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Editor's Roundup for Issue #1 of 2022

Editor's Roundup for Issue #1 of 2022 EDITORIAL Electroconvulsive Therapy's Impact on Suicidal Behavior, Decision Making, and the Cardiovascular System William V. McCall, MD, MS lectroconvulsive therapy (ECT) is recognized as a powerful treatment for severe mood and psychotic E disorders, and the successful treatment of severe psychiatric disorders would be expected to reduce the risk of suicide. Most of the evidence for an antisuicide effect for ECT is derived from clinical trials that do not always translate to “real-world” outcomes. In this issue, the article by Salagre et al capitalizes upon a large Danish register to describe the role of ECT in reducing rates of suicidal behavior. Suicidal behavior is relatively uncommon, thus requiring large samples (approximately 1000 persons) to detect an effect. Even larger studies would be required (estimated to be as high as 20,000) to show favorable ef- fects on suicide death rates. The effects of ECT upon cognition are complex. Although it is widely acknowledged that ECT has short-term effects upon anterograde learning, the effects upon decision-making capacity are not as well described. Concerns about effects on decision-making capacity lead the ECT practitioner to advise pa- tients to avoid major life decisions during and immediately after ECT (ie, buying and selling valuable property, entering into contracts, etc) The article by Loughran et al is reassuring in that it shows favor- able effects on some aspects of decision making, with other facets of decision making unchanged. The authors acknowledge that the patients included in their report did not represent the most ill among ECT patients (ie, persons with catatonic stupor, delirious mania, etc) and hence even larger favorable effects would be expected when ECT restores mental health to this most ill group. The rapid clinical changes seen with ECT lead to interesting phenomenon, such as antidepressant effects observed before improvement in mood reported by patients. Paralleling these discrepancies in observer-rated versus subjective mood, in the present issue, Hammershøj et al describe discrepancies be- tween subjective versus objective cognitive function in ECT patients. The authors find that patients' report of cognition was more negative than could be substantiated by objective tests. The authors acknowledge that a major limitation of their methods was the omission of tests of autobiographical memory. Advances in ECT technique such as modifications of electrode placement and the use of ultrabrief pulse stimuli have markedly improved the cognitive adverse effects with ECT and have allowed consid- eration of the application of ECT to patients that previously would have been overlooked as candidates for ECT. For example, Hermida et al describe their favorable experience with the application of ECT in a case series of patients with neurobehavioral complications of Lewy body dementia. Also in this issue, Hermida et al offer an updated review on the effects of ECT on the cardiovascular system, concluding that ECT can be safely applied in the context of most concurrent cardiovascular conditions. REFERENCES 1. Salagre E, Rohde C, Østergaard SD. Self-harm and suicide attempts preceding and following electroconvulsive therapy: a population-based study. JECT.2022;38:13–23. 2. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry.2003;60:82–91. 3. Loughran OFM, Dud I, Galligan T, et al. Decision-making capacity for treatment following electroconvulsive therapy for depression. JECT.2022;38:24–29. 4. Sayer N, Sackeim H, Moeller J, et al. The relations between observer-rating and self-report of depressive symptomatology. Psychol Assess. 1993;5:350–360. 5. Hammershøj LG, Petersen JZ, Jensen HM, et al. Cognitive adverse effects of electroconvulsive therapy: a discrepancy between subjective and objective measures? JECT. 2022;38:30–38. 6. Hermida AP, Sterina E, Schwab PP, et al. Ultrabrief right unilateral electroconvulsive therapy for the treatment of the neuropsychiatric symptoms of dementia with Lewy bodies. JECT. 2022;38;39–44. 7. Hermida AP, Mohsin M, Marques Pinheiro AP, et al. The cardiovascular side effects of electroconvulsive therapy and their management. JECT. 2022;38:2–9. From the Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA. Received for publication December 21, 2021; accepted December 21, 2021. Reprints: William V. McCall, MD, MS, Department of Psychiatry and Health Behavior, Medical College of Georgia, 997 St Sebastian Way, Augusta, GA 30912 (e‐mail: wmccall@augusta.edu). The author has no conflict of interest or financial disclosures to report. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/YCT.0000000000000829 Journal of ECT � Volume 38, Number 1, March 2022 www.ectjournal.com 1 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Journal of ECT Wolters Kluwer Health

