Search

Objective: The study aimed to explore cognitive outcomes after electroconvulsive therapy (ECT) depending on which version of common single nucleotide polymorphisms the patient expressed for brain-derived neurotrophic factor (BDNF) and catechol-O-methyltransferase (COMT)., Methods: A total of 87 patients from the clinical ECT service in Aberdeen, Scotland, were included in the study. Cognitive function testing (using Spatial Recognition Memory task from the Cambridge Neuropsychological Test Automated Battery and Mini-Mental State Examination) and mood ratings (Montgomery-Åsberg Depression Rating Scale) were performed before ECT, after 4 treatments, at the end of ECT and 1 and 3 months after the end of treatment. These scores were compared depending on BDNF and COMT variant at each time point using the Student t test and using a time series generalized least squares random effects model., Results: No differences were found between the val and met versions of the BDNF or COMT polymorphism in either cognitive or mood outcomes at any time point during ECT treatment or up to 3 months of follow-up., Conclusions: This study did not detect significant differences in cognitive or mood outcomes between patients who have the val66val or met versions of the BDNF polymorphism. Our results suggest that these polymorphisms will not be helpful in clinical practice for predicting cognitive outcomes after ECT.

Objective: To assess the relationship between electrical stimulation administered to patients undergoing bilateral electroconvulsive therapy (ECT) and subsequent measures of cognitive function and depression severity., Methods: Stimulus dose titrated patients receiving bilateral ECT were assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) Spatial Recognition Memory test and Montgomery Asberg Depression Rating Scale (MADRS) at baseline, after 4 ECT treatments and on course completion. Changes in CANTAB and MADRS scores were assessed in relation to electrical dosage, initial stimulus dose, and demographic variables using linear mixed models., Results: Data pertained to 143 patients (mean age, 56.85 [SD, 14.94], 43% male). Median change in CANTAB score was -10% (-20% to 5%) after 4 ECT treatments and -10% (-20% to 5%) at course completion. Median change in MADRS score was -22 (-33 to -13) after 4 ECT treatments and -14 (-25 to -7) at course completion. Electrical dosage had no effect on CANTAB or MADRS change scores either after 4 treatments or course completion. Improvement in CANTAB score at end of course was associated with female sex (P < 0.05), higher intelligence quotient (P = 0.01), and age. After 4 treatments, improvement in CANTAB score was associated with younger age (P < 0.001) and higher intelligence quotient (P < 0.01). Improved MADRS score at course completion was associated with older age (P < 0.001 at end of course and after 4 treatments)., Conclusions: Electroconvulsive therapy has significant antidepressant and cognitive effects which are not associated with the total electrical dose administered. Other, unalterable variables, such as age and sex, have an influence on these effects.

Background: Electroconvulsive therapy (ECT) is held to confer anticonvulsant effects, although the role of rise in seizure threshold upon clinical effect is uncertain. This study investigated the relationship in a large, consecutive, retrospective sample of patients receiving ECT in Aberdeen. We have tested the hypotheses of previous authors to further examine the relationship between seizure and therapeutic effect as well as discuss the potential underlying neurobiological mechanisms., Methods: All patients receiving ECT at the Royal Cornhill Hospital between 2000 and the end of 2008 were identified from the Scottish ECT Accreditation Network. Electroconvulsive therapy was administered twice weekly with a bifrontotemporal electrode placement using routine dosage schedules. Data were gathered from the Scottish ECT Accreditation Network and case notes regarding ECT course and clinical effect., Results: The seizure threshold increased in 219 (94.4%) patients, stayed the same in 13 (5.6%) patients, and decreased in 0 patient (n = 232). No significant relationship was present between change in seizure threshold and change in Montgomery-Asberg Depression Rating Scale score (P = 0.39; Kendall τ b r = 0.047; n = 182), although responders did display greater increase in seizure threshold than nonresponders., Conclusions: Electroconvulsive therapy confers anticonvulsant effects in a consecutive sample of real-life patients. Neither initial seizure threshold nor magnitude of seizure threshold increase is a predictor of clinical response to ECT. A rise in seizure threshold is not essential for therapeutic effect but may represent an important marker of underlying neuronal state. The evidence reviewed in this article supports a link between neuroplastic effects of ECT and the evidenced rise in seizure threshold.

This study describes the relationship between socioeconomic deprivation and electroconvulsive therapy (ECT) prescription and outcomes. Two research questions are addressed in this study: (1) Does the rate of ECT prescription increase with deprivation? and (2) Does deprivation influence ECT outcomes? Electroconvulsive therapy outcomes, of consecutive patients from Aberdeen, were compared across socioeconomic groups determined by the Scottish Index of Multiple Deprivation (SIMD) quintiles. A primary care sample, invited to complete the Hospital Anxiety and Depression Scale (HADS), was used for comparison. The proportion of patients in the most affluent quintile (32%) was greater than that in the least affluent (9%): this reflects the distribution of the local population, unlike the prevalence of depressive disorder, as demonstrated in our primary care group. Severity of depressive symptoms in patients receiving ECT was no different across the socioeconomic groups: before ECT (χ = 8.056; df = 4; P = 0.09), after ECT (χ = 6.035; df = 4; P = 0.197); nor was the total change in score (χ = 4.367; df = 4; P = 0.359). There were no differences among the SIMD quintiles for the number of ECT treatments administered (χ = 6.076; df = 4; P = 0.194) or the number of courses of ECT each patient had during contact with the service (χ = 6.505; df = 4; P = 0.164).Socioeconomic deprivation has no effect on the rate of ECT prescription or treatment outcomes despite a higher proportion of patients with severe depressive symptoms in the least affluent groups in a local community sample.

Objectives: Electroconvulsive therapy (ECT) is often given by a specialist ECT team on behalf of a patient's treating psychiatrist. A key aspect of this interface is the communication between these care teams. This study describes the introduction of an ECT treatment report at the Royal Cornhill Hospital in Aberdeen. The aim of the current study was to evaluate whether these reports were useful to psychiatrist., Methods: The report was designed to provide feedback to the treating psychiatrists on a range cognitive (Mini Mental State Examination, spatial recognition memory on the Cambridge Automated Neuropsychological Testing Battery, Squire Subjective Memory Scale, and Prospective And Retrospective Memory Questionnaire) and mood scores (Montgomery Åsberg Depression Rating Scale) routinely collected by the ECT team. The reports contain the patient's score and the mean of all patients treated in the service. A questionnaire was sent to all treating psychiatrists to evaluate the usefulness of the reports., Results: A 76% response rate was obtained. The reports were well received by treating teams, among whom 78.9% thought they were necessary, 74% thought they were easy to understand, and 79% thought the report was informative. A minority 47.4% thought the report influenced clinical practice, and only 31.3% showed the report to patients., Conclusions: From the results of our evaluation, the provision of an "ECT Treatment Report" providing a summary of the routinely collected mood and cognitive rating data was useful for psychiatrists prescribing ECT. It is thus likely that such a report would be useful in other ECT services.