Maintenance Electroconvulsive Therapy Research Articles

Maintenance electroconvulsive therapy: An effective yet underused treatment modality in psychiatry: A case series

Maintenance Electroconvulsive Therapy (M-ECT) refers to ECTs administered beyond 6 months after the remission of illness. Maintenance electroconvulsive therapy (M-ECT) can be used to reduce the risk for relapse and recurrence of illness in patients who fare poorly with standard medication regimens. There is improvement in the relapse rate of major psychiatric disorders when continuation or maintenance (C or M-ECT) are used with psychotropics. These are single-center, retrospective case studies of patients diagnosed with major psychiatric disorders (as per International Classification of Diseases, 11th edition) who are receiving M-ECT in Department of Psychiatry, B.J. Government Medical College and Sassoon Hospital, Pune. We included 12 patients- 8 males and 4 females in this study. 4 cases were of patients suffering from schizophrenia, 3 cases were of patients suffering from depression, 1 case of bipolar affective disorder and 4 cases of patients of intellectual disability with psychosis. There was a reduction in hospitalization rate for acute exacerbation and significant improvement in the patients’ overall functioning on standardized rating scales without any significant adverse effects. Maintenance ECT is an underused treatment option that can substantially reduce risks of relapse in patients with major depressive disorder, bipolar disorder and schizophrenia as well. Despite the potential value of these ECT schedules, these are relatively neglected in clinical practice. This article aims to explore the clinical utility of maintenance ECTs and emphasizes the use of maintenance ECTs in routine psychiatric care.

Maintenance Electroconvulsive Therapy in Catatonia: Clinical Profiles From a Case Series.

This study aims to conduct a descriptive analysis of the clinical features and treatment responses in 6 patients with catatonia who received maintenance electroconvulsive therapy (ECT). Our study included all patients who underwent maintenance ECT (mECT) at the Hospital Clínic de Barcelona between September 2020 and September 2022 following a catatonic episode. The study cohort comprised 5 patients with schizophrenia and 1 patient with major depressive disorder. Among patients with schizophrenia, the first catatonic episode occurred several years after their initial paranoid psychotic episode, whereas the patient with depression experienced a rapid progression from the first depressive episode to catatonia. After acute ECT, 4 patients achieved complete symptomatic remission, 1 patient exhibited a partial response, and another maintained a severe catatonic state. Maintenance ECT was indicated because of the high risk of severe relapses. The mean frequency of mECT sessions was 9.83 (SD, 5.60) days. Notably, 66.67% of the patients were concurrently receiving clozapine as part of their pharmacological treatment. Among patients with schizophrenia, mECT sessions could not be extended beyond 7 to 10 days, whereas the depressed patient could space ECT sessions up to 21 days without experiencing a relapse. Maintenance ECT proves to be a safe and well-tolerated strategy for preventing relapses in severe catatonic patients who have previously stabilized with acute ECT. Further research is needed to develop clinical guidelines that define optimal application strategies for mECT in catatonia.

Vagus Nerve Stimulation as an Alternative to Maintenance Electroconvulsive Therapy for Difficult-to-Treat Depression.

Vagus nerve stimulation (VNS), an implantable neurostimulator, provides a valuable long-term treatment option for patients with difficult-to-treat depression. It has been reported that previous response to electroconvulsive therapy (ECT) might predict a better response to VNS and that VNS could reduce or eliminate the need for maintenance ECT in some patients. We present the case of a patient who received a total of more than 120 sessions of ECT over the course of 13 years because of a major depressive disorder, with favorable response but without achieving full remission. After implantation of VNS, ECT was discontinued, and her depressive symptoms improved, achieving remission within 12 months. This case supports VNS as an alternative to maintenance ECT in patients with difficult-to-treat depression who have shown previous response to ECT treatment.

Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series.

