The effect of continuation and maintenance electroconvulsive therapy on cognition: A systematic review of the literature and meta-analysis.

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for depression, mania, and refractory schizophrenia. Its tolerability profile is established for acute treatment, but less is known regarding the effects of longer treatment courses, particularly on cognitive performance. OBJECTIVES: To assess the effect of the long-term ECT on cognition. METHODS: We searched CINAHL, EMBASE, PsychInfo and Pubmed, for the period between January 1, 2010, and June 30, 2022, in English or French, for randomized controlled trials, prospective or retrospective studies of ECT continued for at least 2 months for the treatment of mood or schizophrenic disorders and which measured cognition before and at the end of treatment. Non-peer reviewed records were excluded. The Cochrane Risk of Bias tool was used to assess study quality. Classical meta-analyses, with heterogeneity statistics (tau2, I2) were complemented with three level-meta-analysis and Bayesian Meta-analyses. RESULTS: Nine studies were included in the narrative and quantitative review. Controlled comparison at 6 months (k = 6, n = 334) and at 12 months (k = 3, n = 56), within-subject comparisons at 6 (k = 6, n = 218) and 12 months (k = 4, n = 147) showed no detrimental effect of maintenance or continuation ECT on cognition, with little to no heterogeneity. Bayesian analysis further confirmed that data better supported the no effects hypothesis. LIMITATIONS: Insufficient data resulted in imprecision in estimates. CONCLUSIONS: Continuation and maintenance ECT do not appear detrimental for cognitive performance. However, the low number of studies limit the interpretation of the results.

Down and High: Reflections Regarding Depression and Cannabis.

In light of the recent changes in the legal status of cannabis in Canada, the understanding of the potential impact of the use of cannabis by individuals suffering from depression is increasingly considered as being important. It is fundamental that we look into the existing literature to examine the influence of cannabis on psychiatric conditions, including mood disorders. In this article, we will explore the relationship that exists between depression and cannabis. We will examine the impact of cannabis on the onset and course of depression, and its treatment. We have undertaken a wide-ranging review of the literature in order to address these questions. The evidence from longitudinal studies suggest that there is a bidirectional relationship between cannabis use and depression, such that cannabis use increases the risk for depression and vice-versa. This risk is possibly higher in heavy users having initiated their consumption in early adolescence. Clinical evidence also suggests that cannabis use is associated with a worse prognosis in individuals with major depressive disorder. The link with suicide remains controversial. Moreover, there is insufficient data to determine the impact of cannabis use on cognition in individuals with major depression disorder. Preliminary evidence suggesting that the endogenous cannabinoid system is involved in the pathophysiology of depression. This will need to be confirmed in future positron emission tomography studies. Randomized controlled trials are needed to investigate the potential efficacy of motivational interviewing and/or cognitive behavioral therapy for the treatment of cannabis use disorder in individuals with major depressive major disorder. Finally, although there is preclinical evidence suggesting that cannabidiol has antidepressant properties, randomized controlled trials will need to properly investigate this possibility in humans.

Chiari Malformation and Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. Chiari malformations (CM), first described approximately a hundred years ago, refer to a spectrum of hindbrain malformations characterized by cerebellar herniation through the foramen magnum. We present the case of a 28-year-old woman with ADHD and concurrent Chiari malformation type I (CM-I) that was diagnosed by CT scan. There is growing evidence supporting the role of the cerebellum and its associated structures in the pathophysiology of ADHD. Thus, a cerebellar malformation such as CM may impact neurological circuitry in a manner favoring the development of a neuropsychiatric disorder such as ADHD. Our case highlights the need for further studies pertaining to the role of the cerebellum in the pathophysiology of ADHD and the importance of considering the presence of CM when evaluating a patient with ADHD.

The screen for cognitive impairment in psychiatry (SCIP) is associated with disease severity and cognitive complaints in major depression.

