Use Of Electroconvulsive Therapy Research Articles

Uses of Electroconvulsive Therapy in Conditions Other than Major Depressive Episode

The effectiveness of electroconvulsive therapy (ECT) in the treatment of unipolar and bipolar major depressive episodes (MDE) is well known, and the US Food and Drug Administration has recently reclassified ECT devices to a less restrictive category for treatment of MDE and catatonia. In this review, we look at the existing evidence supporting the use of ECT in conditions other than MDE, such as bipolar mania and mixed states, schizophrenia, catatonia, Parkinson's disease, agitation in dementia, and status epilepticus. [ Psychiatr Ann . 2019;49(4):157–163.]

Caregivers' Attitude and Perspective on Coercion and Restraint Practices on Psychiatric Inpatients from South India.

Background:Coercion and restraint practices in psychiatric care are common phenomena and often controversial and debatable ethical issue. Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients have received relatively less research attention till date.Aims:Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients.Methodology:This is a hospital-based, a descriptive, cross-sectional study. A total of 200 (n = 200) consecutive patient and their caregivers were chosen between June 2013 and September 2014 through computer-generated random numbers sampling technique. We used a semi-structured interview questionnaire to capture caregivers’ attitude and perspective on coercion and restraint practices. Sociodemographic and coercion variable were analyzed using descriptive statistics. McNemar test was used to assess discrete variables.Results:The mean age was 43.8 (±14.9) years. About 67.5% of the caregivers were family members, 60.5% of them were male and 69.5% were from low-socioeconomic status. Caregivers used multiple methods were used to bring patients into the hospital. Threat (52.5%) was the most common method of coercion followed by persuasion (48.5%). Caregivers felt necessary and acceptable to use chemical restraint (82.5%), followed by physical restraint (71%) and electroconvulsive therapy (ECT) (56.5%) during acute and emergency psychiatric care to control imminent risk behavior of patients.Conclusion:Threat, persuasion and physical restraint were the common methods to bring patients to bring acutely disturbed patients to mental health care. Most patients caregivers felt the use of chemical restraint, physical restraint and ECT as necessary for acute and emergency care in patients with mental illness.

Electroconvulsive therapy for treatment-resistant schizophrenia.

This is the protocol for a review and there is no abstract. The objectives are as follows: Our primary objective is to assess the effects (benefits and harms) of ECT for people with treatment-resistant schizophrenia. Our secondary objectives are to determine whether ECT produces a differential response in people: who are treated with unilateral compared to bilateral ECT; who have had a long course of ECT (more than 12 sessions) or short course of ECT; who are given continuation or maintenance ECT; who are diagnosed with well defined treatment resistant schizophrenia as opposed to less rigorously defined treatment-resistant schizophrenia (who would be expected to have a greater affective component to their illness).

Is There a Change in Electroconvulsive Therapy Practice Following the New Mental Health Act 2014 in Victoria?: A Study at a Metropolitan Mental Health Service.

The main objective of our study was to examine whether there has been any change to electroconvulsive therapy (ECT) practice since the new Mental Health Act 2014 (MHA) in a public metropolitan mental health service in Victoria. This retrospective study examined any change in ECT rate following the new MHA. We compared sociodemographic, clinical, and ECT-related variables for patients treated before (July 1, 2013, and June 30, 2014) and after (1st July 2014 and the 30th June 2015) the new MHA. A reduction of 11.15% in ECT use per 1000 admissions and 16.4% in ECT use per 100,000 persons was observed subsequent to the new MHA. Hospital legal status at admission positively predicted the chance of starting ECT treatment under involuntary consent. Hospital legal status at admission and discharge, history of involuntary ECT, and final Clinical Global Impression-Severity scores positively predicted, but the year of treatment negatively predicted the chance of completing ECT treatment under involuntary consent. The new MHA appeared to have been associated with reduced ECT use and lower rate of completing ECT under involuntary consent.

