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•What is the primary question addressed by this study?Is there preliminary evidence for efficacy and mechanism-of-action, of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), for depression symptoms?•What is the main finding of this study?TranS-C improved depression response rates 6-months postintervention. During the acute treatment phase, improvements in interdaily stability (in older adults) and reduction in insomnia severity (in younger adults) correlated with the degree of depression symptom reductions 6-months later.•What is the meaning of the finding?Future studies are warranted to confirm that TranS-C, a targeted sleep-wake treatment, improves the durability of depression symptom response via the identified pathways.

The majority of the previous research has focused on the impact of average sleep parameters on longevity. In this study, we aimed to investigate the associations of day-to-day deviations in sleep parameters with biological ages among 6052 adults participating in the 2011-2014 waves of the US National Health and Nutrition Examination Survey.

Longitudinal observational studies have shown a meaningful decrease in suicidal thinking and suicidal behavior after receipt of electroconvulsive therapy (ECT). The antisuicide effect of ECT may be related to success in the global relief of the presenting syndrome such as depressive or psychotic illness. However, it is possible that the antisuicide effect is specific to ECT per se, over and above the relief of the clinical syndrome. Electroconvulsive therapy is associated with many observable neurochemical and physiologic effects, and some of these may plausibly be specifically linked to an antisuicide effect. The phenomenon of physiologic hyperarousal has been named as a candidate mechanism driving the risk for suicide. Hyperarousal is associated with decreased neuropsychological executive function responsible for response inhibition and can lead to impulsive action. The level of arousal within the autonomic nervous system (ANS) can be assayed with the pupillary light reflex, electrodermal activity, or with heart rate variability (HRV). This article summarizes the literature on the effects of ECT on HRV 24 to 72 hours after a course of ECT and finds evidence for increases in HRV, which indicates lower levels of arousal in the ANS. This finding suggests that ECT-related reductions in ANS arousal, presumably with corresponding improvements in response inhibition, may be one mechanism whereby ECT reduces risk for suicide.

Transcranial magnetic stimulation is typically administered daily for 6 to 9 weeks with gradual resolution of major depressive disorder. However, there is little evidence to guide clinicians when clinical improvement is not forthcoming as the course proceeds. We describe a patient whose depression score remained unchanged after 10 single daily intermittent thetaburst transcranial magnetic stimulation sessions targeting F3 in the dorsolateral prefrontal cortex and our efforts to modify the technique and monitor progress with heart rate variability (HRV) measures. The motor threshold position and intensity were verified to be unchanged from the baseline visit. Stimulation of F3 and treatment target 6 cm anterior to the mapped motor cortex site seemed to slow heart rate and increase HRV equally. We increased the number of daily intermittent thetaburst pulse trains for the remainder of the treatment course, targeting the 6-cm target. Our patient subsequently improved, and we observed concurrent changes in HRV suggestive of enhanced parasympathetic activity. These improvements were found to be durable at 10-week follow-up.

•How can clinicians best achieve equity in informed consent for geriatric minority patients considering treatment with electroconvulsive therapy (ECT)?•Elderly minorities, by virtue of their age and race/ethnicity, have witnessed and survived more healthcare injustices than most of their clinically-matched Caucasian peers will ever see. These actual experiences of medical mistreatment combine with ECT's pervasive social stigma to give elderly minority patients reasonable cause to doubt the clinical suggestion as a treatment as unfortunately stigmatized as ECT.•Reducing healthcare disparities for elderly minority patients in ECT requires clinicians to validate the unique lived experiences of medical injustice that elderly minorities have faced in order to become more trustworthy of their consent before, during, and after treatment.

Currently 1.7 million individuals reside in 15,600 nursing homes in US (www.cdc.gov). These individuals often have difficulty adjusting to their new environment. They may refuse daily care, meals, and medications. Resistance-to-care behavior was reported in 9% of dementia patients in US studies and 96.9% in a Norwegian study (Konno R 2012). A definition of rejection of care and a conceptual framework of rejection of care incorporating 7 components was proposed by Ishii S. 2012). Increased caregiver stress can cause both physical and psychological injury to caregivers (Cody SJ 2001). Informant distress related to patients behavioral and psychological symptoms of dementia (BPSD) rather than symptoms themselves, were noted to be associated with higher healthcare utilization and costs (Maust D. 2017). Increased mortality and death rate are associated with use of antipsychotic medications (Tampi R 2017). Different interventions have been reported to decrease resistance to care behaviors including Music therapeutic caregiving (Hammer L 2011), simulated presence therapy (Woods p 1995), Family-generated videotapes Cohen-Mansfield J 1997), video simulated presence(VSP) (O'Conner C 2012). AlzhaTV displayed family videos to dementia patients to reorient, reassure, encourage to cooperate with care, showed decrease in NPI-NH (Neuropsychiatric inventory – Nursing home) scores by 85% by day 90 (Varshney S 2018). Noncooperation with healthcare workers to overall daily care, medications, and treatments is a major factor in increased cost of care for dementia patients in nursing homes. A Resistiveness to Care scale was developed by (Mahoney EK 1999) to measure a wide range of resistive behaviors. Some strategies can be implemented to improve cooperation. However, our literature search didn't find any study/scale to assess co-operation with care that would help compare outcomes of different studies that used different interventions to improve cooperation with care. We created and tested a scale to measure cooperation with the care (Varshney S 2018) then revised to add frequency component to obtain a comprehensive assessment on cooperation with the care. We applied Cooperation with Care Scale – Revised (CWCS-R) to nurses taking care of 15 nursing home dementia patients, in a systematic approach to test its validity and reliability.

