Ciapparelli A, Dell'Osso L, Tundo A, Pini S, Chiavacci M C, Di Sacco I, Cassano G B
Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Italy.
J Clin Psychiatry. 2001 Jul;62(7):552-5. doi: 10.4088/jcp.v62n07a09.
The aim of this study was to investigate the effectiveness of electroconvulsive therapy (ECT) in medication-nonresponsive patients with mixed mania and bipolar depression.
Forty-one patients with mixed mania (DSM-IV diagnosis of bipolar I disorder, most recent episode mixed) and 23 patients with bipolar depression (DSM-IV diagnosis of bipolar I disorder, most recent episode depressed) consecutively assigned to ECT treatment were included in this study. Subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impressions-Severity of Illness scale (CGI-S). Assessments were carried out the day before starting ECT, 48 hours after completion of the third session (T1), and a week after the last session of ECT (T2).
Both groups received an equal number of ECT sessions (mean +/- SD = 7.2 +/- 1.7 vs. 7.3 +/- 1.6). In both groups, within-group comparisons showed that there was a significant reduction in CGI-S score (mixed mania, p <.0001 at T1 and T2; bipolar depression, p < .01 at T1, p < .0001 at T2), MADRS total score (both groups, p < .0001 at T1 and T2), BPRS total score (mixed mania, p < .0001 at T1 and T2; bipolar depression, p < .001 at T1, p < .0001 at T2), and BPRS activation factor score (mixed mania, p < .0001 at T1 and T2; bipolar depression, NS at T1, p < .01 at T2). Between-group comparisons revealed that patients with mixed mania showed significantly greater decrease in MADRS score (p < .001) and a greater proportion of responders (CGI-S) than patients with bipolar depression at endpoint (56% [N = 23] vs. 26% [N = 6], p = .02). Patients with mixed mania showed a greater reduction in suicidality, as measured by MADRS score, than patients with bipolar depression (p < .02).
In our study, ECT was associated with a substantial reduction in symptomatology, in both patients with mixed mania and those with bipolar depression. However, the mixed mania group exhibited a more rapid and marked response as well as a greater reduction in suicidal ideation. Response to ECT was not influenced by the presence of delusions.
本研究旨在探讨电休克治疗（ECT）对药物治疗无效的混合性躁狂和双相抑郁患者的疗效。
本研究纳入了41例混合性躁狂患者（根据《精神疾病诊断与统计手册》第四版[DSM-IV]诊断为双相I型障碍，最近一次发作是混合性发作）和23例双相抑郁患者（DSM-IV诊断为双相I型障碍，最近一次发作是抑郁发作），这些患者均连续接受ECT治疗。使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）、简明精神病评定量表（BPRS）和临床总体印象-疾病严重程度量表（CGI-S）对受试者进行评估。评估在开始ECT治疗前一天、第三次治疗结束后48小时（T1）以及ECT最后一次治疗后一周（T2）进行。
两组接受的ECT治疗次数相同（平均±标准差=7.2±1.7次 vs. 7.3±1.6次）。两组的组内比较均显示，CGI-S评分（混合性躁狂，T1和T2时p<.0001；双相抑郁，T1时p<.01，T2时p<.0001）、MADRS总分（两组，T1和T2时p<.0001）、BPRS总分（混合性躁狂，T1和T2时p<.0001；双相抑郁，T1时p<.001，T2时p<.0001）以及BPRS激活因子评分（混合性躁狂，T1和T2时p<.0001；双相抑郁，T1时无统计学意义，T2时p<.01）均显著降低。组间比较显示，混合性躁狂患者在终点时的MADRS评分下降幅度显著大于双相抑郁患者（p<.001），且缓解者比例更高（CGI-S）（56%[N = 23] vs. 26%[N = 6]，p = .02）。通过MADRS评分测量，混合性躁狂患者的自杀观念下降幅度大于双相抑郁患者（p<.02）。
在我们的研究中，ECT与混合性躁狂患者和双相抑郁患者的症状显著减轻相关。然而，混合性躁狂组表现出更快、更明显的反应以及自杀观念的更大幅度下降。对ECT的反应不受妄想存在的影响。
