Modified Electroconvulsive Therapy Research Articles

Effects of Chaihu Guizhi Ganjiang Decoction (CGGD) Combined with Cognitive Behavioral Intervention on Cognitive Behavior and Depressive State in Patients with Major Depressive Disorder After Modified Electroconvulsive Therapy

Major depressive disorder (MDD) is a mental disease characterized by depressed mood, anhedonia, and lack of energy. Modified electroconvulsive therapy (MECT) can effectively alleviate depression. However, it has been reported that MECT may cause cognitive impairments. Therefore, it is imperative to explore a new treatment approach with high efficacy in alleviating depressive symptoms and ensuring safety. In this study, we investigate the clinical efficacy of Chaihu Guizhi Ganjiang Decoction (CGGD) combined with cognitive behavioral intervention in patients with MDD after MECT and elucidate the therapeutic mechanism of CGGD in treating MDD. A total of 90 patients with MDD who underwent MECT at our hospital from 2021.01 to 2023.01 were included and randomly divided into 2 groups: a regular group received cognitive behavioral intervention and a coalition group received cognitive behavioral intervention combined with CGGD. A comparative analysis was performed on the clinical efficacy, cognitive function, and depressive state between the two groups. We observed that the coalition group exhibited a significantly higher total effective rate (93.33%) compared to the regular group (73.3%). After the intervention, the HAMD scores in the coalition group were lower than those in the regular group. Furthermore, our results demonstrated that compared to the regular group, the coalition group showed higher numbers of total tests and correct responses and lower numbers of wrong responses and persistent errors. In conclusion, these findings suggest that the combined treatment can effectively enhance antidepressant effects and improve cognitive function in patients with MDD after MECT.

Effect of psychological nursing interventions on effectiveness and quality of life in schizophrenia patients receiving modified electroconvulsive therapy

BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances, hallucinations, delusions, and emotional instability. For some patients, conventional treatment methods may not effectively alleviate symptoms, necessitating the use of alternative therapeutic approaches. Modified electroconvulsive therapy (MECT) is an effective treatment modality for schizophrenia, inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity. AIM To explore the impact of psychological nursing intervention (PNI) before and after MECT on the efficacy and quality of life of patients with schizophrenia. METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups: The intervention group (n = 40) and the control group (n = 40). The intervention group received PNI before and after MECT, while the control group received routine nursing care. The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) before and after the treatment. The quality of life was assessed by the Short Form 36 Health Survey (SF-36) after the treatment. RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment (P < 0.05). The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning (P < 0.05). CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia. It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.

The Neuroimaging Role of Modified Electroconvulsive Therapy in the Major Depressive Disorder: Effectiveness in First-Episode Antipsychotic-Naive Major Depressive Disorder Patients

Objectives. It is a high risk for adolescents with first-episode major depressive disorder (MDD) to commit suicide. However, few studies reported the effect of modified electroconvulsive therapy (MECT) in first-episode antipsychotic-naive MDD adolescents. Methods. The study explores the alternations of regional homogeneity of modified electroconvulsive therapy to treat the first-episode antipsychotic-naive major depressive disorder. 72 first-episode MDD patients were recruited from Tianyou Hospital Affiliated to Wuhan University of Science and Technology from October 2017 to May 2020, and 65 of 72 completed the trial. Results. Before MECT treatment, ReHo values of the bilateral cerebellum and left cuneus were higher, and ReHo value of left postcentral and supramarginal gyrus was lower in MDD patients compared to healthy subjects (HS). After treatment, the MDD patients have higher ReHo values of the right insula and postcentral gyrus, while left fusiform gyrus were lower than the pretreatment. Compared to the HS, the ReHo values of left lingual gyrus, right calcarine cortex, and right mid occipital thalamus were higher in the posttreatment. In the posttreatment, left calcarine cortex and right cerebrum were lower than in healthy subjects. Conclusions. The study confirmed that MECT improves psychotic symptoms in patients with first-episode antipsychotic-naive MDD. These results further contributed to a more tailored treatment approach to MDD from the pathophysiological and neuroimaging views.

