Maintenance Electroconvulsive Therapy in Catatonia: Clinical Profiles From a Case Series.

OBJECTIVES: This study aims to conduct a descriptive analysis of the clinical features and treatment responses in 6 patients with catatonia who received maintenance electroconvulsive therapy (ECT). METHODS: Our study included all patients who underwent maintenance ECT (mECT) at the Hospital Clínic de Barcelona between September 2020 and September 2022 following a catatonic episode. RESULTS: The study cohort comprised 5 patients with schizophrenia and 1 patient with major depressive disorder. Among patients with schizophrenia, the first catatonic episode occurred several years after their initial paranoid psychotic episode, whereas the patient with depression experienced a rapid progression from the first depressive episode to catatonia. After acute ECT, 4 patients achieved complete symptomatic remission, 1 patient exhibited a partial response, and another maintained a severe catatonic state. Maintenance ECT was indicated because of the high risk of severe relapses. The mean frequency of mECT sessions was 9.83 (SD, 5.60) days. Notably, 66.67% of the patients were concurrently receiving clozapine as part of their pharmacological treatment. Among patients with schizophrenia, mECT sessions could not be extended beyond 7 to 10 days, whereas the depressed patient could space ECT sessions up to 21 days without experiencing a relapse. CONCLUSIONS: Maintenance ECT proves to be a safe and well-tolerated strategy for preventing relapses in severe catatonic patients who have previously stabilized with acute ECT. Further research is needed to develop clinical guidelines that define optimal application strategies for mECT in catatonia.

Discontinuation of maintenance electroconvulsive therapy: Lessons learned from the COVID-19 pandemic / Discontinuación de la terapia electroconvulsiva de mantenimiento: lecciones aprendidas de la pandemia COVID-19

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The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review.

Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aß peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aß40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT.

Can the Addition of Maintenance Electroconvulsive Therapy to Pharmacotherapy Improve Relapse Prevention in Severe Major Depressive Disorder? A Randomized Controlled Trial.

Few systematic evaluations have been performed of the efficacy of electroconvulsive therapy (ECT) as a relapse prevention strategy in major depressive disorder (MDD). This is a single-blind, multicenter, randomized controlled trial to compare the efficacy and tolerability of pharmacotherapy plus maintenance ECT (M-Pharm/ECT) versus pharmacotherapy alone (M-Pharm) in the prevention of MDD relapse. Subjects with MDD who had remitted with bilateral acute ECT (n = 37) were randomly assigned to receive M-Pharm/ECT (n = 19, 14 treatments) or M-Pharm (n = 18) for nine months. The subjects were followed up for 15 months. The main outcome was relapse of depression, defined as a score of 18 or more on the Hamilton Depression Rating Scale. At nine months, 35% of the subjects treated with M-Pharm/ECT relapsed as compared with 61% of the patients treated with M-Pharm. No statistically significant differences between groups were indicated by either Kaplan-Meier or Cox proportional hazards regression analyses. The subjects without psychotic features were at higher risk of relapse. There were no statistically significant differences in the MMSE scores of the two groups at the end of the study. Further studies are needed to better define the indications for M-ECT in order to improve its efficacy as a relapse prevention strategy.

Clock gene polygenic risk score and seasonality in major depressive disorder and bipolar disorder.

Seasonal changes in mood and diurnal preference are two well-characterized chronobiological phenotypes in major depressive disorder (MDD) and bipolar disorder (BD). The biological mechanisms regulating physiological changes related to seasonality and chronotype involve several genes known as "clock" or circadian genes. Our goal was to study the relationship between the polygenic risk score (PRS) obtained from a set of clock genes and chronobiological traits in patients with mood disorders. The sample included 445 patients with mood disorders (256 MDD; 189 BD). Seasonality was assessed using the Seasonal Pattern Assessment Questionnaire (SPAQ), and chronotype was assessed using the Horne and Östberg Morningness-Eveningness Questionnaire. We selected 248 single nucleotide polymorphisms located within 19 genes. PRS for both MDD and BD was calculated using the Psychiatric Genetics Consortium latest datasets as discovery samples. Another PRS was calculated using results from a genome-wide association study focusing on chronotype. SPAQ results were significantly associated with MDD-PRS (p = 0.037) and chronotype-PRS (p = 0.019), which also showed a significant interaction with age (p = 0.039). No significant association was observed between the measured PRS and chronotype. Our results reflect that small effect variants associated with MDD and chronotype within clock genes are associated with seasonality traits in patients with mood disorders, further explaining the mechanism through which the circadian system might influence mood disorder clinical presentation. Future studies measuring PRS from specific gene sets and focusing on biological endophenotypes will help to elucidate the pathways from genetic variations to clinical outcome.

