Electroconvulsive therapy: 80 years old and still going strong

Electroconvulsive therapy (ECT), which is among the oldest and most controversial treatments in the field of psychiatry, has its 80^th birthday this year. In this brief historical overview, the discovery of the therapeutic effects of convulsive therapy by Laszló Meduna, and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described. Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT. The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications, including catatonia, and pre- and postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving. Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed. The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys. This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT, which constitutes a violation of psychiatric patients’ right to an effective treatment.     

Treatment Rate for Major Depressive Disorder in China: a Meta-Analysis of Epidemiological Studies

Psychiatric Quarterly - Major depressive disorder (MDD) is a common psychiatric disorder in China, but its reported treatment rate varies largely across different studies. The objective of this...     

Psychiatric Morbidity in Dependent Z-Drugs and Benzodiazepine Users

Zolpidem/zopiclone (Z-drugs) and benzodiazepines (BDZs) have different profiles of comorbidity, but studies have seldom explored these differences. This study examined psychiatric comorbidity in patients dependent on Z-drugs or BDZs attending substance abuse clinics in Hong Kong. In this retrospective chart review, the medical records of 207 patients (117 on Z-drugs and 90 on BDZs) treated between January 2008 and August 2012 were analysed. Demographic data, patterns of substance misuse and comorbid psychiatric diagnoses were recorded. Patients dependent on Z-drugs were younger (40.5?±?10.4 vs. 46.8?±?11.6; p?<?0.001), had an earlier age of onset of drug misuse (p?=?0.047) and were more likely to currently use cough syrup (29.5?±?12.1 vs. 33.6?±?14.5; p?=?0.009) than the BDZs dependent patients. Overall, the Z-drugs and BDZs groups had a similar frequency of comorbid psychotic disorders, mood disorders and anxiety disorders. Mood disorders were the most common comorbid psychiatric disorders. The zopiclone group had a significantly higher percentage of psychotic disorders than the zolpidem group (25.5 % vs. 0; p?=?0.022). To summarize, patients with Z-drugs or BDZs dependence have similar psychiatric comorbidities, with depressive disorder the most common comorbidity. Zopiclone is more likely to be associated with psychotic disorders than zolpidem.     

EARLY DIAGNOSIS IN POST RENAL TRANSPLANT OPPORTUNISTIC INFECTIONS: A FRESH LOOK

A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and live unrelated donor (LURD) kidneys were studied for opportunistic infections. Immune diagnosis of Toxoplasma, Cytomegalovirus (CMV), Herpes-simplex virus type II (HSV-2), Aspergillosis and Tuberculosis was carried out in these patients along with sputum examination, CSF studies and biopsy of lymphnode and other tissues in few cases. A high degree of Toxoplasma, CMV & HSV-2 positivity was seen in transplanted patients. However sensitivity of serological diagnosis of tuberculos was found to be low with standard criteria, which increased significantly when modified criteria were used. It is concluded that regular immunological monitoring should be carried out in transplanted patients so as to reach an early diagnosis and management of opportunistic infections.KEY WORDS: Immune diagnosis, Opportunistic infections, Transplantation     

Is fatigue associated with suicidality in stroke?

Tang W-K, Lu J-Y, Mok V, Ungvari GS, Wong K-S. Is fatigue associated with suicidality in stroke?

Objective

To evaluate the relationship between poststroke fatigue and suicidality (SI) in Chinese patients with first or recurrent stroke.

Design

Cross-sectional survey.

Setting

Acute stroke unit of a general hospital.

Participants

Patients with acute ischemic stroke (N=595) admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong.

Interventions

Not applicable.

Main Outcome Measures

SI was assessed with the Geriatric Mental State Examination at 3 months after the subjects' index stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). The association between the mean FSS score and SI was examined and adjusted for potential confounders, including age, sex, marital status, previous stroke, depression, Mini-Mental State Examination score, and neurologic deficits in terms of the National Institutes of Health Stroke Scale score.

Results

Seventy-six (12.8%) of the patients had SI (the SI group). The FSS score was significantly higher in the SI group (4.0±1.4 vs 2.8±1.2). The FSS score remained a significant predictor of SI in the subsequent forward logistic regression (odds ratio=1.5), adjusting for the possible confounders.

Conclusions

These findings should alert clinicians that early identification and treatment of fatigue may reduce the suicidal risk in stroke patients.     

Health-related quality of life in patients with poststroke emotional incontinence

Chen Y-K, Wong KS, Mok V, Ungvari GS, Tang WK. Health-related quality of life in patients with poststroke emotional incontinence.

Objective

To assess the effect of poststroke emotional incontinence (PSEI) on health-related quality of life (HRQOL).

Design

Cross-sectional observational study.

Setting

Psychiatric clinic.

Participants

Stroke survivors (N=385; consecutive series) discharged from the acute stroke unit between December 2004 and June 2007.

Interventions

Not applicable.

Main Outcome Measures

Chinese (Hong Kong) version of the 36-Item Short Form Health Survey (SF-36) for HRQOL.

Results

Fifty-eight (15.1%) patients had PSEI. After adjustment for possible demographic and clinical confounders, subjects with PSEI had significantly lower physical and mental summary scores, particularly in the General and Mental Health, Social Function, and Role–Emotional subscales of the SF-36.

Conclusion

PSEI has an independent effect on HRQOL. Longitudinal studies of stroke are warranted to confirm and extend this finding.     

Association of frontal subcortical circuits infarcts in poststroke depression: a magnetic resonance imaging study of 591 Chinese patients with ischemic stroke

Despite extensive research into poststroke depression (PSD), the role played by lesion location in the pathogenesis of PSD remains uncertain. The aim of this study was to estimate the magnetic resonance imaging (MRI) correlates of PSD in Chinese patients with first or recurrent stroke. A total of 591 patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were recruited. A psychiatrist assessed all the patients 3 months after the stroke. The psychiatrist used the Structured Clinical Interview for Diagnostic and Statistical Manual, fourth edition (DSM-IV) to confirm whether the patients met the criteria of a depressive disorder. In addition, a host of demographic, clinical, and radiological variables were examined. A tota; of 475 and 116 patients had first and recurrent strokes, respectively. In all, 75 (12.7%) patients received a diagnosis of PSD. In univariate analysis of the MRI findings, the presence of infarcts in the frontal subcortical circuits ([FSC], 66.7% vs 53.3%) was significantly associated with PSD (P = .03) compared to the patients without PSD. The FSC infarct-PSD association remained significant (odds ratio = 2.6) in subsequent logistic regression analysis after adjusting for gender, history of depression, neurological impairment, level of social support, and major life events. In conclusion, FSC infarcts are independent predictors of PSD. Further work is needed to clarify whether these infarcts have an impact on the clinical presentation, treatment responses, and prognosis of PSD.