BACKGROUND Treatment-resistant depression(TRD)has a poor response to clinical treatment.Patients with TRD do not respond adequately to standard antidepressants.Even after receiving a full dose and sufficient duration ...BACKGROUND Treatment-resistant depression(TRD)has a poor response to clinical treatment.Patients with TRD do not respond adequately to standard antidepressants.Even after receiving a full dose and sufficient duration of combined antidepressant therapy,significant improvement is still difficult to achieve.At present,electroconvulsive therapy(ECT)remains a clinically effective method for treating refractory depression.A good anesthesia regimen can enhance its clinical efficacy.Actively exploring high-quality anesthesia regimens has become a current research hotspot.AIM To explore the effect of esketamine and etomidate anesthesia on the clinical efficacy of ECT for TRD.METHODS A total of 120 patients with TRD,treated at the Department of Psychiatry,The Second Affiliated Hospital of Shandong First Medical University,China between April 2020 and April 2024,were selected for the study.The patients were allocated at random into two groups using a random number table:The combination and control groups,with 60 patients in each group.Both groups underwent ECT;the combination group received esketamine and etomidate anesthesia,while the control group received etomidate anesthesia.The following parameters were compared between the two groups:Heart rate(HR);mean arterial pressure(MAP);peripheral capillary oxygen saturation(SpO2);initial and final threshold charges;and serum brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),5-hydroxytryptamine(5-HT),and interleukin-4(IL-4)levels.Neurological functions,basic executive function scores,and adverse reactions were compared during the treatment process.RESULTS During treatment,the maximum and minimum HR and MAP values in the combination group were markedly lower than those in the control group(P<0.05),whereas there was no significant difference in SpO2 between the two groups(P>0.05).During the treatment,there were no significant differences in the initial threshold charge and average duration of seizures during ECT between the two groups(P>0.05).However,the final threshold charge and total charge in the combination group were considerably lower than those in the control group(P<0.05).After treatment,the BDNF,NGF,5-HT,and IL-4 levels were evidently higher in the combination group than in the control group(P<0.05).During treatment,as the number of ECT sessions increased,both BRNAS and Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery(MCCB)scores increased,whereas Hamilton Depression Rating Scale(HAMD)-24 scores decreased in both groups.Starting from the third treatment session,the BRNAS and MCCB scores in the combination group were higher than in the control group,whereas the Hamilton Depression Scale-24 score was lower in the combination group than in the control group(P<0.05).After treatment,the Wisconsin Card Sorting Test scores and Tower of Hanoi test results in the combination group were significantly better than those in the control group(P<0.05).The occurrence of adverse reactions was compared between the two groups(P>0.05).CONCLUSION Esketamine and etomidate anesthesia during ECT for patients with TRD helps maintain stable vital signs during the treatment process,improves depressive symptoms,and enhances neurological and basic executive functions.展开更多
BACKGROUND Auditory verbal hallucinations(AVHs)are believed to be characteristic symptoms of schizophrenia.The prevalence of AVHs in deaf patients with schizophrenia is comparable to that in patients with schizophreni...BACKGROUND Auditory verbal hallucinations(AVHs)are believed to be characteristic symptoms of schizophrenia.The prevalence of AVHs in deaf patients with schizophrenia is comparable to that in patients with schizophrenia who have normal hearing ability.AVHs in deaf patients with schizophrenia require treatment.CASE SUMMARY A 22-year-old deaf woman with schizophrenia had experienced AVHs for 3 months.Her psychotic symptoms were not alleviated by antipsychotic medication alone.Modified electroconvulsive therapy in combination with antipsychotic drugs effectively alleviated her AVHs and disorganized behavior.During outpatient follow-up for 6 months,her condition have remained stable,and she has been able to take care of herself.CONCLUSION Treatment with modified electroconvulsive therapy was found to be safe and might be indicated for deaf patients whose symptoms are not well managed with antipsychotic medication alone.Deaf people might be unable to communicate through spoken language;therefore,to make proper diagnoses and provide appropriate treatment for these patients,psychiatrists must have patience and seek to understand patients’mental state.展开更多
Electroconvulsive therapy(ECT)uses a certain amount of electric current to pass through the head of the patient,causing convulsions throughout the body,to relieve the symptoms of the disease and achieve the purpose of...Electroconvulsive therapy(ECT)uses a certain amount of electric current to pass through the head of the patient,causing convulsions throughout the body,to relieve the symptoms of the disease and achieve the purpose of treatment.ECT can effectively improve the clinical symptoms of patients with major depression,but its therapeutic mechanism is still unclear.With the rapid development of neuroimaging technology,it is necessary to explore the neurobiological mechanism of major depression from the aspects of brain structure,brain function and brain metabolism,and to find that ECT can improve the brain function,metabolism and even brain structure of patients to a certain extent.Currently,an increasing number of neuroimaging studies adopt various neuroimaging techniques including functional magnetic resonance imaging(MRI),positron emission tomography,magnetic resonance spectroscopy,structural MRI,and diffusion tensor imaging to reveal the neural effects of ECT.This article reviews the recent progress in neuroimaging research on ECT for major depression.The results suggest that the neurobiological mechanism of ECT may be to modulate the functional activity and connectivity or neural structural plasticity in specific brain regions to the normal level,to achieve the therapeutic effect.展开更多
Electroconvulsive therapy(ECT),which is among the oldest and most controversial treatments in the field of psychiatry,has its 80th birthday this year.In this brief historical overview,the discovery of the therapeutic ...Electroconvulsive therapy(ECT),which is among the oldest and most controversial treatments in the field of psychiatry,has its 80th birthday this year.In this brief historical overview,the discovery of the therapeutic effects of convulsive therapy by LaszlóMeduna,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 preand 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.展开更多
BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat...BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the patients were i.v. injected with 1 mg of butorphanol tartrate parenteral solution （Jiangsu Hengrui Medicine Co., Ltd., No.05100732） 5 minutes prior to anesthesia; the remaining treatments were the same as in the control group. （2） Evaluations： myalgia conditions were assessed 6 hours after the patients opened their eyes. The patients were evaluated by a visual analogue scale and Ramsay sedation scale immediately, and at 3 minutes and 6 hours after they opened their eyes. MAIN OUTCOME MEASURES： （1） Conditions of myalgia. （2） Scores of visual analogue scale and Ramsay sedation scale. RESULTS： All 120 psychiatric patients were involved in the final analysis. （1） Conditions of myalgia： 6 hours after modified electroconvulsive therapy, 22 patients in the control group and 1 patient in the treatment group complained of myalgia, which resulted in a significant difference between the two groups （P 〈 0.05）. （2） Scores of visual analogue scale and Ramsay sedation scale： the scores of visual analogue scale at 30 minutes and 6 hours after opening eyes were significantly lower in the treatment group than the control group （P 〈 0.05）, and the scores of Ramsay sedation scale were not significantly different between the two groups （P 〉 0.05）. CONCLUSION： Preemptive analgesia by butorphanol can effectively alleviate modified electroconvulsive therapy-induced myalgia, without adverse reactions.展开更多
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 tr...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.展开更多
BACKGROUND Major depressive disorder(MDD)tends to have a high incidence and high suicide risk.Electroconvulsive therapy(ECT)is currently a relatively effective treatment for MDD.However,the mechanism of efficacy of EC...BACKGROUND Major depressive disorder(MDD)tends to have a high incidence and high suicide risk.Electroconvulsive therapy(ECT)is currently a relatively effective treatment for MDD.However,the mechanism of efficacy of ECT is still unclear.AIM To investigate the changes in the amplitude of low-frequency fluctuations in specific frequency bands in patients with MDD after ECT.METHODS Twenty-two MDD patients and fifteen healthy controls(HCs)were recruited to this study.MDD patients received 8 ECT sessions with bitemporal placement.Resting-state functional magnetic resonance imaging was adopted to examine regional cerebellar blood flow in both the MDD patients and HCs.The MDD patients were scanned twice(before the first ECT session and after the eighth ECT session)to acquire data.Then,the amplitude of low-frequency fluctuations(ALFF)was computed to characterize the intrinsic neural oscillations in different bands(typical frequency,slow-5,and slow-4 bands).RESULTS Compared to before ECT(pre-ECT),we found that MDD patients after the eighth ECT(post-ECT)session had a higher ALFF in the typical band in the right middle frontal gyrus,posterior cingulate,right supramarginal gyrus,left superior frontal gyrus,and left angular gyrus.There was a lower ALFF in the right superior temporal gyrus.Compared to pre-ECT values,the ALFF in the slow-5 band was significantly increased in the right limbic lobe,cerebellum posterior lobe,right middle orbitofrontal gyrus,and frontal lobe in post-ECT patients,whereas the ALFF in the slow-5 band in the left sublobar region,right angular gyrus,and right frontal lobe was lower.In contrast,significantly higher ALFF in the slow-4 band was observed in the frontal lobe,superior frontal gyrus,parietal lobe,right inferior parietal lobule,and left angular gyrus.CONCLUSION Our results suggest that the abnormal ALFF in pre-and post-ECT MDD patients may be associated with specific frequency bands.展开更多
BACKGROUND Electroconvulsive therapy(ECT)is both an effective treatment for patients with major depressive disorder(MDD)and a noxious stimulus.Although some studies have explored the effect of sedation depth on seizur...BACKGROUND Electroconvulsive therapy(ECT)is both an effective treatment for patients with major depressive disorder(MDD)and a noxious stimulus.Although some studies have explored the effect of sedation depth on seizure parameters in ECT,there is little research on the noxious stimulation response to ECT.In this study,we used two electroencephalography(EEG)-derived indices,the quantitative consci-ousness(qCON)index and quantitative nociceptive(qNOX)index,to monitor sedation,hypnosis,and noxious stimulation response in patients with MDD undergoing acute ECT.METHODS Patients with MDD(n=24)underwent acute bilateral temporal ECT under propofol anesthesia.Before ECT,the patients were randomly divided into three groups according to qCON scores(qCON60-70,qCON50-60,and qCON40-50).Continuous qCON monitoring was performed 3 minutes before and during ECT,and the qCON,qNOX,vital signs,EEG seizure parameters,and complications during the recovery period were recorded.The 24-item Hamilton Rating Scale for Depression,Zung’s Self-rating Depression Scale,and Montreal Cognitive Asse-ssment scores were evaluated before the first ECT session,after the fourth ECT session,and after the full course of ECT.RESULTS A total of 193 ECT sessions were performed on 24 participants.The qCON index significantly affected the EEG seizure duration,peak mid-ictal amplitude,and maximum heart rate during ECT(P<0.05).The qNOX index significantly affected the post-ictal suppression index(P<0.05).Age,number of ECT sessions,and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters(P<0.05).However,there were no significant differences in complications,24-item Hamilton Rating Scale for Depression scores,Zung’s Self-rating Depression Scale scores,or Montreal Cognitive Assessment scores among the three groups(P>0.05).CONCLUSION Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.展开更多
Objective:To investigate the effects of propofol and ketamine on seizure duration,hemodynamics,and recovery of electroconvulsive therapy(ECT).Methods:This prospective randomized trial included patients who had undergo...Objective:To investigate the effects of propofol and ketamine on seizure duration,hemodynamics,and recovery of electroconvulsive therapy(ECT).Methods:This prospective randomized trial included patients who had undergone ECT under anesthesia.Patients received injection of propofol 1.5 mg/kg i.v.(the propofol group)or ketamine 0.8-1.2 mg/kg i.v.(the ketamine group)during ECT.Seizure duration,hemodynamics,and recovery were recorded and compared between the two groups.Results:This trial included 44 patinets with 22 patients receiving propofol and 22 patients receiving ketamine.The total dose of propofol and ketamine was(105.68±25.27)mg and(81.36±24.55)mg,respectively.The motor seizure and electroencephalogram seizure duration were prolonged in the ketamine group(P<0.001).The hemodynamics at the admission of the two groups were comparable(P>0.05);however,the mean systolic blood pressure during the procedure was significantly higher in the ketamine group(P=0.04).Besides,spontaneous eye-opening in the ketamine group took longer than that of the propofol group(P=0.001).Conclusion:Both propofol and ketamine are safe as anesthetic agents for modified ECT,and ketamine provides a longer seizure duration without hemodynamic instability or any significant complication.展开更多
BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances,hallucinations,delusions,and emotional instability.For some patients,conventional treatment methods may not ...BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances,hallucinations,delusions,and emotional instability.For some patients,conventional treatment methods may not effectively alleviate symptoms,necessitating the use of alternative therapeutic approaches.Modified electroconvulsive therapy(MECT)is an effective treatment modality for schizophrenia,inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity.AIM To explore the impact of psychological nursing intervention(PNI)before and after MECT on the efficacy and quality of life of patients with schizophrenia.METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups:The intervention group(n=40)and the control group(n=40).The intervention group received PNI before and after MECT,while the control group received routine nursing care.The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale(PANSS)and the Clinical Global Impression Scale(CGI)before and after the treatment.The quality of life was assessed by the Short Form 36 Health Survey(SF-36)after the treatment.RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment(P<0.05).The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning(P<0.05).CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia.It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.展开更多
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...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.展开更多
BACKGROUND Traditional treatments for major depressive disorder(MDD),including medication and therapy,often fail and have undesirable side effects.Electroconvulsive therapy(ECT)uses electrical currents to induce brief...BACKGROUND Traditional treatments for major depressive disorder(MDD),including medication and therapy,often fail and have undesirable side effects.Electroconvulsive therapy(ECT)uses electrical currents to induce brief seizures in the brain,resulting in rapid and potent antidepressant effects.However,owing to misconceptions and controversies,ECT is not as widely used as it could and often faces stigmatization.AIM To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.METHODS This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups.The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions.The non-ECT group received medication and/or therapy according to clinical guidelines for MDD.The primary outcome was the variation in the hamilton depression rating scale(HDRS)score from treatment/ECT initiation to week 12.In addition,patients’quality of life,cognitive abilities,and biomarkers were measured throughout the study.RESULTS Although both groups showed significant improvements in their HDRS scores over time,the improvement was more pronounced in the ECT group than in the non-ECT group.Additionally,the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group.Compared with the non-ECT group,the ECT group exhibited evidently lower variations in the brain-derived neurotrophic factor(BDNF)and cytokine interleukin-6(IL-6)levels.The side effects were generally mild and comparable between the two groups.ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms,enhancing wellbeing,and bolstering cognitive capabilities in individuals with severe MDD.ECT may also affect the levels of BDNF and IL-6,which are indicators of neuroplasticity and inflammation,respectively.CONCLUSION ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.展开更多
BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the...BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.METHODS We analyzed the relationships between relapse,the diagnostic change from MDD to bipolar disorder(BP),and treatment after the initial ECT.We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital.The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP.A receiver operating characteristic(ROC)curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study.Compared with the MDD participants,more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission(65.6%vs 15.1%,P<0.001;relative risk=4.35,95%CI:2.19-8.63,P<0.001).Twenty-nine patients experienced relapses during the three-year follow-up.In 21(72.4%,21/29)patients with relapse,the diagnosis was changed from MDD to BP.The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients(9.63±10.4 mo vs 3.38±3.77 mo,P=0.022);for most patients,the interval was less than one month.The relative risk of depressive symptoms based on diagnostic changes was 4.35(95%confidence interval:2.19–8.63,P<0.001),and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756(95%CI:0.562-0.895,P=0.007).CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.展开更多
This editorial evaluated the findings of a comprehensive study focused on the effects of anesthesia depth on seizure parameters during electroconvulsive therapy(ECT)in patients with major depressive disorder.The study...This editorial evaluated the findings of a comprehensive study focused on the effects of anesthesia depth on seizure parameters during electroconvulsive therapy(ECT)in patients with major depressive disorder.The study utilized quantitative consciousness and quantitative nociceptive indices for monitoring sedation,hypnosis,and nociceptive responses.The analysis included 193 ECT sessions across 24 patients,revealing significant impacts of anesthesia depth on electroencephalography(EEG)seizure parameters.Key findings include that lighter anesthesia resulted in longer EEG seizure duration and higher post-ictal suppression index,without increasing complications.These insights emphasize the importance of optimal anesthesia management to improve therapeutic outcomes in ECT.展开更多
<strong>Objective:</strong> This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depre...<strong>Objective:</strong> This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depression. <strong>Methodology:</strong> Twenty-nine (N = 29) individuals over the age of 65 years of age and older were assigned to a control or treatment group on the basis of their decision to receive M-ECT (treatment group) or to refrain from receiving the treatment (control group). A battery of psychometric tests designed to measure severity of depression, quality of life, and cognition were administered at baseline as well as at 6-month and 1-year intervals. <strong>Results:</strong> Statistical analysis of the data indicated no significant differences in the efficacy of M-ECT between the control and treatment groups in any of the tests administered during the participation of the study. <strong>Conclusion:</strong> The results of the study suggest that there is no added benefit for patients administered M-ECT. However, study sample size and availability of alternative treatment regimens for the control group limit generalizability of these findings and warrant further investigation.展开更多
