Indications For Electroconvulsive Therapy Research Articles

A comparative study of electroconvulsive therapy among the elderly and adult patients with depressive disorder

ABSTRACT Aim: The present study aimed to compare the clinical profile, indications for electroconvulsive therapy (ECT), effectiveness of ECT, and complications associated with the use of ECT among elderly and adult patients. Methodology: Using a retrospective study design, data from patients with a diagnosis of unipolar depression, who received ECT between January 2013 and March 2023 was extracted. Based on the age at the time of receiving ECT, the study sample was divided into adult (age <60 years) and elderly (≥60 years) groups and compared. Results: The study included data from 1144 patients with depression. Of them, 371 (32.4%) patients were aged 60 years or above. Compared to the adult group, a significantly higher number of patients in the elderly group were diagnosed with recurrent depressive disorder (P < 0.001), had psychotic symptoms (P < 0.001), and had at least one medical comorbidity. Compared to adult patients, elderly depressed patients had longer total lifetime duration of illness (P < 0.001) and longer duration of current symptoms (P = 0.012). In terms of indications for ECT, the elderly patients had a higher frequency of poor response to the pharmacological treatment (P = 0.003) and a lower frequency of suicidality and attempts at self-harm (P < 0.001). Compared to adults, elderly patients received a higher number of effective ECTs (P = 0.04). There were no differences between the two groups in terms of the reason for stopping ECT and the extent of improvement. However, a higher proportion of the elderly experienced complications related to ECT and received repeat ECT courses (P = 0.003) and continuation ECT (P < 0.001). Conclusion: The present study shows that there are some differences between the elderly and adult patients with depression in terms of indications for ECT, side effects related to ECT, need for multiple courses of ECT, and continuation ECT. However, the efficacy of ECT does not differ between the two groups.

Posttraumatic stress disorder comorbidity in patients undergoing ECT for major depressive disorder.

Posttraumatic stress disorder (PTSD) is not recognized as an indication for electroconvulsive therapy (ECT). However, research indicates promise for this treatment modality. To elucidate the effects of ECT for treating PTSD, prospective research is needed. The first step in assessing the feasibility of such research is to determine if many patients being treated with ECT have comorbid PTSD. This study examined the PTSD comorbidity rates and compared demographic data among patients with major depressive disorder (MDD) who were treated with ECT vs patients with MDD who were not treated with ECT. Data from patients with MDD were obtained from the Nationwide Inpatient Sample. Approximately 10% of patients undergoing ECT for MDD also had PTSD. The difference in comorbidity of PTSD in those treated with ECT vs those not treated with ECT was approximately 1%. Prospective naturalistic studies that examine the response of PTSD to ECT are feasible because a sizable number of patients with PTSD are receiving ECT.

Affected cortico-striatal-cerebellar network in schizophrenia with catatonia revealed by magnetic resonance imaging: indications for electroconvulsive therapy and repetitive transcranial magnetic stimulation.

Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders, including schizophrenia. Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophrenia is poorly understood. However, emerging neuroimaging studies in catatonia patients have indicated that a disruption in anatomical connectivity of the cortico-striatal-cerebellar system is part of the neurobiology of catatonia, which could serve as a target of neurostimulation such as electroconvulsive therapy and repetitive transcranial magnetic stimulation.

Somatic symptom disorder with predominant pain treated by electroconvulsive therapy: a case report

