Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.
Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
J Affect Disord. 2016 Jan 15;190:178-186. doi: 10.1016/j.jad.2015.10.013. Epub 2015 Oct 22.
No study has previously investigated whether the speed of recovery from disorientation in the post-ictal period may predict the short-term treatment outcome of electroconvulsive therapy (ECT).
This longitudinal cohort study included 57 elderly patients with unipolar or bipolar major depression, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed weekly during the ECT course using the 17-item Hamilton Rating Scale for Depression (HRSD17). The post-ictal reorientation time (PRT) was assessed at the first and third treatments.
Longer PRTs at the first and third treatments predicted a more rapid decline and a lower end-point in continuous HRSD17 scores (p=0.002 and 0.019, respectively). None of the patients who recovered from disorientation in less than 5 min met the remission criterion, defined as an HRSD17 score of 7 or less. A greater increment in stimulus dosage from the first to the third ECT session rendered a smaller relative decline in PRT (p<0.001).
The limited number of subjects may reduce the generalizability of the findings.
The speed of recovery from disorientation at the first and third sessions seems to be a predictor of the treatment outcome of formula-based ECT, at least in elderly patients with major depression. It remains to be clarified how the PRT may be utilized to guide stimulus dosing.
以前没有研究调查过发作后意识错乱的恢复速度是否可以预测电抽搐治疗（ECT）的短期治疗结果。
这项纵向队列研究纳入了 57 名年龄在 60-85 岁之间的单相或双相重性抑郁的老年患者，他们接受基于公式的 ECT 治疗。在 ECT 疗程中，每周使用 17 项汉密尔顿抑郁量表（HRSD17）评估治疗效果。在第一次和第三次治疗时评估发作后定向时间（PRT）。
第一次和第三次治疗时较长的 PRT 预示着 HRSD17 评分更快下降和更低的终点（分别为 p=0.002 和 0.019）。在少于 5 分钟内恢复定向的患者中没有一人达到缓解标准，定义为 HRSD17 评分<7。从第一次 ECT 到第三次 ECT 治疗时刺激剂量的更大增量导致 PRT 的相对下降更小（p<0.001）。
研究对象数量有限可能会降低研究结果的普遍性。
第一次和第三次治疗时意识错乱恢复的速度似乎是基于公式的 ECT 治疗结果的预测指标，至少在老年重性抑郁患者中是这样。尚不清楚 PRT 如何用于指导刺激剂量。
