Electric Convulsive Therapy Research Articles

The influence of EEG channels and features significance on automatic detection of epileptic waves in MECT

Modified Electric Convulsive Therapy (MECT) is an efficacious physical therapy in treating mental disorders. The occurrence of epilepsy is a crucial benchmark for evaluating therapeutic effectiveness. However, the medical field still lacks relevant research on automatically detecting epileptic waves in MECT. Therefore, this article proposes a novel automatic detection method of epileptic waves in MECT. In this article, EEG local features (time, frequency, and time-frequency domains) and global features (Pearson correlation coefficient) are combined for epileptic wave detection with SVM (Support Vector Machine). We researched the system with 15 EEG detection channels. The dataset under investigation contains EEG data from 22 patients who received MECT and presented with epileptic seizures. The results revealed that LA (Logarithm of Activity) feature exhibits the best classification significance. When epileptic waves appear, there is a decrease in the power ratio of delta waves and an increase in the power ratio of theta waves. Additionally, the complexity of EEG decreases while the correlation between EEG channels increases. The Cz, F4, and P3 channels exhibit the highest classification significance among all EEG channels. Furthermore, based on the channel classification significance, the EEG detection channels number can be reduced to 8. Similarly, based on the feature classification significance, the local feature number can be reduced from 9 to 3. These conclusions can improve detection efficiency and reduce the cost for MECT. Moreover, the method we proposed can effectively detect epileptic waves in MECT. This work can provide physicians with a reference for evaluating the effectiveness of MECT.

A Case of Successful Ketamine Treatment after ECT Failure in a patient with Major Depressive Disorder

<h3>Introduction</h3> Electroconvulsive therapy (ECT) has long been a treatment modality of choice for treatment resistant depression. It remains one of the most effective treatments in psychiatry for a multitude of diseases. However, if patients fail ECT there is a lack of robust options for alternative treatments. This case describes a patient who was initially treated with ECT with no response after several treatments and subsequently transitioned to IV ketamine. Once started on ketamine patient showed a significnat improvement in his depressive symptoms and was able to be discharged from an inpatient psychiatric unit. Mr. X is a 70 year old male with a history of major depressive disorder and three prior suicide attempts. He had multiple recent life stressors, including a spouse diagnosed with cancer and being unable to work after back surgery which significantly contributed to his depression. He was admitted to the psychiatric hospital after an attempted overdose. He was started on escitalopram and buproprion XL, which were titrated to max doses throughout his hospitalization. Given his history of incomplete response with medication, his severe depression, and his high suicide risk, aggressive treatment was warranted. ECT was initiated and he underwent 5 treatments of right unilateral, 2 treatments of bifrontal, and 1 treatment of bitemporal. Throughout the course of ECT he had a lack of seizures despite flumazenil, hyperventilation, various induction agents (including ketamine) and pharmacology. During that time he was not getting out of bed, reporting consistently depressed mood, amotivated, and apathetic. He also began noticing some increased cognitive difficulties with the bifrontal and bitemporal ECT treatments. He ultimately was deemed an ECT failure after 8 treatments with no response. Given his continued depression and failure of ECT, it was decided to attempt IV ketamine infusions as the next intervention for his depression. <h3>Methods</h3> A literature review was conducted searching for Ketamine vs ECT treatment for depression and suicidality using MESH terms of "(Depression) AND (Suicidal behavior) AND (Electroconvulsive therapy OR Electroshock therapy OR Shock therapy OR Electroshock OR Shock treatment OR Convulsive therapy OR Electric shock therapy OR Electric Convulsive therapy OR ECT) AND Ketamine" and "(Depression) AND (Suicidality) AND (Electroconvulsive therapy OR Electroshock therapy OR Shock therapy OR Electroshock OR Shock treatment OR Convulsive therapy OR Electric shock therapy OR Electric Convulsive therapy OR ECT) AND Ketamine." Additional literature regarding Ketamine for treatment resistant depression was searched for using MESH terms of "(Ketamine OR CI-581 OR CI 581 OR CI581 OR Ketalar OR Ketaset OR Ketanest OR Calipsol OR Kalipsol OR Calypsol) AND (therapy OR medical plan OR treatment OR regimen) AND (treatment resistant depression OR therapy resistant depression OR TRD OR refractory depression)." <h3>Results</h3> After initiation of ketamine Mr. X noticed an immediate improvement. He was given 3 total treatments while inpatient with significant clinical improvment noted after each treatment. He was noted to be more engaged, had improved eye contact, and was reporting improvment in his mood. He was also more active, and was noted to be consistently out of bed ambulating with his walker. After the 3 treatments inpatient he was deemed psychiatrically stable for discharge with the plan to continue an acute course of treatment post discharge. He received 2 more treatments after discharge as an outpatient before ultimately being lost to follow up. Electroconvulsive Therapy continues to show a robust response rate of approximately 80%, with remission in about 75% of cases. Even with these response rates, there is a significant patient population that will not respond to ECT. Research has shown that ketamine can have an immediate response of up to or greater than 70% of patietns within the 24 hours post-infusion. Duration of response is varied, though has been found to be present in about 50–70% of patients. However, there has not been significant published research looking into response to ketamine post ECT failure. <h3>Conclusions</h3> Mr. X is a prime example of the ongoing difficulties in treating patients with treatment resistant depression who do not respond to ECT. This case shows that after ECT failure it is appropriate to attempt treatment with ketamine barring the patient having any contraindications for treatment. Given that there is little published data regarding the response of patients who have failed ECT but subsequently respond to ketamine infusions, this case is an attempt to add to the literature in that regard. <h3>Funding</h3> None

