Severe Depressive Disorder Research Articles

Intramuscular Ketamine to Treat Major Depressive Disorder: A Case Series of Forty Patients

Introduction: While the use of ketamine to treat severe depression and post-traumatic stress disorder has been well documented in the literature, fewer studies have investigated the efficacy of Intramuscular (IM) ketamine to treat these conditions.

EMOTIONAL COMPETENCE AS A COMPONENT OF MENTAL HEALTH IN SOCIONAMIC EMPLOYEES

The article is devoted to the topical problem of modern psychological science – emotional competence. There are presented generalized results of theoretical study of emotional competence, which are based on researches of domestic and foreign scientists. In the article was analyzed approaches to the definition of emotional competence. There are considered the definition and structure of emotional competence of a person, its components. Namely: the ability to realize and evaluate yourself; manage yourself; motivate yourself; understand people, their emotions, feelings, accept others in their individuality; build relationships with people. There are analyzed factors influencing the development of emotional competence: genetic, social. In the article was substantiated the social significance of this phenomenon. There are determined the correlation of the concepts “emotional intelligence”, “emotional competence”. In the article was considered the definition of mental health as a state of psychosomatic and psychological well-being, which is based on a sense of strength and value of one's own “I”, its ability to achieve harmony with itself and others on the basis of appropriate, given environmental conditions, regulation of behavior and activity, is characterized by the absence of painful mental manifestations and provides adequate regulation of behavior to the conditions of the surrounding reality. There are determined levels of mental health: existential, interpersonal, psychosexual, cognitive, behavioral, psychophysiological. Was analyzed the consequences of a person's contemptuous attitude to the emotional sphere: an increase in the number of disorders of the affective spectrum, depressive, anxiety, psychosomatic, eating behavior, an increase in the number of severe mental states, anxiety and depressive disorders. There are considered the results of the theoretical analysis of the problem of research of emotional competence as an indicator of mental health of employees of the social specialty. It has been established that a high level of emotional competence is a prerequisite for mental health and success in the professional activities of socionomic specialists. For the purpose of further scientific achievements on the identified issues, is substantiated the need for empirical research.

Toward Targeted ECT: The Interdependence of Predictors of Treatment Response in Depression Further Explained.

Several clinical variables assumed to be predictive of electroconvulsive therapy (ECT) outcome in major depressive disorder show substantial interrelations. The current study tries to disentangle this interdependence to distill the most important predictors of treatment success to help improve patient-treatment matching. We constructed a conceptual framework of interdependence capturing age, episode duration, and treatment resistance, all variables associated with ECT outcome, and the clinical symptoms of what we coin core depression, ie, depression with psychomotor agitation, retardation, psychotic features, or a combination of the three. The model was validated in a sample of 73 patients with a major depressive episode according to DSM-5 treated twice weekly with ECT (August 2015-January 2018) using path analyses, with the size and direction of all direct and indirect paths being estimated using structural equation modeling. Reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores during treatment was the ECT outcome measure. The baseline presence of psychomotor agitation, retardation, and/or psychotic symptoms strongly correlated with beneficial ECT outcome (z = 0.84 [SE = 0.17]; P < .001), and the association between age and the effect of ECT appears to be mediated by their presence (z = 0.53 [SE = 0.18]; P = .004). There was no direct correlation between age and ECT response (P = .479), but there was for episode duration and ECT outcome (z = -0.38 [SE = 0.08]; P < .001). ECT is a very effective treatment option for severe depressive disorder, especially for patients suffering from severe depression characterized by the presence of psychomotor agitation, psychomotor retardation, psychotic symptoms, or a combination of these 3 features, with the chance of a beneficial outcome being reduced in patients with a longer episode duration. Age may heretofore have been given too much weight in ECT decision making. ClinicalTrials.gov Identifier: NCT02562846.

In Response.

