Browsing by Subject "Electroconvulsive Therapy"
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Item The Effectiveness of Electroconvulsive Therapy for Major Depressive Disorder According to Patient Self-Report(2013-08-28) Metoyer, Melissa C.; Chiu, Chung-Yi; McClintock, Shawn Michael; Brewer-Mixon, KarenBACKGROUND: Major depressive disorder (MDD) is a common, typically recurrent, often chronic, and disabling disorder affecting approximately 14 million adults in the United States (US) each year. Electroconvulsive therapy (ECT) is a neurostimulation therapeutic intervention that is highly effective and most often used to treat certain psychiatric conditions, in particular MDD. Despite the proven effectiveness of using ECT to treat MDD there have been no other studies that have addressed methods of assessing the severity of depressive symptoms using patient self report instrument. SUBJECTS: Ninety-four participants, comprised of 58 (61.7%) females and 36 (38.3%) males who ranged from 20 to 85 years of age (M=51.76, SD=15.19) participated in this study. All subjects had a diagnosis of MDD and were treated with ECT over an average of 11 sessions on an inpatient or outpatient basis at the UT Southwestern Medical Center Zale Lipshy University Hospital (ZLUH, Dallas, TX). METHOD: The 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) measure was used to determine the effectiveness of ECT in treating MDD. Data was acquired at baseline and after the end of the acute ECT treatment course. Paired t-tests were applied to determine if there were significant depression improvements and effect size (r) was calculated to determine the effect size between pre- and post- treatment scores on the Quick Inventory of Depressive Symptomatology-Self Report₁₆ total score and each domain score. RESULTS: The overall baseline average total score of QIDS-SR₁₆ (M=18, SD=4.34) for the study sample was in the severe range. After completion of the acute ECT course, the QIDS-SR₁₆ total score on average significantly decreased to the mild range (M=7.18, SD=4.74). The overall total QIDS-SR₁₆ score had a large effect size (E.S.) (E.S. (r) =.91; t = 20.98, df = 93, p =. 000). Consistent with this, the domain scores also had a large effect size. The E.S. (r)-scores from greatest to the least for the domain scores are mood (E.S. (r) =.88; t = 17.58, df = 93, p =.000), suicide (E.S. (r) =.83; t = 9.19, df = 93, p =.000), fatigue (E.S. (r) =.78; t = 12.13, df = 93, p=.000), self-outlook (E.S. (r) =.75; t = 11.07, df = 93, p =.000), concentration (E.S. (r) =.72; t = 10.03, df = 93, p =.000), sleep (E.S. (r) =.68; t = 8.96, df = 93, p =.000), loss of interest (E.S. (r) =.68; t = 14.58, df = 93, p = .000), psychomotor(E.S. (r) =.65; t = 8.35, df = 93, p = .000), and appetite change (E.S. (r) =.62; t = 7.74, df = 93, p = .000). Data revealed few differences between electrode configuration placements. The sad mood and suicide domains resulted in a greater decline in symptom ratings than the remaining seven domains over the course of an acute ECT treatment. DISCUSSION: The findings of the study are consistent with prior research suggesting that ECT is an effective treatment for MDD. Specifically, depressive symptoms as rated by self report showed a significant decrease from baseline to completion of the acute ECT course. The data from the QIDS-SR16 revealed an overall marked improvement in total depression severity, and in specific depressive domains including mood, suicidal ideation, energy, self-outlook and concentration/decision making. IMPLICATIONS: The research has some limitations. the present study only recruited patients from one hospital, which may limit the generalizability of the findings. This was a naturalistic study based on a clinical database. There could have been possible comorbidities (both medical and neuropsychiatric) that could have affected outcome. The switch of electrode placement was non-systematic and based on physician judgment and not based on the study’s criteria.Item Neurocognitive Functioning in Severe Depression(2006-12-19) McClintock, Shawn Michael; Cullum, C. MunroResearch has suggested that major depressive disorder can negatively impact neurocognitive functioning. Depression has been implicated in affecting many cognitive domains, including executive function, attention, memory, and psychomotor and processing speed. However, there has been limited examination of the relationship between neurocognitive functioning and depressive characteristics such as depression severity, depressive subtypes, number of depressive episodes, and episode duration. The primary goal of this study was to explore the relationship between neurocognitive functioning and depressive characteristics in severe unipolar major depressive disorder. Baseline socio-demographic, clinical, and neuropsychological information was examined in 145 inpatients enrolled in a large electroconvulsive therapy study (the Consortium for Research in ECT). Results revealed that depression severity was unrelated to global cognitive functioning and executive functioning. However, performance on certain neurocognitive variables accounted for 25% of the variability in the magnitude of depression severity. Various clinical dimensions of depression, including depressive subtype, number of episodes, and episode duration did not show a systematic relationship to neurocognitive functioning. Patients with psychotic depression performed similarly to patients without psychosis, and the ability to predict the presence of psychosis by neuropsychological performance was low. Those with atypical depression performed similarly to patients with typical depression, although patients with atypical depression showed better performance on a measure of verbal memory. No significant differences were found between subjects with multiple versus single episodes of depression, and the number of depressive episodes was unrelated to neurocognitive performance. These data indicate that the depressive characteristics examined were not systematically related to neurocognitive functioning among severely depressed patients in this well characterized and carefully selected sample.