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

Grözinger, M.; Smith, Elke; Conca, Andreas

doi:10.1007/s00508-015-0749-z

Cited by 22 publications

(17 citation statements)

References 31 publications

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“…When rates of ECT in the diagnostic categories in the total patient group are assessed, ECT was administered to 12 of 259 psychotic disorder patients (4.6 %), 8 of 294 bipolar patients (2.7 %), 4 of 43 schizoaffective patients (9.3 %), and 2 of 144 depressive patients (1.3 %). ECT rates in these diagnostic categories are similar to/compatible with the rates reported in the literature [6,37].…”

Section: Discussionsupporting

confidence: 84%

“…Presence of catatonia, resistancy to treatment and suicidality are common indications for ECT [1][2][3]. The remission rate may be as high as 95 % in psychotic depression, which is the major indication for ECT, and around 55-84 % in non-psychotic melancholic depression [4][5][6][7][8]. Despite its superior efficacy, ECT is often approached with caution but indicated if other methods of treatment are not effective or contraindicated, the symptoms are very acute and severe, and a good response to ECT can be expected.…”

Section: Introductionmentioning

confidence: 99%

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Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Özdemir

Poyraz²,

Erten

et al. 2016

Psychiatr Q

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The aim was to evaluate the clinical profile and effectiveness of ECT in women. A retrospective chart review was carried out to identify female patients who had received ECT during the period September 2013-February 2015. Details regarding their sociodemographic, clinical, and treatment data were extracted from these records for the present study. The total number of patients, admitted to our psychiatry inpatient clinic during the survey period, was 802. During this period, 26 (3.24 %) female patients received ECT. Patients who received ECT were mostly in age group of 25-44 years (76.9 %). Twenty percent of patients were in the postpartum period. Psychotic disorders (46.1 %) was the most common diagnosis for which ECT was used, followed by bipolar affective disorder, current episode manic (19.2 %). At the end of ECT courses, 70 % of the patients showed good response with a CGI-I of 1 or 2, and 30 % showed minimal response with a CGI-I score of 3. The most common side effects were post-ECT confusion (15.4 %) and prolonged seizure (11.5 %). This rate of prolonged seizure was higher the rates reported in the literature. The bronchospasm related with remifentanil, post-ECT bradycardia, hypertensive crisis and oligohydramnios were also reported in one case each. ECT is a safe and effective treatment option in women with severe psychiatric disorders and disorders in the perinatal/postpartum period are a major area of ECT use. The female gender may be a contributing factor for the higher rates of prolonged seizure.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Özdemir

Poyraz²,

Erten

et al. 2016

Psychiatr Q

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“…However, the issue of when to consider ECT is fraught with more non-clinical baggage than almost any other decision in medicine. As one group of ECT researchers recently stated, 'Despite positive scientific evidence, the therapy [ECT] is often approached with reserve that cannot be explained rationally' (1). ECT remains stigmatized because of lack of knowledge and understanding about modern ECT technique; persistent, unrealistic negative portrayals in the media; and concerns about adverse effects, primarily cognitive effects.…”

Section: Introductionmentioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

141

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When to consider electroconvulsive therapy (ECT) Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT).Objective: To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. Method: We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. Results: ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. Conclusion: ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia. Clinical recommendations for ECT• ECT should be prescribed earlier in the course of a severe depressive episode, not necessarily withheld until after numerous medication trials • ECT may be considered a first-line (primary) treatment for certain urgently ill patients, including those who are very suicidal, psychotic, or physically debilitated from depression Diagnostic indications for ECT • In many Western countries, severe and treatment-resistant depression is the main indication for ECT • Schizophrenia is the number one indication for ECT worldwide, but is little used for this indication in Western countries • ECT is an effective treatment for treatment-resistant mania • Delirious mania is an urgent indication for ECT • ECT is effective for treatment-resistant schizophrenia, including clozapine-resistant illness • Catatonia is very responsive to ECT • Both the motor and behavioural symptoms of Parkinson's disease respond to ECT Predictors of ECT response • Older age, psychotic symptoms, and shorter episode duration are predictors of better ECT response • Melancholic features and greater baseline depressive symptom severity are likely associated with better ECT response 304 ECT technique • Bilateral, bifrontal, and right unilateral electrode placement are all effective ECT techniques • Less urgently ill patients are often treated initially with right unilateral electrode placement • Brief and ultrabrief pulse width stimuli, now commonly used, are associated with a more benign cognitive effect profile • There is no a priori fixed number of ECT in an acute course: patients should continue treatment with ECT until they remit or a plateau has been reached, or tolerability issues require interruption of the course • Tapering of acute courses of ECT should be considered for most patients (e.g., approximately weekly treatments for several weeks past remission) • Continuation/Maintenance (C/M) ECT should be considered for patients with a history of severe, recurrent episodes who have failed to remain well on medications Additional comments • ECT is underutilized because of stigma, lack of knowledge about it, and bureaucratic restrictions • ECT is among the safest procedures performed under general anesthesia • Cognitive adverse effects are markedly decreased with modern ECT techniques, largely transient, and should not deter seriously ill patients from considering ECT.

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“…Following this idea, he tested camphor and, later on, pentylenetetrazol, to induce seizure in animals and humans. 4,5 In 1934, a catatonic psychotic patient was successfully cured with therapeutic seizures, triggered by administering intramuscular camphor.…”

Section: Historymentioning

confidence: 99%

Electroconvulsive therapy: old acquaintance for the youngster or new opportunity for the elder? Review of the literature and applications in the geriatric population

Palleschi

Trubian

Palleschi³

2019

Geriatr Care

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Electroconvulsive therapy (ECT) is among the most controversial and mythicized therapies in the psychiatric and medical clinical context. Historically, this practice was used in some contexts as a torture or a coercive method and the lay public as well as the collective imaginary has always considered and represented this treatment as inhuman. Prejudices and limited knowledge of this therapeutic tool have contributed to consider this procedure as a violent act and an assault to human dignity, progressively reducing its employment in time. Despite these prejudices, in the international literature several studies have demonstrated a considerable evidence in support of the use of ECT for some psychiatric diseases, considering it among the safest and most effective treatments. Especially in case of life-risk diseases, such as major depression, ECT proved to be necessary in dealing with pharmaco-resistance and bringing to remission psychotic depression with high risk of suicide. Furthermore, to date ECT results to be the treatment of choice in depressed patients that cannot be treated with pharmacotherapy, e.g. in pregnant women, in which the use of antidepressant drugs exposes the fetus to a teratogenic risk, or in elder patients, in which multiple-drug treatments and interactions have to be carefully considered. The purpose of this paper is to provide a review of the literature regarding ECT and concise guidelines for this treatment and its clinical outcomes, with special reference to geriatric population.

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

Abstract: ECT is a modern, highly effective and safe treatment of severe mental diseases with comparatively few side effects. The method should not be used as a last resort but in an evidence-based way. Patients should be informed timely and adequately about the therapeutic option.

Cited by 22 publications

References 31 publications

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

Electroconvulsive Therapy in Women: A Retrospective Study from a Mental Health Hospital in Turkey

When to consider electroconvulsive therapy (ECT)

Electroconvulsive therapy: old acquaintance for the youngster or new opportunity for the elder? Review of the literature and applications in the geriatric population

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