Liang C-S, Chung C-H, Tsai C-K, Chien W-C
Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC.
Eur Psychiatry. 2017 May;42:29-35. doi: 10.1016/j.eurpsy.2016.12.005. Epub 2016 Dec 22.
Electroconvulsive therapy (ECT) remains irreplaceable in the treatment of several psychiatric conditions. However, evidence derived using data from a national database to support its safety is limited. The aim of this study was to investigate in-hospital mortality among patients with psychiatric conditions treated with and without ECT.
Using data from the Taiwan National Health Insurance Research Database from 1997 to 2013, we identified 828,899 inpatients with psychiatric conditions, among whom 0.19% (n=1571) were treated with ECT.
We found that ECT recipients were more frequently women, were younger and physically healthier, lived in more urbanized areas, were treated in medical centers, and had longer hospital stays. ECT recipients had lower odds of in-hospital mortality than did those who did not receive ECT. Moreover, no factor was identified as being able to predict mortality in patients who underwent ECT. Among all patients, ECT was not associated with in-hospital mortality after controlling for potential confounders.
ECT was indicated to be safe and did not increase the odds of in-hospital mortality. However, ECT appeared to be administered only on physically healthy but psychiatrically compromised patients, a pattern that is in opposition with the scientific evidence supporting its safety. Moreover, our data suggest that ECT is still used as a treatment of last resort in the era of modern psychiatry.
电休克疗法（ECT）在几种精神疾病的治疗中仍然不可替代。然而，利用国家数据库数据来支持其安全性的证据有限。本研究的目的是调查接受和未接受ECT治疗的精神疾病患者的院内死亡率。
利用1997年至2013年台湾国民健康保险研究数据库的数据，我们识别出828,899名患有精神疾病的住院患者，其中0.19%（n = 1571）接受了ECT治疗。
我们发现接受ECT治疗的患者女性更常见，年龄更小且身体更健康，居住在城市化程度更高的地区，在医学中心接受治疗，住院时间更长。接受ECT治疗的患者院内死亡几率低于未接受ECT治疗的患者。此外，未发现任何因素能够预测接受ECT治疗患者的死亡率。在所有患者中，在控制潜在混杂因素后，ECT与院内死亡率无关。
ECT被证明是安全的，且不会增加院内死亡几率。然而，ECT似乎仅用于身体状况良好但有精神问题的患者，这种模式与支持其安全性的科学证据相悖。此外，我们的数据表明，在现代精神病学时代，ECT仍被用作最后的治疗手段。
