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Pre- and Post-Electroconvulsive Therapy Multidomain Cognitive Assessment in Psychotic Depression: Relationship to Premorbid Abilities and Symptom Improvement

Bayless, John D. PhD; McCormick, Laurie M. MD; Brumm, Michael C. BS; Espe-Pfeifer, Patricia B. PhD; Long, Jennifer J. BA; Lewis, Jerry L. MD

doi: 10.1097/YCT.0b013e3181ac8ec2
Original Studies

Objectives: Cognitive changes have been reported in patients after electroconvulsive therapy (ECT), but few studies have investigated post-ECT changes across multiple cognitive domains. Because cognitive dysfunction is presumed to be more salient in psychotic depression, we propose a brief pre-ECT multidomain cognitive assessment battery, assessing neurocognitive function in this population before and after ECT. We also compared performance to estimated premorbid levels and determined if neuropsychological functioning was related to symptom improvement.

Methods: Twenty participants with psychotic depression (12 females, 8 males) undergoing ECT for severe depression received the repeatable battery for the assessment of neuropsychological status (RBANS) and additional tasks. The wide range achievement test reading test provided an estimate of premorbid intellectual functioning. Depressive symptoms were assessed with the Hamilton Depression Scale-28, whereas negative and positive symptoms were assessed with the Scale for Assessing Negative and Positive Symptoms.

Results: There was a significant improvement in depressive symptoms with most measures of cognitive function showing net gains. When cognitive performances were compared with estimated premorbid abilities, findings indicated significant movement toward normalization in overall RBANS score, particularly involving the language index and attention index. Considered individually, 6 (30%) participants showed pre-ECT cognitive dysfunction (RBANS total score ≤80), with only 2 (10%) showing such impairment posttreatment associated with inadequate response to ECT. A linear regression analysis revealed that the changes in RBANS and executive functioning were directly related to change in negative symptoms, but not to change in depression, anxiety or psychotic symptoms.

Conclusions: Multidomain pre-ECT cognitive assessment is feasible and well-tolerated in most patients. Cognitive performance did not worsen after ECT in people with psychotic depression and improved on some measures. The degree of cognitive improvement seems to be directly related to the improvement in negative symptoms.

From the Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA.

Received for publication November 17, 2008; accepted April 30, 2009.

Reprints: John D. Bayless, PhD, Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242 (e-mail:

This project was funded by a Collaborative Interdisciplinary Project Grant from the University of Iowa College of Medicine and Nellie Ball Trust Foundation Grant. None of the authors had financial conflicts of interest for this study.

Preliminary results were presented at a poster session at the 2007 annual meeting of the International Neuropsychological Society in Portland, OR.

© 2010 Lippincott Williams & Wilkins, Inc.