Patients with psychosis are treated in outpatient community clinics during most of their lifetime. Antipsychotic treatments are commonly used in regular clinical practice. However, the non-adherence is one of the main causes of relapses. Long-acting injectables (LAIs) could be a safe option to guarantee the efficacy.

Our purpose is to evaluate the efficacy of the switch to paliperidone palmitate from other oral or LAI antipsychotics, in terms of hospital and emergency admissions.

We performed a mirror-image study in an outpatient mental health clinic, comparing patients before and after paliperidone palmitate change over 43 months. Fifty-seven patients were included, most of them (n = 47) were diagnosed with psychotic disorders (82.5%) while 4 were bipolar patients (7%), and the remained patients (n = 6; 10.6%) were classified as behavioral disorders. The following variables were studied before and after the switching: number of admissions, days of stay and emergency visits.

From those 57 patients, 44 were previously treated with other LAIs, whereas 13 were taking oral antipsychotics. The median age at switch was 49 years (SD = 12.31). The reasons for switching were: inefficacy (26.3%), non-adherence (19.3%), side effects (38.6%), and non-specified (15.8%). We found significant differences between the three main variables: number of admissions (t = 4.59; P ≤ 0.001), days of stay (t = 2.27; P = 0.027) and emergency visits (t = 3.74; P ≤ 0.001).

Paliperidone palmitate seems to be an effective treatment in order to guarantee the adherence. Our preliminary data show that paliperidone palmitate might reduce the sanitary cost in outpatients.

The authors have not supplied their declaration of competing interest.

Persons using the Internet generate large amounts of health-related data, which are increasingly used in modern health sciences.

We analysed the relation between annual prescription volumes (APV) of several antidepressants with marketing approval in Germany and corresponding web search query data generated in Google to test, if web search query volume may be a proxy for medical prescription practice.

We obtained APVs of several antidepressants related to corresponding prescriptions at the expense of the statutory health insurance in Germany from 2004–2013. Web search query data generated in Germany and related to defined search-terms (active substance or brand name) were obtained with Google Trends. We calculated correlations (Pearson's r) between the APVs of each substance and the respective annual “search share” values; coefficients of determination (R2) were computed to determine the amount of variability shared by the two variables.

Significant and strong correlations between substance-specific APVs and corresponding annual query volume were found for each substance during the observational interval: agomelatine (r = 0.968; R2 = 0.932; P = 0.01), bupropion (r = 0.962; R2 = 0.925; P = 0.01), citalopram (r = 0.970; R2 = 0.941; P = 0.01), escitalopram (r = 0.824; R2 = 0.682; P = 0.01), fluoxetine (r = 0.885; R2 = 0.783; P = 0.01), paroxetine (r = 0.801; R2 = 0.641; P = 0.01), and sertraline (r = 0.880; R2 = 0.689; P = 0.01).

Although the used data did not allow to perform an analysis with a higher temporal resolution our results suggest that web search query volume may be a proxy for corresponding prescription behaviour. However, further studies analysing other pharmacologic agents and prescription data that facilitates an increased temporal resolution are needed to confirm this hypothesis.

The authors have not supplied their declaration of competing interest.

Drug safety surveillance strongly depends on the spontaneous and voluntary reporting of adverse drug reactions (ADR). A major limiting factor of spontaneous reporting systems is underreporting (UR) which describes incorrectly low reporting rates of ADR. Factors contributing to UR are numerous and feature country-dependent differences.

Understanding causes of UR is necessary to facilitate targeted interventions to improve ADR reporting and pharmacovigilance.

A cross-sectional questionnaire-based telephone survey was performed among physicians in outpatient care in a federal state of Germany.

From n = 316 eligible physicians n = 176 completed the questionnaire (response rate = 55.7%). Most of the physicians (n = 137/77.8%) stated that they report ADR, which they have observed to the competent authority rarely (n = 59/33.5%), very rarely (n = 59/33.5%) or never (n = 19/10.8%); the majority (n = 123/69.9%) had not reported any ADR in 2014. Frequent subjective reasons for ADR non-reporting were (specified response options): lack of time (n = 52/29.5%), the subjective evaluation that the required process of reporting is complicated (n = 47/26.7%) or requires too much time (n = 25/14.2%) or the assessment that reporting of an ADR is needless (n = 22/12.5%); within free answers the participants frequently stated that they do not report ADR that are already known (n = 72/40.9%) and they only report severe ADR (n = 46/26.1%).

