Course Of ECT Research Articles

Usefulness of Hamilton rating scale for depression subset scales and full versions for electroconvulsive therapy.

ObjectivesWe investigated the predictive value of subset scales and full versions of the Hamilton Rating Scale for Depression (HAMD) for therapeutic outcomes in ECT.MethodsThis secondary analysis of patients with major depression (N = 136; 63% female; age = 56.7 [SD = 14.8]) from the EFFECT-Dep trial (NCT01907217) examined the predictive value of Evans-6, Toronto-7, Gibbons-8 and Maier-Philip 6 HAMD subset scales and three ‘full’ versions (HAMD-17, HAMD-21 and HAMD-24) on therapeutic outcomes. We also examined early improvement on subset scales and full versions as predictors of response and remission and explored predictive abilities of individual HAMD-24 items.ResultsThe subset scales and full scales lacked sufficient predictive ability for response and remission. Receiver operating characteristic curves identified a lack of discriminative capacity of HAMD subset scales and full versions at baseline to predict response and remission. Only the Maier-Philip-6 was significantly associated with percentage reduction in HAMD-24 scores from baseline to end of ECT course. Early improvement on most of the subset scales and full versions was a sensitive and specific predictor of response and remission. Four of the HAMD-24 items were significantly associated with response and one with remission.ConclusionsLimited utility of the HAMD subset scales and full versions in this context highlight a need for more tailored depression rating scales for ECT.

Individual response to electroconvulsive therapy is not correlated between multiple treatment courses

ObjectivesElectroconvulsive therapy (ECT) effectively treats depressive disorders, but many patients will have subsequent relapses. While some guidelines suggest prior response to ECT is an indication for ECT in a subsequent mood episode, it is unknown whether response to ECT is correlated between treatment courses. This study explores whether response to ECT at a first treatment correlates with response to treatment in a second independent ECT course. MethodsSingle-center retrospective cohort of patients receiving two different ECT treatment courses between 2011 and 2020 and who self-reported depression symptoms using the Quick Inventory of Depressive Symptomatology (QIDS) at baseline and following treatment #5. Results286 patients received two independent ECT series during the study period, of whom 153 received at least 5 treatments in both series. Patients had similar QIDS scores at the start of each treatment series (Pearson's correlation, r = 0.58, p <0.001), but the change in QIDS following 5 ECT treatments was not correlated between series for individual patients (Pearson's correlation, r = 0.083, p = 0.31). In multivariate analyses, change in QIDS was similar for both treatment series, but patients were less likely to receive 5 treatments in the second treatment series. Limitationsretrospective cohort cannot control for factors influencing access to repeat ECT treatment ConclusionsWhile on average final QIDS score was the same following two independent treatment courses, for individual patients the change in depression symptoms was not correlated between treatment series. Further research is needed to identify factors that may predict longitudinal ECT response.

Clinical features and predictors of non-response in severe catatonic patients treated with electroconvulsive therapy

Objective To explore the demographic and clinical features of severe catatonic patients, comparing responders and non-responders to ECT in order to detect possible predictors of non-response. Methods This naturalistic study included 59 catatonic inpatients with a diagnosis of mood disorder according to DSM-IV-TR criteria. All patients were treated with bilateral ECT and evaluated before and after ECT course. The response to ECT was defined as a Clinical Global Impression (Improvement subscale) rating 1 ‘very much improved’ or 2 ‘much improved’. Clinical variables were compared between responders and non-responders; logistic regression was used to predict the probability of non-response, with regard to the symptoms presented by the patients. Results The response rate was 83.1%. Non-responders (n = 10) to ECT showed neurological comorbidities, treatments with dopamine agonists and anticholinergic drugs, waxy flexibility, and echophenomena more frequently than respondents (n = 49). Echophenomena resulted a significant predictor of non-response in the multivariate analysis. Conclusion In line with previous reports, ECT resulted effective in the vast majority of severe catatonic patients. The association between ECT resistant catatonia and neurological comorbidity, use of dopamine-agonist and anticholinergic medications is consistent with the hypothesis that ECT is more effective in ‘top-down’ than in ‘bottom-up’ variant of catatonia. Key points Catatonic symptoms are frequently associated with severe and psychotic mood disorders. Electroconvulsive therapy is effective in treating most forms of severe catatonia. Neurological comorbidity and the presence of ‘echopraxia/echolalia’ could represent predictors of non-response to ECT.