OBJECTIVE: To assess the relationship between the Screen for Cognitive Impairment in Psychiatry (SCIP) score and illness severity, subjective cognition and functioning in a cohort of major depressive disorder (MDD) patients. METHODS: Patients (n = 40) diagnosed with MDD (DSM-IV-TR) completed the SCIP, a brief neuropsychological test, and a battery of self-administered questionnaires evaluating functioning (GAF, SDS, WHODAS 2.0, EDEC, PDQ-D5). Disease severity was evaluated with the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI). RESULTS: Age and sex were associated with performance in the SCIP. The SCIP-Global index score was associated with disease severity (r = -0.316, p < .05), the SDS, a patient self-assessment of daily functioning (r = -0.368, p < .05), and the EDEC subscales of patient-reported cognitive deficits (r = -0.388, p < .05) and their functional impacts (r = -0.335, p < .05). Multivariate analysis adjusted for age and sex confirmed these tests are independent predictors of performance in the SCIP (CGI-S, F[3,34] = 4.478, p = .009; SDS, F[3,34] = 3.365, p = .030; EDEC-perceived cognitive deficits, F[3,34] = 5.216, p = .005; EDEC-perceived impacts of functional impairment, F[3,34] = 5.154, p = .005). CONCLUSIONS: This study confirms that the SCIP can be used during routine clinical evaluation of MDD, and that cognitive deficits objectively assessed in the SCIP are associated with disease severity and self-reported cognitive dysfunction and impairment in daily life.

Rapid screening for cognitive deficits in attention deficit and hyperactivity disorders with the screen for cognitive impairment in psychiatry.

Cognitive impairments constitute a core feature of attention deficit and hyperactivity disorders (ADHD), but are infrequently assessed in the clinical setting. We have previously demonstrated the ability of an objective cognitive battery, the Screen for Cognitive Impairment in Psychiatry (SCIP), to differentiate adult ADHD patients from healthy controls in five cognitive domains. Here, we further characterize these subtle cognitive deficits by conducting additional univariate analyses on our ADHD dataset to assess the contributions of various demographic characteristics on SCIP performance and to determine correlations between SCIP scores and scores on other measures evaluating illness severity, perceived cognitive deficits, and overall functioning. Age and years of education were moderately associated with performance on the SCIP and/or its subscales in our ADHD cohort. The SCIP global index score was moderately correlated with clinician-rated measures of illness severity and weakly associated with clinician-rated overall functional status. Intriguingly, overall SCIP performance was only weakly associated with patient self-reported measures of cognitive functioning. Of practical importance, small-to-moderate associations were consistently observed between performances on two subscales of the SCIP and the other measures evaluating illness severity, overall functioning, and patient self-reported cognitive functioning (the working memory and visuomotor tracking subscales). Thus, these data demonstrate that the SCIP, particularly the working memory and visuomotor tracking subscales, is sensitive enough to detect cognitive deficits in adult patients with ADHD, and that these deficits are correlated with functional impairments. Furthermore, these data highlight the importance of integrating both objective and subjective evaluations of cognition in adult ADHD.

Duloxetine in adults with ADHD: a randomized, placebo-controlled pilot study.

OBJECTIVE: To assess the effect of duloxetine on ADHD in adults. METHOD: In a 6-week double-blind trial, 30 adults with ADHD received placebo or duloxetine 60 mg daily. The Conners' Adult ADHD Rating Scale (CAARS) and the Clinical Global Impression Scales (CGI) were used to assess symptom severity and clinical improvement. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used to measure the effect on anxiety and depressive symptoms. RESULTS: The Duloxetine group showed lower score on CGI-Severity at Week 6 (3.00 vs. 4.07 for placebo, p < .001), greater improvement on CGI-Improvement (2.89 vs. 4.00 at Week 6, p < .001), and greater decreases on five of eight subscales of the CAARS. There was no treatment group effect on HDRS or HARS scores. CONCLUSION: Duloxetine may be a therapeutic option for adults with ADHD, but further studies are required to replicate these findings in larger samples.

Improvement with duloxetine in an adult ADHD patient.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a common and disabling disorder among adults and is treated with stimulant and non stimulant medication. OBJECTIVE: To report the case of a patient with ADHD showing good clinical response to duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). CASE PRESENTATION: A 53 year-old man with a recently diagnosed ADHD was successfully treated with duloxetine 60 mg and showed reduced scores on the Conners' Adult ADHD Rating Scales - Self-Report Scale: Short Version (CAARS-S:S). CONCLUSION: Duloxetine could be an option for patients who either do not tolerate or show resistance to more common pharmacological choices. Randomized controlled trials are needed to assess the efficacy of duloxetine in treating ADHD symptoms.