published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Thesis (Ph. D.)--University of Wisconsin--Madison, 1951. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [277]-284).

Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 42-45).

Electroconvulsive therapy (ECT) is a safe and effective treatment of severe depressive illness. Although it has now been used for over five decades, the mechanism of action remains unknown. A major side effect of ECT is a transient disturbance of memory. These factors have limited the acceptability and use of ECT. Detailed examination of the neurobiological effects of ECT may lead not only to the refinement of treatment but also to a better understanding of the disease that ECT treats so effectively. In recent years, many investigations into the neurobiology of memory have focused on an electrophysiological phenomenon known as long-term potentiation (LTP). LTP is an experimentally induced form of synaptic plasticity which can be readily demonstrated in the hippocampus and consititutes a long-lasting increase in synaptic strength. It has been proposed as a candidate mechanism for the neural substrate of learning. The aim of this thesis is to examine the effects of repeated ECS on this form of synaptic plasticity. Electrophysiological experiments demonstrate that repeated, spaced ECS causes a profound enhancement of the dentate gyms field response to stimulation of the perforant path afferent fibres in vivo and reduces the ability of this synaptic pathway to support experimentally induced LTP. A single ECS is not sufficient to produce this effect. Measurement of field potentials in unanaesthetised animals reveals that the increase in EPSP slope developes incrementally over the course reaching a maximum after five seizures. The effect of repeated ECS on synaptic plasticity is long-lasting but ultimately reversible as LTP can be induced, to within control levels, 40 days but not 10 days after the last treatment. The administration of ketamine (an NMDA receptor antagonist) for anaesthesia during ECS is shown to prevent the enhancement of the EPSP and impairment of LTP. In behavioural studies, repeated ECS significantly impairs spatial learning in the watermaze as measured by a consistent increase in escape latencies which is accompanied in one experiment by decreased searching in the vicinity of the platform during a retention test. The increase in escape latencies is prevented by the administration of ketamine anaesthesia during ECS in the same animals in which prevention of the effects on synaptic plasticity can be demonstrated These findings suggest that the profound but reversible impact of ECS on hippocampal LTP may account for the memory impairment described after electroconvulsive Stimulation in humans and other species. Ketamine, which reduces the impact of seizures on this process, may protect against ECS-induced memory impairment and thus prove useful in alleviating the transient cognitive impairment following ECT in humans.

Thesis (Psy. D.)--Wheaton College, 2007. / Abstract. Includes bibliographical references (leaves 54-59).

ECT is the most effective treatment available for depression. Its usefulness is limited by side effects. The most commonly discussed side effect is cognitive dysfunction. This thesis investigates various aspects of ECT efficacy and the impact upon cognitive function. Using a clinical sample from the Royal Cornhill Hospital, Aberdeen, it was found that repeat courses of ECT are common. Repeated courses were as effective as single courses. On binary logistic regression psychotic symptoms at first treatment and lower MADRS score after first treatment predicted repeat courses. Lithium was underused to reduce relapse in the sample. ECT is prescribed to patients from different socioeconomic groups at a rate consistent with the population distribution in each socioeconomic quintile; ECT is not prescribed to patients from different socioeconomic groups at a rate consistent with the distribution of depression or severe depression in each quintile. Using the empirically determined seizure threshold a commonly used stimulus dosing protocol was compared with the half age method and a fixed by age method of ECT dosing. The fixed by age method was superior to stimulus dosing in terms of fewer stimulations, reduced cumulative electricity and fewer treatment sessions. More therapeutic seizures at first stimulus were achieved compared to the half age method. The CANTAB SRM was used to assess the cognitive function of patients during and after ECT. On this measure deficits were found up to three months following ECT but cognitive function had improved relative to baseline at six months. The MMSE was not sufficiently sensitive to detect change. Subjective memory correlated with mood score and the PRMQ was acceptable to patients. The val66met BDNF SNP and the val158met COMT SNP had no effect on cognitive function during the ECT process and up to three months of follow-up. Neither SNP affected ECT outcomes.

Thesis (Psy. D.)--Wheaton College, 2007. / Abstract. Includes bibliographical references (leaves 54-59).

