Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression : a systematic review and meta-analysis

Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the "gold standard" treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performedpeer-reviewe

Maintenance Electroconvulsive Therapy in a Patient with Treatment-Resistant Paranoid Schizophrenia and Comorbid Epilepsy

The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT) and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response

Psychiatric admissions in Malta : demographics and diagnoses

Background: The decision to hospitalize a patient exhibiting signs of psychiatric distress is made as a last resort after outpatient management has failed. The rising number of admissions also has an effect on costs burden within the national health system. This audit is set to determine the main psychiatric reasons for admission to hospital in Malta and analyze demographics, source of referrals and mental health act status whilst comparing such result to those abroad. --- Methods: Data from admissions between the 15th October 2018 till the 1st March 2019 was collected, using a recently established electronic database system. Details including; age, sex, nationality, type of admission (new case versus readmission), mental health act status and reason for admission were collected. --- Results: 300 patients admitted to Mount Carmel hospital during the stated period. Roughly 2 male patient were admitted for every female. 75.3% of the cohort were of Maltese nationality. The majority of foreign patient were European, 14%, followed by African, 8.3%, Asian and American. The most common sources of referrals were casualty at 40%, followed by those from general practitioners at 26.7%. --- Conclusion: Reasons for admission were most commonly, substance abuse(15.3%), depression (15%) and acute psychosis (13.3%), following similar trends across Europe. Methods to decrease unnecessary referrals include better training of emergency doctors and general practitioners. Additionally, recent implementation of a 24 hour on call crisis service should provide better acute management of patients and help to prevent saturation of inpatients with cases that can handled in the community.peer-reviewe

Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis. Depress Res Treat 2014;2014:135049

Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This metaanalysis will therefore compare the "gold standard" treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performed

Maintenance Electroconvulsive Therapy in a Patient with Treatment-Resistant Paranoid Schizophrenia and Comorbid Epilepsy

The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT) and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response