Pinna Martina, Manchia Mirko, Oppo Rossana, Scano Filomena, Pillai Gianluca, Loche Anna Paola, Salis Piergiorgio, Minnai Gian Paolo
Psychiatry Unit, San Martino Hospital-Health Agency N. 5, Oristano, Sardinia, Italy.
Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
Neurosci Lett. 2018 Mar 16;669:32-42. doi: 10.1016/j.neulet.2016.10.047. Epub 2016 Oct 25.
Electroconvulsive therapy (ECT), developed in the 30's by Bini and Cerletti, remains a key element of the therapeutic armamentarium in psychiatry, particularly for severe and life-threatening psychiatric symptoms. However, despite its well-established clinical efficacy, the prescription of ECT has declined constantly over the years due to concerns over its safety (cognitive side effects) and an increasingly negative public perception. As for other treatments in the field of psychiatry, ECT is well suited to a personalized approach that would increment its efficacy, as well as reducing the impact of side effects. This should be based on the priori identification of sub-populations of patients sharing common clinical and biological features that predict a good response to ECT. In this review we have selectively reviewed the evidence on clinical and biological predictors of ECT response. Clinical features such as an older age, presence of psychotic and melancholic depression, a high severity of suicide behavior, and speed of response, appear to be shared by ECT good responders with depressive symptoms. In mania, a greater severity of the index episode, and a reduction of whole brain cortical blood flow are associated with ECT good response. Biological determinants of ECT response in depressive patients are the presence of pre-treatment hyperconnectivity between key areas of brain circuitry of depression, as well as of reduced glutamine/glutamate levels, particularly in the anterior cingulated cortex (ACC). Furthermore, pre ECT high plasma homovanillic acid (HVA) levels, as well as of tumor necrosis factor (TNF)-α, and low pre-ECT levels of S-100B protein, appear to predict ECT response. Finally, polymorphisms within the genes encoding for the brain-derived neurotrophic factor (BDNF), the dopamine 2 receptor gene (DRD2), the dopamine receptor 3 gene (DRD3), the cathechol-o-methyltransferase (COMT), the serotonin-transporter (5-HTT), the 5-hydroxytryptamine 2A receptor (5-HT), and the norepinephrine transporter (NET), appear to predict a good response to ECT. The integration of these data in specific treatment algorithm might facilitate a personalized approach in ECT.
电休克疗法（ECT）由比尼（Bini）和塞尔莱蒂（Cerletti）在20世纪30年代研发，至今仍是精神病学治疗手段中的关键组成部分，尤其适用于严重且危及生命的精神症状。然而，尽管其临床疗效已得到充分证实，但由于对其安全性（认知副作用）的担忧以及公众认知日益负面，多年来ECT的处方量持续下降。与精神病学领域的其他治疗方法一样，ECT非常适合采用个性化方法，这将提高其疗效，并减少副作用的影响。这应该基于对具有共同临床和生物学特征、预示对ECT有良好反应的患者亚群的预先识别。在本综述中，我们选择性地回顾了关于ECT反应的临床和生物学预测因素的证据。ECT有抑郁症状的良好反应者似乎具有一些临床特征，如年龄较大、存在精神病性和抑郁性抑郁、自杀行为严重程度高以及反应速度快。在躁狂症中，首发发作的严重程度更高以及全脑皮质血流量减少与ECT良好反应相关。抑郁患者ECT反应的生物学决定因素包括抑郁脑回路关键区域治疗前的高连接性，以及谷氨酰胺/谷氨酸水平降低，特别是在前扣带回皮质（ACC）。此外，ECT治疗前高血浆高香草酸（HVA）水平、肿瘤坏死因子（TNF）-α以及ECT治疗前低水平的S-100B蛋白似乎可预测ECT反应。最后，编码脑源性神经营养因子（BDNF）、多巴胺2受体基因（DRD2）、多巴胺受体3基因（DRD3）、儿茶酚-O-甲基转移酶（COMT）、5-羟色胺转运体（5-HTT）、5-羟色胺2A受体（5-HT）和去甲肾上腺素转运体（NET）的基因内的多态性似乎可预测对ECT的良好反应。将这些数据整合到特定的治疗算法中可能有助于ECT的个性化治疗方法。
