Atrial Fibrillation Following Electroconvulsive Therapy: A Systematic Review and Case Report.

ABSTRACT: Electroconvulsive therapy (ECT) is considered the gold standard treatment for many psychiatric illnesses; however, it is not without risk. There have been no systematic reviews to date on new-onset atrial fibrillation following ECT. Thus, the aim of this study is to identify reported occurrences of new-onset atrial fibrillation following ECT and the ability to safely resume ECT thereafter.A case pertaining to the development of atrial fibrillation after ECT in a young healthy male is presented. In addition, a systematic review of the literature pertaining to atrial fibrillation after ECT was conducted through PubMed, PsycInfo, and EMBASE. Of the 233 articles screened, 15 articles were selected for in-depth review. Of the 15 articles, only 10 articles met inclusion criteria. These articles included 9 case reports and 1 retrospective review. The retrospective review included 1 patient that developed atrial fibrillation out of 13 patients receiving ECT at the site. The 10 patients included varied in age, risk factors, type of ECT conducted, and treatment of the atrial fibrillation. Of the 4 articles that discussed outcomes, all patients were able to return to ECT without further complications.There are many potential reasons ECT may induce atrial fibrillation, and there are additional treatment considerations for atrial fibrillation in patients receiving ECT. Notably, our results indicate that many have been able to continue ECT without further complications; however, more research is needed to identify the frequency of this adverse reaction.

The Use of Electroconvulsive Therapy in Neuropsychiatric Complications of Coronavirus Disease 2019: A Systematic Literature Review and Case Report.

BACKGROUND: There is a significant prevalence of new onset neuropsychiatric symptoms (NPS), some severe and persistent, in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE: This study reports on the use of electroconvulsive therapy (ECT) to treat NPS associated with COVID-19. METHODS: A review of the literature pertaining to the use of ECT in patients with COVID-19 and NPS was performed through PubMed, PsycINFO, and MEDLINE. Search terms included "Electroconvulsive Therapy" and "ECT," combined with "COVID-19" and "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2)." In addition, we present a case in which ECT was used to achieve complete remission in a patient who developed new onset, treatment-resistant depression, psychosis, and catatonia, associated with COVID-19. RESULTS: A total of 67 articles were reviewed with 3 selected for inclusion. These articles detailed 3 case reports of patients with new onset NPS (mania, psychosis and suicidality, and catatonia) that developed in the context of active COVID-19 and were treated successfully with ECT. CONCLUSIONS: ECT, a broad-spectrum treatment that has been found to be effective in various NPS (independent of etiology), is shown in our case report and others, to be safe and effective for NPS associated with COVID-19. Although we identified only 3 other cases in the literature, we believe that the probable antiinflammatory mechanism of ECT, its safety and tolerability, and the faster time to symptom remission support the need for more research and increased clinician awareness about this life-saving procedure.

A Case of Ischemic Stroke Incidental to the Postelectroconvulsive Therapy Period.

Electroconvulsive therapy (ECT) is a routine treatment for multiple psychiatric disorders including treatment-refractory mood and psychotic disorders. Although ECT is generally a safe and well-tolerated intervention, rare cerebrovascular and cardiovascular complications have been reported. The hemodynamic changes during the ECT seizure are well-recognized, with an initial parasympathetically mediated decrease in heart rate and blood pressure followed by a sympathetically mediated increase in these parameters. Despite intraoperative or postoperative blood pressure fluctuations, the risk of a hypertensive intracerebral bleed during ECT is very low and the risk of ischemic stroke after ECT appears to be even rarer. The authors present a case of a patient who developed an ischemic stroke after ECT treatment. Before stroke, the patient had been undergoing ECT routinely for over 2 years without alarming complications. Ischemic strokes are a rare but serious complication of ECT treatment.

The Use of Electroconvulsive Therapy in Eating Disorders: A Systematic Literature Review and Case Report.

OBJECTIVE: The aim of this study was to determine the potential for safe and effective use of electroconvulsive therapy (ECT) in treating eating disorders (EDs) in patients with and without comorbid psychiatric disorders. METHODS: A review of the literature pertaining to the use of ECT in patients with EDs was performed through PubMed, PsycINFO, and MEDLINE. Search terms included "Electroconvulsive Therapy," "ECT," and "Electroshock" each combined with "Anorexia Nervosa," "Bulimia Nervosa," "Binge Eating Disorder," "Eating Disorder," "EDNOS," and "OSFED." Additionally, a case in which ECT was used in treating a patient with anorexia nervosa is presented. RESULTS: Eighty-nine articles were reviewed, and 11 were selected for inclusion. These articles detailed 14 patients with active EDs who received ECT during their course of treatment. Of these patients, 13 were noted to have shown improvement in disordered eating after receiving ECT, and no adverse medical outcomes were reported. Our case detailed an additional patient who benefitted from ECT. CONCLUSIONS: There are limited data supporting the use of ECT in treating EDs; however, there is evidence to support that ECT is safe in this population and has been effective in cases of patients with AN with and without psychiatric comorbidities as well as binge eating disorder. More research is needed for treatment guidelines.

An Overview of Reviews on the Safety of Electroconvulsive Therapy Administered During Pregnancy.

