Electroconvulsive therapy plays an irreplaceable role in treatment of major depressive disorder

Major depressive disorder is a serious and common neuropsychiatric disorder that affects more than 350 million people worldwide. Electroconvulsive therapy is the oldest and most effective treatment available for the treatment of severe major depressive disorder. Electroconvulsive therapy modifies structural network changes in patients with major depressive disorder and schizophrenia. And it can also affect neuroinflammatory responses and may have neuroprotective effects. Electroconvulsive therapy plays an irreplaceable role in the treatment of major depressive disorder.     

Electroconvulsive therapy

Electroconvulsive therapy treatment for severely depressed adults is increasing because it economically and rapidly reduces symptoms in most patients. Improved administration and unilateral electrode placement have decreased complications. However, concern exists about cognitive and other adverse effects of electroconvulsive therapy. Nurses are in a critical position to educate patients about electroconvulsive therapy, to be advocates for patients' rights, and to monitor responses to treatment. Because both depression and electroconvulsive therapy may impair cognitive functioning, nurses should renegotiate patients' consent during electroconvulsive therapy. Nurses who know, research, and evaluate memory and confusion can effectively observe and diminish the side effects of electroconvulsive therapy.     

Electroconvulsive therapy as maintenance therapy and for prevention of recurrence in psychiatric disorders and Parkinson disease

Electroconvulsive therapy is a reliable and safe option for patients with psychiatric disorders who are resistant or intolerant to medication as these patients usually respond quickly to this form of treatment. For clinicians, the management of these often severely ill patients is an important challenge given the high rate of relapse of these disorders. Maintenance electroconvulsive therapy is an interesting treatment option for these patients. Until now, only few controlled studies exist about the long-term outcome of this treatment in depressive disorders and other psychiatric disorders. Altogether, this form of outpatient prophylactic therapy has been found to be safe, well tolerated, and efficacious in relapse prevention. Moreover, it has been found to reduce hospitalization rates. Particularly in the elderly, and in patients who have been shown to be refractory to medication regimens, maintenance electroconvulsive therapy should be seriously considered as a means to reduce the risk of recurrence of illness. In Parkinson's disease maintenance electroconvulsive therapy is not widely established although its usefulness has been documented in numerous studies. First-line evidence data on incidence, dimensions and outcome of cognitive side effects under maintenance electroconvulsive therapy is still warranted.     

Electroconvulsive therapy for phantom limb pain

Phantom limb pain is common in amputees. Although several treatments are available, a significant number of patients are refractory. Electroconvulsive therapy (ECT), which is usually given to patients with psychiatric disorders such as major depression, has shown efficacy in patients with a variety of pain syndromes occurring along with depression. Two patients are described herein with severe phantom limb pain refractory to multiple therapies, without concurrent psychiatric disorder, who received ECT. Both patients enjoyed substantial pain relief. In one case, phantom pain was still in remission 3.5 years after ECT. It is concluded that phantom limb patients who are refractory to multiple therapies may respond to ECT.     

Childhood depressive disorders.

About 5% of children and adolescents in the general population suffer from depressive disorders at any given point in time. Children under stress, those who experience loss, or children who have attention, learning, conduct, or anxiety disorders are at a higher risk for depressive disorders. Depressive disorders cause diminished quality of life and can ultimately affect mortality through increased risk of suicide and acts of violence. This article describes the incidence and prevalence of childhood depressive disorders, reviews the diagnostic criteria for and the symptom manifestations of depressive illnesses, and discusses recommended treatments.     

Electroconvulsive therapy: present and future

Electroconvulsive therapy (ECT) has been used to treat patients for 60 years. It is a humane and effective treatment. It is now firmly established as an important and effective method of treating certain severe forms of depression. Still, very little is known about its mode of action. Research in the refinement of administration has reduced undesirable side effects. There are almost no absolute contraindications to its administration. Nurses are involved directly with patients before, during, and after treatment.     

Molecular biology of depressive disorders

Heritability of major depression from twin studies is estimated as -40% that is relatively small as compared with -80% for schizophrenia and -90% for bipolar affective disorder. It suggests that genetic as well as environmental factors contribute to the aetiology of major depression. Approximately 800 association studies on candidate genes of depression have been published, and among them, several genes were confirmed as risk for vulnerability to major depression by meta-analyses. Recent investigations on pathophysiology of depression have focused on hippocampus as a modulator of Hypothalamus-Pituitary-Adrenal (HPA) glands axis. Molecular biological studies on the interaction between stress, hippocampus and HPA axis reveal glucocorticoid and brain-derived neurotrophic factor(BDNF) are key molecules developing and recovering from depressive disorder.     

