1: J ECT. 2003 Sep;19(3):148-50.
The relationship between changes in learning and memory after right unilateral
electroconvulsive therapy.
Frasca TA, Iodice A, McCall WV.
Department of Psychiatry and Behavioral Medicine, Wake Forest University School
of Medicine, Winston-Salem, North Carolina 27157, USA.
SUMMARY: OBJECTIVE: We investigated whether the ability to learn new
information, as opposed to recall information, would change significantly in
depressed individuals treated by low- or high-dose right unilateral
electroconvulsive therapy and tested whether change in learning explained
changes in recall. METHOD: Fifty-four depressed patients randomized to receive
right unilateral electroconvulsive therapy (ECT) at approximately 2.25 times
their seizure threshold (ST) or at doses greater than 2.25 times ST were
evaluated for verbal and figural memory as well as verbal and figural learning
both pre- and post-ECT. A subset of scores from the Rey Auditory Visual Learning
Test and the Rey Figure Test were analyzed using analysis of variance and linear
regression techniques. RESULTS: Scores reflecting verbal learning decreased by a
mean of approximately 50% immediately after a completed course of ECT as
compared with pre-ECT verbal learning scores. Stratification of effect by dose
of electrical charge revealed trends that did not achieve statistical
significance. Approximately 8% of the change in delayed verbal recall was
predicted by changes in verbal learning. Figural learning was not significantly
changed in the aggregate (pre-versus post-treatment) or when the effect was
stratified by electrical charge. CONCLUSIONS: Verbal learning scores declined
immediately after ECT, but the change in learning scores explained only a minor
part of the observed changes in verbal recall. These findings support the notion
that the deficits in delayed recall after ECT represent a relatively specific
cognitive effect that is not completely explained by changes in other aspects of
cognition such as learning.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12972984 [PubMed - indexed for MEDLINE]
2: J Neuropsychiatry Clin Neurosci. 2003 Summer;15(3):333-9.
The influence of cognitive reserve on memory following electroconvulsive
therapy.
Legendre SA, Stern RA, Solomon DA, Furman MJ, Smith KE.
University of Rhode Island, Kingston, Rhode Island, USA.
Cognitive reserve (CR) theory proposes that certain genetic and nonacquired
variables, such as larger head size and greater neuronal density, and some life
experiences, such as higher educational and occupational attainment, provide a
buffer against brain dysfunction in the face of acquired central nervous system
(CNS) dysfunction. This study examined CR in the pseudoexperimental paradigm of
electroconvulsive therapy (ECT). Subjects included fifty (N = 50) depressed
patients treated with bilateral ECT. Subjects were placed in high (n = 27) or
low (n = 23) CR groups based on years of education and occupational attainment.
At baseline, no significant differences were observed between the groups in the
amount of information forgotten on a verbal memory measure (Randt stories) after
a 30-minute delay. Following three ECT treatments, however, the high CR group
forgot significantly less information after a 30-minute delay, as compared to
the low CR group (p < 0.01). These data provide further support for CR theory
and suggest that CR may be an underlying factor in differential memory loss in
ECT.
PMID: 12928509 [PubMed - indexed for MEDLINE]
3: BMJ. 2003 Jun 21;326(7403):1363.
Comment in:
Evid Based Ment Health. 2004 Feb;7(1):27.
Patients' perspectives on electroconvulsive therapy: systematic review.
Rose D, Fleischmann P, Wykes T, Leese M, Bindman J.
Service User Research Enterprise, PO34, Institute of Psychiatry, De Crespigny
Park, London SE5 8AF. d.rose@iop.kcl.ac.uk
OBJECTIVE: To ascertain patients' views on the benefits of and possible memory
loss from electroconvulsive therapy. DESIGN: Descriptive systematic review. DATA
SOURCES: Psychinfo, Medline, Web of Science, and Social Science Citation Index
databases, and bibliographies. STUDY SELECTION: Articles with patients' views
after treatment with electroconvulsive therapy. DATA EXTRACTION: 26 studies
carried out by clinicians and nine reports of work undertaken by patients or
with the collaboration of patients were identified; 16 studies investigated the
perceived benefit of electroconvulsive therapy and seven met criteria for
investigating memory loss. DATA SYNTHESIS: The studies showed heterogeneity. The
methods used were associated with levels of perceived benefit. At least one
third of patients reported persistent memory loss. CONCLUSIONS: The current
statement for patients from the Royal College of Psychiatrists that over 80% of
patients are satisfied with electroconvulsive therapy and that memory loss is
not clinically important is unfounded.
Publication Types:
Review
Review, Academic
PMID: 12816822 [PubMed - indexed for MEDLINE]
4: Psychol Med. 2003 Feb;33(2):345-50.
Pattern of cognitive dysfunction in depressive patients during maintenance
electroconvulsive therapy.
Rami-Gonzalez L, Salamero M, Boget T, Catalan R, Ferrer J, Bernardo M.
