Journal of Ect最新文献

Somatic Symptom Disorder (SSD) is characterized by persistent, distressing somatic symptoms accompanied by disproportionate health-related cognitions and behaviors. Electroconvulsive therapy (ECT) has no established indication in SSD; however, isolated case reports have suggested potential benefit in severe, refractory presentations. We report a 46-year-old postmenopausal woman with severe, refractory SSD who failed to respond to 4 months of combined pharmacotherapy and cognitive-behavioral therapy. Three sessions of bifrontotemporal ECT produced a striking symptomatic response, with her Somatic Symptom Scale-8 (SSS-8) score declining from 18 (severe) to 3 (minimal), a reduction sustained at follow-up. ECT was well tolerated. We discuss putative neurobiological mechanisms, including ECT-mediated changes in limbic and prefrontal circuits implicated in SSD pathophysiology. This case supports consideration of ECT in treatment-refractory SSD and highlights the need for systematic investigation of its efficacy and optimal parameters in this population.

Electroconvulsive therapy (ECT) can provoke a brief parasympathetic surge, commonly causing transient sinus bradycardia or a short sinus pause. Most events last only seconds and resolve without intervention. Rarely, however, bradyarrhythmia or asystole may persist long enough to threaten cerebral perfusion, requiring anesthesia teams to respond immediately. We report the case of a male patient with treatment-resistant major depressive disorder who underwent bilateral ECT under methohexital and succinylcholine. Baseline sinus bradycardia was present at 47 beats per minute. Immediately after the ECT stimulus, the monitor demonstrated high-grade atrioventricular block that progressed to ventricular asystole with a flat plethysmographic waveform. Within 10 to 15 seconds, while glycopyrrolate and epinephrine were being prepared, percussion pacing was delivered using the ulnar aspect of a closed fist over the left lower sternal edge at ∼ the fourth-to-fifth intercostal space. Each blow produced a QRS complex on electrocardiography and a pulsatile deflection on the plethysmogram. An organized intrinsic rhythm returned after 3 impulses. The patient recovered uneventfully, and subsequent ECT sessions were preceded by prophylactic intravenous glycopyrrolate without recurrence. This case describes percussion pacing as an immediately deployable, equipment-free bridge within the cardiovascular rescue strategy for ECT services, with a low threshold to escalate to chest compressions and advanced cardiac life support.

Background: Electroconvulsive therapy (ECT) is effective for severe psychiatric disorders, but relapse after a successful acute course of ECT remains common. Identification of biological predictors of relapse is therefore clinically important. In this exploratory prospective study, we investigated changes in inflammatory and neurogenesis-related biomarkers following an acute course of ECT, and examined their association with relapse during 1-year follow-up.

Methods: Enrolled were 30 patients with major depressive disorder, bipolar disorder, or schizophrenia spectrum disorders who received their first acute course of bitemporal ECT. Clinical assessments and venous blood sampling were conducted before and after the ECT course. We measured serum inflammatory markers, anti-inflammatory factors, and brain-derived neurotrophic factor (BDNF). Relapse was prospectively evaluated using monthly Clinical Global Impression-Severity assessments over 1 year. Repeated-measures analyses were performed to examine biomarker changes and their interaction with relapse status.

Results: Following the acute ECT course, 48.1% of patients achieved remission, and 37.0% experienced relapse during 1-year follow-up. ECT was associated with a significant decrease in serum soluble interleukin-2 receptor levels and significant increases in eicosapentaenoic acid and docosahexaenoic acid, indicating an anti-inflammatory effect. Notably, serum BDNF levels increased in the nonrelapse group but decreased in the relapse group, with a significant time-by-relapse interaction.

Conclusion: An acute course of ECT is associated with anti-inflammatory biological changes and differential modulation of serum BDNF. Increases in BDNF after ECT may be linked to a reduced risk of relapse, suggesting that serum BDNF could be a potential prognostic biomarker for long-term outcomes following ECT.

Background: Electroconvulsive therapy (ECT) is among the most effective treatments for severe and treatment-resistant psychiatric disorders but remains underused in many low- and middle-income countries because of limited training and negative attitudes. To our knowledge, no previous study has examined psychiatrists' knowledge of, experience with, and attitudes toward ECT in Central Asia.

Methods: We conducted a cross-sectional anonymous survey of psychiatrists in Uzbekistan. A 33-item questionnaire assessed knowledge, clinical exposure, and attitudes toward ECT across age groups and psychiatric diagnoses. Group comparisons were performed using Kruskal-Wallis and χ2 tests. Multivariable logistic and linear regression analyses identified independent predictors of favorable attitudes and ECT knowledge.