<h3>Introduction</h3> Somatic symptom disorder is a challenging condition for which there are limited pharmacological modalities available for treatment. There have been no epidemiologic studies on somatic symptom disorder since the adoption of DSM-5 in 2013, but somatic symptom disorder has been considered with a prevalence of around 5 % based on previous research in somatization disorder (Creed et al. 2004). The diagnosis of somatic symptom disorder is often delayed. As somatic symptoms progress to the level of functional decline, patients are eventually referred to psychiatrists for additional assessment and treatment. Unfortunately, the underlying neurobiology of this condition is largely unknown. Given these circumstances, the current treatment guideline recommends initial treatment targeting comorbid depressive symptoms or anxiety as well as a cognitive behavior approach. Patients benefit from scheduled visits with a primary care provider and collaborative care among all providers (Kurlansik et al. 2016). The goal of treatment is not to cure symptoms but the management of symptoms to maintain an individual's function in life. However, there are certain refractory and debilitating cases of somatic symptom disorder despite multiple trials and therapeutic approaches. As with the indication of electroconvulsive therapy (ECT) for refractory depression, bipolar disorder, and schizophrenia, there have been several case reports highlighting ECT for the treatment of somatic symptom disorder (Gahr et al. 2011, Suda et al. 2008). <h3>Methods</h3> We present a case of somatic symptom disorder (with predominant pain in chest, abdomen, and back) refractory to multiple medications without primary mood disorders, which was eventually treated with an acute course of ECT. <h3>Results</h3> A 68-year-old male with no previous psychiatric history self-presented to the emergency room with the chief complaint of pain frequently over the course of three years, with greater than 50 presentations in 12 months. Chief complaints included left-sided-chest pain, facial paresthesias, and numbness and tingling sensation in his left arm and ankle. Broad medical workup including EKG, troponin, EMG, chest and abdomen CT, brain and whole spine MRI showed no medical cause for the pain. Trials of duloxetine, nortriptyline, gabapentin, Tramadol and hydromorphone were tried without improvement. Weekly cognitive behavioral therapy for his nonadaptive health seeking behavior and anxiety was conducted. Eventually, he was admitted to the hospital to pursue an ECT trial to target his chronic pain symptoms diagnosed as a somatic symptom disorder. Prior to his initial ECT treatment, pain was rated as 10 plus out of 10. Following one ECT treatment, pain was rated as two on the day of treatment. He initially experienced side effects of ECT including generalized confusion and disorientation to time and place, however this resolved within several hours. Pain increased to 5 one day after the first ECT, however it continued to improve over the course of receiving ECT with 0 after the sixth session over the two weeks. Throughout the course of ECT, his mood was reported as "fine" with a stable score of 15 in PHQ-9. <h3>Conclusions</h3> We suggest that ECT could be considered as a possible treatment option for refractory somatic symptom disorder. It is unclear about the efficacy of ECT for somatic symptom disorder with the current evidence base. Further research with a large number of cases and with a focus on the biological approach are still needed to elucidate the underlying mechanism of action to support the indication of ECT for somatic symptom disorder. <h3>This research was funded by</h3> All authors have no funding to report.

Major Depressive Disorder in the Older Adult Associated With Globus Pharyngeus and Weight Loss – An Indication for Electroconvulsive Therapy

Aspiration pneumonia and extreme weight loss are risks whenever globus pharyngeus (GP) complicates major depressive disorder (MDD) in the older adult. The timely administration of electroconvulsive therapy (ECT) may reverse GP in this context. We review cases of GP in depressed older adults and describe both successful outcomes, as well as a fatal outcome associated with delays in offering ECT. MDD in the older adult complicated by GP and marked weight loss, or repeated aspiration, should be considered an urgent indication for ECT.

Major depressive disorder: treatment and future perspective

SUMMARY Major depressive disorder is a mood disorder characterized by both severe affective and neurovegetative symptoms together. It is a common disorder seen in a quarter of consecutively admitted depressed patients and is often associated with severe symptomatology, increased suicide risk, poor acute response to antidepressants and poor acute and long-term treatment outcome. The question of the optimal duration of pharmacotherapy in order to prevent relapse and improve the long-term (i.e., 5-year) outcome is a focus of current investigation. This article will review currently recommended treatment strategies for the acute, continuation and maintenance phases of therapy. In particular, it will address the role of newer-generation antidepressants, the use of mood stabilizers and indications for electroconvulsive therapy. Other possible treatment strategies such as transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and glucocorticoid receptor antagonists will be discussed.

Effectiveness of Electroconvulsive Therapy for Depression and Cotard’s Syndrome in a Patient with Frontotemporal Lobe Dementia

In the field of psychogeriatrics, the differential diagnosis of depression and dementia, as well as the treatment of depression and comorbid dementia, is an important issue. In this paper, the authors present the case of a 72-year-old woman with Cotard's syndrome and frontotemporal dementia (FTD) who was admitted to a psychiatric hospital with delusions of negation accompanied by depressive symptoms. Pharmacotherapy over a 2-year hospitalization was unsuccessful, and she was subsequently transferred to our university hospital. A total of 18 sessions of electroconvulsive therapy released her from psychomotor inhibition, appetite loss, and Cotard's delusions. The indication for electroconvulsive therapy in patients with dementia is discussed.