SUCCESSFUL USE OF ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF NEUROPSYCHIATRIC MANIFESTATIONS OF DEMENTIA WITH LEWY BODIES

Introduction Dementia with Lewy bodies (DLB) is one of the most common neurodegenerative disorders. DLB is characterized by progressive cognitive decline, executive dysfunction, visual hallucinations, fluctuating cognition, and Parkinsonism. Up to 65% of patients with Lewy Body Dementia have depression. Psychiatrists frequently treat individuals with DLB given prominent neuropsychiatric manifestations, including depression, hallucinations, delusions, agitation, and fluctuating cognition. Individuals with DLB require a comprehensive but specific treatment approach given sensitivity to both antipsychotic medications and anticholinergic side effects of other medications. Electroconvulsive therapy (ECT) is often omitted from the treatment model for DLB because of limited evidence. We highlight the use of electroconvulsive therapy (ECT) in a case of DLB. Methods We provide a case report and literature review on the use of ECT for the treatment of DLB. A 67-year-old male veteran with depression, 10-year history of REM sleep behavior disorder, bradykinesia, three-year history of cognitive impairment, and visual hallucinations was admitted for depressed mood and disturbing visual hallucinations featuring a saw blade swinging around his head and somatic delusion of a water hose traversing his body. At night he moved to avoid being hit by the blade. His wife reported word-finding difficulty, memory problems, and having to manage their finances. Four years prior to presentation, he stopped working as a pastor due to inability to write sermons. On admission, his MOCA was 19/30 and QIDS was 22. Medication trials including paroxetine, sertraline, escitalopram, vilazodone, bupropion, mirtazapine, venlafaxine, quetiapine, aripiprazole, alprazolam, buspirone, and lorazepam failed to address his depression and hallucinations. Results Brain MRI was unremarkable, with mild microvascular ischemic changes in periventricular white matter. Iodine-123 dopamine transporter SPECT (DAT-scan) imaging showed abnormal uptake consistent with a Parkinsonian syndrome (supporting the diagnosis of DLB). Considering past medication failures, patient consented for an acute course of ECT. He received eight right unilateral (RUL) ultra-brief pulse treatments utilizing Mecta Spectrum over the course of three weeks without any major side effects. For muscle relaxation he received succinylcholine; methohexital and remifentanil were given for anesthesia. Over his acute course of treatment, charge was progressively increased from six, to eight, to ten times the seizure threshold. At the end of his acute course of eight ECT treatments, his MOCA improved from 19/30 to 23/30 and QIDS improved from 22 to 12. Following the course of ECT, his visual hallucinations disappeared, and he was more interactive, engaged, and less depressed. The patient's improvement is congruent with other case reports in the literature showing clinical improvement following ECT for symptoms related to DLB. A table with a literature review describing the use of ECT for DLB will be presented. Conclusions DLB presents frequently to psychiatrists secondary to prominent psychiatric manifestations of the illness such as mood and behavioral disturbances. The treatment of psychiatric symptoms in DLB is often challenging due to the sensitivity of antidopaminergic medications on motor symptoms. ECT is a feasible alternative to treat neuropsychiatric manifestations of DLB; however, infrequently considered due to fear of complications and stigma. Modifications to the treatment such us holding dopamine agonists the morning of ECT to avoid delirium, decreasing the frequency of ECT to twice per week to minimize cognitive effects, and close monitoring of the patient's cognitive function are measures that can be implemented to optimize ECT in this population. No double-blinded randomized control trials exist in this area; comparing standard treatment to ECT would help further delineate the role of ECT in treating patients with DLB. 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

POST HOC ANALYSES OF ESKETAMINE NASAL SPRAY PLUS AN ORAL ANTIDEPRESSANT IN ELDERLY PATIENTS WITH TREATMENT-RESISTANT DEPRESSION

