Mode of action of electroconvulsive therapy: an update

2011 ◽  
Vol 17 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Allan I. F. Scott

SummaryIt has become acceptable for psychiatrists to say that they simply do not know how electroconvulsive therapy (ECT) works. This frame of mind runs the risk that there will be no expectation that psychiatrists remain familiar with seminal studies on the mode of action of ECT. This article is intended as a reminder of these studies and illustrates how the original theories have evolved. This evolution has been brought about largely by modern brain imaging techniques in human studies and in patients treated with ECT. These new findings will be set in the context of contemporary ideas about the neuroanatomy of mood disorders and the cellular mechanisms of the long-term effects of antidepressant treatments.

Author(s):  
Ruth E. Grunau ◽  
Jillian Vinall Miller ◽  
Cecil M. Y. Chau

The long-term effects of infant pain are complex, and vary depending on how early in life the exposure occurs, due to differences in developmental maturity of specific systems underway. Changes to later pain sensitivity reflect multiple factors such as age at pain stimulation, extent of tissue damage, type of noxious insult, intensity, and duration. In both full-term and preterm infants exposed to hospitalization, sequelae of early pain are confounded by parental separation and quality of pain treatment. Neonates born very preterm are outside the protective uterine environment, with repeated exposure to pain occurring during fetal life. Especially for infants born in the late second trimester, the cascade of autonomic, hormonal, and inflammatory responses to procedures may induce excitotoxicity with widespread effects on the brain. Quantitative advanced imaging techniques have revealed that neonatal pain in very preterm infants is associated with altered brain development during the neonatal period and beyond. Recent studies now provide evidence of pathways reflecting mechanisms that may underlie the emerging association between cumulative procedural pain exposure and neurodevelopment and behavior in children born very preterm. Owing to immaturity of the central nervous system, repetitive pain in very preterm neonates contributes to alterations in multiple aspects of development. Importantly, there is strong evidence that parental caregiving to reduce pain and stress in preterm infants in the Neonatal Intensive Care Unit (NICU) may prevent adverse effects, and sensitive parenting after NICU discharge may help ameliorate potential long-term effects.


2019 ◽  
Vol 44 (10) ◽  
pp. 1805-1811 ◽  
Author(s):  
Akihiro Takamiya ◽  
Eric Plitman ◽  
Jun Ku Chung ◽  
Mallar Chakravarty ◽  
Ariel Graff-Guerrero ◽  
...  

2020 ◽  
Author(s):  
Thomas Heisser ◽  
Rafael Cardoso ◽  
Feng Guo ◽  
Tobias Moellers ◽  
Michael Hoffmeister ◽  
...  

AbstractObjectiveThe performance of colorectal cancer (CRC) screening programs depends on the adherence to screening offers. However, identical adherence levels may result from varying patterns of the population’s screening behavior. We quantified the effects of different adherence patterns on the long-term performance of CRC screening for annual fecal immunochemical testing (FIT) and screening colonoscopy at ten-year intervals.DesignUsing a multistate Markov model, we simulated scenarios where, while at the same overall adherence level, a certain proportion of the population adheres to all screening offers (‘selective’ adherence) or the entire population uses the screening offers at some point(s) of time, albeit not in the recommended frequency (‘sporadic’ adherence). Key outcomes for comparison were the numbers of prevented CRC deaths and prevented years of potential life lost (YPLL) after 50 simulated years.ResultsFor screening with annual FIT at adherence levels of 10-50%, ratios of prevented CRC deaths (YPLL) resulting from a sporadic versus a selective pattern ranged from 1.9-5.0 (1.9-5.0) for men and from 1.8-4.1 (1.8-4.3) for women, i.e. up to 4-5 times more CRC deaths and YPLL were prevented when the population followed a sporadic instead of a selective adherence pattern. Comparisons of simulated scenarios for screening colonoscopy revealed similar patterns.ConclusionAt the same overall level of adherence, ‘sporadic’ adherence patterns go along with much larger preventive effects than ‘selective’ adherence patterns. Screening programs should prioritize efforts to reach as many people as possible at least sporadically over efforts to maximize full adherence to repeat screening offers. Adherence statistics should be refined to better reflect ‘effective adherence’.What You Need to KnowBACKGROUND AND CONTEXTThe evidence on long-term effects of different patterns of longitudinal adherence (e.g. consistent or sporadic uptake) to colorectal cancer screening offers is limited.NEW FINDINGSIn a simulated hypothetical German population, at identical overall participation levels, large proportions of the population making sporadic use of screening offers were up to 4-5 times more beneficial to achieve sustained reductions of colorectal cancer mortality than small proportions of the population utilizing screening offers at the recommended frequency.LIMITATIONSThis study is limited by model simplifying assumptions and uncertainties related to input parameters.IMPACTEfforts to increase screening uptake should be concentrated on groups of consistent non-responders, e.g. by low-threshold screening offerings, such as directly mailed stool tests. Adherence statistics should be refined to better reflect “effective adherence”.SHORT SUMMARYThis simulation study demonstrates that commonly used adherence metrics for colorectal cancer screening do not sufficiently cover the effect of varying patterns of longitudinal adherence, which may considerably impact the long-term efficacy of screening programs.


