Electroconvulsive therapy in chronic psychotic patients: the interface between perceived stress, anxiety and depression and clinical outcome

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Abstracts / Brain Stimulation 10 (2017) 346e540

Introduction: In 1985, Jacob Zbara patented an invention for a surgically implanted, programmable device that would deliver intermittent or “on demand” electrical stimulation to cranial nerve X to generate interference with abnormal neural discharge patterns or cancel neural signals associated with seizures. Cyberonics’ VNS device received regulatory approval for seizure disorders in Europe (1994) and USA (1997); US-FDA approved it for adjunctive treatment of medication-resistant depression in 2005. VNS has also been investigated as potential therapy for a broad array of chronic medical conditions including cardiac disease, obesity, headache, inflammation, asthma, pain, multiple sclerosis, and dementia. Recent work has examined noninvasive modalities for VNS, resulting in regulatory approval in some countries of external/transcutaneous VNS medical devices or direct-to-consumer devices to promote general wellness. Methods: Review results from randomized clinical controlled trials to highlight the strength of scientific evidence supporting VNS for treating different disorders. Review proposed mechanisms of action and data demonstrating biological correlates of VNS. Contrast safety/efficacy data from newer studies of noninvasive VNS with data from implanted VNS devices. Results/Discussion: There is good evidence of VNS efficacy for reducing seizure frequency and improving mood in epilepsy patients. Evidence for VNS to treat major depressive episodes is generally positive but not based on randomized controlled trials. VNS data for other conditions remains preliminary, though demonstration of down-regulation of inflammatory cytokine release and modulation of autonomic function highlights considerable therapeutic potential. Across different target diseases and device types, optimal stimulation parameters are not known. Studies using transcutaneous VNS have generated promising preliminary results with outcomes comparable to those from implanted VNS systems. Devices that noninvasively stimulate the vagus nerve have facilitated research examining acute and chronic effects in a variety of populations; ongoing and future work will likely determine the role of VNS in routine patient care. Keywords: Clinical trials, depression, VNS, implanted device [0660] ELECTROCONVULSIVE THERAPY IN CHRONIC PSYCHOTIC PATIENTS: THE INTERFACE BETWEEN PERCEIVED STRESS, ANXIETY AND DEPRESSION AND CLINICAL OUTCOME D. Mabunda*1, 2, A. Palha 4, J. Mari 5, M. Morais 1, A. Pala 3, J. Mota 6, M. Oquendo 3, J. Bessa 1. 1 University of Minho, Portugal; 2 University Eduardo Mondlane, Mozambique; 3 Columbia University, USA; 4 University of Porto,

~o Paulo, Brazil; Portugal; 5 University Federal of Sa Lemos, Portugal

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~es Hospital Magalha

Objective: This study aimed to investigate the effects of Electroconvulsive therapy (ECT) on positive and negative symptoms in chronic psychotic patients using the Positive and Negative Symptom Scale (PANSS); investigate the effect of ECT on perceived stress, anxiety and depression using the Perceived Stress Scale (PSS) scale and the Hospital Anxiety and Depression Scale (HADS); and investigate the relationship between salivary cortisol levels and clinical response to ECT. Methods: Thirty-six chronically psychotic inpatients were included in the study from October 2013 to April 2014. Salivary cortisol was measured at 09:00 am before the first ECT and one week after a course of ECT. Positive and negative symptoms were evaluated before and one week after ECT by using the PANSS Perceived stress and anxiety and depression were measured before and one week after ECT by using the PSS and the HADS. Results: There was a significant decrease in patients’ PANSS scores after a course of ECT, from 120.5 ± 17.8 to 55.97 ± 14.4 t(35)¼ 24.92, p<0.001. Paired T-test analysis revealed a significant global effect of ECT on the PSS scores t(35)¼12.07 p<0.001. Paired T-test analysis revealed a significant global effect of ECTon the HADS scores t(35)¼ 11.215 p<0.001. There was a decrease in cortisol levels between the baseline treatment and one week after the last ECT, from 0.86 mg/dl ± 0.53 to 0.58 ± 0.27. However, none of the therapeutic effects were associated with changes in cortisol levels after treatment. Discussion: These results demonstrate that ECT is an effective and valuable therapeutic option that could be useful as an adjunctive therapy in refractory chronically ill psychotic patients. Its positive effects on not only decreasing psychotic and depressive symptoms but in decreasing stress translate to improved outcomes for these patients in a variety of domains. Keywords: Electrocinvulsive therapy, Chronic, psychosis, cortisol [0661] QUANTITATIVE EVALUATION OF ANTIEPILEPTOGENIC EFFECTS OF LFS EITHER BEFORE OR AFTER KINDLING STIMULATION USING SPECTRAL POWER ANALYSIS OF EXTRACELLULAR EEG IN RATS M. Jalilifar, A. Yadollahpour*, A.A. Moazedi, Z. Ghotbeddin. Ahvaz Jundishapur University of Medical Sciences, Iran Purpose: Low Frequency Stimulation (LFS) is an alternative for treatment of epilepsy. EEG extracted measures are reliable markers to study the hemodynamic and physiological effects of LFS on kindling-induced epileptogenesis because of their high temporal resolution. Therefore, the

Figure 1. Contribution of each sub bands in different groups. *: significant difference compared with kindle group (P <0.05).Ă