Terapia electroconvulsiva de mantenimiento y recuperación de la disfunción cognitiva: a propósito de un caso de trastorno depresivo recurrente / Maintenance electroconvulsive therapy and cognitive disfunction recovery: A case of recurrent major depressive disorder

Objetivo: Cuestionar que la terapia electroconvulsiva (TEC) sea perjudicial a nivel cognitivo a medio y largo plazo en el trastorno depresivo recurrente.Caso clínicoSe presenta el caso de una mujer de 75 años con trastorno depresivo recurrente, resistente e intolerante a varios psicofármacos, descartada previamente para TEC por sospecha de deterioro cognitivo, pero incluida en junio de 2016 en el programa de TEC de mantenimiento (TEC-M), tras 10 sesiones de TEC aguda.ResultadosTras más de 30 sesiones de TEC-M la paciente se mantiene eutímica, recibiendo una sesión trimestral de TEC y mostrando recuperación de la disfunción cognitiva tanto en la valoración subjetiva como mediante test de screening.ConclusionesLa TEC-M es eficaz en ancianos con depresión y puede mejorar e incluso normalizar la función cognitiva. (AU)

Aim: Challenge the idea that electroconvulsive therapy (ECT) is cognitively detrimental in the medium and long term in recurrent depressive disorder.Clinical caseWe introduce the case of a 75-year-old woman with recurrent major depressive disorder, resistant and intolerant to various antidepressant drugs, previously ruled out for ECT due to suspected cognitive decline, but included in June 2016 in the maintenance-electroconvulsive therapy (M-ECT program), after 10 sessions of acute ECT.OutcomesAfter more than 30 sessions of M-ECT, the patient remains euthymic, receiving a quarterly session of ECT and showing recovery from cognitive dysfunction both in the subjective assessment and through the screening test.Main findingsM-ECT is effective in the elderly with major depression, and may improve and even normalize cognitive function. (AU)

Influence of emotional contexts on facial emotion attribution in schizophrenia.

Recent emotion recognition studies in schizophrenia have reported misattribution of emotional content to emotionally neutral faces. While in these studies faces are presented in the absence of any contextual reference, in daily life facial expressions are typically perceived within a specific situational context. However, there is no evidence on the possible modulatory role of contextual aids on emotion attribution to neutral faces. We address this issue in the present study. Thirty schizophrenia patients and thirty paired controls performed an emotion categorization task (by choosing one among six labels of emotions) with neutral target faces that were superimposed on affectively positive, negative or neutral scenes. In presence of positive contexts, patients categorized neutral faces as happy and fearful more frequently than controls. When negative contexts were present, patients also categorized neutral faces as fearful more frequently than controls. However, in the presence of neutral contexts patients and controls did not differ in their categorization pattern. These results suggest that explicit presence of a neutral context seems to compensate for the bias showed by patients. With the purpose of correcting emotion misattribution in schizophrenia, emotionally neutral contexts might be incorporated to treatments aimed at improving social cognition performance in this patient population.

Reduced visual surround suppression in schizophrenia shown by measuring contrast detection thresholds.

Visual perception in schizophrenia is attracting a broad interest given the deep knowledge that we have about the visual system in healthy populations. One example is the class of effects known collectively as visual surround suppression. For example, the visibility of a grating located in the visual periphery is impaired by the presence of a surrounding grating of the same spatial frequency and orientation. Previous studies have suggested abnormal visual surround suppression in patients with schizophrenia. Given that schizophrenia patients have cortical alterations including hypofunction of NMDA receptors and reduced concentration of GABA neurotransmitter, which affect lateral inhibitory connections, then they should be relatively better than controls at detecting visual stimuli that are usually suppressed. We tested this hypothesis by measuring contrast detection thresholds using a new stimulus configuration. We tested two groups: 21 schizophrenia patients and 24 healthy subjects. Thresholds were obtained using Bayesian staircases in a four-alternative forced-choice detection task where the target was a grating within a 3∘ Butterworth window that appeared in one of four possible positions at 5∘ eccentricity. We compared three conditions, (a) target with no-surround, (b) target embedded within a surrounding grating of 20∘ diameter and 25% contrast with same spatial frequency and orthogonal orientation, and (c) target embedded within a surrounding grating with parallel (same) orientation. Previous results with healthy populations have shown that contrast thresholds are lower for orthogonal and no-surround (NS) conditions than for parallel surround (PS). The log-ratios between parallel and NS thresholds are used as an index quantifying visual surround suppression. Patients performed poorly compared to controls in the NS and orthogonal-surround conditions. However, they performed as well as controls when the surround was parallel, resulting in significantly lower suppression indices in patients. To examine whether the difference in suppression was driven by the lower NS thresholds for controls, we examined a matched subgroup of controls and patients, selected to have similar thresholds in the NS condition. Patients performed significantly better in the PS condition than controls. This analysis therefore indicates that a PS raised contrast thresholds less in patients than in controls. Our results support the hypothesis that inhibitory connections in early visual cortex are impaired in schizophrenia patients.