Electroconvulsive Therapy Research Articles

Challenges in maintaining remission after ECT - Insights from a six-month follow up study.

Electroconvulsive therapy (ECT) is a widely recognized treatment for severe depressive disorders, particularly in cases of inadequate response to pharmacological interventions or when rapid symptom relief is essential. Although ECT demonstrates high efficacy, a notable proportion of patients relapse after a successful ECT course. This study investigated clinical baseline characteristics and residual depressive symptoms associated with relapse - defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score >15, restart of ECT, or suicide attempt - within six months after successful ECT. Data were obtained from the PROTECT study, a single-site, prospective cohort study conducted at the University Psychiatric Center Duffel, Belgium. - Among the 65 patients who completed the ECT course, 40 patients (62%) achieved remission. At six months, 32 patients were reassessed, and 18 (56%) of them experienced relapse. No significant associations were identified between relapse and baseline factors, including age, social circumstances, baseline depression severity, psychomotor symptoms, cognitive functioning, treatment resistance, lithium use, or the presence of psychotic or melancholic features. Residual depressive symptoms at the end of the ECT course also did not predict relapse. - The observed high relapse rate underscores the critical need for robust continuation and maintenance strategies following ECT. Future research should prioritize larger cohorts to better identify predictors of relapse and optimize post-ECT treatment protocols.

Trajectory of peripheral inflammation during index ECT in association with clinical outcomes in treatment-resistant depression.

Electroconvulsive therapy (ECT) is a highly efficacious intervention for severe and intractable depression. Evidence suggests ECT provokes an initial acute inflammatory response that subsequently decreases with repeated administration. However, relationships between inflammatory changes and clinical effects are unclear. Improved understanding of these processes may provide critical insight into effective intervention for treatment-resistant depression (TRD). Plasma inflammatory markers were assessed at pre-treatment (T1), after the second ECT session (T2), and after ECT index series completion (post-treatment/T3) in TRD (n=40). Changes were examined over time and in association with post-treatment Responder/Non-responder status (≥50% reduction in global depression severity) and percent change in affective, cognitive and neurovegetative depressive symptom domains. C-reactive protein (CRP) and interleukin-6 (IL-6) increased from pre-treatment to T2, and decreased from T2 to post-treatment. Neither early (%T2-T1) nor total (%T1-T3) change in inflammation predicted clinical outcomes, however, the interaction between early/acute inflammatory response and post-treatment inflammation (relative to baseline) was associated with clinical outcomes. Larger initial increases in IL-6 predicted greater reductions in both affective and cognitive symptoms in subjects with higher post-treatment IL-6; those with lower post-treatment IL-6 trended toward the opposite. The same was found between changes in CRP and neurovegetative symptoms. Though preliminary, these results demonstrate how processes involved in the acute inflammatory response to ECT may differentially influence clinical outcomes depending on overall trajectory of inflammation following ECT. Findings also highlight the importance of examining symptom-specific changes in depression when studying treatment mechanisms, rather than relying solely on global measures of severity.

Impact of electroconvulsive therapy on inflammatory markers in patients with severe mental disorders.

Evaluation of the effects of electroconvulsive therapy (ECT) on systemic inflammatory markers in patients with severe mental disorders and determination of potential clinical predictors of treatment response. The current retrospective cohort study included 156 patients with psychotic and mood disorders who underwent ECT. Pre- and post-ECT blood samples were collected to assess inflammatory markers, including C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and other complete blood count derived indices. Clinical outcomes were measured using the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Severity (CGI-S). Significant reductions in several inflammatory markers were identified, including NLR, monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), CRP and CRP-albumin ratio, following ECT. Both BPRS and CGI-S scores also showed marked improvement post-ECT. Psychotic presentation was identified as a predictor of greater symptom improvement; changes in inflammatory markers were not significantly correlated with clinical outcomes. ECT can reduce systemic inflammation in patients with severe mental disorders; however, this reduction may not directly correspond to clinical improvement. These findings suggest that inflammation plays a complex role in the therapeutic effects of ECT.

