Electroconvulsive therapy in pregnant patients

Objectives

In this study, the aim was to evaluate the clinical characteristics of patients that received electroconvulsive therapy (ECT) during pregnancy due to psychiatric disorders, evaluate the safety and efficacy of ECT in pregnant women, and evaluate the overall status of mothers and babies during the postpartum period.

Methods

The study included 33 patients who were admitted as inpatients with the indication of ECT due to pregnancy and concurrent psychiatric disorders.

Results

Upon ECT administration, a complete response to treatment was seen in 84.21% of patients with major depression (n= 16), a partial response to treatment in 15.78% of patients (n= 3), a complete response to treatment in 91.66% of patients with bipolar disorder (n= 11), a partial response to treatment in 8.33% of the patients(n= 1), and a full response to treatment in 50% of patients with schizophrenia (n= 1) and a partial response to treatment in 50% of patients with schizophrenia (n= 1) were obtained. We had after birth information of 27 infants from total 33. It was learned that two of them had disease, one was stillbirth and 24 of them did not have any health problems.

Conclusions

ECT administration during pregnancy to treat psychiatric disorders was found to be an effective treatment method. No risk of preterm birth in mothers treated with ECT during pregnancy was detected.     

Electroconvulsive therapy-induced Wolff–Parkinson–White syndrome: a case report

Objective

Wolff–Parkinson–White (WPW) syndrome is characterized by premature ventricular excitation due to the presence of an abnormal accessory pathway. Electrocardiography (ECG) of patients with WPW syndrome portrays a short PR interval and a wide QRS interval with a delta wave.

Methods

Herein, we report the case of a patient with schizophrenia who developed a wide QRS interval with a delta wave immediately following electroconvulsive therapy (ECT).

Results

Initially, the delta wave disappeared within 2 days after ECT. However, the duration of the delta wave increased exponentially to 4 months when ECT was repeated.

Conclusion

Although the patient's cardiocirculatory dynamics remained normal, we continued to monitor her ECG until the delta wave disappeared because WPW syndrome can lead to serious arrhythmia.     

Paranoid psychosis and cognitive impairment associated with hepatitis C antiviral therapy

Objective

To report a case of paranoid psychosis and cognitive impairment associated with Hepatitis C virus (HCV) antiviral therapy.

Methods

Case report.

Results

A 55-year-old male presented with paranoid psychosis and cognitive impairment, 4 months after initiating interferon-based HCV antiviral therapy. His psychosis resolved with discontinuation of therapy and initiation of risperidone, but his cognitive impairment persisted. His psychosis also re-emerged months later when attempting to titrate down his risperidone. Brain MRI demonstrated bilateral asymmetric subcortical and deep white matter changes, which were non-specific but may have rendered him susceptible to neuropsychiatric sequelae of antiviral therapy.

Conclusion

This case emphasizes the importance of neuropsychiatric screening and monitoring of patients being treated with interferon-based therapy for HCV, particularly if there is evidence of previous neurologic disease.     

Diabetes and life-long cognitive ability

Objectives

There is a widespread consensus that diabetes impairs cognitive functioning. However, some recent findings have shown that many health conditions generally thought to be detrimental to cognitive functioning are in fact linked to pre-morbid cognitive ability, suggesting reverse causation. To better understand the causality in diabetes–cognition relationship, this study investigates the association of older-age diabetes with concurrent and childhood cognitive functioning.

Methods

Lothian Birth Cohort 1936 participants (N = 1017) completed the same general cognitive ability test at ages 11 and 70 years. Scores were compared between those with and without diabetes at age 70. Diabetes status was based on self-reports and haemoglobin A1c levels.

Results

People with diabetes had lower mean cognitive ability scores at ages 11 and 70 when compared with those without diabetes. The effect size was roughly similar at both ages (Cohen's d ≈ 0.32). When adjusted for age-11 cognitive ability, diabetes status was not associated with cognitive ability at age 70. The association between childhood cognitive ability and older-age diabetes was partly accounted for by body mass index and cholesterol level in older-age.

Conclusion

In this sample, diabetes was associated with poorer cognitive ability in old age but this was because of life-long lower cognitive ability in people with diabetes instead of diabetes impairing cognitive functioning.     

