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1.
Psychiatr Genet ; 34(2): 54-60, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38441120

RESUMO

OBJECTIVE: The molecular mechanism of electroconvulsive therapy (ECT) for schizophrenia remains unclear. The aim of this study was to uncover the underlying biological mechanisms of ECT in the treatment of schizophrenia using a transcriptional dataset. METHODS: The peripheral blood mRNA sequencing data of eight patients (before and after ECT) and eight healthy controls were analyzed by integrated co-expression network analysis and the differentially expressed genes were analyzed by cluster analysis. Gene set overlap analysis was performed using the hypergeometric distribution of phypfunction in R. Associations of these gene sets with psychiatric disorders were explored. Tissue-specific enrichment analysis, gene ontology enrichment analysis, and protein-protein interaction enrichment analysis were used for gene set organization localization and pathway analysis. RESULTS: We found the genes of the green-yellow module were significantly associated with the effect of ECT treatment and the common gene variants of schizophrenia ( P  = 0.0061; family-wise error correction). The genes of the green-yellow module are mainly enriched in brain tissue and mainly involved in the pathways of neurotrophin, mitogen-activated protein kinase and long-term potentiation. CONCLUSION: Genes associated with the efficacy of ECT were predominantly enriched in neurotrophin, mitogen-activated protein kinase and long-term potentiation signaling pathways.


Assuntos
Eletroconvulsoterapia , Esquizofrenia , Humanos , Esquizofrenia/genética , Esquizofrenia/terapia , RNA-Seq , Fatores de Crescimento Neural , Biologia Computacional , Proteínas Quinases Ativadas por Mitógeno
2.
Dtsch Arztebl Int ; 121(4): 137, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38518298
4.
BMJ Case Rep ; 17(2)2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38307623

RESUMO

SummaryThe common features of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis are neuropsychiatric symptoms that are often challenging, treatment refractory and take years to recover. Electroconvulsive therapy (ECT) is effective in treating these symptoms in the acute phase, including catatonia and psychiatric issues.We describe the case of a man in his 30s with anti-NMDA receptor encephalitis characterised by neuropsychiatric features and treatment-refractory impulsivity, who was successfully treated with ECT. This case suggests that ECT use for behavioural symptoms can be associated with a significant response and may contribute to faster recovery from the disease.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Catatonia , Eletroconvulsoterapia , Masculino , Humanos , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Catatonia/complicações
5.
J ECT ; 40(1): 47-50, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38411578

RESUMO

INTRODUCTION: Seizure quality is considered to be associated with treatment outcomes of electroconvulsive therapy (ECT). A wide range of treatment parameters and patient characteristics are known to influence seizure quality. However, conflicting results exist for the role of serum electrolyte levels and seizure quality. METHODS: We retrospectively analyzed a total of 454 patients and a total of 2119 individual acute ECT sessions irrespective of diagnosis where a clinical evaluation of serum levels of sodium, potassium, and calcium took place routinely up to 2 days before the ECT session. To assess the impact of serum electrolyte levels on seizure quality parameters, we used mixed-effects linear regression analysis with Bonferroni correction for multiple testing. RESULTS: Serum sodium, potassium, and calcium levels were not associated with seizure quality markers after correcting the significance level for multiple testing. Younger age was consistently associated with higher postictal suppression, interhemispheric coherence, midictal amplitude, and peak heart rate. Lower dose was consistently associated with longer electroencephalogram and motor seizure duration. CONCLUSIONS: Our results suggest that there is no clinically relevant effect of serum electrolyte levels on seizure quality, at least within clinically commonly observed ranges of serum electrolyte concentrations.


