Chapter
3 Neurochemical effects of electrically induced seizures: Relevance to the antidepressant mechanism of electroconvulsive therapy
The effect of ECT on neurotransmitters and receptors in the brain
Neurotransmitters, receptors, depression, and ECT
Serotonin, depression, and the effects of ECT
Effects of ECS on serotonin receptors
The noradrenergic (norepinephrine) pathway
Norepinephrine, depression, and the effects of ECT
Effects of ECT on NE receptors
The effect of ECT on neuropeptides
The effect of ECT on gene transcription and neurotrophic factors
Arachidonic acid cascade genes
Angiogenesis-, metabolism-, and homeostasis-regulating genes
Activity regulated cytoskeleton gene
Thyrotropin-releasing hormone
Tissue inhibitors of metalloproteinases-1
N-Myc downstream-regulated protein 2 gene
Vesicle-associated membrane protein 2
The effect of ECS on synaptic plasticity and neurogenesis
4 Hypothesized mechanisms and sites of action of electroconvulsive therapy
Neurotransmitter theories
Intracellular signaling, gene transcription, and neurotrophic action
The diencephalic theory or neuroendocrine view
Anatomical theory or prefrontal model
Seizure generalization theory
Developing a theory of ECT action – synthesis
Different organizational levels are involved in the pathophysiology of mental disorders
What happens during electrical stimulation?
Eliciting a seizure by overcoming surrounding inhibition
Functional consequences in response to ECT
Restoring balanced neuronal network function after repeated seizures
5 Brain imaging and electroconvulsive therapy
Definition of the ictal and interictal periods
What does neuroimaging measure?
Ictal neuroimaging in ECT
Interictal neuroimaging in ECT
Conclusions and future directions
6 Evidence for electroconvulsive therapy efficacy in mood disorders
How effective is ECT for depression?
Is ECT more effective than placebo procedure?
Is ECT more effective than antidepressant medications?
Do various forms of ECT differ in therapeutic efficacy?
Do subtypes of depression respond differently to ECT?
7 Clinical evidence for the efficacy of electroconvulsive therapy in the treatment of catatonia and psychoses
Methodological limitations
ECT in schizophreniform disorder
ECT in the acute phase of schizophrenia
ECT in the acute phase of catatonic schizophrenia
ECT in malignant catatonia
ECT in schizoaffective disorders
ECT in the chronic phase of schizophrenia
Effect of catatonic features on response to ECT in chronic schizophrenia
Continuation ECT and MECT
ECT in catatonia associated with depression
ECT in catatonia associated with mania
ECT in catatonia associated with medical conditions (“organic” catatonia)
ECT in childhood and adolescent psychoses associated with catatonia
8 Hormonal effects of electroconvulsive therapy
Consequences of ECT-induced hormone release
Comparing hormone changes
Prolactin release, an archetype
Posterior pituitary hormone release
Future clinical applications
Part II Historical, societal, and geographic perspectives
9 History of electroconvulsive therapy
Insulin coma and early convulsive therapies
The debate over technique
Stigmatization and the decline of ECT
The placement debate resurfaces
Electrode placement: Recent innovations
10 Electroconvulsive therapy in biographical books and movies
The accounts of early treatment
11 Professional barriers to providing electroconvulsive therapy
Professional barriers to providing electroconvulsive therapy 199
Nonpsychiatric physicians
Interference from practice patterns and settings
Regulation as a professional barrier
Malpractice and other liability concerns
12 Legislation that regulates, limits, or bans electroconvulsive therapy
Legislation that regulates, limits, or bans electroconvulsive therapy 209
Legislation recapitulates litigation
Popular and professional literature on ECT
Anti-ECT ideology and movement
A brief legislative history
The informed consent model
Toward constructive law making
Part III International perspectives
13 Electroconvulsive therapy availability in the United States
State and regional variation
Service site: Public versus private hospital
Service site: Inpatient versus outpatient
Demographic variation: Age, gender, race/ethnicity, and socioeconomic factors
Socioeconomic factors/insurance
State regulations (sociopolitical factors)
14 Electroconvulsive therapy in Scandinavia and the United Kingdom
The practice of ECT in Scandinavia, past and present
A Scandinavian research tradition
Standards and practice of ECT: The United Kingdom context before the National Institute for Clinical Excellence
The National Institute for Clinical Excellence and ECT in the United Kingdom
Post-NICE developments in the United Kingdom
Training in ECT in Scandinavia
Training in ECT in the United Kingdom
The future of ECT in Scandinavia and the United Kingdom
15 Electroconvulsive therapy in continental Western Europe: A literature review
16 Electroconvulsive therapy in Asia
Age classification of patients receiving ECT
Sex distribution of patients receiving ECT
Regulation of ECT and training of ECT professionals in Asia
17 History of electroconvulsive therapy in the Russian Federation
ECT in the 1940s and 1950s: The bloom and the freeze
ECT in the 1960s and 1970s
From the 1980s through the end of the 20th century
Present ECT use in the Russian Federation
18 Electroconvulsive therapy in Latin America
Mental health in Latin America
History and use of ECT in specific countries
Part IV Administrative perspectives
19 Electroconvulsive therapy hospital policy and quality assurance
A. Legal requirements for informed consent
B. Convulsive treatment procedures for voluntary patients
C. Convulsive treatment procedures for involuntary patients (including anyone under Lanterman-Petris-Short (L-P-S) guardianship or conservatorship)
D. ECT procedures for minors
E. Review and post-treatment audit committee
F. Excessive use of convulsive treatment
G. Reports on convulsive treatment
I. General guidelines for electroconvulsive therapy
