Unilateral Ultrabrief Electroconvulsive Therapy Research Articles

Rapid Amelioration of Clozapine-Resistant Thought Broadcast in Schizophrenia With High-Dose Right Unilateral Ultrabrief Electroconvulsive therapy—A Single Case Report

Rapid Amelioration of Clozapine-Resistant Thought Broadcast in Schizophrenia With High-Dose Right Unilateral Ultrabrief Electroconvulsive therapy—A Single Case Report

Ultrabrief Electroconvulsive Therapy for Mania: Data From 11 Acute Treatment Courses.

Electroconvulsive therapy (ECT) is an effective treatment of mania. Ultrabrief ECT is a novel modality that is associated with fewer cognitive adverse effects than the standard pulse width brief pulse ECT. It has been well studied in depression. However, its use in mania is not yet known. Following a retrospective chart view, we report a small sample of patients who had Right Unilateral Ultrabrief ECT (RUB-ECT) for mania. Eleven RUB-ECTs were identified for 9 patients; 72.8% remission rate was observed with RUB-ECT. Two patients required switch into bitemporal ECT in view of minimal clinical response and 1 patient to right unilateral brief pulse ECT because of poor seizure parameters. All patients achieved remission eventually. The possible mechanisms of ECT in mania and clinical implications of ultrabrief ECT are discussed.

Neuromodulation therapies for geriatric depression.

Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

Use of ultra-brief pulse electroconvulsive therapy to treat severe postnatal mood disorder

To describe the use of ultra-brief electroconvulsive therapy (ECT) in three postnatal women with severe, treatment resistant depression. The indications and evidence for the use of ECT in the treatment of postnatal depression are discussed. We present a case series and review relevant literature. Three patients with severe episodes of depression postnatally, not responding to medication, presented to a private mother-baby inpatient unit. All three patients had significant suicidal ideation and two underwent involuntary treatment in public hospitals during the course of their presenting illnesses. They were treated with right unilateral ultra-brief ECT and a range of medications. All women began to respond within 3-6 treatments and no significant cognitive side effects were observed. Our findings suggest that right unilateral ultra-brief ECT is a useful treatment modality for severe and treatment resistant depression in the postnatal period. ECT is a useful option in women who have experienced significant medication side effects, or for those whose severity of illness necessitates rapid symptom resolution. Ultra-brief ECT caused minimal clinically observable side effects, which may assist mothers to resume care of their infants more rapidly.

Predictors of Patient Satisfaction After Ultrabrief Bifrontal and Unilateral Electroconvulsive Therapies for Major Depression

To assess patient satisfaction after ultrabrief electroconvulsive therapy (ECT). As part of a larger clinical and neuropsychological assessment, a Patient Satisfaction Survey was obtained from patients participating in a randomized trial comparing bifrontal and unilateral ultrabrief ECT. Forty-eight patients (75%) completed the Patient Satisfaction Survey. Fifty-eight percent of the patients endorsed the statement "If my doctor recommended ECT in the future, I would choose to have ECT again." A greater change in Hamilton Rating Scale for Depression score (regression weight, 0.28; t1 = 5.30; P = or < 0.0001) and the absence of psychotic symptoms at baseline (regression weight, -2.40; t1 = -2.54; P = 0.0148) predicted a higher satisfaction. In a multiple regression model with the same predictors but with change in Hamilton Rating Scale for Depression scores being replaced by change in Squire Subjective Memory Questionnaire scores, decrease in memory complaints proved to be a significant predictor of satisfaction. There were no significant differences between the patients given bifrontal ECT and those given unilateral ECT. Patients report a considerable degree of satisfaction after ultrabrief ECT. Patients who experience a more robust improvement in depressive symptoms and subjective memory complaints, and who have no psychotic symptoms at baseline, are more satisfied after treatment.

The successful use of right unilateral ultra-brief pulse electroconvulsive therapy in an adolescent with catatonia

Right unilateral ultra-brief electroconvulsive therapy (RUL UB ECT) has been shown to be efficacious with minimal cognitive adverse effects in adult patients with major depression. We present the case of a 14-year-old girl with major depressive disorder with catatonic and psychotic features whose symptoms remitted after 12 treatments of RUL UB ECT.

Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects

Objective The cognitive side-effects of bifrontal (BF) and right unilateral (UL) ultra-brief pulse (0.3 ms) electroconvulsive therapy (ECT) were compared, in the treatment of patients with a depressive episode. Method Neuropsychological functioning in patients with a medication refractory depressive episode, that were treated with a course of BF ultra-brief ECT at 1.5 times seizure threshold (ST) or UL ultra-brief ECT at 6 times ST, by random assignment, was assessed before treatment, and 1 and 6 weeks after the treatment course, by a blinded rater. Results Of the 64 patients that were included, 32 (50%) received BF ECT, and 32 (50%) received UL ECT, by random assignment. Neuropsychological testing 1 and 6 weeks after treatment was performed by 30 (93.75%) and 19 (59.37%) patients, respectively, in the BF-group and 29 (90.62%) and 20 (62.50%), respectively, in the UL-group. There was no deterioration in any of the neuropsychological measures. Patients rated their memory as clearly improved after treatment. There were no significant differences between the patients given BF ECT and those given UL ECT. Conclusions Ultrabrief pulse ECT, used either in combination with a UL electrode position and a stimulus of 6 times ST, or a BF electrode position with a stimulus of 1.5 times ST, are effective antidepressant techniques, that do not have a deleterious effect on cognitive function.