Editor's Roundup for Issue #1 of 2022

McCall, William V.
The Journal of ECT , Volume 38 (1) – Mar 4, 2022
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Wolters Kluwer Health
Copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1095-0680
eISSN
1533-4112
DOI
10.1097/yct.0000000000000829
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Abstract

EDITORIAL Electroconvulsive Therapy's Impact on Suicidal Behavior, Decision Making, and the Cardiovascular System William V. McCall, MD, MS lectroconvulsive therapy (ECT) is recognized as a powerful treatment for severe mood and psychotic E disorders, and the successful treatment of severe psychiatric disorders would be expected to reduce the risk of suicide. Most of the evidence for an antisuicide effect for ECT is derived from clinical trials that do not always translate to “real-world” outcomes. In this issue, the article by Salagre et al capitalizes upon a large Danish register to describe the role of ECT in reducing rates of suicidal behavior. Suicidal behavior is relatively uncommon, thus requiring large samples (approximately 1000 persons) to detect an effect. Even larger studies would be required (estimated to be as high as 20,000) to show favorable ef- fects on suicide death rates. The effects of ECT upon cognition are complex. Although it is widely acknowledged that ECT has short-term effects upon anterograde learning, the effects upon decision-making capacity are not as well described. Concerns about effects on decision-making capacity lead the ECT practitioner to advise pa- tients to avoid major life decisions during and immediately after ECT (ie, buying and selling valuable property, entering into contracts, etc) The article by Loughran et al is reassuring in that it shows favor- able effects on some aspects of decision making, with other facets of decision making unchanged. The authors acknowledge that the patients included in their report did not represent the most ill among ECT patients (ie, persons with catatonic stupor, delirious mania, etc) and hence even larger favorable effects would be expected when ECT restores mental health to this most ill group. The rapid clinical changes seen with ECT lead to interesting phenomenon, such as antidepressant effects observed before improvement in mood reported by patients. Paralleling these discrepancies in observer-rated versus subjective mood, in the present issue, Hammershøj et al describe discrepancies be- tween subjective versus objective cognitive function in ECT patients. The authors find that patients' report of cognition was more negative than could be substantiated by objective tests. The authors acknowledge that a major limitation of their methods was the omission of tests of autobiographical memory. Advances in ECT technique such as modifications of electrode placement and the use of ultrabrief pulse stimuli have markedly improved the cognitive adverse effects with ECT and have allowed consid- eration of the application of ECT to patients that previously would have been overlooked as candidates for ECT. For example, Hermida et al describe their favorable experience with the application of ECT in a case series of patients with neurobehavioral complications of Lewy body dementia. Also in this issue, Hermida et al offer an updated review on the effects of ECT on the cardiovascular system, concluding that ECT can be safely applied in the context of most concurrent cardiovascular conditions. REFERENCES 1. Salagre E, Rohde C, Østergaard SD. Self-harm and suicide attempts preceding and following electroconvulsive therapy: a population-based study. JECT.2022;38:13–23. 2. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry.2003;60:82–91. 3. Loughran OFM, Dud I, Galligan T, et al. Decision-making capacity for treatment following electroconvulsive therapy for depression. JECT.2022;38:24–29. 4. Sayer N, Sackeim H, Moeller J, et al. The relations between observer-rating and self-report of depressive symptomatology. Psychol Assess. 1993;5:350–360. 5. Hammershøj LG, Petersen JZ, Jensen HM, et al. Cognitive adverse effects of electroconvulsive therapy: a discrepancy between subjective and objective measures? JECT. 2022;38:30–38. 6. Hermida AP, Sterina E, Schwab PP, et al. Ultrabrief right unilateral electroconvulsive therapy for the treatment of the neuropsychiatric symptoms of dementia with Lewy bodies. JECT. 2022;38;39–44. 7. Hermida AP, Mohsin M, Marques Pinheiro AP, et al. The cardiovascular side effects of electroconvulsive therapy and their management. JECT. 2022;38:2–9. From the Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA. Received for publication December 21, 2021; accepted December 21, 2021. Reprints: William V. McCall, MD, MS, Department of Psychiatry and Health Behavior, Medical College of Georgia, 997 St Sebastian Way, Augusta, GA 30912 (e‐mail: wmccall@augusta.edu). The author has no conflict of interest or financial disclosures to report. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/YCT.0000000000000829 Journal of ECT � Volume 38, Number 1, March 2022 www.ectjournal.com 1 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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The Journal of ECT – Wolters Kluwer Health

Published: Mar 4, 2022

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