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[电休克治疗的有效性和耐受性:从患者角度看临床反应的影响]

[Effectiveness and tolerability of electroconvulsive therapy : Influence of clinical response from the patient's point of view].

作者信息

Belz M, Besse M, Krech L, Methfessel I, Zilles D

机构信息

Klinik für Psychiatrie und Psychotherapie, Station 4193, Universitätsmedizin Göttingen, v. Siebold-Str. 3, 37075, Göttingen, Deutschland.

出版信息

Nervenarzt. 2018 Nov;89(11):1271-1276. doi: 10.1007/s00115-018-0604-3.

DOI:10.1007/s00115-018-0604-3
PMID:30171302
Abstract

BACKGROUND

Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients’ view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response.

MATERIAL AND METHODS

In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI-II).

RESULTS

Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients’ rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate.

CONCLUSION

Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients’ perspective.

摘要

背景

电休克疗法(ECT)对于普通大众和精神科医生而言,都是一种高效但仍具争议的治疗方法。在本研究中,我们在考虑个体临床反应的情况下,调查了患者对电休克疗法有效性和耐受性的看法。

材料与方法

对31例重度抑郁症患者,在ECT治疗前、治疗期间和治疗后,通过一份详细的问卷评估主观有效性和耐受性。使用蒙哥马利-奥斯伯格抑郁评定量表(MADRS)和贝克抑郁量表第二版(BDI-II)对症状进行评分。

结果

患者在治疗前和治疗后均认为ECT总体有效。这一观点与他们个体的治疗效果无关。相比之下,患者对个体有效性的评分取决于其症状的客观改善情况。副作用总体被评为轻度至中度。

结论

在对ECT持续存在批评的背景下,相关患者的观点为我们对这种治疗方法进行恰当判断提供了重要参考。结果表明,从患者角度来看,ECT的效益风险比良好。

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本文引用的文献

1
Influence of depressed patients' expectations prior to electroconvulsive therapy on its effectiveness and tolerability (Exp-ECT): a prospective study.电抽搐治疗前抑郁患者预期对其疗效和耐受性的影响(Exp-ECT):一项前瞻性研究。
Eur Arch Psychiatry Clin Neurosci. 2018 Dec;268(8):809-817. doi: 10.1007/s00406-017-0840-8. Epub 2017 Sep 22.
2
The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis.电休克治疗的死亡率:一项系统评价与汇总分析
Acta Psychiatr Scand. 2017 May;135(5):388-397. doi: 10.1111/acps.12721. Epub 2017 Mar 23.
3
The experience of electroconvulsive therapy and its impact on associated stigma: A meta-analysis.
电抽搐治疗的体验及其对相关耻辱感的影响:一项荟萃分析。
Int J Soc Psychiatry. 2016 Dec;62(8):708-718. doi: 10.1177/0020764016675379. Epub 2016 Oct 26.
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A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study.老年抑郁症维持性电休克治疗的新策略:PRIDE研究的第二阶段
Am J Psychiatry. 2016 Nov 1;173(11):1110-1118. doi: 10.1176/appi.ajp.2016.16010118. Epub 2016 Jul 15.
5
Right Unilateral Ultrabrief Pulse ECT in Geriatric Depression: Phase 1 of the PRIDE Study.老年抑郁症的右侧单侧超短脉冲电休克治疗:PRIDE研究的第一阶段。
Am J Psychiatry. 2016 Nov 1;173(11):1101-1109. doi: 10.1176/appi.ajp.2016.15081101. Epub 2016 Jul 15.
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Response of depression to electroconvulsive therapy: a meta-analysis of clinical predictors.抑郁症对电休克治疗的反应:临床预测因素的荟萃分析
J Clin Psychiatry. 2015 Oct;76(10):1374-84. doi: 10.4088/JCP.14r09528.
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Electroconvulsive therapy: a review of knowledge, experience and attitudes of patients concerning the treatment.电抽搐治疗:对患者关于治疗的知识、经验和态度的回顾。
World J Biol Psychiatry. 2010 Apr;11(3):525-37. doi: 10.3109/15622970903559925.
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Electroconvulsive therapy: Part II: a biopsychosocial perspective.电休克治疗:第二部分:生物心理社会视角。
J Psychiatr Pract. 2009 Sep;15(5):369-90. doi: 10.1097/01.pra.0000361278.73092.85.
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Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report.急性电休克治疗(ECT)对重度抑郁症的反应速度和缓解情况:电休克治疗研究联盟(CORE)报告
J Clin Psychiatry. 2004 Apr;65(4):485-91. doi: 10.4088/jcp.v65n0406.
10
Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis.电休克治疗在抑郁症中的疗效与安全性:一项系统评价和荟萃分析
Lancet. 2003 Mar 8;361(9360):799-808. doi: 10.1016/S0140-6736(03)12705-5.