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Park S, Forester BP, Lapid MI, Harper DG, Hermida AP, Inouye SK, McClintock SM, Nykamp L, Petrides G, Schmitt EM, Seiner SJ, Mueller M, Patrick RE. A Novel Approach to Monitoring Cognitive Adverse Events for Interventional Studies Involving Advanced Dementia Patients: Insights From the Electroconvulsive Therapy for Agitation in Dementia Study. J Geriatr Psychiatry Neurol 2024; 37:234-241. [PMID: 37848185 DOI: 10.1177/08919887231207641] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To develop an individualized method for detecting cognitive adverse events (CAEs) in the context of an ongoing trial of electroconvulsive therapy for refractory agitation and aggression for advanced dementia (ECT-AD study). METHODS Literature search aimed at identifying (a) cognitive measures appropriate for patients with advanced dementia, (b) functional scales to use as a proxy for cognitive status in patients with floor effects on baseline cognitive testing, and (c) statistical approaches for defining a CAE, to develop CAEs monitoring plan specifically for the ECT-AD study. RESULTS Using the Severe Impairment Battery-8 (SIB-8), baseline floor effects are defined as a score of ≤5/16. For patients without floor effects, a decline of ≥6 points is considered a CAE. For patients with floor effects, a decline of ≥30 points from baseline on the Barthel Index is considered a CAE. These values were derived using the standard deviation index (SDI) approach to measuring reliable change. CONCLUSIONS The proposed plan accounts for practical and statistical challenges in detecting CAEs in patients with advanced dementia. While this protocol was developed in the context of the ECT-AD study, the general approach can potentially be applied to other interventional neuropsychiatric studies that carry the risk of CAEs in patients with advanced dementia.
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Affiliation(s)
- Soohyun Park
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Brent P Forester
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Maria I Lapid
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - David G Harper
- Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Sharon K Inouye
- Aging Brain Center, Hebrew Senior Life, Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Louis Nykamp
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Georgios Petrides
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eva M Schmitt
- Aging Brain Center, Hebrew Senior Life, Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Stephen J Seiner
- Psychiatric Neurotherapeutics Program, McLean Hospital, Belmont, MA, USA
| | - Martina Mueller
- College of Nursing and Department of Public Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Regan E Patrick
- Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Loef D, van Eijndhoven P, van den Munckhof E, Hoogendoorn A, Manten R, Spaans HP, Tendolkar I, Rutten B, Nuninga J, Somers M, van Dellen E, van Exel E, Schouws S, Dols A, Verwijk E. Pre-treatment predictors of cognitive side-effects after treatment with electroconvulsive therapy in patients with depression: A multicenter study. J Affect Disord 2024; 349:321-331. [PMID: 38195009 DOI: 10.1016/j.jad.2024.01.049] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive episodes (MDE). However, ECT-induced cognitive side-effects remain a concern. Identification of pre-treatment predictors that contribute to these side-effects remain unclear. We examined cognitive performance and individual cognitive profiles over time (up to six months) following ECT and investigated possible pre-treatment clinical and demographic predictors of cognitive decline shortly after ECT. METHODS 634 patients with MDE from five sites were included with recruitment periods between 2001 and 2020. Linear mixed models were used to examine how cognitive performance, assessed with an extensive neuropsychological test battery, evolved over time following ECT. Next, possible pre-treatment predictors of cognitive side-effects directly after ECT were examined using linear regression. RESULTS Directly after ECT, only verbal fluency (animal and letter; p < 0.0001; Cohen's d: -0.25 and -0.29 respectively) and verbal recall (p < 0.0001; Cohen's d: -0.26) significantly declined. However, during three and six months of follow-up, cognitive performance across all domains significantly improved, even outperforming baseline levels. No other pre-treatment factor than a younger age predicted a larger deterioration in cognitive performance shortly after ECT. LIMITATIONS There was a substantial amount of missing data especially at 6 months follow-up. CONCLUSIONS Our findings show that verbal fluency and memory retention are temporarily affected immediately after ECT. Younger patients may be more susceptible to experiencing these acute cognitive side-effects, which seems to be mostly due to a more intact cognitive functioning prior to ECT. These findings could contribute to decision-making regarding treatment selection, psychoeducation, and guidance during an ECT course.
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Affiliation(s)
- Dore Loef
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands.
| | | | | | - Adriaan Hoogendoorn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Ruby Manten
- GGZ Noord-Holland-Noord Mental Health Care, Alkmaar, the Netherlands
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud umc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Bart Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jasper Nuninga
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Metten Somers
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels, Belgium
| | - Eric van Exel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Sigfried Schouws
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Annemiek Dols
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Esmée Verwijk
- Parnassia Psychiatric Institute, The Hague, the Netherlands; University of Amsterdam, Department of Psychology, Amsterdam, the Netherlands; Amsterdam UMC, AMC, Department of Medical Psychology, Amsterdam, the Netherlands
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Copersino ML, DeTore NR, Piltch C, Bolton P, Henderson T, Davis VF, Eberlin ES, Kadden L, McGurk SR, Seiner SJ, Mueser KT. A Pilot Study of Adjunctive Group Therapy to Enhance Coping With Cognitive Challenges and Support Cognitive Health After Electroconvulsive Therapy. J ECT 2023; 39:248-254. [PMID: 37530733 DOI: 10.1097/yct.0000000000000943] [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: 08/03/2023]
Abstract
OBJECTIVES Concerns about the cognitive adverse effects of electroconvulsive therapy (ECT) are common among recipients of the treatment despite its relatively small adverse effects on cognitive functioning. Interventions aimed at remediating or improving coping with cognitive adverse effects of ECT have not been developed. The Enhancing Cognitive Domains after ECT (ENCODE) program is a new group intervention aimed at teaching self-management strategies to cope with the cognitive challenges and associated anxiety that often accompanies ECT. METHODS This pilot study used a pretest-posttest design to examine the feasibility and clinical utility of delivering ENCODE to 20 adults who had received ECT in a hospital-based ECT program. RESULTS The program was found to be both feasible and acceptable as indicated by the attainment of recruitment targets, high rates of attendance (85% of participants attended at least 5 of the 6 group sessions), and high participant satisfaction ratings (88% reported that ENCODE helped or helped very much to manage their cognitive challenges). The clinical utility of the program was suggested by reductions in depressive symptom severity and subjective memory complaints. Nonsignificant improvements were observed in global cognitive function and cognitive self-efficacy. CONCLUSIONS This study provides preliminary evidence for the feasibility and clinical utility of ENCODE based on program demand, strong participant satisfaction, and postgroup reductions in distress and subjective memory complaints.