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

BackgroundData on the pharmacological management of acute agitation in schizophrenia are scarce. The aim of this study is to investigate the prescription practices in the treatment of agitation in Chinese patients with schizophrenia.MethodsWe conducted a large, multicenter, observational study in 14 psychiatry hospitals in China. Newly hospitalized schizophrenia patients with the PANSS-EC total score ≥ 14 and a value ≥4 on at least one of its five items were included in the study. Their drug treatments of the first 2 weeks in hospital were recorded by the researchers.ResultsEight hundred and 53 patients enrolled in and 847 (99.30%) completed the study. All participants were prescribed antipsychotics, 40 (4.72%) were prescribed benzodiazepine in conjunction with antipsychotics and 81 were treated with modified electric convulsive therapy (MECT). Four hundred and 12 (48.64%) patients were prescribed only one antipsychotic, in the order of olanzapine (120 patients, 29.13%), followed by risperidone (101 patients, 24.51%) and clozapine (41 patients, 9.95%). About 435 (51.36%) participants received antipsychotic polypharmacy, mostly haloperidol + risperidone (23.45%), haloperidol+ olanzapine (17.01%), olanzapine+ ziprasidone (5.30%), haloperidol + clozapine (4.37%) and haloperidol + quetiapine (3.90%). Binary logistic regression analysis suggests that a high BARS score (OR 2.091, 95%CI 1.140–3.124), severe agitation (OR 1.846, 95%CL 1.266–2.693), unemployment or retirement (OR 1.614, 95%CL 1.189–2.190) and aggressiveness on baseline (OR 1.469, 95%CL 1.032–2.091) were related to an increased antipsychotic polypharmacy odds. Male sex (OR 0.592, 95%CL 0.436–0.803) and schizophrenia in older persons (age ≥ 55 years, OR 0.466, 95%CL 0.240–0.902) were less likely to be associated with antipsychotic polypharmacy.ConclusionThe present study demonstrates that monotherapy and polypharmacy display equally common patterns of antipsychotic usage in managing agitation associated with schizophrenia in China. The extent and behavioral activities of agitation and several other factors were associated with polypharmacy.

