Safety Of Electroconvulsive Therapy Research Articles

Safety of Electro-Convulsive Therapy in Combination with Duloxetine in Treatment-resistant Depressive Patients: A Randomized Clinical Trial

Background: There are several strategies in the management of treatment-resistant depression (TRD), including the administration of other antidepressants, augmentation therapy, electro-convulsive therapy (ECT), and a combination of ECT and antidepressants. The safety of ECT combined with any medication must be confirmed. The aim of this study was to assess the safety of duloxetine and ECT combination therapy. Materials and Methods: In this randomized clinical trial, the probable side effects of ECT plus duloxetine were compared with ECT plus sertraline in two groups of admitted TRD patients. Patients with general medical diseases and/or any contraindications to ECT or any of the two drugs were excluded. General side effects, including nausea, vomiting, and headache reported by patients (hours after ECT) as well as cardiotoxicity by electrocardiogram (immediately after any ECT episode), cognitive status by mini-mental state examination (MMSE, one month after the last ECT), and seizure duration were recorded for each patient. Results: No significant differences were observed in nausea, vomiting, headache, and myalgia between ECT+duloxetine and ECT+sertraline groups. Heart rate, QTc interval, ST-T change, and the incidence of arrhythmia were the same between the two arms of the study. Also, no prolonged seizures and status epilepticus were recorded among the studied patients. The MMSE revealed no marked differences in the cognitive status among patients of the two groups. Conclusion: ECT+duloxetine and ECT+sertraline were equally safe in patients with TRD.

Electroconvulsive therapy improves psychotic symptoms in patients with dementia with Lewy bodies.

The aim of this study was to examine the efficacy and safety of electroconvulsive therapy (ECT) for psychotic symptoms of dementia with Lewy bodies (DLB), and also to determine its use as an adaptive criterion. Eight patients aged 66-83years old (mean 75.4±5.9years) diagnosed with probable DLB based on the criteria for DLB and who received ECT between September 2013 and December 2019 at Aichi Medical University were enrolled. The efficacy and safety of ECT were retrospectively examined. Psychotic symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS), while parkinsonism was evaluated based on Hoehn-Yahr (HY) stage, with both scores analyzed and comparedstatistically between before and after ECT. Additionally, a follow-up survey after undergoing ECT was performed. Two incidents occurred during ECT sessions, arrhythmia in one patient and respiratory arrest in another, both of whom quickly recovered. Following ECT, a significant improvement in BPRS score was noted (p<0.018, Wilcoxon signed rank test), whereas no significant difference was seen in regard to HY stage (p=0.059). Follow-up survey findings obtained after ECT (mean observation period 15.9±16.7months), showed that all eight patients were alive and none had a relapse of psychotic symptoms. The present results suggest that ECT for patients with mild to moderate DLB and drug therapy-resistant psychotic symptoms is safe, well tolerated and effective. We consider it worth considering as a DLB therapeutic option.

Diagnosis and Treatment of Hyperkinetic Catatonia: A Case Report

Hyperkinetic catatonia is a rare syndrome found in mood and psychotic disorders characterized by features such as purposeless motor hyperactivity, extreme agitation, and echophenomena. Although general catatonia is often treated with benzodiazepines and electroconvulsive therapy (ECT), there is no standardized treatment for hyperkinetic catatonia. The case presented here is that of a 44-year-old woman with a diagnosis of schizophrenia with hyperkinetic catatonia. Included is a review of the clinical evaluation and diagnostic impressions, as well as approaches to management and treatment. The patient underwent multiple sessions of ECT that yielded significant improvement in disorganized behavior and hyperactivity. This case demonstrates the diagnostic challenges in differentiating hyperkinetic catatonia from delirious mania and other mood disorders, and the effectiveness and safety of ECT in a patient with hyperkinetic catatonia. [ Psychiatr Ann. 2022;52(9):389–392.]

Analiza skuteczności i bezpieczeństwa zabiegów elektrowstrząsowych u pacjentów w wieku podeszłym: badanie retrospektywne w populacji polskiej

The aim of the study was to assess the efficacy and safety of electroconvulsive therapy in a population ≥ 65 years old. The study was naturalistic, retrospective. The study group included 65 patients, women and men, hospitalized in the departments of the Institute of Psychiatry and Neurology and undergoing ECT treatment. The authors analyzed the course of 615 ECT procedures performed in 2015-2019. The effectiveness of ECT was assessed using the CGI-S scale. Safety was assessed by analyzing side effects of the therapy, taking into account the somatic diseases in the study group. As many as 94% of patients initially met the drug resistance criteria. In the study group, no serious complications such as death, life-threatening condition, necessity to be hospitalized in another ward or permanent health impairment were reported. In total, in the whole group, adverse effects were reported in 47. 7% of older patients, in the majority of cases (88%) they were of slight intensity and resolved without any particular intervention. The most frequently observed side effect of ECT was an increase in blood pressure (55. 4% of patients). Four patients did not complete ECT therapy due to side effects. In the majority of patients (86. 2%) at least 8 ECT treatments were performed. ECT turned out to be an effective method of treatment in the population of patients over 65 years of age - response to treatment was found in 76. 92% and remission in 49. 23% of the study group. The severity of the disease according to the CGI-S scale was on average 5. 54 before and 2. 67 after the ECT treatment. Tolerance of ECT is worse after 65 years than in younger age groups. Most of the side effects are associated with underlying somatic diseases, mainly cardiovascular problems. This does not change the fact that ECT therapy is highly effective in this population and can be a very good alternative to pharmacotherapy, which, in this age group, is often ineffective or causes side-effects.

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Background:Catatonia is a motor syndrome associated with various psychiatric and medical disorders. Studies show that 20-39% of patients with catatonia have an underlying organic aetiology which is often under diagnosed in non-psychiatric settings. Although no specific guidelines are available, lorazepam and electroconvulsive therapy (ECT) have been the mainstay in the management of organic catatonia. We aim to report the clinical correlates and outcome in patients presenting with catatonia secondary to physical illness.Methodology:This was a retrospective file review study of 7 patients with a diagnosis of organic catatonia between January 2016 and September 2021. We extracted sociodemographic details, clinical features, and details of medical co-morbidities, biochemical investigations, electroencephalogram and neuroimaging findings, and treatment response.Results:Seven patients (4 female and 3 male) with a mean age of 30.14 (SD 8.38) years presented with organic catatonia. The median duration of symptoms was 10 (IQR 44) days. Mutism (n=7) and staring (n=7) were the most common catatonic symptoms. Five out of 7 patients responded to lorazepam with a mean dose of 8 (SD 3.26) mg, and the remaining 2 received ECT and had poor outcome.Conclusion:Organic catatonia is often under diagnosed and poses varied treatment challenges due to co-morbid physical illness. Treatment with lorazepam appears to be promising as first line option. Safety of ECT in organic catatonia needs further evaluation.Key messages:1. Organic catatonia poses varied diagnostic and therapeutic challenges in comparison to its psychiatric counterpart.2. Lorazepam is promising in the management of organic catatonia, while the safety of electroconvulsive therapy needs further evaluation.

A Study to Assess the Effectiveness of Planned Teaching Program on Knowledge Regarding Electro Convulsive Therapy among Patient’s Relatives Undergoing ECT in Selected Hospitals in Vadodara

Background of Study: Electroconvulsive therapy (ECT) is a safe and efficacious treatment; there is awidespread negative view of electroconvulsive therapy in public and professional circles. Clinical experienceand research have resulted in continued improvements to the efficacy and safety of electro convulsivetherapy. It is necessary to conduct research on this basis to modify the misconceptions and prejudices aboutthe electroconvulsive therapy1.Objectives: 1. To assesses the existing level of knowledge regarding electro convulsive therapy amongpatient’s relatives undergoing ECT.2. To determine the effectiveness of planned teaching on knowledgeregarding electro convulsive therapy among patient’s relatives undergoing ECT.3. To find out associationbetween pre test knowledge scores of patients relatives with their selected demographic variables.Methodology: Quantitative Research Approach was use with 2 Group pre test &amp; Post test Design. Theinvestigator used pre-experimental one group pre-test post-test research design. Purposive samplingtechnique used for Selecting 30 Samples. The Structural questioners Used Check knowledge of ECT before&amp; after administration of planned teaching program.Results: Analysis of paired t test is done to assess the effectiveness of planned teaching on knowledgeregarding electroconvulsive therapy. Researcher has found t value= 24.853 thus the obtained t value inthis study is more than the table value of t test at 0.05 level of significance. Hence the obtained t valueis significant. So it reveals that planned teaching on knowledge regarding electroconvulsive therapy isimproved in knowledge among patient’s relatives.