2015 ◽  
Vol 6 (2) ◽  
pp. 59-65
Author(s):  
Viktoriya Vladimirovna Vorob’eva ◽  
Irina Viktorovna Zarubina ◽  
Petr Dmitrievich Shabanov ◽  
Sergei Nikolaevich Proshin

The analysis of the reasons for the children to the intensive care unit indicates that the poisoning is one of the most important cause of life-threatening conditions in childhood. The poisoning by drugs and ethanol dominates among other poisoning factors. Multiple drug poisoning is not so rare case as well as intentional self-poisoning among teenagers. It is dangerous not only toxigenic phase of poisoning by various chemical compounds but also their long-term effects. The symptoms of cerebroasthenia, minimal dysfunction of brain, vascular disorders, violation of thermoregulation, convulsions, visual impairment, hepatopathy, nephropathy, adrenal dysfunction are discussed as the effects of acute poisoning in children. Above-mentioned facts indicate the need to improve the toxicological assistance not only during resuscitation but also in a phase of long-term effects. The as early as possible elimination of the effects of acute poisoning leaves the possibility of development of the child according to age. The study of the general laws of chemical and biological interaction of poison with organs and tissues of animals in the experiment can detect adaptive and compensatory mechanisms to ensure stability of the basic functions of the organism to the damaging effects of xenobiotics. The study of the molecular and cellular mechanisms of action of exogenous chemical factors elucidates the target points to the impact of pharmacological agents. Taking into account that the mandatory pathogenetic component of the process of intoxication is hypoxia we used the ethylene glycol poisoning model to test direct antihypoxants 2 etiltiobenzimidazola hydrobromide (metaprot) and 5-ethoxy-2-etiltiobenzimidazol (etomerzol). Aim: to estimate antihypoxic and antioxidant effects of actoprotective substances as metaprot and etomerzol in the model of ethylene glycol poisoning.


1991 ◽  
Vol 179 (9) ◽  
pp. 526-533 ◽  
Author(s):  
AVRAHAM CALEV ◽  
DORON NIGAL ◽  
BARUCH SHAPIRA ◽  
NURITH TUBI ◽  
SHELLA CHAZAN ◽  
...  

1974 ◽  
Vol 125 (588) ◽  
pp. 490-495 ◽  
Author(s):  
Larry R. Squire ◽  
Patricia L. Miller

The memory loss that follows a series of electroconvulsive therapy (ECT) treatments has been well documented. The amnesia appears to involve an impairment in the ability to acquire new memories, an impairment of memory for events that occurred shortly before ECT (Dornbush, 1972; Williams, 1966), and an impairment in the ability to recall material from remote memory (Janis, 1950; Squire, 1974a). Several characteristics of the anterograde amnesia produced by ECT have been the subject of contradictory reports. For example, it has been reported that memory functions can improve markedly or even return to pre-ECT levels within hours after the last of a short series of treatments (Brengelmann, 1959; Zinkin and Birtchnell, 1968; Zirkle, 1956). Yet, it has also been found that amnesic effects of a short series of treatments can be detected for weeks (Cronin, Bodley, Mather, Gardner and Tobin, 1970; Halliday, Davison, Browne and Krieger, 1968). Moreover, some reports suggest that memory recovers at the same rate following each of the first few treatments in a series (Brengelmann, 1959; Zinkin and Birtchnell, 1968), whereas other reports demonstrate that the effects of the first few treatments on memory can be cumulative (Bidder, Strain and Brunschwig, 1970). One explanation for such variant findings is that different memory tests have been employed in these studies. To obtain accurate estimates of the effects of ECT on memory, tests used to assess memory should be as sensitive as they can be to memory impairment. This point is particularly relevant, of course, to the evaluation of long-term effects of ECT on memory. Patients who had sustained partial temporal lobectomy could perform normally in tests of immediate reproduction from memory, but were markedly impaired in tests that imposed long delays between learning and retention (Milner, 1958). Apparently tests involving delayed reproduction from memory are a more sensitive index of organic memory dysfunction than tests that involve immediate reproduction. The present study assessed the ability of patients receiving ECT to retain newly learned material for 30 minutes and 24 hours. The results of these delayed retention tests demonstrate that recovery from anterograde amnesia is quite gradual and that the effects of the first few ECT treatments on memory are cumulative; and underscore the value of such tests as sensitive indicators of possible long-term effects of ECT on memory.