Striving to strengthen the ecosocial framework in social work in Finland

AbstractThere is no economic or social sustainability without ecological sustainability, yet the latter can hardly be achieved without the other forms of sustainability. While contemporary consumer societies are still today fundamentally unsustainable, advancing the overall sustainability transition as well as mitigating and preventing the ecological crisis should be high on the social work and community development agendas. On one hand, this is because the ecological crisis both causes and increases social inequality and vulnerability. On the other hand, aspiring sustainability requires profound social and cultural changes, bringing about which belongs to social work and community work’s areas of expertise.Asking how to respond to the socio-environmental crisis and its ramifications in social work education, this article focuses on the currently evolving ecosocial framework in Finnish social work education and practice, paying special attention to the opportunities and hindrances in its realization. The inquiry is based on thematic analysis of advanced level social work students’ views on these issues, as presented on a 5 ECTS (credits as per the European Credit Transfer and Accumulation System) course Social Work in Ecosocial Transition, part of the University of Jyväskylä’s social work master’s degree curriculum. In countries like Finland, where community development has a marginal role, adoption of the ecosocial framework would inherently strengthen the community based and political orientation in social work.

PBMC telomerase activity in depression and the response to electroconvulsive therapy

Telomerase, the DNA polymerase responsible for maintaining telomere length, has previously been implicated in depression and the response to antidepressant drugs. In this study, we aimed to compare telomerase activity in peripheral blood mononuclear cells between patients with severe depression recruited as part of the KEEP-WELL Trial (Ketamine for Depression Relapse Prevention Following ECT; NCT02414932) and age- and sex-matched healthy volunteers both at baseline/pre-ECT and at follow-up 1 month later for controls or in patients after a course of ECT. We found no differences in telomerase activity between patients with depression (n = 20) compared to healthy controls (n = 33) at baseline/pre-ECT, or between patients treated with ECT compared to controls at follow-up. In patients, telomerase activity was not associated with mood, as assessed by the 24-item Hamilton Rating Scale for Depression, or the duration of the current depressive episode. Additionally, we found no significant relationship between telomerase activity and exposure to recent or childhood adversity in either the patient or control groups. Overall, our results suggest that telomerase activity is not associated with depression, the therapeutic response to ECT, or exposure to adversity.

Relapse after abrupt discontinuation of maintenance electroconvulsive therapy during the COVID-19 pandemic.

ObjectiveMaintenance 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.MethodsEighty‐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.ResultsThirty‐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.ConclusionAlmost 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.

Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: A longitudinal in vivo human imaging study

BackgroundElectroconvulsive therapy (ECT) applies electric currents to the brain to induce seizures for therapeutic purposes. ECT increases gray matter (GM) volume, predominantly in the medial temporal lobe (MTL). The contribution of induced seizures to this volume change remains unclear. MethodsT1-weighted structural MRI was acquired from thirty patients with late-life depression (mean age 72.5 ± 7.9 years, 19 female), before and one week after one course of right unilateral ECT. Whole brain voxel-/deformation-/surface-based morphometry analyses were conducted to identify tissue-specific (GM, white matter: WM), and cerebrospinal fluid (CSF) and cerebral morphometry changes following ECT. Whole-brain voxel-wise electric field (EF) strength was estimated to investigate the association of EF distribution and regional brain volume change. The association between percentage volume change in the right MTL and ECT-related parameters (seizure duration, EF, and number of ECT sessions) was investigated using multiple regression. ResultsECT induced widespread GM volume expansion with corresponding contraction in adjacent CSF compartments, and limited WM change. The regional EF was strongly correlated with the distance from the electrodes, but not with regional volume change. The largest volume expansion was identified in the right MTL, and this was correlated with the total seizure duration. ConclusionsRight unilateral ECT induces widespread, bilateral regional volume expansion and contraction, with the largest change in the right MTL. This dynamic volume change cannot be explained by the effect of electrical stimulation alone and is related to the cumulative effect of ECT-induced seizures.

