Electroconvulsive Therapy Research Articles

An Investigation of Antipsychotic Activity of Plant Extracts in Experimental Animals

The current study is done on plant extracts as antipsychotic medication in ayurvedic formulation. The hallucinations are induced by electro shock therapy or apomorphine. After induction of hallucinations the plant extract is administered as standard group, control group and simple group of six albino rats and the results are screened and analyzed with standard drug comparision. Pre-treatment of MEIR (methanolic extract of Ipomoea reniformis) for 15days at the dose of 200 and 400 milligram per kilogram body weight was used to evaluate antipsychotic activity. The antipsychotic activity was also studied against Apomorphine induced stereotype behavior in rats, Pilocarpine induced purposeless chewing in rats and Apomorphine induced climbing behavior in mice. In pre-treatment studies of antipsychotic activity, MEIR at the dose of 200 and 400 milligram per kilogram body weight significantly (p<0.001) reduced the stereotyped behavior against Apomorphine induced stereotypy behavior model. In Pilocarpine induced purposeless chewing behavior, MEIR at the dose of 200 and 400 milligram per kilogram body weight significantly (p<0.01) decreased chewing behavior and in Apomorphine induced climbing behavior, MEIR significantly (p<0.001) reduced the climbing activity at the dose of 200 and 400 milligram per kilogram body weight. The results of the Pr (+) study suggest that the MEIR possess antipsychotic activity in rats and mice. The results of each activites are compared with standard medicament and evaluated. Keywords: Ipomoea reniformis, apomorphine, locust bean gum, pilocarpine, hallucinations, antipychotic activity

Electroconvulsive therapy use in New South Wales between 1944 and 1949.

To identify clinical and other factors associated with the use of electroconvulsive therapy (ECT) in New South Wales for the period 1944-1949 and to compare with contemporaneous practice. Annual reports of the Inspector-General of Mental Hospitals in NSW (1944/45 to 1948/49) were examined. Seven hospitals reported a total of 8964 courses of treatment during the period. Demographically, 60.6% of patients who received ECT were female, and rural hospitals reported 13.6% of courses. ECT was as likely to be given for non-affective psychoses (37.7%), as for affective psychoses (35.0%). ECT was also administered for confusional states and non-psychotic disorders. Better outcomes were observed for depression, anxiety and confusional states than non-affective psychoses. Recovery rates declined over the study period. Mortality was <1%. The clinical indications for ECT in the mid-twentieth century in NSW were much broader than currently. There has been no change in the sex ratio of patients administered ECT or reported mortality.

Effectiveness of the Combined Antipsychotic and Electroconvulsive Therapy (ECT) in Patients with First Episode Psychosis

Aim: This is a naturalistic controlled study to assess the efficacy of electroconvulsive therapy (ECT) as an augmentation strategy in patients with first episode psychosis (FEP). Subjects and methods: Sixty-five patients diagnosed with FEP according to DSM-IV -TR were included. Patients with affective psychosis and/or any other major psychiatric disorders or neurological disorders were excluded. Fifty patients were allocated to ECT group treated with combined antipsychotics and ECT therapy, with maximum 12 sessions, and 15 patients were allocated to non ECT group treated by antipsychotic medications only. Severity of symptoms and treatment response of the subjects in both groups were measured using Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) at admission and discharge, and the percentage of change in the scores of both groups were compared. Results: At baseline, the ECT group showed significantly higher severity of symptoms. At the endpoint both groups had a significant decrease from basal score, yet the ECT group showed highly statistically significant difference as regard the percentage of change as scored by the BPRS, CGI, and total PANSS and all its subscales. These differences were more pronounced in positive vs. negative symptoms. Conclusion: The combination of ECT and antipsychotic medications could be an effective early psychosis intervention and showed better results than antipsychotic drugs used alone. However, in contrast to our expectation it did not decrease the duration of hospitalization.