Evolución clínica tras la discontinuación de la terapia electroconvulsiva de mantenimiento. Estudio de seguimiento retrospectivo / Clinical outcome after discontinuation of maintenance Electroconvulsive Therapy. A retrospective follow-up study

INTRODUCCIÓN: La terapia electroconvulsiva de continuación/mantenimiento (TEC-c/m) es una opción terapéutica tras la TEC aguda. Aunque es ampliamente usada, tanto su duración como la evolución de los pacientes tras su discontinuación no están bien establecidas. El objetivo del estudio fue evaluar la tasa de recidivas y los factores clínicos asociados a la misma tras discontinuar la TEC-c/m. MATERIAL Y MÉTODOS: Evaluación retrospectiva de 73 pacientes a los que se les discontinuó la TEC-c/m. El tiempo de evaluación mínimo fue de un año. Se consideró recidiva la necesidad de ingreso o de nueva tanda aguda de TEC. La tasa de recidivas se determinó como porcentaje y el tiempo estimado hasta la recidiva se analizó a través de un análisis de supervivencia. Posibles asociaciones entre la recidiva y variables clínicas se analizaron mediante análisis univariado y multivariado de Cox. RESULTADOS: Treinta y seis pacientes (49,3%) recidivaron. El 61,1% lo hizo durante el primer año tras la discontinuación de la TEC-c/m (36,1% durante los primeros 6 meses). El tiempo estimado hasta la recidiva fue de 38,67 meses. El 50% de los pacientes que recayeron precisaron una nueva tanda aguda de TEC y el 44,4% reiniciaron TEC-c/m posteriormente. Los pacientes con un intervalo entre sesiones inferior a un mes y aquellos con más episodios previos presentaron mayor riesgo de recidiva. CONCLUSIONES: Ante la discontinuación de la TEC-c/m debe considerarse el riesgo de recidiva. Tras la discontinuación, casi la mitad de los pacientes recidivaron, la mayoría en el primer año. Es recomendable realizar un seguimiento estrecho tras la discontinuación de la TEC-c/m y no es aconsejable su retirada cuando se administra con intervalos entre sesiones inferiores a un mes. Se requieren nuevos estudios para identificar grupos de riesgo para la recidiva

INTRODUCTION: Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS: Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS: Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS: The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse

Clinical outcome after discontinuation of maintenance Electroconvulsive Therapy. A retrospective follow-up study. / Evolución clínica tras la discontinuación de la terapia electroconvulsiva de mantenimiento. Estudio de seguimiento retrospectivo.

INTRODUCTION: Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS: Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS: Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS: The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse.

Early improvement as a predictor of final remission in major depressive disorder: New insights in electroconvulsive therapy.

BACKGROUND: Early improvement to antidepressant drugs predicts remission, but the predictive value of early improvement to electroconvulsive therapy (ECT) is still unclear. The main aim of this study was to determine the optimal definition of early improvement in the treatment of major depressive disorder (MDD) with ECT, by analyzing its value as a predictor of remission. METHODS: A naturalistic study was conducted in 87 adult MDD patients treated with acute ECT. ROC curves were generated to identify the best time point (week 1 or 2 of treatment) predicted remission. Sensibility, specificity, and predictive values were calculated for several definitions of early improvement previously proposed in the literature (20%, 25%, 30%, and 35%). Complementary, time to remission was analyzed and a logistic regression model was performed to further characterize the impact of the optimal definition of early improvement on remission while adjusting for other clinically relevant variables. RESULTS: A 30% reduction in the HAM-D score after 2 weeks was identified as the optimal definition of early improvement, with acceptable sensitivity (76%), and specificity (67%). Complementary analyses provided further support for this definition showing a shorter time to remission and a significant effect adjusted for the rest of variables. LIMITATIONS: Relatively small sample size, ECT restricted to brief bilateral treatment. CONCLUSIONS: Early improvement, defined as a 30% of reduction in the HAM-D21 score at week 2, is a good predictor of remission in MDD patients treated with bilateral ECT, with potential clinical impact. Lack of early improvement could indicate a need for further changes in treatment strategies.