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Schuurmans RGM, Krijnen de Bruin E, van Asperen GCR, Poslawsky IE, Hafsteinsdóttir TB, van Meijel B. Factors influencing motivation of patients diagnosed with depression to have electroconvulsive therapy. J Psychiatr Ment Health Nurs 2023; 30:1019-1026. [PMID: 36998159 DOI: 10.1111/jpm.12925] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The clinical effect of electroconvulsive therapy (ECT) has been confirmed for a majority of patients with several psychiatric disorders. ECT is mostly used in patients with severe depression. Choosing, persevering with and completing ECT depends on the patients' motivation for undergoing this therapy. However, the factors influencing patients' motivation for ECT have not yet been studied. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Four important factors that influence the motivation of patients diagnosed with major depression to have ECT were identified: (1) psychological pain and distress; (2) perceived need for treatment; (3) perception of ECT as an effective treatment; (4) influence of the environment. The first factor, psychological pain and distress, was perceived as the primary motivator for starting and continuing ECT. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professionals should be aware of the factors that influence patients to have electroconvulsive therapy and their own role in the decision-making process and during treatment. As patients are susceptible to emotional support and as the motivation of patients for starting and continuing ECT is positively influenced by the advice and support of mental health professionals, these professionals have a key role in motivating patients for ECT. When the patient has decided to start ECT, mental health professionals should explore the factors that influence their motivation and regularly assess these factors so that they can guide the patient in their process. The professional should have an overview of these factors and investigate how they can be positively influenced to help patients keep their motivation during the treatment process. This will contribute to person-centred care and could lead to better treatment outcomes. ABSTRACT: Introduction The factors influencing patients' motivation for undergoing electroconvulsive therapy (ECT) have not yet been subjected to a thorough study. Knowledge of these factors could improve the quality of care for patients with depression recommended to have ECT. Aim To identify the factors that influence the motivation of patients diagnosed with depression to have ECT. Method This qualitative study followed a grounded theory approach in which semi-structured interviews were conducted with 18 patients from four different psychiatric hospitals to study their perspectives on factors influencing their motivation to have ECT. Results The explanatory framework of factors influencing motivation for ECT comprises four main categories, starting with the most important category, psychological pain and distress, and continuing with the following categories: perceived need for treatment; perception of ECT as an effective treatment; environmental influences. Discussion In this study, we found that the psychological pain and distress of depression, and their consequences in daily life, had been the primary experiences that motivated patients to start and continue ECT. Implications for Practice This is the first study that has examined motivational factors for patients with severe depression to participate in ECT. Professionals appear to have a key role in motivating patients for ECT. They should explore factors that influence motivation for ECT, regularly assess their motivation and intervene on influential factors.
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Affiliation(s)
| | | | | | - Irina E Poslawsky
- Department of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Department of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (location VUmc), Amsterdam, The Netherlands
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Cai H, Du R, Song J, Wang Z, Wang X, Yu Y, Wang Y, Shang L, Zhang J, Yang K, Li W. Suicidal Ideation and Electroconvulsive Therapy: Outcomes in Adolescents With Major Depressive Disorder. J ECT 2023; 39:166-172. [PMID: 36800536 PMCID: PMC10487452 DOI: 10.1097/yct.0000000000000906] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/14/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Few studies on electroconvulsive therapy (ECT) investigate efficacy and safety on depressive adolescents with strong suicidal ideation. Our study examined adolescents (aged 13-18 years) with major depressive disorder to explore ECT effectiveness in improving suicidal ideation and depressive symptoms, as well as its impact on cognitive function. METHODS This nonrandomized controlled trial enrolled 183 adolescent patients suffering from major depressive disorder. The ECT group (n = 81) was treated with antidepressants and 8 rounds of ECT for 2 weeks. The control group comprised 79 patients treated with antidepressants only. Depressive symptoms, suicidal ideation, and cognitive functions were assessed at baseline (pre-ECT) and at 2 and 6 weeks post-ECT. RESULTS The ECT group showed significant improvements over control in suicidal ideation from the end of treatment to 6 weeks after ( P < 0.001). Depressive symptoms also improved ( P < 0.001). Patients treated with ECT demonstrated poorer performance in delayed memory, attention, and language, but these impairments were transient. Thus, ECT was generally safe in adolescent patients with major depressive disorder. CONCLUSIONS Our findings verified ECT as effective and safe for improving suicidal ideation and depressive symptoms of adolescent patients with major depressive disorder. In addition, partially impaired cognitive function recovered gradually after ECT.
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Affiliation(s)
| | - Ruonan Du
- Huilongguan Clinical Medical School, Peking University, Beijing Huilongguan Hospital, Beijing, China
| | | | | | - Xin Wang
- From the Beijing Huilongguan Hospital
| | | | | | - Lan Shang
- From the Beijing Huilongguan Hospital
| | | | | | - Wei Li
- From the Beijing Huilongguan Hospital
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Tuncturk M, Ermis C, Buyuktaskin D, Turan S, Saglam Y, Alarslan S, Guler D, Sut E, Unutmaz G, Guzel AB, Atay Canbek O, Inal N, Karacetin G, Hazell P. Electroconvulsive therapy or clozapine for adolescents with treatment-resistant schizophrenia: an explorative analysis on symptom dimensions. Int J Psychiatry Clin Pract 2023; 27:257-263. [PMID: 36576216 DOI: 10.1080/13651501.2022.2160764] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/16/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study sought to compare pre-intervention patient characteristics and post-intervention outcomes in a naturalistic sample of adolescent inpatients with treatment-resistant psychotic symptoms who received either electroconvulsive therapy (ECT) or clozapine. METHODS Data of adolescents with schizophrenia/schizoaffective disorder receiving ECT or clozapine were retrospectively collected from two tertiary-care psychiatry-teaching university hospitals. Subscale scores of the Positive and Negative Symptom Scale (PANSS) factors were calculated according to the five-factor solution. Baseline demographics, illness characteristics, and post-intervention outcomes were compared. RESULTS There was no significant difference between patients receiving ECT (n = 13) and clozapine (n = 66) in terms of age, sex, and the duration of hospital stay. The ECT group more commonly had higher overall illness and aggression severity. Smoking was less frequent in the clozapine group. Baseline resistance/excitement symptom severity was significantly higher in the ECT group, while positive, negative, affect, disorganisation, and total symptom scores were not. Both interventions provided a significant reduction in PANSS scores with large effect sizes. CONCLUSION Both ECT and clozapine yielded high effectiveness rates in adolescents with treatment-resistant schizophrenia/schizoaffective disorder. Youth receiving ECT were generally more activated than those who received clozapine.