Long-Term Adverse Effects After Electroconvulsive Therapy (ECT): A Narrative Analysis Exploring People's Experiences, Meaning-Making, and Coping.

Approximately 2500 people receive electroconvulsive therapy (ECT) annually in the United Kingdom; however, there is growing evidence of long-term adverse effects. Few studies have focused on people's experience of ECT, particularly over the long term. The experience of ECT is known to be complex, requiring qualitative exploration. Therefore, this study aimed to explore the long-term adverse experiences of ECT, including psychological impacts, meaning-making, and coping. Narrative analysis considered thematic, structural, and performative elements of seven people's stories. Themes were explored across the timeline of participants' experiences. Before ECT, participants felt misinformed regarding ECT and misunderstood by healthcare professionals. They noticed immediate changes in their cognition, memory, and mood after ECT. Returning home was important in participants' discovery of differences. Long-term impacts were loss (of ability, memory, humanity, and connection), the realization that ECT had been damaging, and understanding ECT to have caused brain damage. The extensive nature of loss experienced by participants was comparable to the concept of ambiguous loss. They experienced a lack of follow-up care and denial of their experiences, which could contribute to psychological iatrogenic harm. Participants coped with adverse experiences by using prompts and strategies and connecting with others. Further research is needed into the adverse long-term effects of ECT, especially considering cognitive effects, memory loss, and how these contribute to a changed sense of self. Service development is urgently required, especially for ECT follow-up care.

Magnetic Seizure Therapy in Refractory Psychiatric Disorders: A Systematic Review and Meta-Analysis: La thérapie par convulsions magnétiques pour la prise en charge des troubles psychiatriques réfractaires : revue systématique et méta-analyse.

To qualitatively and quantitatively synthesize the literature on the efficacy and safety of magnetic seizure therapy (MST) in psychiatric disorders. A literature search was conducted of the OVID Medline, OVID EMBASE, PsychINFO, CINAHL, Web of Science and Cochrane databases from inception to 14 January 2024, using subject headings and key words for "magnetic seizure therapy." Randomized controlled trials (RCTs), post-hoc analyses of RCTs, open-label trials, or case series investigating MST in adults with a verified psychiatric diagnosis and reporting on two possible primary outcomes (1) psychiatric symptom reduction (as measured by validated rating scale) or (2) neurocognitive outcomes (as measured by standardized testing), were included. Abstracts, individual case reports, reviews and editorials were excluded. Extracted data included: (1) basic study details; (2) study design; (3) sample size; (4) baseline demographics; (5) outcome data (including secondary outcomes of suicidal ideation and adverse events); and (6) stimulation parameters. Cochrane's risk of bias tool was applied. A quantitative analysis was conducted for the depression studies, using Hedge's g effect sizes. A total of 24 studies (n = 377) were eligible for inclusion. Seventeen studies in depression (including three RCTs), four studies in schizophrenia (including one RCT), one study in bipolar disorder, one study in obsessive-compulsive disorder and one study in borderline personality disorder were summarized. We found no significant difference in depressive symptom reduction between MST and electroconvulsive therapy (ECT) in randomized, controlled trials (g = 0.207 towards ECT, 95% confidence interval (CI) -0.132 to 0.545, P = 0.232). We found a significant reduction in depressive symptoms overall with MST in the pooled RCT and open-label analysis (g = 1.749, CI 1.219 to 2.279, P < 0.005). It is suggested that MST has modest cognitive side effects. Large-scale RCTs are necessary to confirm early signals of MST as an effective intervention in psychiatric disorders with a cognitive profile that is potentially more favourable than ECT.