Successful Resolution of Messianic Delusion following Bi-temporal Modified Electroconvulsive Therapy in a Patient with Treatment-resistant Schizophrenia

Messianic delusion comprises a delusional system centered on the patient’s conviction that he has been selected by God for a special task or mission and has unique abilities to carry it out. The present case report describes a case of Treatment-Resistant Schizophrenia (TRS) with Messianic delusion in a 23-year-old unmarried male who presented to the Emergency Department with complaints of muttering to himself, decreased sleep, suspiciousness, socio-occupational dysfunction, aggressive behaviour, and a recent suicide attempt. Key interventions offered during the ward stay included rapid tranquilisation, antipsychotics, and benzodiazepines. The patient completely recovered with the concurrent use of clozapine and Modified Electroconvulsive Therapy (MECT). The patient received 16 sessions of MECT. He achieved both short-term and long-term remission with the therapy, as observed during regular follow-ups in the next six months. The present case emphasises the need for a multidisciplinary approach to the management, early detection, and adequate treatment of this challenging illness.

Successful Resolution of Messianic Delusion following Bi-temporal Modified Electroconvulsive Therapy in a Patient with Treatment-resistant Schizophrenia

Messianic delusion comprises a delusional system centered on the patient’s conviction that he has been selected by God for a special task or mission and has unique abilities to carry it out. The present case report describes a case of Treatment-Resistant Schizophrenia (TRS) with Messianic delusion in a 23-year-old unmarried male who presented to the Emergency Department with complaints of muttering to himself, decreased sleep, suspiciousness, socio-occupational dysfunction, aggressive behaviour, and a recent suicide attempt. Key interventions offered during the ward stay included rapid tranquilisation, antipsychotics, and benzodiazepines. The patient completely recovered with the concurrent use of clozapine and Modified Electroconvulsive Therapy (MECT). The patient received 16 sessions of MECT. He achieved both short-term and long-term remission with the therapy, as observed during regular follow-ups in the next six months. The present case emphasises the need for a multidisciplinary approach to the management, early detection, and adequate treatment of this challenging illness.

Effects of electrode placement on symptoms, memory, and sustainment of results after electroconvulsive therapy- A comparative study

ABSTRACT Background: The memory-related side-effects rank among the strongest reasons for hostility against Modified Electroconvulsive Therapy (MECT). Most of the studies comparing the Unilateral v/s Bilateral Electrode placements on memory have been conducted on patients with depression while very few studies have been conducted on patients with psychosis in the Indian population. Aim: To compare the effects of right unilateral (RU/L) and bilateral (B/L) MECT on the severity of symptoms as well as memory in patients with psychosis after the fourth session and two weeks after the final session of the MECT. Materials and Methods: One hundred patients having a psychotic illness were randomized into either RU/L or B/L group. Comprehensive psychopathological rating scale (CPRS), clinical global impressions scale (CGI-S), and PGI-memory scale were applied before starting of MECT, after four sessions of MECT and two weeks after the last session of ECT. Results: The results show similar symptomatic improvement in patients receiving RU/L and B/L MECT and the results persisted beyond the therapy sessions. But, in the case of RU/L-MECT group, the deterioration in memory was less as compared to the B/L-MECT group. Both groups had no significant difference in psychopathology and its severity (CPRS and CGI). Both groups were significantly different in memory side effects after the fourth session and two weeks after the last session. Both groups showed a consistent downward trend in psychopathology and its severity. The consistent fall in the total PGI scores remained even after two weeks of the final session in the B/L group (total of six points as compared to baseline) while it came to baseline levels in the RU/L group. Both groups differed significantly in total PGI scores after the fourth session and two weeks after the final session. Conclusion: This study points toward a favorable outcome in the case of therapeutic response with MECT without any significant difference between both types of electrode placements and even after stopping MECT, the improvement appears to be stable over time. Although, there was a side-effect of memory impairment, it appears to be for a shorter duration and it improves with time. The side-effect profile of RU/L electrode placement is lower as compared to bilateral placement. In the post-MECT period, the patients receiving MECT with RU/L electrode placement showed better improvement in memory functions.

