Background: Controversy persists about the use of right unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT). While RUL ECT results in less severe short-term and long-term cognitive effects, there is concern that it is less efficacious than BL ECT.

Increasing the electrical dosage increases the efficacy of right unilateral electroconvulsive therapy, although not to the level of bilateral therapy. High electrical dosage is associated with a more rapid response, and unilateral treatment is associated with less severe cognitive side effects after treatment.

The Behavioral Syndromes Scale for Dementia (BSSD) is a new instrument that showed strong internal consistency and interrater reliability in an outpatient sample of 106 patients with probable Alzheimer's disease. Factor analysis provided support for a priori symptom groupings, particularly the syndromes of disinhibition and apathy-indifference. Dependency (87%), denial of illness (63%), and motor agitation (55%) were common, while sexual disinhibition (2.9%) and self-destructive behaviors (2.9%) were rare. Virtually all symptoms were predominantly minimal to mild in severity. Patients with longer illness duration were more apathetic. Disinhibited behaviors and apathy-indifference increased with greater severity of dementia. Catastrophic reactions, aggression, and agitation were associated with greater functional impairment. There was great heterogeneity in symptom presentation. In Alzheimer's disease, several behavioral changes might be direct manifestations of underlying brain pathology, rather than being solely secondary to cognitive impairment.

An Autobiographical Memory Interview (AMI) was administered to 75 depressed inpatients and 16 nondepressed controls. Patients were randomized to 1 of 4 forms of electroconvulsive therapy (ECT) that varied in electrode placement and stimulus intensity. Short-term retrograde amnesia was assessed during the week following the randomized phase. Bilateral ECT produced more marked deficits than right unilateral ECT. At a 2-month follow-up, persistent amnesic deficits were related to having received a second ECT course and, to a lesser extent, bilateral ECT during the randomized phase. The magnitude of clinical improvement was not associated with amnesia scores at either time point. There were no differential amnesic effects as a function of the affective valence of memories. It appears that retrograde amnesia for autobiographical information after ECT and mood congruence effects on recall are independent phenomena. The magnitude and persistence of retrograde amnesia is related to how ECT is performed and not to changes in clinical state or the affective valence of memories.Electroconvulsive therapy (ECT) has well-documented neuropsychological effects. Shortly after an ECT course, patients typically manifest retention deficits for newly learned information (anterograde amnesia) against a background of improved performance on tests of attention, immediate learning, and