ECT-Related Anxiety: A Systematic Review.

BACKGROUND: A significant proportion of electroconvulsive therapy (ECT)-treated patients experience anxiety anticipating the treatment, often to such an extent that they refuse or discontinue a much-needed treatment. Despite its great impact on treatment adherence, anxiety in patients receiving ECT is underexposed in the scientific literature. OBJECTIVES: We aimed to review the prevalence and specific subjects of ECT-related anxiety and therapeutic interventions to reduce it. METHODS: We performed a computerized search (EMBASE, MEDLINE, and PsycINFO) for articles meeting the following inclusion criteria: (1) qualitative (interview) studies, quantitative (questionnaire) studies, or experimental (interventional) studies that (2) report on anxiety that is related to a planned, ongoing, or past ECT treatment. RESULTS: Of 1160 search results, 31 articles were included. Electroconvulsive therapy-related anxiety is estimated to be present in 14% to 75% of patients and is most often linked to worries about memory impairment or brain damage. Only a few interventions (chlorpromazine, meprobamate, propofol, a talking-through technique, an information leaflet, and animal-assisted therapy) have been proposed to reduce patients' ECT-related anxiety. CONCLUSIONS: Electroconvulsive therapy-related anxiety is a highly prevalent phenomenon, and the literature provides little guidance for its clinical management. Most studies are of a low methodological quality and suffer from significant limitations, thereby hampering generalized conclusions. Given the clinical importance of ECT-related anxiety, further study on its nature and evolution through the course of treatment and on anxiety-reducing interventions is warranted.

Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: a review.

Electroconvulsive therapy (ECT) and ablative neurosurgical procedures are established interventions for treatment-resistant depression (TRD), but their use may be limited in part by neuropsychological adverse effects. Additional neuromodulation strategies are being developed that aim to match or exceed the efficacy of ECT/ablative surgery with a better neurocognitive side effect profile. In this review, we briefly discuss the neurocognitive effects of ECT and ablative neurosurgical procedures, then synthesize the available neurocognitive information for emerging neuromodulation therapies, including repetitive transcranial magnetic stimulation, magnetic seizure therapy, transcranial direct current stimulation, vagus nerve stimulation, and deep brain stimulation. The available evidence suggests these procedures may be more cognitively benign relative to ECT or ablative neurosurgical procedures, though further research is clearly needed to fully evaluate the neurocognitive effects, both positive and negative, of these novel neuromodulation interventions.

Recognition memory in amnesia: effects of relaxing response criteria.

In two experiments, using the remember/know paradigm, we examined whether recognition memory in amnesic patients can be improved by instructing patients to relax their response criterion. Experiment 1 was modeled after a study by Dorfman, Kihlstrom, Cork, and Misiaszek (1995), in which direct instructions to respond more leniently led to an increase in recognition accuracy in patients with ECT-induced amnesia. We failed to extend this finding to patients with global amnesia, but the manipulation was unsuccessful in control subjects as well. In Experiment 2, response criterion was manipulated indirectly by providing information about the alleged base rate of study items on the recognition test. This manipulation led to a criterion shift in control subjects and enhanced discriminability in amnesic patients. Analysis of "remember" and "know" responses suggests that improved accuracy in amnesia was associated with enhanced familiarity-based recognition.