Severe depression episode with an incredible improvement after electroconvulsive therapy

Aim: The primary aim of this article is to present a case study of a patient with severe depressive episode that was refractory to extensive pharmacological treatment, but exhibited remarkable improvement following electroconvulsive therapy (ECT). Materials and Methods: The patient’s medical records were obtained from II Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin. Cited literature was searched on the PubMed database using the following keywords: Major depressive disorder or MDD, Electroconvulsive therapy, and Benzodiazepine dependence. Results and conclusions: A 55-year-old woman with recurrent depressive disorder and benzodiazepine dependance, unresponsive to multiple medications, requested an ECT. She was then treated with a cycle of 12 Seizure Electroconvulsive Therapy (SECT) sessions. Initially bedridden with severe anxiety, suicidal thoughts, and no clinical improvement despite maximal pharmacotherapy, she exhibited significant improvement after three SECT sessions. Her anxiety decreased, suicidal ideation resolved, and symptoms of anergy and anhedonia diminished. At the end of the SECT cycle, the patient's mood stabilised, and her activity level and social engagement increased. At discharge, she showed no suicidal ideation, tendencies, or psychotic symptoms.This case demonstrates the effectiveness of ECT in treating severe, pharmacologically resistant depressive episodes. It highlights the importance of considering patient requests in conjunction with clinical assessments to achieve positive outcomes. Raising awareness about ECT's safety and efficacy among the public and mental health professionals is crucial for optimizing treatment strategies for severe depression. Proper qualification and timely administration of ECT can significantly enhance treatment outcomes beyond pharmacotherapy alone.

Neuromodulation Strategies in Lifelong Bipolar Disorder: A Narrative Review.

Bipolar disorder is a debilitating psychiatric condition characterized by recurrent episodes of mania and depression, affecting millions worldwide. While pharmacotherapy remains the cornerstone of treatment, a significant proportion of patients exhibit inadequate response or intolerable side effects to conventional medications. In recent years, neuromodulation techniques have emerged as promising adjunctive or alternative treatments for bipolar disorder. We performed a narrative review, according to the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, to provide a comprehensive overview of the current literature on neuromodulation interventions in bipolar disorder across the course of lifespan. Specifically, it examines the efficacy, safety, and mechanisms of action of various neuromodulation strategies, including, among others, transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and it describes the therapeutic experiences across the different ages of illness. Additionally, this review discusses the clinical implications, challenges, and future directions of the integration, in clinical practice, of neuromodulation into the management of bipolar disorder. By synthesizing evidence from different studies, this review aims to inform clinicians, researchers, and stakeholders about the evolving landscape of neuromodulation treatments and their potential role in improving outcomes for individuals with bipolar disorder.

Translation and Critical Evaluation of the Columbia University Autobiographical Memory Interview-Short Form for use in the Dutch Language.

Assessment of autobiographical memory following electroconvulsive therapy is lacking multilingual options. We therefore developed the Dutch translation of the Columbia University Autobiographical Memory Interview-Short Form (CUAMI-SF). We aimed to assess its practical use and identify segments for potential revision to improve the interview's applicability. The CUAMI-SF comprises 30 questions asking details about 6 segments (eg, last trip, last birthday) and 7 question categories (eg, dates, list of persons present). The interview was translated to Dutch using blind back-translation principles. We evaluated practicality and potential redundancy, through surveying a focus group and quantitative analyses of 60 participants, including depressed patients treated with electroconvulsive therapy (n = 14) or deep brain stimulation (n = 25) and healthy controls (n = 21). For the quantitative analyses, we compared the average percentage of nonanswered questions at baseline between groups. The average consistency scores after a follow-up of approximately 6 weeks were also calculated and compared for each segment between the groups. The focus group mostly found the CUAMI-SF easy to use and to score, but argued redundancy in specific questions asking for dates, numbers, and addresses. The largest differences in consistency scores between the groups were present for the segments "travel," "birthdays," "New Year's Eve," and "doctor's visits," indicating higher sensitivity compared with "family member" and "job." The CUAMI-SF was found easy to use by administrators. The segments "family member" and "job" emerged as less sensitive. Therefore, removal might maintain sensitivity while reducing administration time, which could prove beneficial in clinical and research settings.

MADRS single items differential changes among patients with melancholic and unspecified depression treated with ECT: an exploratory study.