•What is the primary question addressed by this study?What are the acute neurocognitive effects of ultrabrief pulse, dose titrated, right unilateral ECT, and venlafaxine in elderly adults with major depressive disorder?•What is the main finding of the study?There were statistically significant declines in performance across neurocognitive measures. However, the magnitude of decline was clinically modest, with small differences relative to baseline, and some cognitive performance only fell into the mildly impaired range.•What is the meaning of the finding?The combination of RUL-UB ECT with venlafaxine is a relatively cognitively safe treatment in late-life depression.

Predicting which patient(s) will respond to Electroconvulsive Therapy (ECT) has very important clinical implications. The aim of this manuscript is to review the current literature on clinical, physiologic and laboratory biomarkers as predictors of ECT response and remission related to the treatment of major depressive disorder (MDD). We will briefly discuss available research on the predictors of cognitive side effects of ECT. Although each clinical factor may have subtle influence on ECT response, taken together clinical predictors can lead to a robust treatment plan tailored for an individual patient, and advise on the likelihood of ECT response. Available literature supports the predictive value of several clinical factors. Older age, psychotic depression, and depression severity positively predict ECT response. Limited data is available for catatonia specific to MDD, but overall data shows positive response of ECT for the treatment of catatonia. Multiple medication trials in the current episode and comorbid psychiatric diagnosis (including borderline personality disorder and substance use disorder) predict lower response.

The effectiveness of electroconvulsive therapy (ECT) in the treatment of unipolar and bipolar major depressive episodes (MDE) is well known, and the US Food and Drug Administration has recently reclassified ECT devices to a less restrictive category for treatment of MDE and catatonia. In this review, we look at the existing evidence supporting the use of ECT in conditions other than MDE, such as bipolar mania and mixed states, schizophrenia, catatonia, Parkinson's disease, agitation in dementia, and status epilepticus. The effectiveness of electroconvulsive therapy (ECT) in the treatment of unipolar and bipolar major depressive episodes (MDE) is well known, and the US Food and Drug Administration has recently reclassified ECT devices to a less restrictive category for treatment of MDE and catatonia. In this review, we look at the existing evidence supporting the use of ECT in conditions other than MDE, such as bipolar mania and mixed states, schizophrenia, catatonia, Parkinson's disease, agitation in dementia, and status epilepticus. [[Psychiatr Ann. 2019;49(4):157–163.]

The use of electroconvulsive therapy (ECT) for those suffering from major depressive disorder is well-evidenced, time-honored, and recognized by most treatment guidelines. However, since its inception ECT has been used by practitioners for a broader range of neuropsychiatric conditions. This article reviews the highly variable evidence supporting the use of ECT in conditions other than depression, such as schizophrenia, bipolar manic states, catatonia, Parkinson disease, and post-traumatic stress disorder.

This commentary reflects upon the study of Braga et al of open-label continuation electroconvulsive therapy (ECT) plus clozapine in treatment-resistant schizophrenia (TRS), as reported in this issue of The Journal of ECT. The evidence base for ECT in TRS is scant, and the study of Braga et al is a step forward. However, their report raises other important questions including (1) what is the proper frequency of continuation ECT in TRS, and (2) should TRS patients, even TRS patients who have failed clozapine, receive acute ECT + clozapine, or is ECT + conventional antipsychotics sufficient? In this commentary, we examine these questions and outline a future research strategy for TRS that includes large simple trials.

•What are the long-term neurocognitive effects of continuation treatment with ultra-brief pulse, 6 times seizure threshold, right unilateral ECT in combination with venlafaxine and lithium relative to only venlafaxine and lithium in older adults with major depressive disorder?•At the 6-month final time point, there were no statistically significant differences across all neurocognitive outcomes between the two treatment groups. Equally important, within each treatment group, there was statistically significant and qualitative improvement across most neuropsychological measures.•The combination of RUL-UB ECT with venlafaxine and lithium is a relatively tolerable and cognitively safe continuation treatment in late-life depression.

•What is the primary question addressed by this study?What are is the presentation and course of major depression complicated by globus pharyngeus and weight loss in the older adult?•What is the main finding of this study?The complication of major depression occurring with globus pharyngeus in the older adult may be accompanied by life threatening weight loss and aspiration of oral secretions. The depression, globus pharyngeus and weight loss can be simultaneously reversed with the timely offering of electroconvulsive therapy.•What is the meaning of the finding?Most cases of globus pharyngeus are self-limited. However, when globus pharyngeus occurs in the setting of major depression in the older adult, then weight loss may be progressive and severe, and accompanied by life-threatening aspiration. The appearance of aspiration or marked weight loss should lead to early consideration of electroconvulsive therapy.

Insomnia is a common symptom in the clinical course of schizophrenia. There is a robust association between insomnia and suicidality in other psychiatric disorders. Two previous studies found associations between insomnia and suicide attempt or completed suicide in patients with schizophrenia. We hypothesized that greater insomnia would be associated with greater levels of suicidal ideation in patients with schizophrenia and other nonaffective psychoses.