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Affiliation(s)
- Mustafa Tuncturk
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | | | | | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Yesim Saglam
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Duru Guler
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ekin Sut
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Guldal Unutmaz
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ayse Beste Guzel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ozge Atay Canbek
- Department of Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Neslihan Inal
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gul Karacetin
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Philip Hazell
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Rowland T, Mann R, Azeem S. The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression: A Systematic Review of Randomized and Observational Studies. J ECT 2023; 39:141-150. [PMID: 36961277 DOI: 10.1097/yct.0000000000000914] [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: 03/25/2023]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.
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Affiliation(s)
| | - Roshani Mann
- From the Coventry and Warwickshire NHS Partnership Trust
| | - Samina Azeem
- From the Coventry and Warwickshire NHS Partnership Trust
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Castaño Ramírez OM, Gómez Bedoya CA, Lemos Buitrago R, Castro Navarro JC, Valencia Aristizábal LG, Valderrama Sánchez A, Botero PF, Reinoso Gualtero MA. Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression. Rev Colomb Psiquiatr (Engl Ed) 2023; 52:107-112. [PMID: 37500238 DOI: 10.1016/j.rcpeng.2021.03.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/23/2021] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.
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Affiliation(s)
| | | | - Rocío Lemos Buitrago
- Department of Mental Health and Human Behavior, University of Caldas, Manizales, Colombia
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Iltis AS, Fortier R, Ontjes N, McCall WV. Ethics Considerations in Laws Restricting Incapacitated Patients' Access to ECT. J Am Acad Psychiatry Law 2023; 51:47-55. [PMID: 36646453 DOI: 10.29158/jaapl.220029-21] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment used for numerous psychiatric conditions. While many patients for whom ECT is indicated are able to give voluntary informed consent, some lack decision-making capacity (DMC), at least temporarily. Case reports from numerous countries involving ECT for patients who lack DMC indicate overall positive outcomes and high patient satisfaction with results comparable with those of consenting patients; some patients regain DMC with ECT. Laws and regulations pertaining to ECT vary widely around the world and across the United States. Many United States jurisdictions over-regulate ECT relative to other interventions with comparable risks and potential benefits. While laws restricting whether and under what circumstances patients who lack DMC may receive ECT likely are aimed at protecting incapacitated persons, such laws sometimes undermine important ethics obligations and should be re-evaluated.
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Affiliation(s)
- Ana S Iltis
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA.
| | - Reese Fortier
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA
| | - Noah Ontjes
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA
| | - William V McCall
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA
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Wells K, Hancock N, Honey A. How Do People Perceive and Adapt to Any Consequences of Electro Convulsive Therapy on Their Daily Lives? Community Ment Health J 2022; 58:1049-1059. [PMID: 34812963 DOI: 10.1007/s10597-021-00913-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
Great controversy surrounds the use of electroconvulsive therapy or ECT. However, it continues to be used internationally. While research on short term effects of ECT abound, there is limited knowledge about long term impacts of ECT on individuals, especially from the lived experience perspective. The aim of this qualitative study was to gain an in-depth understanding of longer-term lived experiences of ECT and how people navigate any impacts on their daily lives. Twenty-three people participated in semi-structured interviews. Data collection and analysis involved an iterative process. Data were coded into four categories: (1) My ECT experience included physical mechanics, decision making, clinic experiences, post ECT support and attitudes and support of others); (2) Direct impacts of ECT on me encompassed both cognitive and emotional impacts; (3) Impacts on my life comprised daily activities, relationships, ongoing health care; and My strategies incorporated fixing or working around the problem, reframing, using support networks, protecting myself and taking control. Insights gleaned through lived experiences have important implications for other service users, direct service providers and those striving for system reforms that embrace more recovery orientated and trauma informed practices.
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Affiliation(s)
- Karen Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia.
| | - Nicola Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia
| | - Anne Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia
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Chan P, Waxman RE, Woo S, Docherty C, Rayani K, Fischler I, Ghaffar O, Elmi S. Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder: A Prospective, Observational Study. J ECT 2022; 38:81-87. [PMID: 35613007 DOI: 10.1097/yct.0000000000000814] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPSs) in those with major neurocognitive disorder (MNCD) include the responsive behaviors of agitation and aggression. Electroconvulsive therapy (ECT) has shown some effectiveness based on retrospective studies and one open label prospective study. We hypothesized that ECT will reduce NPSs between baseline and after treatment in those with medication-refractory behaviors. METHOD/DESIGN This Canadian prospective multicenter study included MNCD patients admitted to geriatric psychiatry units for the management of refractory NPSs. All treatment-refractory participants suffered from advanced MNCD. We conducted the Neuropsychiatric Inventory-Clinician version and the Pittsburgh Agitation Scale at baseline, and during and after the ECT course. A bitemporal or bifrontal ECT series based on dose titration to 1.5 to 2.5 times seizure threshold was administered. RESULTS Data were collected for 33 patients with a mean age of 73 and categorized with severe MNCD using the Functional Assessment Staging of Alzheimer's Disease scale (stages 6 and 7). The data showed a drop in mean Neuropsychiatric Inventory-Clinician version from 58.36 to 24.58 (P < 0.0001). Mean Neuropsychiatric Inventory agitation subscale dropped from 7.12 to 3.09 (P = 0.007). Mean Neuropsychiatric Inventory aggression subscale dropped from 6.94 to 0.97 (P < 0.0001). There was a concomitant significant decline in Pittsburgh Agitation Scale scores. No participants dropped out because of intolerance of ECT. One participant died from pneumonia, which did not appear related to ECT. CONCLUSIONS In this naturalistic study, ECT was found to be a safe and effective treatment for certain NPSs in people with MNCD. This can translate into improving quality of life.