家庭心理剧治疗对抑郁障碍患者家庭功能的影响

目的:探讨家庭心理剧治疗对改善抑郁障碍患者家庭功能的效果。方法:将符合入组标准的抑郁障碍患者51例随机分为研究组27例和对照组24例,均进行常规药物治疗和护理,研究组在此基础上进行家庭心理剧治疗。对两组完成研究的患者(各23例)进行家庭关怀度指数问卷(APGAR)测试、比较。结果:重复测量的方差分析,治疗因素对家庭关怀度指数中的适应度、合作度、成长度及APGAR总分存在主效应(P<0.05,P<0.01),时间因素对家庭关怀度指数各因子和总分存在主效应(P<0.01),治疗因素和时间因素对家庭关怀度指数中适应度、合作度、成长度及APGAR总分存在交互作用(P<0.05,P<0.01)。逐步回归分析显示,家庭心理剧治疗、治疗前家庭功能分数对家庭关怀度指数总分、适应度、合作度、成长度及情感度增加值具有预测作用(P<0.05,P<0.01),病程仅对亲密度具有预测作用(P<0.05)。结论:家庭心理剧治疗能够改善抑郁障碍患者的家庭功能和精神症状。     

Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy

Background

Mood and anxiety symptoms in chronic hepatitis C (CHC) may be related to the patient awareness of the diagnosis and prognosis, to side effects induced by interferon (IFN)-alpha treatment, as well as to substance abuse. However, the observation of metabolic alterations in patients with CHC has led to hypothesize a direct effect of hepatitis C virus (HCV) on brain function. This study was aimed at elucidating whether CHC is associated with specific anxiety or mood disorders independently of confounding factors.

Methods

Patient cohort: consecutive patients, 135 with CHC and 76 with chronic hepatitis B (CHB). Exclusion criteria: previous treatment with IFN-alpha, co-infection with HCV and hepatitis B virus, infection with human immunodeficiency virus, drug or alcohol abuse, or malignancies. Controls: subjects without evidence of hepatitis randomly extracted from the database of a previous epidemiological study; they were divided into two groups of 540 (332 males) and 304 (220 males) as controls for patients with CHC and CHB, respectively. The psychiatric diagnosis was formulated by means of the Composite International Diagnostic Interview Simplified carried out by a physician according to DSM-IV criteria.

Results

A higher lifetime prevalence of major depressive disorder (MDD) was observed among CHC compared to CHB or controls. The risk of MDD was not statistically different between CHB and controls. Both the CHC and CHB groups showed a significantly higher frequency of panic disorder when compared to controls. No statistical differences were observed in the prevalence of general anxiety disorder and social phobia when CHC or CHB were compared to controls.

Conclusion

The present study provides the first evidence of an association between CHC and MDD, diagnosed on the basis of well-defined international criteria. This association is independent of treatment with IFN-alpha and is not influenced by substance or alcohol abuse. By contrast, anxiety disorders do not appear to be specifically associated with CHC.

     

Electroconvulsive therapy: a review of the literature

Electroconvulsive therapy (ECT) is a procedure that has been used in the treatment of mental illness for over 60 years. Despite its continued use it remains a controversial treatment, with questions concerning its efficacy being raised not only by mental health professionals, but also service users themselves. The following article reviews the current literature on the administration and effectiveness of ECT, highlighting some of the main points of contention in the debate over its use. In providing a balanced review of the literature, this article aims to serve as an information source for nurses and other mental health professionals who may be involved in the administration of ECT and care of the patients receiving treatment.     