Neuromodulatory techniques in eating disorders: From electroconvulsive therapy to transcranial magnetic stimulation and beyond: A mixed method systematic meta-review.

Psychosocial and pharmacological interventions can effectively treat eating disorders (EDs), but improvements are often short-term and modest. Neuromodulation, altering nerve activity through targeted neurological stimulation, is an emerging intervention in neuropsychiatric disorders. This meta-review synthesizes evidence on neuromodulatory techniques in ED patients, identifying research gaps and future directions. PubMed/Medline, EMBASE, and PsycINFO were searched using relevant terms. Only systematic reviews or meta-analyses reporting on neuromodulatory techniques in ED patients were included. Three evaluators extracted data, resolving discrepancies with two experienced researchers. Study quality was assessed using AMSTAR-2. Defined outcomes and effect sizes were reported for systematic reviews, and pooled effect sizes and heterogeneity information for meta-analyses. Eighteen systematic reviews (five meta-analyses) were included, with minimal primary study overlap (<5%). Most focused on anorexia nervosa (AN), some on treatment-resistant cases, and others on bulimia nervosa (BN) and binge eating disorder (BED). The quality of most systematic reviews was critically low, and they often combined observational studies with randomized-controlled trials (RCTs). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed promising results in RCTs, managing binge eating and craving levels more effectively than body mass index in AN. Side effects included headaches, nausea, and drowsiness for rTMS and tDCS, and rare instances of seizures and infection with deep brain stimulation. Neuromodulation holds promise for treating EDs. Future studies should prioritize RCTs, objective outcome measures, longer follow-up for stability assessment, and comprehensive adverse event monitoring.

Misidentification syndromes: A retrospective study from India.

Delusional misidentification syndromes (DMS) are rare neuropsychiatric syndromes. Most of the available data on DMS is from the developed countries. The present retrospective analysis was conducted on patients utilizing the psychiatry services in a North Indian tertiary care hospital. Out of the 2596 treatment records that were screened, DMS was seen in 20 (0.77 %) patients. Majority of the patients exhibiting the phenomenon in patients diagnosed with schizophrenia (N = 13) and schizoaffective disorder (N = 3). Females (N = 14) outnumbered males (N = 6), and the most common DMS noted was Capgras syndrome. The study found that 12 out of 16 patients with schizophrenia or schizoaffective disorder with DMS had treatment-resistance, necessitating the use of clozapine, with 4 patients also requiring electroconvulsive therapy. The study highlights the fact that DMS is a rare neuropsychiatric syndrome seen in patients with schizophrenia and schizoaffective disorder, and respond poorly to conventional antipsychotics.

Indicative biomarkers of Lewy body disease as predictors of treatment resistance in late-onset depression.

Late-onset depression (LOD) may indicate the prodromal phase of Lewy body disease (LBD) and is often associated with treatment resistance. However, the relationship between treatment resistance and indicative biomarkers of LBD is still unknown. This retrospective study investigated whether 123I-ioflupane dopamine transporter single-photon emission computed tomography (DaT-SPECT) and 123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy can predict treatment resistance in hospitalized patients with LOD. The study included 79 inpatients diagnosed with LOD between October 2018 and September 2023 at a geriatric psychiatry ward. DaT-SPECT and MIBG cardiac scintigraphy were used to assess dopaminergic and autonomic function, respectively. Treatment resistance was defined as an inadequate response to antidepressant monotherapy, where cases require electroconvulsive therapy (ECT) analyzed as a distinct group. Logistic regression showed that DaT-SPECT abnormalities significantly predicted nonresponse to antidepressant monotherapy (OR = 4.70, p=0.013). While oral sensory hallucinations, another clinical marker linked to dopaminergic dysfunction, did not significantly predict treatment response, MIBG cardiac scintigraphy findings enhanced predictive accuracy for severe cases requiring ECT. Additionally, the Cochran-Armitage test indicated that the likelihood of nonresponse to antidepressant monotherapy and the need for ECT increased significantly with a higher number of abnormal LBD biomarkers (z=7.37, p=0.007; z=10.91, p<0.001, respectively). These results suggest that neurodegenerative processes in the prodromal phase of LBD may contribute to treatment resistance in LOD. The combination of DaT-SPECT and MIBG cardiac scintigraphy improves early identification of treatment resistance, supporting more timely and personalized interventions for hospitalized patients with LOD.