The use of vagus nerve stimulation (VNS) to reduce or stop electroconvulsive therapy (ECT) in treatment-resistant depression seems promising. The aim of this study was to investigate the efficacy of VNS on the reduction of ECT sessions and mood stabilization. We conducted a monocentric retrospective case series of patients who suffered from treatment-resistant depression, treated with ECT and referred to our center for VNS. We investigated the number and the frequency of ECT sessions before and after VNS implantation. Secondary criteria consisted in the Montgomery Åsberg Depression Rating Scale (MADRS) score, number of medical treatments, dosage of the main treatment and length of hospital stays before and after VNS. Additionally, we sent an anonymous survey to psychiatrists and other physicians in our institution to investigate their knowledge and perception of VNS therapy to treat treatment-resistant depression. Seven patients benefited from VNS: six (86%) were female (mean age of 51.7 +/- 16.0 years at surgery), and five (71%) suffered from bipolar depression (three type I and two type II). All patients were followed up at least 2 years post-implantation (range: 27-68 months). Prior to VNS, six patients were treated by maintenance ECT. After VNS, three (43%) patients did not require maintenance ECT anymore, and three (43%) patients required less frequent ECT session with a mean 14.7 +/- 9.8 weeks between sessions after VNS vs. 2.9 +/- 0.8 weeks before VNS. At last follow-up, 4 (57%) patients had stopped ECT. Five (71%) patients implanted with VNS were good responders (50% decrease relative to baseline MADRS). According to the survey, psychiatrists had a significantly better perception and knowledge of ECT, but a worse perception and knowledge of VNS compared to other physicians. VNS is a good option for treatment-resistant depression requiring maintenance ECT dependence. Larger on-going studies will help broaden the implanted patients while strengthening psychiatrists' knowledge on this therapy.

Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial.

This study aimed to compare the long-term effects of maintenance electroconvulsive therapy (M-ECT) with medication and medication only in patients with depression. A randomized controlled trial of 1 year of M-ECT with medication or medication only investigated relapse/recurrence among 56 patients in remission after electroconvulsive therapy (ECT) for depression was conducted. The results of the first year are published already and showed a significant advantage of M-ECT with medication.The current study was a long-term follow-up. When the randomized treatment allocation ended, medication was continued in both groups but M-ECT was terminated. Patients were followed for up to 10 years via Swedish national registers until the study endpoint of a new psychiatric diagnosis as an inpatient, suicide, suspected suicide, or death of another cause. Time to relapse was compared between the M-ECT with medication group and the medication-only group using Kaplan-Meier estimates. The median follow-up time was 6.5 years for the M-ECT and medication group and 3.1 years for the medication-only group. One year after randomization 22 patients remained in the M-ECT and medication group, and 14 patients remained in the medication-only group. Relapse patterns between the treatment groups after the completion of M-ECT seemed to be similar according to visual inspection. This long-term follow-up study suggests that most of the benefit achieved during the treatment period with M-ECT is maintained over several years, but the small sample size, with accompanying large statistical imprecision, makes the results uncertain. More long-term studies of M-ECT are required.Trial registration: ClinicalTrials.gov identifier: NCT00627887.

Examining the clinical effectiveness of continuation and maintenance electroconvulsive therapy in schizophrenia

ObjectiveThere are few studies that examine the effectiveness of Continuation/Maintenance Electroconvulsive Therapy (C/M-ECT) in schizophrenia, despite the documented effectiveness of acute ECT treatment. We aimed to investigate the clinical effectiveness of C/M-ECT for in-patients with Schizophrenia in a naturalistic setting. We examined the medical records of 46 in-patients who were diagnosed with Schizophrenia and had received C/M-ECT belonging to non-acute extended care service in a public psychiatry hospital in Sydney, Australia. The focus of analysis was on 138 treatment cycles (71 acute only cycles and 67 acute-continuation/maintenance cycles) across 45 subjects. A linear mixed effects model was used to describe the change in clinical global impression-severity (CGI-S) over time 4 time points viz., pre-post acute and pre-post continuation/maintenance ECT. ResultsAcute-only cycles and acute-continuation/maintenance cycles had identical pre- (M = 5, C.I. = 4–6), post-cycle CGI-S scores, and identical CGI-S difference scores (M = 0, C.I. = −1 – 1). Broadly in each continuation/maintenance cycle, we observed an initial sharp decrease in CGI-S scores followed by a logarithmic increase in scores over time, with satisfactory CGI-S score maintenance observed for approximately 6 months. Bitemporal ECT influenced CGI-S across maintenance ECT (p < 0.05) indicating smaller declines in CGI-S scores over time. ConclusionIn schizophrenia, C/M ECT preserves effects on illness severity for at least upto 6 months following an acute course of ECT. Bitemporal ECT vis a vis other electrode positions differentiated clinical severity over time.