园艺治疗在精神科陪护病房抑郁障碍患者中的应用

目的探讨园艺治疗在精神科陪护病房抑郁障碍患者中的应用效果。方法将2018年1月至2019年10月我院收治的精神科陪护病房抑郁障碍患者60例作为研究对象,随机将其等分为对照组和研究组,对照组接受常规护理,研究组在对照组基础上联合实施园艺治疗。入院时及干预3个月后,比较两组患者SDS、SAS评分及希望量表、生活质量。结果研究组SAS,SDS评分显著低于对照组(P<0.05);研究组希望水平和生活质量评分高于对照组(P<0.05)。结论在精神科陪护病房抑郁障碍患者积极实施园艺治疗,有助于改善焦虑抑郁等负性情绪,提升生活质量及希望水平,对于改善预后具有重要价值。     

Attentional processes in depressive disorders

Theory and research in depression have recently emphasized that self-focused attention may be an important cognitive aspect of this disorder. Although previous research has demonstrated a relationship between self-focused attention and subclinical depression, empirical studies to date have not examined the occurrence of this process in clinically depressed individuals. Using a measure of state self-focused attention frequently employed in social-cognitive research on self-focused attention, the present study addressed this issue in a clinically depressed sample. Results indicated that depressed subjects evidenced significantly more self-focused attention than did a nondepressed control group. Moreover, the proportion of this attention that was personally unfavorable was also substantially greater in the depressed group. Results were discussed in terms of the manner in which increased self-focused attention might potentially be related to the onset and course of depression.Appreciation is expressed to the staff of the Department of Psychiatry at St. Paul-Ramsey Medical Center, St. Paul, Minnesota, for assistance in the collection of data for the present study.     

Epidemiology and comorbidity of depressive disorders

Recent epidemiological surveys in general populations of different countries of the world found lifetime prevalence rates of major depressions between 3.3% and 17%. For dysthymia (depressed mood over a period of at least two years with at least two concomitant depressive symptoms) the prevalence rate was found to be between 2% and 7%. The prevalence rates of major depressions and dysthymia are usually higher for females than for males. Bipolar disorders can be observed in about 1% of a general population over lifetime, and they seem to be somewhat more common among males than females. Divorced and separated persons have a higher risk of suffering from major depressions than married persons. Major depressions are thought to be more common among members of the lowest social class than among people belonging to the upper classes. Major depressions usually start between the age of 25 and 30 years, and the age of onset of bipolar disorders is between the age of 18 and 30 years. For western industrial nations a secular trend towards an increase in the prevalence of major depressions may be presumed. However, such a secular trend has not yet been confirmed, owing to biases associated with methodological problems. A notable comorbidity of major depressions can be observed with all anxiety disorders, obsessive-compulsive disorders, eating disorders, post-traumatic stress disorder, disorders of impulse control, abuse and dependence of alcohol and of other legal and illegal drugs, pathological gambling, migraine, fibromyalgia and irritable bowel syndrome. This observation has led to the concept of an "affective spectrum". This phenomenon has to be kept in mind during the diagnostic process and treatment.     

Electroconvulsive therapy in the management of chronic pain

Electroconvulsive therapy (ECT) is used predominantly to treat major depressive illness but has also been used for chronic pain. ECT causes a variety of neurochemical and neurophysiologic effects, some of which may interact with the pathophysiologic mechanisms in complex pain states. An extensive literature on the use of ECT in pain patients identifies subgroups for whom ECT may result in substantial pain relief. In this article, we review the literature on the use of ECT in pain patients, suggest possible neurobiologic bases for the efficacy of ECT in such patients, and conclude with our recommendations for current clinical practice.     

Comorbidity of headache and depressive disorders

The goal of the present study was to investigate the clinical profile of patients with primary headache syndromes who also suffer from mood disorders. Four-hundred-and-seventy headache outpatients (170M, 300F) and 150 age- and sex-matched healthy subjects were screened using a specific questionnaire that included the Hamilton rating scales for anxiety and depression. The average scores of the Hamilton rating scales for anxiety and depression were significantly higher in headache sufferers (17.4 and 14.2, respectively) than in healthy people (6.8 and 5.7, respectively). The frequency of headache attacks, the history of headaches, and gender (women more than men) were correlated with the score of the Hamilton rating scale for both anxiety and depression. Sixteen headache patients (3.4%) achieved the DSM-IV criteria for major depression or dysthymia versus one among headache-free subjects (0.6%; OR 5.2). Patients suffering from drug-overuse and migraine with aura showed the higher odds ratios (35 and 17, respectively). These results suggest that those headache patients with long history and high frequency of headaches, or patients suffering from migraine with aura and drug-overuse might benefit from psychiatric evaluation.