Pharmacological prevention of postictal agitation after electroconvulsive therapy-A systematic review and meta-analysis.

Background: Postictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7-36% of patients and recur in 19-54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT. Method: A systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323. Results: We screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32-0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I2 = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence. Conclusion: For clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA.

Early Secure Attachment as a Protective Factor Against Later Cognitive Decline and Dementia.

The etiology of neurodegenerative disorders such as dementia is complex and incompletely understood. Interest in a developmental perspective to these pathologies is gaining momentum. An early supportive social environment seems to have important implications for social, affective and cognitive abilities across the lifespan. Attachment theory may help to explain the link between these early experiences and later outcomes. This theory considers early interactions between an infant and its caregiver to be crucial to shaping social behavior and emotion regulation strategies throughout adult life. Furthermore, research has demonstrated that such early attachment experiences can, potentially through epigenetic mechanisms, have profound neurobiological and cognitive consequences. Here we discuss how early attachment might influence the development of affective, cognitive, and neurobiological resources that could protect against cognitive decline and dementia. We argue that social relations, both early and late in life, are vital to ensuring cognitive and neurobiological health. The concepts of brain and cognitive reserve are crucial to understanding how environmental factors may impact cognitive decline. We examine the role that attachment might play in fostering brain and cognitive reserve in old age. Finally, we put forward the concept of affective reserve, to more directly frame the socio-affective consequences of early attachment as protectors against cognitive decline. We thereby aim to highlight that, in the study of aging, cognitive decline and dementia, it is crucial to consider the role of affective and social factors such as attachment.

The role of the basolateral amygdala in dreaming.

Neuroimaging studies have repeatedly shown amygdala activity during sleep (REM and NREM). Consequently, various theorists propose central roles for the amygdala in dreaming - particularly in the generation of dream affects, which seem to play a major role in dream plots. However, a causal role for the amygdala in dream phenomena has never been demonstrated. The traditional first step in determining this role is to observe the functional effects of isolated lesions to the brain structure in question. However, circumscribed bilateral amygdala lesions are extremely rare. Furthermore, the treatment of the amygdala as a unitary structure is problematic, as the basolateral and centromedial amygdala (BLA and CMA) may serve very different functions. We analysed 23 dream reports collected from eight adult patients with bilateral calcification of the BLA as a result of a very rare genetic condition called Urbach-Wiethe Disease (UWD). We compared these dream reports to 52 reports collected from 17 matched controls. Given that the BLA has been implicated in various affective processes in waking life, we predicted that the emotional content of the patients' dreams would differ from that of controls. Due to the exploratory nature of this research, a range of different dream characteristics were analysed. A principal components analysis run on all data returned three key factors, namely pleasantness, length and danger. The UWD patients' dream reports were significantly more pleasant and significantly shorter and less complex than control reports. No differences were found in levels of threat or danger. The results support some current hypotheses concerning the amygdala's role in dreaming, and call others into question. Future research should examine whether these UWD patients show generally impaired emotional episodic memory due to BLA damage, which could explain some of the current findings.