The Clinical Alliance and Research in Electroconvulsive Therapy Network: An Australian Initiative for Improving Service Delivery of Electroconvulsive Therapy.

OBJECTIVE: There is currently substantial heterogeneity in electroconvulsive therapy (ECT) treatment methods between clinical settings. Understanding how this variation in clinical practice is related to treatment outcomes is essential for optimizing service delivery. The Clinical Alliance and Research in ECT Network is a clinical and research framework with the aims of improving clinical practice, enabling auditing and benchmarking, and facilitating the collection of naturalistic clinical data. METHODS: The network framework and clinical and treatment variables collected and rationale for the use of particular outcome measures are described. Survey results detailing the use of ECT across initial participating clinical centers were examined. RESULTS: The data are reported from 18 of 22 participating centers, the majority based in Australia. Melancholic unipolar depression was the most common clinical indication (78%). Right unilateral (44%) and bifrontal (39%) were the most commonly used electrode placements. Eighty one percent of the centers used individual seizure titration for initial dosing. CONCLUSIONS: There was substantial heterogeneity in the use of ECT between participating centers, indicating that the Network is representative of modern ECT practice. The Clinical Alliance and Research in ECT Network may therefore offer the opportunity to improve service delivery and facilitate the investigation of unresolved research questions pertaining to modern ECT practice.

Effectivity and Cost-effectivity of the Maintenance Electroconvulsive Therapy: A mirror naturalistic analysis.

INTRODUCTION: Maintenance Electroconvulsive Therapy (mECT) is a biological long-term treatment in which patients receive ECT on periods from 2 to 4 weeks, during a variable period of time, usually for more than 6 months. Recent studies showed the efficacy of mECT in prevention of relapse and recurrences. Our study wants to demostrate the effectivity and cost-effectivity of this therapy in the naturalistic conditions of our area. DESIGN: Retrospective longitudinal study, with mirror analysis in naturalistic conditions. SUBJECTS: Patients attended at the Corporació Sanitària Parc Taulí (Sabadell, Catalonia), and included in the mECT program during more than six months. We performed diagnostic following DSM-IV criteria, subdividing the sample in three groups: patients affected of Recurrent Major Depression, Bipolar Disorder and Schizophrenia and Related Disorders. MEASURES: Number and duration of hospitalizations for the previous three years before the beginning of mECT, compared with the same data for the next three years following the beginning of mECT. Comparative analysis of direct hospitalization costs, costs of the mECT and pharmacologic costs. Statistic: Descriptive and non- parametric tests. RESULTS: Sample of 35 patients (1997-2008). There is a significative reduction the number of hospitalizations and days of hospitalization in the total sample and also in each of the three subgroups. The direct total cost decreased but it was only significant in the Bipolar Disorder subgroup, due to the increased pharmacological costs. CONCLUSIONS: mECT in our area is an effective and costeffective treatment with a great impact on the reduction of clinical decline and hospitalizations.

Efectividad y Coste-Efectividad de la Terapia Electroconvulsiva de Mantenimiento: un análisis naturalístico en espejo / Effectivity and Cost-effectivity of the Maintenance Electroconvulsive Therapy: A mirror naturalistic analysis

Introducción. La Terapia Electroconvulsiva de Mantenimiento (TECm) es un régimen de tratamiento biológico a largo plazo en el cual los pacientes reciben TEC en intervalos habitualmente de 2 a 4 semanas y a lo largo de un período variable según los casos y normalmente de más de seis meses. Estudios recientes han demostrado la eficacia de TECm en la prevención de recaídas y recurrencias. Nuestro estudio pretende averiguar su efectividad y coste-efectividad en nuestro medio. Metodología. Diseño: Estudio retrospectivo longitudinal, con análisis en espejo en condiciones naturalísticas. Sujetos: Pacientes atendidos en la Corporació Sanitària Parc Taulí (Sabadell, Cataluña), en programa de TECm durante más de seis meses. Realizamos los diagnósticos según criterios DSM-IV, subdividiendo la muestra en tres subgrupos: Depresión Mayor Recurrente, Trastorno Bipolar y Esquizofrenia y trastornos Relacionados. Medidas: Análisis comparativo respecto al número de ingresos y duración en los tres años previos al inicio de la TECm y los 3 años posteriores. Análisis comparativo paralelo de los costes directos: ingresos hospitalarios, TECm y costes farmacológicos. Estadística: Descriptiva y pruebas no paramétricas. Resultados. Muestra de 35 pacientes (1997-2008). Existe una disminución significativa de los días y número de ingresos en el total de la muestra y en cada uno de los subgrupos diagnósticos. El coste total directo disminuye, pero, debido al incremento de los costes farmacológicos, sólo es significativo en el caso del subgrupo de Trastorno Bipolar. Conclusiones. La TECm en nuestro medio es un tratamiento efectivo y coste-efectivo con un importante impacto en la reducción de agudizaciones e ingresos hospitalarios (AU)