Expert consensus on hospitalization for assessment: a survey in Japan for a new forensic mental health system

BackgroundIn Japan, hospitalization for the assessment of mentally disordered offenders under the Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity (the Medical Treatment and Supervision Act, or the MTS Act) has yet to be standardized.MethodsWe conducted a written survey that included a questionnaire regarding hospitalization for assessment; the questionnaire consisted of 335 options with 9 grades of validity for 60 clinical situations. The survey was mailed to 50 Japanese forensic mental health experts, and 42 responses were received.ResultsAn expert consensus was established for 299 of the options. Regarding subjects requiring hospitalization for assessment, no consensus was reached on the indications for electroconvulsive therapy (ECT) or for confronting the offenders regarding their offensive behaviors.ConclusionsThe consensus regarding hospitalization for assessment and its associated problems were clarified. The consensus should be widely publicized among practitioners to ensure better management during the hospitalization of mentally disordered offenders for assessment.

When is electroconvulsive therapy appropriate for children and adolescents?

The indications for electroconvulsive therapy in children and adolescents are similar to those in adults, including severe affective, psychotic and catatonic pathology that has proven refractory to psychotropic medications and causes significant functional impairment. ECT may be indicated as well in specific pediatric neurological conditions. Multiple published reports demonstrate the safety and efficacy of ECT in pediatric patients with a wide range of psychopathology. ECT has also been successfully used in youth with autism and other neurodevelopmental disabilities who present with catatonic deterioration. However, resistance and stigma persist regarding the use of ECT in children and adolescents in both the professional and lay communities, creating barriers to pediatric ECT access. We argue that the use of ECT in children and adolescents is appropriate for specific clinical indications, and urge removal of impediments to ECT access in this population.

Self-injury in autism as an alternate sign of catatonia: Implications for electroconvulsive therapy

Multiple reports show the efficacious usage of ECT for catatonia in individuals with autism. There are also a few reports showing that ECT improves self-injury in people with and without autism. In this hypothesis, self-injury in autism and other developmental disorders may be an alternate sign of catatonia, and as such an indication for electroconvulsive therapy. The issue is important because self-injury occurs at an increased rate in autistic and intellectually disabled individuals, but is poorly understood and often difficult to treat with psychological and pharmacological means. Self-injury may be considered a type of stereotypy, a classic symptom of catatonia that is exquisitely responsive to electroconvulsive therapy (ECT). Historical and modern reports further support the association of self-injury, tics and catatonia. Central gamma-aminobutyric acid (GABA) dysfunction may provide an important explanatory link between autism, catatonia and self-injury. Therefore, people with autism and other developmental disorders who develop severe self-injury (with or without concomitant tics) should be assessed for catatonia, and ECT should be considered as a treatment option. Further studies of the utility of ECT as an accepted treatment for catatonia are warranted in the study of self-injury in autism.

Current and emerging somatic treatment strategies in psychotic major depression

Psychotic major depressive disorder (MDD) is a mood disorder characterized by severe affective and neurovegetative symptoms together with the presence of delusions and/or hallucinations. It is a common disorder seen in a quarter of consecutively admitted depressed patients and is often associated with severe symptomatology, increased suicide risk, poor acute response to antidepressants and poor acute and long-term treatment outcome. It is possible that poor response in psychotic depression is caused by the fact that we have yet to identify the most efficacious treatment protocol for psychotic MDD. Multiple studies have shown that modifications in the treatment paradigm may increase treatment efficacy in psychotic MDD. It has been generally accepted that, during the acute treatment phase, antidepressant–antipsychotic drug combination therapy is more effective than either treatment alone, although this strategy has recently been challenged. The question of the optimal duration of pharmacotherapy in order to prevent relapse and improve long-term (i.e., 5-year) outcome is a focus of current investigation. This article will review currently recommended treatment strategies for the acute, continuation and maintenance phases of therapy. In particular, it will address the role of newer-generation antidepressants, the role of second-generation antipsychotics, the use of mood stabilizers and indications for electroconvulsive therapy. Other possible treatment strategies such as transcranial magnetic stimulation, vagus nerve stimulation, deep-brain stimulation and glucocorticoid receptor antagonists will be discussed. Current recommendations for the prevention of relapse and improvement of long-term outcome will be reviewed.