SPE Journal ◽  
2015 ◽  
Vol 20 (05) ◽  
pp. 923-941 ◽  
Author(s):  
Klemens Katterbauer ◽  
Ibrahim Hoteit ◽  
Shuyu Sun

Summary Electromagnetic (EM) heating is becoming a popular method for heavy-oil recovery because of its cost-efficiency and continuous technological improvements. It exploits the relationship that the viscosity of hydrocarbons decreases for increasing temperature; the heavy-oil components become more fluid-like, and hence easier to extract from the reservoir. Although several field studies have considered the effects of heating on the viscosity of the hydrocarbons, there has been very little research on the long-term effects of field production and the forecasting of the development of the reservoir. Increased flow rates within the reservoir render the moving fluids less viscous, implying fast-changing fluid-propagation patterns and increased uncertainty about the state of the oil displacement. This means, in the long term, strongly varying production projections, strong dependence on the permeability of the reservoir, and potentially undesirable fluid migration. To improve the forecasting of production in heavy-oil fields and to accurately capture the dynamics of the fluid movements, we present a history-matching framework incorporating well data and seismic and EM crosswell-imaging techniques. The incorporation of seismic and EM data into the history-matching process counteracts the changing reservoir dynamics caused by increased fluid velocity caused by heating and is shown to significantly improve reservoir matching and forecasts for a variety of different heating scenarios.


2016 ◽  
Vol 33 (S1) ◽  
pp. S329-S329
Author(s):  
J. Bjorke-Bertheussen ◽  
B. Auestad ◽  
U. Kessler ◽  
H. Schoyen

IntroductionBipolar depression is difficult to manage, and causes considerable disability and distress for patients and their surroundings. Electroconvulsive therapy (ECT) is an effective treatment, but there are concerns regarding long-term neurocognitive impairment, and in particular autobiographical memory.ObjectivesTo compare the long-term effects of algorithm-based pharmacologic treatment (APT) and ECT in treatment-resistant bipolar depression as measured with standard neurocognitive tests and autobiographical memory interview.AimsTo examine the long-term neurocognitive effects of ECT.MethodsIn this multicenter randomized controlled trial 73 in-patients with treatment resistant bipolar depression were randomized to either APT or unilateral ECT. Patients were assessed at baseline and at 6 months. Neurocognitive functions were assessed with the MATRICS Consensus Cognitive Battery (MCCB), Wechsler Abbreviated Scale of Intelligence (WASI) and the Autobiographical Memory Inventory - Short form (AMI-SF). At 6 months, neurocognitive data were available for 26 patients (APT n = 11, ECT n = 15).ResultsThere were no group-differences at baseline.At 6 months, there was no group-difference in MCCB-score (APT 44.9 vs. ECT 46.0, P-value: 0.707), or WASI total IQ-score (APT 103.9 vs. ECT 107.2, P-value: 0.535). There were indications of (P-value: 0.109) poorer AMI-SF consistency score in the ECT group (APT 72.3% vs. ECT 64.3%).ConclusionsThis study does not find that ECT causes long-term impairment in neurocognitive function as measured with standard neuropsychological tests. We find a trend towards poorer autobiographical memory in the ECT-group, and there needs to be further research regarding this.Disclosure of interestThe authors have not supplied their declaration of competing interest.


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