Electroconvulsive Therapy in Geriatric Patients Undergoing Anticoagulation Therapy

Antidepressant treatment of the depressed geriatric patient can be complicated by concomitant medical illness. We report the successful administration of electroconvulsive therapy (ECT) in three depressed geriatric patients who received the oral anticoagulant warfarin (Coumadin) for cardiovascular disease. The physiologic changes associated with modified ECT and risk factors for intracerebral hemorrhage in patients receiving anticoagulants are discussed.     

Age-Related Changes in Cardiovascular Function Associated with Electroconvulsive Therapy

The relationship between hemodynamic changes induced by electroconvulsive therapy (ECT) and age was studied in 13 patients. Their average age was 43 years (range 20-64 years). Heart rate, arterial blood pressure, and rate-pressure product (RPP) all increased significantly following ECT. There was an inverse relationship between age and the magnitude of the chronotropic response, the percentage increase in diastolic and mean arterial blood pressure, and the RPP. Duration of the electroencephalographic and motor seizures was also inversely related to age.     

Electroconvulsive Therapy in Patients with Cerebral Palsy

Recent reviews attest to the safety and efficacy of electroconvulsive therapy (ECT) in psychiatrically ill patients with concomitant neurologic disease. Four patients with mood disorders and cerebral palsy are described who achieved a therapeutic response with ECT without neurologic deterioration. ECT is safe in the treatment of mood disorders in patients with cerebral palsy.     

Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression

This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: “electroconvulsive elderly,” “electroconvulsive geriatric,” “ECT and elderly,” and “ECT elderly cognition.” The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.     

The Effects of Baseline Impaired Global Cognitive Function on the Efficacy and Cognitive Effects of Electroconvulsive Therapy in Geriatric Patients: A Retrospective Cohort Study

ObjectivesThis study explores the association between baseline impaired global cognitive function and changes in global cognitive function and depression among geriatric patients undergoing acute course electroconvulsive therapy (ECT).DesignRetrospective cohort study.SettingSingle freestanding psychiatric hospital.ParticipantsPatients aged 50 and older receiving ECT.Interventions10 ECT treatments.MeasurementsCognitive assessments with the Montreal Cognitive Assessment (MoCA). Depression assessment with the Quick Inventory of Depressive Symptomatology Self Report 16 item scale (QIDS).ResultsBaseline and follow-up data were available for 684 patients. On average, patients with baseline normal cognition (MoCA ≥26; N = 371) had a decrease in MoCA of -1.44±0.26 points over the course of treatment, while those with baseline impaired global cognitive function (MoCA <26; N = 313) had an increase in MoCA of 1.72±0.25 points. Baseline cognitive status was not associated with a differential response on the QIDS.ConclusionsPatients with baseline impaired global cognitive function did not demonstrate a worsening in cognition following ECT, and baseline global cognitive function was not associated with a differential change in depression with ECT. These results suggest that impaired global cognitive function should not be viewed as a contraindication to ECT in geriatric patients.     

Cardiovascular Response and Anesthetic Recovery in Electroconvulsive Therapy with Propofol or Thiopental

Propofol provokes a slight hypotensive effect that could mitigate the cardiovascular response to electroconvulsive therapy (ECT). In this study we compared the effects of propofol and thiopental for ECT anesthesia in seven women (22-67 years of age). Anesthesia was induced with either thiopental or propofol, and with atropine and suxamethonium for each treatment. The first anesthesia was assigned to thiopental or propofol at random; the next anesthesia was induced with the other drug, and alternated thereafter. Systolic blood pressure, diastolic blood pressure (DBP), and heart rate (HR) were recorded before anesthesia, after anesthetic induction, and 1 and 5 min after ECT. ECT-induced increases in DBP and HR were less marked with propofol than with thiopental. Seizure durations were decreased with propofol compared with thiopental.     

Age-Dependent Effects of Electroconvulsive Therapy on Memory

We examined the relation between age and recovery of memory functions after electroconvulsive therapy (ECT). In a group of patients 20-65 years of age, older depressed patients treated with ECT experienced more severe and longer lasting memory deficits than did younger patients. Testing conducted 24-72 h after a course of ECT showed more severe deficits in older patients for verbal and visuospatial anterograde memory, and for retrograde memory. The difference between younger and older subjects was marginal at 1 month follow-up, seen only in differences in verbal anterograde memory. At 6 months follow-up, no difference in memory test scores between older and younger patients was observed. Older patients are more vulnerable to cognitive effects of ECT, and these effects last longer.     

Informing Patients About Electroconvulsive Therapy: Effects of a Videotape Presentation

Issues of information given for consent purposes are particularly problematic with electroconvulsive therapy (ECT). The authors investigated the efficacy of an informative videotape recording in this process. The videotape contained factual information about ECT, an interview with a patient before and after treatment, and the presentation of an actual treatment. A patient group assigned to watch the videotape, in addition to the usual consent process involving written and verbal information from the treating resident psychiatrist, showed only one postconsent difference from a group that had the usual consent process without the videotape. Those who saw the videotape were less sure that they had adequate information to decide whether to have ECT than those who did not see it (p < 0.05). Although patients likely to benefit from such an audiovisual approach may be identifiable, it seems that an informative videotape offers no universal advantage over more conventional information giving in the consent process.     

Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients

Knowledge about cognitive side-effects induced by electroconvulsive therapy (ECT) in depressed elderly patients is sparse. In this study we investigated changes in the cognitive functioning of non-demented elderly depressed patients receiving ECT (n = 62) compared with healthy elderly people (n = 17). Neuropsychological tests were administered at the start of treatment and again within 1 week after treatment. We computed reliable change indices (RCIs) using simple regression methods. RCIs are statistical methods for analyzing change in individuals that have not yet been used in studies of the acute cognitive side-effects of ECT. At the group level, only letter fluency performance was found to be significantly reduced in the ECT group compared with the controls, whereas both groups demonstrated stable or improved performance on all other measures. At the individual level, however, 11% of patients showed retrograde amnesia for public facts post-ECT and 40% of the patients showed a significant decline in neuropsychological functioning. Decline on a measure of delayed verbal anterograde memory was most common. Our findings indicate that there are mild neurocognitive impairments in the acute phase for a substantial minority of elderly patients receiving ECT. Analysis of reliable change facilitated the illumination of cognitive side-effects in our sample.     

Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study

ObjectiveThere is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study.MethodsElderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05.ResultsA total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest.ConclusionThis is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.     

Intraocular Pressure Changes in Nonglaucomatous Patients Undergoing Electroconvulsive Therapy

Before, during, and after electroconvulsive therapy (ECT), intraocular pressure (IOP) was evaluated in ten patients with a negative history for ocular disease. IOP values were obtained using an applanation tonometer. IOP increased dramatically, returning to baseline within 90 s after completion of seizure activity. We conclude that the magnitudes of the IOP elevation, although not hazardous in nonglaucomatous eyes, could possibly compromise ocular functioning in patients with severe glaucoma despite the transient nature of this relative increase in IOP.     

Electroconvulsive Therapy in the Treatment of Episodic Aggressive Dyscontrol in Psychotic Patients

Five patients with chronic psychosis and episodic aggressive dyscontrol were treated with electroconvulsive therapy (ECT). Four patients also demonstrated clinical evidence of seizure disorder. ECT resulted in marked reduction of both episodic aggressive dyscontrol and clinical seizures, with modest improvement of psychosis. No patient developed clinical signs of organic brain syndrome during ECT. Albeit in a small number of patients, our findings indicate that ECT may have short-term therapeutic effects on episodic aggressive dyscontrol in patients with chronic psychoses.     

Potential Mechanisms Underlying the Therapeutic Effects of Electroconvulsive Therapy

In spite of the extensive application of electroconvulsive therapy(ECT), how it works remains unclear.So far, researchers have made great efforts in figuring out the mechanisms underlying the effect of ECT treatment via determining the levels of neurotransmitters and cytokines and using genetic and epigenetic tools, as well as structural and functional neuroimaging. To help address this question and provide implications for future research, relevant clinical trials and animal experiments are reviewed.     

Biogenic Amine Metabolites During Electroconvulsive Therapy of Melancholic Patients

We assayed the urinary neurotransmitter metabolites 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 5-hydroxy-indoleacetic acid (5-HIAA) in unipolar depressed patients before and after a simulated electroconvulsive therapy ECT (SECT), and during course of 10 ECT sessions. A repeated measures analysis of variance (ANOVA) showed no significant changes in the three-metabolite excretion during the course of ECT. Planned comparisons performed after ANOVA revealed a trend for HVA and 5-HIAA levels to increase after SECT and a significantly higher MHPG excretion after the 10th ECT session. Seven depressed patients who responded favorably to ECT (reduction in Hamilton Rating Scale for Depression score of 50% or more) but not the seven nonresponders had significantly higher MHPG excretion after the final ECT compared to baseline levels. A significant relationship was found between low pretreatment MHPG excretion and therapeutic response.     

急性脑血管病心律失常的观察

目的观察不同类型急性脑血管病患并发心律失常情况,分析QTc间期与心律失常关系。方法用TCL-98-24小时动态心电图仪对82例脑血管病住院患进行动态心电图观察,分析心律失常发生率、类型及其与脑卒中的关系。结果82例(100％)均发生心律失常;室上性快速心律失常20例,52例(63．41％)出现严重心律失常,致命性室心律失常42例次;同一病例发生两种及两种以上心律失常的患共22例(26．83％);27例患长QT间期综合征(LQTS)患,25例(92．59％)发生严重心律失常。结论急性脑血管病患心律失常发生率非常高,特别是严重心律失常;建议在治疗原发病同时,常规做动态心电图检查或心电监护,特别是出现长QT间期综合征时,加强对心律失常的诊治。     

Electroconvulsive Therapy in Patients at High Risk for Physical Complications

Nineteen patients had unrelieved incapacitating or life-threatening conditions likely remediable with electroconvulsive therapy (ECT). They also had coexisting medical conditions originally judged to preclude ECT because it risked unacceptable complications. ECT was administered with attempts to prevent complications, although some procedures were canceled for medical reasons. Fourteen of 19 patients completed their course of ECT; one patient died. Sixteen of 19 patients returned to baseline functioning and were discharged. Judicious attempts to treat such high-risk patients with ECT yield therapeutic gains.