Our results suggest a need of interventions to inform physicians about pharmacovigilance and to modify the required procedure of ADR reporting or to offer other reporting options.

The authors have not supplied their declaration of competing interest.

Adherence to prescribed antipsychotic drugs is a crucial factor in predicting medium- to long-term clinical outcome in schizophrenia. A helpful approach to promote adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics.

To evaluate:

– the global functioning and the hospitalization rate occurred in the year before and in the year following the switch from a low-efficacy oral antipsychotic to either a LAI once-monthly therapy (palmitate paliperidone or olanzapine pamoate) or the corresponding oral compound (paliperidone\risperidone or olanzapine) in schizophrenic patients;

– the treatment attitude and the insight in patients treated with second-generation antipsychotic (SGA)-LAIs and with the corresponding oral compounds.

Sixty adult schizophrenic outpatients: thirty were switched to LAIs and thirty to the corresponding oral antipsychotic. We used the following scales: Drug Attitude Inventory (DAI), Schedule for the Assessment of Insight (SAI), Life Skill Profile (LSP).

Number of hospitalizations per year decreased in both groups (LAIs: from 1.3 ± 0.5 to 0.3 ± 0.5; oral: from 1.3 ± 0.5 to 0.6 ± 0.5). We found a direct association between the “hospitalization event” and the oral drug compared to the corresponding LAI formulation (P = 0.049; OR: 3.05; 95% IC: 1.01–9.26). Patient receiving LAIs achieved a more significant improvement at the LSP score compared to the oral group (P < 0.001 vs. P = 0.0034) and higher DAI (5.9 ± 4.3 vs. −1.1 ± 4.3) and SAI (8.7 ± 2.9 vs. 5.6 ± 2.1).

Our data suggest that SGA-LAIs, improving the adherence to the treatment, may sensitively reduce costs in mental health services.

The authors have not supplied their declaration of competing interest.

Haloperidol has been used for the treatment of schizophrenic disorders and other disorders with psychotic symptoms in psychiatric cares. It has been reported that haloperidol can cause QT-prolongation as well as Torsades de Pointes, especially in hypokalemic condition. Here, we tested the usefulness of the large clinical electronic medical record system data from a hospital located in South Korea and further investigated any change in potassium levels before and after an exposure to haloperidol.

The dataset used in this study is derived from open access database with information such as admission, discharge, diagnosis, prescribed drugs and selected laboratory data for the period 1 June 1994 to 31 July 2013. This database contains information of total 461,170 patients with 4,920,758 prescriptions and 3,811,812 data about serum potassium levels.

Extracting a dataset from this database to compare the levels of serum potassium before and after haloperidol usage, we selected 3661 cases of data, 2476 of them (67.6%) were males and 1185 (32.4%) were females. More than 98.5% (3606) was Asians, and mean age of the patients was 68.63 ± 17.3 years old. The levels of serum potassium before and after haloperidol usage were 4.93 ± 2.53 and 3.86 ± 0.6 mEq/L, respectively, and t-tests revealed that those levels were significantly different (< 0.001).

Findings showed that an exposure to haloperidol could lead to a decrease in levels of serum potassium. We suggested that EMR data can be a valuable tool to investigate the effects of treatment on several clinical data.

The authors have not supplied their declaration of competing interest.

In the pharmacological treatment of schizophrenia, more and more authors suggesting the use of injectable antipsychotics long-term these patients, since it increases adherence to treatment, one of the risk factors for relapse that argues most often to explain the failure of the treatment of these patients.

In the present study, it is to observe the evolution of a group of such patients to assess efficacy and tolerability of treatment with Aripiprazole LAI.

Data from 17 patients treated at a mental health center in Navarra (Spain), diagnosed with schizophrenic disorder, followed over a year after beginning treatment with Aripiprazol LAI are collected.

The data collected are:

– date of treatment change (month and year);

– antipsychotic previous;

– reason for change;

– aripiprazole LAI dose;

– number of income before and after the start of Aripiprazole LAI (mirror);

– effects adverse pre and post start of treatment with Aripiprazole LAI: metabolic, endocrine, extrapyramidal;

– treatment antipsychotic concomitant pre and post start Aripiprazole LAI.

The results show a decrease in the number of income after the start with Aripiprazole LAI, with very good retention of treatment, and a low number of side effects, which were mild.

