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This scoping literature review describes the practices of nurses working in mental asylums between 1800 and 1960 prior to the introduction of psychotropic drugs. Studies published in English from 1976 to 2021 from CINAHL, PubMed, ProQuest, PsyINFO, MEDLINE and Google were searched in August 2021. Twenty-three papers were retrieved with three distinct periods identified that shaped nursing practice. These were custodial care, moral and somatic treatment. Shifts in nursing practice were shaped by the desire of psychiatry to be recognised as a medical speciality, the feminisation of nursing and the formal development of nurse training in general hospitals. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) is a controversial treatment. Research has predominantly focused on clinician assessment of short-term efficacy and, occasionally, on participant experiences of the treatment itself. While service user accounts of the long-term impacts of ECT are reported, they are dispersed throughout the literature and typically tangential to studie's main foci. The aim of this study was to synthesise service-user accounts, within peer-reviewed literature, of long-term impacts of ECT in their daily lives. A qualitative meta-synthesis was conducted. A systematic literature search identified qualitative articles meeting the inclusion criteria. Results sections of eligible papers were analysed thematically. From 16 eligible papers, the review identified 11 long-term impacts, four social influences and five strategies that people employed to navigate these long-term impacts. Limited research has examined long-term experiences of ECT from service-user perspectives. These lived experience perspectives are required to facilitate peer-to-peer learning and assist future service delivery to align with needs of people living with long-term ECT impacts. [ABSTRACT FROM AUTHOR]

This paper explores the hyper-performative expectations of early career teachers (ECTs) in the context of neoliberal education assemblages. The need to support and retain beginning teachers is a salient issue in the context of troubling rates of teacher attrition. The study explores how ECTs perceive teacher identities in response to national standards. Our research revealed that ECTs held concerning conceptions of 'quality teaching' that are largely constructed through discourses of competition and job insecurity. ECT subjectivities were heavily influenced excessive extra-curricular hours, high-stress environments, and performative school cultures. This paper concludes that hyper-performative expectations of ECTs and insecure patterns of employment contribute to teacher attrition. [ABSTRACT FROM AUTHOR]

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Previous studies have investigated the relationship between political instability and economic growth separately from the relationship between military expenditure and economic growth. Besides, they did not cover the period after 2011 (i.e. the Arab Spring and its consequences). Therefore, this paper attempts to empirically analyze the long-run and short-run impacts of both political instability and military expenditure on economic growth in Egypt. We estimate the autoregressive distributed lag (ARDL) approach using data on the Egyptian economy over the period 1982–2018. For the robustness of our results, we use the fully modified ordinary least squares (FMOLS) estimator. Results of the ARDL approach indicate a significant negative relationship between political instability and economic growth in both the long-run and short-run. Contrarily, military expenditure has an insignificant impact on economic growth, especially in the long-run. These results are confirmed by the FMOLS estimator. Moreover, the estimated coefficient on the one-period lagged error correction term (ECTt-1) indicates that deviations from the long-run equilibrium relationship are corrected within a year. [ABSTRACT FROM AUTHOR]

An association is found between changes in cytokine levels and antidepressant treatment outcome. Also, a proinflammatory profile is associated with a favourable electroconvulsive therapy (ECT) outcome. This paper investigates the pattern of inflammatory markers during a course of ECT in older depressed patients and whether this pattern is associated with ECT outcome. We hypothesised that ECT has an anti-inflammatory effect. The pattern of CRP, IL-6, IL-10, and TNF-α during a course of ECT was examined using longitudinal mixed model analyses. Serum samples were collected in 99 older depressed patients (mean age: 72.8 ± 8.3 years, MADRS score 33.8 ± 9.0). After Bonferroni correction, there were no statistically significant alterations in levels of inflammatory markers during and after ECT. Effect sizes (Cohen's d) were −0.29 for CRP, −0.13 for IL-6, −0.06 for IL-10, and −0.07 for TNF-α. Changes in CRP or cytokine levels did not differ between remitters and non-remitters. Median baseline levels of CRP were significantly higher in remitters. A small to medium effect size towards decreased CRP and IL-6 levels was observed. An anti-inflammatory effect of ECT could not be confirmed. However, the findings may suggest that patients with an inflammatory profile benefit more from ECT than other patients. Further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses reports about Italian psychiatry.

Introduction: We aimed to review the safety and effectiveness of dual-layer micromesh stents for the endovascular treatment of carotid artery stenosis. Methods: Electronic bibliographic databases were searched using the words 'micromesh carotid stent'. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Results: The search of the Literature retrieved 84 results. After assessment of full texts, 13 papers were included in the study. The analyzed studies included 797 patients, 32.1% of them were symptomatic. The reported technical success rate was 100% in all cases. During early follow-up, complications occurred overall in 16/797 patients (2%: 12 strokes, 3 deaths, and one transient ischemic attack). The study with the longest follow-up reported a survival rate of 82% at 4 years and a stroke-free survival rate of 84% at 4 years. Conclusion: With the limit of low data quality, the use of dual-layer stents was reported to be as safe and effective at 30 days for the endovascular treatment of extracranial carotid artery stenosis. The reported technical success was 100% in all cases. Further data coming from randomized controlled trials and larger cohort studies with longer follow-up are nevertheless needed for a better evaluation. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) has been an important procedure, ever since its introduction. Despite being a life-saving treatment there remains a great deal of public concern about ECT's continued use. Pakistan is a low-income country and psychiatry in Pakistan is continuously in the evolutionary process. Electroconvulsive therapy provides a welcome relief from the suffering of various mental illnesses for many patients, though its standards and practice vary remarkably. This paper gives a brief overview of ECT practice in a private outpatient clinic in Lahore, Pakistan. [ABSTRACT FROM AUTHOR]

