Use Of ECT Research Articles

Are we withholding the most effective treatment for severe depression from our patients?

SUMMARYIn response to an article on recent advances in the use of ECT for depression, this commentary supports earlier and more extensive use of the treatment. It challenges the belief that ECT is associated with a higher risk of cognitive deficits and mortality and points out its rapid effect compared with antidepressant medication. It calls for clinicians to remain up to date regarding ECT and consider its opportune use in severe depression.

ECT practice in England from 2012/13 to 2018/19: a retrospective analysis

AimsThe purpose of this study was to look longitudinally at ECT practice in England over the past 7 years: namely over the following key time periods; 2012/13, 2014/15, 2016/17, 2017/18, and 2018/19. A previous study by Chaplin et al, published in 2016, found that there had been a striking decline observed in the number of courses of ECT prescribed to patients from 2006 to two time points i.e. 2012/13 and 2014/15.In this study we investigated whether or not this trend had continued. Hence we looked at the change in frequency of ECT use, the length of ECT courses, patient demographics and clinical outcomes; between 2012/13 and 2018/19.BackgroundElectroconvulsive therapy (ECT) is an effective treatment for Major Depression, Treatment-Resistant Depression, Catatonia, and Clozapine-resistant psychosis. There have been regular improvements in the administration of ECT, over the past two decades. Increases in the volume of the hippocampus and the amygdala have consistently been observed in ECT studies. Stigma has been the major barrier to patients receiving ECT in a timely fashion. The Royal College of Psychiatrists (RCPsych) Centre for Quality Improvement (CCQI) established the ECT Accreditation Service (ECTAS) back in 2006. ECTAS had the aim of standardising ECT practice through the production of evidence-based standards that all member ECT Clinics could use to support their practice.MethodWe looked at the minimum dataset of information collected from ECTAS Members within England for the following years; 2012/13, 2014/15, 2016/17, 2017/18, 2018/19. In 2012/13, 2325 adjusted courses of ECT treatment were given to patients in England. In 2014/15 it was 2302.ResultBetween 2012/13 and 2018/19; two thirds of ECT patients continue to be female. The modal age of patients has also remained the same at 70 years. The number of patients detained under the Mental Health Act 1983 receiving ECT has gone up by 12%; suggesting that the patients receiving ECT were more clinically unwell. After treatment, CGI scale scores (i.e. the very much improved and much improved scores) slightly reduced by 6% from 2012/3 to 2018/19.ConclusionThe use of ECT in England notably declined from 2006 to 2012/13 and 2014/15. However, from 2012/13 to 2018/19, ECT use has remained relatively stable; suggesting that it is currently being used appropriately on patients, who are amongst the most severely unwell. The clinical effectiveness of ECT remains high however, it has slightly dipped by 6%.

Electroconvulsive therapy and informed consent in compulsory treatment – an ethical dilemma

IntroductionGiven the effectiveness and overall safety in several psychiatry conditions, electroconvulsive therapy remains a widely used procedure in current medical practice. Informed consent is still a requirement for the use of ECT both in voluntary and compulsory treatment; however, since severe mental illness can affect decision-making capacity and insight of the need for treatment, this requirement often constitutes an obstacle to its use. In addition, stigma around ECT still contributes to treatment refusal.ObjectivesTo summarize the most recent evidence published about ECT and discuss the ethical and legal implications of its use, enlightened by the empirical description of a clinical vignette.MethodsReview of literature on the ethical and legal issues involving the ECT use in patients on compulsory treatment, considering the efficacy, risks, the mental health legislation in Portugal, and several international directives.ResultsInformed consent is the basic tenet in the contemporary physician-patient relationship. In principle, ECT can only be administered to patients who prior consent to the treatment. In contemporary practice, providing the best medical assistance and respecting the patient’s autonomy are two fundamental principles. However, we often face an ethical dilemma, when severely ill patients, whose insight, the ability for self-determination and decision-making capacity may be impaired, refuse a potential beneficial treatment as ECT.ConclusionsThe use of ECT in severe mental illness is still hampered by legal and ethical constraints. A future revision of the law could protect patients from being excluded from a treatment that may change the course of the disease.DisclosureNo significant relationships.