Major depressive disorder (MDD) exhibits heterogeneity in treatment response. This exploratory analysis aims to evaluate the differential changes in individual items of the MADRS between melancholic MDD (M-MDD) and unspecified MDD (U-MDD) following electroconvulsive therapy (ECT). The study included 23 patients with unipolar MDD who received ECT. Patients were classified as M-MDD or U-MDD according to DSM-5 criteria. MADRS scores were assessed at baseline and one-month post-ECT. Differences between subtypes were analyzed using the Wilcoxon test and multiple linear regression. Among 23 participants receiving ECT for MDD, 10 had M-MDD and 13 had U-MDD. Baseline MADRS items showed significantly higher scores in the M-MDD group, except for reported sadness, suicidal ideation, and concentration difficulties. Total MADRS score reduction was significantly greater in the M-MDD group. This decline was especially pronounced in M-MDD patients for specific items, including apparent sadness, inability to feel, pessimistic thoughts, sleep disturbances, reduced appetite, and concentration difficulties, after adjusting for age and sex. MADRS score reductions were more substantial for M-MDD than U-MDD in both total and specific items following one month of ECT. Further research with larger samples is needed to clarify MADRS response differences after ECT between melancholic and unspecified depressive subtypes.

Relatives' Knowledge, Attitudes, and Experiences Toward Electroconvulsive Therapy: A Systematic Review.

Electroconvulsive therapy (ECT) is an effective treatment for patients with severe psychiatric disorders. Stigma and lack of knowledge surrounding ECT are major obstacles for both patients and their caregivers, who play an important role as shared decision-makers. Insight in caregivers' perspectives on ECT can support the consent process and patient compliance with ECT. We aimed to review perspectives on knowledge, attitudes, and experiences of caregivers of adult and adolescent patients who received ECT. We performed a computerized search (EMBASE, MEDLINE) for articles meeting the following inclusion criteria: (1) qualitative studies, quantitative studies, or quasi-experimental studies that (2) report on caregiver perspectives of patients who received ECT. We conducted our systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. In total, 29 articles were included. Variation in knowledge about ECT was high among caregivers. Their attitudes were generally positive and most would advise for future ECT if necessary. Psychoeducational tools and ECT experience increased knowledge and attitudes in caregivers. In general, caregivers were satisfied with ECT but wanted more information on risks and side effects before ECT. Caregivers reported more positive attitudes toward and had better experiences with ECT compared with patients. Our systematic review demonstrated moderate knowledge, but overall positive attitudes and experiences on ECT in caregivers. Overall low methodological quality of included studies limits our conclusions. Future research should focus more on qualitative methods and cohort studies.

Practice of Electroconvulsive Therapy in Catalonia in 2022: Results From a Large Cross-Sectional Survey.

The practice of electroconvulsive therapy (ECT) exhibits variability across various domains, both between regions, and between centers within the same region. The ECT Working Group of the Catalan Society of Psychiatry conducted a comprehensive survey in Catalonia, Spain, to assess the current status of those variables essential in the clinical practice of ECT. The survey comprised 50 items, including various question types such as multiple-choice, numerical response, and open-ended questions. It was administered to the 20 public hospitals that currently provide ECT in Catalonia during the year 2022. Information was gathered on 4 main areas: Organization of the ECT Unit, Specific Technique of ECT Application, Strategies and Organization of the Therapeutic Plan, and Epidemiological Data, Training, and Healthcare Resource Management. Some notable findings include an application rate of 1.1 per 10,000 inhabitants, major depression diagnosis as the primary indication for ECT in 80% of the centers, and the ability to perform maintenance ECT in 100% of centers. Following the survey and analysis, 3 main findings emerged: minimal variation in ECT application rates compared to the previous decade, increased complexity in current ECT practices with a focus on quality and patient safety, and identified areas for improvement in resource management and the necessity for a well-trained and stable multidisciplinary team.

Dexmedetomidine and Nitrous Oxide as Anesthetic Agents for Electroconvulsive Therapy: A Case Report.

