2 results
P1: Dosing and treatment outcomes of rTMS for treatment-resistant depressed older adults in a naturalistic outpatient clinic population.
- Amanda Tan, Adriana Patricia, Rachel Hershenberg, Anthony Chatham, Eugenia Giampetruzzi, Valeriya Tsygankova, Gregory Job, Andrea Crowell, Patricia Riva Posse, William McDonald, Brandon Kitay
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 191-192
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Introduction:
Repetitive transcranial magnetic stimulation (rTMS) is an effective, safe, and well-tolerated option for treatment-resistant depression (TRD). The minimal medical and cognitive side effects are advantages of rTMS for all patients. However, the majority of rTMS studies in older adults are notable for underdosing rTMS relative to the corresponding FDA-protocol, as noted by recent international meta-analyses. This study utilizes the standardized rTMS FDA protocol and compares the response rates between older adult and non-older adult patients in a TRD clinic in Atlanta, Georgia with depressive symptoms as the primary outcome and anxiety symptoms as the secondary outcome.
Methods:This retrospective chart review of patients who received rTMS between March 2017 to June 2022 used descriptive statistics to compare treatment parameters and dropout rates between older adult and non-older adult patients. A 2 x 3 repeated-measures analysis of variance (ANOVA) analyzed changes in self-reported depression and anxiety symptom severity throughout treatment course (baseline, treatment midpoint, and final treatment) between the two groups.
Results:Eighty-nine patients were included for analysis: Group 1: >55 years old (n= 42; M= 66.48, sd= 6.16; 71% female), and Group 2: <55 years old (n = 47; M= 37.40, sd= 9.13; 60% female). All patients received at least 3000 pulses per session, with 85.71% of patients completing the FDA protocol in Group 1 and 85.11% of patients completing in Group 2. A >50% improvement in depression scores at the end of treatment were seen in 38.1% of patients in Group 1 and 31.9% of patients in Group 2. Both groups demonstrated significant within-group reductions of depression throughout treatment (ps < .001). A smaller subset of patients completed an anxiety questionnaire. Forty percent in Group 1 (n=24) and 33.3% in Group 2 (n=25) showed a >50% improvement in anxiety scores by end of treatment. Both groups demonstrated significant within-group reductions of anxiety throughout treatment (ps < .001). The between groups’ difference for change in depression and anxiety scores was not statistically significant.
Conclusion:With FDA protocol dosing, older and non-older patients have consistent response and tolerability. While overall response rates were slightly lower than reported standardized clinical trials, our real-world sample highlights the effectiveness of rTMS for patients, including adults over 55, treated in an unselected, naturalistic outpatient sample.
432 - Ultrabrief Right Unilateral ECT in Older Adults with Catatonia: A Case Series and Literature Review
- Cristina Pritchett, Adriana Hermida, Amanda Tan, Gregory Job
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, pp. 51-52
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Objectives:
Comparing Ultra-brief (UB) Right Unilateral Electroconvulsive Therapy (RU ECT) to the existing literature, this case series highlights the use of the treatment with geriatric patients.
Methods:This is a retrospective chart review of 5 patients with catatonia who were successfully treated with UB RUL ECT. Medical records were reviewed for clinical data and ECT treatment. The existing literature is compared and contrasted with other published cases. Quick Inventory of Depressive Symptomatology (QIDS) was completed both pre-ECT and post-ECT. Clinical Global Impression–Improvement (CGI-I) scale was performed post-ECT. Response was defined as decrease of QIDS by 50% and remission was defined as QIDS ≤5. CGI response was defined as CGI-I ≤2.
Results:All patients received UB RUL ECT treatment (mean age 67, 100% female). 20% (n=2) were caucasian. 60% had mood disorders and 40% had psychotic disorders. Number of treatments in the acute treatment course ranged from 5 to 20, charge was dosed at 6-10 times the seizure threshold determined at first treatment. All patients had a significant clinical response to ECT as reflected by clinical data, ECT procedure notes, and rating scales when available. All patients completed post ECT CGI-I. Response rate was 60% (n = 3). We also assessed QIDS scores for patients with comorbid depression. Out of these patients, 40% (n = 2) were unable to complete baseline QIDS secondary to symptoms severity. Mean baseline QIDS for the remaining patients was 9.67 (SD 1.53). Post-treatment QIDS was 3.67 (SD 5.51). Paired-samples t-test comparing these scores at baseline and post-ECT demonstrated a significance P value of 0.14. None of the patients experienced worsening of cognitive function.
Conclusions:UB RUL ECT is a safe and effective treatment for Catatonia. Our data demonstrate clinical improvement in patients with Catatonia with UB RUL ECT. In addition, this method may lower the burden of cognitive effects that can significantly benefit the older adult population. The literature is limited regarding the use of Ultra-brief (<0.37 milisec) Right Unilateral (RU) ECT in Catatonia. Additional studies will benefit from the inclusion of objective metrics such as Bush Francis Catatonia Scale, Scale for the Assessment of Psychotic Symptoms (SAPS), and the systematic evaluation of cognitive status and function.