Critical analysis of the electroconvulsive therapy unit of centro hospitalar lisboa norte

IntroductionElectroconvulsivotherapy (ECT) one of the oldest treatments in biological psychiatry, is used nowaday mainly due to safety, efficacy and tolerability. Can be first-line treatment for mood disorders with catatonic or psychotic symptoms, and a second-line tretament to pharmacoherapy resistance or intolerable side effects.ObjectivesTo analyze the number of ECTs done, the number of patients submitted to this procedure in the ECT Unit in Centro Hospitalar Lisboa Norte (CHULN) comparing their diagnosis. To evaluate the number of patients that underwent maintenance and/or continuation treatment.MethodsRetrospective study involving patients submitted to ECT from 1 of January to 31 of December of 2019. A literature review exploring the use of ECT in psychiatry was conducted.ResultsDuring the 12-month period were performed 179 sessions, corresponding to 18 patients. The diagnosis were schizophrenia, 55%, bipolar disorder, 39% and 6% with major depression. Only 28% underwent continuation and/or maintenance treatment.ConclusionsIn this sample, of those diagnosed with schizophrenia, 90% were submitted to ECT due to oral therapy failure and 10% due to catatonia. Of those diagnosed with bipolar disorder 42.9% had a depressive episode and of these 14.2% had psychotic symptoms. This Unit is integrated in the biggest hospital of Portugal, it is import to understand the small number of patients submitted to this treatment and identify factors that may be preventing the referral of patients to this treatment. Clinicians may have the impression that ECT should be left as a last resort treatment which may explain the low percentage of major depression among our patients.DisclosureNo significant relationships.

Effective and Safe Use of ECT in Patient with Pacemaker: A Case Report

Effective and Safe Use of ECT in Patient with Pacemaker: A Case Report

Ease of Use of the Electroconvulsive Therapy App by Its Users: Cross-Sectional Questionnaire Study

Background Electroconvulsive therapy (ECT) is one of the oldest, most effective, and potentially life-saving noninvasive brain stimulation treatments for psychiatric illnesses such as severe depression, mania, and catatonia. The decision-making process to use ECT involves well-informed discussion between the clinician and the client. A platform, like an app, which provides this information in an easy-to-understand format may be of benefit to various stakeholders in making an informed decision. Apps developed by clinicians/hospitals taking into consideration user perspectives will filter and provide trustworthy information to the users. In this regard, the ECT app, an app which is freely available for download at the Apple Store, was developed by the Leicestershire Partnership National Health Service (NHS) Trust and Leicestershire Health Informatics Service (LHIS). Objective The objective of this study is to evaluate and demonstrate the accessibility of the ECT app to the chosen audiences it was created for, via a paper and electronic questionnaire. Methods A survey was conducted between January 2017 and March 2019. A survey questionnaire designed for the study was sent to mental health professionals, medical students, patients, carers, and members of the public via post, email, and SurveyMonkey or informed via posts shared in Psychiatry online groups and face-to-face contact. All participants who were willing to participate in the study were included. Results Results were collected via paper forms, email responses, and SurveyMonkey and all were inputted into SurveyMonkey to facilitate analysis. A total of 20 responses were received during the study period (January 2017 to March 2019). The participants of the survey, which included a mixed group of professionals (12/20, 60%), patients (3/20, 15%), and carers (1/20, 5%), opined that the app was easy to download (14/20, 70%) and use (9/20, 45%); contained adequate information (19/20, 95%); they felt more informed after having used the app (9/20, 45%); and they would recommend it to others (19/20, 95%). The participants of the survey also provided suggestions on the app (10/20, 50%). Conclusions The ECT app can be beneficial in sharing appropriate information to professionals and the public alike and help in gathering unbiased and nonjudgmental information on the current use of ECT as a treatment option.

Current clinical practice of electroconvulsive therapy and repetitive transcranial magnetic stimulation in psychiatry, a German sample