Multiple therapies relieve long-term tardive dyskinesia in a patient with chronic schizophrenia: A case report

BACKGROUND Tardive dyskinesia (TD) is a serious and disabling movement disorder; it impairs social function and quality of life and increases the mortality rate. TD is usually induced by the use of antipsychotic drugs; however, the underlying mechanism remains unclear. Pharmacotherapy of TD includes cholinergic drugs, benzodiazepines, ginkgo biloba extract (GBE), antioxidants, amantadine, propanolol, botulinum toxin, valbenazine, and deutetrabenazine, whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy (MECT) and deep brain stimulation. We successfully treated a chronic schizophrenia patient with comorbid long-term severe TD using deutetrabenazine, clozapine, and MECT. CASE SUMMARY A 69-year-old woman who was diagnosed as having schizophrenia 16 years ago developed severe TD after 6-mo prescription of risperidone oral solution. Her TD symptoms did not resolve despite various treatments, such as GBE, vitamin E, trihexyphenidyl, promethazine, benzodiazepines, and switching to quetiapine and olanzapine. After admission, she was given deutetrabenazine 6 mg bid. Her buccal tremor was slightly resolved 3 d later; however, her tongue remained protruded and could not be retracted. Quetiapine was switched to clozapine on day 4, and the buccal tremor remarkably resolved, and the tongue could be retracted into the mouth from day 6 onward. After three sessions of MECT, the buccal tremor resolved further. Since then, she has been able to take a semifluid diet, and her quality of life improved remarkably during 6 mo of follow-up. CONCLUSION TD is a serious condition which could be caused by antipsychotic medications; however, the best strategy against TD is prevention and monitoring during using antipsychotics. For patients with TD caused by antipsychotic medication use, multiple measures should be considered like switching to clozapine, adjunction with deutetrabenazine, or even MECT.

Clinical effect of modified electroconvulsive therapy on schizophrenia.

To investigate the clinical efficacy of modified electroconvulsive therapy (MECT) in patients with schizophrenia and provide a reference for the selection of safe and effective treatment options in clinical practice. A total of 200 patients with schizophrenia, who were admitted to Wuhan Wudong Hospital Psychiatric Hospital from January 2019 to December 2020, were selected as the study subjects. They were divided into an observation group and a control group (100 cases in each group) according to a random number table. The control group was treated with conventional antipsychotics (risperidone and aripiprazole), and the observation group was given conventional antipsychotics (risperidone and aripiprazole) with MECT. After 8 weeks, the clinical efficacy, cognitive and memory functions and the occurrence of adverse reactions between the two groups were compared. The total clinical effective rate of the observation group was 90%, which was higher than that of the control group (74%), and the difference was statistically significant (p<0.05). The Wisconsin Card Sorting Test results of the observation group were better than those of the control group, and the cognitive function of the observation group was better than that of the control group (p<0.05). The Wechsler Adult Intelligence Scale-Fourth Edition index of the observation group was higher than that of the control group, and the memory function of the observation group was better than that of the control group (p<0.05). The overall incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (p=0.001). The application of MECT in patients with schizophrenia can produce a good clinical curative effect, which is beneficial to the improvement and promotion of memory and cognitive functions in patients. Since the occurrence of adverse reactions is controllable, and safety is ideal, MECT has value in clinical application.

Non-antipsychotic medicines and modified electroconvulsive therapy are risk factors for hospital-acquired pneumonia in schizophrenia patients.