Older women are particularly prone to being treated for depression, and, despite the controversy surrounding it, electroconvulsive therapy (ECT) has gained popularity as a treatment with this population. Research has examined the physical and cognitive changes associated with ECT but there is little understanding regarding how older women themselves experience this treatment. In order to gain better understanding into the subjective experience of receiving ECT, this qualitative study explored the experiences of six older women who were treated with ECT for a diagnosis of depression, using in-depth personal interviews. Analysis suggests that this experience for these older women could not be understood in isolation. Rather, their stories highlighted the importance of interpreting the ECT experience within a broader context that included the larger depression experience, the dynamics of helping relationships, and the discourse available to them for sense-making. Specifically, the central theme underpinning all of these women's stories was the shifting of power from themselves to others. This paper examines how this occurred and discusses implications for practice. [ABSTRACT FROM AUTHOR]

Fifty years ago Juhn A.Wada developed the intracarotid amobarbital procedure (IAP), a test in which first one and then the other cerebral hemisphere is temporarily anaesthetised through direct intracarotid application of sodium amytal. The IAP was devised initially as a method to allow unilateral electroconvulsive shock therapy for psychosis. The method subsequently proved its value for the lateralisation of language and, following adaptation of the test protocol, for the assessment of memory functions. Thus the IAP became a standard test in the presurgical evaluation for resective surgical treatment of medically intractable epilepsy. This paper will briefly review the history of the IAP, the controversies concerning its current applications and its expected eventual replacement by less invasive and more easily repeatable methods, notably functional magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to fill a gap in the social work literature which has not, to date, included a thorough discussion of electroconvulsive therapy (ECT) from a social work perspective. It discusses the rationale for ECT in current practice; enumerates improvements made in stimulus delivery since convulsive therapy was introduced in 1934; and summarizes the myths, realities, advantages and limitations of the treatment in modern psychiatry. It advocates a team approach, which includes social work support and education of the patient and family regarding treatment related matters and discharge planning. Several clinical vignettes are included to illustrate the types of illness for which ECT is used as well as the social work role with the team and patient/family during hospitalization and discharge planning. The Ontario College of Certified Social Workers Guidelines are used to explain social work interventions. The paper is also relevant to social workers in non-psychiatric settings in understanding and planning with patients and families where a member has experienced ECT. [ABSTRACT FROM AUTHOR]

Objectives.Brain stimulation techniques are non-pharmacologic strategies which offer additional therapeutic options for treatment-resistant depression (TRD). The purpose of this paper is to review the current literature regarding the use of brain stimulation in resistant bipolar disorder (BD), with particular reference to hypomanic/manic symptoms.Methods.Keywords pertaining to the brain simulation techniques used in the treatment of depression (either unipolar or bipolar) along with their role in regard to hypomanic/manic symptoms were used to conduct an electronic search of the literature. Pertinent findings were identified by the authors and reviewed.Results.Brain stimulation techniques represent a valid therapeutic option in TRD. They have been extensively studied in unipolar depression and, to a minor extent, in the depressive phase of BD, showing encouraging but often limited results. With exception of electroconvulsive therapy, the efficacy of brain stimulation in the treatment of manic symptoms of bipolar patients is still uncertain and needs to be fully evaluated.Conclusions.Brain stimulation in BD is derived from its use in unipolar depression. However, there are many important differences between these two disorders and more studies with a systematic approach need to be conducted on larger samples of bipolar patients with treatment-resistant characteristics. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) is an acute and severe neurological disorder. A small number of SE cases cannot be terminated by a sufficient therapeutic dose and duration of two to three common anticonvulsant therapies. The continuing seizures often lead to poor prognosis and a higher mortality rate. Novel non-drug treatment options to terminate SE are greatly needed. Induced hypothermia and electroconvulsive therapies are used to treat SE. There are many case studies and multiple experimental investigations of these methods in the literature. This article reviews the historical evolution, mechanisms, clinical applications and adverse reactions of SE, some of which have shown that both treatments are beneficial and relatively safe. The purpose of this paper is to provide alternative treatment methods for SE. [ABSTRACT FROM AUTHOR]

Aside from the focus on satisfaction levels, psychological aspects of the experience of electroconvulsive therapy (ECT) have not traditionally been the focus of significant research. Given that clinical psychologists work closely with professionals involved in administering ECT, and have increasing involvement with decisions about ECT, there is a potential role for clinical psychologists in this area. To review the diverse sources of literature regarding how patients psychologically experience, and react to, ECT. A literature search identified relevant published papers related to the patient experience of ECT. Reviewed articles included clinician and service user led research, comprising qualitative and quantitative research approaches and policy documents. Patients have multiple and diverse reactions to ECT. These can be considered under the themes of consent, fear, powerlessness, memory and identity. The experience of ECT can significantly impact on patients and this can have a negative long-term influence. Clinical psychologists need to be actively involved in consent procedures, use clinical formulation to understand the perspective of patients, and empower patients to share their views of ECT with mental health professionals and service developers. Further research into how patients experience ECT, particularly using qualitative methods, is recommended. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) has been used clinically since 1938. Its most common use is in the treatment of depression: first line treatment where rapid recovery is a priority, but more frequently as an effective treatment for patients who do not respond to pharmacological and psychological approaches. Whilst it is widely hailed as an effective treatment, concerns about its effect on cognition remain. The development of magnetic seizure therapy (MST) over the past decade has attempted to devise a therapy with comparable efficacy to ECT, but without the associated cognitive side effects. The rationale for this is that MST uses magnetic fields to induce seizures in the cortex, without electrical stimulation of brain structures involved with memory. MST has been used successfully in the treatment of depression, yet there is a dearth of literature in comparison with ECT. We present a systematic review of the literature on ECT (from 2009-2011) and MST (from 2001-2011). [ABSTRACT FROM AUTHOR]