ELECTROCONVULSIVE THERAPY FOR TREATMENT OF TACTILE HALLUCINATIONS

Abstract Tactile hallucinations can be highly distressing and lead to psychiatric morbidities and functional impairments. There are no established treatments for tactile hallucinations that occur outside of primary psychotic disorders, and available pharmacologic and nonpharmacologic therapies may have limited effectiveness. We present a case of a 75-year-old female with treatment-refractory tactile hallucinations successfully treated with electroconvulsive therapy (ECT). She endorsed 13 months of distressing tactile hallucinations described as slimly substances on her skin. Symptoms started insidiously, became more severe with time and refractory to multiple antipsychotic medications. She became so severely distressed from the tactile hallucinations that she developed a major depressive episode and became suicidal. Relevant medical history included one prior depressive episode, occipital lobe stroke, restless legs syndrome, and obstructive sleep apnea. She was hospitalized in an inpatient psychogeriatric unit and treated with ECT for 12 sessions over 3.5 weeks. Hallucinations responded well to ECT. Patient experienced some mild memory impairment from treatment. Treatment was optimized with duloxetine titration, addition of mirtazapine and repletion of B6 vitamin. Following the acute course of ECT, she reported an 80 % improvement in tactile hallucinations. Depressive symptoms improved, and suicidal thoughts resolved. She was able to discharge from the hospital and continued with maintenance ECT. Our case illustrates the potential therapeutic role of brain stimulation in the treatment of refractory cases of tactile hallucinations. Further studies are needed to determine effective treatment strategies for treatment-refractory tactile hallucinations to prevent progression to severe psychiatric disturbances and improve quality of life.

P179: Clinical characteristics and potential link to Parkinson’s disease and dementia with Lewy bodies in patients with major depressive disorder who received maintenance ECT

Introduction:Maintaining remission after electroconvulsive therapy (ECT) is of clinical relevance in patients with depression, and maintenance ECT is introduced in patients who fail to maintain remission after ECT. However, the clinical characteristics and the biological background of patients who receive maintenance ECT are barely understood.Methods:At Keio University Hospital, Patients with major depressive disorder according to DSM-IV who received ECT between January 2012 and March 2019 followed by maintenance ECT (mECT group) and those who did not (aECT group) were included. Clinical characteristics including the results of neuroimaging marker for Parkinson’s disease and dementia with Lewy bodies were compared between groups.Results:Thirteen and one hundred forty-six patients were included in mECT and aECT groups, respectively. Compared with aECT group, the age of onset and the age of the first ECT was older in mECT group. Besides, mECT group showed significantly higher prevalence of melancholic feature (92.3% vs. 27.4%, p&lt;0.001) and catatonic feature (46.2% vs. 9.6%, p=0.002). The results of neuroimaging marker obtained in 123I-metaiodobenzylguanidine scintigraphy and dopamine transporter scan revealed that 5 of 13 patients and 16 of 146 patients showed Parkinson’s disease and dementia with Lewy bodies in mECT and aECT groups, respectively.Conclusion:Patients who underwent acute and maintenance ECT have impaired dopamine function. Investigating the neurobiology of patients who receiving maintenance ECT is an important area for development of appropriate treatment for depression.

Electroconvulsive therapy parameters for behavioral and psychological symptoms of dementia