Objective: to study the effect of comprehensive nursing care for psychotic patients treated with modified electroconvulsive therapy. Methods: 84 psychotic patients admitted to hospital from November 2019 to November 2...Objective: to study the effect of comprehensive nursing care for psychotic patients treated with modified electroconvulsive therapy. Methods: 84 psychotic patients admitted to hospital from November 2019 to November 2020 were randomly divided into reference group and experimental group with 42 cases in each group. All patients need to receive the treatment of modified electroconvulsive therapy. The patients in the reference group use routine care, while the patients in the experimental group use comprehensive care. The quality of life and ability of the two groups were compared. Results: there was significant difference in ability improvement between the two groups (P < 0.05). There was no significant difference in the scores before nursing between the two groups (P > 0.05). After nursing, the difference between the two groups was significant (P < 0.05). Conclusion: the effect of comprehensive nursing is more ideal, the ability to improve their lives, so that patients can gradually recover in treatment and nursing, which is worthy of promotion and application.展开更多
Background： Electroconvulsive therapy （ECT） can alleviate the symptoms of treatment-resistant depression （TRD）. Functional network connectivity （FNC） is a newly developed method to investigate the brain＇s func...Background： Electroconvulsive therapy （ECT） can alleviate the symptoms of treatment-resistant depression （TRD）. Functional network connectivity （FNC） is a newly developed method to investigate the brain＇s functional connectivity patterns. The first aim of this study was to investigate FNC alterations between TRD patients and healthy controls. The second aim was to explore the relationship between the ECT treatment response and pre-ECT treatment FNC alterations in individual TRD patients. Methods： This study included 82 TRD patients and 41 controls. Patients were screened at baseline and after 2 weeks of treatment with a combination of ECT and antidepressants. Group information guided-independent component analysis （G1G-ICA） was used to compute subject-specific functional networks （FNs）. Grassmann maniibld and step-wise forward component selection using support vector machines were adopted to perform the FNC measure and extract the functional networks＇ connectivity patterns （FCP）. Pearson＇s correlation analysis was used to calculate the correlations between the FCP and ECT response. Results： A total of 82 TRD patients in the ECT group were successfully treated. On an average, 8.50 ~ 2.00 ECT sessions were conducted. After ECT treatment, only 42 TRD patients had an improved response to ECT （the Hamilton scores reduction rate was more than 50%）, response rate 51%. 8 FNs （anterior and posterior default mode network, bilateral frontoparietal network, audio network, visual network, dorsal attention network, and sensorimotor network） were obtained using GIG-ICA. We did not found that FCPs were significantly different between TRD patients and healthy controls. Moreover, the baseline FCP was unrelated to the ECT treatment response. Conclusions： The FNC was not significantly different between the TRD patients and healthy controls, and the baseline FCP was unrelated to the ECT treatment response. These findings will necessitate that we modify the experimental scheme to explore the mechanisms underlying ECT＇s effects on depression and explore the specific predictors of the effects of ECT based on the pre-ECT treatment magnetic resonance imaging.展开更多
Background The hippocampus has been widely reported to be involved in the neuropathology of major depressive disorder(MDD).All the previous researches adopted group-level hippocampus subregions atlas to investigate ab...Background The hippocampus has been widely reported to be involved in the neuropathology of major depressive disorder(MDD).All the previous researches adopted group-level hippocampus subregions atlas to investigate abnormal functional connectivities in MDD in absence of capturing individual variability.In addition,the molecular basis of functional impairments of hippocampal subregions in MDD remains elusive.Objective We aimed to reveal functional disruptions and recovery of individual hippocampal subregions in MDD patients before and after ECT and linked these functional connectivity differences to transcriptomic profiles to reveal molecular mechanism.Methods we used group guided individual functional parcellation approach to define individual subregions of hippocampus for each participant.Resting-state functional connectivity(FC)analysis of individual hippocampal subregions was conducted to investigate functional disruptions and recovery in MDD patients before and after ECT.Spatial association between functional connectivity differences and transcriptomic profiles was employed to reveal molecular mechanism.Results MDD patients showed increased FCs of the left tail part of hippocampus with dorsolateral prefrontal cortex and middle temporal gyrus while decreased FC with primary visual cortex.These abnormal FCs in MDD patients were normalized after ECT.In addition,we found that functional disruptions of the left tail part of hippocampus in MDD were mainly related to synaptic signaling and transmission,ion transport,cell-cell signaling and neurogenesis.Conclusion Our findings provide initial evidence for functional connectome disruption of individual hippocampal subregions and their molecular basis in MDD.展开更多
Autism spectrum disorder(ASD)is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction,alongside restricted,repetitive patterns of behaviors(RRB),interests,or ...Autism spectrum disorder(ASD)is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction,alongside restricted,repetitive patterns of behaviors(RRB),interests,or activities.It often co-occurs with various neuropsychiatric disorders,though their frequency varies widely due to unclear boundaries between the core features of ASD and common comorbidities.Catatonia,increasingly noted in neurodevelopmental conditions like ASD,shares striking similarities with ASD in symptomatology,brain mech-anisms,and treatment responses,prompting the question of whether it is a core feature of ASD or a distinct condition.This paper delved into this overlap,ex-ploring the relationship between catatonia and ASD through a narrative review of peer-reviewed literature from 1943 to 2024,sourced from PubMed and psy-chiatric journals.Focusing on ASD diagnostic evolution,symptom overlap with catatonia,and shared neurobiological and therapeutic characteristics,we used thematic analysis to synthesize findings into key areas such as historical nosology,phenomenological overlap,neurobiological parallels,and treatment response.The evidence revealed weak support for separating catatonia from overlapping RRB features of ASD,suggesting that some RRB might align more with comorbid catatonia than intrinsic ASD traits.However,this idea needs further validation through rigorous clinical trials.Clarifying this relationship could refine diagnostic approaches and open doors to targeted treatments,potentially improving out-comes for those affected.展开更多
Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning.Treatment during the acute phase of a major depressive episode aims to help the patient reach a remissio...Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning.Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning.Pharmacotherapy,especially selective serotonin reuptake inhibitors antidepressants,remains the most frequent option for treating depression during the acute phase,while other promising pharmacological options are still competing for the attention of practitioners.Depressionfocused psychotherapy is the second most common option for helping patients overcome the acute phase,maintain remission,and prevent relapses.Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations;meanwhile,other methods have limits,and their specific indications are still being studied.Combining medications,psychotherapy,and somatic therapies remains the most effective way to manage resistant forms of depression.展开更多
文摘BACKGROUND Treatment-resistant depression(TRD)has a poor response to clinical treatment.Patients with TRD do not respond adequately to standard antidepressants.Even after receiving a full dose and sufficient duration of combined antidepressant therapy,significant improvement is still difficult to achieve.At present,electroconvulsive therapy(ECT)remains a clinically effective method for treating refractory depression.A good anesthesia regimen can enhance its clinical efficacy.Actively exploring high-quality anesthesia regimens has become a current research hotspot.AIM To explore the effect of esketamine and etomidate anesthesia on the clinical efficacy of ECT for TRD.METHODS A total of 120 patients with TRD,treated at the Department of Psychiatry,The Second Affiliated Hospital of Shandong First Medical University,China between April 2020 and April 2024,were selected for the study.The patients were allocated at random into two groups using a random number table:The combination and control groups,with 60 patients in each group.Both groups underwent ECT;the combination group received esketamine and etomidate anesthesia,while the control group received etomidate anesthesia.The following parameters were compared between the two groups:Heart rate(HR);mean arterial pressure(MAP);peripheral capillary oxygen saturation(SpO2);initial and final threshold charges;and serum brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),5-hydroxytryptamine(5-HT),and interleukin-4(IL-4)levels.Neurological functions,basic executive function scores,and adverse reactions were compared during the treatment process.RESULTS During treatment,the maximum and minimum HR and MAP values in the combination group were markedly lower than those in the control group(P<0.05),whereas there was no significant difference in SpO2 between the two groups(P>0.05).During the treatment,there were no significant differences in the initial threshold charge and average duration of seizures during ECT between the two groups(P>0.05).However,the final threshold charge and total charge in the combination group were considerably lower than those in the control group(P<0.05).After treatment,the BDNF,NGF,5-HT,and IL-4 levels were evidently higher in the combination group than in the control group(P<0.05).During treatment,as the number of ECT sessions increased,both BRNAS and Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery(MCCB)scores increased,whereas Hamilton Depression Rating Scale(HAMD)-24 scores decreased in both groups.Starting from the third treatment session,the BRNAS and MCCB scores in the combination group were higher than in the control group,whereas the Hamilton Depression Scale-24 score was lower in the combination group than in the control group(P<0.05).After treatment,the Wisconsin Card Sorting Test scores and Tower of Hanoi test results in the combination group were significantly better than those in the control group(P<0.05).The occurrence of adverse reactions was compared between the two groups(P>0.05).CONCLUSION Esketamine and etomidate anesthesia during ECT for patients with TRD helps maintain stable vital signs during the treatment process,improves depressive symptoms,and enhances neurological and basic executive functions.
基金the Doctoral Startup Fund of the Second Affiliated Hospital of Xinxiang Medical University.
文摘BACKGROUND Auditory verbal hallucinations(AVHs)are believed to be characteristic symptoms of schizophrenia.The prevalence of AVHs in deaf patients with schizophrenia is comparable to that in patients with schizophrenia who have normal hearing ability.AVHs in deaf patients with schizophrenia require treatment.CASE SUMMARY A 22-year-old deaf woman with schizophrenia had experienced AVHs for 3 months.Her psychotic symptoms were not alleviated by antipsychotic medication alone.Modified electroconvulsive therapy in combination with antipsychotic drugs effectively alleviated her AVHs and disorganized behavior.During outpatient follow-up for 6 months,her condition have remained stable,and she has been able to take care of herself.CONCLUSION Treatment with modified electroconvulsive therapy was found to be safe and might be indicated for deaf patients whose symptoms are not well managed with antipsychotic medication alone.Deaf people might be unable to communicate through spoken language;therefore,to make proper diagnoses and provide appropriate treatment for these patients,psychiatrists must have patience and seek to understand patients’mental state.
基金Supported by the Natural Science Foundation of ChinaNo.81901373。
文摘Electroconvulsive therapy(ECT)uses a certain amount of electric current to pass through the head of the patient,causing convulsions throughout the body,to relieve the symptoms of the disease and achieve the purpose of treatment.ECT can effectively improve the clinical symptoms of patients with major depression,but its therapeutic mechanism is still unclear.With the rapid development of neuroimaging technology,it is necessary to explore the neurobiological mechanism of major depression from the aspects of brain structure,brain function and brain metabolism,and to find that ECT can improve the brain function,metabolism and even brain structure of patients to a certain extent.Currently,an increasing number of neuroimaging studies adopt various neuroimaging techniques including functional magnetic resonance imaging(MRI),positron emission tomography,magnetic resonance spectroscopy,structural MRI,and diffusion tensor imaging to reveal the neural effects of ECT.This article reviews the recent progress in neuroimaging research on ECT for major depression.The results suggest that the neurobiological mechanism of ECT may be to modulate the functional activity and connectivity or neural structural plasticity in specific brain regions to the normal level,to achieve the therapeutic effect.
文摘Electroconvulsive therapy(ECT),which is among the oldest and most controversial treatments in the field of psychiatry,has its 80th birthday this year.In this brief historical overview,the discovery of the therapeutic effects of convulsive therapy by LaszlóMeduna,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 preand 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.