OBJECTIVE: To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment. METHODS: A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews. Articles were reviewed and critically appraised using components of the PRISMA and AMSTAR systematic review assessment tools. RESULTS: Of the 9 articles that were identified, 5 publications of varying methodological quality met inclusion criteria and involved a range of 32 to 339 patients. The most common problems that occurred in association with ECT were fetal arrhythmia, fetal bradycardia, premature birth, developmental delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption, and threatened abortion. The number of fetal deaths in each of the reviews ranged from 2 to 12. The authors of 1 of the 5 reviews recommended that ECT only be used as a last resort, whereas the authors of the other reviews took the stance that the administration of ECT during pregnancy was relatively safe. Differences in recommendations among reviews were in part due to inclusion criteria and how adverse events were attributed to ECT. CONCLUSIONS: Our overview supports the conclusion, which has also been endorsed by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, that administration of ECT during pregnancy is relatively safe. Conclusions about safety, however, will become better established with the availability of more data.

Regulation of Electroconvulsive Therapy: A Systematic Review of US State Laws.

OBJECTIVES: The goal of this study was to systematically review current US state laws on electroconvulsive therapy (ECT) in order to provide a comprehensive resource to educate practitioners, potential patients, and lawmakers. METHODS: Individual state legislative Web sites were searched by 2 independent authors using the following search terms: "electroconvulsive therapy," "convulsive therapy," "electroconvulsant therapy," "electroshock therapy," and "shock therapy" from March 2017 to May 2017. All sections of state law pertaining to ECT were reviewed, and pertinent data regarding consent, age restrictions, treatment limitations, required reporting, defined qualified professionals, fees, and other information were extracted. RESULTS: State regulation on ECT widely varied from none to stringent requirements. There were 6 states without any laws pertaining to ECT. California, Illinois, Massachusetts, Missouri, New York, South Dakota, Tennessee, and Texas were noted to be the most regulatory on ECT. CONCLUSIONS: There are no US national laws on ECT leaving individual state governments to regulate treatment. Whereas some states have detailed restrictions on use, other states have no regulation at all. This variation applies to multiple areas of ECT practice, including who can receive ECT, who can provide informed consent, who can prescribe or perform ECT, and what administrative requirements (eg, fees, reporting) must be met by ECT practitioners. Knowledge of these state laws will help providers not only to be aware of their own state's regulations, but also to have a general awareness of what other states mandate for better patient care and utilization of ECT.

Electroconvulsive Therapy (ECT) and Race: A Report of ECT Use and Sociodemographic Trends in Texas.

OBJECTIVES: Minimal research on race and other sociodemographic disparities in patients receiving electroconvulsive therapy (ECT) exists. One previously noted national trend reveals whites receiving ECT disproportionately more than other races. The aim of this study is to determine whether a county ECT program demonstrates similar disparities observed at the state and national levels. METHODS: This study examined 21 years of ECT data, between 1993 and 2014, provided by the Texas Department of State Health Services, focusing on race, sex, age, and payer source and 2.5 years of the same variables from a Harris County hospital ECT program. In addition, population demographic data for Harris County and the state of Texas during the same period were obtained from the Department of State Health Services Web site. RESULTS: Despite an overall decrease in the population of whites countywide and statewide, whites continue to use more ECT than African Americans, Latinos, and Asians in both Harris County and Texas. However, the rates of ECT use in minorities increased overall. Both countywide and statewide, ECT was used more than twice as often in women than men. Statewide, elderly patients (>65 years old) saw decreases in ECT use, and there was an increase in private third-party payer source. CONCLUSIONS: Electroconvulsive therapy remains underused among African Americans, Latinos, and Asians. Hypotheses and areas for future study include cultural beliefs, stigma, patient and provider knowledge of ECT, and access to care. Despite this, the general use of ECT in Texas has increased overall, and minority use is slowly on the rise.

A Systematic Review of the Safety of Electroconvulsive Therapy Use During the First Trimester of Pregnancy.

OBJECTIVES: Because of the lack of focus on the safety of electroconvulsive therapy (ECT) during the first trimester of pregnancy in current literature, we set out to assess the safety of ECT use during this vital period of fetal development. METHODS: A systematic review was conducted, and a case where ECT was employed during the first trimester was presented. Cochrane Library, Ovid MEDLINE, PsycINFO, and PubMed were independently searched by 2 authors using the following search terms: "ECT," "electroconvulsive therapy," "electroshock" combined with "pregnancy," "first trimester of pregnancy," and "teratogenicity." RESULTS: Of the 97 articles reviewed, 13 met inclusion criteria. We identified 32 first-trimester patients as cases or case series. Adverse outcomes, including miscarriage with previous vaginal bleeding, vaginal bleeding, self-limited abdominal pain, and self-limited fetal spasms, were observed. We added 1 case of a pregnant patient at approximately 9 weeks gestation who experienced a threatened abortion after the administration of ECT. CONCLUSIONS: Although the data are limited, they suggest that ECT is relatively safe when administered during the first trimester of pregnancy. The possible adverse consequences of ECT during the first trimester of pregnancy should be carefully weighed against the potential benefits of ECT on untreated mental illness.