We thank the editor for giving us the opportunity to respond to Dr Ansari et al,1 who claim that the association of exposure to general anesthesia for cesarean delivery with elevated risk of severe postpartum depression (PPD) might be due to residual confounding and that our conclusion implies a causality.1,2 Dr Ansari et al1 misread our study, and their concerns are unfounded. We discussed extensively in our article the limitations of our study, its proof-of-concept nature, and the need for confirmatory studies. More importantly, we explicitly stated that “[T]he reported association between exposure to general anesthesia and the risk of PPD and suicidality does not necessarily represent a causal relationship,” and “confounding by indication and residual confounding could explain the observed association between general anesthesia and postpartum mood disorders.”2 We also used the E value to evaluate the potential bias from residual confounding and acknowledged that “the exact indication for general anesthesia cannot be accurately identified in administrative data and the propensity score used to estimate the odds of receiving general anesthesia includes only known confounders or available confounders.”2 Dr Ansari et al1 assert that “General anesthesia is not generally performed without a clinical rationale…As such, women who do receive general anesthesia are likely to have had a more complicated peripartum course than women receiving regional anesthesia.” They attempted to back up this assertion by using the results from a quick chart review of 100 cesarean deliveries under general anesthesia performed in a single academic medical center. Based on a convenience sample, their result is not peer reviewed and cannot be taken as evidence to refute our findings. Our recent study in New York State indicates that about 40% of cesarean deliveries performed under general anesthesia did not have such a clinical rationale and could have been potentially avoided.3 Although postoperative depressive disorders are an understudied area in anesthesia outcomes research, there is emerging experimental and epidemiologic evidence linking general anesthesia to increased risk of postoperative depression, as alluded to in our study. Recent research in nonobstetric patients suggests that exposure to surgery under general anesthesia is associated with the development of newly onset postoperative depressive disorders and the acceleration of preexisting depressive symptoms.4 Studies in obstetric patients indicate that exposure to general anesthesia is partially responsible for heightened risk of postpartum depression. Acute or persistent postoperative pain, delayed first interaction with the newborn, and delayed breastfeeding have all been associated with the development of postpartum depression and are more frequent when general anesthesia is used for cesarean delivery.2,5,6 The antidepressant effect of ketamine does not necessarily contradict our findings, because the prophylactic administration of ketamine to surgical patients does not decrease the risk of newly onset postoperative depressive symptoms or the acceleration of preexisting depressive symptoms.4 Similarly, the therapeutic effect of electroconvulsive therapy on severe depressive disorders is due to the electrical current applied to the brain rather than the general anesthetic used for performing this traumatic procedure. Our preliminary findings should be viewed as positive signals that exposure to general anesthesia for cesarean delivery is a partially modifiable risk factor for PPD. More rigorous research is warranted to better establish the relationship between exposure to general anesthesia and PPD, assess the causative nature of this relationship, and elicit the mechanisms underlying this relationship. Jean Guglielminotti, MD, PhDDepartment of AnesthesiologyColumbia University Vagelos College of Physicians and SurgeonsNew York, New York[email protected] Guohua Li, MD, Dr PHDepartment of AnesthesiologyColumbia University Vagelos College of Physicians and SurgeonsNew York, New YorkDepartment of EpidemiologyColumbia University Mailman School of Public HealthNew York, New York

The latest research on risk factors and pathomechanisms of depression – review

Introduction: Depression is a mental disorder that is increasingly being diagnosed in middle and more developed countries (MDC). Symptoms of depression in patients with severe depressive disorder (MDD) include sadness, regret, negative thoughts, anxiety, and more.The aim of the study: The aim of the study was to summarize the latest research (from 2020) on factors related to the occurrence of depression, as well as the current findings on depression (also those related to the COVID-19 pandemic).Material and method: For this purpose, scientific search engines such as PubMed and Google Scholar were used.Description of the state of knowledge: In 2020, apart from research on pathomechanisms and environmental factors, a large part of the research focused on the COVID-19 pandemic as a risk factor for the development of depression symptoms. Many studies from different parts of the world have confirmed that a pandemic can have a significant impact on the occurrence of depression.Summary: There are many factors that can cause depression and it is important to keep them in mind both in everyday life and in clinical practice. Studies from various parts of the world have shown that the COVID-19 pandemic has exacerbated the experience of depressive symptoms, also in those who have not yet been diagnosed with MDD. The degree of severity of depressive symptoms depended on such factors as: financial situation, social isolation.

