Husain Mustafa M, McClintock Shawn M, Rush A John, Knapp Rebecca G, Fink Max, Rummans Teresa A, Rasmussen Keith, Claassen Cynthia, Petrides Georgios, Biggs Melanie M, Mueller Martina, Sampson Shirlene, Bailine Samuel H, Lisanby Sarah H, Kellner Charles H
Department of Psychiatry, University of Texas (UT) Southwestern Medical Center at Dallas, TX 75390-8898, USA.
J Clin Psychiatry. 2008 Mar;69(3):406-11. doi: 10.4088/jcp.v69n0310.
This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT).
Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) and the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR(30)). Remission was defined as at least a 60% decrease from baseline in HAM-D(24) score and a total score of 10 or below on the last 2 consecutive HAM-D(24) ratings. The randomized controlled trial was performed from 1997 to 2004.
The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D(24).
Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features.
clinicaltrials.gov Identifier: NCT00000375.
本研究探讨了接受急性双侧电休克治疗（ECT）的伴或不伴有非典型特征的重度抑郁症（MDD）患者的特征及治疗结果。
对489例符合DSM-IV标准的MDD患者进行分析。根据ECT治疗前基线时获得的DSM-IV结构化临床访谈，将受试者分为典型或非典型。抑郁症状严重程度通过24项汉密尔顿抑郁量表（HAM-D(24)）和30项抑郁症状自评量表（IDS-SR(30)）进行测量。缓解定义为HAM-D(24)评分较基线至少降低60%，且在连续最后2次HAM-D(24)评分中总分达到10分或更低。该随机对照试验于1997年至2004年进行。
典型组（N = 453）和非典型组（N = 36）在多个社会人口统计学和临床变量上存在差异，包括性别（p = 0.0071）、年龄（p = 0.0005）、治疗抵抗（p = 0.0014）、首次发病年龄（p < 0.0001）和当前发作年龄（p = 0.0008）。在接受急性双侧ECT治疗后，典型组（67.1%）和非典型组（80.6%）中相当一部分患者达到缓解。根据HAM-D(24)对年龄、精神病、性别、临床地点和抑郁严重程度进行调整后，非典型组缓解的可能性是典型组的2.6倍（95%置信区间 = 1.1至6.2）。
急性ECT是治疗具有典型或非典型症状特征的抑郁症患者的有效方法。
clinicaltrials.gov标识符：NCT00000375。