Introduction Major depressive disorder in the elderly is correlated with lower response and remission rates, greater disability, decreased quality of life, and greater mortality from suicide; approximately 18-40% develop treatment-resistant depression (TRD). Moreover, the elderly respond less well to currently available treatments and may be more vulnerable to their adverse effects. The severity of TRD in the elderly is exemplified by a 5-fold increased use of electroconvulsive therapy, highlighting a critical need for alternative safe and effective treatments. A companion abstract discusses results from the first large phase 3 study of esketamine nasal spray in elderly patients with TRD. Post hoc analyses presented here explored factors that may have contributed to the lack of statistical significance observed in the study, despite a numerical advantage on the primary endpoint–Montgomery Asberg Depression Rating scale (MADRS) LS mean scores–in the esketamine arm vs the control arm of the trial. Methods The primary phase 3, double-blind, multicenter, active controlled study (NCT02422186), included adults ≥65 years of age (N=138) with TRD. Patients were randomized (1:1) to flexibly-dosed esketamine nasal spray (28, 56 or 84 mg twice weekly) and a new oral antidepressant (esketamine/antidepressant), or a new oral antidepressant and placebo nasal spray (antidepressant/placebo). Change from baseline was analyzed using mixed-effects model for repeated measures (MMRM). Analyses were conducted at a 2-sided significance level of 0.05. Findings from the primary analysis are described in the companion abstract. Post hoc analyses explored factors that may have affected the study outcome including (1) impact of study stage, i.e. pre interim analysis (IA) (stage 1) or post IA (stage 2): modifications were made early in the study including training of remote MADRS raters to work with elderly and site discussions related to dose that, because of timing for implementation of the changes, had the greatest impact on stage 2; (2) impact of dose assessed by stage of the IA; (3) age subgroups (65-74 and ≥75 years); (4) age of onset of depression ( Results For reference, the primary efficacy endpoint, the LS mean (95% CI) difference for change in MADRS total scores from baseline to day 28 between the esketamine/antidepressant group and the antidepressant/placebo group using MMRM was -3.6 (−7.20, 0.07; p=0.059). Post hoc analyses included (1) a marked difference in efficacy between stages of the IA: LS mean (95% CI) difference was -1.6 (-6.85, 3.70) in stage 1 vs -5.6 (-10.78, -0.32) in stage 2. The primary analysis applied equal weight to stage 1 (51 patients) and stage 2 (87 patients) effectively down-weighting the results of stage 2. Overall analysis, without adjusting for the IA, showed LS mean (95% CI) change of -4.0 (-7.71, -0.25); (2) use of maximum dose of 84mg: 52.5% at day 25 of stage 1 vs 71.8% at day 25 of stage 2; (3) age: 65-74 years LS mean (95% CI) change of -4.9 (-8.96, -0.89) vs ≥75 years -0.4 (-10.38, 9.50); (4) age at onset of depression Conclusions While MADRS improvement with esketamine/antidepressant vs treatment with antidepressant/placebo was not statistically significant in the primary analysis, a nonsignificant favourable trend was found, with a treatment effect size similar to that seen in younger adult esketamine studies. Post hoc analyses assessed factors potentially affecting the primary outcome. In the short-term study, use of lower doses earlier in the study may have decreased efficacy. In the post hoc analysis, a 95% CI of difference that did not include 0 indicated that esketamine/antidepressant was favoured over antidepressant/placebo without the corrective weighting for the IA, as well as for patients 65-74 years of age, and for those with the onset of depression at age This research was funded by This study was funded by Janssen Research & Development, LLC.

Early use of electroconvulsive therapy in individuals with first episode psychosis: A case series

The use of electroconvulsive therapy (ECT) in various neuropsychiatric disorders has been well accepted. ECT has been proven to be safe and effective in adolescents and in old age. However, only a handful of literature is available on its effectiveness in first episode psychosis (FEP). In this case series, individuals with FEP who received ECT in their 1st month of treatment for various indications were described. During follow-up, subjects showed considerable improvement in their psychopathology and functional outcomes. None of them had any adverse events during or after ECT sessions. Thus, the present case series highlights the usefulness and safety of early use of ECT in individuals with first episode psychosis and its effectiveness in reducing the acute symptoms leading to remission and better outcomes.

Electroconvulsive Therapy in Incapable Patients Refusing Treatment: Prevalence, Effectiveness, and Associated Factors.

Severe psychiatric disorders may be accompanied by life-threatening conditions, lack of insight, and treatment refusal. Involuntary treatment may be indicated in patients who lack capacity to consent and refuse treatment. In this context, there is a lack of systematic data regarding the use of electroconvulsive therapy (ECT) in Germany. A questionnaire with 25 items comprising quantitative and qualitative data was sent to all psychiatric hospitals in Germany that perform ECT. Cases of ECT treatment in incapable patients refusing therapy were identified retrospectively in a 12-month period. Fifty-three hospitals completed the questionnaire, and 15 cases of ECT in incapable and refusing patients were reported. A marked clinical response was observed in 14 patients. Capacity to consent was restored in 11 patients. In contrast to this particularly good effectiveness, psychiatrists' attitudes revealed a widespread lack of experience as well as reservations and uncertainties regarding the use of ECT against the patient's wishes. In line with other recent publications, our data suggest a very good benefit-to-risk ratio for ECT in incapable patients refusing the treatment, while at the same time the provision of ECT in such patients is rare in Germany. In light of the scarcity of treatment alternatives and the possible consequences of a refusal to perform ECT in life-threatening conditions, a general rejection of involuntary ECT does not seem ethically appropriate.

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.