Institute of Psychiatry and Psychology, Hospital Clinic, Barcelona, Spain.
BACKGROUND: Objective data regarding adverse cognitive deficits associated with
maintenance electroconvulsive therapy (M-ECT) are lacking. This study examined
the cognitive state of depressive patients during M-ECT. METHOD: A
cross-sectional study was carried out in 11 depressive patients in remission,
all with a DSM-IV diagnosis of major depressive disorder. The mean number of
previous ECT sessions was 36.1, and the mean intersession interval was 52.7
days. A group of 11 patients who had not received ECT was selected for
comparison and matched for diagnosis, sex, age and years of schooling. All
subjects were assessed using a complete neuropsychological battery including
memory, attention and frontal function tests. RESULTS: Groups did not present
differences in long delay verbal recall. Encoding of new information and results
on the frontal function tests were significantly lower in the M-ECT patients.
CONCLUSION: Depressed patients preserve long-term memory, but suffer short-term
memory impairment and frontal function alteration during M-ECT. Further
longitudinal studies are necessary to determine the influence of M-ECT on
non-memory functions and different memory subtypes.
PMID: 12622313 [PubMed - indexed for MEDLINE]
5: Aust N Z J Psychiatry. 2003 Feb;37(1):49-54.
The subjective experience of patients who received electroconvulsive therapy.
Koopowitz LF, Chur-Hansen A, Reid S, Blashki M.
Department of Psychiatry, University of Adelaide, South Australia, Australia.
leslie.koopowitz@adelaide.edu.au
OBJECTIVE: Despite the vast amount of scientific literature available on
electroconvulsive therapy (ECT), there is little qualitative focus upon the
patients' subjective experience of this procedure. Using an exploratory
descriptive methodology, this study aims to provide a more unique insight into
what certain patients actually think of ECT. METHOD: Semistructured interviews
were conducted to explore eight patients' opinions and experiences of ECT.
Interviews were subjected to analysis by a five-step framework approach that
identified prominent themes in relation to five broad questions and in
conjunction with issues raised by the subjects themselves. RESULTS: Eleven major
themes were identified. Four of these were chosen for discussion, not only as
the most prevalent themes (in terms of how frequently they were mentioned by the
subjects), but also as the most striking (in regards to the intensity of
emotions evoked, or their influence on their perception of ECT as a future
treatment option). The four themes are fear of ECT, attribution of cognitive
decline and memory loss to ECT, positive ECT experiences, and patients'
suggestions. CONCLUSIONS: Using such a qualitative approach, the depth of the
information obtained has revealed new perspectives on how patients perceive the
experience of ECT. Fears reported by patients present an opportunity to address
specific areas of the procedure that generate the most angst. These were closely
associated with recommendations that many patients proposed throughout the
interviews. Patients' perceptions of the cognitive effects of ECT do not
necessarily correspond with those commonly reported in the literature on ECT.
Positive experiences with ECT were more complex than simply its efficacy. There
is a need for future research in order to explore and address patients'
experiences of ECT.
PMID: 12534656 [PubMed - indexed for MEDLINE]
6: Cogn Affect Behav Neurosci. 2001 Mar;1(1):3-9.
Recognition memory in amnesia: effects of relaxing response criteria.
Verfaellie M, Giovanello KS, Keane MM.
Boston VA Healthcare System, Boston University School of Medicine, Boston,
Massachusetts, USA. verf@bu.edu
In two experiments, using the remember/know paradigm, we examined whether
recognition memory in amnesic patients can be improved by instructing patients
to relax their response criterion. Experiment 1 was modeled after a study by
Dorfman, Kihlstrom, Cork, and Misiaszek (1995), in which direct instructions to
respond more leniently led to an increase in recognition accuracy in patients
with ECT-induced amnesia. We failed to extend this finding to patients with
global amnesia, but the manipulation was unsuccessful in control subjects as
well. In Experiment 2, response criterion was manipulated indirectly by
providing information about the alleged base rate of study items on the
recognition test. This manipulation led to a criterion shift in control subjects
and enhanced discriminability in amnesic patients. Analysis of "remember" and
"know" responses suggests that improved accuracy in amnesia was associated with
enhanced familiarity-based recognition.
PMID: 12467099 [PubMed - indexed for MEDLINE]
7: Rev Neurol. 2002 Nov 1-15;35(9):805-8.
[Selective alteration of the declarative memory systems in patients treated with
a high number of electroconvulsive therapy sessions]
[Article in Spanish]
Rami-Gonzalez L, Boget-Llucia T, Bernardo M, Marcos T, Canizares-Alejos S,
Penades R, Portella MJ, Castelvi M, Raspall T, Salamero M.
Servicio de Psicologia. Hospital Clinic i Provincial de Barcelona, Barcelona,
Espana.
