Kumar Channaveerachari Naveen, Phutane Vivek Haridas, Thirthalli Jagadisha, Jayaram Naveen, Kesavan Muralidharan, Mehta Urvakhsh Meherwan, Tyagi Vidhi, Gangadhar Bangalore N
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Consultant Psychiatrist, Aged Psychiatric Assessment and Treatment Team (APATT), Goulburn Valley Area Mental Health Service (GVAMHS), GV Health, Shepperton, Melbourne, Australia.
Indian J Psychol Med. 2017 Jul-Aug;39(4):488-494. doi: 10.4103/IJPSYM.IJPSYM_75_17.
Cognitive impairments are among the most important adverse effects of electroconvulsive therapy (ECT). Although much is known about them in patients with depression, there is very little information about these in persons with schizophrenia.
In this study, we examined the persistence of cognitive impairments in a subsample of patients (n = 49) with schizophrenia who had earlier participated in a clinical trial comparing the therapeutic and cognitive efficacy of bifrontal ECT (BFECT; n = 23) and bitemporal ECT (BTECT; n = 29) electrode placements. Total scores on Hindi Mental State Examination, processing speed, working memory, and verbal fluency were assessed in these patients at two points: first, at the end of their respective ECT course and at the follow-up (mean [standard deviation] = 98.7 [38.3] days). The course of cognitive impairments was assessed in all patients (n = 49) as a single group. Further, BFECT and BTECT patients were also compared with one another.
ECT-induced acute cognitive impairments in patients with schizophrenia had normalized by the end of 3 months' follow-up post-ECT. All the tested parameters in the realm of Hindi Mental Status Examination, speed of processing, sequencing, spatial and working memory and verbal fluency showed recovery. Further, across all tests, BFECT and BTECT ultimately had similar scores at the follow-up though BFECT performed relatively better with regards to the acute effects. In fact, worst performing BTECT group caught up to recover to comparable levels of performance by the end of follow-up.
In patients with schizophrenia, most of acute ECT-induced cognitive impairments recover by the end of 3 months' post-ECT. Further, different electrode placements do not seem to make any difference regarding ultimate recovery of cognitive deficits. Future prospective studies are needed that could address the limitations of this study.
认知障碍是电休克治疗（ECT）最重要的不良反应之一。虽然在抑郁症患者中对此了解很多，但关于精神分裂症患者的认知障碍信息却非常少。
在本研究中，我们对一组曾参与比较双额叶ECT（BFECT；n = 23）和双颞叶ECT（BTECT；n = 29）电极放置的治疗及认知效果的临床试验的精神分裂症患者子样本（n = 49）的认知障碍持续性进行了研究。在两个时间点对这些患者进行印地语精神状态检查总分、处理速度、工作记忆和语言流畅性评估：首先，在各自ECT疗程结束时，以及随访时（平均[标准差]= 98.7 [38.3]天）。将所有患者（n = 49）作为一个整体评估认知障碍的病程。此外，还对BFECT组和BTECT组患者进行了相互比较。
ECT引起的精神分裂症患者急性认知障碍在ECT后3个月随访结束时已恢复正常。印地语精神状态检查、处理速度、序列、空间和工作记忆以及语言流畅性方面的所有测试参数均显示恢复。此外，在所有测试中，尽管BFECT在急性效应方面表现相对较好，但BFECT组和BTECT组在随访时最终得分相似。事实上，表现最差的BTECT组在随访结束时赶上并恢复到了相当的表现水平。
在精神分裂症患者中，大多数ECT引起的急性认知障碍在ECT后3个月结束时恢复。此外，不同的电极放置似乎对认知缺陷的最终恢复没有任何影响。未来需要进行前瞻性研究以解决本研究的局限性。