Educating PhD students for knowledge-driven society

Universities educate students for working in knowledge-driven societies. Whereas subject-related knowledge is part of every curriculum, institutions of higher education fail to teach systematically how to utilize and benefit from today’s variety of digital tools. Students and researchers are mostly unaware of what they lack to work more effectively and efficiently and to benefit from existing knowledge. Since this lack of awareness is not obvious to students and researchers (unknown unknowns; you cannot miss something that you do not know), it is difficult to convince them that there is a gap that needs to be filled. In 2014, we decided to tackle this problem by creating and developing the course “Scientific Information Retrieval &amp; Management in Life Sciences and Chemistry”. The unique 2 ECTS course features a multi-level approach to obtain and employ scientific information and to get students information savvy. On one hand, the course demonstrates the bigger picture: We discuss the aspects of scientific writing and publishing, critical choice of data sources, patents, visualisation and design, text mining and data pipelining, knowledge generation, outreach and impact of publications. On the other hand, we highlight an extensive list of field-proven tools that can assist researchers in their daily activities. We also wanted to foster a lasting impact on how students utilize databases, tools, software,and web services. Thus, at the end of the course students have to write an essay describing their current information workflow or their (un)met information needs. These essays confirm and explain how the students changed their information use, and which parts of the course they may have not understood. Moreover, essays that describe unmet information needs allow us to explore possible solutions and to work with our vendors. In our talk, we will share the concept for the course and report on our experiences.

ECT practice in England from 2012/13 to 2018/19: a retrospective analysis

AimsThe purpose of this study was to look longitudinally at ECT practice in England over the past 7 years: namely over the following key time periods; 2012/13, 2014/15, 2016/17, 2017/18, and 2018/19. A previous study by Chaplin et al, published in 2016, found that there had been a striking decline observed in the number of courses of ECT prescribed to patients from 2006 to two time points i.e. 2012/13 and 2014/15.In this study we investigated whether or not this trend had continued. Hence we looked at the change in frequency of ECT use, the length of ECT courses, patient demographics and clinical outcomes; between 2012/13 and 2018/19.BackgroundElectroconvulsive therapy (ECT) is an effective treatment for Major Depression, Treatment-Resistant Depression, Catatonia, and Clozapine-resistant psychosis. There have been regular improvements in the administration of ECT, over the past two decades. Increases in the volume of the hippocampus and the amygdala have consistently been observed in ECT studies. Stigma has been the major barrier to patients receiving ECT in a timely fashion. The Royal College of Psychiatrists (RCPsych) Centre for Quality Improvement (CCQI) established the ECT Accreditation Service (ECTAS) back in 2006. ECTAS had the aim of standardising ECT practice through the production of evidence-based standards that all member ECT Clinics could use to support their practice.MethodWe looked at the minimum dataset of information collected from ECTAS Members within England for the following years; 2012/13, 2014/15, 2016/17, 2017/18, 2018/19. In 2012/13, 2325 adjusted courses of ECT treatment were given to patients in England. In 2014/15 it was 2302.ResultBetween 2012/13 and 2018/19; two thirds of ECT patients continue to be female. The modal age of patients has also remained the same at 70 years. The number of patients detained under the Mental Health Act 1983 receiving ECT has gone up by 12%; suggesting that the patients receiving ECT were more clinically unwell. After treatment, CGI scale scores (i.e. the very much improved and much improved scores) slightly reduced by 6% from 2012/3 to 2018/19.ConclusionThe use of ECT in England notably declined from 2006 to 2012/13 and 2014/15. However, from 2012/13 to 2018/19, ECT use has remained relatively stable; suggesting that it is currently being used appropriately on patients, who are amongst the most severely unwell. The clinical effectiveness of ECT remains high however, it has slightly dipped by 6%.

Changes in seizure duration during acute course electroconvulsive therapy

Seizure duration has long been measured as a potential marker of ECT treatment efficacy, with concern that short seizures may be clinically ineffective. Relatively small studies have documented a trend towards shorter seizures during acute course ECT, but data from large cohorts would help provide normative data on seizure duration changes during treatment. This study analyzes the effects of age, sex, ECT dose, and treatment number on the duration of electrographic seizures during acute course ECT in a large single-center cohort. A single-center retrospective chart review was conducted of adult patients receiving a first course of ECT from 2000 to 2017at a large freestanding psychiatric hospital. 3648 patients met inclusion criteria, receiving 32,879 acute course ECT treatments. There was a shortening of mean ECT seizure duration over the acute course, with the greatest decrease in duration over the first 3 treatments but continuing decreases over the entire acute course. Older age, higher ECT dose, and increasing treatment number were all associated with shorter seizures, while sex was not significantly associated. Increasing treatment dose was associated with shorter seizures relative to no dose increase, with those patients receiving the highest cumulative doses also having the shortest cumulative seizure time. Among patients undergoing acute-course ECT treatment, seizure duration decreased over the treatment course, and increases in applied electrical charge were associated with shorter seizures.

