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    Teaching basic relaxation procedures to psychiatric patients receiving electronconvulsive therapy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1982) Simons, Bruce Francis
    There has been no research on psychiatric patients examining the ability to remember relaxation skills whilst receiving electroconvulsive therapy. This thesis addressed itself to the question of whether the patients could remember the relaxation procedures that were taught immediately before, during, or immediately after the ECT series. Fourteen patients were assigned to three different groups. The first group received the relaxation training (RT) prior to beginning the ECT series, the second group received the RT during the ECT series and the third group received the RT immediately after the ECT series. Assessment was made of the verbal instructions taught to the patients using a checklist devised by the author. Comparisons were made between patients on their performance according to several different independent variables, diagnosis, frequency of ECT, response to treatment and order of presentation effects. Eleven of the fourteen subjects learnt the RT procedures within three training sessions. The remaining subjects failed to learn the RT procedures in six sessions but this study did not confirm that ECT was a precipitant in their failure to learn. No significant effect was associated with diagnosis, frequency of ECT or response to treatment. It was concluded that it is possible to teach RT procedures to the majority of psychiatric patients at the institution where this study was completed. This study produced no evidence to suggest that it is preferable to teach RT to patients at any particular point in ECT treatment sequence and in addition there was no evidence of any anterograde or retrograde amnesic effects associated with ECT sufficient to interfere with the learning of verbal instructions associated with RT.
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    Cognitive change and assessment during electroconvulsive therapy : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2014) Thornton, Anneke Annette
    Electroconvulsive therapy (ECT) is the most effective treatment available for depression; however, cognitive side effects limit its use. If detected early in treatment, cognitive decline can be reduced by modifying the way the treatment is administered. Currently, no gold standard measures exist to assess ECT related cognitive change. The studies within this thesis aimed to improve the standard in which cognition is assessed during a course of ECT. Study One surveyed health professionals across New Zealand on their current practice of cognitive assessment during ECT. Study Two collected normative data for a neuropsychological measure of motor speed which had potential to be included in a cognitive screening measure for use with people receiving ECT. Study Three prospectively investigated objective cognitive changes in 13 people receiving electroconvulsive therapy for a mood disorder. Study Four investigated the subjective cognitive changes by qualitatively analysing patients’ reports of cognitive function throughout treatment. Finally, a brief but comprehensive cognitive screening measure was proposed for repeated use with patients receiving ECT. This measure was largely informed by findings from the aforementioned studies. Time, resources and a lack of sensitive tests restricted professionals from conducting more frequent and thorough cognitive assessments. ECT resulted in both cognitive decline and improvement across a range of cognitive domains. Alleviation in depression was associated with improvement in cognitive function from baseline. Six weeks post ECT, cognitive decline most often resolved back to or was superior to the baseline functioning. Domains sensitive to decline during a course of treatment included retrograde memory, anterograde memory, verbal and visual learning, attention, verbal fluency and information processing speed. Retrograde amnesia was more likely for memories formed closer in time to ECT treatment. Subjective reports of cognitive change were broad, and varied as a function of treatment phase and severity of depression. It is proposed that future research determine the psychometric properties of the suggested screening measure.
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    An evaluation of the cognitive outcomes of electroconvulsive therapy : a retrospective study : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Wellington, New Zealand.
    (Massey University, 2012) Luther, Kiri M
    The aim of the current study detailed in the following pages was to investigate the cognitive functioning from quantitative and qualitative perspectives of a group of 19 people who had received ECT two or more years previously. Reviews of the literature conducted prior to the study suggested the domains most commonly reported affected by ECT were verbal learning and memory, visual learning and memory, global cognitive functioning, subjective complaints, retrograde amnesia/memory, attention, retrieval, autobiographical memory, anterograde amnesia/memory and aspects of executive functioning. The most commonly used objective measures for these domains were the Rey Auditory Verbal Learning Test, the Rey Complex Figure Test, the Mini Mental State Examination and the Autobiographical Memory Inventory. Qualitative assessment most often utilised subjective measures such as the Cognitive Failures Questionnaire or the Squire Subjective Memory Questionnaire. The current study planned to extend qualitative assessment using Interpretative Phenomenological Analysis. Specific hypothesis were that 1) scores on the RCFT, RAVLT and AMI for patients who received their last ECT two or more years ago would be below the age-matched norms (cut-off ranges in the case of the AMI) for each test, 2) the MoCA would identify more participants with Global Cognitive deficits than the MMSE and 3) participants would report a higher degree of difficulty with their memory and cognition than what was identified by the objective assessment measures. Findings did not confirm hypothesis 1) with the exception of scores on the RCFT. Hypothesis 2) was confirmed, with the MoCA identifying more participants with deficits than the MMSE. Hypothesis 3) was confirmed, with participants reporting subjective complaints that were not identified by the objective measures. The study was limited by small sample size for quantitative analysis and further research utilising a larger sample which assesses at baseline, during and immediately after ECT and the development of a qualitative assessment measure is also recommended.
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    Cognitive assessment during a course of electroconvulsive therapy - A national questionnaire survey of current practice in Aotearoa, New Zealand
    (1/07/2014) Thornton A; Leathem J; Flett R
    Objective: To shed light on current practice regarding cognitive assessment during electroconvulsive therapy (ECT) across Aotearoa. Design/Participants: 24 medical professionals representing all ECT administering district health boards responded to an electronic questionnaire. Results: 73.7% assess cognitive function at least once during a course of ECT. 27.3% assess at baseline, at least once during the course and again post-treatment. Assessments are primarily conducted by nurses (38.8%), psychiatrists (22.2%) and psychologists (22.2%). 66% of respondents reported cognitive assessment was not conducted frequently or thoroughly enough in their workplace due to a lack of time, resources and sensitive tests. Conclusion: Respondents recognised assessing cognitive change during a course of ECT was important, though large variations in the nature, frequency and length of assessments existed. Future research should focus on the development of a sensitive screening measure tailored for use with patients receiving ECT to help overcome the current restrictions to cognitive assessment.