Our aim was to observe the frequency of combination therapy using antiepileptic drugs (AEDs) and electroconvulsive therapy (ECT) in Austria and the literature, and to provide rationales and recommendations based on clinical and molecular properties. The responsible ECT leaders of eight Austrian departments were contacted for information about combination therapy. A computerized PubMed database search was performed and supplemented by cross-referencing from papers, review articles and psychiatric manuals. The frequency of combination therapy in Austrian departments ranges between 0 and 85.7%. In 17 studies enrolling a total of 189 patients, 87 (46.0%) patients received combination therapy. Of these 87 patients, nine (10.3%) reported adverse effects. ECT and AEDs show overlapping clinical and molecular properties. Combination therapy is an observed reality and, according to the currently available literature, feasible. A comparison of clinical and molecular properties indicates possible augmentative effects, making combination therapy a promising alternative in treatment-resistant cases. But there is still a clear need for prospective case controlled data concerning side effects, safety profiles and effectiveness until it can be recommended. [ABSTRACT FROM AUTHOR]

Psychotic symptoms in people with Parkinson's disease (PD) have attracted increasing. Recommendations on treating psychosis often fail to take into account what psychotic symptoms require treatment, which has been complicated by the increasing number of reports documenting the frequency of 'minor' hallucinations. This article focuses both on the phenomenology of psychotic symptoms and their management. Understanding the nature and implications of the types of psychotic symptoms in PD is the key to proper treatment. Evidence and experience-based data on the effect of anti-psychotic medications will be reviewed and how the various clinical settings should determine the treatment approach. The evidence base consists of all reported blinded trials recorded in PubMed and the experience-based studies are those chosen by the author from PubMed as illustrative. Specific recommendations for the treatment of psychosis will be listed for specific situations. Pimavanserin is the first-line choice for mild symptoms; quetiapine for symptoms that require improvement in a short period and clozapine for urgent problems or those which fail the other approaches. Psychotic symptoms are common in PD, affecting the majority of patients by the time of death. 'Minor hallucinations' rarely require treatment but formed hallucinations and delusions often do. The vast majority of patients requiring treatment are on medications for PD motor problems. Some patients can be treated with reduction of psychoactive medications that are unrelated to PD, and some may tolerate reductions in PD medications without intolerable worsening of motor function. The remainder require treatment with medications that reduce psychotic symptoms, which include cholinesterase inhibitors, clozapine, pimavanserin, and possibly quetiapine and electroconvulsive therapy. Only clozapine and pimavanserin have unequivocal evidence for efficacy and motor tolerance. Data will be reviewed in support of each of these medications will be reviewed and pragmatic suggestions based on a large experience on when each might be used, and in what order they may be tried if initial approaches fail. [ABSTRACT FROM AUTHOR]

To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. This was an observational register study using data from the Swedish National Quality Registry for ECT (2011–2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (−0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p =.011). The corresponding analysis for EQ VAS did not show any statistically significant associations. No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about the role of a psychiatrist are anecdotally widespread but have been under researched. Aims: This study aimed to establish views on training and working in psychiatry amongst preclinical medical students at a South London Medical School and amongst a general public sample. Methods: A semi-structured online questionnaire was used to survey medical students, with a similar paper questionnaire being used to survey members of the public in a general practice waiting room using a convenience sampling method. Results: Strikingly, the majority of the public thought that psychiatrists did not need a medical degree (54%) or postgraduate training (56%). There were significant misconceptions about treatments used in mental health, for example 16% of the public sample thought psychiatrists never use medication and 31% of medical students (and 14% of the public) thought psychiatrists never use electroconvulsive therapy (ECT). In response to 'do you believe a psychiatrist is able to know what people are thinking?', 45% of students and 57% of the public answered 'sometimes'. Conclusion: The results have important implications for public education, as lack of awareness about psychiatry may inhibit help seeking for mental illness, and have a negative impact on recruitment to psychiatry amongst medical students. [ABSTRACT FROM AUTHOR]

