Paolo Decina

The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression

After clinical response to electroconvulsive therapy (ECT), 58 patients with major depressive disorder were followed for 1 year or until relapse. The rate of relapse was substantially higher in patients who had failed adequate antidepressant medication trials prior to ECT than in patients not determined to be medication resistant. Adequacy of post-ECT pharmacotherapy was only marginally related to likelihood of relapse. The subgroup of patients who appeared to benefit from adequate post-ECT pharmacotherapy were those who did not receive an adequate medication trial prior to ECT. The findings call into question the common practice of administering as continuation pharmacotherapy following ECT the same class of medications that patients had failed with during the acute episode prior to ECT. The findings also indicate that resistance to antidepressant medication is a strong predictor of relapse following response to ECT.

Effects of depression and ECT on anterograde memory

This study investigated immediate and delayed recognition memory in depressed patients undergoing electroconvulsive therapy (ECT) and in matched, normal controls. At baseline, patients manifested a marked deficit in immediate memory (acquisition), but showed no deficit in delayed memory (retention). When retested 24-36 hr following the seventh ECT, patients showed reductions in both immediate and delayed memory performance. At retesting 4 days, on average, after the ECT course, immediate memory scores returned to baseline levels, but delayed memory performance remained impaired. The findings supported the classic claims that depression is associated with a deficit in the acquisition of information, whereas ECT has a more profound influence on the retention of information. This dissociative pattern could not be viewed as an artifact of task psychometric properties, nor of practice effects in control subjects.

Acute effects of ECT on cardiovascular functioning: relations to patient and treatment variables

ABSTRACT— In 34 patients with primary, major depressive disorder, randomly assigned to bilateral or right unilateral ECT, heart rate (HR) and blood pressure (BP) were assessed prior and following seizure induction at every treatment. In contrast to prior reports, no cumulative pattern was observed in HR or BP changes as a function of treatment number. Generally, treatment variables, including ECT modality (bilateral vs. unilateral), anesthetic agent (methohexital vs. pentothal), and prior subconvulsive stimulation in a session, had no effects on the magnitude of peak postictal increases in HR or BP. The peak changes were also unrelated to the history of cardiac illness, remission of depressive symptomatology, patient seizure threshold and patient seizure duration. Pre‐treatment HR was strongly predictive of peak postictal change in both HR and BP, while pretreatment BP was not. Patients with high pre‐ECT HR had smaller peak postictal HR and BP increases. The findings suggested that low dosage, titrated ECT has HR and BP effects similar to traditional high dosage techniques, and that pre‐treatment HR is the best predictor of these effects.

Lithium in the treatment of bipolar disorders associated with epilepsy: an open study.

Eight DSM-III bipolar patients with seizure disorders were treated in an open study evaluating the effects of maintenance lithium treatment on affective relapses and clinical seizure activity. Lithium was effective in preventing the recurrence of affective episodes without worsening seizure frequency in patients with active seizures and did not induce seizures in those whose seizures were in remission. One patient showed remission of both affective and seizure symptoms on lithium alone. Lithium appears to be safe and effective in bipolar disorders associated with epilepsy and may have an anticonvulsant effect in some patients.

Relative response of endogenous and non-endogenous symptoms to electroconvulsive therapy

A sample of patients with endogenous depression (RDC), who had only a partial response to electroconvulsive therapy (ECT), was identified from a larger group of patients participating in a study of the affective and cognitive effects of low-dose titrated ECT. Using symptom scores on the Hamilton Rating Scale for Depression, subscales were constructed to reflect Kleins formulation of endogenomorphic depression, the RDC for endogenous subtype, and the DSM-III criteria for melancholia. Regardless of the subscale used, no evidence was obtained that endogenous symptoms were more responsive to ECT than non-endogenous symptoms.

Patterns of Illness in Parent-Child Pairs Both Hospitalized for Either Schizophrenia or a Major Mood Disorder

Results are reported of a blind rediagnosis of a consecutive series of parent-child pairs hospitalized with a diagnosis of schizophrenia or mood disorder. Patterns of illness in pairs meeting DSM-III-R criteria for either disorder were examined by contrasting the two generations on their respective distributions of diagnoses, and means of age at onset and severity of illness. While no case of mood disorder was found in the children of schizophrenic parents, 50% of the children of parents with psychotic mood disorders presented with schizophrenia. The offspring also had an earlier age at onset of illness than did their parents.

Effects of ect on the TRH stimulation test

The prognostic value of the TRH stimulation test was evaluated in 23 inpatients with major depressive disorder before and after a trial of ECT. In contrast to previous reports, the peak TSH response to TRH was significantly decreased after treatment compared with before treatment. This effect was consistent across individuals and subgroups (responders/nonresponders; unilateral/bilateral ECT). The particular ECT technique used in the study may account for the discrepancies between these findings and those previously reported by other authors.

Serial dexamethasone suppression tests in initial suppressors and nonsuppressors treated with electroconvulsive therapy

Four different methods of quantifying the 1-mg Dexamethasone Suppression Test (DST) were contrasted with serial testing in endogenous depressives receiving electroconvulsive therapy (ECT). Of three continuous measures in 38 patients with pretreatment DSTs, only the log-transformed value for plasma cortisol was normally distributed, indicating that it possessed superior psychometric properties. Pretreatment Hamilton Depression Rating Scores (HAM-D) correlated positively with pretreatment DST status, with a similar association noted between posttreatment DST status and HAM-D scores. There was no uniform effect of ECT on the DST. Although pretreatment nonsuppressors showed a trend toward decreased postdexamethasone cortisol values, initial suppressors (cutoff: 5 micrograms/dl) evidenced a significant increase in these values, and 35.3% of initial suppressors were nonsuppressors at final DST assessment. These trends were noted in the DST assessment done following the third ECT treatment, suggesting an effect of regression to the mean. The findings highlight the importance of following initial DST suppressors in studies of this type.

Birth weight and CT scan findings in chronic schizophrenic patients

The relations of birth weight to CT scan measures of lateral ventricular size, third ventricular size, frontal cortical sulcal prominence, and parieto-occipital cortical sulcal prominence were examined in 24 chronic schizophrenic patients. In contrast to the inverse correlation between birth weight and ventricular size found among offspring of schizophrenic parents in the Danish High-Risk Study, and the predictions of the subsequent hypothesis, no significant relations between birth weight and CT scan measures were observed in this study