INTRODUCTION: The reversible electrochemical effects of electroconvulsive
therapy (ECT) on specific areas of the brain enable the neuroanatomical bases of
some cognitive functions to be studied. In research carried out on memory
systems, a selective alteration of the declarative ones has been observed after
treatment with ECT. Little work has been done to explore the differential
alteration of the memory subsystems in patients with a high number of ECT
sessions. AIM. To study the declarative and non declarative memory system in
psychiatric patients submitted to maintenance ECT treatment, with a high number
of previous ECT sessions. PATIENTS AND METHODS: 20 patients submitted to
treatment with ECT (10 diagnosed as having depression and 10 with schizophrenia)
and 20 controls, who were paired by age, sex and psychopathological diagnosis.
For the evaluation of the declarative memory system, the Wechsler Memory Scale
(WMS) logical memory test was used. The Hanoi Tower procedural test was employed
to evaluate the non declarative system. RESULTS: Patients treated with ECT
performed worse in the WMS logical memory test, but this was only significant in
patients diagnosed as suffering from depression. No significant differences were
observed in the Hanoi Tower test. CONCLUSIONS: A selective alteration of the
declarative systems was observed in patients who had been treated with a high
number of ECT sessions, while the non declarative memory systems remain
unaffected.
PMID: 12436375 [PubMed - indexed for MEDLINE]
8: J ECT. 2002 Sep;18(3):126-9.
Comment in:
J ECT. 2003 Jun;19(2):121; author reply 121-2.
Markedly suprathreshold right unilateral ECT versus minimally suprathreshold
bilateral ECT: antidepressant and memory effects.
McCall WV, Dunn A, Rosenquist PB, Hughes D.
Department of Psychiatry and Behavioral Medicine, Wake Forest University School
of Medicine,Winston-Salem, North Carolina27127, USA. vmccall@wfubmc.edu
Right unilateral (RUL) ECT is reported to have fewer memory side effects than
bilateral (BL) ECT. We compared RUL ECT at eight times the seizure threshold
(ST) against BL ECT at 1.5 times the ST. Adults with major depression were
randomly assigned to RUL ECT at eight times ST or BL ECT at 1.5 times the ST.
Blinded ratings of mood and memory were made before ECT, 1 to 3 days after the
final ECT, and at 2 and 4 weeks after ECT. Forty patients received RUL and 37
received BL ECT. The antidepressant response rate was not significantly
different for the RUL and BL groups (60% vs. 73%). Sustained antidepressant
response, accompanied by recovery from anterograde memory side effects, was seen
through the first month with both treatments. Measures of mood and memory were
not significantly different for the two groups at any time point. The modest
sample sizes of this study do not rule out a type II error in the detection of
small but meaningful differences between assigned treatments. Also, the period
of post-ECT observation consisted of 1 month of naturalistic treatment. Both RUL
ECT at eight times the ST and BL ECT at 1.5 times the ST produce similar mood
and memory effects. Both forms of ECT produced acceptable antidepressant
response rates and only transient anterograde amnesia. No clear advantage
emerged for either form of ECT, and both are justifiable as first-line
techniques of ECT.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12394530 [PubMed - indexed for MEDLINE]
9: J Geriatr Psychiatry Neurol. 2002 Summer;15(2):73-6.
Clinical outcome and adverse effects of electroconvulsive therapy in elderly
psychiatric patients.
Kujala I, Rosenvinge B, Bekkelund SI.
Department of Psychiatry, University Hospital of Tromso, Norway.
We evaluated the short-term outcome and side effects of electroconvulsive
treatment (ECT) in a population of elderly psychiatric patients. The material
included patients consecutively hospitalized at a psychogeriatric department
within a period of 5 years. From a total number of 239 patients, we included 52
treated with ECT (22%). Altogether, 41 patients (79%) improved clinically. Of
them, 21 (40%) of the patients went home after the treatment. Twenty patients
(38%) developed adverse reactions from the ECT treatment. Impaired memory (14%),
confusion (6%), and hypertension (6%) represented the most commonly reported
negative reactions secondary to the treatment. The findings from the study
support previous assumptions that ECT is effective in the treatment of serious
psychiatric disorders in elderly patients. Because of the relative high
frequency of side effects, the patients should be selected
PMID: 12083596 [PubMed - indexed for MEDLINE]
10: J Affect Disord. 2001 Oct;66(2-3):237-45.
"Side effects" of ECT are mainly depressive phenomena and are independent of
age.
Brodaty H, Berle D, Hickie I, Mason C.
School of Psychiatry, University of New South Wales, Sydney, Australia.
research.adpg@unsw.edu.au
BACKGROUND: The aetiology of reported side effects of electroconvulsive therapy
(ECT) is unclear. We examined the interaction of depression and age on adverse
neuropsychological and putative side effects of ECT. METHOD: Inpatients (N=81;
median age 70 years) with major depression were assessed prospectively pre-ECT,
immediately post-ECT and 1-3 years later. Patients were administered the
Hamilton Rating Scale for Depression (HRSD), the Global Assessment of
Functioning scale (GAF) and neuropsychological tests from the Wechsler Memory
Scale. Side effects and total burden scores were rated pre- and post-treatment.