Linear and non-linear EEG analysis of adolescents with attention-deficit/hyperactivity disorder during a cognitive task

Objective

We aimed to investigate whether electroencephalograph (EEG) dynamics differ in adolescents with attention-deficit/hyperactivity disorder (ADHD) compared with healthy subjects during the performance of a cognitive task.

Methods

We recorded EEGs from 19 scalp electrodes in 11 adolescent boys with ADHD and 12 age-matched healthy boys while the subjects were at rest and during a continuous performance test (CPT). The approximate entropy (ApEn), a non-linear information-theoretic measure, was calculated to quantify the complexity of the EEGs.

Results

The mean ApEn of the ADHD patients was significantly lower than the healthy subjects over the right frontal regions (Fp2 and F8) during the performance of the cognitive task, but not at rest. The spectral analysis showed significant differences between the two groups in the P3 and T4 regions at rest and the Fp2 and F8 regions during task performance.

Conclusions

The differences in EEG complexity between the two groups suggest that cortical information processing is altered in ADHD adolescents, and thus their levels of cortical activation may be insufficient to meet the cognitive requirements of attention-demanding tasks.

Significance

This study suggests that a non-linear measure such as ApEn is useful for investigating neural dysfunctions in adolescents with ADHD.     

Imagerie cérébrale et lithium

Objectives

Recent neuroimaging techniques like MRI, allow a better understanding of the mechanism of action of lithium. In this article, we summarize the main results about neuroimaging and lithium in bipolar disorder.

Methods

We selected relevant literature about brain imaging and lithium action in bipolar disorder.

Results and conclusions

Brain imaging studies bring evidence that lithium therapeutic effect is associated with a neurotrophic effect, especially in the grey matter and the hippocampus. They also raise hopes that we may in the future use brain imaging to measure directly brain lithium concentrations with spectroscopy and to help the clinician predict the response to lithium.     

Adverse childhood experiences worsen cognitive distortion during adult bipolar depression

Background

Cognitive distortion is a central feature of depression, encompassing negative thinking, dysfunctional personality styles and dysfunctional attitudes. It has been hypothesized that ACEs could increase the vulnerability to depression by contributing to the development of a stable negative cognitive style. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and cognitive distortion, and whether any gender differences exist.

Aim

The aim of this study was to examine the association between ACEs and cognitive distortions and possible differences between genders in a sample of patients affected by bipolar disorder.

Method

130 patients with bipolar disorder (BD) (46 men and 84 females), completed the Risky Family Questionnaire to assess ACEs and the Cognition Questionnaire (CQ) to assess cognitive distortions.

Results

A positive association was found between ACE and the CQ total score. Investigating the 5 dimensions assessed through the CQ, only the dimension “generalization across situations” was significantly associated to ACE. An interaction between ACE and gender was found for “generalization across situations”, while no differential effect among females and males was found for CQ total score.

Conclusion

This is the first study to report a relationship between negative past experiences and depressive cognitive distortions in subjects affected by BD. Growing in a family environment affected by harsh parenting seems to a cognitive vulnerability to depression; this effect is especially strong in females.     

Paliperidone-associated motor tics

Objectives

Paliperidone-associated motor tics.

Method

Case report.

Results

We report a 30-year-old man with schizophrenia who developed motor tics (eye blinking) after treatment of paliperidone up to 15 mg daily.

Conclusion

Tic-like symptoms, from simple eye blinking to complex Tourette-like syndrome, may occur during paliperidone treatment, especially with high dose.     

Psychosis in a cocaine-dependent patient with ADHD during treatment with methylphenidate

Objective

The objective was to report a case of experienced psychosis during the treatment with methylphenidate (MPH) in a cocaine-dependent adult treated for attention-deficit/hyperactivity disorder (ADHD) with comorbid cocaine dependence.

Conclusion

ADHD is a frequent comorbidity in substance use disorder (SUD) patients. MPH may be effective in treating ADHD symptoms in SUD patients, thus preventing possible adverse outcomes. Cocaine-induced psychosis may be a risk factor for development of psychosis in the presence of a concurrent treatment with MPH.     