Electroconvulsive therapy (ECT) is a therapeutic intervention that induces generalized seizures under general anesthesia. This case report compares the efficacy of dexmedetomidine (DEX) and nitrous oxide (N2O) to that of propofol during ECT procedures. A 33-year-old woman with a 15-year history of schizophrenia and recurrent psychotic episodes underwent ECT. During a previous hospitalization, she underwent 14 ECT sessions using propofol and succinylcholine. The mean electrical stimulation dose was 598.9 ± 237.6 mC, with mean motor and electroencephalogram seizure durations of 23.8 ± 8.0 and 34.9 ± 8.3 seconds, respectively. During her current hospitalization, she underwent an additional 14 ECT sessions using DEX and N2O. The mean electrical stimulation dose was significantly lower, at 239.4 ± 54.7 mC, with comparable motor and electroencephalogram seizure durations of 34.6 ± 11.6 and 36.3 ± 12.5 seconds, respectively. Our case report emphasizes the effectiveness of using DEX and N2O for ECT anesthesia compared to propofol. Despite a significantly lower mean electrical stimulation dose requirement with DEX and N2O (t = 5.5155, P < 0.00001), no significant differences were observed in electroencephalogram seizure duration between the groups.

Clinical Response to Electroconvulsive Therapy in a Young Adult With Down Syndrome Regression Disorder.

Down syndrome regression disorder (DSRD) is a condition in which individuals with Down syndrome experience a decline in social and adaptive functioning in adolescence to early adulthood. Initially described as catatonic psychosis and later designated Down syndrome disintegrative disorder (DSDD), the etiology for DSRD remains unclear but has been hypothesized to relate to autoimmune function, stress, and psychiatric disease. DSRD presents heterogeneously and has no clearly established diagnostic criteria, which can complicate treatment recommendations. ECT has been used to successfully treat DSRD, but the number of reported cases remains low, especially when it is unclear whether there are comorbid catatonic features. Here, we present a case of successful use of ECT in an individual with DSRD in which catatonic features were difficult to ascertain, and we make recommendations for the use of ECT in the treatment of DSRD.

Persistent pro-inflammatory trait in elderly patients following treatment-resistant major depressive disorder: a longitudinal exploratory study

Objectives Considering that the remission rate for major depressive disorder (MDD) in elderly patients is below 50%, there is a compelling requirement for an enhanced comprehension of the underlying mechanisms. Chronic low-grade inflammation has been posited as one potential contributor to treatment-resistant MDD in the elderly. Accordingly, the objective of our study was to explore the longitudinal trends of systemic immune markers in elderly inpatients referred to electroconvulsive therapy due to an episode of treatment resistant unipolar MDD. Methods The study encompassed 64 elderly inpatients with unipolar MDD that had failed to respond to therapy in primary health care, and 18 non-depressed controls. Blood samples were collected at pre-treatment, mid-treatment, post-treatment and 12 weeks follow-up. We assessed 27 immune markers via multiplex assays. Depressive symptoms were evaluated using the Hamilton Rating Scale of Depression at these timepoints. For controls, the immune markers and depressive symptoms, were measured at baseline and eight weeks follow-up using identical methods. Results At follow-up, patients showed higher concentrations of 23 immune markers compared to controls, although the concentration of 19 immune markers decreased significantly from pre-treatment to follow-up. No differences in immune marker concentrations between treatment responders and non-responders were observed pre- and post-treatment in the patient group. Conclusion Our findings suggest that a pro-inflammatory trait persists in elderly after an episode of treatment resistant unipolar MDD. Thus, our study supports that chronic low-grade inflammation may characterise elderly with treatment-resistant unipolar MDD.

Palliative Electroconvulsive Therapy: A Descriptive Cohort Study.