The use of electric shock rods in the training of autistic and retarded institutional children has polarized psychologists into incompatible camps, those who favor the use of shock and those opposed. The controversy was debated by the governing structure of the American Psychological Association for several seasons. It was not resolved but rather spread into a spectrum of opinions and positions. This paper examines the dispute and suggests alternative directions that research with autistic children might more profitably take. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that affects a significant number of individuals worldwide. Major depressive disorder (MDD) is among the most common comorbidities reported in people with OCD. The emergence of MDD in individuals with OCD can be attributed to the increased severity of OCD symptoms and their profound impact on daily functioning. Depressive symptoms can also modify the course of OCD. In this review, the authors explore potential shared neurobiological mechanisms that may underlie both OCD and MDD, such as disturbed sleep patterns, immunological dysregulations, and neuroendocrine changes. Furthermore, they address the challenges clinicians face when managing comorbid OCD and MDD. The authors also discuss a range of treatment options for OCD associated with MDD, including augmentation strategies for serotonin reuptake inhibitors (e.g. aripiprazole), psychotherapy (especially CBT/EPR), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and deep brain stimulation (DBS). Although there is no 'rule of thumb' or universally acceptable strategy in the treatment of OCD comorbid with MDD, many clinicians, including the authors, tend to adopt a unique transdiagnostic approach to the treatment of OCD and related disorders, focusing on strategies known to be effective across diagnoses. Nevertheless, the existing 'cisdiagnostic approaches' still retain importance, i.e. specific therapeutic strategies tailored for more severe forms of individual disorders. [ABSTRACT FROM AUTHOR]

Health service providers must balance the needs of high-risk patients who require urgent medical attention against those of lower-risk patients who require reassurance or less urgent medical care. Based on their characteristics, we developed a tool to classify patients as low- or high-risk, with correspondingly different patient pathways through a service. Rather than choosing the threshold between low- and high-risk patients solely considering classification accuracy, we demonstrate the use of discrete-event simulation to find the best threshold from an operational perspective as well. Moreover, the predictors in classification tools are often categorical, and may be inter-dependent. Defining joint distributions of these variables from empirical data assumes that missing combinations are impossible. Our new approach involves using Poisson regression to estimate the joint distributions in the underlying population. We demonstrate our methods on a practical example: setting the threshold between low- and high-risk patients with proposed different pathways through a breast diagnostic clinic. [ABSTRACT FROM AUTHOR]

This study attempts to assess the concentration of two opposite-acting adipokines (anti-inflammatory adiponectin and pro-inflammatory resistin) in antidepressant-resistant patients undergoing ketamine infusion (KI) and electroconvulsive therapy (ECT). The study group comprised 52 patients hospitalised due to episodes of depression in the course of bipolar disorders. The Hamilton depression scale was used to assess the intensity of the depression symptoms before starting therapy and one day after its completion. The serum concentration of adipokines was determined before and after the therapeutic intervention using an ELISA method. Baseline adipokine levels differed between patients receiving KI and ECT therapy. Regardless of the procedure used, these levels changed after treatment, with the nature of these changes being different. In the case of KI, the adiponectin levels increased, and resistin levels decreased. In contrast, after ECT, the concentrations of both adipokines decreased. Changes in adipokine concentrations correlated with improvement in mental status, as assessed by the Hamilton Rating Scale, type of bipolar disorder, and gender. Adipokines remain interesting candidate biomarkers in assessing the state and course of the disease depending on the therapeutic procedure applied. However, the relatively small study group and limited original research available for discussion justify further investigation. [ABSTRACT FROM AUTHOR]

The article discusses two books that provide new perspectives on the First World War in Eastern Europe. "Forgotten Wars: Central and Eastern Europe, 1912-1916" by Włodzimierz Borodziej and Maciej Górny challenges the traditional understanding of the war by examining events before and during the conflict, highlighting the impact on non-combatants and the ethnicization process that occurred. "In the Shadow of the Great War: Physical Violence in East-Central Europe, 1917-1923" edited by Jochen Böhler, Ota Konrád, and Rudolf Kučera explores the political violence that occurred during and after the war, examining various aspects such as paramilitarism, sexual violence, and press appreciations. The books provide valuable insights into the Eastern dimensions of the war and shed light on the experiences of the region during this period. [Extracted from the article]

Mitral regurgitation (MR) is associated with substantial morbidity and mortality. Within the past 15 years, mitral valve edge-to-edge repair (M-TEER) has developed from an experimental approach to a guideline-recommended, safe, and effective treatment option for patients with severe primary or secondary mitral regurgitation. This review covered relevant publications of M-TEER and summarizes the development of M-TEER devices within the last 15 years. It outlines anatomical challenges which drove the evolution of M-TEER devices, provides an overview about the current state of clinical application and research, and offers an outlook into the future of transcatheter mitral valve treatment. The development and refinement of new M-TEER device generations offer the possibility to treat a wide range of mitral valve anatomies. Choosing the best device for the individual anatomic properties of the patients and considering comorbidities is the key to maximized MR reduction, minimalized complication rates, and thus optimized postinterventional prognosis. Independent from prognostic implications, quality of life has become an important patient-centered outcome that can be improved by M-TEER in virtually all patients treated. [ABSTRACT FROM AUTHOR]

Intrathecal therapy has been limited by non-randomized prospective studies, particularly for those suffering from non-cancer. Further, no prospective, randomized studies investigating the efficacy, safety, and utilization of intrathecal polyanalgesic consensus guidelines exist. After IRB approval, patients were enrolled in a 1:1 fashion for intrathecal drug delivery (IDD) or conventional management (CMM), employing standard of care, excluding intrathecal drug delivery, based on the principal investigator's discretion. They were followed 3, 6, 9, and 12 months. Assessments included PROMIS 29, NPRS, and PriceMonkey. Seventy-nine patients were screened, 54 patients were enrolled: 26 to IDD and 28 to CMM. At 3 months, there was no measurable difference in pain improvement in either subgroups within the CMM for chronic pain-related syndromes (CPRS) or failed back and related spine disorders (FBRS). For the IDD, early and maintained benefit from the baseline was statistically achieved. Cost analysis of pump to CMM breakeven was 4.5 months. There were no adverse events related to compounded intrathecal medications. This is the first randomized prospective, multicenter study investigating the safety, cost, and efficacy of off-label medications for intrathecal therapy, as compared to conventional management, and suggests early detection of improvement, cost savings, safety of intrathecal compounded medication use, and safety and efficacy of employing the PACC guidance. [ABSTRACT FROM AUTHOR]