Electroconvulsive therapy (ECT) for severe mental illness (SMI) during perinatal period: The role of bifrontal (BF) ECT

Aim & Background: ECT's play an important role in the management of severe mental illness especially in antepartum and postpartum population.Hence the patterns of ECT use and efficacy of BF against BT in antepartum (AP) and postpartum (PP) women with severe mental illness who were admitted in Mother and Baby unit (MBU) were assessed.

Therapy-oriented induction of seizures

In any given year, 2.5 percent of the population experiences treatment resistant depression (TRD). TRD is estimated to cost 60-100 billion per year to treat in the US. Electroconvulsive therapy (ECT) is effective for TRD with remission rates ranging from 50 to 75 percent. However, ECT use in TRD is limited to fewer than 1 percent of patients due to fear, stigma and memory side effects. Repetitive transcranial magnetic stimulation (rTMS) and magnetic seizure therapy (MST) offer a viable alternative to ECT with treatment results suggesting significant mood improvement in TRD. These treatments are also associated with significant rates of remission of suicidal ideation (SI). In this presentation, rTMS and MST will be discussed in detail. Novel rTMS and MST treatment approaches will also be discussed

Therapeutic Uses of Seizures in Neuropsychiatry.

Although seizures typically indicate a state of brain dysfunction, there are circumstances in which the biological effects of a seizure may exert therapeutic benefits. The standard technique for inducing controlled therapeutic seizures in humans is electroconvulsive therapy (ECT), a treatment that involves the application of an electrical stimulus to the scalp of a patient under general anesthesia and muscle relaxation. This review discusses the contemporary use of ECT for treating certain mental and neurologic disorders and previews two experimental forms of seizure therapy that are related to ECT and may hold promise for the future: focal electrically administered seizure therapy and magnetic seizure therapy.

Inpatient care and use of Electroconvulsive Therapy in children and adolescents: Aligning with Mental Health Care Act, 2017.

Inpatient care and use of Electroconvulsive Therapy in children and adolescents: Aligning with Mental Health Care Act, 2017.

Maintenance Electroconvulsive Therapy for Agitation and Self Injurious Behaviors in Autism Spectrum Disorder

Self-injurious behaviors (SIBs) in autism spectrum disorder (ASD) are destructive symptoms that can lead to dangerous injuries and life-threatening risks. Agitation and SIBs may not respond to psychopharmacological and behavioral interventions. There are reports in the literature on improvement after electroconvulsive therapy (ECT) in cases not responding pharmacotherapy. However, data on the efficacy of the therapy on the benefiting patients, the course of the treatment and on the use of maintenance ECT (m-ECT) are very limited. This report presents the clinical features and the course of m-ECT on two cases under follow up for pharmacotherapy resistant ASD with significant agitation, mood disorder and SIBs that could cause severe head traumas. The initial stage of therapy consisted of 7 sessions of ECT patients showed improvement after the 5th session. m-ECT were started since the agitation repeated one week after discharge despite ongoing pharmacotherapy. In the first case, m-ECT was continued once every two weeks for a total of 46 sessions; and in the second case a total of 18 weekly sessions were conducted. No significant side effects or complications were observed and the general state of well-being was preserved. Our paper is among the few that reported succesful treatment of agitation with m-ECT. m-ECT should be considered in treatment resistant cases.

Terapija peripartalnih psihičkih poremećaja

During the peripartum period, women are at a greater risk of developing a mental disorder or experiencing an exacerbation of the pre-existing mental disorders. Therapeutic interventions are based primarily on psychotherapy, but if the symptoms are severe and pose a risk to the mother and the child, then the use of drugs, hospitalization or electroconvulsive therapy is considered. Cognitive-behavioral psychotherapy is the first line of treatment in postpartum blues and postpartum depression, panic disorder, generalized anxiety disorder, and mild to moderate obsessive-compulsive disorder. More recent conceptions regarding the use of drugs during the postpartum period indicate that medications should be prescribed if the risk of using them is lower than the risk of complications caused by the symptoms of mental disorders. Nortriptyline or desipramine are recommended from the group of tricyclic antidepressants, but newer generation antidepressants are shown to be safer during pregnancy. Fluvoxamine, paroxetine and sertraline can be used in postpartum period during breastfeeding, while fluoxetine and citalopram should be avoided. The use of first-generation antipsychotics haloperidol and trifluoperazine is recommended in the antepartum period, during which some of second-generation antipsychotics such as quetiapine, olanzapine, risperidone and aripiprazole can also be used. Clozapine should be avoided during breast-feeding. The use of mood stabilizers during pregnancy requires a thorough knowledge of the recommendations, and it is not advised to use them during the postpartum if the patient is breastfeeding. From the group of benzodiazepines, it is recommended to uselorazepam. Every form of therapeutic approach has proven to be more effective in the presence of emotional support from partners and other family members.