Mental reactions of doctors against the background of the SARS-CoV-2 pandemic (message 2)

This article continues the review of the complex of mental reactions of doctors against the background of the SARS-CoV-2 pandemic (from anosognosia to severe anxiety and depressive disorders) described in message 1. Significant correlations were found between a number of indicators of experimental psychological research methods and the data from the questionnaire developed by us, which allows speaking about the influence of strategies for coping with stress behavior in doctors of various profiles on the quality of life and their mental responses.

Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders.

Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions. To describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder. We describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures. MRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events. MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure-the anterior capsulotomy.

Mental reactions of doctors against the background of the SARS-CoV-2 pandemic (message 1)

The article considers various mental reactions of doctors against the background of the SARS-CoV-2 pandemic, based on a brief scientific analysis of the literature and experimental psychological research methods. It has been found that currently, the impact of the SARS-CoV-2 pandemic on medical workers causes a complex of mental reactions (from anosognosia to severe anxiety and depressive disorders) and is accompanied by an increase in general anxiety. This pilot study showed the need for further analysis of the problem under consideration.

Scoping review des stratégies de prise en charge du trouble dépressif caractérisé comorbide d’une anorexie mentale à l’adolescence

ObjectivesPsychiatric comorbidities are frequent in anorexia nervosa, with the highest rate of suicidal lethality among psychiatric disorders. Major depressive disorder is one of the most life-threatening comorbidities of anorexia nervosa, exacerbating the risk of suicide, aphagia, and pervasive refusal syndrome. The aim of this study is to conduct a systematic review of studies exploring strategies for the treatment of severe depression in the acute phase of anorexia nervosa in adolescence. MethodsWe conducted a scoping review of the publications dealing with the treatment of depressive comorbidities in adolescents suffering from anorexia nervosa published between 2005 and 2019. An electronic search in Pubmed and Medline for relevant studies used the following keywords adolescent, youth, anorexia nervosa, depress*, suicide*, “melancholic depression”, treat*, therapy*, care. Included studies were dealing with 10–18-year-old inpatient or outpatient adolescents presenting an anorexia nervosa complicated by a major depressive disorder. ResultsOf 562 studies identified, eight were included in the final sample. Regarding psychiatric treatments, four studies concerned the prescription of antidepressants, one case-study was described a treatment by electroconvulsive therapy and another was dealt with light therapy. Finally, the two last studies evaluated the effect of nutritional treatment on psychiatric symptoms but found no significant direct association between weight gain and improvement of depressive symptoms. DiscussionThere is a need to identify faster severe depressive disorders in adolescents with anorexia nervosa in order to provide, along with refeeding, a more intensive treatment of mood symptoms. A multidisciplinary and coordinated approach must be initiated at the beginning of the trouble. There is a need for more systematic studies on the therapeutic approaches of mood disorder comorbidities in adolescents suffering from anorexia nervosa.

Psychiatric inpatient beds for youths in China: data from a nation-wide survey

BackgroundThe development of child psychiatric services in China has been slow and very limited resources have been allocated to support its growth. This study set out to investigate the child and adolescent inpatient psychiatric resources currently available in top-tier psychiatric hospitals in China and the characteristics of youth patients hospitalized on an adult unit.MethodsAs part of an official national survey, 29 provincial tertiary psychiatric hospitals in China were selected. Data from 1975 inpatients discharged from these hospitals from March 19 to 31, 2019 were retrieved and analyzed.ResultsThe mean number of youth psychiatric beds was 27.7 ± 22.9 in these hospitals and 6/29 hospitals had no youth beds. There were significantly more youth beds in developed regions than in less developed regions (P < 0.05). Most of the discharged youth patients were teenagers with severe mental illnesses, including schizophrenia, depressive disorder and bipolar disorder. 7.5% (149) of the 1975 discharged patients were children or adolescents, however youth beds only accounted for 3.2% (804/25,136) of all psychiatric beds. 45.6% (68) of youth patients were discharged from adult psychiatric units.ConclusionOur findings highlight the lack of adequate youth psychiatric inpatient services for children and adolescents living in China, especially in less developed regions. There is an urgent need to build more child and adolescent psychiatric units in provinces where there are none, and to increase the number of beds within the units that exist presently.

Bridging the distance: Continuing psycho-oncological care via video-consults during the COVID-19 pandemic.