Hospital-acquired pneumonia (HAP) has a significant and detrimental impact on schizophrenia patients. Non-antipsychotic medicines and modified electroconvulsive therapy (MECT) are frequently used in conjunction with antipsychotics to treat schizophrenia. Whether non-antipsychotic medicines or MECT are risk factors for HAP in schizophrenia treated with antipsychotics is still unknown. Patients with schizophrenia who were admitted to the Fourth People's Hospital of Chengdu between January 2015 and April 2022 were included in this retrospective cohort study. Individuals with HAP were 1:1 matched to individuals without HAP (non-HAP) using propensity score matching (PSM). The risk factors for HAP were analyzed by comparing the two groups. A total of 7,085 schizophrenia patients were included in this study, with a mean age of 39.77 ± 14.45 years. 193 patients developed HAP on an average of 22.26 ± 21.68 days after admission with an incidence of 2.73%. After 1:1 PSM, 192 patients from each group (HAP and non-HAP) were included. The HAP group had significantly more patients with MECT and taking benzodiazepines, antidepressants, mood stabilizers, and anti-parkinsonians both before and after PSM by Bonferroni correction (P < 0.001). Multivariate logistic regression analysis showed that, combined with antipsychotics, non-antipsychotic medicines including benzodiazepines (OR = 3.13, 95%CI = 1.95-5.03, P < 0.001), mood stabilizers (OR =3.33, 95%CI =1.79-6.20, P < 0.001) and MECT (OR =2.58, 95%CI =1.49-4.46, P = 0.001) were associated with a significantly increased incidence of HAP. The incidence of HAP in schizophrenia patients in our cohort was 2.73%. MECT and non-antipsychotic medicines, including benzodiazepines and mood stabilizers were risk factors for HAP in schizophrenia patients treated with antipsychotics.

A Case Report of Leukocytosis During Modified Electroconvulsive Therapy of Paranoid Personality Disorder

IntroductionModified electroconvulsive therapy (MECT) is a viable therapeutic option for patients with mood disorders and schizophrenia. We found that there is a relationship between MECT and leukocytosis. To the best of our knowledge, this is the first case of this problem. There are no relevant guidelines recommending the risk of leukocytosis caused by MECT, nor the method to reduce the risk. We hope to share this case to provide a reference for the prevention and treatment of similar patients with leukocytosis during or after MECT and remind psychiatrists to pay attention to this risk of leukocytosis before making the decision of MECT while knowing how to deal with it.Case presentationWe describe a case of a 24-year-old woman diagnosed with Paranoid personality disorder (PPD) whose symptoms began at 19 years old. Her main clinical manifestations are feeling targeted, cheated, tracked, misunderstood, and repeating action. Since antipsychotic treatment was ineffective, we considered MECT. After MECT, the patient’s body temperature increased, and leukocytosis was found. After excluding infection and other possibilities, we added 1,000 ml physiological saline to the patient through the vein. The white blood cell (WBC) count returned to normal in a short time.ConclusionBefore MECT, it is necessary to screen blood cytology. During and after MECT, we should be alert to leukocytosis that may be related to MECT and deal with it correctly in time.

Polymorphisms in MicroRNA Genes Associated with Schizophrenia Susceptibility but Not with Effectiveness of MECT.

Schizophrenia (SCZ) is a common and complex psychiatric disease associated with hereditary and environmental risk factors. MicroRNAs (miRNAs or miRs) are small, noncoding RNA molecules that endogenously regulate gene expression. Single nucleotide polymorphisms (SNPs) in related miRNA genes are associated with susceptibility of the disorder. We wonder if the SNPs have influence on the effectiveness of modified electroconvulsive therapy (MECT) for SCZ. rs1625579 within miR-137, rs6577555 within miR-34, and rs2296616 within miR-107 were sequenced in 150 cases and 150 controls to check the potential association between the SNPs and SCZ. Our results showed that allele G in rs1625579 (p = 0.005, adjusted OR = 1.379, 95%CI = 1.108 − 1.634), allele A in rs6577555 (p = 0.014, adjusted OR = 1.246, 95%CI = 1.045 − 1.463), allele G in rs2296616 (p < 0.001, adjusted OR = 1.646, 95%CI = 1.374 − 1.879) are positively associated with the disorder risk. MECT courses did significantly decrease the level of the miRNAs, except for the variant of rs2296616 with the AA genotype. Schizophrenic phenotypes assessed by the positive and negative syndrome scale (PANSS) were improved after MECT, and there was no significant relevance observed between the effectiveness of MECT and the variants of these loci. Thus, our findings indicate that polymorphisms within the loci may be involved in the pathogenesis of SCZ, and MECT is effective and unbiased for patients harboring different genotypes of the loci.