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Affiliation(s)
| | | | | | - Claire Docherty
- From the Department of Psychiatry, Faculty of Medicine, University of British Columbia
| | - Kaveh Rayani
- Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
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12
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most acutely effective treatment for severe treatment-resistant depression. However, there are concerns about its cognitive side-effects and we cannot yet confidently predict who will experience these. Telomeres are DNA-protein complexes that maintain genomic integrity. In somatic cells, telomeres shorten with each cell division. Telomere length (TL) can thus provide a measure of 'biological' aging. TL appears to be reduced in depression, though results are mixed. We sought to test the following hypotheses: (1) that TL would be shorter in patients with depression compared to controls; (2) that TL would be a predictor of response to ECT; and (3) that shorter TL would predict cognitive side-effects following ECT. METHOD We assessed TL in whole blood DNA collected from severely depressed patients (n = 100) recruited as part of the EFFECT-Dep Trial and healthy controls (n = 80) using quantitative real-time polymerase chain reaction. Mood and selected cognitive measures, including global cognition, re-orientation time, and autobiographical memory, were obtained pre-/post-ECT and from controls. RESULTS Our results indicate that TL does not differ between patients with depression compared to controls. TL itself was not associated with mood ratings and did not predict the therapeutic response to ECT. Furthermore, shorter baseline TL is not a predictor of cognitive side-effects post-ECT. CONCLUSIONS Overall, TL assessed by PCR does not represent a useful biomarker for predicting the therapeutic outcomes or risk for selected cognitive deficits following ECT.
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Affiliation(s)
- Karen M Ryan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
- Department of Psychiatry, St. Patrick's University Hospital, Trinity College Dublin, James Street, Dublin 8, Ireland
| | - Declan M McLoughlin
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
- Department of Psychiatry, St. Patrick's University Hospital, Trinity College Dublin, James Street, Dublin 8, Ireland
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13
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Takács R, Ungvari GS, Gazdag G. Electroconvulsive therapy on Hungarian websites. Psychiatr Danub 2012; 24:86-9. [PMID: 22447091 DOI: pmid/22447091] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although there are several similarities in terms of their equipment and the way they are performed, the social perception and public attitudes towards electroconvulsive therapy (ECT) and electric cardioversion (ECV) is entirely different. The aim of this study was to assess and compare the information on Hungarian Internet sites on ECT and ECV with respect to their depiction and acceptance by the public. SUBJECTS AND METHODS An Internet search was undertaken with the Google search engine using the terms "ECT", "electroconvulsive therapy", "electroshock", "defibrillator" and "electric cardioversion". The search was restricted to information published in the Hungarian language from 1 January 2000 to 31 December 2010. All communications were classified into negative, neutral and positive groups depending on their attitude towards the aforementioned treatment methods. Professional or non-professional categories were also distinguished. RESULTS The total number of communications, which appeared between 2000 and 2010 and contained one of the search words for ECT was 66. The majority of them portrayed ECT in a negative (24; 36.4%) or neutral (25; 37.9%) fashion. Most of the websites (139; 95.2%) related to ECV were reflected positive (120; 82.2%) and neutral opinions (19; 13.0%). CONCLUSIONS Hungarian-language Internet sites mainly view ECT as negative or neutral in contrast to ECV cardioversion, which has almost entirely a positive reputation. Although the effectiveness of both therapies is equally well established, their public image as manifested on the Internet differs significantly. This may have a major impact on the frequency of their use.
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Affiliation(s)
- Rozália Takács
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Abstract
OBJECTIVE Watching a live electroconvulsive treatment (ECT) has both positive and negative effects on spectators. The authors aim to survey the attitude change towards ECT in interns after watching a live ECT session. METHODS A 23-item questionnaire was administered to 66 interns before and after watching ECT. RESULTS In five statements, the number of answers indicating negative attitudes decreased significantly after viewing ECT. A general change in attitude towards ECT depended on the interns' knowledge about the treatment. In the group of interns claiming minimal knowledge about ECT, a positive attitude change toward ECT and an increase in the acceptance of ECT were found, while in the group with moderate self-rated knowledge no significant attitude change, but a decrease in acceptance, were detected. CONCLUSION The visual information on ECT reduced the interns' negative attitudes, in general; however, acceptance of the treatment decreased in a subgroup of interns.
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Rehor G, Conca A, Schlotter W, Vonthein R, Bork S, Bode R, Hüll M, Plewnia C, Di Pauli J, Prapotnik M, Peters O, Peters J, Eschweiler GW. [Relapse rate within 6 months after successful ECT: a naturalistic prospective peer- and self-assessment analysis]. Neuropsychiatr 2009; 23:157-163. [PMID: 19703381] [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] [Indexed: 05/28/2023]
Abstract
BACKGROUND Up to 100% relapse rate after successful electroconvulsive therapy (ECT) poses a challenge for patients and psychiatrists. The aim of the study was to evaluate the outcome of patients affected by major depression after the successful course of acute ECT. METHODS 84 patients recruited in a randomized double blind multicenter study designed to investigate the optimal stimulation placement in acute ECT had a follow up under naturalistic conditions between the 5th and 7th month. Outcome, maintenance therapy and patients; attitude were evaluated with semi structured questionnaires by patients and the study raters. RESULTS 82.14% (68/84) questionnaires of the patients and 83.3% (70/84) of the rater were returned. 98% of the patients had at least one antidepressant; only in 23% (20/68) lithium was prescribed. 35% (7/20) of the patients with lithium and 57% (16/28) without lithium had a relapse within the first 6 months (OR 0.6) in a median of 2.5 months. Only one institution offered maintenance ECT in 8.3% (7/84) patients. For 52.2% of the patients ECT was a helpful treatment an 49.3% would recommend the therapy to their relatives. The vast majority (59.4%) wishes a better information about the ECT and 21.4% feel frightening about the therapy. CONCLUSIONS The results show a high relapse rate and highlight the meaning of maintenance medication especially for a lithium combination therapy, as stated before. In regard to the subjective sensation the patients claim a better education about the ECT and anyway one of four patients feel frightening about the therapy.
