Tuesday, April 09, 2024

Electroconvulsive therapy (ECT) shown to reduce severity of certain mental illnesses

EUROPEAN PSYCHIATRIC ASSOCIATION

Researchers have found that Electroconvulsive Therapy (ECT), where an electric current is passed through the brain, can reduce the severity of mental illnesses.

ECT is a safe and effective treatment for some mental illnesses including severe/psychotic depression, postnatal psychosis and mania.[1],[2] Patients are placed under general anaesthetic and the brain is stimulated with short electric pulses.[3] This causes a brief seizure which lasts for less than two minutes.[3]

The use of ECT across Scotland was assessed over an 11-year period from 2009 to 2019 using data from the Scottish Electroconvulsive Therapy (ECT) Audit Network (SEAN). The Scotland-wide naturalistic study assessed the efficacy and side effects of ECT across a range of common mental illnesses such as depression, bipolar depression, schizophrenia, and mania.

Key findings from the study include:

ECT was shown to be effective in reducing illness severity, as measured by Clinical Global Impression Scale (CGI-S). CGI-S is a validated clinician administered assessment tool which measures illness severity.
2,920 ECT episodes had CGI-S scores recorded for patients before and after treatment. The mean CGI-S score prior to treatment indicated marked illness severity (5.03 95% CI 4.99-5.07), whilst after treatment, the mean CGI-S score was reduced to 2.07, (95% CI 2.03-2.11) indicating a reduction to borderline illness severity.
The study also assessed side effects of ECT. Anaesthetic complications and prolonged seizures were rare, occurring in <1% of treatment episodes. Cardiovascular complications were reported in 2.2%. Nausea was reported in 7.2% and muscle aches in 12%. Confusion was reported in 19% and cognitive side effects in 26.2%.

Dr Julie Langan Martin, Senior Clinical Lecturer in Psychiatry, Director of Education at the University of Glasgow, Scotland, said “Our findings from this large naturalistic study across Scotland from over an 11-year period reinforce the widely held, but nonetheless underexplored view, that ECT is both a safe and effective treatment when delivered to appropriate groups of people with severe mental illness. Monitoring of side effects, especially cognitive side effects should be undertaken carefully and rigorously in all patients receiving ECT.”

“This study on ECT presents compelling evidence of its effectiveness in reducing the severity of mental illnesses, with major side effects found to be rare. It challenges common misconceptions and stigmas associated with ECT, providing valuable insights that can reshape public perceptions and stimulate informed discussions among healthcare professionals,” said Dr Julian Beezhold, Secretary General of the European Psychiatric Association.

The European Congress of Psychiatry takes place from 6-9 April 2024 in Budapest, Hungary, and represents Europe’s largest congress dedicated to psychiatry, with over 4000 participants: epa-congress.org.

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Notes to editors

Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes (O0100)

Introduction: Despite its apparent efficacy in the treatment of a range of psychiatric disorders, electroconvulsive therapy (ECT) is viewed by some as a contentious treatment. Although most clinicians and researchers consider ECT a safe and effective treatment, there are ongoing and significantly publicised concerns about potential side effects.

Objectives: To explore use of ECT across Scotland in a large naturalistic clinical sample across an 11-year period from 2009 to 2019. To consider the efficacy and side effects of ECT for a range of common psychiatric disorders including, depression, bipolar depression, schizophrenia, and mania.

Methods: Using data from the Scottish Electroconvulsive Therapy (ECT) Accreditation Network (SEAN), information was collected for all adults who had received ECT. Variables included age, sex, Scottish Index of Multiple Deprivation (SIMD) quintile, International Classification of Diseases, Tenth Edition (ICD-10) diagnosis, indication for ECT, Mental Health Act status, consent status, entry and exit Montgomery-Asberg Depression Rating Scores (MADRS), entry and exit Clinical Global Index Severity CGI-S) scores and reported side effects. Side effects were recorded as present if the side effect was reported at any point during the episode of treatment.

Results: 4826 ECT episodes were recorded. The majority of episodes were in women (68.4%, n=3,301). Average age at treatment onset was 58.52 years. Males were slightly younger (m=58.24 years vs f= 58.65 years, p= 0.20). Mean number of treatments/episode was 9.59 (95% CI 9.32 – 9.85). Mean treatment dose delivered was 277.75mC (95%CI 272.88 – 282.63mC).