Obsessive compulsive disorder: a case of extreme obsessional slowness in an 18-year-old presenting to the national OCD unit

ObjectiveObsessional slowness in OCD is a rare phenomenon on which there is minimal published literature. This is a particularly severe and atypical case of early onset OCD with extreme obsessional slowness and mutism. To the best of our knowledge, there have been no reports of similar severity published in this age group. This report seeks to provide discussion of important organic causes that may need to be considered as well as information on treatment approach.Case reportAn 18-year-old male was admitted to the National OCD Unit, Springfield Hospital with a history of autism and normal development until the age of 14, after which symptoms of OCD with fear of contamination emerged, followed by progressive motor slowness and mutism.Due to the severity of OCD and self-neglect he had two previous admissions to CAMHS wards and required a course of ECT to treat catatonic symptoms age 17.Pharmacological treatment has included Aripiprazole 5 mg and Fluoxetine 60 mg, which the patient was taking at admission. The latter was subsequently switched to Sertraline 250 mg and Aripiprazole increased. As it was hypothesized that his obsessional slowness stemmed from severe levels of anxiety, Buspirone was also added.Therapy has been intensive, although communication difficulties have made targeting specific fears challenging as the exact nature of the intrusive thoughts remains unclear.DiscussionFollowing combined neurology and neuropsychiatry review, the patient spent four weeks in a general hospital for further investigation as it was initially felt an organic cause was likely. Initial differentials included Juvenile Onset Parkinson's or Wilson's disease. Both were subsequently ruled out and despite multiple investigations, no obvious organic cause was found. A markedly abnormal FDG PET scan showed findings usually seen in advanced dementia, but not necessarily clinically correlating to his current presentation.The OCD unit have continued to provide intensive input and tailored treatment programme, encouraging actions against any rules he has in place. Prompting and pacing, verbal exercises and regular stretching exercises due to stooped posture which he attributed to needing to obey certain rules have been used.ConclusionIt is important for clinicians to be aware of obsessional slowness in OCD and this report highlights a particularly rare and severe example in a young adult who has been difficult to treat. Organic causes may need to be considered and MDT approach to treatment is essential.

Effectiveness of maintenance electroconvulsive therapy-Evidence from modifications due to the COVID-19 pandemic.

ObjectiveContinuation and maintenance ECT (c‐/m‐ECT) are effective in the prevention of relapse and recurrence of both affective and psychotic disorders. However, data are scarce concerning the trajectories of severe mental disorders after the end of c‐/m‐ECT. This prospective study investigates the clinical outcome of patients with versus without modifications of their c‐/m‐ECT schedules.MethodsIn the context of the COVID‐19 pandemic, ECT capacities were restricted at many clinics in early 2020. All patients receiving c‐/m‐ECT in March and April 2020 at our department (n = 53, unipolar depression, bipolar disorder, schizophrenia) were followed up for six months to investigate the impact of treatment modifications imposed by the pandemic. Based on individual decisions, c‐/m‐ECT was either (a) continued without modification, (b) continued with reduced frequency, or (c) discontinued.ResultsBoth reduced frequency and discontinuation of c‐/m‐ECT were associated with significant clinical deterioration as measured by CGI‐I (Clinical Global Impression Scale ‐ Global Improvement) during the six‐month follow‐up when compared to the subgroup of patients without any treatment modification (p = 0.005, p = 0.011). Furthermore, patients with discontinued or reduced c‐/m‐ECT showed significantly higher rates of rehospitalizations (p = 0.028) and new acute courses of ECT (p = 0.018).ConclusionDespite the limitations of a heterogeneous and relatively small sample, our study strongly corroborates the effectiveness of c‐/m‐ECT in a real‐world population. Especially, patients with shorter time since index ECT seem to be at high risk for severe clinical deterioration in the case of treatment discontinuation or reduction.

