Electroconvulsive therapy for depression and ketamine for relapse prevention: factors affecting response, cognition and research participation
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Martha Finnegan, 'Electroconvulsive therapy for depression and ketamine for relapse prevention: factors affecting response, cognition and research participation'Download Item:
Abstract:
This thesis comprises five clinical research studies.
Study 1. Pilot randomised controlled trial: Ketamine vs midazolam for depression
relapse prevention following successful electroconvulsive therapy (ECT), the KEEPWELL
Trial (NCT02414932)
The objective of this study was to conduct a randomised controlled pilot trial of a fourweek
course of once-weekly ketamine or midazolam infusions for relapse prevention
following ECT for depression to assess trial procedures for feasibility for a future
definitive trial. Forty-three participants were recruited to a monitoring phase but only six of
these were eligible and agreeable to randomised treatment. No participant completed the
treatment protocol. The study found that the trial protocol is not feasible and therefore not
suitable for a definitive trial. Future studies could consider open-label treatment,
recruitment of participants who live very nearby.
Study 2. Prospective cohort study: Effects of mood and time on autobiographical
memory before and after electroconvulsive therapy for depression
This study aimed to examine performance on the full Kopelman Autobiographical Memory
Interview in severely depressed patients (n=27) before and after a course of ECT and to
compare this with the performance of healthy controls (n=72) before and after a 4-week
interval. I found that autobiographical memory is profoundly impaired in depressed people
and that the Kopelman Autobiographical Memory Interview is likely not adequately
sensitive to change to identify any overall change in autobiographical memory
performance after ECT.
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Study 3. Prospective cohort study: Effect of personality disorder on response to ECT
for depression: a prospective cohort study
The aim of this study was to assess for association between scores on the brief personality
screening tool, the self-reported Standardised Assessment of Personality – Abbreviated
Scale (SAPAS) and response to ECT among patients with unipolar major depressive
disorder (n=49). I found that while the presence of likely personality disorder on the
SAPAS was associated with lower ECT response rate, it is unlikely to contribute to
cognitive impairment.
Study 4. Prospective cohort study: Childhood trauma and response to ECT for
depression: a prospective cohort study
This study aimed to examine report of childhood trauma and recent trauma in a severely
depressed population referred for ECT (n=44) and assess for association between presence
of childhood or recent trauma and response to ECT. I found that both childhood and recent
trauma were common in depressed people having ECT and that the presence of childhood
trauma is associated with reduced response rate to ECT.
Study 5. Retrospective chart review: Involuntary and voluntary electroconvulsive
therapy: a case-control study
In this study I compared courses of involuntary ECT (n=48) with matched voluntary ECT
courses (n=96) in terms of clinical and demographic factors, treatment requirements, and
outcomes. I found that the groups were similar in many respects and results of clinical ECT
research can therefore be generalised to people having involuntary ECT.
Author: Finnegan, Martha
Advisor:
McLoughlin, DeclanQualification name:
Doctor of Philosophy (Ph.D.)Type of material:
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