Results: Of 212 respondents (response rate 37.6%), 44.3% reported no previous ECT exposure. Misconceptions were common: 19.8% believed ECT is administered without anesthesia, 39.6% believed psychiatric medications should be discontinued before treatment, and 65.1% considered pregnancy a contraindication. Restrictive attitudes toward ECT in children and older adults were also common. Direct clinical and indirect ECT exposure were independently associated with greater knowledge and more favorable attitudes. Rural practice location and exclusive child and adolescent practice independently predicted lower knowledge, whereas female psychiatrists were less likely to recommend ECT as a treatment option for a friend or relative.

Conclusions: Psychiatrists in Uzbekistan reported limited ECT training and experience, substantial knowledge gaps, and restrictive attitudes toward ECT. Clinical exposure was the strongest independent predictor of greater knowledge and more favorable attitudes, supporting the importance of expanding supervised ECT training and educational opportunities.

Objectives: Treatment-resistant depression (TRD) is highly prevalent and debilitating. Electroconvulsive therapy (ECT) is an efficacious intervention for TRD. This study sought to clarify ECT's mechanisms by examining relationships between ECT-induced changes in regional brain volume and in peripheral inflammatory markers in TRD, and associations between these structural neural changes and clinical outcomes.

Methods: Volume/thickness of 8 corticolimbic regions of interest (ROIs) were identified before and after index series ECT in n=44 TRD subjects. Changes in ROI size were assessed using MANCOVA in TRD compared with healthy controls. Regressions within TRD then assessed ROI changes in association with changes in IL-6 and CRP, and changes in symptoms of depression.

Results: Following ECT, the bilateral hippocampus, amygdala, striatum, and ACC, and left insula, DLPFC, and DMPFC, were found to be increased in TRD relative to baseline. Within TRD, these increases were not associated with any longitudinal changes in inflammatory markers that occurred during the course of treatment. Increases in the hippocampus, DLPFC, DMPFC, and OFC predicted improvement in affective symptoms of depression. Increased DLPFC thickness also predicted improvement in cognitive symptoms of depression.

Conclusions: Although we previously found that changes in inflammatory measures were associated with changes in affective and cognitive symptoms of depression, just as DLPFC and DMPFC increases were, these biomarkers were not associated with each other. It is possible that these processes relate to clinical effects of ECT through independent or distally related means, although further research is required.

Electroconvulsive therapy (ECT) is typically performed under general anesthesia without a secured airway, placing patients with retained gastric contents at increased risk of aspiration. As more patients present for ECT while taking GLP-1 receptor agonists, standard fasting requirements pose unique safety and patient-experience challenges. A 24-hour clear-liquid diet every other day is burdensome, while frequent rapid sequence intubations may prolong treatment and recovery. To address this, ECT and anesthesia leadership developed a novel pre-ECT fasting protocol for patients on GLP-1 RAs. We report a patient with refractory major depressive disorder on tirzepatide who successfully completed 17 ECT treatments without complications.

Catatonia is a neuropsychiatric syndrome that may complicate medical and surgical conditions but is often underrecognized, particularly in patients with intellectual disability. Electroconvulsive therapy (ECT) is an established treatment for benzodiazepine-resistant catatonia, although seizure induction can be difficult in some cases. We report a 52-year-old man with intellectual disability who developed postoperative catatonia after laparoscopic pancreaticoduodenectomy for insulinoma. Despite prolonged agitation, echolalia, mutism, rigidity, and catalepsy, catatonia was not recognized at multiple hospitals, and he was repeatedly discharged without appropriate treatment. After transfer to our facility, catatonia was confirmed. Because of recurrent aspiration pneumonia and oversedation with lorazepam, ECT was initiated promptly. Seizure induction was exceptionally difficult. Bilateral electrode placement with standard pulse width required escalation to the maximum charge output (200%, 1008 mC), and adequate seizures remained inconsistent. Sequential modifications included right unilateral electrode placement, ultrabrief pulse width, and later extension of pulse width to 1.50 ms at 50 Hz. Even then, consistent seizure induction was not achieved until the anesthetic was changed from propofol to thiamylal and flumazenil pretreatment was added, which suggests a synergistic effect of extended pulse width with right unilateral electrode placement, together with thiamylal and flumazenil. This case underscores that catatonia in patients with acute medical illness or intellectual disability is easily overlooked and that delayed recognition can result in serious medical complications; early diagnosis and prompt treatment are therefore essential. It further suggests that multimodal optimization of ECT parameters and anesthetic management may be required for reliable seizure induction in refractory cases.