Effects of 3 different stimulus intensities of ultrabrief stimuli in right unilateral electroconvulsive therapy in major depression: A randomized, double-blind pilot study

Objective

Efficacy and cognitive outcome of ECT is depending on electrode placement, pulse width and electrical dosage. Several studies showed that high-dosage right unilateral ECT (RULECT) had a better antidepressant effects than low-dosage RULECT and less cognitive side effect than bilateral stimulation. In this prospective, randomized, double-blind trial, we examined the efficacy and cognitive side effects of RULECT with three different (high dose) stimulus intensities (4×, 7× and 10× above the seizure threshold (ST)).

Methods

41 patients with treatment resistant unipolar or bipolar depression were randomized to one of the three stimulation intensities. For stimulation, we used an ultrabrief pulse (0.3 ms). Primary outcome measures were reduction of the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and the response rate (50% reduction of the HDRS) in the three groups. For cognitive side effects, a neuropsychological test battery was assessed.

Results

All three groups responded significantly to 9 ECTs (p < 0.005), but there were no statistical significant differences in the response rates between the three intensity groups. Besides of the Verbal Learning Memory Recognition Test (VLMT), which showed significant impairments in the high dose intensity groups, no differences could be shown between the three study groups in all neuropsychological tests.

Conclusion

A RULECT with ultrabrief pulse stimulation and 4× ST intensity is effective and from good tolerability. Higher intensity dosages seem to be associated with more cognitive side effects during a course of acute ECT treatment.     

Does photoparoxysmal response in children represent provoked seizure? Evidence from simultaneous motor task during EEG

Objectives

Acute cognitive changes during epileptiform discharges have been studied using computer assisted cognitive tasks. We aimed to demonstrate acute behavioral change (using a simple motor response task MRT) during photoparoxysmal response (PPR) in children below 18 years.

Methods

Children performed a simple repetitive motor task during intermittent photic stimulation (IPS). All episodes of PPR not associated with obvious clinical change (as observed by the technologist or reported by the patient) were analyzed for this study. The average time interval between two successive motor responses across a PPR (test time) was compared to the average time interval between two successive motor responses during IPS not associated with PPR (control time) using Wilcoxon signed ranks test.

Results

21 children who had PPR successfully completed the MRT. The difference between the mean durations was 0.894 s (p = 0.002). More than 50% increase compared to the control time was considered a delay in MRT during PPR. 10 children showed slowing of MRT during PPR.

Conclusion

By definition, acute behavioral change during generalized epileptiform discharges represent provoked seizures. Detecting subclinical seizures can have important safety implications in children (skiing, skating and driving) with PPR on EEG, but no clinical seizures. We recommend MRT during IPS.     

Association between asymptomatic carotid stenosis and cognitive function: A systematic review

Background

Asymptomatic carotid stenosis (CS), traditionally considered clinically silent, may be an independent risk factor for a cognitive impairment.

Methods

To determine whether an association exists between asymptomatic CS and cognitive function, we systematically reviewed the literature in the Cochrane Library, MEDLINE, EMBASE and the China National Knowledge Infrastructure databases.

Results

A total of 8 cross-sectional studies and 2 community-based cohort studies were included, comprising 763 participants in the CS group and 6308 participants in the non-CS group. All but one study supported the association between asymptomatic CS and cognitive impairment. Pooled analysis identified older age (2 studies) and cerebral hypoperfusion (2 studies) as additional factors in patients with asymptomatic CS that may linked to cognitive decline.

Conclusions

These results suggest that rather than being clinically silent, asymptomatic CS may be associated with cognitive impairment, and this should be further investigated in high-quality studies.     

Indications curative et préventive dans le trouble bipolaire

Objectives

The efficacy of lithium in bipolar disorder is widely accepted for many years. It is still considered as the gold standard in most international guidelines. Lithium is indicated in the treatment of mania, of depressive episodes and in the prevention of mania and depression. The objective of this paper is to focus on scientific data supporting the interest of lithium in the management of bipolar disorder.

Methods

A Medline search of papers published between 1950 and 2013 and focusing on the efficacy of lithium in bipolar disorder was performed. The content of this paper was mainly based on the most recent studies comparing lithium to placebo and to new drugs potentially effective in the treatment of bipolar disorder.

Results

This review shows that the evidence is strong in the treatment of mania and in the prevention of recurrences. The results in the treatment of depression are more conflicting. Some studies suggested both positive and negative predictors of response to lithium in the treatment of mania. The serum-lithium level associated with an optimal preventive effect against manic and depressive recurrence is probably between 0,6 and 0,8 mEq/L.