Experience, Knowledge, and Attitudes of Child and Adolescent Psychiatrists in Belgium Toward Pediatric Electroconvulsive Therapy.

The purpose of the present study was to ascertain the experience, knowledge, and attitudes of child and adolescent psychiatrists toward the use of ECT (electroconvulsive therapy) in children and adolescents in Belgium. A questionnaire was mailed to all the members of the Flemish and Walloon Association of Child and Adolescent Psychiatrists. Thirty-five percent (n = 151) of the psychiatrists responded to the questionnaire. Sixty-seven percent (n = 101) rated their knowledge about ECT in children and adolescents as nil or negligible. Only one percent (n = 2) estimated their knowledge to be advanced. Fifteen percent (n = 22) were aware of a minor treated with ECT. Ten (n = 16) and thirty-one percent (n = 47) believed that ECT is a safe treatment for children and adolescents, respectively. Only six percent (n = 10) would recommend ECT for a major psychiatric disorder in a child, whereas thirty-eight percent (n = 58) for an adolescent. Fifty-three percent (n = 71) regarded ECT as a treatment of last resort. A significant correlation was identified between knowledge and attitudes toward the use of ECT in minors. Respondents with some or advanced knowledge perceived ECT as a safer and a more effective treatment option than those with negligible knowledge. Most (91%, n = 138) of the child and adolescent psychiatrists are enthusiastic to learn more about the use of ECT in minors. Flemish and Walloon child and adolescents psychiatrists have very little experience with using ECT in minors. They self-estimated their knowledge as negligible but are keen to learn more about this treatment option. The lack of knowledge likely explains the rare use of ECT in Belgium for children and adolescents with serious psychiatric disorders.

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.

Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review

Takotsubo cardiomyopathy (TC) is a rare complication of electroconvulsive therapy (ECT), an effective and safe treatment for severe cases of depression and psychosis. There are reports on 16 patients who developed TC after ECT, and these were predominantly female patients treated with antidepressants for depressive disorder. We describe a case of a 40-year-old male patient, with a history of schizophrenia and heavy caffeine and nicotine use, treated for acute psychotic episode with haloperidol and clozapine. Propranolol was administered because of clozapine-induced tachycardia. After 8 weeks without therapeutic response, the patient was referred for standard ECT procedure, which included premedication and bifrontotemporal stimulation. Two hours later, the patient experienced gastric pain and had increased troponin and natriuretic peptide levels and ST-elevation. After inotrope and anticoagulant treatment and replacement of antipsychotics, the patient remained stable. Contrary to common opinion, previous adrenergic blockade in this patient did not prevent TC occurrence. TC pathophysiology remains unclear although it has been related to the burst of norepinephrine neurons. Psychosis has also been associated with catecholamine dysfunction, and excessive psychological stress with long-term norepinephrine dysfunction. Animal models have shown that ECT, clozapine, and nicotine and caffeine use could considerably increase catecholamine levels. Clinical understanding of rare cardiac ECT complications could improve early recognition of patients at risk for TC and ensure safe ECT protocols.

Determinants of relapse after electroconvulsive therapy in depressed patients

Maintaining remission after successful acute treatment remains a challenge in the use of electroconvulsive therapy (ECT). For this purpose, the concept of gradually tapered continuation ECT (C-ECT) has been increasingly propagated. The present study is aimed at identifying factors that contribute to relapse after ECT in depressed patients. After successful acute treatment of a depressive episode with ECT, all patients were offered a fixed schedule of C-ECT. The number of C-ECT sessions varied in this naturalistic setting depending on compliance. All patients with follow-up data of at least 6 months were included (n = 82). Survival analyses with time to relapse as dependent variable were used to estimate the risk of relapse. 34.1 % of the patients relapsed within 6 months. Factors associated with a decreased relapse rate were: 1. C-ECT treatment, especially within the first three month; 2. higher mean charge during I-ECT; 3. switch from unilateral to bilateral electrode placement during I-ECT, and 4. male sex. However, the sensitivity analyses suggest that the influence of sex on relapse was limited to the first three months of the continuation phase. As expected, C-ECT reduced relapse rates, especially when performed early after I-ECT. Besides, increased charge and a change of electrode placement from unilateral to bilateral during the index series were associated with a lower risk of relapse. Compared to men, there was a higher rate of relapse in women.