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van Oorsouw WMWJ, Israel ML, von Heyn RE, Duker PC. Side effects of contingent shock treatment. Res Dev Disabil 2008; 29:513-523. [PMID: 17945467 DOI: 10.1016/j.ridd.2007.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 08/29/2007] [Indexed: 05/25/2023]
Abstract
In this study, the side effects of contingent shock (CS) treatment were addressed with a group of nine individuals, who showed severe forms of self-injurious behavior (SIB) and aggressive behavior. Side effects were assigned to one of the following four behavior categories; (a) positive verbal and nonverbal utterances, (b) negative verbal and nonverbal utterances, (c) socially appropriate behaviors, and (d) time off work. When treatment was compared to baseline measures, results showed that with all behavior categories, individuals either significantly improved, or did not show any change. Negative side effects failed to be found in this study.
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Affiliation(s)
- W M W J van Oorsouw
- Pluryn Werkenrode Groep (Winckelsteegh) and Radboud University, Nijmegen, The Netherlands.
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Flint V, Hill-Johnes S. How effective is ECT for those with borderline personality disorder? Nurs N Z 2008; 14:12-14. [PMID: 18959290] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Kirov G, Ebmeier KP, Scott AIF, Atkins M, Khalid N, Carrick L, Stanfield A, O'Carroll RE, Husain MM, Lisanby SH. Quick recovery of orientation after magnetic seizure therapy for major depressive disorder. Br J Psychiatry 2008; 193:152-5. [PMID: 18670002 PMCID: PMC2587356 DOI: 10.1192/bjp.bp.107.044362] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Magnetic seizure therapy, in which seizures are elicited with a high-frequency magnetic field, is under development as a new treatment for major depressive disorder. Its use may be justified if it produces the antidepressant effects of electroconvulsive therapy (ECT), coupled with limited cognitive side-effects. AIMS To evaluate the usefulness of a new 100 Hz magnetic seizure therapy device. METHOD We induced seizures with 100 Hz magnetic transcranial stimulation in 11 patients with major depressive disorder during one session of a regular course of ECT. Recovery times after seizures induced by magnetic seizure therapy and ECT were compared. RESULTS Seizures could be elicited in 10 of the 11 patients. Stimulation over the vertex produced tonic-clonic activity on 9 out of 11 occasions. Stimulation over the prefrontal midpoint elicited seizures on 3 out of 7 occasions. The mean duration of magnetically induced seizures was 31.3 s, ranging from 10 to 86 s. All patients had an exceptionally quick recovery of orientation: mean of 7 min 12 s (s.d.=2 min 7 s, range 4 min 20 s to 9 min 41 s). The recovery times were on average 15 min 35 s shorter with magnetic seizure therapy than with ECT in the same patients (paired-samples t-test: P<0.0001). Patients reported feeling less confused after magnetic seizure therapy. Side-effects were confined to myoclonic movements, associated with the use of etomidate. CONCLUSIONS The new 100 Hz magnetic stimulator elicits seizures in the majority of patients when administered over the vertex. Magnetic seizure therapy was associated with shorter recovery times and less confusion following treatment. Subsequent work will be required to assess the safety and effectiveness of magnetic seizure therapy in the treatment of depression.
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Affiliation(s)
- George Kirov
- Cardiff University, Henry Wellcome Building, Heath Park, Cardiff, UK
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Rödding W. [Reply to Lubenau's description of ECT from the patient's perspective. Psychiat Prax 2008; 35: 48-49]. Psychiatr Prax 2008; 35:262. [PMID: 18626851 DOI: 10.1055/s-2008-1081449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Kopecek M, Cerná L, Sulak J, Raszka M, Bares M, Seifertová D. Depressed patients perception of the efficacy of electroconvulsive therapy and venlafaxine therapy. Neuro Endocrinol Lett 2007; 28:889-894. [PMID: 18063943] [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: 10/08/2007] [Accepted: 10/24/2007] [Indexed: 05/25/2023]
Abstract
BACKGROUND The aim of our study was to evaluate the efficacy of electroconvulsive (ECT) and venlafaxine therapy from the patient's point of view. METHODS We used a retrospective chart review from 22 inpatients who underwent ECT and 22 patients treated with venlafaxine due to resistant unipolar or bipolar depression. We used bilateral ECT in a median of 8 (IQR 7-9.7) sessions and venlafaxine therapy with a median daily dosage of 225 mg (IQR 150-225 mg) for a median of 4 (IQR 4-5) weeks. The main outcome was change in a self-evaluation scale - Short Form of the Beck Depression Inventory (BDI-SF). The response was defined as the decreasing of the BDI-SF score by >or=50%, remission as decreasing of BDI-SF score <or=4. RESULTS We did not find significant differences between sex, age and BDI-SF before therapy in both groups. The reduction of BDI-SF score was significantly higher in the ECT group than in venlafaxine group (p=0.025). Significantly more patients treated with ECT reached response than patients treated with venlafaxine (68% vs. 23%; <0.01). The remission rate after ECT was not significantly higher than venlafaxine therapy (27% vs. 5%; p=0.094). The number needed to treat (NNT) of ECT for BDI-SF response was 3 (CI95% 1.4 to 5.2) and NNT for BDI-SF remission was 5 (CI95% 2.3 to 45.8). DISCUSSION After the median of 3 failed antidepressant trials, ECT was more effective than venlafaxine in the short term therapy in some parametres according to our patients. We suggest that the fact that mental state was evaluated by patients themselves is an important pro-argument in the discussion about ECT.
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Stek ML, van der Wurff FB, Uitdehaag BMJ, Beekman ATF, Hoogendijk WJG. ECT in the treatment of depressed elderly: lessons from a terminated clinical trial. Int J Geriatr Psychiatry 2007; 22:1052-4. [PMID: 17457952 DOI: 10.1002/gps.1800] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Arshad M, Arham AZ, Arif M, Bano M, Bashir A, Bokutz M, Choudhary MM, Naqvi H, Khan MM. Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan. BMC Psychiatry 2007; 7:27. [PMID: 17584946 PMCID: PMC1929082 DOI: 10.1186/1471-244x-7-27] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 06/21/2007] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients. METHODS This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan. RESULTS We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001). CONCLUSION We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.
