双相 I 型、双相 II 型和单相抑郁症对电休克治疗的反应。

Response to ECT in bipolar I, bipolar II and unipolar depression.

作者信息

Medda P, Perugi G, Zanello S, Ciuffa M, Cassano G B

机构信息

Department of Psychiatry, Neurobiology, Pharmacology, and Biotecnology University of Pisa, Italy.

出版信息

J Affect Disord. 2009 Nov;118(1-3):55-9. doi: 10.1016/j.jad.2009.01.014. Epub 2009 Feb 14.

DOI:10.1016/j.jad.2009.01.014

PMID:19223079

Abstract

OBJECTIVES

A significant body of evidence indicates the efficacy of electroconvulsive therapy (ECT) in unipolar depression but mixed results have been reported in bipolar depression. We explored difference of response to ECT in unipolar (UP), bipolar I (BP I) and bipolar II (BP II) depression, in a sample of patients resistant to pharmacological treatment.

METHODS

One hundred and thirty depressive patients (17 with Major Depression (UP), 67 with bipolar disorder II (BP II) and 46 with bipolar disorder I (BP I) according to DSM-IV criteria) were included in the study and treated with bilateral ECT, on a twice-a-week schedule. The patients were assessed before (baseline) and a week after the ECT course (final score), using the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Improvement (CGI).

RESULTS

The three groups (UP, BP II, BP I) showed a significant improvement after the ECT course. Global response rate (CGI<2) was 94.1% for UP, 79.1% for BP II and 67.4% for BP I. Concerning depressive symptomatology, the remission rate (HAM-D <8) was respectively 70.5 for UP, 56.7% for BP II and 65.3% for BP I. The best results were achieved by UP patients, while BP I group showed the worst results with a lower remission rate and higher scores in YMRS and BPRS psychotic cluster at the final evaluation.

CONCLUSION

ECT turns out to be a viable option for the treatment of both unipolar and bipolar depressive patients resistant to pharmacological treatment. Nevertheless, while the UP group showed the best response and clinical outcomes, the BP I patients tended to exhibit residual manic and psychotic symptomatology.

摘要

目的

大量证据表明电休克治疗（ECT）对单相抑郁症有效，但双相抑郁症的治疗效果报道不一。我们在一组对药物治疗耐药的患者样本中，探讨单相（UP）、双相I型（BP I）和双相II型（BP II）抑郁症患者对ECT反应的差异。

方法

本研究纳入130例抑郁症患者（根据DSM-IV标准，17例为重度抑郁症（UP），67例为双相情感障碍II型（BP II），46例为双相情感障碍I型（BP I）），采用双侧ECT治疗，每周两次。在ECT疗程前（基线）和疗程后一周（最终评分），使用汉密尔顿抑郁量表（HAM-D）、杨氏躁狂量表（YMRS）、简明精神病评定量表（BPRS）和临床总体印象量表（CGI）对患者进行评估。

结果

三组（UP、BP II、BP I）在ECT疗程后均有显著改善。UP组的总体缓解率（CGI<2）为94.1%，BP II组为79.1%，BP I组为67.4%。关于抑郁症状，缓解率（HAM-D<8）UP组为70.5%，BP II组为56.7%，BP I组为65.3%。UP组患者的治疗效果最佳，而BP I组在最终评估时缓解率较低，YMRS和BPRS精神病性因子得分较高，治疗效果最差。