Treatment Continuation of Asenapine or Olanzapine in Japanese Schizophrenia Patients: A Propensity Score Matched Study.

ObjectiveAsenapine is a second-generation antipsychotic agent that is classified as a multi-acting receptor-targeted antipsychotic and is similar to olanzapine. Our study aimed to compare the treatment continuation rate and reason for discontinuation of asenapine or olanzapine in schizophrenia using real-world data.MethodsThis design was a retrospective study. The primary endpoint was Kaplan–Meier estimates of the continuation rate at six months, with the propensity score method applied to adjust for potential confounders.ResultsA total of 95 patients were analyzed in this study (asenapine, n = 46; olanzapine, n = 49). Matched data were adjusted to consider six covariates (age, sex, chlorpromazine equivalent, diazepam equivalent, history of clozapine use, and history of modified electro convulsive therapy). The continuation rate at six months was 27.3% (95% CI, 15.6–47.6) in the asenapine group and 50.8% (95% CI, 34.3–75.3) in the olanzapine group (hazard ratio, 0.41; 95% CI, 0.21–0.82; P = 0.0088 by the Log rank test) in matched data. Cases of discontinuation because of the lack of efficacy were almost as frequent for asenapine (13.0%) as for olanzapine (10.2%). Discontinuation due to bitter taste (6.5%) and burden of the dosing method (6.5%) were observed only with asenapine, whereas anticholinergic side effects such as dry mouth (4.1%) and constipation (2.0%) were observed only with olanzapine.ConclusionThe low continuation rate of asenapine in real-world data may be related to specific factors such as bitter taste and burden of the dosing method.

Magnetic Resonance Imaging (MRI) Based on Machine Learning Algorithms for the Diagnosis in Efficacy of Dexmedetomidine along with Modified Electroconvulsive Therapy Nursing on First Episode Schizophrenia

This study was aimed to explore the efficacy of dexmedetomidine combined with modified electroconvulsive therapy (MECT) and continuous nursing on first episode schizophrenia (FES), as well as the continuous monitoring effect of magnetic resonance imaging (MRI) on the FES patients under machine learning algorithms. In this study, 48 schizophrenia patients who received the combined treatment of MECT and dexmedetomidine were selected, and they were divided into the routine group (RG) and observation group (OG), with routine nursing and continuous nursing, respectively. Besides, another 30 healthy people were included as the control group (Ctrl group). Based on MRI characteristics, the machine learning algorithm designed for FES patients was used to analyze the changes in the amplitude low-frequency fluctuations (ALFF) of the static state brain MRI; the positive and negative score scale (PANSS) was used to evaluate the mental symptoms of patients. The Schizophrenia Quality of Life Scale (SQLS) score, treatment compliance rate, follow-up rate, and recurrence rate of patients were also compared. The results showed that the image quality of the weakened and enhanced areas of brain MRI was significantly improved under the machine learning algorithm. After treatment, the total score of PANSS and the scores of all dimensions were greatly reduced ( P &lt; 0.05 ). For the FES patients, the ALFF value of the frontal right lower lobe before treatment was higher than that of the Ctrl group ( P &lt; 0.05 ), while the ALFF value of the right insula and right superior frontal gyrus after treatment was lower than that of the Ctrl group ( P &lt; 0.01 ), and the ALFF value of the left inferior frontal gyrus opercular part was lower than that of the Ctrl group ( P &lt; − 0.05 ). The SQLS score, treatment compliance rate, follow-up rate, and recurrence rate of OG after nursing intervention were all much higher than those of the Ctrl group ( P &lt; − 0.05 ). In summary, MRI based on machine learning algorithms could be applied to monitor the effect of dexmedetomidine combined with MECT, and continuous nursing made an effective improvement in SQLS score of FES patients, though which the risk of recurrence was reduced.