Introduction. Maintenance Electroconvulsive Therapy (mECT) is a biological long-term treatment in which patients receive ECT on periods from 2 to 4 weeks, during a variable period of time, usually for more than 6 months. Recent studies showed the efficacy of mECT in prevention of relapse and recurrences. Our study wants to demostrate the effectivity and cost-effectivity of this therapy in the naturalistic conditions of our area. Methodology. Design: Retrospective longitudinal study, with mirror analysis in naturalistic conditions. Subjects: Patients attended at the Corporació Sanitària Parc Taulí (Sabadell, Catalonia), and included in the mECT program during more than six months. We performed diagnostic following DSM-IV criteria, subdividing the sample in three groups: patients affected of Recurrent Major Depression, Bipolar Disorder and Schizophrenia and Related Disorders. Measures: Number and duration of hospitalizations for the previous three years before the beginning of mECT, compared with the same data for the next three years following the beginning of mECT. Comparative analysis of direct hospitalization costs, costs of the mECT and pharmacologic costs. Statistic: Descriptive and non- parametric tests. Results. Sample of 35 patients (1997-2008). There is a significative reduction the number of hospitalizations and days of hospitalization in the total sample and also in each of the three subgroups. The direct total cost decreased but it was only significant in the Bipolar Disorder subgroup, due to the increased pharmacological costs. Conclusions. mECT in our area is an effective and cost-effective treatment with a great impact on the reduction of clinical decline and hospitalizations (AU)

Patrón de uso de la terapia electroconvulsiva en España: propuestas para una práctica óptima y un acceso equitativo / Pattern of electroconvulsive therapy use in Spain: Proposals for an optimal practice and equitable access

Objetivos. Analizar en términos cuantitativos y cualitativos la situación del uso de la terapia electroconvulsiva (TEC) en España en la actualidad, así como explorar aquellos aspectos que pudieran condicionar su utilización. Metodología. Encuesta transversal en todas las unidades psiquiátricas existentes en España a fecha 31/12/2012. Resultados. El 54,9% de las unidades estudiadas aplicaban TEC, resultando en una tasa de aplicación de 0,66 por 10.000 habitantes. Existen amplias variaciones en las tasas de aplicación entre comunidades autónomas (0,00-1,39) y provincias (0,00-3,90). La TEC se indicó en el período estudiado a una media de 25,5 pacientes en los centros que disponían de la técnica, y a 4,5 en los centros que remitían a otros para aplicarla (p=0,000), pero con amplias diferencias entre centros. Conclusiones. El número de centros que disponen de TEC en España es uno de los más elevados entre los países occidentales, pero la tasa de aplicación de esta técnica continúa siendo una de las más bajas, existiendo además marcadas diferencias entre las distintas comunidades autónomas, e incluso entre provincias y centros hospitalarios de una misma comunidad autónoma. Parece preciso implementar estrategias de planificación sanitaria y de formación para reducir la heterogeneidad observada en la prescripción y aplicación de la TEC en España (AU)