Stimulants augmentation with an antidepressant for the treatment of the major depressive disorder (MDD)

The use of antidepressants and sedative drugs is the best treatment proved for major depressive disorder and in some cases the electrical convulsion therapy. The use of stimulants off-label in clinical practice an increasing concern as there is no research evidence to support their effectiveness.

Acupuncture for schizophrenia.

Background Acupuncture, with many categories such as traditional acupuncture, electroacupuncture, laser acupuncture, and acupoint injection, has been shown to be relatively safe with few adverse effects. It is accessible and inexpensive, at least in China, and is likely to be widely used there for psychotic symptoms. Objectives To review the effects of acupuncture, alone or in combination treatments compared with placebo (or no treatment) or any other treatments for people with schizophrenia or related psychoses. Search methods We searched Cochrane Schizophrenia Group’s Trials Register (February 2012), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and clinical trials registries. We also inspected references of identified studies and contacted relevant authors for additional information. Selection criteria We included all relevant randomised controlled trials involving people with schizophrenia-like illnesses, comparing acupuncture added to standard dose antipsychotics with standard dose antipsychotics alone, acupuncture added to low dose antipsychotics with standard dose antipsychotics, acupuncture with antipsychotics, acupuncture added to Traditional Chinese Medicine (TCM) drug with TCM drug, acupuncture with TCM drug, electric acupuncture convulsive therapy with electroconvulsive therapy. Data collection and analysis We reliably extracted data from all included studies, discussed any disagreement, documented decisions and contacted authors of studies when necessary. We analysed binary outcomes using a standard estimation of risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we calculated mean differences with 95% CI. For homogeneous data we used fixed-effect model. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Main results After an update search in 2012 the review now includes 30 studies testing different forms of acupuncture across six different comparisons. All studies were at moderate risk of bias. When acupuncture plus standard antipsychotic treatment was compared with standard antipsychotic treatment alone, people were at less risk of being 'not improved' (n = 244, 3 RCTs, medium-term RR 0.40 CI 0.28 to 0.57, very low quality evidence). Mental state findings were mostly consistent with this finding as was time in hospital (n = 120, 1 RCT, days MD -16.00 CI -19.54 to -12.46, moderate quality evidence). If anything, adverse effects were less for the acupuncture group (e.g. central nervous system, insomnia, short-term, n = 202, 3 RCTs, RR 0.30 CI 0.11 to 0.83, low quality evidence). When acupuncture was added to low dose antipsychotics and this was compared with standard dose antipsychotic drugs, relapse was less in the experimental group (n = 170, 1 RCT, long-term RR 0.57 CI 0.37 to 0.89, very low quality evidence) but there was no difference for the outcome of 'not improved'. Again, mental state findings were mostly consistent with the latter. Incidences of extrapyramidal symptoms - akathisia, were less for those in the acupuncture added to low dose antipsychotics group (n = 180, 1 RCT, short-term RR 0.03 CI 0.00 to 0.49, low quality evidence) - as dry mouth, blurred vision and tachycardia. When acupuncture was compared with antipsychotic drugs of known efficacy in standard doses, there were equivocal data for outcomes such as 'not improved' using different global state criteria. Traditional acupuncture added to TCM drug had benefit over use of TCM drug alone (n = 360, 2 RCTs, RR no clinically important change 0.11 CI 0.02 to 0.59, low quality evidence), but when traditional acupuncture was compared with TCM drug directly there was no significant difference in the short-term. However, we found that participants given electroacupuncture were significantly less likely to experience a worsening in global state (n = 88, 1 RCT, short-term RR 0.52 CI 0.34 to 0.80, low quality evidence). In the one study that compared electric acupuncture convulsive therapy with electroconvulsive therapy there were significantly different rates of spinal fracture between the groups (n = 68, 1 RCT, short-term RR 0.33 CI 0.14 to 0.81, low quality evidence). Attrition in all studies was minimal. No studies reported death, engagement with services, satisfaction with treatment, quality of life, or economic outcomes. Authors' conclusions Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.