The acute effect of bitemporal electroconvulsive therapy on synchronous changes in heart rate variability and heart rate in patients with depression

Objective.The transient autonomic nervous system responses induced by electroconvulsive therapy (ECT) may serve as critical indicators of treatment efficacy and potential side effects; however, their precise characteristics remains unclear. Considering that the intense stimulation of ECT may disrupt the typical antagonistic relationship between the sympathetic and parasympathetic branches, this study aims to conduct a meticulous analysis of the rapid changes in heart rate variability (HRV) and HR during ECT, with a particular focus on their synchronized interplay.Methods.Pulse interval sequences were collected from 50 sessions of bitemporal ECT administered to 27 patients diagnosed with major depressive disorder. The average HR and ultra-short term HRV indices RMSSD and SDNN, as well as the Poincaré indices SD1, SD2 and SD2/SD1, were calculated using a 10 s sliding window with a step size of 1 s. In particular, the synchronous changes between SD1, SD2, SD2/SD1 and HR were analyzed.Results.The synchronous changes of the indices showed different characteristics over time. In particular, SD1, SD2 and HR increased significantly by 41.50 ± 11.45 ms, 33.97 ± 10.98 ms and 9.68 ± 2.00 bpm respectively between 8 and 20 s, whereas they decreased significantly by 19.89 ± 9.07 ms, 17.54 ± 8.54 ms and 3.80 ± 1.33 bpm respectively between 45 and 53 s after ECT stimulus onset. SD1 and SD2 both had highly significant positive correlations with HR in the above phases.Conclusion.The results suggest that bitemporal ECT induces the sympathetic and parasympathetic co-activation during the early ictal period and brief co-inhibition approximately 45 s after stimulus. Our findings may provide new insights comprehending the mechanisms of ECT and its associated cardiovascular risks.

Differential Effects of Electroconvulsive Therapy on Patients with Schizophrenia Versus Depressive Disorder: Clinical Distinction Between Antipsychotic and Antidepressant Effects of Electroconvulsive Therapy

Objective: Electroconvulsive therapy (ECT) is utilized for treating psychiatric disorders, such as schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). We aimed to compare pre- and post-ECT treatment outcomes between patients with SCZ and a combined group of patients with MDD and BD (MDD+BD) to assess the distinction between the antipsychotic and antidepressant effects of ECT. Methods: ECT was administered to patients with SCZ (n = 17) and those with MDD+BD (n = 7). Symptoms were evaluated using the brief psychiatric rating scale (BPRS), clinical global impression scale (CGI), and global assessment of functioning (GAF). Plasma brain-derived neurotrophic factor (BDNF) levels were also measured. Results: The BPRS, CGI, and GAF scores significantly differed after ECT compared with those before ECT in each patient group. However, no significant differences were observed between the groups for each disorder. No significant differences were observed in plasma BDNF levels between the groups at baseline and during ECT. At baseline, only depression scores were more favorable in the SCZ group, whereas positive symptoms and disorganization scores were higher in the MDD+BD group. During treatment, positive symptoms, activation, and disorganization items were significantly more favorable in the MDD+BD group compared with the SCZ group. Total BPRS scores were not associated with plasma BDNF levels; however, rating scores of the several items related to activation, resistance, and disorganization were positively correlated with BDNF levels. Conclusion: ECT effects on several clinical outcomes in the MDD+BD group were associated with plasma BDNF levels. These findings suggest that ECT may be more effective for treating MDD than SCZ.

Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability: An Observational Study.