The purpose of the study was to evaluate the current clinical practice of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in German psychiatry. Case-based data (> 1.000.000 cases) were collected according to §21 of the German hospital remuneration law from January 2015 to December 2017. The study cohort comprises approximately 35–40% of the annual psychiatric cases and hospitals in Germany. Frequency of ECT and rTMS cases were investigated considering main diagnoses according to ICD-10 and treatment settings (inpatient vs. day-care). ECT cases with short-term hospitalization (≤ 4 days) were supposed to be maintenance ECT cases. A linear regression analysis was conducted to estimate trends in the use of ECT and rTMS. Different groups were compared using Chi-square tests. ECT and rTMS cases appear to increase in total during the observation period possibly due to facilities newly introducing ECT and rTMS but also to increased frequency of treatments. Both treatments were rarely performed in day-care settings (0.89% and 11.25%). ECT was performed in 1.72% of all cases with affective disorders and in 1.48% with major depressions, respectively. Age ≥ 65 years, females, severe and psychotic depression were significantly associated with a higher rate of ECT cases. > 40% of all ECT cases were possibly maintenance ECT cases. Only 0.60% of these were performed in day- care settings. rTMS was primarily performed in major depression (86,7% of all rTMS cases). This study suggests a growing demand for ECT and rTMS. Nevertheless, the use of ECT is still low compared to the high prevalence of treatment resistant depression. The use of rTMS is even lower and seems to be restricted to specialized institutions. Maintenance ECT is frequently carried out in an inpatient setting. Limitations of this study are the case- and group-based analysis, missing data on outpatient services and treatment sessions per case. Therefore, the database is not necessarily representative for the entire German healthcare system. Further studies are needed to verify the presented findings and should address the feasibility of ambulatory and day-care ECT services.

5.57 UTILITY OF ECT IN THE MANAGEMENT OF CATATONIA ASSOCIATED WITH SEROPOSITIVE, SERONEGATIVE, AND POSSIBLE AUTOIMMUNE ENCEPHALITIS IN CHILDREN AND ADOLESCENTS

Recent expansion in our exploration and understanding of autoimmune encephalitis (AE) has guided diagnostic and therapeutic approaches to the illness. Cognitive, neuropsychiatric, and autonomic manifestations of AE are well-specified, but a majority of patients also may demonstrate symptoms consistent with catatonic syndrome within the course of the illness. Whereas ECT use in the pediatric population has been demonstrated as efficacious and safe, a paucity of exploration into its role in treating catatonia associated with AE exists in this group. This study explores the use of ECT in pediatric AE.

Computational comparison of conventional and novel electroconvulsive therapy electrode placements for the treatment of depression

BackgroundElectroconvulsive therapy (ECT) is a highly effective treatment for severe psychiatric disorders. Despite its high efficacy, the use of ECT would be greater if the risk of cognitive side effects were reduced. Over the last 20 years, developments in ECT technique, including improvements in the dosing methodology and modification of the stimulus waveform, have allowed for improved treatment methods with reduced adverse cognitive effects. There is increasing evidence that the electrode placement is important for orienting the electrical stimulus and therefore modifying treatment outcomes, with potential for further improvement of the placements currently used in ECT. ObjectiveWe used computational modelling to perform an in-depth examination into regional differences in brain excitation by the ECT stimulus for several lesser known and novel electrode placements, in order to investigate the potential for an electrode placement that may optimise clinical outcomes. MethodsHigh resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare regional differences in average electric field (EF) magnitude among a total of thirteen bipolar ECT electrode placements, i.e. three conventional placements as well as ten lesser known and novel placements. Results and conclusionIn this exploratory study on a systemic comparison of thirteen ECT electrode placements, the EF magnitude at regions of interest (ROIs) was highly dependent upon the position of both electrodes, especially the ROIs close to the cortical surface. Compared to conventional right-unilateral (RUL) ECT using a temporo-parietal placement, fronto-parietal and supraorbito-parietal RUL also robustly stimulated brain regions considered important for efficacy, while sparing regions related to cognitive functions, and may be a preferrable approach to the currently used placement for RUL ECT. The simulations also found that regional average EF magnitude varied between individual subjects, due to factors such as head size, and results also depended on the size of the defined ROI.

Electroconvulsive therapy: A review

Electroconvulsive therapy, or ECT, is an effective treatment for severe, persistent neuropsychiatric disorders, including mood disorders, acute suicidality, catatonia, neuroleptic malignant syndrome, and, to a lesser extent, schizophrenia. ECT is generally reserved for adults, but adolescents with “treatment‐resistant” conditions, defined as failure of two or more adequate medication trials, also benefit. Studies show that the majority of child and adolescent psychiatrists lack the necessary training to administer ECT. What's more, ECT is often represented inaccurately and negatively in popular media, resulting in controversial public opinion and increased stigmatization. Despite nearly 70 years of evidence supporting the efficacy and safety of ECT, including 2004 American Academy of Child and Adolescent Psychiatry (AACAP) guidelines for ECT use in adolescents and an ethical review of this intervention, ECT continues to be underutilized. The aim of this article is to dispel myths about ECT by providing evidence‐based psychoeducation, a review of the indications and when providers should consider a referral.