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Affiliation(s)
- Mehreen Arshad
- Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Ahmad Zafir Arham
- Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Mansoor Arif
- Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Maria Bano
- Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Ayisha Bashir
- Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Munira Bokutz
- Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | | | - Haider Naqvi
- Department of Psychiatry, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Murad Moosa Khan
- Department of Psychiatry, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
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Electroconvulsive therapy. With new methods and accumulated evidence, this treatment survives its critics. Harv Ment Health Lett 2007; 23:1-4. [PMID: 17340741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Duker PC, Van den Munckhof M. Heart rate and the role of the active receiver during contingent electric shock for severe self-injurious behavior. Res Dev Disabil 2007; 28:43-9. [PMID: 16412609 DOI: 10.1016/j.ridd.2005.05.010] [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] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Revised: 01/20/2005] [Accepted: 05/18/2005] [Indexed: 05/06/2023]
Abstract
Five individuals, who were treated for severe self-injurious behaviors with contingent electric shock, participated. Hereby, each occurrence of the target response was followed by a remotely administered aversive consequence. Participants' heart rates were compared at times when the active device of the equipment for the above procedure was attached to their body and when the active device was detached. Although typical response patterns emerged across the participants results demonstrated that heart rates were lower when the active device was attached, tentatively supporting the notion that anxiety and stress may be collateral to participants' SIB.
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Affiliation(s)
- Pieter C Duker
- Radboud University Nijmegen and Pluryn/Werkenrode Group, Nijmegen, The Netherlands.
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McCall WV, Prudic J, Olfson M, Sackeim H. Health-related quality of life following ECT in a large community sample. J Affect Disord 2006; 90:269-74. [PMID: 16412519 DOI: 10.1016/j.jad.2005.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Revised: 11/07/2005] [Accepted: 12/02/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND While electroconvulsive therapy (ECT) is a potent antidepressant, little is known about its long-term effects on health-related quality of life (HRQOL). METHODS Using a naturalistic, observational design, 283 depressed patients, who received ECT at 7 hospitals in the New York City area, were assessed for HRQOL with the Medical Outcomes Study Short Form - 36 (SF-36) at baseline, several days after ECT, and 24 weeks later. Depression severity was assessed with the Hamilton Rating Scale for Depression, and a neuropsychological battery was also administered. RESULTS Baseline SF-36 scores were very low, indicating poor HRQOL. These scores were improved at postECT and at the 24-week follow-up. Unexpectedly, the degree of retrograde amnesia for autobiographical information was associated with better HRQOL in the immediate postECT period, but not at 24-week follow-up. In contrast, improvement in global cognitive status was associated with superior HRQOL at the 24-week time point. LIMITATIONS This study was limited by the lack of a non-ECT comparison group, and the naturalistic design of treatment. CONCLUSIONS ECT is associated with improved HRQOL in the short- and long-term, with the enhancements largely explained by improvements in depressive symptoms. The acute cognitive effects of ECT may also influence HRQOL assessment, and evaluations removed in time from the treatment may have greater validity.
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Affiliation(s)
- W Vaughn McCall
- Department of Psychiatry and Behavioral Medicine, Wake Forest University Health Sciences, Medical Center Blvd., Winston-Salem, NC 27157, USA.
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Abstract
The authors present a discourse analysis of an influential paper on the experience of electroconvulsive therapy (ECT). By focusing on how patients are construed in this article, they deconstruct the ways in which the case for ECT as 'helpful and not particularly frightening' is made. They argue that, as with all academic writing, a discourse of scientific objectivity can be used to privilege certain views and promote certain interests.
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Affiliation(s)
- Lucy Johnstone
- Bristol Doctorate in Clinical Psychology, University of Bristol, UK.
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Abstract
Older women are particularly prone to being treated for depression, and, despite the controversy surrounding it, electroconvulsive therapy (ECT) has gained popularity as a treatment with this population. Research has examined the physical and cognitive changes associated with ECT but there is little understanding regarding how older women themselves experience this treatment. In order to gain better understanding into the subjective experience of receiving ECT, this qualitative study explored the experiences of six older women who were treated with ECT for a diagnosis of depression, using in-depth personal interviews. Analysis suggests that this experience for these older women could not be understood in isolation. Rather, their stories highlighted the importance of interpreting the ECT experience within a broader context that included the larger depression experience, the dynamics of helping relationships, and the discourse available to them for sense-making. Specifically, the central theme underpinning all of these women's stories was the shifting of power from themselves to others. This paper examines how this occurred and discusses implications for practice.
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Affiliation(s)
- Alison Orr
- Adult/Older Adult Program, Vancouver Coastal Health, Vancouver, BC, V5Z 4H5.
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Bargiel-Matusiewicz K, Kucia K. [Cognitive appraisal and psychic comfort of patients undergoing electroconvulsive therapy]. Wiad Lek 2005; 58:147-50. [PMID: 16119154] [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] [Indexed: 05/04/2023]
Abstract
In spite of the constant development of pharmacotherapy, electroconvulsive therapy (ECT) remains highly efficient form of therapy in psychiatry. Among the interesting aspects connected with ECT we can mention patients' attitude and their psychic comfort. Since many patients undergoing ECT treat the situation as stressful, the research being done has been situated in a relational stress paradigm. The obtained results confirm the assumed direction of relations between cognitive appraisal of a situation and the experienced emotions. The way in which patients undergoing ECT perceive their situation substantially influences the level of their psychic comfort. Persons, who make the cognitive appraisal of a situations as a challenge, are much more efficient on the level of the experienced emotions than those who appraise a situation as a threat. It makes us pay particular attention to patients' beliefs connected with ECT. The adequate psychoeducational influence based upon creating a motivation for treatment, forming an ability of concentrating attention at positive aspects of a situation and possible benefits may contribute to the more positive reception of ECT and thus to increasing patients' psychic comfort during the treatment process.