Treatment with Aripiprazole LAI is a good therapeutic alternative to the use of antipsychotic drugs by mouth, with good adherence, tolerability and efficacy.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

An increasing body of evidence suggests that antipsychotic medication can cause immunological changes that could be attributed to the amelioration of psychotic symptoms or the metabolic side effects of the drugs. So far, the results of the studies remain controversial.

Our aim was to compare the levels of interleukin (IL) IL-2, IL-6 and transforming growth factor-β2 (TGF-β2) in drug-naïve, first-episode patients with psychosis before and after six weeks of antipsychotic medication.

Thirty-nine first episode patients with psychosis were enrolled in the study. Serum levels of IL-2, IL-6 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before and six weeks after the initiation of antipsychotic medication. In addition, clinical psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) before and after treatment.

Serum levels of IL-2 were significantly higher in the study group six weeks after the initiation of antipsychotic treatment (P < 0.001) while TGF-β2 levels were decreased (P < 0.001) and IL-6 levels were slightly reduced (P < 0.004).

The changes in cytokine levels may be attributed to the action of antipsychotic medication and the remission of psychopathology. The reduction in TGF-β2 levels is observed in all patients and with all antipsychotic medications used. TGF-β2 may be a marker of clinical efficacy.

The authors have not supplied their declaration of competing interest.

Alzheimers disease (AD) is a neurodegenerative disorder characterized by loss of memory and cognitive deficits. Ghrelin is a peptide hormone which has been linked to neuroprotection, memory and learning processes.

This study investigated the effects of ghrelin-induced memory retention on amelioration of cognitive deficits via restoration of long-term potentiation (LTP) and induction of synaptic plasticity in hippocampal CA3, using a rat model of AD induced by amyloid-β (1-42) injection.

Five groups of male rats (230–270 g) including ghrelin-treated (200 ng/rat, [ICV], daily for two weeks), Aβ1-42 injected (5 μL/rat) and Aβ1-42 plus ghrelin-treated animals were designed. Ghrelin was administered after an ICV injection of Aβ1-42. To assess cognitive performance and the motor dysfunction, passive avoidance tests and open-field were performed, respectively. Step-through latency (STL) was evaluated as learning and memory index. Intrahippocampal field potential recordings were done.

Results showed that following Aβ1-42 injection, STL and induction of LTP were significantly decreased whereas ICV injection of ghrelin significantly enhanced memory retention by improvement of STL and restitution of LTP in the CA3 with increased EPSP slope and PS amplitude, suggesting the involvement of ghrelin in postsynaptic mechanisms of hippocampal LTP.

It was revealed that neuroprotective effects of chronic ghrelin not only can enhance but also can restore LTP in the CA3 area in Aβ-induced AD. Results suggest that ghrelin may be considered as a promising therapeutic agent to alleviate cognitive deficits of AD.

The author has not supplied his/her declaration of competing interest.

In healthy volunteers, light acting through serotonin pathways, decreases the threshold for sweet, but not salt taste; similar to SSRI paroxetine. In depressive disorders, there is deficiency of serotonin throughput, which is remedied by SSRI medications, and results in improvement in symptoms of depression. Thus, we report on taste thresholds before and after SSRI treatment.

To study the variation in thresholds for sweet with SSRI treatment in depressed patients in short- and long-term.

To compare the threshold for sweet (test) and salt (control) after 1 and 4 weeks of SSRI escitalopram therapy in depressed patients.

The project was approved by the institutional ethics committee. Following informed consent, depressed patients were initiated on escitalopram 10 mg/d (increased to 15 or 20 mg, if required after 1 week,). Taste recognition threshold, intensity and pleasantness were measured for sweet and salt. Each tastant was made −1 to −3 (100 mM–1 mM). Regional recognition thresholds were determined at the tip of the tongue using a cotton bud well soaked in the tastant.

Three males and 4 females of mean ages 39.1 years completed the study. There was significant shift to the left for sweet thresholds between days 0 and 7, and 7 and 28 [F(Dfn, Dfd) = 9.242 (4.162) P < 0.0001]. A similar shift to the left was seen for salt but day 7 only [F(Dfn, Dfd) = 6.213 (4.162)].

The increase in serotonin throughput as envisaged through SSRI treatment was paralleled by decrease in sweet thresholds.

The authors have not supplied their declaration of competing interest.