Demographic and Clinical Profile of Patients Receiving Electroconvulsive Therapy at Federal Neuropsychiatric Hospital Yaba in Lagos, Nigeria

Aims: To obtain sociodemographic and clinical profile of patients receiving Electroconvulsive therapy in a Nigerian psychiatric hospital.
 Study Design: A retrospective study.
 Place and duration: The study was carried out at the Federal Neuropsychiatric Hospital Yaba, Lagos, Nigeria over a period of 3 months.
 Methodology: An extensive review of the hospital records of patients receiving the modified form of electroconvulsive therapy for the first time over a period of eight years was done. The demographic information, clinical diagnosis and indication for electroconvulsive therapy were retrieved and analysis was done using SPSS 19.
 Results: There were a total of 222 cases, ranging from 45 in 2000 to 21 in 2007. Mean age was 31.7 ± 9.65. Male: female ratio was 1:2. Almost 60% of them were single and unemployed. Clinical diagnosis using ICD 10 ranged from schizophrenia (44.8%), severe depression (27.8%), bipolar disorder (15.5%) to puerperal psychosis (8.2%). Indications for electroconvulsive therapy included psychosis (41.6%), severe depressive episode (25.8%), catatonia (23.7%) and manic episode (7.4%).
 Conclusion: This study has shown that the use of ECT has declined in the facility over the study periods. Also, females were twice as likely to receive electroconvulsive therapy compared to males and schizophrenia still remains the most common diagnosis among the patients.

UPDATE ON ELECTROCONVULSIVE THERAPY IN GERIATRIC DEPRESSION: Session 300

Dr. McCall will review the data on the improvement in quality of life after treatment with ECT supporting the relationship of ECT treatment with significant improvements in mental health of older adults with severe recurrent depression. Dr. Petrides will summarize the data from the CORE group which over several decades has provided a roadmap to increasing the efficacy of ECT while minimizing cognitive side effects and preventing relapse. Dr. Hermida will discuss the use of ultrabrief right unilateral ECT (UB RUL), a form of ECT that may be particularly beneficial in the elderly due to the decreased cognitive side effects. She will review a case study of 100 patients treated with UB RUL who were diagnosed with psychotic depression and catatonia. Dr. Kellner will conclude with a discussion of the use of ECT in the United States. He will review the status of the use (actually underuse) of ECT in the United States. Recent data on the number of procedures performed, demographics of ECT patients, health economic impact of ECT, and details of how ECT is administered (technique, setting, practitioner information) will be covered. Given the suicide epidemic and the increased prevalence of treatment resistant depression, ECT remains a vital treatment for severe mood and psychotic disorders. Newer data suggest increased use of ECT could lead to improved public health outcomes.

The use of electroconvulsive therapy in dementia with behavioral disturbances

As many as 50% of demented patients are agitated at some point during their illness and up to a third may became physically aggressive toward caregivers. First-line treatment approaches for behavioral disturbances in dementia are psychosocial and not pharmacological. Pharmacological interventions are second line, but the use of most medications is off label and complicated by potentially serious side effects. There is an absence of evidence-based data as to the use of ECT to treat refractory behavioral disturbances in dementia, although a large body of case reports and case series points to its possible safety and efficacy. In the absence of clear evidence for its efficacy and indications for use, we have developed a clinical guide to inform the use of ECT in this population.

Geographical access to electroconvulsive therapy services in Texas

AimsElectroconvulsive Therapy (ECT) is a well-established and effective treatment in mood disorders but the use of ECT in Texas is much lower than the general average among the United States. Our goal is to explore the geographical accessibility of Electroconvulsive Services in Texas. Methods22 ECT Centers in Texas listed in State's 2016 annual ECT report were enrolled and georeferenced. We used Esri's StreetMap Premium Network release 1 network dataset to generate 1-hour drive time service areas for these ECTs. We estimated populations within these service areas based on US Census Tract level population-weighted centroids; generated from the 2015, American Community Survey (ACS) estimates at the US Census Block Group level. ResultsAbout 75% (19,851,802 of 26,538,614) of Texas total population is within a 1-hour drive time to any ECT Services location. When focusing on population below the poverty level from 2015 Block Group level ACS data: 68% (3,046,141 of 4,472,451) are within a 1-hour drive time. ConclusionsECT services are geographically accessible in Texas. Other barriers may contribute to lower use of ECT.