2920 episodes of treatment had CGI-S entry and exit recorded. At entry, mean CGI-S indicated marked illness (5.03 95% CI 4.99-5.07). Recipients with schizophrenia had the highest CGI-S score (5.45 95% CI 5.21-5.60), followed by those with post-partum disorders (5.38, 95% CI 4.61-6.14). At exit, mean CGI scores indicated borderline illness (2.07, 95% CI 2.03-2.11), recipients diagnosed with mixed affective state had the lowest CGI-S score (1.72, 95% CI 0.99-2.47) followed by those with schizoaffective disorder (2.01, 95% CI 1.76-2.42).

Anaesthetic complications (n=34) and prolonged seizures (n=38) were rare, occurring in <1% of treatment episodes. Cardiovascular complications were reported in 2.2% (n= 102). Nausea was reported in 7.2% (n= 334) and muscle aches in 12% (n=560). Confusion was reported in 19% (n=879) and cognitive side effects were reported in 26.2% (n=1212). One third of treatment episodes reported confusion or cognitive side effects (33.1%, n=1545).

Conclusions: From this large naturalistic clinical sample, ECT appears to be effective in improving illness severity as measured by CGI-S score. While some side effects (such as prolonged seizures and cardiovascular complications) were rare, others (such as confusion or cognitive side effects) were relatively common.

Disclosure of interest: None declared.

About the European Psychiatric Association

With active individual members in as many as 88 countries and 44 National Psychiatric Association Members who represent more than 78,000 European psychiatrists, the European Psychiatric Association is the main association representing psychiatry in Europe. The EPA’s activities address the interests of psychiatrists in academia, research and practice throughout all stages of career development. The EPA deals with psychiatry and its related disciplines and focuses on the improvement of care for the mentally ill as well as on the development of professional excellence. More information: https://www.europsy.net/

References

[1] Park MJ, Kim H, Kim EJ, Yook V, Chung IW, Lee SM, Jeon HJ. Recent Updates on Electro-Convulsive Therapy in Patients with Depression. Psychiatry Investig. 2021 Jan;18(1):1-10. doi: 10.30773/pi.2020.0350. Epub 2021 Jan 19. PMID: 33321557; PMCID: PMC7897863.

[2] Elias A, Thomas N, Sackeim HA. Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience. Am J Psychiatry. 2021 Mar 1;178(3):229-239. doi: 10.1176/appi.ajp.2020.20030238. Epub 2020 Nov 10. PMID: 33167675.

[3] Electroconvulsive therapy (ECT). Royal College of Psychiatrists. Available at: www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect (Accessed: February 2024).

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

Avoidance, confusion, solitude: whales react to rising noise pollution

UNIVERSITY OF MELBOURNE

Animation - whale migration (avoidance) — VIDEO:
THIS IS WHALE MIGRATION IN A FUTURE OCEAN SOUNDSCAPE, WHERE THE MAJOR CONTRIBUTION TO UNDERWATER NOISE IS FROM SHIPPING ACTIVITY. HERE THIS ACTIVITY IS CREATING REGIONS THAT WHALES WANT TO AVOID DUE TO THE HIGH LEVELS OF NOISE. WE CAN SEE THAT THE WHALES TEND TO BE LOCATED IN REGIONS OF LOWER NOISE (DARKER BLUE), AND END UP TRAPPED BEHIND A WALL OF NOISE AT THE END OF THE SIMULATION. ANIMATION: SUPPLIED BY DR STUART JOHNSTON
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CREDIT: DR STUART JOHNSTON, UNIVERSITY OF MELBOURNE

Researchers from the University of Melbourne and Politecnico di Torino report that shipping, sonar, exploration, and offshore construction are interfering with the whale songs and other acoustic communication many whales rely on to broadcast information to each other during migration.   

University of Melbourne mathematician Dr Stuart Johnston, who co-authored the paper published in Movement Ecology, said the simulation study suggests the current soundscape for whales – compared to pre-industrial conditions – might be causing a three-to-four-day delay in migration arrivals, representing an extra 20 per cent in travel time. If noise levels continue to rise, the model suggests some whales may never reach their destination, due to either drifting off course or avoiding loud noises blocking their route.

“We found that human-made noise is having three main effects on migration: it’s reducing the ability to hear acoustic communication like songs among whales, it’s generating an avoidance response when sufficiently loud, and it’s lowering the detection of environmental cues that some whales use to inform navigation,” Dr Johnston said. 

“Baleen [toothless] whales such as minke whales, humpback whales and blue whales are renowned for their extraordinary acoustic communication, which can cross hundreds of kilometres, because sound travels a long way in water. We know noise pollution affects whale behaviour, reducing their communication range, and increasing their stress levels, which has been linked to strandings. But it hasn’t been known to what extent – that’s what we wanted to explore,” he said.  