RESULTS: HRSD and GAF scores improved with treatment after ECT, but the
prevalence and total burden of side effects were unchanged. Side effect burden
was related to depression level before and after ECT. Improvement in depression
correlated with reduction in side effect burden. There was a significant decline
in side effect burden after controlling for change in depression. Patients'
scores on neuropsychological measures did not appear to change after ECT or
between pre-ECT and follow-up. Re-analysis, allowing for age, chronicity of
depression, medication use and development of dementia, did not alter the
findings. LIMITATIONS: lack of a control group, lack of information on ECT
technique, incomplete data sets and limited neuropsychological testing.
CONCLUSIONS: ECT, an effective treatment for depression, does not cause
significant side effects or neuropsychological impairment, which are more likely
to be depressive phenomena. ECT appears to be safe for old (> or =65 years) and
very old (> or =75 years) patients, who do not appear to be more susceptible to
adverse effects.
PMID: 11578677 [PubMed - indexed for MEDLINE]
11: J ECT. 2001 Sep;17(3):170-4.
Impact of maintenance ECT on concentration and memory.
Datto CJ, Levy S, Miller DS, Katz IR.
Hospital of the University of Pennsylvania and Friends Hospital, Philadelphia,
Pennsylvania 19104, USA. cdatto@mail.upenn.edu
INTRODUCTION: With the increased administration of outpatient electroconvulsive
therapy (ECT), it is important to develop methods for monitoring patients for
adverse effects of treatment. This pilot study was designed to evaluate the
utility of using telephone assessments to determine whether patents receiving
maintenance ECT (MECT) experience cognitive deficits related to individual
treatments. METHOD: Patients were recruited from an existing population of
outpatients receiving MECT. The consenting patients were called on three
occasions and given a battery of telephone cognitive assessments including
Orientation-Memory-Concentration, Buschke Selective Reminding, Verbal Fluency,
"World" Backwards, Serial Sevens, and Wechsler Logical Memory. The occasions for
the telephone interviews were the day before ECT, the day after a treatment, and
a week later. RESULTS: Sixteen patients completed the study. The correlation
between baseline and time 3 ranged from 1.00 for spelling "world" backward to
0.509 for Verbal Fluency Category, indicating considerable variability in
test-retest reliability. One test, Verbal Fluency Category, showed group level
effects, with decrements in performance the day after a treatment. One of the 16
patients showed global cognitive deficits the day after a treatment. DISCUSSION:
The pilot results suggest that telephone assessment may be a useful approach for
monitoring patients receiving outpatient ECT. Monitoring may serve to guide
clinicians in advising individuals and their caregivers about the return to
activities after an individual treatment. Overall these findings support the
tolerability of MECT.
Publication Types:
Clinical Trial
PMID: 11528306 [PubMed - indexed for MEDLINE]
12: J ECT. 2001 Jun;17(2):129-35.
Subtypes of memory dysfunction associated with ECT: characteristics and
neurobiological bases.
Rami-Gonzalez L, Bernardo M, Boget T, Salamero M, Gil-Verona JA, Junque C.
Department of Psychiatry and Clinical Psychobiology, University of Barcelona,
Spain.
Electroconvulsive therapy (ECT) is an effective treatment for a variety of
psychiatric syndromes. However, one of its adverse secondary effects is
neurocognitive dysfunction. The aim of this paper is to review different
subtypes of memory dysfunction associated with ECT from a neuropsychological
perspective. Declarative memory is clearly impaired after ECT. Immediate memory,
however, is broadly preserved. Few studies have addressed procedural and
incidental memory. Selective memory is impaired, probably due to the disruption
of specific brain regions. Some of the possible neurobiological bases of ECT
memory dysfunction are discussed in this paper. Synaptic plasticity, the
cerebral neurotransmission system, and cerebral metabolism are examined in
relation to the dysfunction and subsequent recovery of each memory subtype.
Publication Types:
Review
Review, Tutorial
PMID: 11417924 [PubMed - indexed for MEDLINE]
13: J ECT. 2000 Dec;16(4):370-9.
Efficacy and cognitive effects of right unilateral electroconvulsive therapy.
Ng C, Schweitzer I, Alexopoulos P, Celi E, Wong L, Tuckwell V, Sergejew A,
Tiller J.
The Melbourne Clinic, Department of Psychiatry, University of Melbourne,
Richmond, Victoria, Australia.
The efficacy, memory, and cognitive effects of right unilateral (RUL)
electroconvulsive therapy (ECT) at 2.5 times threshold in 32 inpatients with
moderate to severe major depressive disorder were evaluated at baseline, during
the course of treatment, and 1 month after treatment. Neuropsychological
assessment included the Randt Memory Test, Personal Memory Test, short-version
Wechsler Adult Intelligence Scale-Revised, and Self-Rating Scale of Memory
Functions. At the treatment end point, although the Hamilton Depression Rating
Scale mean score was decreased by 54.2%. the response rate of 2.5 times
threshold RUL ECT using stringent criteria was only 31.2%. Treatment was
associated with significant anterograde memory impairment in the short term.