Catatonia is a highly morbid psychomotor and affective disorder, which can affect autistic individuals with and without intellectual disability. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments in autistic individuals has not been described. We conducted a prospective observational cohort study of patients with autism and co-morbid catatonia who received outpatient care in a specialized outpatient clinic from July 1, 2021 to May 31, 2024. Data investigating pharmacologic interventions, and clinical measures including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical Global Impression-Improvement (CGI-I) were collected. Forty-five autistic patients with co-morbid catatonia were treated during the study period. The mean age was 15.6 (SD = 7.9) years [Mdn = 16.0, range 6.0-31.0]. Forty-one patients (91.1%) met criteria for autism with co-occurring intellectual disability. All patients received pharmacotherapy. Forty-four (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD = 15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than one medication class for treatment. Sixteen (35.6%) patients received electroconvulsive therapy. Fourteen patients (31.1%) attempted to taper off benzodiazepines after achieving clinical improvement during the study period; of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9 (17.8%) discontinued the taper due to a return of catatonic symptoms. Statistically significant improvement was observed across all clinical domains except the KCS. However, the majority remained at least partially symptomatic over the study period. Three patients (6.7%) died over the study period. Despite clinical improvements while receiving the gold standard for psychopharmacologic management of catatonia, chronic symptoms remained for the majority of catatonia patients over the study period, and few were able to taper and discontinue benzodiazepine treatment. Notably, the open label design of this study is a limiting factor when interpreting the results.

P-03 NORMALIZATION OF THE DEXAMETHASONE SUPPRESSION TEST FOLLOWING PSYCHIATRIC TREATMENT IN A PATIENT WITH PSYCHOTIC DEPRESSION: A CASE REPORT

Abstract Introduction Cushing's syndrome (CS) is characterized by hypercortisolism and is typically diagnosed through clinical and laboratory evaluations. However, severe depression can lead to misleading results. In this case, a patient with severe depressive symptoms initially showed abnormal dexamethasone suppression test (DST) results, which normalized following psychiatric treatment. This case highlights the impact of psychiatric conditions on CS assessment and demonstrates how psychiatric intervention can influence test outcomes. Clinical Case A 67-year-old male patient with a known diagnosis of psychotic depression was referred to our outpatient clinic for hormonal evaluation after a left adrenal mass was detected. Physical examination revealed no signs of hypercortisolism. The patient's blood pressure was 100/70 mmHg, weight 50 kg, height 168 cm, and BMI 17 kg/m². Initial tests revealed that the nadir cortisol level after a 1 mg DST was not suppressed, with a value of 16 µg/dL. Additional tests for hypercortisolism were ordered. The patient’s 24-hour urinary free cortisol (UFC) was 97 µg/dL (normal: &amp;lt;130 µg/dL), and late-night salivary cortisol was 0.64 ng/mL (normal: &amp;lt;2.74 ng/mL), both within normal ranges. An ACTH level of 121 pg/mL was noted, leading to a planned evaluation for ACTH-dependent hypercortisolism. The laboratory results are presented in Table 1. The patient underwent dynamic contrast-enhanced 3-Tesla MRI to evaluate ACTH-dependent hypercortisolism. The sella MRI did not reveal any adenoma or other pathology. Due to the patient's agitation, bilateral inferior petrosal sinus sampling could not be performed. Given the absence of clinical signs of hypercortisolism, the patient’s psychiatric treatment was adjusted, and a re-evaluation from an endocrinological perspective was planned. Following nine sessions of inpatient electroconvulsive therapy, during which the patient was initiated on olanzapine 20 mg once daily and venlafaxine 150 mg once daily, he was discharged and continued these medications as part of his outpatient treatment. The patient was subsequently reassessed in the endocrinology clinic. With the adjusted psychiatric treatment, the patient’s nadir cortisol level after 1 mg DST decreased to 0.78 µg/dL. 24-hour UFC and late-night salivary cortisol levels were within normal ranges. It was concluded that the untreated psychiatric disorder had affected the DST results. The patient was placed under regular follow-up by the psychiatric unit. Conclusion This case underscores the potential impact of untreated psychiatric disorders on diagnostic tests for CS, such as the DST. The normalization of test results following effective psychiatric treatment highlights the importance of considering psychiatric conditions in the comprehensive laboratory evaluation of patients, particularly those without clinical signs of hypercortisolism.Table 1:The laboratory test resultsACTH=Adrenocorticotropic hormone; DST=Dexamethasone suppression test; HbA1c=Hemoglobin A1C; UFC=Urinary free cortisol