Assuntos
Eletroconvulsoterapia , Humanos , Cálcio , Estudos Retrospectivos , Potássio , Convulsões , Sódio , Eletrólitos
9.
J ECT ; 40(1): 41-46, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38411577

RESUMO

OBJECTIVES: The aim of this study was to evaluate whether high-definition transcranial direct current stimulation (HDtDCS) priming improves the efficacy of intermittent theta burst stimulation (iTBS) in improving TRD. METHODOLOGY: A prospective hospital-based, randomized control study where the participants were divided into active or sham HDtDCS-primed iTBS stimulation groups for a total of 10 sessions and were assessed on clinical parameters at baseline, end of week 1, and end of week 2 was done. Primary outcome of the study was the difference in Hamilton Depression Rating Scale (HDRS) scores over 2 weeks of HDtDCS-primed iTBS. RESULT: A significant effect of time was seen over HDRS scores in both active and sham groups with a large effect size. Significant effect of time was also found over the Clinical Global Impressions-Severity Scale scores of patients with a large effect size. The difference in the improvement in depressive severity as measured using HDRS and Clinical Global Impressions-Severity Scale scores between active and sham groups was also found to be significant with large effect sizes. CONCLUSION: High-definition tDCS-primed iTBS is superior to normal iTBS in patients with depression who have failed a trial of 2 antidepressants, whereas both mechanisms are of benefit to the patients.


Assuntos
Eletroconvulsoterapia , Estimulação Transcraniana por Corrente Contínua , Humanos , Depressão/terapia , Estudos Prospectivos , Estimulação Magnética Transcraniana
11.
Psychiatry Res Neuroimaging ; 339: 111788, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38335560

RESUMO

OBJECTIVE: Our objective is to innovatively integrate both linear and nonlinear characteristics of brain signals in Electroconvulsive Therapy (ECT) research, with the goal of uncovering deeper insights into the pathogenesis of Major Depressive Disorder (MDD) and identifying novel targets for other physical intervention therapies. METHODS: We measured brain entropy (BEN) in 42 MDD patients and 42 matched healthy controls (HC) using rs-fMRI data. Brain regions that differed significantly in patients with MDD before and after ECT were extracted. Then, we use these brain regions as seed points to investigate the differences in whole-brain resting-state functional connectivity (RSFC) patterns before and after ECT. RESULTS: Compared to HCs, patients had higher BEN levels in the right precuneus (PCUN.R) and right angular gyrus (ANG.R). After ECT, patients had lower BEN levels in the PCUN.R and ANG.R. Compared with before ECT, patients showed significantly increased RSFC after ECT between the PCUN.R and right middle temporal gyrus and ANG.R. Significantly increased RSFC was observed between the ANG.R and right middle frontal gyrus and right supramarginal gyrus after ECT. CONCLUSION: Combining the linear and nonlinear characteristics of brain signals can effectively explore the pathogenesis of depression and provide new targets for ECT.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Humanos , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/terapia , Depressão , Entropia , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem
12.
Asian J Psychiatr ; 93: 103938, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38335891

RESUMO

The manuscript calls for establishing a standard for electroconvulsive devices by manufacturers for better regulation in India. This is most relevant in the context of two recent developments, (a) Notification of medical devices rules, 2017 with classification of ECT as Class C and (b) Recent change in classification of ECT devices by US-FDA in 2018. The establishment of standards would help in upregulating the standard of ECT devices as well as ECT practices.


Assuntos
Eletroconvulsoterapia , Estados Unidos , Humanos , United States Food and Drug Administration , Índia
13.
Eur Psychiatry ; 67(1): e16, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38351599

RESUMO

BACKGROUND: Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT. METHODS: We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha-delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration. RESULTS: In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored. CONCLUSIONS: We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures.