Mean total scores of the Randt Memory Test and Personal Memory Test were
decreased from baseline by 14.8% and 32.5%, respectively, after six sessions of
ECT. These memory deficits were significantly improved by the 1 month follow-up
examination. Subjective memory scores increased consistently during treatment,
correlating with improvements in mood. No adverse effects on nonmemory cognition
were found. Although RUL ECT at 2.5 times threshold is not associated with
marked or persistent cognitive disturbances, its efficacy may be insufficient in
clinical practice.
Publication Types:
Clinical Trial
PMID: 11314875 [PubMed - indexed for MEDLINE]
14: J Child Adolesc Psychopharmacol. 2000 Winter;10(4):269-76.
Cognitive side effects of electroconvulsive therapy in adolescents.
Ghaziuddin N, Laughrin D, Giordani B.
Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor
48109-0390, USA. neerag@umich.edu
OBJECTIVE: The primary aim of this study was to determine the presence of
cognitive impairments among adolescents treated with electroconvulsive therapy
(ECT) and whether these deficits would persist several months following the
treatment. METHODS: Retrospective data resulting from standard clinical care of
a convenience sample with naturalistic follow-up were used. Subjects were 16
adolescents (13 females, 3 males; mean age = 15.9 +/- 1.6 years) hospitalized
with a mood disorder (unipolar depression = 14, bipolar depression = 2).
Cognitive tests administered prior to ECT were compared with results at 7.0 +/-
10.3 days following the last treatment and with a second testing at 8.5 +/- 4.9
months after the last treatment. RESULTS: Comparison of pre-ECT and the first
post-ECT testing administered during the first 10 days of the treatment yielded
significant impairments of concentration and attention, verbal- and
visual-delayed recall, and verbal fluency. A complete recovery of these
functions was noted at the second post-ECT testing. There was no deficit in the
ability to problem solve during the initial or the subsequent testing.
CONCLUSION: Cognitive parameters found to be impaired during the first few days
of ECT recovered over several months following the treatment. Therefore, there
was no evidence of long-term damage to concentration, attention, verbal and
visual memory, or verbal fluency. There were no impairments of motor strength
and executive processing, even during the early (within 7-10 days) post-ECT
period. These results should be regarded as preliminary, awaiting confirmation
with larger samples.
PMID: 11191687 [PubMed - indexed for MEDLINE]
15: Depress Anxiety. 2000;12(3):130-4.
Side effects of electroconvulsive therapy.
Datto CJ.
University of Pennsylvania, 3600 Market St. 7th floor, Philadelphia, PA 19104,
USA. cdatto@mail.med.upenn.edu
Electroconvulsive therapy is extremely effective and is the fastest acting
antidepressant treatment now available, although not necessarily limited to use
with depression. Despite years of experience with this technique and its
unparalleled successes, patients continue to be affected by mostly transient,
but sometimes impairing side effects from memory problems and cardiovascular
changes associated with ECT treatments. Nausea, headache, muscle aches, and
other side effects that have been referenced in the literature and clinical
experience will also be discussed in this review. Helpful literature with
recommendations on minimizing the risks of these side effects and improving the
tolerability of the electroconvulsive treatments will also be presented.
Publication Types:
Review
Review, Tutorial
PMID: 11126187 [PubMed - indexed for MEDLINE]
16: Int J Geriatr Psychiatry. 2000 Aug;15(8):729-35.
Comment in:
Int J Geriatr Psychiatry. 2001 Sep;16(9):919-20.
The benefits and risks of ECT for patients with primary dementia who also suffer
from depression.
Rao V, Lyketsos CG.
Neuropsychiatry and Memory Group, Department of Psychiatry and Behavioral
Sciences, School of Medicine, The John Hopkins University, Baltimore, MD 21287,
USA.
BACKGROUND: Major depression afflicts 20-25% of patients with dementia. Of
these, about a third do not improve with antidepressant therapy and may be
suitable candidates for electronconvulsive treatment (ECT). However, the use of
ECT is dementia patients is concerning due to possible adverse effects on memory
and cognition. Outcome studies of ECT in patients with primary dementia and
depression are very rare. OBJECTIVE: To determine the effectiveness and
complications of ECT treatment for depression in dementia. METHOD: A chart
review was conducted of all 31 patients wit ha discharge diagnosis of 'Dementia
with depression' treated with ECT at the Johns Hopkins Hospital, over a
five-year period. Admission and discharge ratings were made on the Mini-Mental
State Examination (MMSE) and the Montgomery-Asberg Depression Rating Scale
(MADRS) as part of the clinical routine. RESULTS: All patients suffered from
dementia: 55% had vascular dementia, 13% Alzheimer's disease, and 32%
degenerative dementia of uncertain etiology. The admission MADRS mean score was
27.5 (SD 8.1) and the MMSE mean score was 18.8 (SD 5. 5). The patients received
between 1 and 23 ECT treatments (mean 9, SD 5.7). At discharge, there was a
statistically significant mean decline on the MADRS of 12.28 points (p<0.01).
