Differential response to right unilateral ECT in depressed patients: impact of comorbidity and severity of illness [ISRCTN39974945]

Heikman, Pertti; Katila, Heikki; Sarna, Seppo; Wahlbeck, Kristian; Kuoppasalmi, Kimmo

doi:10.1186/1471-244x-2-2

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…Heikman et al (29) found that a homogenous group of patients with depression as the only indication for ECT responded better to ECT than a group of patients with comorbidities. In line with that study, our results suggest that patients without comorbid anxiety or substance dependence tended to have higher response rates than patients with these comorbidities, although the differences were not statistically significant, possibly due to the small number of participants.…”

Section: Comorbiditymentioning

confidence: 99%

Improvement of cycloid psychosis following electroconvulsive therapy

Holm

Brus

Båve

et al. 2017

Nordic Journal of Psychiatry

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Background: The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness. Aims: The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome. Methods: Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n ¼ 42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test. Results: The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p < 0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p ¼ 0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p ¼ 0.31). None of the other investigated potential predictors was statistically significantly associated with outcome. Conclusions: ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies. Clinical implications: The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.

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Section: Comorbiditymentioning

confidence: 99%

Improvement of cycloid psychosis following electroconvulsive therapy

Holm

Brus

Båve

et al. 2017

Nordic Journal of Psychiatry

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“…An acute recovery prefers older age, 35 whereas heterogeneity, with consequential comorbidity, of a patient group can drastically diminish the response. 36 Some authors have also reported a dependence on the subtype of depression, 37 but some disagree with this. 38 Our study had a rather small but diagnostically homogenous sample that included only patients with psychotic depression.…”

Section: Discussionmentioning

confidence: 96%

Enhanced Attention-dependent Auditory Processing by Electroconvulsive Therapy in Psychotic Depression

Nurminen

Valkonen‐Korhonen²,

Mervaala³

et al. 2005

The Journal of ECT

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There is a lack of knowledge about the effect of electroconvulsive therapy (ECT) on auditory event-related potentials (ERPs) in severe psychotic depression. The aim of this study was to investigate both the effect of ECT on attention-dependent ERP (P300) and the correlation of P300 values with depression level. We recorded the auditory ERPs of 23 patients expressing psychotic symptoms and fulfilling the DSM-III-R criteria for treatment-resistant severe major depressive episode before and a week after successful bitemporal ECT. The clinical status was assessed with Hamilton (Ham-D) and Montgomery and Asberg (MADRS) depression scales. ECT was clinically very effective with these scales. On the level of auditory processing, ECT increased P300 amplitude with no significant effect on latency. Small amplitudes over the left hemisphere before treatment were associated with bigger Ham-D-score decrement. ECT produces a significant increase in brain activity at the level of attention-dependent auditory processing in severe depression. The change in electrical responses seems to represent a largely independent variable from the clinical assessment scales, even if the recovery rate was remarkable, because the change in overall symptom scores did not correlate with the P300 changes.

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“…65,100,101 Six trials used explicit diagnostic criteria. Two used ICD-10 5 criteria for major depression, 110,112 one 111 used DSM-III, 262 one used DSM-IV, 103 one used the Feighner 264 criteria 102 and one 107 used the criteria specified by Klein. 265 Four trials specified the severity of depression for inclusion according to the HRSD, with two 103,105 specifying scores on the 17-item HRSD of less than 17, one 111 specifying a score of less than 20 and one specifying scores of less than 22 on the 21-item HRSD.…”

Section: Chaptermentioning

confidence: 99%

Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies

Greenhalgh

Knight²,

Hind³

et al. 2005

Health Technol Assess

157

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Real ECT is probably more effective than sham ECT, but as stimulus parameters have an important influence on efficacy, low-dose unilateral ECT is no more effective than sham ECT. ECT is probably more effective than pharmacotherapy in the short term and limited evidence suggests that ECT is more effective than repetitive transcranial magnetic stimulation. Tricyclic antidepressants (TCAs) may improve the antidepressant effect of ECT during the course of treatment. Continuation pharmacotherapy with TCAs combined with lithium in people who have responded to ECT reduces the rate of relapses. Overall, gains in the efficacy of the intervention depending on the stimulus parameters of ECT are achieved only at the expense of an increased risk of cognitive side-effects. Limited evidence suggests these effects do not last beyond 6 months, but there is no evidence examining the longer term cognitive effects of ECT. There is little evidence of the long-term efficacy of ECT. ECT either combined with antipsychotic medication or as a monotherapy is not more effective than antipsychotic medication in people with schizophrenia. More research is needed to examine the long-term efficacy of ECT and the effectiveness of post-ECT pharmacotherapy, the short-term and longer term cognitive side-effects of ECT, and the impact of ECT on suicide and all-cause mortality. Further work is needed to examine the information needs of people deciding whether to accept ECT and how their decision-making can be facilitated. More research is also needed on the mechanism of action of ECT. Finally, the quality of reporting of trials in this area would be vastly improved by strict adherence to the Consolidated Standards of Reporting Trials recommendations. Economic analysis may identify areas in which research would be best targeted by identifying parameters where reducing the level of uncertainty would have the most effect in helping to make the decision on whether ECT is a cost-effective treatment.

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Differential response to right unilateral ECT in depressed patients: impact of comorbidity and severity of illness [ISRCTN39974945]

Abstract: Background: Recent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes.

Cited by 12 publications

References 26 publications

Improvement of cycloid psychosis following electroconvulsive therapy

Improvement of cycloid psychosis following electroconvulsive therapy

Enhanced Attention-dependent Auditory Processing by Electroconvulsive Therapy in Psychotic Depression

Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies

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