Second-generation antipsychotics (SGAs) are notoriously associated with a wide range of metabolic adverse effects, and their chronic use is related with an increased risk for the development of metabolic syndrome (MS). The nutraceutical approach to the management of MS might be a promising strategy in the prevention of cardio-metabolic risk. In this context, Red yeast rice (RYR) have been shown to have a lipid lowering effect in an increasing number of clinical studies.

The present study was aimed to explore the efficacy and safety of RYR treatment on metabolic parameters in a sample of subjects receiving atypical antipsychotics.

Ten outpatients treated with atypical APs assumed RYR at single daily dose of 200 mg/day for 30 days. Total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides, fasting levels of glucose, and glycated hemoglobin were determined.

RYR administration non-resulted in a statistically significant reduction of metabolic parameters in the study sample. However, a trend for total cholesterol (T0 vs. T1: 159.6 vs. 145.6) and LDL (T0 vs. T1: 94.1 vs. 77.6) decrease was observed.

Our findings in patients receiving atypical antipsychotics did not confirm the beneficial effect of RYS on lipemic profiles previously found in subjects who do not take this class of drugs. Further clinical trials with adequately-powered and well-designed methodology are needed to better explore the RYS effectiveness on the SGAs-induced metabolic side effects.

The authors have not supplied their declaration of competing interest.

Modulators of the brain renin-angiotensin system (RAS) have been shown to improve cognitive functioning in several animal models of neuropsychiatric disorders. Moreover, the brain RAS has been considered a new target for the treatment of Alzheimer's disease (AD). However, there are no population-based follow-up studies supporting this hypothesis.

Cross-sectional and prospective relationships between cognitive decline and ARB treatment were examined in the population-based Kuopio Ischemic Heart Disease Risk Factor Study.

To evaluate procognitive/antidementia capacity of orally delivered angiotensin II receptor blockers (ARB).

The study was conducted on a sample of 1774 subjects (920 females, 854 males; age range at baseline: 42–61 years) from Eastern Finland. An established cutoff score of at least 2-point decrease in the Mini Mental State Examination over a 9-year follow-up was used to detect age-related cognitive decline in the cross-sectional setting. In the prospective setting, a hospital discharge diagnosis of dementia/AD was used as outcome variable. Cross-sectional relationships were determined with logistic regression and prospective analyses were conducted with the Cox proportional hazards model (both adjusted for relevant background variables).

Cross-sectional analysis displayed a decrease of the odds of cognitive decline (n = 87; 4.9% of participants) in those with ARB treatment; OR = 0.445, 95% CI: 0.22–0.90, P = 0.024. Furthermore, in the prospective setting, the risk of dementia/AD diagnosis (n = 149; 8.4% of participants) was significantly reduced in ARB treated participants; HR = 0.621, 95% CI: 0.40–0.98, P = 0.038.

ARB treatment is associated with a decreased risk for age-related cognitive decline and dementia/AD manifestation.

The authors have not supplied their declaration of competing interest.

To investigate the effect of Qing Huan Ling and (or) risperidone on activity and preferences behavior of the hypoglutamatergic schizophrenia model in mice.

Seventy kunming mice were randomly divided into 5 groups, one group as placebo group. The rest groups intraperitoneal injection MK-801 continuously 14 day, then randomly numbered: model group, Qing Huan Ling group, risperidone groupand Qing Huan Ling combined risperidone group. Intragastric administration give corresponding drugs for each group one month, at the same time observe high activities and changes in the preferences of five groups.

Compared with the blank group, activity of the rest model groups induced by MK-801 was increased (P < 0.05). After intragastric administration one month, model groups of high activity was decreased, especially risperidone combined Qing Huan Ling group. There was no statistical meaning in inquiry activity of five groups (P > 0.05). Compared with model group, latent period of step-through test was prolonged 35.5 s (P < 0.05), of step-down test was prolonged 11.4 s in risperidone combined Qing Huan Ling group.

The combination of Qing Huan Ling and risperidone can suppress the high activity; also can protect harmed memory of the preference behavior in the hypoglutamatergic schizophrenia model in mice.

The authors have not supplied their declaration of competing interest.

The electroconvulsive therapy (ECT) is an effective treatment used for several psychiatric disorders. However, there are multiple enigmas about the mechanisms of action and factors that improve its results. Some frequent questions are if the anesthetic drug makes a difference in the time of convulsion and blood pressure.

Our principal aim is to describe the utilization of anesthetic drugs among the patients that are being treated with ECT in hospital del Mar. We also want to know the differences in the time of convulsion and systolic arterial pressure for every anesthetic drug (propofol, thiopental and etomidate).