J. Care of the patient receiving ECT: See “nursing responsibilities”
ECT nursing responsibilities
A. Pre-ECT patient preparation
B. Inpatient transportation
C. Treatment room preparation
D. Nursing staff assistance during the ECT treatment
E. ECT recovery procedure
F. General post-ECT duties
Treating patients who are inpatients elsewhere
C. Post-treatment/recovery
ECT for regional center patients
IV. Reporting requirements
Scope of service: electroconvulsive therapy (ECT)
Location and hours of operation
Scope of services provided
Departmental performance improvement
Quality assurance monitors
20 Staff management and physical layout for electroconvulsive therapy
Equipment necessary for ECT
The small hospital and small-volume operations
Outpatient considerations
Treatment room considerations
The design of the ECT suite
21 Electroconvulsive therapy forms
Nursing record and procedure verification
Part V The clinical manual
22 Patient selection and electroconvulsive therapy indications
The depression that ECT does not treat
ECT preventing anxiety disorders
DSM versus observable melancholia
ECT as first choice treatment
ECT or antipsychotics as first choice
Antidepressant-resistant depression
Antimanic medication–resistant manic episode
Medication-resistant acute psychosis
Medication-resistant intermediate-duration psychosis versus schizophrenia
Medication-resistant chronic psychosis or schizophrenia
ECT as prerequisite for other procedures
Medication-resistant agitated dementia
23 Electroconvulsive therapy or antipsychotic drugs (or benzodiazepines for catatonia)
Mental side effects: Hypofrontality
Mental side effects: Tardive
Mental side effects: Other
Patient tolerance and compliance
ECT versus benzodiazepines in catatonia
Informed consent: Definitions and historical development
Legal application of the doctrine of informed consent
Practical strategies and methods to achieve informed consent
Discussion of the consent process
Discussion of the nature of the illness
Discussion of the reason for ECT and comparison with other treatment alternatives
Discussion of the nature of ECT treatment
Obstacles to informed consent with a competent patient
The incapacitated ECT patient
Court-ordered treatment and advance directives
25 Electroconvulsive therapy in the medically ill
Pacemakers/Implantable cardioverter defibrillators
Intracranial space-occupying lesions
26 Anesthesia for electroconvulsive therapy
Anesthesia for electroconvulsive therapy
Rationale for anesthesia in electroconvulsive therapy
Issues related to the collaboration between anesthesiology and psychiatry
27 Stimulus electrode placement
Units of measure in defining the stimulus dose
Convulsive, subconvulsive, and sham stimulation
Stimulus waveform morphology
Antidepressant efficacy and the magnitude of the stimulus dose
Cognitive side effects and the stimulus dose
Generalizations regarding stimulus dosing for acute treatment of depression
Adjusting the stimulus dose in response to dynamic physiology: “Benchmarking”
Benchmarking: Seizure morphology
Benchmarking: Cardiovascular reactivity
Augmentation strategies when the maximum stimulus dose is reached
Integrating the science of stimulus dosing with the choice
Stimulus dosing in continuation/maintenance ECT in major depression
Examples of stimulus dosing with case vignettes
29 Electroencephalogram monitoring and implications
History of electroencephalogram monitoring
Recording electrode placement
Scalp distribution of ictal EEG
Relationship to clinical changes, adverse effects, and depression
Abortive or brief seizure
30 Heart rate and electroconvulsive therapy
HR reflecting seizure activity
Peak HR and seizure quality
Benchmark Method of stimulus dose regulation
31 Cognitive side effects and psychological testing
Clinical evaluation: Mini Mental State Examination
Neuropsychological examination of patients treated with ECT
Postictal disorientation and confusion
Subjective memory complaints
32 Electroconvulsive therapy in children and adolescents
Assessing adolescent patients for ECT
Need for treatment with ECT
Patient’s fitness to undergo ECT
Further baseline evaluations
33 Postelectroconvulsive therapy evaluation and prophylaxis
Continuation treatment after successful ECT
Patients without medication failure: post-ECT antidepressant
Postelectroconvulsive therapy evaluation and prophylaxis 507
Patients without medication failure: post-ECT lithium
Patients with medication failure: post-ECT antidepressant
Conclusions and recommendations regarding continuation pharmacotherapy for depression
Continuation ECT for depression
Continuation ECT for schizophrenia
34 Ambulatory and maintenance electroconvulsive therapy
Part VI Neuromodulation treatment
35 Transcranial magnetic stimulation
Neurobiological background
Negative symptoms of schizophrenia
Post-traumatic stress disorder
Obsessive-compulsive disorder
Low-/high-frequency/repetitive TMS
Treatment-emergent mania/hypomania
Contraindications to TMS treatment
36 Vagus nerve stimulation: Indications, efficacy, and methods
Introduction and background
Neuroanatomy of the vagus nerve
VNS therapy system and surgical implant procedure
Indications for the use of VNS
VNS for the treatment of epilepsy
Rationale for VNS in depression
Pilot study of VNS in depression
Pivotal trial of VNS to treat depression
Treatment-Resistant Depression (TRD)
Suggested guidelines for VNS applications
VNS stimulation parameter settings
Patient safety and adverse effects
Conclusions and future directions
37 Deep brain stimulation: Methods, indications, locations, and efficacy
History and principles of DBS
Safety and advantages of DBS
Neurobiology of depression and OCD
Studies of DBS and psychiatric disorders
Problems in target selection
DBS targets in depression
Ethical considerations and quality standards in DBS research
38 Transcranial direct current stimulation
Importance as a clinical tool
Electroconvulsive and Neuromodulation Therapies
Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.