短暂脉冲或超短暂脉冲右侧单侧电休克治疗后的复发及长期认知表现：一项多中心自然随访研究

Relapse and long-term cognitive performance after brief pulse or ultrabrief pulse right unilateral electroconvulsive therapy: A multicenter naturalistic follow up.

作者信息

Verwijk Esmée, Spaans Harm-Pieter, Comijs Hannie C, Kho King H, Sienaert Pascal, Bouckaert Filip, Obbels Jasmien, Scherder Erik J A, Stek Max L, Kok Rob M

机构信息

Parnassia Psychiatric Institute, The Hague, The Netherlands.

出版信息

J Affect Disord. 2015 Sep 15;184:137-44. doi: 10.1016/j.jad.2015.05.022. Epub 2015 May 16.

DOI:10.1016/j.jad.2015.05.022

PMID:26093032

Abstract

BACKGROUND

Superior cognitive functioning for electroconvulsive therapy (ECT) with right unilateral (RUL) ultrabrief pulse (UBP) stimulation compared to RUL brief pulse (BP) stimulation is not clearly established and long-term data is needed.

METHODS

We conducted a prospective naturalistic follow-up of 87 inpatients from three tertiary psychiatric hospitals. Before these patients entered the follow up phase, they had participated in a RCT comparing twice weekly RUL BP (1.0 ms) with RUL UBP (0.3-0.4 ms) ECT eight times seizure threshold until remission (MADRS < 10), for a maximum of six weeks. Three and six months after the index ECT patients were monitored for relapse and cognitive performance (retrograde amnesia, semantic memory and lexical memory). We compared relapse rate and cognitive performance between RUL BP and RUL UBP stimulation.

RESULTS

Of the 50 patients who remitted after index ECT 44 (24 BP; 20 UBP) were monitored for follow up. Relapse occurred in 25% of the BP group and in 25% of the UBP group (χ(2) = 0.00, p = 1.0) at three-month follow-up; whereas 43.5% of the BP group and 35% of the UBP group relapsed (χ(2) = 0.322, p = 0.57) at six months follow-up. Cognitive assessments (17 BP; 16 UBP) showed no significant differences between BP and UBP groups, except for an advantage for the BP group in the autobiographical incident questions at three months follow-up only (p = 0.04; d = 0.77).

LIMITATIONS

This study may be limited since relapse in a naturalistic follow-up can be influenced by medication and other unknown factors, like social support, medical comorbidity, and psychotherapy. The small numbers of our subgroups hamper statistical significance.

CONCLUSIONS

Patients that achieved remission after RUL BP or RUL UBP ECT showed similar relapse rates after three and six months. There was no cognitive advantage of UBP over BP ECT in follow up.

CLINICAL TRIALS REGISTRATION

Netherlands trial register www.trialregister.nl registration number NTR1304.

摘要

背景

与右侧单侧（RUL）短脉冲（BP）刺激相比，右侧单侧超短脉冲（UBP）刺激的电休克治疗（ECT）是否具有更好的认知功能尚未明确，需要长期数据。

方法

我们对来自三家三级精神病医院的87名住院患者进行了前瞻性自然随访。在这些患者进入随访阶段之前，他们参加了一项随机对照试验，比较每周两次的RUL BP（1.0毫秒）与RUL UBP（0.3 - 0.4毫秒）ECT，共进行八次达到癫痫阈值直至缓解（蒙哥马利 - 阿斯伯格抑郁量表评分＜10），最长持续六周。在首次ECT治疗后的三个月和六个月，对患者进行复发监测和认知功能评估（逆行性遗忘、语义记忆和词汇记忆）。我们比较了RUL BP和RUL UBP刺激之间的复发率和认知功能。

结果

在首次ECT治疗后缓解的50名患者中，44名（24名BP组；20名UBP组）接受了随访监测。在三个月的随访中，BP组和UBP组的复发率均为25%（χ² = 0.00，p = 1.0）；而在六个月的随访中，BP组的复发率为43.5%，UBP组为35%（χ² = 0.322，p = 0.57）。认知评估（17名BP组；16名UBP组）显示，BP组和UBP组之间无显著差异，仅在三个月随访时的自传性事件问题上BP组具有优势（p = 0.04；d = 0.77）。