Electroconvulsive therapy in the Nordic countries, 1977–1987

In 1977 a questionnaire was sent to all psychiatric departments in the Nordic countries: Sweden, Norway, Denmark, Finland and Iceland, concerning indications for electroconvulsive therapy (ECT) and the use of unilateral and bilateral treatment, respectively. The inquiry was repeated in 1987 and the answers compared with those obtained in 1977. In addition, the answers from Denmark were compared with previously performed inquiries. The use of exclusively unilateral treatment (U) and of both unilateral and bilateral treatment (UB) has increased in most of the countries and exclusively bilateral treatment (B) has decreased drastically. In Denmark the situation has not changed for ECT in endogenous depression and acute delirium, and the use in reactive psychosis, mania and schizophrenia decreased somewhat during the 1970s and then again stabilized or increased during the 1980s. Nearly all departments in the Nordic countries used ECT in endogenous depression in 1977 and were still doing it in 1987. In mania, about 50% of all departments have found ECT indicated occasionally or exceptionally both in 1977 and 1987. Manic-depressive mixed states have been regarded as an indication in somewhat more than two thirds of departments, increasing during the period. The use of ECT in schizophrenia has been rare and somewhat decreasing, but still about half of the departments apply it once in a while. In reactive psychosis the use of ECT decreased slightly, but in 1987 it was still in use for this indication in about 50% of all departments. In acute delirium there has been an overall increase in the use of ECT.(ABSTRACT TRUNCATED AT 250 WORDS)

Electroconvulsive therapy

Despite persistent controversy regarding its clinical use, research interest in electroconvulsive therapy remains active, with more than 400 publications on electroconvulsive therapy and electroconvulsive shock seen during the past year. Indications for electroconvulsive therapy are better delineated; applications in population with special medical problems and safer methods of administration are described, and greater attention is paid to the proposed mechanisms of its action. Two definitive reviews of electroconvulsive therapy practice, one by the Royal College of Psychiatrists and a second by the American Psychiatric Association, provide new national standards of care

Chemotherapy in aged psychiaric patients.

The psychopathology of organic brain syndromes and functional psychiatric disorders in the aged has been outlined, and the various specific and non-specific physical therapies for psychiatric disorders occurring in this age group have been discussed. The indications for electroconvulsive therapy are restricted to depressions, particularly first and acute depressions in this population. Various drug therapies are successfully employed in numerous geriatric conditions. Pharmacotherapy is discussed under six headings: Substitution or replacement therapy —whenever there is a break-down of metabolic processes due to deficiency of an important factor in the complex chain of metabolism; Anticoagulants and Vasodilators — when there is sufficient evidence to believe that decreased brain metabolism plays an important role in the causation of impaired behavioural functioning and inertness; Sedatives (minor tranquillizers) — to control restlessness, tension, anxiety and insomnia; Neuroleptics (major tranquillizers) — for the treatment of psychotic symptoms, e.g. hallucinations, delusions and manneristic behaviour; and Anti-depressants — for the treatment of various depressions. It must be remembered that the general indications for these treatments are the same in geriatric as in younger patients, but the geriatric patient is often more sensitive to drugs and to the side effects they may produce.

ELECTROCONVULSIVE THERAPY AND DEPRESSION. 3. A METHOD FOR PROGNOSIS.

After 25 years there is still considerable disagreement surrounding the indications for electro-convulsive therapy (E.C.T.). This is a particular problem in the treatment of depression, both because of the controversy over the division of depression into endogenous and reactive illnesses and because of the increasing use of the antidepressant drugs. These drugs will induce a remission in many patients, and will alter the clinical picture in others. As their use becomes still more widespread (Freyhan (1) has recommended that intensive imipramine treatment should be tried routinely before E.C.T. in all depressed patients) there may be further difficulties in the selection of depressed patients likely to respond well to E.C.T. Furthermore several recent reviews draw attention to a reduction in the use of E.C.T., and the lack of a consistent rationale for its use (2–4).