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Sakamoto A, Ogawa R, Suzuki H, Kimura M, Okubo Y, Fujiya T. Landiolol attenuates acute hemodynamic responses but does not reduce seizure duration during maintenance electroconvulsive therapy. Psychiatry Clin Neurosci 2004; 58:630-5. [PMID: 15601388 DOI: 10.1111/j.1440-1819.2004.01322.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
Maintenance electroconvulsive therapy (mECT) is an outpatient procedure that requires further consideration in terms of management of ambulatory anesthesia. Although many adjunctive drugs for stabilizing hemodynamic changes during ECT have been reported, side-effects of these drugs may delay recovery and discharge from hospital. The effects of landiolol, a novel ultra-short-acting beta-adrenergic blocker, have been measured on seizure duration, hemodynamic changes, recovery from anesthesia, and cognitive function during mECT under propofol anesthesia. A total of 10 patients with depression in the remission phase, were studied in a randomized, double-blind, placebo-controlled, crossover manner. Administration of 0.1 mg/kg of landiolol immediately before anesthesia significantly blunted the increase in heart rate and blood pressure during convulsions compared with placebo; landiolol was not associated with excessive hypotension or bradycardia. Landiolol did not affect seizure duration, recovery from anesthesia, or cognitive function before or after ECT. These results suggest that landiolol can be used effectively and safely during mECT.
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Abstract
OBJECTIVE Chronic pain improves with electroconvulsive therapy (ECT), yet few case reports account for treatment of comorbid major depression, a significant confounder of the analgesia of ECT. This study reports on the analgesia of ECT, controlling for treatment of depression. METHODS This is a case-matching study comparing outcomes of inpatients with chronic pain and major depression in a multidisciplinary pain treatment unit treated with ECT and medications (cases) with those of inpatients treated with medications only (controls). Both groups received the same behavioral and pharmacological treatments for depression and chronic pain. Outcome measures included 0-10 pain rating scales and the Montgomery-Asberg Depression Inventory. Patients were matched on sex, age within 5 years, admission date within 6 months, psychiatric diagnoses, and, as much as possible, on race and pain syndrome diagnosis. Percentage changes in depression scores and pain scores were calculated from the beginning to the end of admission. RESULTS There were nonsignificant differences in demographics, except in the proportion married. Twenty-five of 28 ECT patients were matched. Depression improvements were similar between cases and controls (55.9% vs 40.5%). Despite higher initial pain (8.1 vs 6.9 on a 10-point scale), the ECT group had less final pain (3.4 vs 5.5). The ECT group had a 59.8% drop in pain versus a 15.8% drop in the control group, P > 0.01. CONCLUSIONS ECT has analgesic properties independent of its improvement of depression in patients with chronic pain and major depression. Improvements in depression were similar, while there was a significantly greater improvement in pain with ECT. The lower post-ECT treatment pain scores suggest a specific analgesic effect of ECT.
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Affiliation(s)
- Ajay D Wasan
- Department of Psychiatry and Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Melamed Y, Altmark D, Alfici S, Or E, Zipris P, Bzura G, Bleich A. [What is the role of compulsory ECT therapy today?]. Harefuah 2004; 143:254-7, 320, 319. [PMID: 15116579] [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] [Indexed: 04/29/2023]
Abstract
Electro-convulsive therapy (ECT) has been effective for years, but it arouses opposition among patients and especially in the general public. ECT treatment is limited and compared to other medical treatment it is considered exceptional by the law, regulations and treatment personnel. A question arises as to the position of therapists regarding compulsory ECT treatment. A questionnaire was sent on this subject to all the units utilizing ECT in Israel. Opinions ranged from complete negation of compulsory ECT, to regarding such treatment as possible in cases when the patient is compulsorily hospitalized and/or when the patient's guardian supports this treatment. The authors' opinion is that the Law of Patients' Rights regarding special treatment when the patient is in extreme danger must be followed. The law requires that three physicians agree to the treatment, and compulsory treatment is no longer applicable when the danger passes. ECT treatment is important and imperative in certain conditions, especially conditions endangering patients' lives. In these conditions the law provides the authority to physicians to make decisions regarding treatment.
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Affiliation(s)
- Y Melamed
- Lev Hasharon Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University.
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Abstract
OBJECTIVE To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy. DESIGN Descriptive systematic review. DATA SOURCES Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. STUDY SELECTION Articles with patients' views after treatment with electroconvulsive therapy. DATA EXTRACTION 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. DATA SYNTHESIS The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. CONCLUSIONS The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.
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Affiliation(s)
- Diana Rose
- Service User Research Enterprise, PO34, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.
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ECT controversy. Am J Nurs 2003; 103:63-4; author reply 64. [PMID: 12807118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Abstract
OBJECTIVE Despite the vast amount of scientific literature available on electroconvulsive therapy (ECT), there is little qualitative focus upon the patients' subjective experience of this procedure. Using an exploratory descriptive methodology, this study aims to provide a more unique insight into what certain patients actually think of ECT. METHOD Semistructured interviews were conducted to explore eight patients' opinions and experiences of ECT. Interviews were subjected to analysis by a five-step framework approach that identified prominent themes in relation to five broad questions and in conjunction with issues raised by the subjects themselves. RESULTS Eleven major themes were identified. Four of these were chosen for discussion, not only as the most prevalent themes (in terms of how frequently they were mentioned by the subjects), but also as the most striking (in regards to the intensity of emotions evoked, or their influence on their perception of ECT as a future treatment option). The four themes are fear of ECT, attribution of cognitive decline and memory loss to ECT, positive ECT experiences, and patients' suggestions. CONCLUSIONS Using such a qualitative approach, the depth of the information obtained has revealed new perspectives on how patients perceive the experience of ECT. Fears reported by patients present an opportunity to address specific areas of the procedure that generate the most angst. These were closely associated with recommendations that many patients proposed throughout the interviews. Patients' perceptions of the cognitive effects of ECT do not necessarily correspond with those commonly reported in the literature on ECT. Positive experiences with ECT were more complex than simply its efficacy. There is a need for future research in order to explore and address patients' experiences of ECT.
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Abstract
This study examined the stability of patients' attitudes toward electroconvulsive therapy (ECT). Surveys were administered to 64 study participants at 2 and 4 weeks post treatment. The survey responses were highly significantly correlated and not significantly different, which suggests that attitudes toward ECT are stable during this time.