Electroconvulsive Therapy and Age: Effectiveness, Safety and Tolerability in the Treatment of Major Depression among Patients under and over 65 Years of Age.

Electroconvulsive therapy (ECT) remains the most effective therapy in treatment-resistant depression. However, the safety of ECT has been consistently questioned, particularly among elderly patients. We assessed the efficacy and safety of ECT in patients before and after 65 years old. The study was conducted between 2015 and 2018 and included 91 patients (61 under and 29 over 65 years old) with major depression undergoing ECT. The Hamilton Depression Rating Scale was used to evaluate efficacy. Cognitive functions were assessed using: MMSE, RAVLT, Trail Making Test, Stroop Test and Autobiographical Memory Interview-Short Form. ECT was more effective in older patients as compared to younger (p < 0.001). No serious adverse events were observed in either group. Increased blood pressure and arrhythmias were more common in the older compared to the younger group (p = 0.044 and p = 0.047, respectively), while disturbances of consciousness did not differ between groups (p = 0.820). Most of the cognitive functions remained unchanged compared to baseline, whereas the outcomes of MMSE, RAVLT and Stroop tests showed greater improvements in the older compared to the younger group (all p < 0.05). The decline in the retrieval consistency of autobiographical memory was more pronounced in the younger group (p = 0.024). ECT is a highly effective, safe and well-tolerated method of treating depression regardless of age.

A Novel Refractory Mood Disorders and Electroconvulsive Therapy Elective for Medical Students: Fighting Stigma through Experience.

Treatment resistant mood disorders (TRMD) have a significant impact on patients and society. Electroconvulsive therapy (ECT) has been shown to be effective for treatment resistant depression (TRD). Despite the effectiveness and safety of ECT, there remains significant stigma surrounding its use. Studies worldwide have shown that many medical students receive their knowledge from the media, which often portrays ECT in a negative light, and very few have exposure to ECT prior to their psychiatric clinical rotations. In this article we highlight the importance of medical education and introduce a novel approach in helping to fight the stigma of ECT through educational intervention for medical trainees that combines active, longitudinal and theoretical learning. By ensuring that trainees have a robust education in this arena, we can help them educate patients about treatment options, improve confidence in prescribing and administering these therapies, and ultimately improve patient and societal outcomes.

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.

Acute effects of a session of electroconvulsive therapy on brain-derived neurotrophic factor plasma levels.

Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are neurotrophins that play critical roles in brain neuronal function. Previous studies have established the association between BDNF and NGF signaling and severe mental disorders, but changes in BDNF plasma levels and electroconvulsive therapy (ECT) response are controversial. The aim of his study was to explore the acute effects of a single session of ECT on these neurotrophins signaling. Plasma levels of BDNF and NGF and their tyrosine kinase-type receptors expression in peripheral blood mononuclear cells (PBMCs) were determined before and two hours after a single ECT session in 30 subjects with a severe mental disorder. Two hours after an ECT session we found a statistically significant decrease of BDNF plasma levels (p=0.007). We did not find significant acute effects on NGF plasma levels or receptors expression in PBMCs. We found a significant inverse correlation between the time of convulsion and BDNF plasma levels decrease (r=-0.041, p=0.024). We have identified a decrease in BDNF plasma levels after 2h of a single ECT session. These results indicate the interest for future research in the role of neurotrophins in the response and safety of ECT.

Assessment of cardiac autonomic activity by studying heart rate variability in adult psychiatric patients subjected to electroconvulsive therapy

The autonomic nervous system (ANS) plays a crucial role in normal functioning of the heart and is responsible for normal cardiac variability, which can be studied by recording (HRV) heart rate variability. HRV is an excellent, noninvasive tool used to show variation over time of period between consecutive heart beats and for assessment of cardiovascular regulation of ANS. Available literature is insufficient to document effect of Electroconvulsive therapy (ECT) on HRV in psychiatry patients. To explore the effect of ECT on HRV with a view to assess the safety of ECT in various age groups of patients requiring ECT. This Non-Randomized comparison study without a control was conducted at a tertiary care teaching hospital in Ludhiana Punjab in 100 cases of ECT over a period of 2 years. A detailed general physical examination as well as systemic examination was done and observations were documented. Each patient was screened for indication for the ECT by the Psychiatrist. HR prior to ECT and HRV in immediate post procedure period were noted. This study indicates that heart rate increased significantly after ECT but this variation remains within the homeostatic limits. Although the study shows safety of ECT in psychiatric patients, it would be advisable to monitor HRV in ECT given in pre-existing cardiac illness.