Conclusion

Today, there is no doubt about the efficacy of lithium in the treatment of mania and in the prevention of mania and depression.     

Mindfulness-based cognitive therapy (MBCT) for patients with medically unexplained symptoms: Process of change

Background

A recent randomized controlled trial provided preliminary evidence for the effectiveness of mindfulness based cognitive therapy (MBCT) for the top 10% frequent attenders in primary care with persistent medically unexplained symptoms (MUS). This qualitative study aims to explore working mechanisms and possible barriers of MBCT in this population.

Methods

Twelve participants of the trial were interviewed about their experiences. This was done before and after the MBCT course, and 12 months later. Written evaluations of participants and notes of participant observers were used for data-triangulation.

Results

In total, 35 qualitative interviews were conducted. MBCT initiated a process of change, starting with awareness of the present moment, the associated sensory experiences, thoughts and emotions and accepting rather than resisting these. Participants started to recognize their own behavioral patterns and change them, thus improving self-care. Self-compassion seemed to result from and facilitate this process. Main barriers were concurrent social problems and the inability or unwillingness to accept symptoms.

Conclusions

MBCT can start a process of change in patients with persistent MUS. Awareness and acceptance of painful symptoms and emotions are key factors in this process. Change of unhelpful behavioral patterns and increased self-care and self-compassion can result from this process.     

Cognition and communication dysfunctions in early-onset schizophrenia: Effect of risperidone

Background

Cognitive impairment and formal thought disorder, also referred to as communication disturbances, are considered the core symptoms of schizophrenia, strongly affecting social functioning and long-term outcome. Several studies in adult patients suggest improvement of both functions after the treatment with atypical antipsychotic drugs. Such medications are also used as first line treatment in early-onset schizophrenia, however their efficacy in cognitive and communication domains in this population have not been systematically assessed.

Aim of the study

Evaluation of risperidone efficacy at psychopathological symptoms, cognitive impairment and formal thought disorder in adolescents with schizophrenia spectrum diagnosis.

Material and method

Psychopathological symptoms, cognitive functioning and formal thought disorder were evaluated in 32 hospitalized adolescent patients with schizophrenia spectrum diagnosis at the beginning of risperidone treatment and after clinical improvement and compared to the results of matched healthy control group.

Results

Risperidone treatment was associated with reduction of symptom severity and moderate improvement of formal thought disorder and some aspects of executive functions. Working memory and verbal fluency were not improved. There were few correlations between psychopathological symptoms and results of cognitive tests, mainly between negative symptoms and executive functions.

Discussion

In early-onset schizophrenia spectrum disorders atypical antipsychotic treatment is associated with alleviation of symptoms and only selective and moderate cognitive and communication improvement.     

Successful measurement of the mismatch negativity despite a concurrent movie soundtrack: Reduced amplitude but normal component morphology

Objective

To examine the mechanisms responsible for the reduction of the mismatch negativity (MMN) ERP component observed in response to pitch changes when the soundtrack of a movie is presented while recording the MMN.

Methods

In three experiments we measured the MMN to tones that differed in pitch from a repeated standard tone presented with a silent subtitled movie, with the soundtrack played forward or backward, or with soundtracks set at different intensity levels.

Results

MMN amplitude was reduced when the soundtrack was presented either forward or backward compared to the silent subtitled movie. With the soundtrack, MMN amplitude increased proportionally to the increments in the sound-to-noise intensity ratio.

Conclusion

MMN was reduced in amplitude but had normal morphology with a concurrent soundtrack, most likely because of basic acoustical interference from the soundtrack with MMN-critical tones rather than from attentional effects.

Significance

A normal MMN can be recorded with a concurrent movie soundtrack, but signal amplitudes need to be set with caution to ensure a sufficiently high sound-to-noise ratio between MMN stimuli and the soundtrack.     

Reduced functional connectivity in visual evoked potentials in children with autism spectrum disorder

Objective

An analysis of EEG synchrony between homologous early visual areas tested the hypothesis that interhemispheric functional connectivity during visual stimulation is reduced in children with autism compared to controls.