Forty percent had scores less than 10 (normal) on the MADRS. While 49% of
patients developed delirium, by discharge there was also a significant mean
increase (improvement) in MMSE of 1.62 points (p<0.02). CONCLUSIONS: ECT is an
effective treatment for depression in dementia, leading to improvements in both
mood and cognition. Multiple ECT treatments may be necessary before a
significant improvement in mode is achieved. Copyright 2000 John Wiley & Sons,
Ltd.
PMID: 10960885 [PubMed - indexed for MEDLINE]
17: Neuropsychologia. 2000;38(10):1405-14.
The effect of electroconvulsive therapy (ECT) on implicit memory: skill learning
and perceptual priming in patients with major depression.
Vakil E, Grunhaus L, Nagar I, Ben-Chaim E, Dolberg OT, Dannon PN, Schreiber S.
Department of Psychology, Bar-Ilan University, Ramat-Gan, 52900, Israel.
vakile@mail.biu.ac.il
While explicit memory in amnesics is impaired, their implicit memory remains
preserved. Memory impairment is one of the side effects of electroconvulsive
therapy (ECT). ECT patients are expected to show impairment on explicit but not
implicit tasks. The present study examined 17 normal controls and 17 patients
with severe major depressive disorder who underwent right unilateral ECT.
Patients were tested in three sessions: 24-48 hours prior to, 24-48 hours
following the first ECT, and 24-48 hours following the eighth ECT. The controls
were tested in three sessions, at time intervals that paralleled those of the
patients. Implicit memory was tested by the perceptual priming task - Partial
Picture-Identification (PPI). The skill learning task used entailed solving the
Tower of Hanoi puzzle (TOHP). Explicit memory was tested by picture recall from
the PPI task, verbal recall of information regarding the TOHP, and by the Visual
Paired Association (VPA) test. Results showed that explicit questions about the
implicit tasks were impaired following ECT treatment. Patients' learning
ability, as measured by the VPA task, was only impaired in the first testing
session, prior to ECT treatment, reflecting the effect of depression. In
addition, groups only differed in the first session on the learning rate of the
skill learning task. Perceptual priming was preserved in the patients' group in
all sessions, indicating that it is resilient to the effect of depression and
ECT. The results are interpreted in terms of the differential effect of
depression and ECT on explicit and implicit memory.
Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 10869584 [PubMed - indexed for MEDLINE]
18: J ECT. 2000 Jun;16(2):144-56.
Herbal treatments for ECS-induced memory deficits: a review of research and a
discussion on animal models.
Andrade C, Sudha S, Venkataraman BV.
Department of Psychopharmacology, National Institute of Mental Health and
Neurosciences, Bangalore, India. candrade@bgl.vsnl.net.in
During the last decade the use of herbal medicinal substances in the attenuation
of anterograde and retrograde amnesia induced by electroconvulsive shock (ECS)
has been studied using animal research. We will discuss the background of herbal
medicine in India, review the research findings on herbal medicines for
ECS-induced amnestic deficits, and examine the applications and limitations of
animal models in this context. We will focus on our own research and insights,
with particular emphasis on practical issues.
Publication Types:
Review
Review, Tutorial
PMID: 10868324 [PubMed - indexed for MEDLINE]
19: J ECT. 2000 Jun;16(2):133-43.
Comment in:
J ECT. 2000 Jun;16(2):87-96.
J ECT. 2002 Jun;18(2):71-3.
Electroconvulsive therapy and memory loss: a personal journey.
Donahue AB.
The cause for the significant gap between research and anecdotal evidence
regarding the extent of some memory loss after electroconvulsive therapy (ECT)
has never been adequately explained. A patient's development of awareness and
self-education about her severe side effects from ECT raises questions regarding
many current assumptions about memory loss. ECT-specific studies, which conclude
that side effects are short term and narrow in scope, have serious limitations,
including the fact that they do not take into account broader scientific
knowledge about memory function. Because of the potential for devastating and
permanent memory loss with ECT, informed consent needs significant enhancement
until advancing research on both improved techniques and on better predictive
knowledge regarding memory loss progresses to making a greater impact on
clinical applications. Follow-up care and education in coping skills need to be
a regular part of ECT practice when patients do experience severe effects.
PMID: 10868323 [PubMed - indexed for MEDLINE]
20: J ECT. 2000 Jun;16(2):121-32.
Comment in:
J ECT. 2000 Jun;16(2):87-96.
Subjective memory complaints: a review of patient self-assessment of memory after
electroconvulsive therapy.
