title: Resolution of SPECT-determined anterior cerebral hypoperfusion correlated with maintenance ECT-derived improvement in residual symptoms in a case of late-life psychotic depression.
abstract: A 70-year-old widow with recurrent psychotic depression was successfully treated with maintenance electroconvulsive therapy (ECT) for 4 years up to the present. Anterior cerebral hypoperfusion visualized by single photon emission computerized tomography (SPECT) before ECT persisted (second SPECT study 14 days after the last ECT session) despite a response to the first course of acute ECT. Only mild symptoms remained. Relapse occurred 2 weeks after the post-ECT SPECT study. The hypoperfusion improved after response to a second course of acute ECT (per SPECT 5 days after the last ECT session), and perfusion was normalized after 2-year maintenance ECT (per SPECT 14 days after the last ECT session). The normalization coincided with improvement in depressive symptoms remaining after the second course of acute ECT. We speculate that the effectiveness of maintenance ECT might have been in part the result of the improvement in residual symptoms and that resolution of the persistent anterior hypoperfusion, which might underlie medical refractoriness, illness chronicity, and relapse tendency in late-life depression, might have been associated with the improvement in residual symptoms achieved by maintenance ECT.
authors.affiliation: Department of Psychiatry, Tohoku University Hospital, Seiryo-machi, Sendai, Japan. kazumasa-tohoku@umin.ac.jp
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Suzuki
authors.forename: Shuichi
authors.initials: S
authors.lastname: Awata
authors.forename: Takehisa
authors.initials: T
authors.lastname: Takano
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ebina
authors.forename: Shinichi
authors.initials: S
authors.lastname: Numata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Kae
authors.initials: K
authors.lastname: Ito
authors.forename: Hiroo
authors.initials: H
authors.lastname: Matsuoka
mesh_terms: D000341:Affective Disorders, Psychotic / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications / Q000517:prevention & control* / Q000523:psychology; D002560:Cerebrovascular Circulation; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D011379:Prognosis; D055502:Secondary Prevention; D013223:Statistics as Topic; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome