Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy.
Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy.
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DOI：
10.1097/yct.0000000000000137
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发表时间：
2014-06
期刊：
影响因子：
--
通讯作者：
Lisanby SH
中科院分区：
文献类型：
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作者：
McClintock SM;Choi J;Deng ZD;Appelbaum LG;Krystal AD;Lisanby SH
对于许多患有神经精神疾病的患者来说，单一或联合药物治疗、心理治疗和经颅磁刺激的标准精神治疗是无效的。对于这些患有难治性神经精神疾病的患者，主要的治疗选择是电休克疗法（ECT）。数十年的研究发现 ECT 非常有效；然而，它也会导致不良的神经认知影响。具体来说，ECT 会导致每次治疗后迷失方向，对最近学到的信息产生顺行性遗忘，对以前学到的信息产生逆行性遗忘。不幸的是，人们对 ECT 的神经认知效应和潜在作用机制仍然知之甚少。本文的目的是将 ECT 神经认知效应背后的多种调节和中介因素综合成一个连贯的模型。这些因素包括人口统计学和神经心理学特征、神经精神症状、ECT 技术参数以及 ECT 相关的神经生理变化。未来的研究有必要评估和测试该模型，以便这些发现可以支持开发更精细的临床癫痫治疗方法和有效的认知补救策略，以提高这种重要且广泛使用的神经精神疾病干预工具的效用。
For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper is to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the utility of this important and widely used intervention tool for neuropsychiatric diseases.