We have used the database of ECT in hospital del Mar. It contains information like age, principal diagnosis, medical background and pharmacological treatment at the moment of starting ECTs; it also contains information of each individual ECT session as basal, 2 and 5 minutes arterial pressure; the anesthetic drug used, and convulsion duration.

We made an analysis of general conditions of the population, the differences of convulsion time and arterial pressure between the three anesthetic drugs.

Propofol was used in 1140 sessions, thiopental in 61 sessions and etomidate in 54 sessions. The differences in the means of convulsion times between propofol and etomidate are statistically significant (“P” value < 0.05). Etomidate or thiopental increases the difference of arterial pressure more than propofol.

Further research about the factors that improve convulsion duration and minimize adverse effects on blood pressure is needed.

The authors have not supplied their declaration of competing interest.

Electroconvulsive therapy (ECT) is an effective NICE-approved treatment for severe depression, treatment-resistant mania and catatonia; the Royal College of Psychiatrists’ (RCPsych) guidelines also support its use fourth line for treatment-resistant schizophrenia.

Evaluate the use of ECT at Broadmoor High Secure psychiatric hospital, focusing on the indications for its prescription and patients’ capacity to consent.

Analyse case records of all patients who received ECT, and of all patients referred for Second Opinion Appointed Doctor (SOAD) certified ECT treatment under Section 58 of the Mental Health Act 1983 (MHA) due to incapacity, between 01.09.11 and 30.07.15.

All patients lacked capacity to consent to treatment during this time. Thirty-three referrals were made to the SOAD service for 15 patients, and of these 30 resulted in certification (T6) of which 10 were not subsequently used. Improvements in mental state and agreement to take clozapine were common reasons for T6s either not being certified or used. Urgent treatment under Section 62 of the MHA was employed 7 times for 4 patients during this period. Of the referrals to the SOAD service, 25 were for treatment-resistant schizophrenia, 5 for mania, 3 for catatonia and none for depression.

Those patients requiring ECT within this population tended to be the most unwell and all lacked the capacity to consent to it. The majority (76%) of patients receiving ECT at Broadmoor do so outside of NICE (but within RCPsych) guidelines. ECT may be an effective strategy for promoting compliance with clozapine.

The authors have not supplied their declaration of competing interest.

Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulation technique used in many indications, especially in psychiatry in the treatment of mood disorders. Although its efficacy in this treatment has been demonstrated, the study of predictive response factors currently remains a major challenge.

We conducted a retrospective study from the cohort of treatment-resistant depressed patients that received rTMS treatment in Esquirol Hospital in Limoges in order to identify response predictors at three months. Of the 416 patients treated between January 2007 and November 2015, 107 subjects have been included. The clinical characteristics of responders and nonresponders at three months after treatment, but also at the end of treatment and after one month were compared. Predictors of clinical improvement objectified by the Hamilton Depression Rating Scale (HDRS) were identified using a logistic regression model.

In our cohort, the response rates were 52% at the end of treatment, 61% at 1 month and 57% at 3 months. Psychiatric family history and the recurrence of thymic episodes were found to be negative predictors of response to rTMS treatment. Similarly, high subscore of depression core symptoms in HDRS could also predict a poorer response.

Our data from a naturalistic cohort tended to prove that a number of clinical features should be taken into account in determining the profile of the treatment-resistant depressed patients that could respond to rTMS treatment.

The authors have not supplied their declaration of competing interest.

Repetitive transcranial magnetic stimulation (rTMS) has important role in treatment of neuropsychiatric disorders. Theta burst stimulation (TBS), a modification of rTMS, seems to produce greater changes in cortical excitability (CE) than those observed in conventional rTMS protocols. TBS is used in different protocols: intermittent TBS (iTBS) and continuous TBS (cTBS). While iTBS facilitates CE, cTBS leads to CE inhibition. However, a prolonged cTBS produces facilitatory effect similar to that of iTBS. Prolonged TBS (pTBS), a novel rTMS paradigm, is of great clinical interest for its short duration, but also because it may induce stronger effect.

To prove the effect of pTBS of motor cortex on changes of motor threshold (MT), CE and pain threshold (PT) in healthy volunteers (HV). To compare the effects of two different forms of active pTBS (pcTBS, piTBS) with placebo.

