Department of Psychiatry, Fourth Military Medical University, Xi'an, Shaanxi, China.
Schizophr Res. 2012 May;137(1-3):97-103. doi: 10.1016/j.schres.2012.01.037. Epub 2012 Feb 17.
Previous studies have demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis.
This case-control study was conducted in inpatients aged 13-20 years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated.
Between March 2004 and November 2009, 112 eligible patients were allocated to control (n=38) and ECT (n=74) group. Additional ECT treatment significantly reduced hospital stay compared to controls (23.2±8.2 days versus 27.3±9.3 days, mean±SD, P=0.018). Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR)=1.961, P=0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls.
ECT is an effective and safe intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be considered as an early psychosis intervention.
既往研究已证实电抽搐治疗（ECT）对药物抵抗性神经精神疾病有效。本研究旨在评估 ECT 对首发精神病青少年的疗效和安全性。
本病例对照研究纳入了年龄在 13-20 岁的首发精神病住院患者。连续招募的每 3 例年龄和性别相同的患者以 1:2 的比例随机分配至对照组和 ECT 组，同时给予抗精神病药物治疗。ECT 治疗为每周 3 次，最多 14 次。终点为出院。采用住院天数、阳性和阴性综合征量表（PANSS）和反应率来评估临床结局。基线和第 2 周时进行多导睡眠图（PSG）检查。同时评估安全性和耐受性。
2004 年 3 月至 2009 年 11 月，纳入 112 例符合条件的患者，分别分配至对照组（n=38）和 ECT 组（n=74）。与对照组相比，额外的 ECT 治疗显著缩短了住院时间（23.2±8.2 天与 27.3±9.3 天，均数±标准差，P=0.018）。生存分析显示，ECT 治疗组的累积反应率显著高于对照组（74.3%比 50%，相对风险（RR）=1.961，P=0.001）。与对照组相比，额外的 ECT 还显著改善了睡眠效率、快速眼动（REM）潜伏期和密度。PSG 改善与总体 PANSS、阳性症状和一般精神病学评分降低显著相关。在住院期间，没有患者停止 ECT 治疗方案。两组大多数不良事件的发生率无差异，但 ECT 治疗组比对照组更常出现短暂性头痛和头晕。
ECT 是一种对首发精神病青少年有效且安全的干预措施。其抗精神病作用与 PSG 变量的改善有关。ECT 可作为早期精神病干预措施。
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