Safety of Electroconvulsive Therapy in Treatment-Refractory Depression in the Setting of Multiple Sclerosis: Erratum.

Safety of Electroconvulsive Therapy in Treatment-Refractory Depression in the Setting of Multiple Sclerosis: Erratum.

Efficacy and Safety of Electroconvulsive Therapy in Adolescents: A Retrospective Chart Review Study From Turkey.

The aim of this study was to report the efficacy and safety of electroconvulsive therapy (ECT) in manic, depressed, psychotic, and catatonic adolescent patients. Medical records of 78 adolescents who had received ECT in Department of Psychiatry, Gaziantep University Medical Faculty, during 2011 to 2017 were reviewed. Sixty-two subjects in this sample were identified to have complete records and met the study inclusion criteria. The mean ± SD age of subjects was 17.11 ± 1.04 years and female sex was 53.2% (n = 33). Primary the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses were bipolar mood disorders (n = 33, 53.2%), major depressive disorder (n = 16, 25.8%), schizophrenia (n = 8, 12.9%), and schizoaffective disorders (n = 5, 8.1%). Electroconvulsive therapy was significantly effective in treating manic, depressive, psychotic, and catatonia symptoms as evidenced by significant differences in pretreatment and posttreatment scores in outcome measures including Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression-Severity Scale (P < 0.001). Presence of comorbidity adversely affected treatment response (P = 0.001). However, ECT was also effective in those with comorbid diagnoses (P < 0.001). Depressive symptoms in patients with bipolar depression responded better than those with unipolar depression (P = 0.012). Electroconvulsive therapy was generally safe with subjective memory complaints (85%), headache (69%), and prolonged seizure (8%) as the reported adverse effects possibly related to ECT. Four subjects (6%) developed a manic switch during ECT. Electroconvulsive therapy is an effective and a safe treatment option in adolescent patients with severe and resistant psychopathology. Although comorbidity may decrease treatment response, ECT seems to be effective even in the presence of multiple psychiatric diagnoses.

Revisiting the role of electroconvulsive therapy in schizophrenia: Where are we now?

The purpose of this opinion article is to review the recent evidence base in relation to the role of electroconvulsive therapy (ECT) in the management of patients with schizophrenia. Specifically, we explore the efficacy and safety of ECT. Furthermore, consideration is given to the profile of patients who benefit most from ECT, the role of maintenance ECT and what happens when ECT is not given. Our brief review of the evidence suggests that clinical practice in developing countries has not kept up with the growing literature supporting ECT use in schizophrenia. As such, we advocate that ECT should not be a treatment of last resort. Rather, it should be considered more readily as an add-on therapy when there has been a poor response to antipsychotic medications or concerns exist about side effects. Further research is needed into the efficacy of maintenance ECT.

Subjective and objective cognitive side effects of electroconvulsive therapy in depression

Background Treatment-resistant depressive disorder is inter alia characterized by cognitive impairments in memory, attention, and executive functions (EF) and can be treated with Electroconvulsive Therapy (ECT), which provides rapid symptom relief in 70% of the patients. So far research focused on the detection of objective memory impairments, whereas changes in subjective measures or other cognitive domains such as attention and EF were barely assessed. Furthermore, a neuropsychological test battery, tailored for the use in depressed patients who are undergoing ECT, is still lacking. Method Subjective and objective performance in attention, EF and memory were assessed in 24 patients with major depression using a novel neurocognitive test battery (Cognitive-Functions-Dementia, CFD) and a modified version of the “Mental Ability Questionnaire” (ModFLei) before and immediately after ECT. Results We found significant improvements in the recognition of verbal information (memory task) and a trend towards a decrease in lexical word fluency. Subjective memory functioning improved significantly, whereas a trend improvement of attention and EF as well as subjective global cognitive functioning could be observed. Conclusion and Outlook These findings support the cognitive safety of ECT and contradict the often-reported memory impairments after ECT, however, in a small sample size. Increasing our knowledge on a broad range of cognitive functions will allow us to develop specific therapeutic tools to counteract cognitive impairments in this patient group. Future research should investigate these questions in larger sample sizes and over a longer period of time.

