Electroconvulsive Therapy

The FDA Final Order on ECT Devices, Finally No abstract available

Painful Petechiae Emerging During Electroconvulsive Therapy No abstract available

Implementing Family-Centered Electroconvulsive Therapy Care No abstract available

Patient- and Family-Centered Electroconvulsive Therapy This article builds upon prior efforts to improve the quality of electroconvulsive therapy (ECT) practice and care by encouraging the participation of family members in the ECT process. This participation included the presence of a family member or significant other (SO) in the treatment room during the ECT procedure. Suggestions for limiting that presence to the induction process and for providing limited physical contact with the patient are proposed. The participation of the SO during the pretreatment assessment process is encouraged. Because of possible impairment of memory and judgment, accurate information about the patient's condition and intercurrent life events, as provided by the SO, is often crucial. Furthermore, the patient's report may be influenced by the common experience of fear of ECT. Under these circumstances, an alliance with the SO may at times be more crucial than the alliance with the patient. The importance of establishing a therapeutic alliance with both patient and SO is emphasized. An illustrative clinical vignette is provided.

Neuroimaging Biomarkers at Baseline Predict Electroconvulsive Therapy Overall Clinical Response in Depression: A Systematic Review Objective Major depressive disorder is a frequent and disabling disease and can be treated with antidepressant drugs. When faced with severe or resistant major depressive disorder, however, psychiatrists may resort to electroconvulsive therapy (ECT). Although very effective, the response falls short of 100%. A recent meta-analysis established clinical and biological predictive factors of the response to ECT. We decided to explore neuroimaging biomarkers that could be predictors of the ECT response. Methods We performed a systematic literature review up to January 1, 2018, using a Boolean combination of MeSH terms. We included 19 studies matching our inclusion criteria. Results Lower hippocampal, increased amygdala, and subgenual cingulate gyrus volumes were predictive for a better ECT response. Functional magnetic resonance imaging also found that the connectivity between the dorsolateral prefrontal cortex and posterior default-mode network is predictive of increased efficacy. Conversely, deep white matter hyperintensities in basal ganglia and Virchow-Robin spaces, medial temporal atrophy, ratio of left superior frontal to left rostral middle frontal cortical thickness, cingulate isthmus thickness asymmetry, and a wide range of gray and white matter anomalies were predictive for a poorer response. Conclusions Our review addresses the positive or negative predictive value of neuroimaging biomarkers for the ECT response, indispensable in a personalized medicine dynamic. These data could reduce the risk of nonresponders or resistance with earlier effective management. It might also help researchers elucidate the complex pathophysiology of depressive disorders and the functioning of ECT.

The Safety of Electroconvulsive Therapy in Patients With Implanted Deep Brain Stimulators: A Review of the Literature and Case Report Currently there is no consensus statement about the safety of electroconvulsive therapy in patients who have implanted electrodes for deep brain stimulation. We present a summary of the existing literature on this topic, consisting of 21 cases, and then report a case performed at the University of Maryland Medical Center. Notably, with appropriate safety precautions and careful patient selection, there were no adverse events reported in the literature that were related to the presence of the deep brain stimulation device in any of the cases. Based on our review of the literature and the case we present, we have found no evidence so far to indicate that electroconvulsive therapy in patients with an implanted deep brain stimulator is unsafe.

Family Presence During Electroconvulsive Therapy Background The practice of electroconvulsive therapy (ECT) is often hampered by stigma and myths prevailing among patients and families. Family attendance at ECT has not been systematically studied. Methods From January 2017 to May 2018, 69 consecutive patients were approached for family attendance at ECT. The inclusion criteria for entry to the ECT suite were consent from families and patients, age older than 18 years, and 1 family member at a time. After watching ECT, family members completed a multiple-choice questionnaire regarding their experience. Results Twenty-one family members watched ECT. A majority viewed the idea of attendance at ECT as reassuring, and a few indicated that it was anxiety provoking. Five participants (24%) felt distressed while watching the procedure, whereas 16 family members rated their experience as comfortable or rewarding (76%). In terms of the outcome, a clear majority have responded that watching the procedure alleviated their fears of ECT or provided transformative knowledge, whereas others felt no change in their attitude toward ECT (71% vs 29%). Most of the participants recommended watching ECT to other family members, whereas a minority was uncertain about their opinion (62% vs 38%). There were no adverse effects, premature exit from the ECT suite, interferences with treatment, or litigations. Conclusions A clear majority of families viewed their attendance at ECT as a beneficial experience. Family presence during ECT may have the potential to promulgate its practice by reducing stigma and misconceptions.

