Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy.

Abstract

For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment-resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper was to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT-associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the use of this important and widely used intervention tool for neuropsychiatric diseases.

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Citation

Published Version (Please cite this version)

10.1097/YCT.0000000000000137

Publication Info

McClintock, Shawn M, Jimmy Choi, Zhi-De Deng, Lawrence G Appelbaum, Andrew D Krystal and Sarah H Lisanby (2014). Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy. J ECT, 30(2). pp. 165–176. 10.1097/YCT.0000000000000137 Retrieved from https://hdl.handle.net/10161/10644.

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Scholars@Duke

Zhi-de Deng

Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences
Krystal

Andrew Darrell Krystal

Professor Emeritus of Psychiatry and Behavioral Sciences

My research is focused on better understanding the pathophysiology of sleep disorders and mood disorders and developing improved treatments for these conditions. My primary research tools are: electroencepahlography (EEG), polysomnography (PSG), computer signal analysis and modeling, functional magnetic resonance imaging (fMRI), and positron emission tomograophy (PET). Nearly all of my projects have been carried out with humans, however, projects are ongoing with gene knock-out models in mice, and lemurs in collaboration with the Duke Primate Center. A few representative current studies are: 1) Defining physiologic (EEG, PSG, PET, fMRI) correlates of sleep complaints and subtyping insomnia on the basis of the associated pathophysiology, 2) Studying the relationship of EEG data recorded during non-REM sleep, daytime function, and insomnia treatment response, 3) Developing new pharmacologic and non-pharmacologic treatments for insomnia, 4) Studying the relationship of natural sleep and hibernation-like phenomena (torpor), 5) Predicting depression treatment response on the basis of pre-treatment EEG and structural MRI data.

Lisanby

Sarah Hollingsworth Lisanby

Professor Emeritus of Psychiatry and Behavioral Sciences

Sarah Hollingsworth “Holly” Lisanby, MD, is an experienced translational researcher and innovator of neuromodulation technologies to study and treat psychiatric disorders. Dr. Lisanby is Director of the Division of Translational Research at NIMH, which funds research on the discovery of preventions, treatments, and cures for mental illness across the lifespan.  She is Founder and Director of the Noninvasive Neuromodulation Unit in the NIMH Intramural Research Program, a multi-disciplinary clinical research program specializing in the innovation of new brain stimulation tools to measure and modulate neuroplasticity to improve mental health.  Dr. Lisanby is former Chair of the Duke Department of Psychiatry & Behavioral Sciences, and JP Gibbons Endowed Professor at Duke University.  She founded and directed both the Duke and the Columbia University Divisions of Brain Stimulation, where she built interdisciplinary research programs specializing in the convergence of Psychiatry, Neuroscience and Engineering. She co-led the NIH BRAIN Initiative Team focused on large-scale neural recording and modulation devices. Dr. Lisanby has been principal investigator on a series of federally funded grants on the development of novel neuromodulation technologies, including the rational design of magnetic and electrical seizure therapies.  Her team pioneered magnetic seizure therapy (MST) as a novel depression treatment from the stages of animal testing, first-in-human, and international clinical trials.  She led a series of studies involving transcranial magnetic stimulation, electroconvulsive therapy (ECT), MST, vagus nerve stimulation, and deep brain stimulation. She has received numerous international recognitions, including the Max Hamilton Memorial Prize of the Collegium Internationale Neuro-Psychopharmacologicum, the Gerald Klerman Award from the National Depression and Manic Depression Association, and the Eva King Killam Research Award from the American College of Neuropsychopharmacology.  She has been a member of the NIMH Board of Scientific Counselors. Dr. Lisanby served on the FDA Neurological Devices Advisory Panel and has held key leadership positions with numerous professional associations, including serving as President for the Association for Convulsive Therapy/International Society of Neurostimulation, and the International Society for Transcranial Stimulation, and Chair of the American Psychiatric Association Task Force to Revise the Practice on ECT. 


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