Electroconvulsive Therapy In Mania Research Articles

Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania

Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. To investigate the response to ECT in patients with manic episodes. This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021. Patients treated with ECT for a mania were identified from the Q-ECT. Response to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT. Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response. Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessive-compulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness. This study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.

Patients With Refractory Bipolar Depression May Benefit From ECT

Patients With Refractory Bipolar Depression May Benefit From ECT

Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience.

Resistance to pharmacological agents is commonly encountered in the treatment of acute episodes of mania. In contemporary practice guidelines, electroconvulsive therapy (ECT), once a widely used standalone intervention for mania, is no longer considered a first-line treatment. Stigma, logistics, and ethical factors constrain ECT administration in this condition and lead to its underutilization. However, the past three decades have produced promising research regarding the use of ECT in mania. Randomized controlled trials, albeit in limited numbers, the adoption of ultrabrief ECT, examination of the safety and efficacy of combining ECT with pharmacological agents, including lithium, and use of ECT as a maintenance strategy have enhanced our understanding of how and when to utilize this intervention in mania. In this comprehensive review, the authors summarize the evidence regarding the efficacy and safety of ECT in mania, including related syndromes, such as delirious mania and mixed affective states. The impact of technical parameters, particularly the choice of treatment frequency, electrode placements, and pulse width, are discussed in the light of recent evidence.

Ultrabrief Electroconvulsive Therapy for Mania: Data From 11 Acute Treatment Courses.

Electroconvulsive therapy (ECT) is an effective treatment of mania. Ultrabrief ECT is a novel modality that is associated with fewer cognitive adverse effects than the standard pulse width brief pulse ECT. It has been well studied in depression. However, its use in mania is not yet known. Following a retrospective chart view, we report a small sample of patients who had Right Unilateral Ultrabrief ECT (RUB-ECT) for mania. Eleven RUB-ECTs were identified for 9 patients; 72.8% remission rate was observed with RUB-ECT. Two patients required switch into bitemporal ECT in view of minimal clinical response and 1 patient to right unilateral brief pulse ECT because of poor seizure parameters. All patients achieved remission eventually. The possible mechanisms of ECT in mania and clinical implications of ultrabrief ECT are discussed.

Efficacy of electroconvulsive therapy (ECT) in the first trimester of pregnancy: A case of manic patient

Women with bipolar disorder have a risk for symptom exacerbation during pregnancy. ECT is an appropriate option for psychiatric symptoms during pregnancy although it is often neglected. We report a case of bipolar, week 6 of gestation woman who discontinued medication in the second week of pregnancy but resumed pharmacotherapy with ECT due to manic episode that recurred during the first trimester. Case A 23-year-old female, with a history of one psychiatric hospitalization (a manic episode three years ago) and lithium 900mg/day, olanzapine 5mg/day use for three years until week 2 of gestation admitted to clinic with complaints of decreased need for sleep, increased speech, lability of emotions, religious delusions and irritability for the last two weeks. Young Mani Score (YMS) was 32. ECT, which was considered as the first-line treatment, was not carried out due to low pseudocholinesterase (2401). Therefore, olanzapine was reinstated with a dose of up to 20mg/day. Although olanzapine, irritability still continued. Therefore, medication was switched from olanzapine to haloperidol 15mg/day and quetiapine 25mg/day. Due to persistent symptoms, after necessary consultations and family approval taken, she was administered 6 sessions of ECT with oral haloperidole, although low pseudocholinesterase. Since 7 YMS, she was discharged with haloperidol 15mg/day, biperiden 4mg/day and quetiapine 25mg/day. Conclusion This case highlights the effectiveness of ECT in mania during the first trimester of pregnancy. We suggest that ECT might be considered as a valid option for manic episode during pregnancy.

Is Electroconvulsive Therapy Safe in the Presence of an Intracranial Metallic Object?

Little is known about the use of electroconvulsive therapy (ECT) in patients with intracranial metallic objects. Theoretically, electric current might cause heating of the metal and damage of the surrounding brain tissue. Moreover, intracranial foreign objects increase the risk for epileptic phenomena and could thus complicate the treatment course. The case of a man with intracranial bullet fragments as a result of a headshot, treated with ECT for mania, is presented. We conducted a PubMed literature search for other relevant cases. In our patient, ECT was completed without complication. Electroconvulsive therapy was safely administered in 22 published cases of patients with intracranial metallic objects. After carefully weighing benefits and risks in each individual case, psychiatrists should not be reluctant to use ECT in patients with intracranial metallic objects. Apart from avoiding empirical dosage titration to minimize the exposure to current, positioning the electrodes to avoid the electric current of heating the metal, and continuing antiepileptic agents in high-risk patients, no precautions need to be considered.