AbstractIntroductionBehavioral and Psychological Symptoms of Dementia (BPSD) are a heterogenous group of non‐cognitive symptoms impacting up to 90% of patients with dementia, and include emotional disturbance, psychosis, agitation, aberrant motor behavior, and circadian rhythm disturbance. Multiple reviews have found ECT to be efficacious in treating BPSD that have not responded to other interventions. However, no published guidelines exist to inform clinicians about how protocols for ECT should be implemented in the treatment of BPSD. This study aims to identify ECT parameters commonly utilized for BPSD in the literature.MethodsMEDLINE and APA PsychInfo were searched from database inception until September 2022. Two reviewers independently screened and full text reviewed the retrieved articles. Articles included in the full text review stage discussed how ECT is implemented for patients experiencing BPSD.ResultsAfter duplicate removal, 800 unique citations were identified for screening. Of these, 160 were included in full text review. 32 studies were ultimately included (Figure 1). Characteristics of included studies are highlighted in Figures 2 and 3.Most studies utilized thrice weekly ECT, however, twice weekly was suggested to carry a lower risk of ECT‐related cognitive side effects. The number of sessions needed for response ranged between 2‐15, with improvement typically observed within 3‐6 treatments. The choice between unilateral and bilateral placement rests on weighing the risk of confusion with improved clinical response. Multiple authors recommend starting with unilateral treatment to reduce cognitive side effects and switching to bilateral if response is inadequate after 3‐5 sessions. Typical pulse width was 0.30‐0.37ms for ultrabrief and 1‐2s for brief treatment. Minimum recommendations for adequate seizure duration varied from 25 to 30 seconds on EEG and 15 to 20 seconds by observed motor movements. Stimulus dosage ranged between 1.5‐2.5x seizure threshold for bilateral placement, and 4‐6x seizure threshold for unilateral placement. Maintenance ECT was commonly used to reduce the risk of relapse.DiscussionECT is both safe and efficacious for patients with BPSD, and the present review focuses on commonly implemented ECT parameters in the literature. Notably, studies are limited by inconsistent reporting of ECT parameters and short follow‐up durations.

Should We Re-estimate the Seizure Threshold during Maintenance ECT?

Should We Re-estimate the Seizure Threshold during Maintenance ECT?

Deep brain stimulation and digital monitoring for patients with treatment-resistant schizophrenia and bipolar disorder: A case series.

The use of deep brain stimulation (DBS) has been recently extended for treating resistant psychiatric disorders, but the experience in patients with schizophrenia-related disorders and bipolar disorder (BD) is scarce. We conducted an observational, one-year longitudinal study to evaluate the effects of DBS in four treatment-resistant patients with schizophrenia, schizoaffective, and BD, included in a pilot, last-resource protocol. Patients were digitally monitored for objective assessment of behavioral changes. After one year of its initiation, DBS of the nucleus accumbens (in subjects N2, N3, and N4) and subgenual anterior cingulate cortex (in N1) produced a significant clinical improvement, associated with decreases in the Clinical Global Impression (from 5.25±0.5 to 3.5±1, p=0.035) and in the Hamilton Depression Rating Scale (HADRS scores, from 14.5±6.56 to 1.5±1.29, p=0.020). We observed a notable, durable therapeutic response in two patients from this cohort (N1 and N3), a clinically relevant relief in a third (N2), and a lack of a significant response in the last one (N4). Maintenance electroconvulsive therapy sessions could be discontinued in the three patients that responded to DBS (N1-3). There were no side effects or relevant changes in cognitive functioning. There were relevant differences between physical activity and sleep time among the four participants. These results suggest initial evidence that DBS may be an effective and safe alternative for treating complex and resistant forms of schizophrenia-related disorders and BD. Digital monitoring may help to capture objective measures of behavioral changes after the intervention.

Balancing the beautiful and the good in pursuit of biomarkers for depression.

Balancing the beautiful and the good in pursuit of biomarkers for depression.

Effects of Anesthesia Changes During Maintenance ECT: A Longitudinal Comparison of Seizure Quality Under Anesthesia Using Propofol/Esketamine Versus Methohexital.

The effectiveness of ECT relies on the induction of a generalized cerebral seizure. Among others, seizure quality (SQ) is potentially influenced by the anesthetic drug used. Commonly used anesthetics comprise barbiturates, etomidate, propofol, and esketamine, with different characteristics and impacts on seizure parameters. So far, no studies have compared the influence of methohexital vs. a combination of propofol/esketamine on established SQ parameters. This retrospective longitudinal study compared eight established SQ parameters (PSI, ASEI, MSC, midictal amplitude, motor and electroencephalography (EEG) seizure duration, concordance, PHR) before and after the change from propofol/esketamine to methohexital in 34 patients under maintenance ECT. Each patient contributed four measurements, two before and two after the anesthesia change. Anesthesia dose, stimulus dose, electrode placement, and concomitant medication remained unchanged throughout the analyzed treatments. Under methohexital (M=88.97 mg), ASEI (p=0.039 to 0.013) and midictal amplitude (p=0.022 to<0.001) were significantly lower, whereas seizure duration (motor and EEG) was significantly longer when compared to propofol/esketamine (M=64.26 mg/51.18 mg; p=0.012 to<0.001). PSI, MSC, seizure concordance, and PHR were not affected by the anesthetic used. Although to what extent these parameters correlate with the therapeutic effectiveness remains ambiguous, a decision for or against a particular anesthetic could be considered if a specific SQ parameter needs optimization. However, no general superiority for one specific substance or combination was found in this study. In the next step, anesthetic effects on treatment response and tolerability should be focused on.