A Retrospective Analysis of the Impact of Electroconvulsive Therapy on Anxiety Symptoms in Patients With Treatment-Resistant Depression.

Electroconvulsive therapy (ECT) is an effective treatment for treatment-resistant depression (TRD). There are limited data on the improvement of anxiety symptoms in patients receiving ECT for TRD. The aim of the study was to examine the extent to which anxiety symptom severity improves, relative to improvements in depressive symptoms, in TRD patients receiving an acute course of ECT. A retrospective chart review of 117 TRD patients who received an acute ECT course in a naturalistic outpatient setting was conducted. Symptomatic response was measured using the Beck Depression Inventory II and Generalized Anxiety Disorder 7 Scale. Two generalized estimating equation models assessed the degree of change in anxious symptoms relative to the change in depressive symptoms. Both depression (-0.09, P < 0.001) and anxiety (-0.08, P < 0.001) improved after ECT treatment, with a greater standardized decrease for symptoms of depression. Higher levels of anxiety over the treatment (-0.42, P < 0.001) were associated with smaller antidepressant improvements. ECT may improve symptoms of anxiety in patients with TRD. Anxiety symptoms show a favorable trajectory of improvement, though to a lesser extent, relative to changes in symptoms of depression. Higher symptoms of anxiety throughout the treatment course may be a negative predictor of antidepressant response in ECT.

Changes in Cerebral Hemodynamic Among Patients With Schizophrenia or Bipolar Disorder Receiving Electroconvulsive Therapy: A Task-Related Functional Near-Infrared Spectroscopy Study.

There remains a scarcity of studies to evaluate the treatment effect of electroconvulsive therapy (ECT). Functional near-infrared spectroscopy (fNIRS) offers a cost-effective method to measure cerebral hemodynamics. This study used fNIRS to evaluate the effect of ECT in patients suffering from schizophrenia or bipolar disorder (manic phase). Thirty patients with mania and 31 with schizophrenia were recruited. Each participant received 6 sessions of ECT. This study utilized the Positive and Negative Syndrome Scale, Young Mania Rating Scale, and fNIRS-verbal fluency test paradigm at baseline and after each session of ECT. The prefrontal cortex hemodynamic response during the performance of verbal fluency test was recorded via a commercial wireless high-density continuous-wave fNIRS system device. The effect of categorical and continuous variables was determined using Pearson's chi-square test and Student's t test or 1-way analysis of variance with Bonferroni-corrected post hoc pairwise comparison, respectively. Comparing the Positive and Negative Syndrome Scale and Young Mania Rating Scale scores between baseline, sessions 3 and 6, the scores were significantly decreased (P < 0.001), with both patient groups achieving more than 50% reduction in scores from baseline to session 6. The fNIRS also showed significant increases in oxy-hemoglobin levels (session 6 vs baseline) in the right ventrolateral prefrontal cortex and left dorsolateral prefrontal cortex for both patient groups (P < 0.05). There were significant correlations in the reduction of symptom severity and increase in HbO2 levels in people with bipolar disorder (manic phase) and schizophrenia (P < 0.05). Monitoring the activation in the right ventrolateral prefrontal cortex and left dorsolateral prefrontal cortex is an objective ECT monitoring indicator for patients suffering from bipolar disorder (manic phase) or schizophrenia.

Neuromonitoring-guided anesthesia depth versus four-minute anesthesia-to-stimulation time interval in electroconvulsive therapy for depressive disorders - A single-blinded, prospective, randomized and controlled study.