Thesis (Ph.D.)--Aberdeen University, 2009. / Title from web page (viewed on July 20, 2009). Includes bibliographical references.

Mood disorders (major depressive and bipolar spectrum disorders) have devastating effects on quality of life, with individuals who do not respond to pharmacological interventions showing a greater risk of impaired functioning, suicidality, and symptom relapse. Electroconvulsive therapy (ECT) has demonstrated consistent efficacy for treating mood disorders. However, there is a relative paucity of research examining the effectiveness of ECT in ambulatory settings and for patients who present with psychiatric comorbidities. This thesis sought to characterize the clinical, functional, and neuropsychological profile and outcomes (i.e., effectiveness and side effects) of a mixed mood disorders population undergoing ambulatory ECT with minimal research-related restrictions. In study one, we demonstrated that ambulatory ECT patients were clinically severe and complex, with frequent psychiatric multimorbidity, high symptom severity, and elevated functional impairment. ECT was effective at significantly reducing depressive symptoms in the short- and long-term; yet the rates of remission and response were lower than expected. In study two, we found that objective cognitive functioning remained largely unchanged following ECT, a finding that should be interpreted with caution given the use of a brief cognitive screening battery. Interestingly, whereas patients who responded to ECT reported a lessening of subjective memory complaints, those who did not respond showed an increase in memory complaints post-ECT. In study 3, we sought to identify clinical and cognitive predictors of ECT outcomes using machine learning methods; we were unable to predict remission status, response status, or percent change in depressive symptoms in our sample. Overall, this thesis advances our understanding of the clinical, cognitive, and functional characteristics and outcomes of ambulatory ECT delivered under naturalistic conditions. This work highlights the importance of considering clinical comorbidities and cognitive functioning in ECT research and delivery and encourages a collaborative approach to clinical care aimed at enhancing treatment of patients with severe mental illness. / Dissertation / Doctor of Philosophy (PhD) / Severe mood disorders, such as depression and bipolar disorder, are associated with significant difficulties in social, occupational, and personal functioning. Electroconvulsive therapy (ECT) has shown consistent efficacy in reducing depressive symptoms, even in patients who did not respond to pharmacotherapy. This thesis advances our understanding of the therapeutic and adverse side effects of ECT in two understudied areas, ECT delivered in an outpatient setting and under naturalistic conditions with minimal research-related restrictions. We found that patients undergoing ECT were clinically complex and severe. ECT was effective at reducing depressive symptoms, but remission and response rates were lower than expected. Although, cognitive functioning, following ECT, remained largely unchanged on a brief screening assessment that may have underestimated cognitive changes, patients continued to report memory concerns. This thesis highlights the importance of considering patients’ full clinical and cognitive presentation in ECT research and delivery and encourages a collaborative approach to clinical care to better treat patients with severe mental illness.

This study assessed the cognitive impact of ECT using: a paired words and short story test, a spatial and pattern recognition memory subtest, a pattern-location associated learning subtest, a delayed matching to sample subtest, a modified version of Kopelman’s Autobiographical Memory Interview (AMI), and a subjective memory test was also included. Tests were conducted on ECT patients, before treatment (baseline), after four treatments, after the final ECT and one month following the final ECT treatment, to measure short and long-term memory loss. Baseline data was collected from 26 patients, thereafter patient numbers varied (details are reported in the results section). This study found that paired word and a short story tasks were insensitive at detecting cognitive deficits during or after ECT; however a delay of one hour increased the sensitivity of these tests. The visual memory battery detected deficits in visual and visuospatial memory during and immediately following a course of ECT but only spatial recognition memory deficits remained one month post-ECT. The modified AMI appeared to be a sensitive measure of retrograde memory loss. Deficits were observed in both semantic and episodic memory. Memory for recent events displayed the greatest losses. Subjective memory complaints were significantly reduced during, after, and at one month following ECT; however these were highly correlated with depression scores. In conclusion, the battery of neuropsychological memory tests adopted for this study appear to be sensitive to the adverse effect of ECT on aspects of anterograde and retrograde memory loss generally. However, the sensitivity of the subjective test is questionable as outcome on this test appears to be influenced by mood.