Prudic J, Peyser S, Sackeim HA.
Department of Biological Psychiatry, New York State Psychiatric Institute, NY
10032, USA.
Interest in patients' subjective complaints about the adverse cognitive effects
of electroconvulsive therapy (ECT) spans several decades. This article reviews
the major areas that have been examined in relation to patients' subjective
assessment of memory function: 1) technical aspects in the administration of
ECT; 2) objective tests of cognitive function; and 3) clinical state. For the
most part, subjective assessments of memory following ECT have relied on a
single instrument, the Squire Subjective Memory Questionnaire (SSMQ). While
older reports of the impact of the technical aspects of ECT on subjective memory
assessment following ECT suggest a detectable negative influence with certain
forms of treatment, most recent studies indicate that subjective memory improves
following ECT. This shift in findings may be due to the change in practice from
sine wave to brief-pulse ECT. While the impact of ECT on objective tests of
memory is clear and reproducible, the relationship of objective findings to
subjective memory assessment appears to be weak. Instead, subjective reports of
cognitive function are strongly influenced by mood state. Current batteries of
objective tests of memory may not include components that are most affected in
reports about subjective memory. In addition, the literature mainly reports
group effects, and sample sizes have been small. We lack data on the number of
individuals who believe ECT has had a markedly negative effect on memory
functioning, and on the characteristics of memory function in this subgroup of
patients who complain of severe impairment. Furthermore, there is a paucity of
information relating patient characteristics to subjective memory outcomes with
ECT.
Publication Types:
Review
Review, Tutorial
PMID: 10868322 [PubMed - indexed for MEDLINE]
21: J ECT. 2000 Jun;16(2):110-20.
Electrophysiological correlates of the adverse cognitive effects of
electroconvulsive therapy.
Sackeim HA, Luber B, Moeller JR, Prudic J, Devanand DP, Nobler MS.
Department of Biological Psychiatry, New York State Psychiatric Institute, New
York 10032, USA.
Resting state, eyes closed, 19-lead EEG recordings were obtained at pre-ECT
baseline and just prior to penultimate treatment and during the week following
the ECT course in 59 patients with major depression. Patients had been
randomized to ECT conditions that varied in electrode placement and stimulus
intensity. The EEG data were submitted to power spectral analysis, and global
and topographic effects were characterized for the delta and theta frequency
bands. Relations between the EEG changes and scores on three cognitive measures
were examined. The period of disorientation immediately following RUL ECT was
associated with an accentuation of delta power in anterior frontal and temporal
regions. Across the electrode placements, increased theta activity in left
frontotemporal regions was associated with longer recovery of orientation.
Post-ECT decrements in global cognitive status, as assessed by the modified
Mini-Mental State exam, were associated with a greater increase in delta
relative to theta power, globally across the cortex. The magnitude of retrograde
amnesia for autobiographical events correlated with increased theta activity in
left frontotemporal regions. The findings suggest that distinct
neurophysiological changes subserve the therapeutic and adverse cognitive
effects of ECT. Postictal disorientation and post-ECT retrograde amnesia appear
to share a common physiological substrate.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10868321 [PubMed - indexed for MEDLINE]
22: J ECT. 2000 Jun;16(2):97-109.
Balancing speed of response to ECT in major depression and adverse cognitive
effects: role of treatment schedule.
Shapira B, Tubi N, Lerer B.
Depression Unit, Herzog Hospital, Jerusalem, Israel.
Schedule of administration (number of ECT per week and total number of
treatments in the course) is one of a number of factors that may significantly
influence the degree of cognitive impairment induced by ECT. We examined the
effect of twice (ECT x 2) versus three times weekly (ECT x 3) bilateral ECT on
cognitive function, particularly memory, in patients with major depression. Two
studies were conducted, both double blind and controlled by the administration
of simulated ECT (anesthesia and muscle relaxant only with no electrical
stimulation). The results of these studies showed that the antidepressant effect
of the two schedules, when assessed at the end of the ECT course, was equal.
Speed of response was significantly greater with ECT x 3 but this schedule
induced more severe memory impairment, even when the number of ECT in the series
was not significantly different between the two groups. These findings are in
general accordance with other studies that were similar in design although not
as rigorously controlled. They support the conclusion that ECT x 2 is the more
appropriate schedule for regular clinical practice unless speed of response is
an overriding concern. In an era when patients administered ECT tend to be older
and are more likely to manifest cognitive impairment for other reasons, choice
of schedule is of particular relevance along with other factors such as
electrode placement and stimulus intensity that influence ECT-induced cognitive
impairment.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10868320 [PubMed - indexed for MEDLINE]
23: Arch Gen Psychiatry. 2000 Jun;57(6):591-2.
Comment on:
Arch Gen Psychiatry. 2000 Jun;57(6):581-90.
Retrograde amnesia with electroconvulsive therapy: characteristics and
implications.
