Psychiatr Scand 2020; 142:132-140. [PMID: 32474903 DOI: 10.1111/acps.13198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Accepted: 05/21/2020] [Indexed: 12/28/2022]
Abstract
AIMS OF STUDY Although electroconvulsive therapy (ECT)-related anxiety is experienced by a significant proportion of patients, it remains understudied. Our aim was to study the course of ECT-related anxiety during ECT. METHODS Seventy-four patients with unipolar or bipolar depression, referred for ECT, were included. ECT-related anxiety was assessed the morning before each ECT session using the ECT-related Anxiety Questionnaire (ERAQ). RESULTS Female patients reported more anxiety than men (F(1,64.6) = 3.95, P = 0.05). Patients with a psychotic depression were more anxious before the start of ECT (F(64.8) = 4.57, P = 0.04), but experienced a significant decrease in ECT-related anxiety (t(63.9) = -3.63, P = 0.0006), whereas patients with a non-psychotic depression remained stable on anxiety during their ECT course (t(63,9) = 0.76, P = 0.45). In addition, we found a significant correlation between the decrease of ECT-related anxiety and the decrease of depression-severity (r = 0.35; P = 0.04). CONCLUSION There are individual differences in ECT-related anxiety trajectories during ECT. Both female patients and patients with psychotic depression experienced more ECT-related anxiety before the start of ECT. The severity of ECT-related anxiety decreased significantly in patients with a psychotic depression, but remained stable in patients without a psychotic depression during ECT. In addition, patients who showed a stronger decrease in depression-severity also showed a stronger decrease in ECT-related anxiety. A better understanding of ECT-related anxiety trajectories can help in designing anxiety-reducing interventions.
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Affiliation(s)
- J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - K Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - E Verwijk
- Department of Medical Psychology, Neuropsychology Department, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands.,Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - S Lambrichts
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - F Bouckaert
- Old-age Psychiatry, KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
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14
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Sienaert P, Lambrichts S, Popleu L, Van Gerven E, Buggenhout S, Bouckaert F. Electroconvulsive Therapy During COVID-19-Times: Our Patients Cannot Wait. Am J Geriatr Psychiatry 2020; 28:772-775. [PMID: 32345550 PMCID: PMC7195425 DOI: 10.1016/j.jagp.2020.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Pascal Sienaert
- KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT) (PS, SL, VG, and SB), University Psychiatric Center, KU Leuven, Leuven, Belgium.
| | - Simon Lambrichts
- KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT) (PS, SL, VG, and SB), University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Leen Popleu
- UHasselt, Center of anatomical sciences and education UHasselt (LP), Diepenbeek, Belgium,KU Leuven, Department of infection control (LP), University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Elke Van Gerven
- KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT) (PS, SL, VG, and SB), University Psychiatric Center, KU Leuven, Leuven, Belgium,KU Leuven, Department of Anesthesiology (EVG), University Hospitals Leuven, Leuven, Belgium
| | - Satya Buggenhout
- KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT) (PS, SL, VG, and SB), University Psychiatric Center, KU Leuven, Leuven, Belgium,KU Leuven, Old-Age Psychiatry (SB and FB), University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- KU Leuven, Old-Age Psychiatry (SB and FB), University Psychiatric Center, KU Leuven, Leuven, Belgium
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15
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Abstract
OBJECTIVES Mania can occur secondary to a medical condition and can be elicited by various pharmacological treatments, both in patients with or without a history of affective disorder. Antibiotic-induced mania or antibiomania is suggested to be a rare phenomenon. We reviewed the literature in order to collect published reports of antibiomania and to summarize new insights about its mechanism and management. METHODS We performed a MEDLINE-search and used manual cross-referencing for reports of antibiotic-induced mania and included cases in which a (hypo)manic episode was diagnosed in close temporal relationship with the prescription of an antibiotic. RESULTS 47 cases were published. Patients' ages ranged from 3 to 77 years (mean 40). Two-thirds of the cases were male. Twelve different anti-bacterial agents were implicated, with antitubercular agents, macrolides and quinolones being the most common causative groups. CONCLUSIONS Antibiotic treatment can be associated with (hypo)mania. The paucity of reported cases precludes statements regarding incidence or antibiotic-specific warnings. In the event of an antibiotic-induced mania, the suspicious drug should be discontinued and manic symptoms can be treated lege artis. The pathophysiological mechanism of antibiomania remains elusive.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, University Psychiatric Center KU Leuven, Herestraat 49, 3000 Leuven / Leuvensesteenweg 517, 3070 Kortenberg, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LABGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium; Consultation-Liaison Psychiatry, University Psychiatric Center KU Leuven, Campus Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Herestraat 49, 3000 Leuven / Leuvensesteenweg 517, 3070 Kortenberg, Belgium; Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
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