Movement, mood and cognition: Preliminary insight into the effects of electroconvulsive therapy in depression through a data-driven resting-state connectivity analysis

IntroductionECT is an effective treatment for depression. Beyond its therapeutic effect on mood it has a unique impact on psychomotor and cognitive symptoms.Its mechanism of action remains still unclear. To investigate this, we set out to study the brain’s response to ECT from a large-scale brain-network perspective.ObjectivesThe aim of this study was to investigate changes in resting-state functional connectivity following ECT at the whole brain, between-network and within-network level, in patients with a depressive episode.MethodsResting-state FMRI data were collected from 17 patients with depression before and after an ECT course. Using a group independent component analysis approach, we focused on four networks that are known to be affected in depression: the salience network (SN), default mode network (DMN), cognitive executive network (CEN) and a subcortical network (SCN). Clinical measures including mood, cognition and psychomotor symptoms were assessed.ResultsECT increased connectivity of the left CEN with the left angular gyrus and left middle frontal gyrus. An increase in left CEN within network connectivity was observed. Both the right CEN and the SCN showed increased connectivity with the precuneus. Furthermore, the anterior DMN showed increased connectivity with the left amygdala. Finally, improvement of psychomotor retardation was positively correlated with an increase of within-posterior DMN connectivity.ConclusionsWe demonstrate that ECT induces a significant increase of connectivity at both the whole brain and within-network level. Furthermore, we provide first evidence on the association between an increase of within posterior DMN connectivity and an improvement of psychomotor retardation, a core symptom of depression.DisclosureNo significant relationships.

Looking beyond electroconvulsive therapy: A case report

IntroductionElectroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.ObjectivesTo present a case report of a patient with psychotic depression with partial response to ECT.MethodsClinical interviews and review of literature using the Pubmed platform.ResultsThe authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.ConclusionsECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.DisclosureNo significant relationships.

Effect of electrode placement on speed of response to ECT

ObjectiveElectroconvulsive therapy (ECT) can be rapidly effective in treating severe depression. Right unilateral (RUL) or bitemporal (BT) electrode placement may affect the speed of ECT effectiveness although our current understanding of demographic and clinical factors for predicting predict speed of response and remission with ECT is limited. We investigated differences in improvement speed and also time to achieving response and remission criteria between brief-pulse moderate-dose (1.5 x seizure threshold) BT ECT and high-dose (6 x seizure threshold) RUL ECT. Additionally, we explored the influence of demographic and clinical characteristics.MethodsSe analysed weekly 24-item Hamilton Depression Rating Scale scores obtained from severely depressed patients participating in the EFFECT-Dep trial (ISRCTN23577151). Improvement speeds in patients treated randomly with a course of either BT (n = 69) or RUL ECT (n = 69) were compared using independent sample t-tests. Weekly proportions of responders and remitters were compared using chi-square tests. Cox regression analyses were used to explore predictors of speed to achieve response and remission status.ResultsSe found no differences between RUL and BT ECT in speed of improvement or time to achieve response or remission. Exploratory analyses indicated that a wide variety of demographic and clinical features did not serve to predict speed of response and remission to ECT.ConclusionElectrode placement did not substantially influence speed of improvement, response and remission with twice-weekly brief-pulse ECT. Minimising the cognitive side-effects of ECT may be of more relevance when choosing between BT and RUL electrode placement for ECT.DisclosureDeclan M. McLoughlin has received speaker’s honoraria from Mecta and Otsuka and an honorarium from Janssen for participating in an esketamine advisory board meeting. The other author reports no conflicts of interest. This work was supported by awards from

Neurocognitive functioning after electroconvulsive therapy in late-life depression: A 4-year prospective study.

Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side effects of ECT in older patients. In this study, we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression (LLD) from before the start until 4years after the index ECT course. Fourty one patients aged 55years and older with a unipolar depression, referred for ECT, were included. The neuropsychological test battery was assessed prior to ECT, 6months, 1year, 2years, 3years, and 4years after the last ECT session. We did not find any statistically significant cognitive changes from before the start to 4years after ending the ECT course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level. Cognitive performance in patients with LLD runs a stable course from before the start of ECT until 4years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long-term cognitive side effects.

Rate of continuing acute course treatment using right unilateral ultrabrief pulse electroconvulsive therapy at a large academic medical center.