A CASE OF BIGEMINY AND SUCCESSFUL COMPLETION OF ACUTE ELECTROCONVULSIVE THERAPY COURSE

Introduction Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community due to misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Several concerns have risen regarding the safety of ECT on the cardiovascular system. ECT causes periprocedural hemodynamic variability due to the surges in parasympathetic and sympathetic nervous systems following the administration of the electric current.1 Patients experience an increase in cardiac workload and oxygen demand, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest the incidence of cardiac complications is relatively rare and occurs most frequently in patients with underlying cardiovascular disease. Methods We describe a case report of a 53 year old female with history of bipolar I disorder current episode depressed, hyperlipidemia undergoing ECT who developed cardiovascular complications after her seventh brief pulse right unilateral (BRUL) treatment. Electrocardiogram (EKG) monitoring revealed bigeminy for two to three minutes (heart rate in 80s) during post-anesthesia care. Results The cardiovascular system undergoes various changes during ECT including events secondary to the parasympathetic release such as asystole, hypotension, bradycardia, and events secondary to sympathetic release such as hypertension and tachycardia. Other complications include arrhythmias, ST elevation, and Takotsubo Cardiomyopathy. The patient was seen by cardiology for further work-up. EKG, 2-D cardiac echocardiogram, 48-hour Holter monitoring, and coronary CT calcium scan were performed. She was found to have rare premature atrial contractions (PACs) (8 in 48 hours). Her bigeminy resolved spontaneously. The patient was able to complete the acute course of BRUL ECT and continued onto maintenance ECT with good effect. We also present a table with the common cardiovascular side effects from ECT and the most recent evidence-based treatment strategies to manage them. Conclusions Generally, ECT is a safe procedure; complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary-team approach the cardiovascular complications can be well managed and minimized. Our case highlights the benefits of a multidisciplinary care model between psychiatry, anesthesia, and cardiology. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide. This research was funded by None.

ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF ACUTE AGITATION AND AGGRESSION IN ALZHEIMER'S DEMENTIA (ECT-AD)

Introduction Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of aging, affecting approximately 5.4 million individuals in the US, and predicted to increase to 13.8 million by 2050. Occurring in over 90% of AD patients, neuropsychiatric symptoms such as agitation, depression and apathy, contribute to caregiver burden and increase patient morbidity and mortality. With no FDA-approved options available, treatments for severe agitation in people with advanced dementia are limited, with modest evidence for efficacy and substantial safety concerns. Behavioral therapies are recommended as first-line treatments for agitation in AD; however, they require substantial time to take effect and may be less efficacious for the most severely agitated patients. Psychotropic medications, especially antipsychotics, are widely used off-label to treat agitation in AD even with documented limitations in efficacy and safety concerns. Therefore, new treatments for severe agitation in AD refractory to standard interventions are timely and warranted. Randomized controlled trials have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for the treatment of severe psychiatric disorders of late life, including depression, mania and psychosis. Recently, small open label studies suggest efficacy and safety of ECT for agitation in individuals with AD who are refractory to standard therapies. The present randomized controlled trial builds upon prior work and aims to determine the efficacy and safety of ECT for severe agitation in moderate to severe stage AD, while also examining the durability of the acute treatment effect in an exploratory maintenance naturalistic design. Methods We describe an NIA-funded multi-site, single blind, randomized trial of ECT plus usual care (UC) versus Simulated-ECT (S-ECT) plus UC. We will enroll 200 inpatients with severe agitation and moderate to severe dementia, who have not responded well to prior trials of psychotropic medications. Our primary efficacy outcome measure is the Cohen Mansfield Agitation Inventory (CMAI), and the Neuropsychiatric Inventory – Clinician Version (NPI-C), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale (ADCS-CGIC), and Pittsburgh Agitation Scale (PAS) will be secondary measures. Safety and tolerability will be assessed with the Severe Impairment Battery – 8 item (SIB-8), the Confusion Assessment Method (CAM), and adverse event monitoring. Results Preliminary open-label data from our team suggests acute ECT treatment is safe and effective in reducing agitation in this population as measured by the CMAI, PAS, CGI, and adverse event monitoring. A multi-site, prospective case series investigated ECT treatment in 23 consecutive inpatients with dementia and severe agitation who did not benefit from standard behavioral interventions and pharmacotherapy. Eighteen of the 23 subjects experienced a significant reduction in agitation from baseline to discharge on the CMAI. In a retrospective chart review study of 16 patients undergoing ECT for agitation related to AD, only two experienced more than transient confusion post-ECT that required treatment, and no other clinically significant adverse events were noted in this group. We hypothesize ECT+UC will be more efficacious in reducing severe agitation in AD subjects than S-ECT+UC, as measured by our primary and secondary efficacy measures, and that there will be no difference in tolerability/safety outcomes for ECT+UC and S-ECT+UC as measured by cognitive decline (SIB-8), development of delirium (CAM), and serious adverse event monitoring. Conclusions This innovative study will fill a gap in the current clinical practice of treating severe agitation in AD using a rigorous methodological approach thus providing evidence for a new therapeutic application (severe agitation in AD) of a well-studied, established, and safe treatment (ECT). Study findings may demonstrate support for a new therapeutic use of ECT for severe agitation in AD. Successful management of neuropsychiatric symptoms reduces long-term care placement, decreases the risk of mortality, and enhances patient and caregiver quality-of-life. Such an approach has the potential to offer enormous relief to the substantial socioeconomic burden of AD-related behavioral disturbances. This research was funded by National Institute of Aging R01 AG061100-01