Using data of ships in the North Sea and their noise, researchers constructed sound maps and a sophisticated model that simulates how noise might affect whale migration. The model, which simulated the behaviour of 100 minke whales, also predicted the effect of future noise increases such as shipping, naval sonar operations, seismic exploration by gas industries, and offshore construction on whale migration.

“Whales rely on sounds from each other and from their environment to navigate through the vast oceans. Noise from sonar systems, shipping and construction is reducing the detection of environmental cues that may tell whales where to go. For example, icebergs clashing under the sea makes a very loud noise, which could inform whales what direction to move towards to find cooler polar waters. If they can no longer detect the sound, they are losing a key piece of information to help them navigate,” Dr Johnston said. 

“We also looked at what makes whales avoid a migration route. If there’s loud drilling happening outside a meeting room, you wouldn’t want to use that room. Similarly, whales will avoid an uncomfortable environment when there is significant noise, and this could lead to increased journey time or even failure to arrive.” 

Whales tend to migrate to cooler waters in summer and warmer waters in winter, following food sources and to breed and give birth where conditions are best for their calves. Dr Johnston said extra migration time due to noise interference would leave whales with less time and energy for breeding and searching for food, as well as creating the need to replenish the lost energy. 

“These incredible animals journey up to 10,000km each year during migration – it’s a huge investment of time and energy. We must find a solution within the shipping and construction industries that don’t come at the cost of whale activity and breeding,” Dr Johnston said. 

“The traffic in our oceans is predicted to go up by at least another 50 per cent by 2050. We need to make informed decisions about our continued activities in the ocean, and it’s important that these decisions are driven by science,” he said.

The research was co-funded by the Australian Research Council and the MIUR-Dipartimento di Eccellenza.

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Animation - whale migration (C [VIDEO]

Animation - whale migration (s [VIDEO] |

Animation - whale migration (p [VIDEO]

JOURNAL

Movement Ecology

ARTICLE TITLE

Avoidance, confusion or solitude? Modelling how noise pollution affects whale migration

Peregrine falcons expose lasting harms of flame retardant use

GREEN SCIENCE POLICY INSTITUTE

Map of peregrine falcon egg sampling sites across North America — IMAGE:
MAP OF PEREGRINE FALCON EGG SAMPLING SITES ACROSS NORTH AMERICA

view more
CREDIT: WU ET AL. (2024)

Peregrine falcon populations across North America are heavily contaminated with harmful flame retardants–including those that have been phased out for years–according to a new study published in Environmental Science & Technology. Flame retardants are chemicals added to furniture, electronics, and other everyday products to meet flammability standards, though they often do not work as intended. They also migrate out of products they are added to and end up in wildlife and people and many are linked to serious health and environmental harms.

“Our results expose the long-term consequences of adding flame retardants to consumer products,” said leading author Da Chen, a scientist at Jinan University. “As globally distributed apex predators, the peregrine falcon is the ideal canary in the coal mine for monitoring flame retardant pollution in the environment. Flame retardants phased out a decade ago are still accumulating in these birds and into their eggs, which indicates that the threats of these chemicals to wildlife and people can far outlast their production.”

Researchers measured concentrations of a suite of old and newer halogenated flame retardants in peregrine falcon eggs collected from multiple locations in the U.S. (New Jersey, California, Chesapeake Bay, and Pennsylvania) and Canada (Ontario, Quebec, British Columbia, and New Brunswick) between 1984 and 2016. It is the largest investigation to date of flame retardants in peregrine falcons in terms of both time and space.

In these falcons, polybrominated diphenyl ethers (PBDEs) were the most commonly detected flame retardants and had the highest concentrations. Despite the fact that production of the major PentaBDE and DecaBDE mixtures ceased in North America by the end of 2004 and 2013, respectively, PBDE concentrations did not decline over the study period in most regions. Similarly, although hexabromocyclododecane (HBCDD) has been phased out from the North American market since 2012, it was detected in the majority of eggs and concentrations did not decrease over the study period in any of the regions.

Continued exposure to old flame retardants comes from the release of these chemicals from in-use and discarded products produced before the phase-outs. Further, many flame retardants released from products accumulate up marine and terrestrial food chains over time, making apex predators like peregrine falcons more likely to build up high concentrations in their tissues. The flame retardants also end up in their eggs through maternal transfer.

Concentrations of the unregulated halogenated flame retardants measured by the research team stayed constant or declined throughout the study period, suggesting that non-halogenated flame retardants and polymeric flame retardants are more popular as replacements. Unfortunately, those too are increasingly linked to human and wildlife health harms.