Few studies have investigated the relationship between electroconvulsive therapy (ECT) and markers of nitrosative stress and oxidative DNA damage. The aim of this study is to examine changes in nitrosative stress and oxidative DNA damage in patients with a depressive episode treated with ECT. The current study included 48 patients with a depressive episode treated with ECT and 30 healthy control participants. First, the serum nitrosative stress markers of nitric oxide (NO•), nitric oxide synthase (NOS), and peroxynitrite (ONOO-) and the oxidative DNA damage marker 8-hydroxy-2′-deoxyguanosine (8-OHdG) were compared between the study and control groups. These parameters were also compared pre- and post-treatment for the study group. NO•, NOS, and ONOO- levels were significantly higher in patients with depressive disorder (DD) than in the control group. NO• and NOS levels significantly decreased in the ECT group after treatment while 8-OHdG levels significantly increased. The study findings suggest that ECT may have reduced nitrosative stress levels while increasing oxidative DNA damage. More research is now needed to better understand the issue. Nitrosative stress levels can increase in patients with depressive disorder. Electroconvulsive therapy may reduce nitrosative stress while increasıng oxidative DNA damage. These results suggest that nitrosative stress plays an important role in the mechanism of action of electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

We assessed the role of digital PET/CT (dPET/CT) with 18F-FACBC in patients affected by castration-resistant prostate cancer with PSA levels ≤ 3 ng/mL (early CRPC), no lesions detectable at cross-sectional imaging (CIM) and bone scan (BS). Clinical data of patients submitted to 18F-FACBC dPET/CT were retrospectively reviewed. PET/CT results were analyzed: lesions' number, location, and, in case of positive lymph nodes, largest node's short axis (i.e. SA) were annotated. According to PET/CT's results, patients with 18F-FACBC-avid lesions were further stratified into 1) unifocal; 2) oligometastatic (≤ 5 lesions); 3) disseminated (> 6 lesions). Twenty-four patients were enrolled. 18F-FACBC dPET/CT was positive in 21 out of 24 patients (87.5%). Thirteen patients (54.1%) showed recurrence in pelvic region, seven of whom with pelvic nodes' involvement, while eight cases (33.3%) presented 18F-FACBC-avid metastases to extra-pelvic nodes or bone. Average SA of PET-positive nodes resulted in 8.9 ± 3 mm. Patients were categorized as unifocal in four cases (26.6%), oligometastatic in 10 subjects (66.6%) and disseminated in 1 case (0.6%). PET/CT impacted on clinical management in 14 cases (58.3%). 18F-FACBC dPET/CT detected M1 status in 33.3% of early CRPC patients, significantly impacting on clinical management. [ABSTRACT FROM AUTHOR]

To describe and evaluate the different dosing methods in ECT, and bringing back into focus the Scandinavian time-titration method. A narrative, unsystematic, and selective review and discussion. There are five dosing methods: 1) The Scandinavian time-titration to tonic convulsion, using low-frequency pulses and a long maximal pulse train duration, was highly efficacious with right unilateral (RUL) ECT, comparable to bitemporal (BT) ECT. However, the device used went out of production in the 1990s. Because US devices until 1990 had a short maximal pulse train duration, time-titration went out of use. 2) Fixed high dosing at 50–100% of the device's maximal output, and 3) Formula-based dosing, initially the Age method, long prevailed in USA. Later, the Half-Age method was introduced for BT ECT. 4) Charge-dosing as a multiple of titrated seizure threshold (ST) demonstrated RUL and BT ECT to have comparable outcomes when dosed about six and two times the ST, respectively. 5) Dosing from benchmark is based on a high dose at the first session, to ensure a high peak heart rate and tonic-clonic convulsions. In later sessions the lowest dose producing similar outcomes is chosen. No dosing method is documented superior to the others. Seizure threshold-based and benchmark dosing seems to be more accurate than fixed high and formula-based dosing. However, time-titration dosing makes it possible to adjust the dose at every session, and may be the most efficient method. [ABSTRACT FROM AUTHOR]

Particle drying in fluidized beds is a common and important process in food and pharmaceutical industry. However, the fluidization characteristic is complex due to the moisture content change in the process and it is a challenge to monitor the flow characteristics by conventional measurement approach, likes pressure and thermal probes. In this research, process tomography including capacitance and microwave tomographic systems are used to investigate the flow characteristics in a fluidized bed dryer with high-moisture content particles. Static tests were firstly carried out to investigate the image characteristics based on microwave tomography (MWT) and electrical capacitance tomography (ECT). The imaging ability was compared between MWT and ECT. In the dynamic tests, the drying process for particles with high-moisture content was monitored on-line by MWT and ECT separately. The static test results show that the high calibration for ECT is critical and particles with low moisture content should be used for high calibration of an ECT system to achieve high quality images for the dynamic tests. For the high calibration of ECT, there is an upper limit for the moisture content. With a fixed calibration background, the moisture content of particles should not exceed this upper limit value. MWT basically has no limitation on the moisture content both for high calibration and measurement. Dynamic test results illustrate that MWT is a good option to monitor high-moisture content particles drying in a fluidized bed and it is possible to combine ECT together to identify the gas–solids flow regime transit and to determine the moisture content by MWT in a fluidized bed drying process. [ABSTRACT FROM AUTHOR]