Safety of Electroconvulsive Therapy in 2 Very Young Pediatric Patients With Catatonia Related to Anti-N-methyl-D-aspartate Receptor Encephalitis

Safety of Electroconvulsive Therapy in 2 Very Young Pediatric Patients With Catatonia Related to Anti-N-methyl-D-aspartate Receptor Encephalitis

Analysis of elderly patients treated with electroconvulsive therapy and complication rates: a single center experience

Objective: Electroconvulsive therapy (ECT) is an effective treatment method used in many psychiatric disorders, primarily in mood and psychotic disorders. ECT is also effective and safe for geriatric depression. This study aimed to analyze elderly patients treated with ECT in bipolar disorder, major depressive disorder and psychotic disorder diagnostic groups. Methods: In this study, we retrospectively reviewed 58 geriatric patients over 60 years old who were treated with ECT between January 2014 and December 2017. Patients’ sociodemographic data, preliminary American Society of Anesthesiologists physical status assessments (ASA) scores and Clinical Global Impression (CGI), Hamilton Depression Rating Scale (HAMD), Young Mania Rating Scale (YMRS), Positive and Negative Symptom (PANSS) Scales before and after ECT were analyzed. Results: CGI, HAMD, YMRS and PANSS scores have significantly decreased after ECT. According to preoperative anesthesia consultations of the patients, 62.1% (n=36) were assessed to be in ASA 2 risk group and 34.5% (n=20) in ASA 3 risk group. One patient in the ASA 2 risk group and four patients in ASA 3 group had to discontinue treatment due to cardiovascular instability. These patients were administered medical treatment. There were no other mortalities or severe complications. Conclusion: This data shows that there were no mortalities or severe complications in elderly patients and supports the effectiveness and safety of ECT in elderly patients with bipolar disorder, major depressive disorder and psychotic disorder.

An Overview of Reviews on the Safety of Electroconvulsive Therapy Administered During Pregnancy.

To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment. A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews. Articles were reviewed and critically appraised using components of the PRISMA and AMSTAR systematic review assessment tools. Of the 9 articles that were identified, 5 publications of varying methodological quality met inclusion criteria and involved a range of 32 to 339 patients. The most common problems that occurred in association with ECT were fetal arrhythmia, fetal bradycardia, premature birth, developmental delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption, and threatened abortion. The number of fetal deaths in each of the reviews ranged from 2 to 12. The authors of 1 of the 5 reviews recommended that ECT only be used as a last resort, whereas the authors of the other reviews took the stance that the administration of ECT during pregnancy was relatively safe. Differences in recommendations among reviews were in part due to inclusion criteria and how adverse events were attributed to ECT. Our overview supports the conclusion, which has also been endorsed by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, that administration of ECT during pregnancy is relatively safe. Conclusions about safety, however, will become better established with the availability of more data.