Methods

EEG power and coherence within and between two homologous regions of the occipital cortex were measured during long latency flash visual evoked potentials. Measures were compared between two groups of children (5.5–8.5 years), one with autism spectrum disorders and the other with typical development.

Results

In and below the theta band, interhemispheric synchrony was reduced in autistic subjects compared to typical controls by as much as 50%. Above the theta band interhemispheric synchrony in autistic children became indistinguishable from what would occur for uncorrelated cortical activity. Interhemispheric synchrony in autistic subjects was decreased in spite of bilaterally increased power. Wavelet power showed autistic children had a more rapid initial response to stimulation, a slower recovery, and more modulation at longer latencies.

Conclusions

Results suggest that the sensory cortices of autistic children are hypersensitive to stimulation with concurrent diminished functional connectivity between hemispheres.

Significance

Simultaneously increased intrahemispheric power and decreased interhemispheric synchronization of elemental visual information suggests either that power increases cause poor interhemispheric connectivity or that processes, such as thalamocortical regulation, impact power and coherence independently.     

Endovascular treatment of ruptured intracranial aneurysms during pregnancy: Is this the best way forward? Case report and review of the literature

Objective and importance

Subarachnoid haemorrhage in pregnancy has traditionally been treated by surgical clipping however lately cases of successful coiling have been reported. Nevertheless, the long-term outcome of coiling is not well known in pregnant women. Mortality due to rebleeding of an incompletely treated aneurysm remains high. Only 15 cases of successful endovascular coiling during pregnancy have been reported so far.

Clinical presentation

We report the case of a pregnant woman who presented with aneurysmal subarachnoid hemorrhage (WFNS Grade III) due to rupture of a right posterior communicating artery aneurysm.

Intervention

The patient underwent endovascular coiling successfully followed by an elective caesarian section and delivery of a healthy baby. However, during the course of a 2-year follow up the patient had suffered two relapses of the coiled aneurysm which required additional treatment. These events have affected her choice of extending her family.

Conclusion

The small risk of recurrence and the potential impact on future pregnancies should be explicitly communicated to patients in cases of endovascular coiling.     

Cognitive bias in action: Evidence for a reciprocal relation between confirmation bias and fear in children

Background and objectives

Some cognitive models propose that information processing biases and fear are reciprocally related. This idea has never been formally tested. Therefore, this study investigated the existence of a vicious circle by which confirmation bias and fear exacerbate each other.

Methods

One-hundred-and-seventy-one school children (8–13 years) were first provided with threatening, ambiguous, or positive information about an unknown animal. Then they completed a computerized information search task during which they could collect additional (negative, positive, or neutral) information about the novel animal. Because fear levels were repeatedly assessed during the task, it was possible to examine the reciprocal relationship between confirmation bias and fear.

Results

A reciprocal relation of mutual reinforcement was found between confirmation bias and fear over the course of the experiment: increases in fear predicted subsequent increases in the search for negative information, and increases in the search for negative information further enhanced fear on a later point-in-time. In addition, the initial information given about the animals successfully induced diverging fear levels in the children, and determined their first inclination to search for additional information.

Limitations

As this study employed a community sample of primary school children, future research should test whether these results can be generalized to clinically anxious youth.

Conclusions

These findings provide first support for the notion that fearful individuals may become trapped in a vicious circle in which fear and a fear-related confirmation bias mutually strengthen each other, thereby maintaining the anxiety pathology.     

The differential yet concurrent contributions of motor,cognitive and affective disturbance to freezing of gait in Parkinson's disease

Objectives

We sought to concurrently examine the specific motor, cognitive and affective contributions to self-reported FOG symptoms.

Patients and methods

Ninety-six patients with Parkinson's disease completed the validated freezing of gait questionnaire and had their motor function scored on section three of the Unified Parkinson's Disease Rating Scale questionnaire. A 5-choice reaction time task was administered in order to measure cognitive processing speed and the Beck Depression Inventory was utilised to assess affective disturbance.

Results

The results showed that after controlling disease duration and dopaminergic medication dose, the triad of motor disability, cognitive processing speed and affective symptoms were all significant independent predictors of scores on the freezing of gait questionnaire.

Conclusions

These findings suggest the need to consider the interplay between distinct motor, cognitive and affective domains in aetiological studies of freezing and the development of future therapies.