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Affiliation(s)
- Aline J Iodice
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Abstract
Although electroconvulsive therapy (ECT) is a safe and efficacious treatment, there is a widespread negative view of ECT in public and professional circles. There are no data on Chinese patients' knowledge of, experience with, attitude toward, and level of satisfaction with ECT in Hong Kong. The aims of this study were to examine patients' experience of ECT, and patients' and their relatives' knowledge of, attitude toward, and level of satisfaction with ECT. To this effect, a prospective cross-sectional survey was conducted, involving 96 patients and their 87 relatives. The study showed that the majority of patients believed they had not received adequate information about ECT. The most commonly reported side effect was memory impairment. Patients and relatives had only limited knowledge of ECT, yet the majority of them were satisfied with the treatment and, having found it beneficial, maintained a positive attitude toward its use. The researchers concluded that Hong Kong Chinese patients and their relatives accepted ECT as a treatment. The way information is provided to patients and relatives when obtaining consent for ECT needs improvement.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, China.
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Abstract
OBJECTIVE To determine whether electroconvulsive therapy (ECT) patients' self-reported functional status is similar to that reported by a proxy. BACKGROUND Increasing levels of depression are associated with deteriorating functional status as reflected in the Instrumental Activities of Daily Living (IADL) scale. Depressed patients referred for ECT have poorer IADL status compared with depressed patients receiving medications, suggesting that IADL status may shape physicians' decision to recommend ECT ( 1). Further, IADL status improves with treatment of depression, both in ECT-and medication-treated patients. Given the potential importance of IADL status for ECT patients, we examined whether IADL status as reported by patients prior to ECT was comparable to IADL status as described by a proxy. DESIGN/METHODS Forty depressed patients (23 men and 17 women, mean age 58.1 +/- 17.5) were each interviewed alone with the 21-item Hamilton Depression Rating Scale (HDRS), Mini-Mental State Exam (MMSE), an Activities of Daily Living (ADL) scale, and an IADL scale. We then privately interviewed a first-degree relative who lived with each patient and recorded their impression of the patient's ADL and IADL function before ECT, and at 2 and 4 weeks after ECT. RESULTS baseline scores for HDRS and MMSE were consistent with a severe level of depressive symptoms and intact global cognitive function. Patients' and proxies' IADL scores were highly correlated before ECT, 2 weeks after ECT, and 4 weeks after ECT. Significant, but slightly weaker correlations were seen for ADL scores. CONCLUSIONS Ideally, ADL and IADL function would be measured by direct observation rather than either patient or proxy report. At this time it is unknown whether the patient or the proxy report should be considered the "gold standard." In this study, the patients' self-reported functional scores were highly correlated with the proxies' scores. We conclude that patients' reports of their function are roughly comparable to proxies' impressions before and after ECT.
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Affiliation(s)
- W Vaughn McCall
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Frank LR. Electroshock: a crime against the spirit. Ethical Hum Sci Serv 2002; 4:63-71. [PMID: 15278988] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Since its introduction in 1938, electroshock (electroconvulsive treatment, ECT) has been to its proponents a blessing and to its critics a curse. The author, himself an insulin coma-electroshock survivor, sides with the critics arguing that ECT is inherently harmful and dehumanizing. To support his views, he cites findings and comments from the professional literature in four areas: brain damage, memory loss, death, and brainwashing. The author also presents seven reasons for the continuing use of ECT, including profitability, value as a reinforcer of the biological model of mental illness, the absence of informed consent, the procedure's function as a "treatment of next resort," government and media support, and the public's failure to hold psychiatrists accountable for their conduct. The author concludes the article with his poem "Aftermath."
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Abstract
The aim of the study was to assess retrospectively patients' and parents' experiences and attitudes towards the use of electroconvulsive therapy (ECT) in adolescence. The experiences of subjects (n=10) who were administered ECT in adolescence for a severe mood disorder and their parents (n=18) were assessed using a semi-structured interview after a mean of 4.5 years (range, 19 months to 9 years). Their attitudes were mostly positive and ECT was considered a helpful treatment. Concerns were frequently expressed, probably because ECT was not fully understood by the patients and their families. Most complaints were of transitory memory impairment. The parents were satisfied with the consent procedure, while all but one patient did not remember the consent procedure. We concluded that, despite negative views about ECT in public opinion, adolescent recipients and their parents shared overall positive attitudes towards the use of ECT in this age range.
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Affiliation(s)
- O Taieb
- Department of Child and Adolescent Psychopathology, Groupe Hospitalier Pitié-Salpétrière, 43-87 Boulevard de l'Hôpital, 75013 Paris, France
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Abstract
In two experiments, using the remember/know paradigm, we examined whether recognition memory in amnesic patients can be improved by instructing patients to relax their response criterion. Experiment 1 was modeled after a study by Dorfman, Kihlstrom, Cork, and Misiaszek (1995), in which direct instructions to respond more leniently led to an increase in recognition accuracy in patients with ECT-induced amnesia. We failed to extend this finding to patients with global amnesia, but the manipulation was unsuccessful in control subjects as well. In Experiment 2, response criterion was manipulated indirectly by providing information about the alleged base rate of study items on the recognition test. This manipulation led to a criterion shift in control subjects and enhanced discriminability in amnesic patients. Analysis of "remember" and "know" responses suggests that improved accuracy in amnesia was associated with enhanced familiarity-based recognition.
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Affiliation(s)
- M Verfaellie
- Boston VA Healthcare System, Boston University School of Medicine, Boston, Massachusetts, USA.
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Smith D. Shock and disbelief. Atl Mon 2001; 287:79-90. [PMID: 15997536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Darmon P. [The forgotten victims of torture of World War I: the "pithiatics"]. Hist Econ Soc 2001; 20:49-64. [PMID: 18323025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
This study attempted to illicit the knowledge and attitudes of mental health nurses to electroconvulsive therapy (ECT). A total of 167 questionnaires containing attitude/knowledge scales were returned from the 345 sent out. The author discovered limitations in the reliability of the instrument and thus reliable measures of the respondents' knowledge of ECT were not obtained. The author's findings indicated correlations with higher levels of knowledge and (a) length of experience and (b) area of clinical practice. He also noted significant variations in knowledge of cognitive side-effects. The author concludes that nurses' knowledge of ECT requires improvement in many cases and that this has implications for nurse education.
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Affiliation(s)
- J R Cutcliffe
- Sheffield University and Royal College of Nursing Institute, Oxford
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