Clinical characteristics and potential association to Parkinson’s disease and dementia with Lewy bodies in patients with major depressive disorder who received maintenance electroconvulsive therapy: a retrospective chart review study

BackgroundMaintaining remission after electroconvulsive therapy (ECT) is clinically relevant in patients with depression, and maintenance ECT has been introduced in patients who fail to maintain remission after ECT. However, the clinical characteristics and biological background of patients who receive maintenance ECT are poorly understood. Thus, this study aimed to examine the clinical background of patients who underwent maintenance ECT.MethodsPatients with major depressive disorder who underwent ECT followed by maintenance ECT (mECT group) and those who did not (acute ECT [aECT] group) were included. Clinical characteristics, including the results of neuroimaging examinations for Parkinson’s disease (PD) and dementia with Levy body (DLB) such as myocardial 123I-metaiodobenzylguanidine (MIBG) scintigraphy and dopamine transporter imaging single-photon emission computerized tomography (DaT-SPECT), were compared between the groups.ResultsIn total, 13 and 146 patients were included in the mECT and aECT groups, respectively. Compared to the aECT group, the mECT group showed a significantly higher prevalence of melancholic features (92.3% vs. 27.4%, p < 0.001) and catatonic features (46.2% vs. 9.6%, p = 0.002). Overall, 8 of the 13 patients in the mECT group and 22 of the 146 patients in the aECT group underwent neuroimaging examinations for PD/DLB. The rate of patients examined is significantly higher in the mECT group than in the aECT group (61.5% vs. 11.2%, p < 0.001). Among the groups examined, 7/8 patients in the mECT group and 16/22 patients in the aECT group showed relevant neuroimaging findings for PD/DLB; the positive rate was not significantly different between the two groups (87.5% vs. 72.7%, p = 0.638).ConclusionsPatients who receive acute and maintenance ECT may have underlying neurodegenerative diseases, including PD/DLB. Investigating the neurobiology of patients who receive maintenance ECT is important for developing appropriate treatments for depression.

The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression: A Systematic Review of Randomized and Observational Studies.

Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.

Non-convulsive epiletic seizure after electroconvulsive therapy session

IntroductionElectroconvulsive therapy (ECT) is a procedure performed under general anaesthesia involving triggering an intentional brief seizure through small electrical currents through the brain. The anaesthetic depth should be adequate prior to shock and measured with BIS, a processed electroencephalogram (EEG) monitor. Adjusting the hypnotic dose allows to decrease the ictal threshold and thus improve the response to treatment and decrease side effects.ObjectivesOur goal is detecting elements such as spontaneous epileptiform activity after ECT without tonic-clonic activity with the spectral density matrix (SDM).MethodsOur patient: an 87-year-old woman, diagnosed with F20.2 catatonic schizophrenia and under antipsychotic treatment since her youth. She has required multiple hospital admissions due to psychopathological decompensations until starting monthly maintenance ECT sessions in 2014. Since then she no new hospital admissions have been required.ResultsImages 1D and 1E shows the SDM, a spectrogram of the EEG. The X axis show time (minutes), the Y axis shows the frequency (Hz) and the Z axis shows the energy or intensity of that electrical activity in the frequency bands replaced by colors: warm colors (red) reflecting high intensity electroencephalographic activity and cool colors (yellow, blue and green), low activity. Images 2 and 3’s EDM shows spontaneous epileptiform activity after electroconvulsive therapy without tonic-clonic activity. We observed an initial EDM of an awake patient, with warm colours in practically all frequency bands, including the beta band (13-30 Hz), characteristic of waking states. Around 9:50 anaesthetic induction occurs, activity increases in slow frequencies (red colours in alpha, theta and delta), plus an increase of cold colours in beta, reflecting the disappearance of brain activity in that frequency. The asterisk reflects the EEG response to the electrical discharge, followed by a postcritical state with brain activity exclusively in slow waves and high amplitude (delta and some theta) and absence of activity in other frequencies (blue colour in the beta and alpha bands) around 9:57. At about 10:00 there is an abrupt appearance of high intensity brain activity (warm colours) in beta and alpha and delta, mainly, reflecting spontaneous epileptiform activity after treatment and clinically reflected as a patient absent and disconnected from the environment, but without tonic-clonic activity. New postcritical state in which blue colour predominates, reflecting little brain activity, and warmer colours reappear in all frequency bands, including beta, reflecting the progressive recovery of wakefulness.Image:Image 2:Image 3:ConclusionsPsychiatric pathology can be reflected in the SDM, which allows to observe changes in the EEG, correcting the electrical stimulus of the shock and the dose of anesthetic appropriate to the patient to trigger an intentional brief seizure under general anesthesia.Disclosure of InterestNone Declared