Resting-state functional magnetic resonance imaging analysis of modified electroconvulsive therapy in the treatment of major depressive disorder

Objective: To explore the effect of modified electroconvulsive therapy (MECT) on resting-state functional connectivity (RSFC) in patients with major depressive disorder (MDD). Methods: Patients with MDD from Anhui Mental Health Center from October 2017 to May 2019 were included. Using bilateral nucleus accumbens (NAcc) as seed points, changes of RSFC were investigated before and after MECT through resting-state functional magnetic imaging (fMRI). Antidepressant effects were measured by 17 items of Hamilton Depressive Rating Scale (HDRS-17). Correlation analysis was performed between changed HRSD-17 scores and changes of functional connectivity. Results: A total of 40 MDD patients (10 males and 30 females), aged (38±11) years, who received MECT were included in the study. After MECT, patients showed increased RSFC in the right NAcc (rNAcc) and superior frontal gyrus (P<0.001), right supramarginal gyrus (P<0.001), right angular gyrus (rAG) (P= 0.017), right inferior parietal lobule (P= 0.017), left superior frontal gyrus (LSFG) (P<0.001), left middle temporal gyrus (P=0.017) and left angular gyrus (LAG) (P=0.012), respectively. The RSFC changes of rNAcc-LSFG (r=-0.454, P = 0.003), rNAcc-rAG (r=-0.437, P=0.005) and rNAcc-lAG (r=-0.383, P=0.015) were negatively correlated with the changes of HRSD-17 scores. Conclusions: MECT may alleviate major depression by regulating the functional connectivity between the rNAcc and bilateral angular gyrus and left superior frontal gyrus.

Effect of modified electroconvulsive therapy on neuro metabolites and magnetic resonance spectroscopy imaging signals in patients with refractory obsessive-compulsive disorder

ObjectiveThis study was aimed to investigate the effect of modified electroconvulsive therapy (MECT) on neurometabolites and magnetic resonance spectroscopy imaging (MRSI) signals in patients with refractory obsessive-compulsive disorder (OCD). MethodsFrom January 2018 to January 2020, 64 patients with OCD consecutively treated in the Psychiatric Department of our hospital were randomly divided into a study group treated with MECT and a control group treated with drugs alone. The obsessive-compulsive state, anxiety and depression, MRSI signals, neuro metabolite ratio, and quality of life were all observed in both groups. ResultsAfter treatment, the scores of compulsive behaviors, obsessive thoughts, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) in the study group were lower than those of the control group. The N-acetylaspartate to creatine ratio (NAA/Cr) value was increased in the study group while it was decreased in the control group. In addition, the choline/creatine (Cho/Cr) ratio was decreased in the study group, whereas it was increased in the control group (P < 0.05). Compared to the control group, the study group's social and physiological functions, role limitations, and overall health scores were significantly higher. The amplitudes of low-frequency fluctuations were reduced considerably following MECT treatment in the right anterior cerebellar lobe, left inferior parietal lobule, right paracentral lobule, and right precentral gyrus. ConclusionsMECT can effectively relieve obsessive-compulsive symptoms, regulate neuro metabolite levels, improve quality of life, reduce anxiety and depression, and is linked to changes in right brain functional activities.