The Helen Dowling institute is a mental healthcare institute specialized in psycho-oncology in the Netherlands. We offer face-to-face individual, couple, family and group therapy, to (family members of) cancer out-patients (n = 2.302 clients in the last year). Clients mainly suffer from severe cancer-related fatigue, anxiety, trauma, stress-related and depressive disorders, relationship problems and/or prolonged grief disorder. Since 2009 the institute offers specific internet-based interventions for cancer patients, such as Mindfulness-Based Cognitive Therapy (MBCT) for cancer-related fatigue1, 2 and Anxiety and Depression,3, 4 self-help and blended Cognitive Behavioural Therapy (CBT) for fear of cancer recurrence5, 6 within a secure environment. When it became clear COVID-19 reached the Netherlands, the management team decided on 12 March 2020 that face-to-face care should be continued through video-consults within the same secured environment that provides the platform for our internet-based treatments. All clients received a letter explaining this, including instructions how to download the video-consult app. Two psychologists with extensive internet-based treatment experience provided two webinars for all colleagues to explain the possibilities of our internet-based programs and to exchange tips for video-consults. After 7 weeks we conducted an anonymous survey amongst clients and therapists to learn about their experiences with receiving/delivering mental healthcare through video-consults. We introduced the following open-ended questions: In the context of improving care, the study was approved by the ethical board of the Helen Dowling Institute. It's missing depth, seems more formal. I have to concentrate really hard to let the meaning of the words sink in. I'm easily distracted by sounds around the house. The face-to-face contact was outside my house. It was a place that my brain associated with dark feelings. A neutral space where it was easy for me to talk openly about feelings. Some clients experienced video-consults from their own place as more quiet and relaxed, because they did not experience the stress of traveling and face-to-face contact. When face-to-face contact is possible again in the future, half of the clients would like to make use of video-consults for about a third of their sessions. It is especially viewed as an alternative when they feel too ill/fatigued to travel. The patient care department has a dedicated team of 34 psychologists and 2 psychiatrists. Thirty of them filled out the survey. Though 15 therapists had prior experience with internet-based therapy (eg, MBCT, CBT), only two had prior experience with video consults. We provided support by giving two webinars for all colleagues to explain the possibilities of our internet-based programs and to exchange tips for video-consults, and we assigned colleagues who were available for follow-up questions. Furthermore, weekly multidisciplinary team gatherings continued online, providing the opportunity to help each other. The moment that you walk up the stairs together or gradually end a session are important moments for clients to tune in and regulate emotions, as well as for ourselves. …not being able to put a hand on someone's shoulder to give some consolation or encourage someone is difficult. All therapists indicated that they would make use of video-consults if clients wish to do so in the future. For example, when a client is too ill to travel, or to keep clients motivated to do exercises, video-consults seem a good alternative. If a good working relation has been established therapists think it is easier, while for more complex therapies they prefer face-to-face contact. If possible they would choose to continue with video consults for a mean of 28% of their time (range 1%-55%). Now therapists have become more familiar with working with the secured environment for video consulting they have also started to use our internet-based programs more often. We conclude video-consults have been helpful to continue therapy. While earlier research into internet-based therapies (these work through text-based communication within a developed program with video and audio-files) showed this could lead to a good working alliance, that was experienced as personal,7 video-consults are experienced as more distant by most clients and therapists (see Table 1). It is the non-verbal contact during face-to-face sessions that helps clients to express what is most difficult for them, which is lacking in video consults. At the same time the physical distance from daily life helps clients to make room for their dark feelings. The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.

The Presentation and Treatment Response of Catatonia in Patients Admitted to the Psychiatric Inpatient Unit at Jimma University Medical Center, Ethiopia.