Palliative care (PC) is the standard of care for patients with serious medical illnesses, or those conditions associated with high risk of mortality and negative impact on quality of life (QOL). Electroconvulsive therapy (ECT) is the gold standard treatment for certain psychiatric conditions, which may co-occur with serious medical illnesses. However, the use of "palliative ECT" (PECT) in this context is understudied. We conducted a descriptive retrospective cohort study reviewing the indications, outcomes, and regimens of PECT. We included patients who had an ECT consultation, in addition to either a PC consultation or a do-not-attempt-resuscitation (DNAR) code status between 2018 and 2023. Thirty-one patients met our inclusion criteria and 21 received ECT. The cohort was predominantly female (70%) with a mean age of 67.6 (range 25-90). Catatonia (64.5%) and treatment-resistant depressive disorder (35.5%) were the most common indications for ECT. At the time of ECT consultation, 16 patients (51.6%) had a serious medical illness, including cancer (19.4%) or end-organ disease (22.6%). Fourteen patients had major neurocognitive disorder (MNCD) (45.2%). Surrogate decision-makers consented for ECT in 64.5% of cases. All 21 patients who received ECT experienced psychiatric symptom improvement. ECT was associated with reduced mortality risk in five (23.8%) cases. Five patients initially misdiagnosed with MNCD experienced recovery in cognitive function after ECT and the diagnosis was revised to depression-related cognitive dysfunction (DRCD). Eight patients retained a comorbid MNCD diagnosis but experienced a mean Montreal Cognitive Assessment (MoCA) improvement of five points (range 0 to 17) with ECT. This work highlights the use of ECT among patients with serious medical illnesses, identifying cases when ECT was beneficial or deemed unsuitable. Patients with serious medical illnesses who also had an indication for ECT experienced improved QOL with ECT. Misdiagnoses, such as confusing DRCD and catatonia for MNCD, were effectively addressed through ECT. The findings underscore the importance of cross-specialty collaboration between C-L psychiatry and PC. Patients who receive PECT experience reduced suffering and improved QOL. PECT may be helpful in scenarios of life-threatening psychiatric illnesses, terminal medical illness with comorbid treatment-refractory psychiatric illness, and diagnostic uncertainty with MNCD.

Effects of Electroconvulsive Therapy on Brain Structure - a Neuroradiological Investigation into White Matter Hyperintensities, Atrophy, and Microbleeds.

Electroconvulsive therapy (ECT) is a well-established treatment for severe depression, yet it remains stigmatized due to public perceptions linking it with brain injury. Despite extensive research, the neurobiological mechanisms underlying ECT are not fully elucidated. Recent findings suggest that ECT may work through disrupting depression circuitry. However, whether ECT is associated with neuroradiological correlates of brain injury, including white matter changes, atrophy and microbleeds, remains largely unexplored. We performed MRI scans on 36 ECT patients (19 female), 19 healthy controls (11 female), and 18 atrial fibrillation patients (1 female) treated with electrical cardioversion while receiving an equivalent anesthetic as the ECT group. Scans were conducted at four time points: at baseline, after the first ECT treatment, after the ECT series, and at six-month follow-up. We evaluated white matter changes using the Fazekas and the Age-Related White Matter Changes scales, atrophy using the Global Cortical Atrophy and Medial Temporal lobe Atrophy scales, and cerebral microbleeds using the Microbleed Anatomical Rating Scale. Data were analyzed using non-parametric statistical methods. Patients did not show any changes in radiological scores after ECT (all p >0.1), except for a decrease in microbleeds (p = 0.05). Utilizing state-of-the-art MRI techniques, we found no significant evidence that ECT induces white matter changes, atrophy, or microbleeds. Thus, although ECT may work through disrupting depression circuitry, the treatment is not associated with neuroradiological signs of brain injury.

Pilot Study of Cerebral Hemodynamics in Depressive Patient Under Electroconvulsive Therapy.