Objectives. The main aims of our study were to estimate the current rates and pattern of electroconvulsive therapy (ECT) use in Spain, as well as exploring the causes that may be limiting its use in our country. Methods. A cross-sectional survey was conducted covering every psychiatric unit in Spain as of 31 December 2012. Results. More than half (54.9%) of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. There are wide variations with regard to ECT application rates between the different autonomous communities (0.00-1.39) and provinces (0.00-3.90). ECT was prescribed to a mean of 25.5 patients per hospital that used the technique and 4.5 in referral centre (P=.000), but wide differences were reported in the number of patients who were prescribed ECT from hospital to hospital. Conclusions. Although the percentage of psychiatric units applying ECT in our country is among the highest in the world, the ECT application rate in Spain is among the lowest within western countries. Large differences in ECT use have been reported across the various autonomous communities, provinces and hospitals. Thus, health planning strategies need to be implemented, as well as promoting training in ECT among health professionals, if these differences in ECT use are to be reduced (AU)

Pattern of electroconvulsive therapy use in Spain: Proposals for an optimal practice and equitable access. / Patrón de uso de la terapia electroconvulsiva en España: propuestas para una práctica óptima y un acceso equitativo.

OBJECTIVES: The main aims of our study were to estimate the current rates and pattern of electroconvulsive therapy (ECT) use in Spain, as well as exploring the causes that may be limiting its use in our country. METHODS: A cross-sectional survey was conducted covering every psychiatric unit in Spain as of 31 December 2012. RESULTS: More than half (54.9%) of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. There are wide variations with regard to ECT application rates between the different autonomous communities (0.00-1.39) and provinces (0.00-3.90). ECT was prescribed to a mean of 25.5 patients per hospital that used the technique and 4.5 in referral centre (P=.000), but wide differences were reported in the number of patients who were prescribed ECT from hospital to hospital. CONCLUSIONS: Although the percentage of psychiatric units applying ECT in our country is among the highest in the world, the ECT application rate in Spain is among the lowest within western countries. Large differences in ECT use have been reported across the various autonomous communities, provinces and hospitals. Thus, health planning strategies need to be implemented, as well as promoting training in ECT among health professionals, if these differences in ECT use are to be reduced.

The CORE system for sub-typing melancholic depression: Adaptation and psychometric properties of the Spanish version.

We report the development procedure for a Spanish version of the CORE measure for subtyping melancholic depression and its psychometric properties. The sample comprised two subsets of depressive patients: 117 in-patients clinically assessed after admission and before discharge; and 34 in- and out-patients who were video-recorded, with each recording being rated by independent raters and re-rated six months later. The internal consistency of the Spanish version of the CORE was high, with Cronbach's alpha coefficient of 0.93 for the total CORE score. High intra-class correlation coefficient for the total score (0.96) and the three subscales (around 0.8) indicate high inter-rater reliability. Baseline and six-month ratings of video-recordings showed high test-retest reliability. Regarding construct validity, the correlation between the CORE and the Newcastle endogeneity scale scores was 0.64. A ROC curve generated an optimal cut-off of 10 to predict the definition of endogeneity/melancholia based on the Newcastle score >=6 and the DSM-IV-TR definition of melancholia. The comparison between the CORE scores at admission and at discharge revealed large differences, indicating demonstrable sensitivity to change. The Spanish version of the CORE system is a reliable and valid instrument for sub-typing depression in terms of melancholic versus non-melancholic sub-types.

Electroconvulsive Therapy Practice in Spain: A National Survey.

OBJECTIVES: The use of electroconvulsive therapy (ECT) in Spain has not been systematically evaluated since 2000 to 2001. The aim of this study is to assess the current use of ECT in Spain. METHODS: A cross-sectional survey was conducted covering every psychiatric unit in Spain as of December 31, 2012. RESULTS: About 93.2% of the centers answered the questionnaire. About 54.9% of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. Wide variations existed among the different autonomous communities and provinces. Written informed consent was obtained in all the facilities. About 38.2% of ECT-treated patients were 65 years or older. About 55.7% were women. Depressive episodes were the main indication for ECT (80.2%). All the facilities applied modified ECT. No sine wave current devices are currently used in Spain. Bifrontotemporal ECT was elective in 85% of the hospitals, bifrontal in 13.3%, and unilateral in 1.8%. Stimulus titration methods were elective in 8.6% of the centers. The decision to end ECT relied on the psychiatrist's clinical impression in 89.4% of the centers and on rating scales in 10.6%. The ECT training was mandatory in 56.5% of the centers. CONCLUSIONS: The ECT practice has significantly improved in Spain in recent years. Overall, Spanish facilities seem to comply with established clinical guidelines; however, specific concerns were identified, meaning there is still further scope for improvement.