Assuntos
Eletroconvulsoterapia , Humanos , Convulsões/terapia , Fatores de Tempo , Eletroencefalografia
14.
BMC Psychiatry ; 24(1): 139, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38373994

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered one of the minor complications. Several cases of patients developing Takotsubo cardiomyopathy during a course of ECT have been reported, but none have died. We present a case of post-ECT Takotsubo cardiomyopathy that became fatal. CASE PRESENTATION: We experienced a case of a 67-year-old woman who had delusions and catatonic symptoms due to schizophrenia but was resistant to several medications. Her symptoms improved by conducting ECT, but she had difficulty maintaining her improvement, which caused her to receive multiple courses of ECT. 3 weeks after her 6th course of ECT, the patient was diagnosed with Takotsubo cardiomyopathy and had a fatal outcome. CONCLUSION: Our patient had numerous cases of aspiration pneumonia and malnutrition before ECT was performed, which might have made this case fatal. In conclusion, appropriate supplementation of nutrition and reduction of physical stressors are important to avoid death from Takotsubo cardiomyopathy caused by ECT. Prescribing clozapine was a solution in the present case, but there are some difficulties, such as the restriction against prescribing this drug in Japan.


Assuntos
Catatonia , Eletroconvulsoterapia , Esquizofrenia , Cardiomiopatia de Takotsubo , Humanos , Feminino , Idoso , Eletroconvulsoterapia/efeitos adversos , Esquizofrenia/complicações , Esquizofrenia/terapia , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/terapia , Catatonia/complicações , Japão , Resultado do Tratamento
15.
BMC Psychiatry ; 24(1): 130, 2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-38365634

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is a highly effective treatment for depressive disorder. However, the use of ECT is limited by its cognitive side effects (CSEs), and no specific intervention has been developed to address this problem. As transcranial direct current stimulation (tDCS) is a safe and useful tool for improving cognitive function, the main objective of this study was to explore the ability to use tDCS after ECT to ameliorate the cognitive side effects. METHODS: 60 eligible participants will be recruited within two days after completing ECT course and randomly assigned to receive either active or sham stimulation in a blinded, parallel-design trial and continue their usual pharmacotherapy. The tDCS protocol consists of 30-min sessions at 2 mA, 5 times per week for 2 consecutive weeks, applied through 15-cm2 electrodes. An anode will be placed over the left dorsolateral prefrontal cortex (DLPFC), and a cathode will be placed over the right supraorbital cortex. Cognitive function and depressive symptoms will be assessed before the first stimulation (T0), after the final stimulation (T1), 2 weeks after the final stimulation (T2), and 4 weeks after the final stimulation (T3) using the Cambridge Neuropsychological Test Automated Battery (CANTAB). DISCUSSION: We describe a novel clinical trial to explore whether the administration of tDCS after completing ECT course can accelerates recovery from the CSEs. We hypothesized that the active group would recover faster from the CSEs and be superior to the sham group. If our hypothesis is supported, the use of tDCS could benefit eligible patients who are reluctant to receive ECT and reduce the risk of self-inflicted or suicide due to delays in treatment. TRIAL REGISTRATION DETAILS: The trial protocol is registered with https://www.chictr.org.cn/ under protocol registration number ChiCTR2300071147 (date of registration: 05.06.2023). Recruitment will start in November 2023.


Assuntos
Eletroconvulsoterapia , Estimulação Transcraniana por Corrente Contínua , Humanos , Estimulação Transcraniana por Corrente Contínua/métodos , Eletroconvulsoterapia/efeitos adversos , Depressão/terapia , Córtex Pré-Frontal/fisiologia , Cognição , Método Duplo-Cego , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Affect Disord ; 349: 321-331, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38195009