Anesthesia depth influences seizure quality in patients undergoing electroconvulsive therapy (ECT). EEG-based neuromonitoring has been shown to detect adequate anesthesia depth for ECT. Anesthesia depth-guided ECT management may therefore be a reliable alternative to the predetermined anesthesia-to-stimulation time interval. Patients with depressive disorders and a Montgomery-Asberg Depression Rating Score ≥ 18 were randomly assigned. The anesthesia depth-guided group received stimulation between Narcotrend™ index ratings of 41 and 64 and was compared to the control group with a predetermined anesthesia-to-stimulation time interval of four minutes. The primary endpoint was seizure quality. A total of 225 interventions were conducted in 30 patients. Significant differences were observed between the two groups regarding stimulation intervals (225.0 ± 34.2 s vs. 240.0 ± 0 s; p < 0.001) and the index before electric stimulation (45.0 ± 15.7 vs. 35.0 ± 13.0; p < 0.001). No significant differences in overall seizure quality were found between the groups. The midictal amplitude was higher in the anesthesia depth-guided group (209.2 ± 92.6 vs. 152.6 ± 80.0; p = 0.009). Because of inadequate anesthesia depth, 54 interventions were discontinued for safety reasons. The number of per protocol completed interventions is small due to high exclusion rate from protocol violations. Anesthesia depth-guided ECT management did not significantly improve overall seizure quality compared to a four-minute anesthesia-to-stimulation time interval.

Oral Esketamine as Alternative for Maintenance Electroconvulsive Therapy in Patients With Treatment-Resistant Depression: A Case Series.

This study investigates repeated oral esketamine as a substitution strategy for maintenance electroconvulsive therapy (M-ECT) in eight patients with treatment-resistant depression (TRD). In a 6-week dosing phase, esketamine was titrated from 0.5 or 1.0 mg/kg to a maximum of 3.0 mg/kg twice weekly. Outcomes included 6-week change in Inventory of Depressive Symptomatology - Self-rated (IDS-SR), Hamilton Depression Rating Scale - 17 items (HDRS17), and Outcome Questionnaire 45 (OQ-45), along with esketamine treatmentcontinuation. Depression severity remained stable or improved in five patients, whereas three experienced worsening symptoms and resumed M-ECT. OQ-45 scores were available for five patients, all of whom showed improvement. Currently, four patients are still receiving oral esketamine. Repeated oral esketamine may be a suitable and patient-friendly alternative to M-ECT. We recommend controlled trials to compare long-term safety and efficacy.

Mental Health-Related Disability Days and Costs Among Patients with Treatment-Resistant Depression Initiated on Esketamine Nasal Spray and Conventional Therapies in the USA.

