5.      Guidelines, audits and rating scales

Trends in the administration of electroconvulsive therapy in England . (2009). Bickerton D, Worrall A, Chaplin R. Psychiatric Bulletin, 33, 61-63.
This group from the Royal College of Psychiatrists’ research and training unit surveyed the use of ECT over a 3 month period in England in 2006, comparing rates with those published by the Department of Health in 1999 and 2002. Both the number of clinics and the number of patients had declined giving rise to concerns about the availability of training and experience.

Unilateral and bilateral electroconvulsive therapy: what informs Scottish psychiatrists’ choices? (2009). Kevin Brown. Psychiatric Bulletin, 33, 95-98
The UK ECT Review Group concluded that on the evidence available in 2003 that bilateral ECT was slightly more efficacious than unilateral but resulted in more cognitive side effects. More recent studies have suggested that unilateral ECT given at doses higher than previously is equally as effective. This survey showed that the majority (79%) of Scottish psychiatrists still prefer bilateral electrode placement but that a significant minority (18%) were now using unilateral ECT to try and minimise cognitive side-effects. The author postulates that data from the Scottish ECT Accreditation Network (SEAN) could be used to gather sufficient information to inform practice based on evidence. 

ECT practice and psychiatrists’ attitudes towards ECT in the Chuvash Republic of the Russian federation . (2009). Golenkov A, Ungvari GS, Gazdag G. JeuroPsych. 2009.02.011.
This survey describes the practice of ECT in the Chuvash Republic since becoming available in 1997. The rate of use has doubled from a very low base line to 8 per 100,000 population and most people treated have a diagnosis of schizophrenia. Many psychiatrists held negative attitudes and more than half of those poled believed that ECT was painful and caused brain damage. Reasons for this could be attributed to out of date educational material at Russian medical schools.

Electroconvulsive therapy practice in Poland . (March 2009). Gazdag et al. J of ECT; 25:34-38.
This article contains a table comparing rates of ECT use and concludes that use in Poland is low compared to others. However ECT is mainly given for affective disorders using the bitemporal electrode position, twice or three times per week. There is little standardisation of treatment protocols but all patients are anaesthetised.

Modified and unmodified electroconvulsive therapy. A comparison of attitudes between psychiatrists in Beijing and Hong Kong . (June 2009) Leung C et al. J of ECT; 25:80-84.
Unmodified ECT is still being used in China where 56% of respondents to a survey questionnaire said that they preferred this form of treatment. Patient choice, financial status and safety considerations were the main factors affecting this decision.

6.      Attitudes and opinions

Differences between subjective and objective assessments of the utility of electroconvulsive therapy in patients with bipolar and unipolar depression. (2009). Hallam KT, Smith DI, Berk M. J. Affect. Disord. 112, 212-218.
This was a case note review of787 records. The authors report that there was a significant improvement in clinical global impression and HoNOS scores in both groups but that there was a poorer subjective improvement with ECT in the bipolar compared to the unipolar illness group.

A patients journey: Electroconvulsive therapy. (2009). Webber M. BMJ;338, 169-170.
An article from a husband about his wife’s treatment for recurrent depression and  successful ECT describing the thoughts, feelings and  processes that the couple went through to reach their decisions to continue with maintenance treatment.

Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public. (December 2008) McFarquhar T, Thompson J. J of ECT;24:244-253.
This survey of 70 medical students and 70 members of the public revealed continued fears with respect to ECT based on lack of information on the process and misconceptions gleaned from the media. The aim of educational interventions should be to separate the reality of ECT from the media’s portrayal.

Examination of the effect of education about electroconvulsive therapy on nursing practice and patient satisfaction. (December 2008). Arkan B, Ustun B. J of ECT; 24:254-259
Nor surprisingly education given to nurses was shown to improves practice with the knock on effect of increased patient satisfaction as measured by a global rating scale. The nurse plays a vital role in the care of the patient undergoing ECT.

7.      Anaesthesia for ECT

Medical Evaluation of patients undergoing electroconvulsive therapy. (2009). Tess AV, Smetana Gerald W. New England Journal of Medicine, 360, 1437-1444.
The authors describe cardiac risk in anaesthesia for ECT as analogous to a low risk procedure as defined by the American College of Cardiology and the American Heart Association. They give recommendations for pre-ECT workup and management of inter-current illness.

Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy. (June 2009)Bauer J et al. J of ECT; 25: 85-90.
In the 62 patients studied propofol significantly decreased seizure duration without affecting clinical outcome. Seizure threshold had been measured and patients whose anaesthesia was induced by propofol required higher doses of electricity. However the groups were not matched for age and differences in other variables like the number of treatments required and cognitive side effects did not reach significance.

8.      Side-effects of antidepressants

9.      Mechanisms of ECT action

Antidepressant electroconvulsive therapy: mechanism of action, recent advances and limitations. (2009). Merkl A, Heuser I, Bajbouj M. Experimental Neurology. 219, 20-26.
The authors acknowledge that ECT has stood the test of time even with the introduction of other physical therapies. The article contains sections on history and reviews of possible mechanism of action, efficacy data and adverse effects as well as anaesthetic concerns and possible interactions with prescribed medication.

Neurophysiological mechanisms of electroconvulsive therapy for depression. (2009). Nobuo Kato. Neuroscience Research. 64, 3-11.
A study of the Homer 1a scaffold protein present in neural circuits and induced by electroconvulsive stimulation (ECS). The resultant effect is a reduction in neuronal excitability and presumed modification of the synaptic plasticity. The author postulates that this may tie in with the GABAergic dysfunction hypothesis of depression which features increased excitability of the cerebral cortex in depressed patients.

Chronic treatment with electroconvulsive shock may modulate the immune function of macrophages. (Decemebr 2008) Roman A, Nawrat D, Nalepa I. J of ECT; 24;260-267.The theory being postulated is that an increased number or increased activity of macrophages and their metabolites compared to normal response in the immune system results in depressive illness. Repeated electroconvulsive stimulation (ECS) was shown to change the biological properties of macrophages, reducing their tendency to cause inflammation without damaging their strucure.

10.  Other PhysicalTherapies

Focal electrically administered therapy. Device parameter effects on stimulus perception in humans. (June 2009) Borckardt et al. J of ECT; 25:91-98. A description of this type of transcranial magnetic stimulation, which is reported to be capable of more focal modulation of cerebral activity. The stimulation area was the left forehead and differing experiences of pain and discomfort were recorded  in relation to intensity and type of current used in an attempt to provide a model for accessing scalp pain in relation to non convulsive treatments.