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To date, electroconvulsive therapy (ECT) is the most potent treatment in severe depression. Although ECT has been successfully applied in clinical practice for over 70 years, the underlying mechanisms of action remain unclear. We used functional MRI and a unique data-driven analysis approach to examine functional connectivity in the brain before and after ECT treatment. Our results show that ECT has lasting effects on the functional architecture of the brain. A comparison of pre- and posttreatment functional connectivity data in a group of nine patients revealed a significant cluster of voxels in and around the left dorsolateral prefrontal cortical region (Brodmann areas 44, 45, and 46), where the average global functional connectivity was considerably decreased after ECT treatment (P < 0.05, family-wise error-corrected). This decrease in functional connectivity was accompanied by a significant improvement (P < 0.001) in depressive symptoms; the patients’ mean scores on the Montgomery Asberg Depression Rating Scale pre- and posttreatment were 36.4 (SD = 4.9) and 10.7 (SD = 9.6), respectively. The findings reported here add weight to the emerging \"hyperconnectivity hypothesis\" in depression and support the proposal that increased connectivity may constitute both a biomarker for mood disorder and a potential therapeutic target.

Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs). To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic. Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760) No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course. Ketamine as an anaesthetic does not enhance the efficacy of ECT.

Racial socialization and ethnic identity are emerging, albeit atheoretical, constructs that have been argued to promote prosocial outcomes among ethnic minority youths. Using structural equation modeling, the author explored the influence of racial socialization and ethnic identity on school engagement in a sample of 131 African American youths. The findings indicated that the relationship of racial socialization to school engagement was not statistically significant; however, racial socialization had a statistically significant relationship to ethnic identity. In turn, ethnic identity had a statistically significant relationship to school engagement. Implications for social work research and practice are discussed.

https://doi.org/10.1192/bjp.bp.116.189134, Published by Cambridge University Press, 2 January 2018. First published June, 2017, by The Royal College of Psychiatrists.This notice describes a correction to the above mentioned paper.

The current discussion explores the intersection of trauma, mental health, and college athletics. It emphasizes the need for trauma-informed care in athletic contexts. College athletes often experience trauma both prior to and during their athletic careers, including adverse childhood experiences, injury, performance pressure, and identity struggles. These experiences can significantly impact mental health and athletic performance. The authors argue that traditional athletic cultures may exacerbate mental health challenges due to stigma, unrealistic expectations, and limited institutional support. Trauma-informed care is presented as a vital approach that emphasizes safety, empowerment, and collaboration. The authors highlight the importance of shifting perspectives within both sports and mental health professions to recognize athletes as complex individuals not just performers. These insights have critical implications for sport social work practitioners seeking to promote athlete well-being and resilience.

To date, electroconvulsive therapy (ECT) is the most potent treatment in severe depression. Although ECT has been successfully applied in clinical practice for over 70 years, the underlying mechanisms of action remain unclear. We used functional MRI and a unique data-driven analysis approach to examine functional connectivity in the brain before and after ECT treatment. Our results show that ECT has lasting effects on the functional architecture of the brain. A comparison of pre- and posttreatment functional connectivity data in a group of nine patients revealed a significant cluster of voxels in and around the left dorsolateral prefrontal cortical region (Brodmann areas 44, 45, and 46), where the average global functional connectivity was considerably decreased after ECT treatment (P < 0.05, family-wise error-corrected). This decrease in functional connectivity was accompanied by a significant improvement (P < 0.001) in depressive symptoms; the patients’ mean scores on the Montgomery Asberg Depression Rating Scale pre- and posttreatment were 36.4 (SD = 4.9) and 10.7 (SD = 9.6), respectively. The findings reported here add weight to the emerging “hyperconnectivity hypothesis” in depression and support the proposal that increased connectivity may constitute both a biomarker for mood disorder and a potential therapeutic target.

Background This analysis is based on a survey questionnaire designed to describe medical educators’ views of psychiatry and psychiatrists. Our goals in this paper were to assess the psychometric properties of the survey questions by (a) using exploratory factor analysis to identify the basic factor structure underlying 37 survey items; (b) testing the resulting factor structure using confirmatory factor analysis; and (c) assessing the internal reliability of each identified factor. To our knowledge, this is the first attempt to use these techniques to psychometrically assess a scale measuring the strength of stigma that medical educators attached to psychiatry. Methods Survey data were collected from a random sample of 1,059 teaching faculty in 23 academic teaching sites in 15 countries. We conducted exploratory and confirmatory factor analysis to identify the scale structure and Cronbach’s alpha to assess internal consistency of the resulting scales. Results Results showed that a two-factor solution was the best fit for the data. Following exploratory factor analysis, we conducted confirmatory factor analysis on a split half of the sample. Results highlighted several items with low loadings. Excluding factors with low correlations and allowing for several correlated variances resulted in a good fitting model explaining 95% of the variance in the data. Conclusions We identified two unidimensional scales. The Images Scale contained 11 items measuring stereotypic content concerning psychiatry and psychiatrists. The Efficacy of Psychiatry Scale contained 5 items addressing perceptions of the challenges and effectiveness of psychiatry as a discipline.

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.