Background Catatonia is among the most mysterious and poorly understood neuropsychiatric syndrome. It is underresearched and virtually forgotten but still a frequent neuropsychiatric phenotype in both developed and low-income countries. Catatonia is associated with a number of medical complications like pulmonary embolism, dehydration, or pneumonia if it is not treated and managed adequately. In Ethiopia, however, almost no studies are available to describe the symptoms and the response to treatment in patients with catatonia. The aim of this retrospective study was therefore to describe the symptom profile of catatonia and to evaluate the treatment and outcome of catatonia in patients admitted to the psychiatric inpatient unit at Jimma University, Ethiopia. Method Detailed treatment records of all inpatients were reviewed for the period from May 2018 to April 2019. All patients with catatonia at the inpatient unit of Jimma University Medical Center were assessed with the Bush-Francis Catatonia Rating Scale (BFCRS), and all comorbid psychiatric diagnoses were made according to the criteria of the Diagnostic Statistical Manual V. The presence and severity of catatonia were assessed by using the BFCRS at baseline and at discharge from the hospital. Result In the course of one year, a total of 18 patients with the diagnosis of catatonia were admitted. The mean age of the participants was 22.8 years (SD 5.0; range: 15 to 34 years). The most common diagnosis associated with catatonia was schizophrenia (n = 12; 66.7%), followed by severe depressive disorders (n = 4; 22.2%). Mutism, posture, and withdrawal were registered in all patients (n = 18, 100%). All patients received an injection of diazepam and had improved at discharge. Conclusion Our study provides further evidence that catatonia is most commonly associated with schizophrenia, followed by major depressive disorder, and that mutism, posturing, and withdrawal are the most common signs and symptoms of catatonia.

Internet Cognitive Behavioral Therapy With or Without Face-to-Face Psychotherapy: A 12-Weeks Clinical Trial of Patients With Depression.

Depressive disorders are a curable, global health problem. However, most patients remain untreated, and more and more patients use internet-based interventions, but it is unclear whether it is beneficial for ongoing face-to-face psychotherapy. Thus, we compared the outcome of internet cognitive behavioral therapy (ICBT) with (ICBT+) or without (ICBT) additional face-to-face outpatient psychotherapy in adult patients with moderate to severe depressive disorder. For this longitudinal interventional clinical trial (NCT02112266), 168 of 252 online recruited adults with depressive symptoms received ICBT+ (n = 96) or ICBT (n = 72). Demographics (sex, age, age at first depressive episode, years of education, duration of depressive symptoms) were assessed and compared between groups. All patients underwent ICBT for 12 weeks. Quality of life (QoL) and severity of depressive symptoms were assessed within each group at three time points [baseline (T0), postinterventional after ICBT at 12 weeks (T1), and for follow-up at 6 months (T2)] using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) global score to assess QoL as primary and the Beck Depression Inventory (BDI-II) to assess self-rated depressive symptoms as secondary outcome variables, respectively. Differences were assessed between groups using t test and over time using repeated-measures analysis of variance. Data of intention-to-treat analysis are given as mean ± SD. Group differences were assumed at p < 0.05. Partial η2 is given as effect size. Demographic data, QoL, and depressive symptoms did not differ between groups (ICBT+/ICBT) at baseline (T0). Patients of both groups suffered from moderate to severe depressive disorders and gained improved QoL scores (WHOQOL-BREF-global: p < 0.001, η2 = 0.16), as well as experienced decreased depressive symptoms (BDI-II: p < 0.001, η2 = 0.2) after 12 weeks of ICBT compared to baseline. Patients without additional face-to-face outpatient psychotherapy lost QoL—albeit not significant—and had increased depressive symptoms (BDI: p = 0.02, η2 = 0.04) at 6 months' follow-up. Thus, ICBT is suitable for psychiatric treatment, although additional face-to-face outpatient psychotherapy helps stabilizing long-term outcome.

Experiences of Weight-Loss Surgery in People With Serious Mental Illness: A Qualitative Study.

BackgroundBariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated.ObjectivesA qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness.MethodsNine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken.ResultsFive broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) post-operative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences; (5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery.ConclusionsParticipants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.

Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon: a web-based cross-sectional study

IntroductionAttention deficit hyperactivity disorder (ADHD) is a chronic mental disorder that is associated with poor productivity, with a significant impact on the quality of life.ObjectivesTo determine factors associated with symptoms...