Comparison of etomidate and methohexital as anesthetic agents for continuation and maintenance electroconvulsive therapy: A retrospective analysis of seizure quality and safety

BackgroundThe ideal hypnotic agent for electroconvulsive therapy (ECT) is still under debate and previous studies comparing etomidate and methohexital have produced conflicting results. This retrospective study compares etomidate and methohexital as anesthetic agents in continuation and maintenance (m)ECT with regard to seizure quality and anesthetic outcomes. MethodsAll subjects undergoing mECT at our department between October 1st, 2014 and February 28th, 2022 were included in this retrospective analysis. Data for each ECT session were obtained from the electronic health records. Anesthesia was performed with either methohexital/succinylcholine or etomidate/succinylcholine. Standard seizure quality parameters, anesthesiological monitoring data, pharmacological interventions and side-effects were recorded. Results573 mECT treatments in 88 patients were included (methohexital n = 458, etomidate n = 115). Seizures lasted significantly longer after using etomidate (electroencephalography: +12.80 s [95 %-CI:8.64–16.95]; electromyogram +6.59 s [95 %-CI:4.14–9.04]). Time to maximum coherence was significantly longer with etomidate (+7.34 s [95 %-CI:3.97–10.71]. Use of etomidate was associated with longer procedure duration (+6.51 min [95 %-CI:4.84–8.17]) and higher maximum postictal systolic blood pressure (+13.64 mmHg [95 %-CI:9.33–17.94]). Postictal systolic blood pressure > 180 mmHg, the use of antihypertensives, benzodiazepines and clonidine (for postictal agitation), as well as the occurrence of myoclonus was significantly more common under etomidate. ConclusionsDue to longer procedure duration and an unfavorable side effect profile, etomidate appears inferior to methohexital as an anesthetic agent in mECT despite longer seizure durations.

Editor's Roundup for Issue 1 of 2023: Risk of Motor Vehicle Accident and Electroconvulsive Therapy, Effect of Electroconvulsive Therapy Electrode Placement on Risk for Asystole, Role of Maintenance Electroconvulsive Therapy in Reducing the Risk of Relapse, Long-term Tolerability of Vagus Nerve Stimulation, and Effect of Intensive Theta Burst Transcranial Magnetic Stimulation in Bipolar Depression.

From the Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA. Received for publication November 19, 2022; accepted November 23, 2022. Reprints: William V. McCall, MD, MS, Department of Psychiatry and Health Behavior, Medical College of Georgia, 997 St Sebastian Way, Augusta, GA 30912 (e-mail: [email protected]). Dr McCall receives royalties from Wolters Kluwer and is a scientific advisor for Idorsia. He is also an advisor to Ingenio. The author has no conflict of interest or financial disclosures to report.

A Nationwide Survey of Continuous and Maintenance ECT in Japan

A Nationwide Survey of Continuous and Maintenance ECT in Japan

Cognitive functioning in patients with schizophrenia on long-term maintenance electroconvulsive therapy – A case series

Cognitive functioning in patients with schizophrenia on long-term maintenance electroconvulsive therapy – A case series