Electroconvulsive therapy (ect) and other neuromodulation therapies: a clinical, research & standards of practice update.

Abstract

Background: Electroconvulsive therapy (ECT) is an effective treatment for mood and other neuropsychiatric disorders. New techniques are emerging, while others are being refined based on evidence to maximise benefits and minimise side effects. Research, naturalistic data and lived experience are the elements of such progress. The Royal Australian and New Zealand College of Psychiatrists, Section of ECT and Neurostimulation (RANZCP SEN) nurtures culture of academic rigour and clinical utility. Objective(s): To present clinical and practice standards of ECT that reflects modern ECT practice in Australia and New Zealand. The symposium will provide an opportunity for clinicians to understand the latest evidence while allowing a personalised treatment approach within jurisdictional and legislative requirements. Method(s): The symposium is divided into four presentations with panel Q&A from all presenters at the end: 1. Relevant literature and naturalistic data will be presented to illustrate the potential role of various electrode placements including Left Anterior Right Temporal (LART) and its impact on efficacy and side effects and proposing guidance for clinically relevant prescribing in modern ECT practice. 2. The Clinical Alliance and Research in ECT and related treatments (TMS, tDCS, ketamine, psychedelics), 'CARE', is a consortium of clinicians, who collaborate in developing and using a common data set to improve clinical practice, facilitate benchmarking and research. Insights from recent research studies based on the CARE data set will be presented, including the relevance of melancholia to ECT response, utility of simple tools to track cognition in ECT. 3. The protocol for a funded multicentre randomised controlled clinical trial to investigate whether a course of rTMS to the right temporoparietal junction (rTPJ), which has demonstrated abnormal brain activation in ASD, can improve social communication in adolescents and young adults with ASD. This study will evaluate the safety and efficacy of a 4 week course of intermittent theta burst stimulation (iTBS, a variant of rTMS) in ASD. Participants meeting criteria for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ASD (n = 150, aged 14- 40 years) will receive 20 sessions of either active iTBS (600 pulses) or sham iTBS (in which a sham coil mimics the sensation of iTBS, but no active stimulation is delivered) to the rTPJ. Participants will undergo a range of clinical, cognitive, epi/genetic, and neurophysiological assessments before and at multiple time points up to 6 months after iTBS. Overview from previous findings in literature will be appraised. 4. Review of ECT Practice Standards around Australia and New Zealand and compare it with international standards. Finding(s): Neurostimulation therapies are evolving fields. Ongoing research, naturalistic data can guide new techniques and refinements. More consistent Practice Standards are required across both Australia and New Zealand. Conclusion(s): Psychiatrists and clinicians are encouraged to develop evidence-based personalised treatment plans for patients. ECT Service Providers are urged to standardise service provision of ECT that reflect modern ECT in service provision.