Chronic SJW pretreatment in the regulation of Cerebral Serotonergic and Behavioral Activity

Background: Saint John’s wort (SJW) is known for the medicinal powers of its leaves that are composed of a myriad of chemical components having diverse effects on various conditions like mild to moderately severe depressive disorders. Present study is carried out to explore the presynaptic adaptive measures resulting by the treatment with SJW prior to subjection of rats to forced swim test (FST). Method: Adult Albino Wistar rats were divided into 2 groups (Saline and drug administered rats, n=12 each). Each group was further divided into stressed and unstressed groups (n=6). SJW (500mg/kg/ml) was orally administered to the drug group for 28 days while saline was administered to the other group for the same period. Results: Behavioral analysis of FST shows an increase in swimming time and a decrease in floating time of rats pretreated with SJW. Serotonin transporter (SERT) gene expression is decreased by SJW in both stressed and unstressed groups. SERT protein is increased by SJW in the unstressed group but decreased in the stressed group as compared to the saline administered group. Conclusion: It can be concluded that SJW is affective in containing serotonergic hyperactivity simultaneously alleviating depression by mechanisms probably different to the serotonergic system.

COVID-19: Reducing the risk of infection might increase the risk of intimate partner violence

COVID-19: Reducing the risk of infection might increase the risk of intimate partner violence

What do we know about long-term treatment outcomes for severe depressive disorders?

In a recent issue of BJPsych Open, McPherson & Hengartner (see https://doi.org/10.1192/bjo.2019.65) reviewed 11 trials examining psychological and pharmacological treatment outcomes for chronic or treatment-resistant depression. They concluded that when assessed in the long term, antidepressants become less effective whereas psychological therapies become more effective. We argue that the evidence does not support this; indeed, most of the studies reviewed do not directly compare antidepressant with psychological therapy treatments and there is little consistency between them in terms of populations and interventions examined. The issue of long-term outcomes is key for optimising clinical guidelines and deserves more intensive research and scrutiny to improve patient response in routine practice.

The Impact of Pediatric Basal Ganglia Stroke on Mental Health in Children: Report of 2 Cases

Background:The impact of basal ganglia stroke on mental health is better described in adults than in children. We report 2 children with significant mental health issues after basal ganglia stroke.Case Reports:Patient 1, an 8-year-old boy, had mild anxiety before his left basal ganglia stroke. Post-stroke, he developed severe anxiety, obsessions, depression, and attention deficit hyperactivity disorder, in addition to a right hemiplegia and some mild chorea. He gradually improved over 3 years with psychiatric care and medication but continued to have residual symptoms. Patient 2, a 10-year-old boy, had no history of mental health issues before his right basal ganglia stroke. Post-stroke, he developed significant anxiety and mild depression, along with a left hemiplegia. He improved over 9 months and returned to his mental health baseline.Conclusions:Mental health issues after basal ganglia stroke in children can be significant, and recovery can take months to years.

International Consortium on the Genetics of Electroconvulsive Therapy and Severe Depressive Disorders (Gen-ECT-ic).

Recent genome-wide association studies have demonstrated that the genetic burden associated with depression correlates with depression severity. Therefore, conducting genetic studies of patients at the most severe end of the depressive disorder spectrum, those with treatment-resistant depression and who are prescribed electroconvulsive therapy (ECT), could lead to a better understanding of the genetic underpinnings of depression. Despite ECT being one of the most effective forms of treatment for severe depressive disorders, it is usually placed at the end of treatment algorithms of current guidelines. This is perhaps because ECT has controlled risk and logistical demands including use of general anaesthesia and muscle relaxants and side-effects such as short-term memory impairment. Better understanding of the genetics and biology of ECT response and of cognitive side-effects could lead to more personalized treatment decisions. To enhance the understanding of the genomics of severe depression and ECT response, researchers and ECT providers from around the world and from various depression or ECT networks, but not limited to, such as the Psychiatric Genomics Consortium, the Clinical Alliance and Research in ECT, and the National Network of Depression Centers have formed the Genetics of ECT International Consortium (Gen-ECT-ic). Gen-ECT-ic will organize the largest clinical and genetic collection to date to study the genomics of severe depressive disorders and response to ECT, aiming for 30,000 patients worldwide using a GWAS approach. At this stage it will be the largest genomic study on treatment response in depression. Retrospective data abstraction and prospective data collection will be facilitated by a uniform data collection approach that is flexible and will incorporate data from many clinical practices. Gen-ECT-ic invites all ECT providers and researchers to join its efforts.