Mania: Not the opposite of depression, but an extension? Neuronal plasticity and polarity

What underlies bipolar disorder? What pathophysiologic process can produce symptoms that are apparently polar opposites? Recent studies of neuronal plasticity suggest a mechanism. Both zinc deficiency and social isolation impair neuronal plasticity; both are associated with major depression. Yet when zinc deficiency and social isolation occur together, they are associated with aggression, not with depression. On that basis, and according to additional findings in rats reported herein, it was inferred that moderate impairment of neuronal plasticity induces a depressive state, but that further impairment of neuronal plasticity induces not more depression, but a manic state. However, not only neuronal plasticity, but also some kind of load toward neuronal function can influence polarity or symptoms of mood disorder. Our hypothesis is that mania is an extension of depression from the perspective of neuronal plasticity, and that multiaxial evaluation by neuronal plasticity and neuronal load is useful to elucidate the pathophysiology of mood disorder. Using this hypothesis, many clinical aspects that have been heretofore difficult to interpret can be understood. A mood stabilizer or electric convulsive therapy is often used for the treatment of mood disorder, but it has remained unclear why such therapies are useful for both mania and depression. This hypothesis can explain how mood stabilizers or electric convulsive therapy can improve both mania and depression through the recovery of neuronal plasticity. It is difficult to explain the pathophysiology of manic switching by antidepressants solely from the perspective of the impairment of neuronal plasticity. To interpret this phenomenon, the action of antidepressants to neuronal load should be regarded as the other axis from neuronal plasticity. Based on this hypothesis, it is expected that the pathophysiology of mood disorder and clinical mechanism of mood stabilizers and antidepressants can be understood in an integrated manner.

頭部通電けいれん療法(ECT)に対する一考察

頭部通電けいれん療法(ECT)に対する一考察

Bemegride Lengthens Seizure Duration During Electric Convulsive Therapy in a Schizophrenic Patient With Increased Seizure Threshold

A 48-year-old man who had a history of schizophrenia for 30 years was treated with electroconvulsive therapies. Because of poor seizure even at maximum electrical dosage, aminophylline was administered just before initiating electroconvulsive therapy. Although aminophylline augmentation lengthened the seizure duration, tachycardia and hypertension were observed. Therefore, we switched to bemegride, an antagonist to barbiturate, and seizure length was improved without any side effects. The present case suggested that bemegride is one of the alternative measures in patients with poor seizure quality.

&lt;b&gt;Management of neuropathic pain &lt;/b&gt;&lt;b&gt;in the pain clinic practice &lt;/b&gt;

Neuropathic pain has been recognized as an intractable pain which is difficult to treat. The author described the management of neuropathic pain in the pain clinic practice in Japan. The management includes pharmacological therapy, nerve blocks, neuromodulation therapy, electric convulsion therapy, surgical therapy, gamma knife therapy, low output laser therapy, rehabilitation andmirror box therapy. The author also described the mechanisms of neuropathic pain which shoud be considered when pain clinicians treat this pain. Importance of pharmacological tests for analyzing the mechanisms of neuropathic pain on the clinical aspect also was described.

Sudden Death in Epilepsy: Can Any Lessons be Learned From Convulsive Therapy?

Convulsive therapy (chemically or electrically induced) has been used since the mid-1930s. Initially it had a high mortality rate, but this has been falling slowly in response to refinements in technique (introduction of muscle paralysis during the seizure, brief intravenous general anesthesia and, more recently, the acceptance that adequate ventilation and oxygenation are necessary during the procedure). Mortality during convulsive therapy has been ascribed to both cardiac and respiratory causes (particularly acute arrhythmias and pulmonary edema). There is some evidence that supporting respiration during and after the convulsion has reduced mortality significantly, such that electrical convulsive therapy is now a very low-risk procedure, even in the very elderly. This gives tenuous support for the view that death in epileptic seizures may be of respiratory origin.