Weiner RD.
Department of Psychiatry and Behavioral Sciences, Duke University Medical
Center, Durham, NC 27710, USA. rweiner@duke.edu
Publication Types:
Comment
PMID: 10839337 [PubMed - indexed for MEDLINE]
24: Arch Gen Psychiatry. 2000 Jun;57(6):581-90.
Comment in:
Arch Gen Psychiatry. 2000 Jun;57(6):591-2.
The effects of electroconvulsive therapy on memory of autobiographical and public
events.
Lisanby SH, Maddox JH, Prudic J, Devanand DP, Sackeim HA.
Department of Biological Psychiatry, New York State Psychiatric Institute, New
York 10032, USA. SHL24@columbia.edu
BACKGROUND: Retrograde amnesia is the most persistent cognitive adverse effect
of electroconvulsive therapy (ECT); however, it is not known whether ECT has
differential effects on autobiographical vs impersonal memories. This study
examined the short- and long-term effects of differing forms of ECT on memory of
personal and impersonal (public) events. METHODS: Fifty-five patients with major
depression were randomly assigned to right unilateral (RUL) or bilateral (BL)
ECT, each at either low or high electrical dosage. The Personal and Impersonal
Memory Test was administered by blinded raters at baseline, during the week
after ECT, and at the 2-month follow-up. Normal controls were tested at matched
intervals. RESULTS: Shortly after ECT, patients recalled fewer events and event
details than controls, with the deficits most marked for impersonal compared
with personal events. Bilateral ECT caused more marked amnesia for events and
details than RUL ECT, and especially for impersonal memories. These effects were
independent of electrical dosage and clinical outcome. At the 2-month follow-up,
patients had reduced retrograde amnesia, but continued to show deficits in
recalling the occurrence of impersonal events and the details of recent
impersonal events. CONCLUSIONS: The amnestic effects of ECT are greatest and
most persistent for knowledge about the world (impersonal memory,) compared with
knowledge about the self (personal memory), for recent compared with distinctly
remote events, and for less salient events. Bilateral ECT produces more profound
amnestic effects than RUL ECT, particularly for memory of impersonal events.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10839336 [PubMed - indexed for MEDLINE]
25: Am J Psychiatry. 2000 Mar;157(3):460-2.
Absence of cognitive impairment at long-term follow-up in adolescents treated
with ECT for severe mood disorder.
Cohen D, Taieb O, Flament M, Benoit N, Chevret S, Corcos M, Fossati P, Jeammet
P, Allilaire JF, Basquin M.
Department of Child and Adolescent Psychiatry, Groupe Hospitalier
Pitie-Salpetriere, Paris, France. david.cohen@psl.ap-hop-paris.fr
OBJECTIVE: Cognitive functions of adolescents treated with ECT for mood disorder
were evaluated at long-term follow-up. METHOD: At an average of 3.5 years
(SD=1.7) after the last ECT, 10 subjects treated during adolescence with
bilateral ECT for severe mood disorder completed a clinical and cognitive
evaluation, including the California Verbal Learning Test and Squire's
Subjective Memory Questionnaire. The same assessments were given to 10
psychiatric comparison subjects matched for sex, age, and diagnosis. RESULTS:
All cognitive test scores of the patients treated with ECT were similar to those
of the comparison subjects and did not differ from norms from the community. Six
of the 10 ECT-treated patients reported having had memory losses immediately
after the ECT course, but only one complained of subjective memory impairment at
follow-up. CONCLUSIONS: The results suggest that adolescents given ECT for
severe mood disorder do not suffer measurable cognitive impairment at long-term
follow-up.
Publication Types:
Clinical Trial
PMID: 10698827 [PubMed - indexed for MEDLINE]
26: Harv Rev Psychiatry. 1998 Mar-Apr;5(6):307-17.
A glutamatergic model of ECT-induced memory dysfunction.
Chamberlin E, Tsai GE.
Institute of Living, Hartford, Conn., USA.
Electroconvulsive therapy (ECT) is an efficacious treatment for a variety of
neuropsychiatric conditions including major depression, mania, catatonia,
Parkinson's disease, and neuroleptic malignant syndrome. However, ECT-induced
memory dysfunction complicates the treatment and is a major concern for both
patients and providers. We briefly review ECT-induced memory dysfunction and
propose a glutamatergic model for it. (Articles examined were retrieved by a
Medline search on the terms electroconvulsion and glutamate, with language
limited to English.) Specifically, we hypothesize that ECT-induced memory
dysfunction results from neuronal insults due to excessive release of excitatory
amino acids and activation of their receptors, which produce cation and water
flux and reversible oxidative stress. This model offers multiple testable
hypotheses; exploring them may help to identify the risk factors for this
significant side effect of ECT treatment and may thus yield effective agents for
its prevention and treatment.
Publication Types:
Review
Review, Tutorial
PMID: 9559349 [PubMed - indexed for MEDLINE]