Major depressive disorder (MDD) poses a significant treatment challenge, with some patients unresponsive to conventional therapies. Electroconvulsive therapy (ECT) can be effective but its mechanisms are not fully understood. This study employs functional Near-Infrared Spectroscopy (fNIRS) to explore the neurobiological changes induced by ECT in A MDD patient, aiming to shed light on its therapeutic effects. This study employs fNIRS to assess differences between MDD patient and controls, and examines changes in cerebral hemodynamics and brain network nodes post-ECT to elucidate treatment mechanisms. 26 age and gender-matched controls and one MDD male patient underwent fNIRS during a verbal fluency task. The patient received ECT, with dynamic evaluation of beta, integral, and centroid values in regions of interest (ROIs) post-treatment. Resting-state fNIRS and functional connectivity assessments were also conducted post-ECT. MDD patient exhibited significantly lower hemodynamic metrics and functional connectivity compared to controls at baseline. Post-ECT, dynamic changes in these metrics were observed, trending towards normalization and showing no significant differences from controls. ECT modifies cerebral hemodynamics and functional connectivity in depressive patients, as evidenced by fNIRS metrics. This study underscores the utility of fNIRS for objective neurobiological monitoring in ECT treatment.

Electroconvulsive Therapy With Brain Cyst: A Simulation Study.

Electroconvulsive therapy (ECT) is effective in treating severe depression and other neuropsychiatric disorders, but how the presence of an anatomical anomaly affects the electrical pathways between the electrodes remains unclear. We investigate the difference in electric field (E-field) distribution during ECT in the brain of a patient with an arachnoid cyst relative to hypothetical condition where the cyst was not present. Magnetic resonance imaging scans of the head of a patient with a large left frontal cyst were segmented to construct a finite element model to study the E-field distribution during ECT. Five electrode configurations were investigated: right unilateral, left unilateral, bifrontal, and bitemporal and left anterior right temporal. The E-field distributions for all montages were compared with a hypothetical condition where brain tissue and electrical conductivity from the right frontal region was mirrored across the longitudinal fissure into the cyst. Differences in mean E-field and 90th percentile E-fields were mainly observed in brain regions closest to the cyst including the left inferior frontal gyrus and left middle frontal gyrus. This trend was most pronounced in montages where the electrodes were closest to the cyst such as left unilateral and bitemporal. The presence of a highly conductive cyst close to the ECT electrode tended to attract current into the cyst region, altering current pathways, with potential implications for therapeutic efficacy and safety. Placing electrodes farther away from the cyst is likely to minimize any effects on the E-field distribution and potentially clinical outcomes.

Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes

Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes

CREB: A Promising Therapeutic Target for Treating Psychiatric Disorders.

Psychiatric disorders are complex, multifactorial illnesses. It is challenging for us to understand the underlying mechanism of psychiatric disorders. In recent years, the morbidity of psychiatric disorders has increased yearly, causing huge economic losses to the society. Although some progress, such as psychotherapy drugs and electroconvulsive therapy, has been made in the treatment of psychiatric disorders, including depression, anxiety, bipolar disorder, obsessive-compulsive and autism spectrum disorders, antidepressants and psychotropic drugs have the characteristics of negative effects and high rate of relapse. Therefore, researchers continue to seek suitable interventions. cAMP response element binding protein (CREB) belongs to a protein family and is widely distributed in the majority of brain cells that function as a transcription factor. It has been demonstrated that CREB plays an important role in neurogenesis, synaptic plasticity, and neuronal growth. This review provides a 10-year update of the 2013 systematic review on the multidimensional roles of CREB-mediated transcriptional signaling in psychiatric disorders. We also summarize the classification of psychiatric disorders and elucidate the involvement of CREB and related downstream signalling pathways in psychiatric disorders. Importantly, we analyse the CREB-related signal pathways involving antidepressants and antipsychotics to relieve the pathological process of psychiatric disorders. This review emphasizes that CREB signalling may have a vast potential to treat psychiatric disorders like depression. Furthermore, it would be helpful for the development of potential medicine to make up for the imperfection of current antidepressants and antipsychotics.