Accessibility, standards and challenges of electroconvulsive therapy in Western industrialized countries: A German example

Loh, Nico; Nickl‐Jockschat, Thomas; Sheldrick, Abigail J.; Grözinger, Michael

doi:10.3109/15622975.2012.665176

Cited by 57 publications

(24 citation statements)

References 27 publications

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“…In contrast lower rates of use have recently been reported in Norway (24 per 100 000) (Schweder et al 2011), Slovakia (29 per 100 000) (Dragasek 2012) and Canada (23-25 per 100 000) (Martin et al 2014). The rate of use in Germany 2008 was found to be as low as 3.5/ 100 000 but increasing (Loh et al 2013). This is in contrast to a recent study from the United States, where inpatient hospital care including ECT was estimated to be 7.2/100 000 and declining (Case et al 2013).…”

Section: Clinical Aspectscontrasting

confidence: 54%

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

Nordanskog¹

2015

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Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive. The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature. Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT. The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months. In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up. In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase...

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Section: Clinical Aspectscontrasting

confidence: 54%

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

Nordanskog¹

2015

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“…approximately 0.005 % of the adult population, are treated with ECT. This is roughly 0.05 % of all depressive patients [14]. In Germany, about 1 % of all depressive inpatients are treated with ECT, and up to 5-10 % in specialised centres [17].…”

Section: Epidemiological Aspectsmentioning

confidence: 99%

“…The treatment numbers increased 2.5-fold in the course of 13 years. 80 % of treatments are carried out in therapy-resistant depressive patients [14][15][16]. Each year, about 3000 patients, i.e.…”

Section: Epidemiological Aspectsmentioning

confidence: 99%

On the significance of elektroconvulsive therapy in the treatment of severe mental diseases

Grözinger

Smith

Conca

2015

Wien Klin Wochenschr

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“…In Deutschland werden derzeit jährlich ca. 30.000-35.000 EKT-Sitzungen in i.v.-Kurzzeitnarkose und obligater Muskelrelaxation durchgeführt [10,11].…”

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Ketamin als Anästhetikum bei der Elektrokrampftherapie

et al. 2015

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A repeated measurement multiple logistic regression analysis revealed significant advantages in the ketamine group for seizure concordance and postictal suppression (both are surrogates for central inhibition). S-ketamin also necessitated the use of a higher dose of urapidil and a higher maximum postictal heart frequency. Clinically relevant psychiatric side effects were rare in both groups. No psychiatric side effects occurred in the subgroup of patients with schizophrenia (ketamine: n = 30). The mean dose of S-ketamine used increased in the first years but stabilized at 63 mg per patient in 2014. From these experiences it can be concluded that S-ketamine can be recommended at least as a safe alternative to barbiturates.

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Accessibility, standards and challenges of electroconvulsive therapy in Western industrialized countries: A German example

Cited by 57 publications

References 27 publications

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

On the significance of elektroconvulsive therapy in the treatment of severe mental diseases

Ketamin als Anästhetikum bei der Elektrokrampftherapie

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