An Electrophysiological Biomarker That May Predict Treatment Response to ECT Objective Electroconvulsive therapy (ECT) is the most effective treatment for major depression but also carries risk of cognitive side effects. The ability to predict whether treatment will be effective before initiation of treatment could significantly improve quality of care, reduce suffering, and diminish costs. We sought to carry out a comprehensive and definitive study of the relationship between the background electroencephalography (EEG) and therapeutic response to ECT. Methods Twenty-one channel resting EEG was collected pre-ECT and 2 to 3 days after ECT course from 2 separate data sets, one to develop an EEG model of therapeutic response (n = 30) and a second to test this model (n = 40). A 3-way principal components analysis was applied and coherence and spectral amplitude across 6 frequency bands were examined. The primary outcome measure was the Montgomery-Asberg Rating Scale (MADRS). Results Four patterns of amplitude and coherence along with baseline MADRS score accounted for 85% of the variance in posttreatment course MADRS score in study 1 (R2 = 0.85, F = 11.7, P < 0.0002) and 53% of the variance in MADRS score in study 2 (R2 = 0.53, F = 5.5, P < 0.003). Greater pre-ECT course anterior delta coherence accounted for the majority of variance in therapeutic response (study 1: R2 = 0.44, P = 0.01; study 2: R2 = 0.16, P = 0.008). Conclusions These results suggest a putative electrophysiological biomarker that can predict therapeutic response before a course of ECT. Greater baseline anterior delta coherence is significantly associated with a better subsequent therapeutic response and could be indicative of intact circuitry allowing for improved seizure propagation.

Racial Disparities in the Administration of ECT in Texas, 1998–2013 Objective Electroconvulsive therapy (ECT) is a treatment of choice for severe depression but has been underutilized among black patients. This study investigates racial disparities in the administration of ECT in the state of Texas between 1998 and 2013 using population data. Design Data from the Texas Department of State Health Services were obtained corresponding to the use for all ECT conducted in nonfederal settings during the period from January 2, 1998, to August 30, 2013. The data set comprised quarterly reports generated for each patient, totaling 27,931 patient quarters. Using year-by-year intercensal population estimates for the state of Texas, ECT treatments per capita were compared among black, white, Latina/Latino, and other individuals during this time period. Results Significantly more white patients were treated each quarter than minority patients (P < 0.001), with Latina/Latino patients recording fewer treatment quarters than any other racial group (P < 0.005). Large discrepancies in diagnosis by race were observed. Black patients were less likely than white and Latina/Latino patients to be diagnosed with depression and 4 times as likely as white patients to carry a diagnosis of schizophrenia. Conclusions Concordant with previous data, large racial disparities in the administration of ECT were found in this Texas data set. Despite the limited nature of this data set, these results suggest that continued investigation is required to determine factors responsible for these disparities.

Factors Influencing Staff’s Attitude Toward Electroconvulsive Therapy: A Comparison of New Versus Experienced Electroconvulsive Therapy Clinics Objectives Despite being a highly effective treatment, electroconvulsive therapy (ECT) is still stigmatized even among professionals. The aim of this study was to identify factors associated with a positive attitude toward ECT among health care workers. Methods We investigated staff's attitude and their self-assessment of knowledge while introducing ECT in 3 German psychiatric clinics. Furthermore, we compared this data to that of a clinic where ECT has been applied with a long tradition. An anonymous questionnaire was answered by n = 182 employees in the ECT-introducing clinics (novices) and n = 68 employees in the clinic with a long history of ECT (experts). Results Irrespective of the clinical history, the majority of participants approved the application of ECT in their clinic. Factors associated with a positive attitude were (a) profession (physicians presented a more positive mindset about ECT than nursing staff), (b) subjective feeling of being adequately informed, and (c) having had contact to patients undergoing ECT. Interestingly, the general attitude toward ECT did not differ between subjects who reported to have seen an ECT and those who had not. Conclusions When introducing ECT as a new treatment into a clinic, formal information should be adapted to the needs of each profession with a special emphasis on nurses. To further increase acceptance, contact to ECT-experienced patients (professionals taught by patients) might result in a more positive attitude toward ECT than participation in an ECT treatment itself.