Publications by authors named "Shanthi Sarma"

10 Publications

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The Impact of COVID-19 on Electroconvulsive Therapy: A Multisite, Retrospective Study From the Clinical Alliance and Research in Electroconvulsive Therapy and Related Treatments Network.

J ECT 2021 Aug 12. Epub 2021 Aug 12.

From the School of Psychiatry, University of New South Wales Black Dog Institute, Sydney, New South Wales, Australia Institute of Mental Health, Singapore Flinders Medical Centre, Bedford Park The Queen Elizabeth Hospital, Adelaide, South Australia Gold Coast Health Service, Gold Coast, Queensland Sir Charles Gairdner Hospital, Nedlands University of Western Australia, Perth, Western Australia Royal Australian and New Zealand College of Psychiatry, Melbourne, Victoria, Australia.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to reported change in electroconvulsive therapy (ECT) services worldwide. However, minimal data have been published demonstrating tangible changes across multiple ECT centers. This article aimed to examine changes in ECT patients and ECT service delivery during the pandemic.

Methods: We retrospectively assessed data collected on ECT patients within the Clinical Alliance and Research in Electroconvulsive Therapy and Related Treatments (CARE) Network during a 3-month period starting at the first COVID-19 restrictions in 2020 and compared data with predicted values based on the corresponding 3-month period in 2019. Mixed-effects repeated-measures analyses examined differences in the predicted and actual number of acute ECT courses started and the total number of acute ECT treatments given in 2020. Sociodemographic, clinical, treatment factors, and ECT service delivery factors were compared for 2020 and 2019.

Results: Four Australian and 1 Singaporean site participated in the study. There were no significant differences between the predicted and actual number of acute ECT courses and total number of acute ECT treatments administered in 2020. During 2020, there were statistically significant increases in the proportion of patients requiring ECT under substitute consent and receiving ECT for urgent reasons compared with 2019.

Conclusions: This multisite empirical study is among the first that supports anecdotal reports of changes in the triaging and delivery of ECT during COVID-19. Results suggest that ECT was prioritized for the most severely ill patients. Further data assessing the impacts of COVID-19 on ECT are needed.
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http://dx.doi.org/10.1097/YCT.0000000000000800DOI Listing
August 2021

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial.

Brain Stimul 2021 Sep-Oct;14(5):1095-1105. Epub 2021 Jul 29.

Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia.

Introduction: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established.

Methods: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4.

Results: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p = 0.680).

Conclusion: This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub- and supra-threshold accelerated bilateral TBS.
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http://dx.doi.org/10.1016/j.brs.2021.07.018DOI Listing
July 2021

The place of non-invasive brain stimulation in the RANZCP clinical practice guidelines for mood disorders.

Aust N Z J Psychiatry 2021 04;55(4):349-354

Psychiatry, University of NSW and Black Dog Institute, Sydney, NSW, Australia.

Clinical practice guidelines are important documents as they have the capacity to significantly influence and shape clinical practice in important areas of therapeutics. As such, they need to be developed informed by comprehensive and quality-based systematic reviews, involve consensus deliberations representative of the appropriate experts in the field and be subject to thorough critical review. A revised clinical practice guideline for the management of patients with mood disorders was recently published under the auspices of the Royal Australian and New Zealand College of Psychiatrists. However, this clinical practice guideline was not developed in a manner that reflects the appropriate standards that should apply to clinical practice guideline development and it has critical flaws, especially as it pertains to the use of repetitive transcranial magnetic stimulation treatment for patients with depression. The revision of the college clinical practice guideline has explicitly removed clear and unequivocal evidence-based recommendations that were found in a previous version of the clinical practice guideline and replaced these with consensus-based recommendations. However, the consensus-based recommendations were developed without consultation of the appropriate expert body within the college and contradict the scientific literature. There is substantive and unequivocal evidence supporting the antidepressant use of repetitive transcranial magnetic stimulation in the treatment of patients with depression and its use after a patient with depression has failed a limited number (typically around two) of antidepressant medication trials. Readers should refer to the college Professional Practice Guidelines for repetitive transcranial magnetic stimulation published in 2018 for thorough information about the use of this important new treatment.
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http://dx.doi.org/10.1177/00048674211004344DOI Listing
April 2021

Worsening of movement disorder following treatment with electroconvulsive therapy in a patient with Huntington's disease.

BMJ Case Rep 2019 Aug 10;12(8). Epub 2019 Aug 10.

Department of Psychiatry, Queensland Health, Robina, Queensland, Australia.

This paper describes a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of Huntington's disease (HD) and developed worsening movement disorder symptoms after commencing electroconvulsive therapy (ECT) for depression. The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of worsening movement disorders when using ECT for depression in a patient with HD.
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http://dx.doi.org/10.1136/bcr-2019-230389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700561PMC
August 2019

Effect of Electroconvulsive Therapy on Health-Related Quality of Life in Older Depressed Patients.

J ECT 2020 Mar;36(1):31-35

From the Older Persons Mental Health, Gold Coast University Hospital, Queensland, Australia.

Background: Research has shown large improvements in quality of life after a course of electroconvulsive therapy (ECT) for severe depressive disorder. The effect of ECT on health-related quality of life (HRQOL) in the Australian older population has not been explored.