ECT in schizophrenia: a review of the evidence.

Electroconvulsive therapy (ECT) was initially used for the treatment of schizophrenia, but over the years with the advent of antipsychotics, its use in schizophrenia has been limited. Treatment guidelines vary in their recommendations for the use of ECT in schizophrenia. The usual indications of its use among patients with schizophrenia include treatment resistance, to augment pharmacotherapy, to manage catatonia, suicidal behaviour, severe agitation and clozapine-resistant schizophrenia. Available literature, including meta-analysis and systematic reviews, suggest that ECT is a safe and effective treatment in patients with schizophrenia. However, despite the available evidence, it is highly underutilised and is often used as one of the last resort among patients with schizophrenia. This review focuses on the indications of use of ECT in schizophrenia, studies evaluating its effectiveness, efficacy in certain special situations like first episode schizophrenia, adolescents, catatonia etc., predictors of response to ECT in schizophrenia and influence of various ECT-related parameters on efficacy/effectiveness among patients with schizophrenia. From the review, it can be concluded that ECT is not only is beneficial as an augmenting strategy in treatment-resistant schizophrenia but also can be used effectively in patients with schizophrenia in various other situations.

Use of electroconvulsive therapy in adolescents with schizophrenia in China

BackgroundElectroconvulsive therapy (ECT) is an effective treatment for psychiatric disorders such as schizophrenia, major depression and bipolar disorder. However, few studies have addressed the use of ECT in adolescents with schizophrenia. The aims of our study were to investigate the frequency of ECT, and its relationship with clinical and demographic correlates among adolescents with schizophrenia in China.MethodsThe study was a retrospective study and conducted in the Child and Adolescent Psychiatry Department of Beijing Anding Hospital, and adolescents with schizophrenia over a period of 10 years (2007–2016) were enrolled. The demographic and clinical data were collected from the electronic chart management system.ResultsA total of 835 patients were included, 411/835 (49.2%) of the adolescent inpatients diagnosed with schizophrenia were in ECT group. There were significant differences in the sex, age, high risk for aggression and suicide, family history of psychiatric disorders and concomitant psychotropic medication (antidepressants and benzodiazepines) between the ECT and non-ECT groups. Multiple logistic regression analysis revealed that ECT use was independently and positively associated with sex, high risk for suicide.ConclusionsIn a major psychiatric center in China, the use of ECT was common, and reasons for the high use of ECT for adolescent patients in this hospital should warrant urgent investigations.

Cost-Effectiveness Analysis Builds Strong Case for Third-Line Use of ECT

Cost-Effectiveness Analysis Builds Strong Case for Third-Line Use of ECT

Correction to: Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol.

The name of Heather Burrell Ward was incorrectly captured.

Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group

IntroductionElectroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies. AimsThe primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period. Materials and methodsCases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale – Improvement scale (CGI-I) as responder (CGI-I score 1–2) or non-responder (CGI-I score 3–7). Results185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response. LimitationsThere was no control group without ECT treatment. ConclusionThe response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

Electroconvulsive therapy and age: Age-related clinical features and effectiveness in treatment resistant major depressive episode

ObjectiveThis study was aimed to compare clinical features, treatments outcomes and tolerability between young (18–45 years), middle age (46–64 years) and old (≥ 65 years) patients treated with bilateral ECT for treatment resistant major depressive episode. Method402 patients were evaluated 1 day prior to ECT and a week after the treatment termination using the Clinical Global Impression Scale (CGI), the Hamilton Rating Scale for Depression-17 items (HAM-D-17), the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS) and the Mini Mental State Examination (MMSE). Response was defined as a reduction of at least 50% from baseline on the HAM-D-17 score. Remission was defined as a score ≤ 7 on the HAM-D-17 at the final evaluation. ResultsRates of response were not statistically different in the three groups (69.6% in old versus 63.5% in young and 55.5% in middle age groups). No significant differences were also observed in the proportions of remitters between the age groups (31.4% in young group, 27.7% in middle age group and 29.3% in old group). One week after the end of the ECT course the middle and old age groups showed a statistically significant increase in the MMSE score compared to baseline. We did not find significant differences between the three age groups in rates of premature drops-out due to ECT-related side effects. ConclusionOur data support the use of ECT in elderly patients with treatment-resistant major depressive episode, with rates of response around 70% and effectiveness being independent from age. In the old age group the baseline cognitive impairment improved after ECT and no life-threatening adverse event was detected.