文摘BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the patients were i.v. injected with 1 mg of butorphanol tartrate parenteral solution （Jiangsu Hengrui Medicine Co., Ltd., No.05100732） 5 minutes prior to anesthesia; the remaining treatments were the same as in the control group. （2） Evaluations： myalgia conditions were assessed 6 hours after the patients opened their eyes. The patients were evaluated by a visual analogue scale and Ramsay sedation scale immediately, and at 3 minutes and 6 hours after they opened their eyes. MAIN OUTCOME MEASURES： （1） Conditions of myalgia. （2） Scores of visual analogue scale and Ramsay sedation scale. RESULTS： All 120 psychiatric patients were involved in the final analysis. （1） Conditions of myalgia： 6 hours after modified electroconvulsive therapy, 22 patients in the control group and 1 patient in the treatment group complained of myalgia, which resulted in a significant difference between the two groups （P 〈 0.05）. （2） Scores of visual analogue scale and Ramsay sedation scale： the scores of visual analogue scale at 30 minutes and 6 hours after opening eyes were significantly lower in the treatment group than the control group （P 〈 0.05）, and the scores of Ramsay sedation scale were not significantly different between the two groups （P 〉 0.05）. CONCLUSION： Preemptive analgesia by butorphanol can effectively alleviate modified electroconvulsive therapy-induced myalgia, without adverse reactions.
基金Supported by the Curriculum Reform Project of Taizhou University in 2021,No.xkg2021087.
文摘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.
基金Supported by the Natural Science Foundation of China,No.81901373the Intelligent Medicine Research Project of Chongqing Medical University,No.ZHYX202126.
文摘BACKGROUND Major depressive disorder(MDD)tends to have a high incidence and high suicide risk.Electroconvulsive therapy(ECT)is currently a relatively effective treatment for MDD.However,the mechanism of efficacy of ECT is still unclear.AIM To investigate the changes in the amplitude of low-frequency fluctuations in specific frequency bands in patients with MDD after ECT.METHODS Twenty-two MDD patients and fifteen healthy controls(HCs)were recruited to this study.MDD patients received 8 ECT sessions with bitemporal placement.Resting-state functional magnetic resonance imaging was adopted to examine regional cerebellar blood flow in both the MDD patients and HCs.The MDD patients were scanned twice(before the first ECT session and after the eighth ECT session)to acquire data.Then,the amplitude of low-frequency fluctuations(ALFF)was computed to characterize the intrinsic neural oscillations in different bands(typical frequency,slow-5,and slow-4 bands).RESULTS Compared to before ECT(pre-ECT),we found that MDD patients after the eighth ECT(post-ECT)session had a higher ALFF in the typical band in the right middle frontal gyrus,posterior cingulate,right supramarginal gyrus,left superior frontal gyrus,and left angular gyrus.There was a lower ALFF in the right superior temporal gyrus.Compared to pre-ECT values,the ALFF in the slow-5 band was significantly increased in the right limbic lobe,cerebellum posterior lobe,right middle orbitofrontal gyrus,and frontal lobe in post-ECT patients,whereas the ALFF in the slow-5 band in the left sublobar region,right angular gyrus,and right frontal lobe was lower.In contrast,significantly higher ALFF in the slow-4 band was observed in the frontal lobe,superior frontal gyrus,parietal lobe,right inferior parietal lobule,and left angular gyrus.CONCLUSION Our results suggest that the abnormal ALFF in pre-and post-ECT MDD patients may be associated with specific frequency bands.
基金the National Natural Science Foundation of China,No.81873798 and No.81901377Chongqing Science and Technology Bureau Under Grant,No.cstc2019jcyj-msxmX0839.
文摘BACKGROUND Electroconvulsive therapy(ECT)is both an effective treatment for patients with major depressive disorder(MDD)and a noxious stimulus.Although some studies have explored the effect of sedation depth on seizure parameters in ECT,there is little research on the noxious stimulation response to ECT.In this study,we used two electroencephalography(EEG)-derived indices,the quantitative consci-ousness(qCON)index and quantitative nociceptive(qNOX)index,to monitor sedation,hypnosis,and noxious stimulation response in patients with MDD undergoing acute ECT.METHODS Patients with MDD(n=24)underwent acute bilateral temporal ECT under propofol anesthesia.Before ECT,the patients were randomly divided into three groups according to qCON scores(qCON60-70,qCON50-60,and qCON40-50).Continuous qCON monitoring was performed 3 minutes before and during ECT,and the qCON,qNOX,vital signs,EEG seizure parameters,and complications during the recovery period were recorded.The 24-item Hamilton Rating Scale for Depression,Zung’s Self-rating Depression Scale,and Montreal Cognitive Asse-ssment scores were evaluated before the first ECT session,after the fourth ECT session,and after the full course of ECT.RESULTS A total of 193 ECT sessions were performed on 24 participants.The qCON index significantly affected the EEG seizure duration,peak mid-ictal amplitude,and maximum heart rate during ECT(P<0.05).The qNOX index significantly affected the post-ictal suppression index(P<0.05).Age,number of ECT sessions,and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters(P<0.05).However,there were no significant differences in complications,24-item Hamilton Rating Scale for Depression scores,Zung’s Self-rating Depression Scale scores,or Montreal Cognitive Assessment scores among the three groups(P>0.05).CONCLUSION Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.
