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

Abstract

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.

Using EEG to Predict Clinical Response to Electroconvulsive Therapy in Patients With Major Depression: A Comprehensive Review

“…In auditory ERP studies, authors found a smaller P300 amplitude over Cz in rapid responders to ECT (HDRS = 7, second week) compared to slow responders (HDRS = 7, third and fourth week) and a correlation between the P300 amplitude and the reduction of depressive symptoms after ECT ( 16 , 17 ); the smaller the P300 over C3, the greater the reduction in HDRS scores. Results from the study using TMS-EEG to measure baseline characteristics did not claim for the interest of this measure as a predictive marker of response to ECT ( 18 ).…”

“…Four studies included depressive patients with psychotic features, and one included patients with schizoaffective disorder with depression. Severity of illness before ECT was quite homogeneous with mean scores at the 17-item Hamilton Depressive Rating Scale (HDRS 17 ) ranging from 26.9 ( 16 ) to 28.7 ( 26 ) ( N = 3 studies), from 29.3 ( 17 ) to 29.7 ( 21 ) ( N = 2) at 21-item HDRS and from 34.0 ( 25 ) to 38.5 ( 17 ) at the Montgomery–Asberg Depression Rating Scale (MADRS) ( N = 2, excluding the mean score of 18.3 in Miyauchi and colleagues ( 18 ), where pre-ECT vs. post-ECT MADRS scores were not significant. Non-psychiatric comorbidities were described only in one study ( 21 ).…”

“…Event-related potential (ERP) paradigms EEG experiments were used in three studies to find a biomarker associated with ECT response. Two focus on the auditory P300 ERP ( 16 , 17 ) and one on the combination of TMS with EEG ( 18 ). Three studies used EEG among other polysomnographic recordings ( 19 , 21 , 22 ).…”

Terminology and assessment tools of psychosis: A systematic narrative review

“…Instead of an explicit definition, authors often defined the term using examples. Psychotic symptoms are most frequently hallucinations and delusions or more specifically, auditory hallucinations and delusions . Others only directly referred to delusions or hallucinations .…”

“…Psychotic symptoms are within the general population, 92,95,101,108,181,204,205 on a continuum, and risk factors for developing psychotic disorders . Psychotic symptoms are also symptoms of psychopathological states such as psychosis and psychotic disorders, 98,105,111–113,115,127,138,145,146,149,154,156,162,164,167,169,174,177,179,184,188,189,191–193,196–198 dementia, 103,107,116,117,125,135,137,139,140,152,157,166,168,170,172,173,175,176,186 alongside delirium, substance use, mood disorders, PTSD, personality disorders, medication side effects, and medical conditions such as Parkinson's disease …”