Electroconvulsive Therapy

Efficacy of acute ECT in atypical depression Journal of clinical psychiatry 2008

ACUTE ECT is an efficacious treatment for depressed patients with typical or atypical symptom features.

Indications of ECT in Schizophrenia : extremes of schizophrenia

Acute schizophrenia, treatment-resistant psychosis, depression with suicidal ideation or catatonic behavior or inanition.

Electroconvulsive monotherapy in the treatment of acute confusion psychosis. A case report. Pharmacopsychiatry. 2005

An 18 year old patient's successful treatment of a most acute case of confusion psychosis according to the concept of Karl Leonhard. Was hospitalized 3 times before the current episode and had pharmacologically treatment-resistant psychosis. Typical and atypical antipsychotic as well as mood-stabilizer, sedations didn't work. The implications of this finding are discussed with regard to Leonhard's diagnostic system.

Prevalence and treatment of depression in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2005

Depression in parkinson's disease can be treated with ECT. There is also medication and psychotherpy

Indications of ECT in Major Depressive Disorder : extremes of MDD.

Depression with Suicidal ideation, Psychotic depression, Melancholic depression , Depression with Catatonia, Atypical depression, not eating and nutritionally compromised.

Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder. Am J Psychiatry. 2004. (ECT indication)

Depressives with Bipolar Personality Disorder (comorbidity) had poorer ACUTE response to ECT than with other Personality disorder.

PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder - Third Edition

ECT for Depression patients who were stabilized with drugs and psychotherapy in acute phase but couldn't be stabilized with those in the continuation phase.

Annals of clinical psychiatry 2008. But the treatment response is limited by the chronicity of catatonia.

ECT has been effective in the treatment of catatonia

Efficacy of ECT in adults with mental retardation experiencing psychiatric disorders. Journal of ECT 2004

ECT indicated in treatment-resistant mood disorders (depression, bipoloar, schizoaffective, OCD) and psychotic disorders.

ECT indicated in ACUTE schizophrenia

ECT is not effective in chronic schizophrenia

Combined use of ECT and antipsychotics in schizophrenia: the Indian evidence. A review and a meta-analysis. J ECT. 2006. ECT in schizophrenia

ECT-antipsychotic combinations might be better than antipsychotic drugs used alone in the first few weeks of treatment of schizophrenia; the main benefit seemed to be an acceleration of treatment response. More research required.

A case of long-term maintenance ECT in a 78-year-old with depression and possible Parkinson's disease. CNS Spectrum. May 2007

Effectiveness of LONG TERM MAINTENANCE ECT

Stable phase of schizophrenia, ECT may benefit some patients whose condition has responded to ECT in the acute phase but for whom pharmacological prophylaxis alone has been ineffective or cannot be tolerated.

Example : Acute schizophrenic treated with acute ECT. Stable. Drug prophylaxis to prevent symptoms but doesn't work or the drugs causing too much side effects.

Inanition

Exhausted state/ fatigue due to prolonged undernutrition; starvation

Bilateral generalized seizure is induced in ECT

For both the beneficial and adverse effects of ECT, this is induced. We know ECT has worked.

Raises the seizure threshold during ECT. Plasma amino acid (neuro)transmitters are blocked.

Increase in gamma-aminobutyric acid (GABA) transmission and receptor antagonism has been observed with ECT.

ECT has no absolute contraindications

Many medical conditions place patients at an increased risk for complications and warrant closer monitoring, however.

Treatment response in Melancholia Acta psychiatrica Scandinavica. Supplementum 2007. (http://reference.medscape.com/medline/abstract/17280578) (ECT indication)

Melancholic and non-melancholics respond well to antidepressents and ECT, the only difference between them is melancholics have a poor placebo response, i.e mildly depressed/non-melancholics experience placebo effect.

American journal of psychiatry 2007, ECT indication

Neuroleptic malignant syndrome

Psychomotor agitation : psychosis causing anxiety contributing to psychomotor disturbance.

PSYCHOTIC DEPRESSIVES may have inability to relax/restlessness or sit still. They may rock, fidget, or move their legs a lot, for example.

Relief of acute intractable traumatic pain with ECT. Journal of psychiatric practice. 2007. ECT indication

Pain

ECT has been an effective treatment option in severe and treatment resistant depression. MOA is still unknown. PET studied the effects of ECT.

Reduced glucose metabolism after ECT in bilateral anterior and posterior frontal areas represented the most consistent findings.

Other psychiatric conditions which may present in extremes indicated for ECT

Schizophreniform disorder and schizoaffective disorder

Schizophreniform disorder : Development of schizophrenia or prodrome is several years or is CHRONIC.

Symptoms of schizophrenia, but it is distinguished from that condition by its shorter duration, which is at least 1 month but less than 6 months.

Indication of ECT

Symptoms which are extremes of psychiatric conditions