文摘Objective:To investigate the effects of propofol and ketamine on seizure duration,hemodynamics,and recovery of electroconvulsive therapy(ECT).Methods:This prospective randomized trial included patients who had undergone ECT under anesthesia.Patients received injection of propofol 1.5 mg/kg i.v.(the propofol group)or ketamine 0.8-1.2 mg/kg i.v.(the ketamine group)during ECT.Seizure duration,hemodynamics,and recovery were recorded and compared between the two groups.Results:This trial included 44 patinets with 22 patients receiving propofol and 22 patients receiving ketamine.The total dose of propofol and ketamine was(105.68±25.27)mg and(81.36±24.55)mg,respectively.The motor seizure and electroencephalogram seizure duration were prolonged in the ketamine group(P<0.001).The hemodynamics at the admission of the two groups were comparable(P>0.05);however,the mean systolic blood pressure during the procedure was significantly higher in the ketamine group(P=0.04).Besides,spontaneous eye-opening in the ketamine group took longer than that of the propofol group(P=0.001).Conclusion:Both propofol and ketamine are safe as anesthetic agents for modified ECT,and ketamine provides a longer seizure duration without hemodynamic instability or any significant complication.
文摘BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances,hallucinations,delusions,and emotional instability.For some patients,conventional treatment methods may not effectively alleviate symptoms,necessitating the use of alternative therapeutic approaches.Modified electroconvulsive therapy(MECT)is an effective treatment modality for schizophrenia,inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity.AIM To explore the impact of psychological nursing intervention(PNI)before and after MECT on the efficacy and quality of life of patients with schizophrenia.METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups:The intervention group(n=40)and the control group(n=40).The intervention group received PNI before and after MECT,while the control group received routine nursing care.The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale(PANSS)and the Clinical Global Impression Scale(CGI)before and after the treatment.The quality of life was assessed by the Short Form 36 Health Survey(SF-36)after the treatment.RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment(P<0.05).The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning(P<0.05).CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia.It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.
基金supported by the grants of Shanghai Hospital Development Center,China(SHDC12014111)the Science and Technology Commission of Shanghai Municipality,China(14411961400 and 13dz2260500)the Shanghai Health System Leadership in Health Research Program,China(XBR2011005)
文摘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.
基金ebei Province 2018 Medical Science Research Key Discipline Programs,No.20180214.
文摘BACKGROUND Traditional treatments for major depressive disorder(MDD),including medication and therapy,often fail and have undesirable side effects.Electroconvulsive therapy(ECT)uses electrical currents to induce brief seizures in the brain,resulting in rapid and potent antidepressant effects.However,owing to misconceptions and controversies,ECT is not as widely used as it could and often faces stigmatization.AIM To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.METHODS This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups.The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions.The non-ECT group received medication and/or therapy according to clinical guidelines for MDD.The primary outcome was the variation in the hamilton depression rating scale(HDRS)score from treatment/ECT initiation to week 12.In addition,patients’quality of life,cognitive abilities,and biomarkers were measured throughout the study.RESULTS Although both groups showed significant improvements in their HDRS scores over time,the improvement was more pronounced in the ECT group than in the non-ECT group.Additionally,the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group.Compared with the non-ECT group,the ECT group exhibited evidently lower variations in the brain-derived neurotrophic factor(BDNF)and cytokine interleukin-6(IL-6)levels.The side effects were generally mild and comparable between the two groups.ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms,enhancing wellbeing,and bolstering cognitive capabilities in individuals with severe MDD.ECT may also affect the levels of BDNF and IL-6,which are indicators of neuroplasticity and inflammation,respectively.CONCLUSION ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.
基金Supported by MHLW Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes program,No.21FA0201and MEXT/JSPS,No.17H00872.
文摘BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.METHODS We analyzed the relationships between relapse,the diagnostic change from MDD to bipolar disorder(BP),and treatment after the initial ECT.We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital.The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP.A receiver operating characteristic(ROC)curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study.Compared with the MDD participants,more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission(65.6%vs 15.1%,P<0.001;relative risk=4.35,95%CI:2.19-8.63,P<0.001).Twenty-nine patients experienced relapses during the three-year follow-up.In 21(72.4%,21/29)patients with relapse,the diagnosis was changed from MDD to BP.The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients(9.63±10.4 mo vs 3.38±3.77 mo,P=0.022);for most patients,the interval was less than one month.The relative risk of depressive symptoms based on diagnostic changes was 4.35(95%confidence interval:2.19–8.63,P<0.001),and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756(95%CI:0.562-0.895,P=0.007).CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287 and No.NRF-2021S1A5A8062526Local Government-University Cooperation-Based Regional Innovation Projects,No.2021RIS-003.
文摘This editorial evaluated the findings of a comprehensive study focused on the effects of anesthesia depth on seizure parameters during electroconvulsive therapy(ECT)in patients with major depressive disorder.The study utilized quantitative consciousness and quantitative nociceptive indices for monitoring sedation,hypnosis,and nociceptive responses.The analysis included 193 ECT sessions across 24 patients,revealing significant impacts of anesthesia depth on electroencephalography(EEG)seizure parameters.Key findings include that lighter anesthesia resulted in longer EEG seizure duration and higher post-ictal suppression index,without increasing complications.These insights emphasize the importance of optimal anesthesia management to improve therapeutic outcomes in ECT.
文摘<strong>Objective:</strong> This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depression. <strong>Methodology:</strong> Twenty-nine (N = 29) individuals over the age of 65 years of age and older were assigned to a control or treatment group on the basis of their decision to receive M-ECT (treatment group) or to refrain from receiving the treatment (control group). A battery of psychometric tests designed to measure severity of depression, quality of life, and cognition were administered at baseline as well as at 6-month and 1-year intervals. <strong>Results:</strong> Statistical analysis of the data indicated no significant differences in the efficacy of M-ECT between the control and treatment groups in any of the tests administered during the participation of the study. <strong>Conclusion:</strong> The results of the study suggest that there is no added benefit for patients administered M-ECT. However, study sample size and availability of alternative treatment regimens for the control group limit generalizability of these findings and warrant further investigation.
文摘Objective: to study the effect of comprehensive nursing care for psychotic patients treated with modified electroconvulsive therapy. Methods: 84 psychotic patients admitted to hospital from November 2019 to November 2020 were randomly divided into reference group and experimental group with 42 cases in each group. All patients need to receive the treatment of modified electroconvulsive therapy. The patients in the reference group use routine care, while the patients in the experimental group use comprehensive care. The quality of life and ability of the two groups were compared. Results: there was significant difference in ability improvement between the two groups (P < 0.05). There was no significant difference in the scores before nursing between the two groups (P > 0.05). After nursing, the difference between the two groups was significant (P < 0.05). Conclusion: the effect of comprehensive nursing is more ideal, the ability to improve their lives, so that patients can gradually recover in treatment and nursing, which is worthy of promotion and application.
文摘Background： Electroconvulsive therapy （ECT） can alleviate the symptoms of treatment-resistant depression （TRD）. Functional network connectivity （FNC） is a newly developed method to investigate the brain＇s functional connectivity patterns. The first aim of this study was to investigate FNC alterations between TRD patients and healthy controls. The second aim was to explore the relationship between the ECT treatment response and pre-ECT treatment FNC alterations in individual TRD patients. Methods： This study included 82 TRD patients and 41 controls. Patients were screened at baseline and after 2 weeks of treatment with a combination of ECT and antidepressants. Group information guided-independent component analysis （G1G-ICA） was used to compute subject-specific functional networks （FNs）. Grassmann maniibld and step-wise forward component selection using support vector machines were adopted to perform the FNC measure and extract the functional networks＇ connectivity patterns （FCP）. Pearson＇s correlation analysis was used to calculate the correlations between the FCP and ECT response. Results： A total of 82 TRD patients in the ECT group were successfully treated. On an average, 8.50 ~ 2.00 ECT sessions were conducted. After ECT treatment, only 42 TRD patients had an improved response to ECT （the Hamilton scores reduction rate was more than 50%）, response rate 51%. 8 FNs （anterior and posterior default mode network, bilateral frontoparietal network, audio network, visual network, dorsal attention network, and sensorimotor network） were obtained using GIG-ICA. We did not found that FCPs were significantly different between TRD patients and healthy controls. Moreover, the baseline FCP was unrelated to the ECT treatment response. Conclusions： The FNC was not significantly different between the TRD patients and healthy controls, and the baseline FCP was unrelated to the ECT treatment response. These findings will necessitate that we modify the experimental scheme to explore the mechanisms underlying ECT＇s effects on depression and explore the specific predictors of the effects of ECT based on the pre-ECT treatment magnetic resonance imaging.
基金supported by grants from the National Science Foundation of China(62176044)Natural Science Foundation of Yunnan Province(202102AA100053)Yunnan Fundamental Research Projects(202201BE070001-004).
文摘Background The hippocampus has been widely reported to be involved in the neuropathology of major depressive disorder(MDD).All the previous researches adopted group-level hippocampus subregions atlas to investigate abnormal functional connectivities in MDD in absence of capturing individual variability.In addition,the molecular basis of functional impairments of hippocampal subregions in MDD remains elusive.Objective We aimed to reveal functional disruptions and recovery of individual hippocampal subregions in MDD patients before and after ECT and linked these functional connectivity differences to transcriptomic profiles to reveal molecular mechanism.Methods we used group guided individual functional parcellation approach to define individual subregions of hippocampus for each participant.Resting-state functional connectivity(FC)analysis of individual hippocampal subregions was conducted to investigate functional disruptions and recovery in MDD patients before and after ECT.Spatial association between functional connectivity differences and transcriptomic profiles was employed to reveal molecular mechanism.Results MDD patients showed increased FCs of the left tail part of hippocampus with dorsolateral prefrontal cortex and middle temporal gyrus while decreased FC with primary visual cortex.These abnormal FCs in MDD patients were normalized after ECT.In addition,we found that functional disruptions of the left tail part of hippocampus in MDD were mainly related to synaptic signaling and transmission,ion transport,cell-cell signaling and neurogenesis.Conclusion Our findings provide initial evidence for functional connectome disruption of individual hippocampal subregions and their molecular basis in MDD.
文摘Autism spectrum disorder(ASD)is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction,alongside restricted,repetitive patterns of behaviors(RRB),interests,or activities.It often co-occurs with various neuropsychiatric disorders,though their frequency varies widely due to unclear boundaries between the core features of ASD and common comorbidities.Catatonia,increasingly noted in neurodevelopmental conditions like ASD,shares striking similarities with ASD in symptomatology,brain mech-anisms,and treatment responses,prompting the question of whether it is a core feature of ASD or a distinct condition.This paper delved into this overlap,ex-ploring the relationship between catatonia and ASD through a narrative review of peer-reviewed literature from 1943 to 2024,sourced from PubMed and psy-chiatric journals.Focusing on ASD diagnostic evolution,symptom overlap with catatonia,and shared neurobiological and therapeutic characteristics,we used thematic analysis to synthesize findings into key areas such as historical nosology,phenomenological overlap,neurobiological parallels,and treatment response.The evidence revealed weak support for separating catatonia from overlapping RRB features of ASD,suggesting that some RRB might align more with comorbid catatonia than intrinsic ASD traits.However,this idea needs further validation through rigorous clinical trials.Clarifying this relationship could refine diagnostic approaches and open doors to targeted treatments,potentially improving out-comes for those affected.
文摘Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning.Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning.Pharmacotherapy,especially selective serotonin reuptake inhibitors antidepressants,remains the most frequent option for treating depression during the acute phase,while other promising pharmacological options are still competing for the attention of practitioners.Depressionfocused psychotherapy is the second most common option for helping patients overcome the acute phase,maintain remission,and prevent relapses.Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations;meanwhile,other methods have limits,and their specific indications are still being studied.Combining medications,psychotherapy,and somatic therapies remains the most effective way to manage resistant forms of depression.