Background : ECT is not a rare treatment in the UK today but little research has been conducted into users' views of their experiences. Most of what exists is quantitative in nature. Aims : To investigate consumers' views on the benefits and risks of ECT and to understand the controversy that exists between some users and their organizations and professional bodies. Method : Qualitative data was gathered from the internet, a video archive and consumer publications. This data is referred to as "testimonies". These testimonies were subject to a qualitative analysis using content analysis and a simple form of grounded theory. Results : Twice as many testimonies were very negative about ECT as were very positive. Testimonies revealed themes regarding the experience of receiving ECT which are never elicited by standard "attitude" questionnaires. The main side-effect of ECT apparent in the data was persistent memory loss. Conclusion : Qualitative analysis reveals that consumers' views about health interventions such as ECT are complex and multi-faceted. Further research should seek to use qualitative methods with prospective or random samples as well as relying on theoretical sampling from sources such as the internet. Declaration of interest : The work reported here was funded by a grant from the Department of Health. However the arguments contained herein are the authors' own. [ABSTRACT FROM AUTHOR]

The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery Åsberg Depression Rating Scale between the Q-ECT and the patient record. A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality. [ABSTRACT FROM AUTHOR]

As an emerging neuromodulation therapy, transcutaneous auricular vagus nerve stimulation (taVNS) has been proven to be safe and effective for epilepsy, major depressive disorders, insomnia, glucose metabolic disorders, pain, stroke, post stroke rehabilitation, anxiety, fear, cognitive impairment, cardiovascular disorders, tinnitus, Prader-Willi Syndrome, and COVID-19. Although the history of taVNS is only two decades, the devices carrying taVNS technique have been constantly updated. Especially in recent years, the development of taVNS devices has presented a new trend. To conclude, the development of taVNS devices has entered a new era, thus the update speed and quality of taVNS devices will be considerably improved in the future. This article reviewed the history and classification of taVNS devices. The correlation between the effectiveness and stimulation parameters from taVNS devices still remains unclear. There is a lack of standard or harmonization among different taVNS devices. Strategies, including further comparative research and establishment of standard, have been recommended in this article to promote the future development of taVNS devices. [ABSTRACT FROM AUTHOR]

Objectives: Malignant catatonia (MC) is a rare, yet potentially life-threatening neuropsychiatric condition. Evidence on its therapy is weak, treatment recommendations are scarce and predominantly unprecise. The aim of this study was to compare the effectiveness of different MC treatment approaches regarding outcome and severity of MC. Methods: We conducted systematic searches for MC case reports in biomedical databases and the psychiatric archive of University Hospital Ulm. Treatments were compared considering MC severity and temporal aspects. Results: A total of 117 cases were included. Treatment had a significant influence on outcome: treatment with both benzodiazepines and electroconvulsive therapy (ECT) entailed the most favourable, purely supportive therapy the least favourable outcome. Earlier application of benzodiazepines was significantly associated with a favourable outcome. A classification of MC severity was developed. Patients with severe MC were significantly more often subject to intensive care treatment and had a 78% higher risk of dying than in moderate MC. Conclusions: This is the first study to introduce a severity classification for MC, and the largest to compare outcomes of MC treatments with clear distinction from neuroleptic malignant syndrome (NMS). Preferable MC treatment should include early initiation of benzodiazepines and ECT. MC severity could serve as a prognostic instrument. [ABSTRACT FROM AUTHOR]

Wearable electroencephalography (EEG) for objective seizure counting might transform the clinical management of epilepsy. Non-EEG modalities have been validated for the detection of convulsive seizures, but there is still an unmet need for the detection of non-convulsive seizures. The main objective of this systematic review was to explore the current status on wearable surface- and subcutaneous EEG for long-term seizure monitoring in epilepsy. We included 17 studies and evaluated the progress on the field, including device specifications, intended populations, and main results on the published studies including diagnostic accuracy measures. Furthermore, we examine the hurdles for widespread clinical implementation. This systematic review and expert opinion both consults the PRISMA guidelines and reflects on the future perspectives of this emerging field. Wearable EEG for long-term seizure monitoring is an emerging field, with plenty of proposed devices and proof-of-concept clinical validation studies. The possible implications of these devices are immense including objective seizure counting and possibly forecasting. However, the true clinical value of the devices, including effects on patient important outcomes and clinical decision making is yet to be unveiled and large-scale clinical validation trials are called for. [ABSTRACT FROM AUTHOR]

Background: Pregnancy denial can be broken into two major types, non-psychotic and psychotic deniers, and further classified into pervasive, affective and persistent sub-types. It can lead to increased morbidity and mortality of the mother and neonate. Psychotic pregnancy denial is rare and the medical literature existing on the subject is limited to a small number of case reports and case series. No formal recommendation exists on the clinical management of psychotic pregnancy denial in the antenatal or postpartum period. The authors provide a comprehensive review of the literature regarding psychotic pregnancy denial, present an example of an unpublished case and provide suggestions for clinical management.Case: A 33-year-old primigravida at 37 6/7 weeks gestation presented with new-onset psychotic pregnancy denial with no prior history of psychosis. She had a negative medical work-up for organic causes of psychosis. Using a multidisciplinary approach, the decision was made to deliver the fetus at 38 1/7 weeks via cesarean section due to concerns for patient and fetal safety. Following delivery, she was admitted to an inpatient psychiatric facility and underwent 16 bilateral electroconvulsive therapy (ECT) treatments to which she showed complete response.Conclusion: Psychotic pregnancy denial is rare and potentially dangerous. Delivery prior to 39 weeks gestation is reasonable for worsening psychiatric disease but careful consideration of the risk-benefit analysis and ethical framework must be deliberated.Teaching points: In cases of worsening psychiatric disease in pregnancy, a multidisciplinary approach is necessary for comprehensive care. Psychotic denial of pregnancy leads to increased maternal and neonatal morbidity and mortality. Delivery prior to 39 weeks gestational age is reasonable to expedite psychiatric treatment.PrecisUsing a multidisciplinary approach, the decision to deliver before 39 weeks gestation is reasonable for worsening psychiatric disease. [ABSTRACT FROM AUTHOR]

Introduction: Overactive bladder and urge urinary incontinence affect millions of women and men and results in billions of dollars in health-care expenses. First- and second-line therapy includes behavioral modifications and/or pharmacotherapies however, many patients' symptoms remain or progress on these treatments. There has been concern regarding the detrimental side effects of the most widely prescribed medications for these bladder symptom management. Areas covered: As a result, there has been increased interest in continuous sacral neuromodulation, an FDA approved therapy for refractory urinary urgency and urge urinary incontinence. In this article, we specifically review current research on the efficacy and patient/provider satisfaction and safety profile of the Axonics® System. In addition, we address the current state of sacral neuromodulation and potential future direction and applicability. Expert opinion: The Axonics® system is a safe effective device for the treatment of overactive bladder and urinary urge incontinence. Additionally, it affords patient's the convenience of a rechargeable, compact, MRI safe system. It should be noted that the rechargeable system, while allowing for approximately 15 years of battery and lead life, may have its challenges in terms of charge burden. Furthermore, this system is easily adapted for experienced implanters of sacral neuromodulating devices. [ABSTRACT FROM AUTHOR]

Introduction: The 6 F Tack Endovascular System® is approved by the United States Food and Drug Administration (FDA) for post-percutaneous transluminal angioplasty (PTA) dissection repair in the superficial femoral and proximal popliteal arteries, and the 4 F System for post-PTA dissection repair in the mid/distal popliteal, peroneal and tibial arteries. The latter is the first FDA approval for an infra-popliteal implantable device. Areas covered: An evaluation of the Tack Endovascular System® design and a summary of the current safety and efficacy data. Expert opinion: Endovascular intervention for the treatment of symptomatic peripheral arterial disease (PAD) in the lower extremities is complicated by long-lesion length, extensive calcification and, below the knee, narrow vessel diameter. PTA is a foundational element for the treatment of these lesions and works by causing a controlled dissection and vessel expansion of the target lesion. Occasionally, dissections can extend beyond the target lesion and/or become hemodynamically significant due to lumen impingement necessitating additional intervention. Historically these dissections were treated with the use of stents, prolonged balloon inflation time or went untreated. The Tack Endovascular System® was designed to provide operators a safe and effective device which could repair post-PTA dissections while preserving future treatment options. [ABSTRACT FROM AUTHOR]

Introduction: Many patients with migraine are non-responsive or intolerant to pharmaceutical or surgical interventions. Peripheral nerve stimulation (PNS) offers a potential solution for these patients. This review discusses the external combined occipital and trigeminal neurostimulation (eCOT-NS) provided by the Relivion®, a multi-channel head-mounted device for self-administered PNS. Areas covered: Challenges and advantages of PNS systems for the treatment of migraine and depression are introduced, followed by an overall review of clinical evidence of the efficacy of the Relivion® system in treating migraine. The supporting smartphone app and cloud-based analytics which enable remote treatment management by the health care provider are also discussed. Recent empirical indications for the potency of this PNS combination for the treatment of depression are also summarized. Expert opinion: Relivion® is an eCOT-NS system, featuring Food and Drug Administration-approved, noninvasive, self-administered, customizable, multi-focal PNS for the treatment of migraine. In accordance with current telehealth trends, the Relivion® also enhances remote disease management and personalization using digital-monitoring, cloud-based technology, and artificial intelligence. As research on this system progresses, it may become the preferred treatment for the management of a number of neurological and psychiatric diseases, with migraine and major depressive disorders as precedents. [ABSTRACT FROM AUTHOR]

Introduction: While short-term cognitive impairment following electroconvulsive therapy (ECT) is well described and acknowledged, the relationship between ECT and persistent memory impairment, particularly of autobiographical memory, has been controversial. Methods: We describe the case of a 70-year-old consultant neurophysiologist, AW, who developed prominent, selective autobiographical memory loss following two courses of ECT for treatment-resistant depression. Results: His performance on standard measures of IQ, semantic and episodic memory, executive function and mood was normal, while he performed significantly below controls on measures of episodic autobiographical memory. Conclusions: Explanations in terms of mood-related memory loss and somatoform disorder appear unlikely. We relate AW's autobiographical memory impairment, following his ECT, to reports of similar autobiographical memory impairment occurring in the context of epilepsy, and emphasise the importance of using sensitive approaches to AbM assessment. [ABSTRACT FROM AUTHOR]