Treatment-resistant depression (TRD) is related to disproportionate unemployment and productivity burden in the USA. The current study describes real-world mental health (MH)-related disability days and costs of patients with TRD initiated on esketamine nasal spray or conventional therapies in the USA. Adults with TRD were selected from Merative™ MarketScan® Commercial database (from January 2016 to January 2023) and classified into four cohorts (esketamine, ECT [electroconvulsive therapy], TMS [transcranial magnetic stimulation], and SGA [second-generation antipsychotics] augmentation) based on therapy initiated (index date) on/after 5 March 2019 (esketamine approval date for TRD). Patients had ≥ 12 months of health plan eligibility pre-index date and disability information available pre-and post-index in the Merative™ MarketScan® Health and Productivity Management database (from January 2016 to December 2021). MH-related disability days (i.e., short- or long-term) and associated costs (US dollars [USD] 2022) were reported per-patient-per-month for the 6 months pre- and post-index. The study comprised four cohorts: esketamine (n = 107; mean age: 45.5 years, female: 54.2%), ECT (n = 55; mean age: 47.6 years, female: 41.8%), TMS (n = 443; mean age: 46.1 years, female: 57.3%), and SGA (n = 4374; mean age: 44.8 years, female: 59.1%). In month 6 pre-index, mean number of MH-related disability days was 1.7 in the esketamine cohort, 1.2 in the TMScohort, 1.3 in the ECTcohort, and 0.8 in the SGA augmentation cohort; mean MH-related disability costs were US $443 in the esketamine cohort, US $339 in the TMScohort, US $178 in the ECTcohort, and US $143 in the SGA augmentation cohort. In all cohorts, a peak in mean MH-related disability days and costs was observed 1 month after therapy initiation followed by a decreasing trend. In month 6 post-index versus month 6 pre-index, the mean number of MH-related disability days trended lower in the esketamine cohort (- 0.4 days), remained the same in the TMS cohort and largely the same in the SGA augmentation cohort (+ 0.1 days), and trended higher (+ 1.6 days) in the ECT cohort. In the same timeframe, MH-related disability costs trended lower in the esketamine and TMS cohorts, with observed reductions of US $312 and US$123, respectively. Costs remained largely the same in the SGA augmentation cohort (+US $26), and trended higher (+US $353) in the ECT cohort. In this descriptive study, initiation of esketamine was associated with trends toward lower MH-related disability days and costs. Conventional therapies demonstrated varied patterns, with no consistent trend toward reductions in disability days across all therapies and no observed cost-savings trends for SGA augmentation and ECT. These trends suggest potential economic and societal gains of esketamine treatment for TRD but warrant further investigation with larger samples and robust statistical comparisons.

Alterations in resting-state EEG functional connectivity in patients with major depressive disorder receiving electroconvulsive therapy: A systematic review.

Electroconvulsive therapy (ECT) is highly efficacious for the treatment of major depressive disorder (MDD), but its mechanisms still require clarification. Even though depression is associated with alterations in functional connectivity (FC), EEG studies investigating effects of ECT on FC have not been systematically reviewed. Understanding these effects may help to identify the role of functional brain circuits in depression and its remission. This systematic review aimed to synthesize EEG studies investigating FC changes in ECT-treated patients with depression. A systematic literature search was conducted following PRISMA guidelines. Peer-reviewed studies on pre-to post-ECT resting-state EEG FC changes in adult patients with MDD were included. Three of 143 studies were included, of which two reported reduced FC in the alpha and beta frequency bands and increased theta band FC in patients with ECT-treated MDD. Changes in alpha band FC were associated with treatment outcomes. Patients with MDD exhibit increased electrophysiological resting-state alpha band FC, particularly frontally, compared with healthy subjects. Thus, ECT-induced decrease might indicate a trend toward normalization of oscillatory brain rhythms. As brain oscillations have been proposed to be involved in neuronal synchronization, which is important for communication between networks, the potential restoration in patients with depression and the association of FC changes with clinical improvement may indicate a potential mechanism of action of ECT. Understanding ECT's underlying mechanisms might ultimately enable treatment optimization, thus enhancing patient care. However, the number of studies is limited, with low-to-moderate EEG study quality, small sample sizes, and different electrophysiological FC measures.

Optimising the mechanism of electroshock treatment on the tensile behaviour of the laser melting deposited Ti55531 alloy

ABSTRACT As an important additive manufacturing method, laser melting deposition (LMD) can be utilised to manufacture many high-property components. In this work, the Ti55531 alloy (Ti-5Al-5V-5Mo-3Cr-1Zr) is manufactured by LMD, and a novel electroshock treatment (EST) is introduced to modify the tensile properties of LMD Ti55531. The microstructure of LMD Ti55531 is an alternating arrangement of columnar and equiaxed β grains. The α phase has not undergone an obvious phase transition after 0.06 s EST, and many fine α phase precipitates with EST time increased to 0.08 s. The reduction of dislocations in the trigeminal grain boundary areas improves the ability to accommodate dislocations and plastic deformation, which improves the elongation of LMD Ti55531 from 14.5% to 17.6% without the loss of tensile strength after 0.06 s EST. The precipitation of the fine α phase in the β phase weakens the ability of the sample to withstand plastic deformation after 0.08 s EST, which reduces the elongation. All results indicate that EST is an effective and novel way to optimising the tensile properties of LMD titanium alloys.