Objectives: This study aimed to investigate the impact of ECT on HRQOL in older patients with severe major depression and confirm that ECT in these participants is associated with an improvement in depression and no change in cognition.

Methods: Data on 34 patients from a Public Older Persons Mental Health Service in Queensland were collected. The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, Montgomery-Asberg Depression Rating Scale (MADRS), and Montreal Cognitive Assessment (MoCA) were used pre- and post-ECT. The Wilcoxon signed rank test, Friedman test, and Kendall τ correlation coefficient were performed.

Results: A significant improvement in Quality of Life Enjoyment and Satisfaction Questionnaire Short Form was demonstrated post-ECT. Montgomery-Asberg Depression Rating Scale scores decreased significantly post-ECT. Montreal Cognitive Assessment score increased significantly post-ECT. Significant results were sustained at the 3-month time point.

Conclusions: An acute course of ECT for severe depressive disorder was associated with clinically and statistically significant improvement in HRQOL. There was also clinical and statistical improvement in depression and no significant decrease in global cognitive function, memory, or executive function domains after ECT compared with baseline. In fact, the cohort showed improvement on measures of cognition post-ECT.
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http://dx.doi.org/10.1097/YCT.0000000000000615DOI Listing
March 2020

Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy.

Aust N Z J Psychiatry 2019 07 10;53(7):609-623. Epub 2019 Apr 10.

10 School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.

Objectives: To provide guidance for the optimal administration of electroconvulsive therapy, in particular maintaining the high efficacy of electroconvulsive therapy while minimising cognitive side-effects, based on scientific evidence and supplemented by expert clinical consensus.

Methods: Articles and information were sourced from existing guidelines and the published literature. Information was revised and discussed by members of the working group of the Royal Australian and New Zealand College of Psychiatrists' Section for Electroconvulsive Therapy and Neurostimulation, and findings were then formulated into consensus-based recommendations and guidance. The guidelines were subjected to rigorous successive consultation and external review within the Royal Australian and New Zealand College of Psychiatrists, involving the full Section for Electroconvulsive Therapy and Neurostimulation membership, and expert and clinical advisors and professional bodies with an interest in electroconvulsive therapy administration.

Results: The Royal Australian and New Zealand College of Psychiatrists' professional practice guidelines for the administration of electroconvulsive therapy provide up-to-date advice regarding the use of electroconvulsive therapy in clinical practice and are informed by evidence and clinical experience. The guidelines are intended for use by psychiatrists and also others with an interest in the administration of electroconvulsive therapy. The guidelines are not intended as a directive about clinical practice or instructions as to what must be done for a given patient, but provide guidance to facilitate best practice to help optimise outcomes for patients. The outcome is guidelines that strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that electroconvulsive therapy is a continually evolving practice.

Conclusion: The guidelines provide up-to-date advice for psychiatrists to promote optimal standards of electroconvulsive therapy practice.
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http://dx.doi.org/10.1177/0004867419839139DOI Listing
July 2019

The Clinical Alliance and Research in Electroconvulsive Therapy Network: An Australian Initiative for Improving Service Delivery of Electroconvulsive Therapy.

J ECT 2018 03;34(1):7-13

Objective: There is currently substantial heterogeneity in electroconvulsive therapy (ECT) treatment methods between clinical settings. Understanding how this variation in clinical practice is related to treatment outcomes is essential for optimizing service delivery. The Clinical Alliance and Research in ECT Network is a clinical and research framework with the aims of improving clinical practice, enabling auditing and benchmarking, and facilitating the collection of naturalistic clinical data.

Methods: The network framework and clinical and treatment variables collected and rationale for the use of particular outcome measures are described. Survey results detailing the use of ECT across initial participating clinical centers were examined.

Results: The data are reported from 18 of 22 participating centers, the majority based in Australia. Melancholic unipolar depression was the most common clinical indication (78%). Right unilateral (44%) and bifrontal (39%) were the most commonly used electrode placements. Eighty one percent of the centers used individual seizure titration for initial dosing.

Conclusions: There was substantial heterogeneity in the use of ECT between participating centers, indicating that the Network is representative of modern ECT practice. The Clinical Alliance and Research in ECT Network may therefore offer the opportunity to improve service delivery and facilitate the investigation of unresolved research questions pertaining to modern ECT practice.
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http://dx.doi.org/10.1097/YCT.0000000000000435DOI Listing
March 2018

Relationship between anxiety and quality of life in older mental health patients.

Australas J Ageing 2014 Sep;33(3):201-4

Aim: This study aims to investigate the impact of anxiety on quality of life (QOL) in older people with mental disorders.

Method: Forty patients from a district Older Persons Mental Health Service were assessed using the Mini-International Neuropsychiatric Interview (MINI-5).They then completed the brief version of the World Health Organization Quality of Life Scale (WHOQOL-BREF),Geriatric Anxiety Inventory and Geriatric Depression Scale.

Results: Self-reported anxiety was significantly associated with reduced overall QOL on the WHOQOL-BREF.Anxiety was also associated with the psychological, social and environmental domains of the WHOQOL-BREF, but not with the physical health domain. Anxiety was correlated with more individual domains of QOL than depression.

Conclusions: Anxiety makes a significant contribution to self-rated QOL in older people with serious mental disorders.
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http://dx.doi.org/10.1111/ajag.12102DOI Listing
September 2014
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