A double-blind, placebo-controlled, cross-over study compared the effects of different pTBS of contralateral M1 area on MT, CE and PT. We enrolled 24 HV to the study, who underwent all types of pTBS in randomized order and were assessed before and after each pTBS application. We used MagPro R30 (with coil focused to contralateral M1 area, 1200 pulses/session, 90% MT).

A significant changes in CE and MT were found after application of continuous pTBS. Intermittent and placebo pTBS did not confirm the effect. There were no significant changes on PT after pTBS. Continuous pTBS was better tolerated than intermittent pTBS.

pTBS should be considered as an effective and safe treatment option for neuropsychiatric disorders.

Supported by AZV 16-31380A.

Transcranial direct current stimulation (tDCS) is a promising neuromodulation method that has, for example, been used to treat depression. Nevertheless, the adverse effects of tDCS and the validity of the current standard tDCS sham protocols have received limited attention.

To evaluate the extent and types of tDCS adverse effects and to assess the reliability of sham stimulation as a control procedure for tDCS in a double-blind setting.

To compare adverse effects between tDCS and sham stimulation groups, and to determine how well the participants and the experimenter are able to distinguish tDCS from sham stimulation.

A sample of healthy volunteers received a 20-minute session of either tDCS (n = 41; 2 mA) or sham stimulation (n = 41; ramp up 15 s, ramp down 15 s; no current in between). The anode was placed over F3 and cathode over F4. Both the participants and the experimenter reported immediate adverse effects and the perceived likelihood for the participant to receive tDCS. Analyses were conducted using the Mann–Whitney U-test.

The tDCS group reported more erythema compared with the sham group (P = 0.016, Cohen's D = 0.444). No other significant differences in adverse effects were observed. In the tDCS group, both the participants (P = 0.034, Cohen's D = 0.612) and the experimenter (P = 0.006, Cohen's D = 0.674) reported a higher perceived likelihood of the participant receiving tDCS than in the sham group.

tDCS has only modest adverse effects. Nevertheless, the current standard sham protocol appears insufficient.

The authors have not supplied their declaration of competing interest.

John Farquhar Fulton was an American neurophysiologist and historian, who pioneered psychosurgery based on animal experiments. Together with psychologist Carlyle Jacobsen, Fulton presented the results of bilateral frontal lobe ablation in chimpanzees. This study prompted neurologist Egas Moniz and neurologist Walter Freeman to perform similar brain surgery on human subjects.

To present the scientific papers of John Farquhar Fulton on psychosurgery.

To review available literature and to show evidence that John Farquhar Fulton made a significant contribution to the development of psychosurgery.

A biography and research papers are presented and discussed.

Fulton and Jacobsen experimented with ‘delayed response tasks’ in chimpanzees. The aim was to test the animal's capability to memorize the correct location of the food. They found that after sequential ablations of the left and right frontal association cortices these memory tasks became significantly difficult for the monkeys to perform. The researchers saw parallel conclusions in clinical cases of human frontal lobe damage.

An investigation into the role of the limbic system is one of the crowning achievements of John Farquhar Fulton, as this has influenced even today's thinking about the role of the limbic system. We should thank Fulton for his pioneering work as modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.

The authors have not supplied their declaration of competing interest.

Electroconvulsive therapy (ECT) has been considered a treatment option for the treatment resistance, mania, depression, suicidality and schizophrenia. It has been still controversial due to the lack of controlled clinical trials and unknown biological basis but also because of the negative image from the history of the treatment.

Specifics of the clinical judgement on when and for which patients’ indications, ECT was a treatment choice.

Aim of the study was to evaluate indications for the ECT treatment in the hospitalized psychiatric patients at the psychiatric department.

For all the patient cases in the last 7 years at the department (n = 326), data was analyzed regarding age, gender, number of hospitalizations, age of first episode, diagnose, previous treatment, leading indication for ECT and outcome after the ECT, regarding following treatment.

The leading indication for ECT was psychosis and/or pharmacological treatment resistance, followed by suicidality. Patients with psychosis were younger than patients with other diagnoses when receiving ECT treatment. Regarding the results, indications for ECT had been partially differentiated from expected guidelines. Outcomes after the ECT were favorable in terms of better controlling the symptoms, lowering exacerbation frequency and intensity and partially, functioning.

Studies on ECT indications and outcome could provide further insight on efficacy of the treatment, and possible improvements in clinical assessment on eligible patients who could benefit from the ECT treatment.

The authors have not supplied their declaration of competing interest.