Introduction: Epilepsy affects more than 1% of the US population, and over 30% of adults with epilepsy do not respond to antiseizure medications without life-impacting medication-related side effects. Resection of the seizure focus is not an option for many patients because it would cause unacceptable neurological or cognitive harm. For these patients, neuromodulation has emerged as a nondestructive, effective, and safe alternative. The NeuroPace® RNS® System, the only brain-responsive neurostimulation device, records neural activity from leads placed at one or two seizure foci. When the neurostimulator detects epileptiform activity, as defined for each patient by his or her physician, brief pulses of electrical stimulation are delivered to normalize the activity. Areas covered: This review describes the RNS System, the results of multi-year clinical trials, and the research discoveries enabled by the chronic ambulatory brain data collected by the RNS System. Expert commentary: Brain-responsive neurostimulation could potentially be used to treat any episodic neurological disorder that's accompanied by a neurophysiological biomarker of severity. Combining advanced machine learning approaches with the chronic ambulatory brain data collected by the RNS System could eventually enable automatic fine-tuning of detection and stimulation for each patient, creating a general-purpose neurotechnological platform for precision medicine. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma is the most common type of thyroid cancer; despite its generally indolent course, patients often develop local post-operative recurrences. Re-operation, however, holds a high complication rate, while at the same time, not all patients benefit from radioiodine ablation. This systematic review investigates the application of laser ablation therapy (LAT) for cervical lymph node metastases as an additional treatment modality. Methods: This systematic review was conducted in accordance with the PRISMA Statement. Medline electronic database and Cochrane Library were searched for eligible articles. Results: Five studies were included in the systematic review. All studies included patients with metastatic lymph nodes from papillary thyroid carcinoma, that were unsuitable for further radioiodine or surgical treatment. Patients were treated with two different LAT devices. Regardless of the utilized assessment modalities, all researchers reported significant outcomes on local disease control. No permanent complications were observed. Conclusions: LAT is relatively safe and effective for the treatment of cervical metastatic lymph nodes in patients with papillary thyroid carcinoma. [ABSTRACT FROM AUTHOR]

Background: Based on our Phantom study on transcranial direct current stimulation (tDCS), we hypothesized that EEG band power and field confinement would be greater following left dorsolateral prefrontal cortex (DLPFC – F3) tDCS using circular vs. rectangular electrodes. Methods: Double-blind-randomized trial comparing tDCS with anode over left DLPFC (groups: rectangular electrodes, circular electrodes, sham) and 2 active subgroup references (right shoulder vs. right DLPFC). Results: Twenty-four randomized participants were assessed. We indeed found higher average EEG power spectral density (PSD) across bands for circular vs. rectangular electrodes, largely confined to F3 and there was a significant increase at AF3 for low alpha (p = 0.037). Significant differences included: increased PSD in low beta (p = 0.024) and theta bands (p = 0.021) at F3, and in theta (p = 0.036) at FC5 for the right DLPFC vs. shoulder with no coherence changes. We found PSD differences between active vs. sham tDCS at Fz for alpha (p = 0.043), delta (p = 0.036), high delta (p = 0.030); and at FC1 for alpha (p = 0.031), with coherence differences for F3-Fz in beta (p = 0.044), theta (p = 0.044), delta (p = 0.037) and high delta (p = 0.009). Conclusion: This pilot study despite low statistical power given its small sample size shows that active left DLPFC tDCS modulates EEG frontocentrally and suggests that electrode shapes/reference locations affect its neurophysiological effects, such as increased low alpha power at AF3 using circular vs. rectangular electrodes. Further research with more participants is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and longterm treatment of bipolar mixed states in adults. Methods: Material used for these guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A-F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode. Results: Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention. Limitations: The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands. Conclusions: Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept. [ABSTRACT FROM AUTHOR]

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Objectives:The aim of this study was to examine executive functions (EF) in patients with treatment-resistant depression (TRD) before and after bitemporal electroconvulsive therapy (ECT) and to evaluate possible associations between the depression severity and executive tasks performances. Methods:Patients (n = 29), treated with bitemporal ECT, underwent assessment at three time points: baseline, immediately after ECT course and 1 month later. The Stockings of Cambridge (SOC, CANTAB) was used to assess EF: (1) number of problems solved in minimum moves (SOC-P), (2) initial thinking time (SOC-I) and (3) subsequent thinking time (SOC-T). Results:The scores on the Hamilton Depression Rating Scale and the Clinical Global Impression scale were significantly reduced over time, with no negative effects on the EF. Among SOC subtests, only SOC-I improved over time, which was significantly correlated with the depressive symptoms reduction. SOC-T and SOC-P remained unchanged and did not correlate with mood. Interestingly, the patients with more lifetime psychiatric hospitalisations and more ECT applications were more likely to drop-out and to have longer SOC-T while performing the test. Conclusions:Our results support the view that ECT does not produce long-lasting EF deficits, nor exacerbates the pre-existing ones. The improvement of the EF performances during and after the ECT-induced alleviation of mood symptoms in TRD is based mostly on the reduction of time needed to plan the problem solution. [ABSTRACT FROM AUTHOR]

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 = 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 = 0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1,p = 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. [ABSTRACT FROM AUTHOR]