Comparison of Sodium Thiopentone and Propofol for Electroconvusive Therapy(ECT)

Background: Seizure activity produced by Electroconvulsive Therapy(ECT) is considered as the therapeutic aspect of this form of treatment, but is accompanied by untoward physiologic consequences, mainly cardiovascular neurological in nature. The hemodynamic effects can have a significant impact in patients with underlying cardiovascular disease. A number of medications have been used during ECT including pretreatment sedation, anaesthetic agents, muscle relaxants, anticholinergics, and drugs to attenuate parasympathetic and sympathetic responses. AIMS AND OBJECTIVES: This study was carried out to compare propofol and sodium thiopentonne effectswhen used for modified electroconvulsive therapy . METHODOLOGY: After ethical approval forty patients being planned for modified electroconvulsive therapy were recruited.They were randomly allocated into sodium thiopentone and propofol groups .The two groups had propofol 2mg/kg or sodium thiopentone 5mg/kg respectively and then suxamethonium 1mg/kg. After fasciculation a brief pulse impulse was deliveredby psychiatrist while patient is being ventilated manually with 100% Oxygen.The duration ofseizure,, the time to loss of conscioussness, incidence of complications were recorded. RESULTS: This single blinded study was carried out on 40 adult patients equally divided into two groups of 20 each to compare the haemodynamic effects and seizure activity of thiopentone sodium (GroupS) and propofol(Group P) when used as inducing agents in patients undergoing modified electroconvulsive therapy (MECT). Results showed propofol maintained significantly better haemodynamics compared to thiopentone and seizure time was significantly lower with propofol compared to thiopentone . Recovery from anaesthesia post MECT was significantly quicker with propofol compared with thiopentone. Hence,we conclude that propofol has advantage over thiopentone when used as an induction agent for modified electroconvulsive theraphy. Keywords : Protocol, Sodium thiopentone, Electroconvulsive therapy. DOI: 10.7176/JBAH/11-16-02 Publication date: August 31 st 2021

Transcriptome Sequencing Reveals the Potential Mechanisms of Modified Electroconvulsive Therapy in Schizophrenia.

ObjectiveSchizophrenia (SCZ) is one of the most common and severe mental disorders. Modified electroconvulsive therapy (MECT) is the most effective therapy for all kinds of SCZ, and the underlying molecular mechanism remains unclear. This study is aim to detect the molecule mechanism by constructing the transcriptome dataset from SCZ patients treated with MECT and health controls (HCs). MethodsTranscriptome sequencing was performed on blood samples of 8 SCZ (BECT: before MECT; AECT: after MECT) and 8 HCs, weighted gene co-expression network analysis (WGCNA) was used to cluster the different expression genes, enrichment and protein-protein interaction (PPI) enrichment analysis were used to detect the related pathways. ResultsThree gene modules (black, blue and turquoise) were significantly associated with MECT, enrichment analysis found that the long-term potentiation pathway was associated with MECT. PPI enrichment p-value of black, blue, turquoise module are 0.00127, <1×10-16 and 1.09×10-13, respectively. At the same time, EP300 is a key node in the PPI for genes in black module, which got from the transcriptome sequencing data. ConclusionIt is suggested that the long-term potentiation pathways were associated with biological mechanism of MECT.

Prolonged apnea after ECT in organophosphorus poisoning \u2013 the need to redefine norms

BackgroundPoisoning and deaths by organo-phosphorous (OP) compounds are one of the major causes of death in developing and poor countries, and a common admission in the emergency ward and the ICU. OP compounds act by irreversibly binding to pseudocholinesterase enzyme and hence prolong the apnea in patients being given suxamethonium. We present a unusual case of OP poisoning (OPP) in which prolonged apnea ensued in a patient of severe depression following MECT (modified electroconvulsive therapy) in which suxamethonium was used as muscle relaxant, in whom we were cautious of the side-effect of prior organophosphorus poisoning. Since the cases of OPP are very high worldwide, a thorough knowledge of the interaction of the action of the drug and the receptors on which it acts takes pride of place. This article highlights the nuances in the field of psychiatry and anaesthesia in diagnosis and management of prolonged apnea after ECT.Case presentationA 53/F patient consumed OP 38 days prior to MECT. Since existing literature recommend a delay of 4 weeks and a subminimal dose of suxamethonium to prevent prolonged apnea, both these points were taken into consideration. Despite 38 days post exposure to OP, and a dose of succinylcholine of < 0.3 mg/kg, the patient remained apneic for 3 h. Suxamethionum apnea was managed with elective ventilation. After recovery, patient had no residual effect. Subsequently her pseudocholinesterase levels were done which were found to be very low.ConclusionThis case is being presented to emphasize that behaviour of post synaptic receptors cannot be relied upon after OP poisoning and pseudocholinesterase levels needs to be mandatorily checked, irrespective of duration post-exposure. In strong suspects dibucaine number and fluoride number also needs to be estimated.

