Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review (original) (raw)
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Shanghai archives of psychiatry, 2017
Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) ye...
Severe agitation in severe early-onset Alzheimer's disease resolves with ECT
Neuropsychiatric disease and treatment, 2014
Dementia-related behavioral disturbances are mostly treated with antipsychotics; however, the observed beneficial effects are modest and the risk of serious adverse effects high. We report the case of a 57-year-old woman with severe early-onset Alzheimer's disease and severe agitation, whom we treated with electroconvulsive therapy (ECT). A significant clinical improvement was achieved over eight ECT sessions, which were tolerated well without cognitive worsening, and lasted approximately 3 months. Our case demonstrates the safe and effective use of ECT in pharmacotherapy-resistant severe agitation in Alzheimer's disease. The risk-benefit profile of ECT for dementia-related agitation should be further investigated in clinical trials.
The effectiveness of electroconvulsive therapy: a literature review
To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified. Declaration of Interest: Neither author has any financial conflicts of interest in relation to his paper. KEY WORDS: ECT, evidence-based medicine, literature review, cost-benefit analysis.
The present status of electroconvulsive therapy: a systematic review
Medical Journal of Australia, 1999
B efore the introduction of physical therapies in the 1930s, the only treatment available for severe mental illness was institutional confinement and sedation. I Of the physical therapies, insulin coma therapy is now no longer used and psychosurgery is used only rarely," but electroconvulsive therapy (ECT) remains an important treatment, mostly for patients suffering from depressive disorders. ECT involves the electrical induction of a brief generalised seizure of adequate intensity after administration of a short-acting general anaesthetic and muscle relaxant (Box 1). Given the considerable morbidity and increased rate of mortality (including suicide)! associated with the depressive disorders, which represent, in fact, a greater disease burden than cardiovascular and cerebrovascular disease, it is timely to review the current practice of ECT. 5 Methods We performed a systematic review of recently published primary research related to the current practice of ECT. We searched the MEDLINE database for all English language articles published in 1987-1998, using the term "electroconvulsive therapy" together with "clinical indications", "electrical dose", "electrode placement", "anaesthesia", "side effects", "maintenance treatment" and "training". Results Of 115 references identified by the MEDLINE search, only 11 were reports of randomised controlled trials (RCTs) of ECT;6-16 the result of one meta-analysis was found after a manual search." A further 24 reports were evaluated which reported data from open, retrospective and descriptive studies, or were post-hoc evaluations of one of the RCTs identified. Studies were excluded if they did not report primary research or were unrelated to the aspects of ECT practice in which we were interested. 18 A manual search was also undertaken of the key specialty journal, Convulsive Therapy (since renamed Journal ofBCT), which was listed in MEDLINE for only a part of the period under review, as well as personal libraries and bibliographies of published articles. A few key
Electroconvulsive therapy: current status
Electroconvulsive therapy (ECT) can differ in its application in three ways: electrode placement, frequency of treatments and electrical waveform of the stimulus. Seizure threshold and dosing affects efficacy, speed of clinical response and cognitive deficits. Proposed mechanisms are psychological theories, structural theories, electrophysiology and neurophysiology, biochemical theories and molecular theories. In animal models, there is synaptic plasticity in hippocampus, mossy fibre sprouting, alterations in cytoskeletal structure, promotion of neurogenesis and suppression of apoptosis. Biochemical theories include the monoamine hypothesis, beyond monoamines, vascular endothelial growth factor and brain derived neurotrophic factor. It has generally low risk and one of the safest procedures performed under general anaesthesia. ECT can be given safely to patient with epilepsy; can be given in healed skull and brain trauma, neurologically stable patient after a cerebrovascular accident. Primary use is in rapid definitive response required on medical or psychiatric grounds, risks of alternative treatments outweigh benefits, past history of poor response to psychotropics or good response to ECT and patient preference. ECT is the most effective treatment in depression. Schizophrenia is the second most common diagnostic indication. Some individuals consider ECT to have been a beneficial and lifesaving treatment while others reported feelings of terror, shame and distress. Written, informed consent of the patient is important before ECT is administered. With the development of new techniques for application of ECT its public perception regarding its use has improved in a positive sense.
Efficacy of electroconvulsive therapy: Too Brief Or Not Too Brief?: Too Brief Or Not Too Brief?
2015
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