共病酒精和物质滥用是否会影响电抽搐治疗情绪障碍的效果？

Does comorbid alcohol and substance abuse affect electroconvulsive therapy outcome in the treatment of mood disorders?

机构信息

From the *James Lovell Federal Health Care Center, North Chicago, IL and †Department of Psychiatry and Behavioral Sciences, Chicago Medical School, Rosalind Franklin University, North Chicago, IL.

出版信息

J ECT. 2014 Mar;30(1):22-5. doi: 10.1097/YCT.0b013e31829aaeb8.

DOI:10.1097/YCT.0b013e31829aaeb8

PMID:23859979

Abstract

INTRODUCTION

Antidepressant medications remain the principal agents used to treat patients with mood disorders, although 30% to 40% of these patients do not improve. One of the factors associated with poor medication response is alcohol and substance abuse. Persons with mood disorders are at the greatest risk for suicide, and alcoholism is a significant additional risk factor. Electroconvulsive therapy (ECT) is shown to be the most effective treatment for major depression especially when associated with psychosis, catatonia, and suicide intent. However, similar to most antidepressant trials, patients with depression and comorbid alcohol and substance abuse are excluded from ECT efficacy studies.

METHOD

Through a retrospective chart review, we compared response to ECT in patients with mood disorder and comorbid alcohol and drug abuse to those with mood disorder only. From 2004 to 2010, 80 patients with mood disorder received ECT. Fifty of these had comorbid alcohol or drug abuse. Using a 10-item psychopathology scale, we compared pre- and post-ECT symptom severity between the 2 groups. Outcome was determined by measuring a decrease in the pre-ECT and post-ECT score using Wilcoxon rank tests, with statistical significance at P = 0.05.

RESULTS

There was no difference between the 2 groups in most demographics, ECT medication, or seizure quality. There was no difference in ECT outcome between those with comorbid alcohol abuse and those without based on percent decrease in pre- and post-ECT symptom scores (abuse: mean [SD], 0.89 [0.2] vs nonabuse: mean [SD], 0.93 [0.16]; Wilcoxon, 1332; P = 0.086). When we compared those who met the criteria for alcohol or drug dependence (19 patients) with those with no abuse, there was a trend for the dependence group to not do as well (dependence: mean [SD], 0.83 [0.25] vs nonabuse: mean [SD], 0.93 [0.16]; Wilcoxon, 405; P = 0.053). Those with combined drug and alcohol abuse (18 patients) did have a significantly worse outcome (combined: mean [SD], 0.82 [0.25] vs nonabuse: mean [SD], 0.93 [0.16]; Wilcoxon, 372; P = 0.033).

CONCLUSION

Our results indicate that comorbid alcohol and drug abuse may influence the response to ECT in the treatment of mood disorders. Based on our results, patients with comorbid dependence and combined drug and alcohol abuse showed symptom improvement but did not do as well as those with nonabuse.

摘要

简介

抗抑郁药物仍然是治疗情绪障碍患者的主要药物，尽管其中 30%至 40%的患者没有改善。与药物反应不良相关的因素之一是酒精和物质滥用。情绪障碍患者自杀的风险最高，而酗酒是一个重要的附加风险因素。电惊厥疗法（ECT）被证明是治疗重度抑郁症最有效的方法，尤其是在伴有精神病、紧张症和自杀意念的情况下。然而，与大多数抗抑郁药物试验一样，ECT 疗效研究排除了伴有酒精和物质滥用的抑郁症患者。

方法

通过回顾性图表审查，我们比较了伴有酒精和药物滥用的情绪障碍患者与仅有情绪障碍患者对 ECT 的反应。2004 年至 2010 年，80 名情绪障碍患者接受了 ECT。其中 50 名患者有酒精或药物滥用。我们使用 10 项精神病理学量表，比较了两组患者 ECT 前后的症状严重程度。通过 Wilcoxon 等级检验测量 ECT 前后评分的下降，以 P = 0.05 为统计学意义。

结果

两组在大多数人口统计学、ECT 药物或癫痫发作质量方面没有差异。根据 ECT 前后症状评分的百分比下降，伴有酒精滥用的患者与无酒精滥用的患者在 ECT 结果上没有差异（滥用：平均值 [标准差]，0.89 [0.2] vs 非滥用：平均值 [标准差]，0.93 [0.16]；Wilcoxon，1332；P = 0.086）。当我们比较符合酒精或药物依赖标准的 19 名患者与无滥用的患者时，依赖组的表现趋势不佳（依赖：平均值 [标准差]，0.83 [0.25] vs 非滥用：平均值 [标准差]，0.93 [0.16]；Wilcoxon，405；P = 0.053）。同时患有药物和酒精滥用的 18 名患者的结果明显更差（合并：平均值 [标准差]，0.82 [0.25] vs 非滥用：平均值 [标准差]，0.93 [0.16]；Wilcoxon，372；P = 0.033）。