Dos Santos-Ribeiro Samara, de Salles Andrade Juliana B, Quintas Julliana N, Baptista Karina B, Moreira-de-Oliveira Maria E, Yücel Murat, Fontenelle Leonardo F
Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
Prim Care Companion CNS Disord. 2018 Oct 18;20(5):18r02342. doi: 10.4088/PCC.18r02342.
To assess the efficacy of electroconvulsive therapy (ECT) in DSM-5 obsessive-compulsive-related disorders (OCRDs) and conditions subsumed under an "extended" OCD spectrum, including tic disorders and self-injurious behaviors.
A systematic search of the MEDLINE, Web of Science, Scopus, and LILACS databases and other sources was performed between June 6 and July 2, 2017. Search terms included (Autis*) AND (ECT OR electroconvulsive), (Self-injur*) AND (ECT OR electroconvulsive), (Tic* OR Tourette) AND (ECT OR electroconvulsive), (Body Dysmorphic Disorder OR Dysmorphophobi*) AND (ECT OR electroconvulsive), (Hoard*) AND (ECT OR electroconvulsive), (Trichotillomani*) AND (ECT OR electroconvulsive), (Skin Picking OR Excoriation) AND (ECT OR electroconvulsive), (Grooming) AND (ECT OR electroconvulsive), (Kleptomani*) AND (ECT OR electroconvulsive), and (Pyromani*) AND (ECT OR electroconvulsive). No search restrictions (ie, date, language, or document type) were used.
Fifty-two records that described the individual responses of OCRDs to ECT (involving 69 patients) were selected.
Clinical data and responses of individual cases were recorded. Data from responders were compared to nonresponders.
All records were case reports or case series; there were no randomized controlled trials. Of the 69 OCRD participants who had undergone ECT, a positive response was reported in 73.4% of the cases (including 44.0% of the BDD, 74.1% of the tic disorder, and 85.7% of the self-injurious behavior patients). At follow-up, the majority of responders who had abstained from further ECT had experienced relapse. However, a positive response was obtained in all participants who received a new course of ECT. Patients who responded positively to ECT were likely to report previous unsuccessful treatment with antipsychotics (P < .001) and antidepressants (P = .007).
The finding that more than 70% of the reviewed cases showed some response to ECT should not be considered unequivocal evidence of its efficacy in OCRDs. The available evidence suggests that a randomized controlled trial of ECT in OCRDs may be warranted, particularly in severe tic disorders and self-injurious behaviors.
评估电休克治疗（ECT）对《精神疾病诊断与统计手册》第5版（DSM-5）中强迫症相关障碍（OCRD）以及纳入“扩展”强迫症谱系的疾病（包括抽动障碍和自伤行为）的疗效。
于2017年6月6日至7月2日对MEDLINE、科学网、Scopus和LILACS数据库以及其他来源进行了系统检索。检索词包括（孤独症*）与（ECT或电休克）、（自伤*）与（ECT或电休克）、（抽动或图雷特）与（ECT或电休克）、（躯体变形障碍或畸形恐惧症）与（ECT或电休克）、（囤积*）与（ECT或电休克）、（拔毛癖*）与（ECT或电休克）、（皮肤搔抓或皮肤搔抓障碍）与（ECT或电休克）、（修饰行为）与（ECT或电休克）、（偷窃癖*）与（ECT或电休克）以及（纵火狂*）与（ECT或电休克）。未使用任何检索限制（即日期、语言或文献类型）。
选取了52篇描述OCRD对ECT个体反应的记录（涉及69例患者）。
记录了个体病例的临床数据和反应。将有反应者的数据与无反应者进行比较。
所有记录均为病例报告或病例系列；无随机对照试验。在接受ECT的69例OCRD参与者中，73.4%的病例报告有阳性反应（包括44.0%的躯体变形障碍、74.1%的抽动障碍和85.7%的自伤行为患者）。在随访中，大多数已停止进一步ECT治疗的有反应者出现了复发。然而，所有接受新一轮ECT治疗的参与者均获得了阳性反应。对ECT有阳性反应的患者可能报告既往使用抗精神病药物（P <.001）和抗抑郁药物（P =.007）治疗未成功。
超过70%的 reviewed 病例对ECT有某种反应这一发现不应被视为其对OCRD疗效的确凿证据。现有证据表明，可能有必要对OCRD患者进行ECT的随机对照试验，特别是在严重抽动障碍和自伤行为患者中。
