Effects of electroconvulsive shock on neuro-immune responses: Does neuro-damage occur?

Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression. However, this treatment may produce memory impairment. The mechanisms of the cognitive adverse effects are not known. Neuroimmune response is related to the cognitive deficits. By reviewing the available animal literature, we examined the glia activation, inflammatory cytokines, neuron oxidative stress responses, and neural morphological changes following electroconvulsive shock (ECS) treatment. The studies showed that ECS activates microglia, upregulates neuro-inflammatory cytokines, and increases oxidative stress responses. But these effects are rapid and may be transient. They normalize as ECS treatment continues, suggesting endogenous neuroprotection may be mobilized. The transient changes are well in line with the clinical observations that ECT usually does not cause significant long-lasting retrograde amnesia. The longitudinal studies will be particularly important to explore the dynamic changes of neuroplasticity following ECT (Jonckheere et al., 2018). Investigating the neuroplasticity changes in animals that suffered chronic stress may also be crucial to giving support to the translation of preclinical research.

Electroshock o Terapia Electroconvulsiva (TEC) en Chile: Diagnóstico crítico, activismo social y enfoque de derechos / Electroshock or Electroconvulsive Therapy (ECT) in Chile: Critical diagnosis, social activism and human rights approach

El electroshock o Terapia Electroconvulsiva (TEC) es un procedimiento controversial desde una mi-rada ética y científica. Organizaciones en primera persona del ámbito de la salud mental han generado un debate público respecto a su uso, señalado que es un procedimiento severamente invasivo con efectos dañinos en el cerebro. En ese contexto, el presente artículo realiza una revisión crítica del uso de esta práctica en el campo de la psiquiatría. Junto con ello, describe un panorama general del marco institucional en que se realiza la Terapia Electro-convulsiva (TEC) en Chile. Finalmente, examina los fundamentos e implicancias del enfoque de derechos para una mayor regulación o absoluta prohibición de este procedimiento

Electroshock or Electroconvulsive Therapy (ECT) is a controversial procedure from an ethical and scientific perspective. Organizations led by users and ex users in the field of mental health have generated a public debate regarding its use, pointing out that it is a severely invasive procedure with harmful effects on the brain. In that context, this article critically re-views the use of this practice in the field of psychiatry. In addition, it describes an overview of the institutional framework in which Electroconvulsive Therapy (ECT) is performed in Chile. Finally, it examines the fundamentals and implications of the perspective of human rights for a greater regulation or absolute prohibition of this procedure

Predicting appropriate shocks in patients with heart failure: Patient level meta-analysis from SCD-HeFT and MADIT II.

BACKGROUND: No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). METHODS: Using patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks. RESULTS: There were 1,463 patients randomized to an ICD, and 285 (19%) had ≥1 appropriate shock over a median follow-up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07-2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10-2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02-1.06), absence of beta-blocker therapy (OR 1.61, 95% CI 1.23-2.12), and single chamber ICD (OR 1.67, 95% CI 1.13-2.45). CONCLUSION: In this meta-analysis of patient level data from MADIT-II and SCD-HeFT, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.

Trends in less-lethal use of force techniques by police services within England and Wales: 2007-2011.

The aim of this study was to determine the incidence of, and any changes in, usage patterns of the less-lethal forms of Use of Force (UoF) modalities--incapacitant spray, impact rounds, and Taser(R)--between 2007 and 2011 by English and Welsh police services. Additional information regarding the deployment and discharge of firearms was also sought. Two thousand Freedom of Information Act applications were made to 50 police services in England and Wales and related jurisdictions requesting the provision of: (a) the total number of deployments of incapacitant sprays, Taser(R), impact (baton) rounds, and armed response units (ARU); (b) the numbers and types of any resulting medical complications; and (c) the details of any local policies requiring assessment by a healthcare professional following a deployment. Responses were received from 47 police services, with only 10 of these supplying complete data. The remainder supplied incomplete data or refused to supply any data under s12 of the Freedom of Information Act (time and cost restrictions). From 2007 to 2011, the use of incapacitant sprays, Taser, and firearms have increased (incapacitant sprays deployed: 3496, 3976, 6911, 6679, 6853; Taser deployed: 499, 2659, 4560, 6943, 7203; Taser discharged: 15, 85, 161, 338, 461; firearms: 0, 7, 4, 19, 32). Baton rounds and ARU use showed greater variability over the same time period (baton rounds: 1007, 1327, 1123, 1382, 1278; ARUs: 11688, 13652, 13166, 13959, 12090). Only two services could provide details of medical consequences from use of incapacitant sprays, Taser, and baton rounds. No service could provide details of any related medical complications following use of firearms. Data collection and release are variable and inconsistent throughout English and Welsh police services and thus caution is needed in determining trends of UoF techniques. Deaths or injuries inflicted using UoF techniques result in much public scrutiny and the low level of data recorded in these cases is of concern. Common systems for recording use and adverse outcomes of UoF techniques are needed to inform the public and others who have concerns about such techniques.

Antidepressant electroconvulsive therapy: mechanism of action, recent advances and limitations.

A considerable number of depressive patients do not respond to or remit during pharmacotherapeutical or psychotherapeutical interventions resulting in an increasing interest in non-pharmacological strategies to treat affective disorders. Electroconvulsive therapy (ECT) dates back to the beginning of modern biologic psychiatry and ongoing research has successfully improved efficacy in addition to safety while reducing side effects. Double-blind, randomized, controlled trials have shown powerful interactions between electrode placement (right unilateral, bifrontal, bitemporal) and dosage (relative to seizure threshold) in the efficacy and side effects of ECT. This review aims to summarize current research data on the mechanism of action, efficacy, and recent advances in ECT technique.

The use of electroconvulsive therapy in Latin America and the Caribbean

En 1995 la OPS/OMS llevó a cabo una encuesta postal para investigar las características del uso del tratamiento por electrochoques (TEC) en América Latina y el Caribe de habla inglesa y holandesa. Según los resultados de la encuesta, el uso del TEC difiere en las dos subregiones. La técnica se utiliza ampliamente en América Latina y solo esporádicamente en el Caribe. Asimismo, su uso varía dentro de cada país y ha sufrido cambios a lo largo del tiempo. Solamente la mitad de los países de América Latina tienen normas técnicas para la aplicación del TEC. La administración de anestesia y de relajantes musculares durante el mismo y la obtención de consentimiento informado todavía no son prácticas reglamentarias en las instituciones psiquiátricas de América Latina. La toma de medidas para subsanar estos déficit ayudará a borrar la estereotípica imagen negativa que esta intervención suele evocar

The use of electroconvulsive therapy in Latin America and the Caribbean

En 1995 la OPS/OMS llevó a cabo una encuesta postal para investigar las características del uso del tratamiento por electrochoques (TEC) en América Latina y el Caribe de habla inglesa y holandesa. Según los resultados de la encuesta, el uso del TEC difiere en las dos subregiones. La técnica se utiliza ampliamente en América Latina y solo esporádicamente en el Caribe. Asimismo, su uso varía dentro de cada país y ha sufrido cambios a lo largo del tiempo. Solamente la mitad de los países de América Latina tienen normas técnicas para la aplicación del TEC. La administración de anestesia y de relajantes musculares durante el mismo y la obtención de consentimiento informado todavía no son prácticas reglamentarias en las instituciones psiquiátricas de América Latina. La toma de medidas para subsanar estos déficit ayudará a borrar la estereotípica imagen negativa que esta intervención suele evocar