Lithium Plus ECT for Mania in 90 Cases: Safety Issues

Back to table of contents Previous article Next article LettersFull AccessLithium Plus ECT for Mania in 90 Cases: Safety IssuesFernando Madalena Volpe, M.D., Ph.D., and Almir Ribeiro Tavares Jr., M.D., Ph.D.Fernando Madalena VolpeSearch for more papers by this author, M.D., Ph.D., and Almir Ribeiro Tavares Jr.Search for more papers by this author, M.D., Ph.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.neuropsych.11110321AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The concurrent use of lithium and electroconvulsive therapy (ECT) is subject to controversy.1,2 Whereas lithium discontinuation may result in rebound mania, sparse observational studies and case reports support the rejection of their concomitant administration, because of an increased risk for prolonged apnea and neurological side effects.3 So far, only one small (N=56), controlled experimental study4 assessed the risks of combining lithium and ECT, with no severe adverse outcomes. Managing bipolar disorder often requires much beyond available evidence to keep a patient stable, or alive. Since no well-designed studies support the concomitant use of lithium and ECT, patients and doctors are exposed to safety issues.In the recent past, we have published a retrospective study primarily aimed at investigating inpatient treatment practices for mania.5 ECT was used in one-third of 425 admissions for mania (bilateral electrodes, sinusoidal device, anesthesia with succinylcholine and thiopental). Lithium was frequently used concurrently with ECT (in 63% of the cases; N=90), as well as antipsychotics (in 82%), anticonvulsants (31%), antidepressants (4%), and benzodiazepines (47%). Deaths were neither reported with the lithium/ECT association, nor in a non-lithium ECT subgroup (N=51). Length of stay was not significantly altered because of lithium (20.3 [12.9] versus 21.1 [9.12] days) or of other concomitant medication. The average number of ECT sessions was similar in patients with lithium (5.6 [2.5]) and without lithium (6.2 [2.4]). The average number of internal-medicine referrals during admissions was lower in the ECT+lithium subgroup (1.9 [1.9]) than in the non-lithium ECT subgroup (2.8 [2.8]; p=0.02), and the number of psychiatric calls was statistically similar in patients receiving concomitant lithium (5.3 [6.6]) and not receiving it (6.7 [7.5]). Post-ECT length of stay was not influenced by the concomitant use of lithium (3.5 [6.4] versus 2.9 [5.2]). However, cognitive side effects were not directly assessed in that study.On this case series of 90 mania patients who received lithium+ECT, severe unfavorable outcomes were absent. More subtle adverse effects of this interaction could not be evidenced because of the retrospective study design, and lithium levels were not gathered. However, the naturalistic approach adds real-life evidence to this debate.Currently improved ECT practices, including comprehensive pre-ECT evaluation with neuroimaging, ECT monitoring, optimizing energy use, and targeting for lower lithium serum levels contributes to improve the safety of the lithium+ECT association.Hospital Galba VellosoHospital Foundation of Minas GeraisBelo HorizonteBrazilDept. of PsychiatryFederal University of Minas GeraisBrazilCorrespondence: Dr. Fernando Madalena Volpe; e-mail: [email protected]com.brReferences1 Schou M: Lithium and electroconvulsive therapy: adversaries, competitors, allies? Acta Psychiatr Scand 1991; 84:435–438Crossref, Medline, Google Scholar2 el-Mallakh RS: Complications of concurrent lithium and electroconvulsive therapy: a review of clinical material and theoretical considerations. Biol Psychiatry 1988; 23:595–601Crossref, Medline, Google Scholar3 American Psychiatric Association: The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. Washington, DC, 2001Google Scholar4 Thirthalli J, Harish T, Gangadhar BN: A prospective comparative study of interaction between lithium and modified electroconvulsive therapy. World J Biol Psychiatry 2011; 12:149–155Crossref, Medline, Google Scholar5 Volpe FM, Tavares A, Correa H: Naturalistic evaluation of inpatient treatment of mania in a private Brazilian psychiatric hospital. Rev Bras Psiquiatr 2003; 25:72–77Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByInFo Neurologie & Psychiatrie, Vol. 20, No. 1Psychiatric Clinics of North America, Vol. 41, No. 3The PRIDE Study and the Conduct of Electroconvulsive TherapyThe Journal of ECT, Vol. 33, No. 4Pharmacological Treatment of Bipolar Disorder in the Elderly26 January 2017 | Current Treatment Options in Psychiatry, Vol. 4, No. 1ECT and lithium in old age depression – cause or treatment of rapid cycling?23 June 2015 | Australasian Psychiatry, Vol. 23, No. 5Neuropsychiatry, Vol. 4, No. 1 Volume 24Issue 4 Fall 2012Pages E33-E33 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012

Electroconvulsive therapy in the elderly

Recent evidence indicates that in major depressive disorder, the magnitude by which electrical dosage exceeds the individual's seizure threshold is critical to the efficacy of unilateral electroconvulsive therapy, and to the speed of response of bilateral electroconvulsive therapy. Electroconvulsive therapy appears to be as effective, if not more effective, in elderly people compared with young adults, although careful attention needs to be paid to cardiovascular status and risk factors. Literature reviews provide strong support for the efficacy of electroconvulsive therapy in mania, although there are few controlled studies. Brain-imaging studies reveal a high prevalence of white-matter abnormalities in geriatric major depression, and further work is needed to clarify their clinical correlates

Combined Chlorpromazine and Electroconvulsive Therapy in Mania

We report the efficacy of combined chlorpromazine and electroconvulsive therapy (ECT) in the treatment of mania. Two groups of 15 manic patients received eight ECT sessions either actual or simulated, in a double-blind, controlled study. All patients also received 600 mg of chlorpromazine daily until the sixth session. Results indicate that the group receiving the combination of chlorpromazine and ECT did significantly better than the other group.