Right unilateral ultrabrief pulse (RUL-UBP) ECT has emerged as a promising technique for minimizing cognitive side effects of ECT while retaining clinical efficacy, but it is unknown how often patients will require alternative treatment parameters and at what point in the treatment course this occurs. To better define this problem, this study analyzes continuation in RUL-UBP ECT in a retrospective cohort of patients beginning acute course treatment. A single-center retrospective chart review was conducted of adult patients receiving a first lifetime course of ECT from 2010 to 2017 starting with RUL-UBP treatment parameters. 1793 patients met study criteria. Patients received a mean of 10.0 ± 3.2 ECT treatments, of which a mean of 8.4 ± 3.4 were RUL-UBP treatments; proportion using RUL-UBP through 12 treatments was 57.8%. In total, 65.6% of patients were treated with RUL-UPB ECT exclusively. Mean dose increased from 7.6 × seizure threshold at the second RUL-UBP treatment to 14.3 × seizure threshold at the twelfth RUL-UBP treatment. Rates of continuation in RUL-UBP ECT did not differ based on age or on primary diagnosis of major depression vs. bipolar disorder. Among patients beginning acute-course treatment using RUL-UPB ECT, two thirds were treated with these parameters exclusively. Among patients who received twelve RUL-UBP treatments, mean final dose was 14.3 × seizure threshold. Further studies regarding optimal dosing of RUL-UBP ECT are indicated.

The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode

BackgroundElectroconvulsive therapy (ECT) technique is often changed after insufficient improvement, yet there has been little research on switching strategies. ObjectiveTo document clinical outcome in ECT nonresponders who were received a second course using high dose, brief pulse, bifrontotemporal (HD BP BL) ECT, and compare relapse rates and cognitive effects relative to patients who received only one ECT course and as a function of the type of ECT first received. MethodsPatients were classified as receiving Weak, Strong, or HD BP BL ECT during three randomized trials at Columbia University. Nonresponders received HD BP BL ECT. In a separate multi-site trial, Optimization of ECT, patients were randomized to right unilateral or BL ECT and nonresponders also received further treatment with HD BP BL ECT. ResultsRemission rates with a second course of HD BP BL ECT were high in ECT nonresponders, approximately 60% and 40% in the Columbia University and Optimization of ECT studies, respectively. Clinical outcome was independent of the type of ECT first received. A second course with HD BP BL ECT resulted in greater retrograde amnesia immediately, two months, and six months following ECT. ConclusionsIn the largest samples of ECT nonresponders studied to date, a second course of ECT had marked antidepressant effects. Since the therapeutic effects were independent of the technique first administered, it is possible that many patients may benefit simply from longer courses of ECT. Randomized trials are needed to determine whether, when, and how to change treatment technique in ECT.

Maintenance Electroconvulsive Therapy Meeting Unmet Needs of Antipsychotics in Older Patients: A Case Report

This case report highlights problems encountered by psychiatrists when treating a 68-year-old female patient who presented with a first episode of psychosis. She suffered from constipation, an anticholinergic side effect of quetiapine and both anticholinergic and extrapyramidal side effects of olanzapine. Finally, she was able to tolerate a combination of two pharmacologically different antipsychotics namely olanzapine and aripiprazole combined with a course of ECT followed by maintenance ECT. The authors would like to highlight maintenance ECT as part of the solution to patients who find it difficult to tolerate antipsychotics. Especially when only low doses of antipsychotics can be tolerated by the patient.

Educating PhD students for knowledge-driven society

Universities educate students for working in knowledge-driven societies. Whereas subject-related knowledge is part of every curriculum, institutions of higher education fail to teach systematically how to utilize and benefit from today’s variety of digital tools. Students and researchers are mostly unaware of what they lack to work more effectively and efficiently and to benefit from existing knowledge. Since this lack of awareness is not obvious to students and researchers (unknown unknowns; you cannot miss something that you do not know), it is difficult to convince them that there is a gap that needs to be filled. &#x0D; In 2014, we decided to tackle this problem by creating and developing the course “Scientific Information Retrieval &amp; Management in Life Sciences and Chemistry”. The unique 2 ECTS course features a multi-level approach to obtain and employ scientific information and to get students information savvy. On one hand, the course demonstrates the bigger picture: We discuss the aspects of scientific writing and publishing, critical choice of data sources, patents, visualisation and design, text mining and data pipelining, knowledge generation, outreach and impact of publications. On the other hand, we highlight an extensive list of field-proven tools that can assist researchers in their daily activities. &#x0D; We also wanted to foster a lasting impact on how students utilize databases, tools, software, and web services. Thus, at the end of the course students have to write an essay describing their current information workflow or their (un)met information needs. These essays confirm and explain how the students changed their information use, and which parts of the course they may have not understood. Moreover, essays that describe unmet information needs allow us to explore possible solutions and to work with our vendors. In our talk, we will share the concept for the course and report on our experiences.