Clinical Presentation and Short Term Treatment Response in Catatonia: An Observational Study

Background: Clinical features and treatment response in catatonia is unpredictable and needs to be studied further. Objective: : The aim of this research is to study clinical presentations of catatonia and its response to various modalities of treatment. Methods: This study recruited 50 patients in the age group of 15-65 years, with a diagnosis of catatonia as per DSM 5 criteria, selected by a stepwise process of sample selection. Patients with significant medical or surgical illness warranting immediate intervention were excluded. A detailed history and clinical information was obtained following informed consent from patient’s caregivers and other significant relatives. Rating on the severity of symptoms as well as treatment response was done using the Bush-Francis Catatonia Rating Scale (BFCRS) on 1st, 3rd, 7th, and 14th day of admission. Modified Electro-Convulsive Therapy (MECT) was administered to patients who had an inadequate response to intravenous lorazepam. Results: It was found that 32 (64%) patients had a psychotic disorder, and 18 (36%) patients had mood disorders as an underlying diagnosis in catatonic presentation. Mutism was the most common catatonic sign-on rating with BFCRS, found in 50 (100%) of the patients. Complete resolution of catatonia was observed in 26 (52%) of patients following the use of intravenous lorazepam, while 24 (48%) required MECT. Patients with a diagnosis of schizophrenia required higher doses of intravenous lorazepam (p=0.001) and showed a lesser response to intravenous lorazepam compared to patients with diagnoses of mood disorders and other psychotic disorders. Conclusion: Most common diagnosis in patients of catatonia was found to be psychotic disorder. Retarded signs of catatonia were found to be the commonest presentation. MECT was required to achieve resolution of catatonic symptoms in around half (48%) of the cases. The patients with diagnoses of schizophrenia required higher doses and also showed a lesser response to intravenous lorazepam, hence MECT was required in a higher proportion of such cases.

Inflammatory cytokines derived from peripheral blood contribute to the modified electroconvulsive therapy-induced cognitive deficits in major depressive disorder.

Little is known about the pathophysiology of memory deficits in patients with major depressive disorder (MDD) treated with modified electroconvulsive therapy (MECT). This study examined the profiles of cytokines, the memory function, and their association in MECT-treated MDD patients. Forty first-episode, drug-free MDD patients and 40 healthy controls were recruited. MECT was started with antidepressant treatment at a stable initial dose. The Wechsler Memory Scale (WMS) and Hamilton Rating Scale for Depression 17 (HRSD-17) were used to assess the cognitive function. MDD patients were divided into the memory impairment group (WMS < 50) and the non-memory impairment group (WMS ≥ 50) based on the total WMS scores after MECT. The levels of NOD-like receptor 3 (NLRP3) inflammasome, interleukin-18 (IL-18) and nuclear factor kappa-B (NF-κB) in the serum were measured. MDD patients showed significantly higher levels of NLRP3 inflammasome, IL-18 and NF-κB than that in the controls prior to MECT, and the levels also significantly increased after MECT. In MDD patients, the serum levels of these inflammatory cytokines were negatively associated with the total WMS scores and likely contributed to the scores independently. The receiver operating characteristic curve showed that the serum levels of these inflammatory cytokines may predict the cognitive impairment risk in MDD patients receiving MECT. Abnormal levels of NLRP3 inflammasome, IL-18 and NF-κB reflecting the disturbed balance of pro-inflammatory and anti-inflammatory mechanisms likely contribute to the MECT-induced cognitive deficits in MDD patients.