Electroconvulsive therapy practice in Catalonia: a survey study comparing data from 1993 and 2010.

OBJECTIVE: The aim of this study was to assess the current use of electroconvulsive therapy (ECT) in Catalonia (Spain) as compared with ECT practice 17 years ago (1993). METHODS: This was a descriptive, cross-sectional study using a structured questionnaire to collect data regarding the use of ECT in Catalan psychiatric units in 2010. A comparative approach was used with respect to previously published data. RESULTS: Data were obtained from 25 of the 27 units (92.6%) surveyed. The ECT was used in 20 facilities (80%, as opposed to 60% in 1993), and in all cases, a brief-pulse device was used. The most commonly used anesthetic was propofol (65%), and most facilities recorded the seizure duration (95%). The ECT was always administered in combination with pharmacologic therapy, and the primary clinical indication was depression. Only 20% of the ECT procedures were performed in the inpatient unit. Written informed consent to administer ECT was obtained in all centers. CONCLUSIONS: The ECT practice in Catalonia has changed since the 1990s, being administered more often, in a more standardized way and across a larger number of psychiatric units. The results indicate considerable consensus with regard to its indications and conditions of application, which comply with current clinical practice guidelines and standards.

Acute bilateral ECT in a depressed patient with a hip-aztreonam-spacer and subsequent maintenance ECT after prosthesis collocation.

ABSTRACT Electroconvulsive Therapy (ECT) has been demonstrated to be a safe and effective treatment for geriatric depression, although its application might be challenging when medical comorbidities exist. The present case reports a 78-year-old man diagnosed with recurrent unipolar major depressive disorder (MDD), who presented with a severe depressive episode with psychotic features (DSM IV). He successfully received a course of bitemporal (BT) ECT with a hip-aztreonam-spacer due to a hip fracture that occurred during hospitalization. This was followed by maintenance ECT (M-ECT) with a recent prosthesis collocation. This particular case illustrates the importance of a multidisciplinary approach in geriatric patients with somatic complications receiving ECT.

Propofol y pentotal como agentes anestésicos en la terapia electroconvulsiva: un estudio retrospectivo en el trastorno depresivo mayor / Propofol and thiopental as anesthetic agents in electroconvulsive therapy: a retrospective study in major depression

Objetivo. Determinar la influencia de la utilización de propofol y pentotal como anestésicos en la terapia electroconvulsiva (TEC), en relación con la duración de la crisis, la dosis eléctrica, la eficacia clínica, el perfil cardiovascular y la aparición de efectos cognitivos. Método. Estudio retrospectivo sobre 127 pacientes que recibieron TEC bilateral como tratamiento de un episodio depresivo mayor. Resultados. La duración media de la convulsión eléctrica en el grupo de propofol fue significativamente más corta que en el de pentotal (21,23 ± 6,09 versus 28,24 ± 6,67 s; p < 0,001). La dosis de estímulo media fue de 348,22 mC en el grupo de propofol y de 238 mC en el grupo de pentotal (p < 0,001). Propofol se asoció a un menor incremento de la tensión arterial. No se encontraron diferencias en la respuesta clínica al tratamiento ni en la aparición de otros efectos adversos. Conclusiones. El anestésico utilizado en la TEC puede determinar diferencias en parámetros como la duración de la crisis o la carga eléctrica aplicada. Sin embargo, estas diferencias no parecen traducirse en la eficacia clínica ni en el patrón de efectos adversos (AU)

Objective. To determine the influence of propofol and thiopental as anesthetics in electroconvulsive therapy (ECT), as regards, seizure duration, electrical charge, clinical efficacy, cardiovascular profile, and presence of adverse cognitive effects. Methods. A retrospective design including 127 patients who received bilateral ECT for the treatment of a major depressive episode. Results. The mean seizure duration in the propofol group was significantly shorter than in the thiopental group (21.23 ± 6.09 versus 28.24 ± 6.67 seconds, P < .001). The mean stimulus charge was 348.22 mC in the propofol group, and 238 mC in the thiopental group (P < .001). Propofol was associated with a lower increase in blood pressure. There were no differences between groups in treatment response or presence of adverse effects. Conclusions. The anesthetic agent used in ECT might determine differences in parameters such as seizure duration or electrical charge. However, this does not seem to be translated into differences in clinical efficacy or the pattern of adverse effects observed (AU)