The use of electroconvulsive therapy in patients with intractable anorexia nervosa

The history of the treatment of anorexia nervosa includes the majority of psychological and somatic therapies devised by psychiatrists, psychologists, and general physicians. We review the history of one of these treatments, electrical convulsive therapy (ECT), and discuss three patients treated with ECT for primary anorexia nervosa. Two had a positive response to this treatment, one did not. She later responded favorably to a course of treatment with fluoxetine.

Second Opinions for ECT and Extended Medication—Mental Health Act 1983: Attitudes of Consultant Psychiatrists and Analysis of 200 Second Opinion Visits

The 1983 Mental Health Act made a requirement under Section 58 for a second opinion by an Appointed Doctor when a detained patient either did not understand the nature, purpose, and likely effects of a treatment or did not consent. The present study is confined to second opinions relating to ECT (electric convulsion therapy) and extended medication. It was noted in the Mental Health Act Commission's Biennial report that requests for second opinions varied in numbers between different hospitals and psychiatric units. In 200 personal visits by the author a Treatment Plan by the Responsible Medical Officer (RMO), which is an indication of good practice in the operation of the Act, was written in the case notes in only 66 cases (33%) and then most often by a junior doctor. This finding has been reported generally. It seemed appropriate, therefore, to explore the opinions of Consultant Psychiatrists on the legal requirement for second opinion.

A Review of Electric Convulsive Therapy (ECT)

A Review of Electric Convulsive Therapy (ECT)

Electric convulsive therapy (ECT) increases plasma and red blood cell haloperidol neuroleptic activities

In nine schizophrenic patients (five males and four females) on haloperidol treatment, plasma and red blood cell (RBC) haloperidol neuroleptic activities were measured before and after ECT by radioreceptor assay. Five patients randomly selected from these patients also served as controls on another occasion and neuroleptic activities in plasma and RBC were examined before and after the premedication only. All patients given ECT showed a considerable increase in plasma and RBC haloperidol neuroleptic activities after ECT (% increase in plasma neuroleptic activity, 28–409%; mean + SD, 136 ± 155%, P<0.005, Wilcoxon test; % increase in RBC neuroleptic activity, 11–121%; mean + SD, 59 ± 40%, P<0.005). However, no significant increase was observed for either plasma or RBC haloperidol neuroleptic activity, when patients were examined after premedication only. It was suggested that ECT induced a transient redistribution of haloperidol. It remains to be studied whether this phenomenon is causally related to the previous observation that the combination therapy of ECT and neuroleptics is more effective in the treatment of schizophrenia than ECT alone.

The value of cytidine-5-diphosphate-choline in the prevention of impairment of memory function after electric convulsive therapy. A double-blind study

1. A double-blind study of the effect of CDP-choline on memory impairment following bilateral ECT was performed on 22 inpatients suffering from endogenous depression. 2. Memory scores were checked after 2 and 4 ECT sessions, and the length of the post-ECT confusional state was also measured. 3. The results show no statistically significant differences between the reduced memory scores obtained by both groups. Our findings do not support the hypothesis that CDP-choline affords protection against ECT-induced memory dysfunction in depression cases.

Correction: Electric convulsion therapy in depression: a double-blind controlled trial

Correction: Electric convulsion therapy in depression: a double-blind controlled trial

Points: Effects of electric convulsion therapy

Points: Effects of electric convulsion therapy

Effects of electric convulsion therapy.

Effects of electric convulsion therapy.

Points: Ruptured spleen after electric convulsion therapy

Points: Ruptured spleen after electric convulsion therapy

Effects of the media on attitudes to electric convulsion therapy.

Effects of the media on attitudes to electric convulsion therapy.