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive episodes (MDE). However, ECT-induced cognitive side-effects remain a concern. Identification of pre-treatment predictors that contribute to these side-effects remain unclear. We examined cognitive performance and individual cognitive profiles over time (up to six months) following ECT and investigated possible pre-treatment clinical and demographic predictors of cognitive decline shortly after ECT. METHODS: 634 patients with MDE from five sites were included with recruitment periods between 2001 and 2020. Linear mixed models were used to examine how cognitive performance, assessed with an extensive neuropsychological test battery, evolved over time following ECT. Next, possible pre-treatment predictors of cognitive side-effects directly after ECT were examined using linear regression. RESULTS: Directly after ECT, only verbal fluency (animal and letter; p < 0.0001; Cohen's d: -0.25 and -0.29 respectively) and verbal recall (p < 0.0001; Cohen's d: -0.26) significantly declined. However, during three and six months of follow-up, cognitive performance across all domains significantly improved, even outperforming baseline levels. No other pre-treatment factor than a younger age predicted a larger deterioration in cognitive performance shortly after ECT. LIMITATIONS: There was a substantial amount of missing data especially at 6 months follow-up. CONCLUSIONS: Our findings show that verbal fluency and memory retention are temporarily affected immediately after ECT. Younger patients may be more susceptible to experiencing these acute cognitive side-effects, which seems to be mostly due to a more intact cognitive functioning prior to ECT. These findings could contribute to decision-making regarding treatment selection, psychoeducation, and guidance during an ECT course.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Humanos , Eletroconvulsoterapia/efeitos adversos , Eletroconvulsoterapia/psicologia , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Maior/psicologia , Depressão , Cognição , Memória , Testes Neuropsicológicos , Resultado do Tratamento
18.
J Psychiatr Res ; 170: 318-327, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38194849

RESUMO

Major depressive disorder (MDD) remains a significant global health concern, with limited and slow efficacy of existing antidepressants. Electroconvulsive therapy (ECT) has superior and immediate efficacy for MDD, but its action mechanism remains elusive. Therefore, the elucidation of the action mechanism of ECT is expected to lead to the development of novel antidepressants with superior and immediate efficacy. Recent studies suggest a potential role of hippocampal astrocyte in MDD and ECT. Hence, we investigated antidepressant effect of electroconvulsive stimulation (ECS), an animal model of ECT, -related genes in hippocampal astrocyte with a mouse model of MDD, in which corticosterone (CORT)-induced depression-like behaviors were recovered by ECS. In this model, both of CORT-induced depression-like behaviors and the reduction of hippocampal astrocyte were recovered by ECS. Following it, astrocytes were isolated from the hippocampus of this model and RNA-seq was performed with these isolated astrocytes. Interestingly, gene expression patterns altered by CORT were reversed by ECS. Additionally, cell proliferation-related signaling pathways were inhibited by CORT and recovered by ECS. Finally, serum and glucocorticoid kinase-1 (SGK1), a multi-functional protein kinase, was identified as a candidate gene reciprocally regulated by CORT and ECS in hippocampal astrocyte. Our findings suggest a potential role of SGK1 in the antidepressant effect of ECS via the regulation of the proliferation of astrocyte and provide new insights into the involvement of hippocampal astrocyte in MDD and ECT. Targeting SGK1 may offer a novel approach to the development of new antidepressants which can replicate superior and immediate efficacy of ECT.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Camundongos , Animais , Transtorno Depressivo Maior/tratamento farmacológico , Astrócitos , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Hipocampo/metabolismo , Corticosterona/farmacologia
19.
AANA J ; 92(1): 51-56, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38289687

RESUMO

Electroconvulsive therapy (ECT) was first introduced in the late 1930s. In 2016, 1.4 million people worldwide were treated with ECT, a procedure that differs from any other. Indications for ECT include schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, and bipolar disorder. Additionally, ECT can be beneficial for patients with autism spectrum disorder, specifically those with self-injurious behaviors and severe behaviors related to agitated or excited catatonia. As indications for ECT have grown, the results of therapy have proven beneficial. The anesthesia care for these patients has a direct impact on the initiation of a seizure, the duration and quality of which determines whether the procedure is successful. The anesthetic nuances of the procedure make it imperative that anesthesia providers not only understand the procedure, but also how the medications chosen and comorbidities of the patient can alter the outcome. This can ensure that providers utilize the most up to date practices while ensuring that care is delivered in a systematic approach providing safer, more effective patient care.


Assuntos
Anestesia , Transtorno do Espectro Autista , Transtorno Bipolar , Catatonia , Eletroconvulsoterapia , Humanos , Eletroconvulsoterapia/métodos , Catatonia/tratamento farmacológico , Catatonia/psicologia , Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Transtorno Bipolar/tratamento farmacológico
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