Early career psychiatrists' perceptions of and training experience in electroconvulsive therapy: A cross-sectional survey across Europe.

Electroconvulsive therapy (ECT) is a safe and effective treatment for several major psychiatric conditions, including treatment-resistant depression, mania, and schizophrenia; nevertheless, its use remains controversial. Despite its availability in some European countries, ECT is still rarely used in others. This study aims to investigate the experiences and attitudes of early career psychiatrists (ECPs) across Europe towards ECT and to examine how their exposure to ECT influences their perceptions. In Europe, a cross-sectional survey was conducted among ECPs, including psychiatric trainees and recently fully qualified psychiatrists. A total of 573 participants from 30 European countries were included in the study, of whom more than half (N=312; 54.5%) received ECT training. Overall, ECPs had a positive attitude towards ECT, with the vast majority agreeing or strongly agreeing that ECT is an effective (N=509; 88.8%) and safe (N=464; 81.0%) treatment and disagreeing or strongly disagreeing that ECT was used as a form of control or punishment (N=545; 95.1%). Those who had received ECT training during their psychiatry training were more likely to recommend ECT to their patients (p<0.001, r=0.34), and held more positive views on its safety (p<0.001, r=0.31) and effectiveness (p<0.001, r=0.33). Interest in further education about ECT was moderately high (modal rating on Likert scale: 4, agree), irrespective of prior training exposure. ECT training is associated with more favorable perceptions of its safety and effectiveness among ECPs. There is a general willingness among ECPs to expand their knowledge and training on ECT, which could enhance patients' access to this treatment.

NORSE secondary to anti-GAD65 antibody-positive encephalitis treated with novel adjunctive rapid titrationVNS protocol.

New Onset Refractory Status Epilepticus (NORSE) is a rare and severe condition characterized by refractory seizures in individuals without a prior history of epilepsy. This case report describes a 37-year-old woman diagnosed with anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody-positive encephalitis-related NORSE. Her seizures were refractory to multiple interventions, including anti-seizure medications, anesthetics, immunotherapies, a ketogenic diet, and electroconvulsive therapy. Seizures recurred twice during the tapering of anesthetic medications. However, after 32 days of treatment, the seizures were successfully controlled. To maintain seizure control and facilitate the weaning of anesthetics, a Vagus Nerve Stimulator (VNS) was implanted using a novel rapid titration protocol. This allowed for the successful tapering of anesthetics by day 50, with no recurrence of seizures. At her 9-month follow-up, the patient remained seizure-free and had an improved quality of life. This case highlights that early initiation of immunosuppressive treatment may lead to a favorable prognosis. The novel application of VNS therapy assisted seizure control in NORSE, thus encouraging further research investigating the potential role of VNS in this condition. PLAIN LANGUAGE SUMMARY: New Onset Refractory Status Epilepticus (NORSE) is a rare and severe condition characterized by relentless seizures in individuals without a prior epilepsy history. This report shares the case of a 37-year-old woman with NORSE, associated with a high anti-glutamic acid decarboxylase 65 antibody titer. Her seizures were super-refractory, requiring multiple anti-seizure medications, anesthetics, immunotherapies, a ketogenic diet, and electroconvulsive therapy. Seizures recurred twice during the tapering of anesthetic medications. However, by hospital day 32, the seizures were successfully controlled with these interventions. To further stabilize seizure control and enable the successful discontinuation of anesthetics, a Vagus Nerve Stimulator (VNS) was implanted. The patient had no further seizures and gradually recovered back to her pre-disease baseline. This case suggests that a novel rapid VNS titration protocol could be a promising treatment option for NORSE, warranting further investigation.

Achieving Response With Bolus Dosing of Valproate in Electroconvulsive Therapy (ECT)-Induced Mania: A Case Report

Achieving Response With Bolus Dosing of Valproate in Electroconvulsive Therapy (ECT)-Induced Mania: A Case Report