Peregrine falcons are far from the only species polluted by flame retardants. Last year the Green Science Policy Institute released a map of more than 150 species of wild animals across every continent contaminated with old and new flame retardant chemicals. Polluted wildlife included killer whales, red pandas, chimpanzees and other endangered species.

JOURNAL

Environmental Science & Technology

DOI

10.1021/acs.est.3c10907

ARTICLE TITLE

Exposure of Peregrine Falcons to Halogenated Flame Retardants: A 30 Year Retrospective Biomonitoring Study across North America

ARTICLE PUBLICATION DATE

9-Apr-2024

Military veterans say extremism was preceded by negative service experiences

Veterans also often faced difficulties transitioning to civilian life

RAND CORPORATION

Interviews with military veterans who expressed support for extremist groups or related beliefs on a prior survey show that many experienced a significant negative event during their military service, according to a new RAND report.

Researchers found that these veterans also often faced difficulties transitioning to civilian life and sometimes shared their beliefs with a wider social network.

RAND researchers conducted 21 interviews with veterans who had indicated support for one or more extremist groups or related beliefs to understand possible drivers and patterns of extremism among veterans. That support was expressed as a part of a nationally representative survey of nearly 1,000 veterans in the U.S.

Roughly three-quarters of those interviewed reported a negative or traumatic life event while in the military, ranging from interpersonal conflict (often leading to discharge) to combat trauma, as well as physical and sexual abuse.

“The main take-home lesson of our study is the tremendous heterogeneity underlying what may seem like cut and dried answers when they are compiled as a part of a national survey,” said Ryan Andrew Brown, the study’s lead author and a senior social scientist at RAND, a nonprofit research organization.

“It’s important that there be future research that looks to tease out the relative importance of negative experiences in the military, transition stress and other potential risk factors that may help send veterans on the path to radicalization,” Brown said.

Concern that the veteran community is at increased risk of radicalization to violent extremism increased since reports that a significant proportion of the people who attacked the U.S. Capital on Jan. 6, 2021, were currently or had been affiliated with the U.S. military.

Furthermore, research by the National Consortium for the Study of Terrorism and Responses to Terrorism suggests that veterans increasingly are among those known to have committed political, economic, social or religiously motivated criminal acts.

RAND researchers in late 2022 conducted the first nationally representative survey of veterans’ views about extremism and extremist groups. The survey found that veterans expressed support for extremist groups and extremist ideals at rates similar to or somewhat lower than the U.S. public in general.

To better understand those motivations, researchers invited a group of survey participants who espoused support for extremist ideologies to take part in structured video interviews. The study is the first to use systematic qualitative methods to examine the potential pathways to extremism among veterans.

Participants offered a wide mix of responses when asked whether they supported extremist groups or causes that they had affirmed during the original survey.

Virtually all participants who had supported the Proud Boys now denied such support, while nearly all the participants who affirmed support during the survey for the Great Replacement theory believed that the Democratic Party was attempting to purchase votes through lax immigration policies.

Many participants affirmed support for political violence, though the responses suggested none were intent on acting on such support in the near future.

“While the number of participants who were willing to use the language of violence to discuss political change may be a harbinger of future strife, none seemed poised to act on violence in the near term,” said Todd C. Helmus, a study coauthor and a RAND senior behavioral scientist. “All of this provides a caution to any straightforward interpretation of survey data on extremist beliefs and support for extremist groups, whether with veterans or other groups. Survey responses alone may not be a predictor of future actions.”

Twelve respondents described difficulties with the transition from military to civilian life, including missing the pace and camaraderie of military life, having no resources, and not knowing where to turn, struggling with PTSD or depression, and even experiencing homelessness and becoming imprisoned.

In addition, 12 of those interviewed provided narratives of life experiences that helped push them toward more-extreme political viewpoints, including specific events in U.S. or international politics and history, experiences during deployment or work settings, and life disruptions during the COVID-19 pandemic.

Support for the study was provided by Daniel J. Epstein through the Epstein Family Foundation, which established the RAND Epstein Family Veterans Policy Research Institute in 2021, and the Pritzker Military Foundation on behalf of the Pritzker Military Museum and Library.

The report, “Veteran Narratives of Support for Extremist Groups and Beliefs: Results from Interviews with Members of a Nationally Representative Survey of the U.S. Veteran Community,” is available at www.rand.org. Rajeev Ramchand also co-authored the report.

The RAND Social and Economic Well-Being division seeks to actively improve the health, and social and economic well-being of populations and communities throughout the world.

DOI

10.7249/RRA1071-4