From the University Department, Psychiatric Hospital Duffel, Duffel.
Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine and Health Sciences.
J ECT. 2019 Dec;35(4):238-244. doi: 10.1097/YCT.0000000000000610.
The presence of psychotic symptoms is an important predictor of responsiveness to electroconvulsive therapy (ECT). This study investigates whether a continuous severity measure, the Psychotic Depression Assessment Scale (PDAS), is a more accurate predictor.
Depression severity was assessed before and after the ECT course using the Montgomery-Asberg Depression Rating Scale (MADRS) in 31 patients with psychotic depression and 34 depressed patients without psychotic symptoms. Logistic regression models for MADRS response and remission were fitted, with either the PDAS total score or the dichotomous predictors "absence/presence of psychotic symptoms" as the independent variables. Age, episode duration, and treatment resistance were added as covariates.
Both the asserted presence of psychotic symptoms and a higher PDAS total score reflected MADRS response (areas under the curve, 0.83 and 0.85, respectively), with MADRS remission also being predicted by the presence of psychotic symptoms and higher PDAS scores (areas under the curves, 0.86 and 0.84, respectively). Age was a contributor to these prediction models, with response and remission rates being highest in the older patients. Psychotic Depression Assessment Scale scores decreased significantly during ECT: at end point, 81.5% of the patients showed significant response and 63.9% had achieved remission.
The PDAS indeed accurately predicts response to and remission after ECT in (psychotic) depression and most pronouncedly so in older patients but seems to have no clear advantage over simply verifying the presence of psychotic symptoms. This could be the consequence of a ceiling effect, as ECT was extremely effective in patients with psychotic depression.ClinicalTrials.gov: Identifier: NCT02562846.
精神病症状的存在是对电抽搐治疗（ECT）反应性的重要预测指标。本研究调查了连续严重程度衡量指标——精神病性抑郁评估量表（PDAS）是否是更准确的预测指标。
在 31 例精神病性抑郁症患者和 34 例无精神病症状的抑郁症患者中，使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）在 ECT 疗程前后评估抑郁严重程度。使用 PDAS 总分或二分预测因子“有无精神病症状”作为自变量拟合 MADRS 反应和缓解的逻辑回归模型。年龄、发作持续时间和治疗抵抗作为协变量添加。
精神病症状的存在和 PDAS 总分较高均反映了 MADRS 反应（曲线下面积分别为 0.83 和 0.85），精神病症状的存在和 PDAS 得分较高也预测了 MADRS 缓解（曲线下面积分别为 0.86 和 0.84）。年龄是这些预测模型的一个贡献因素，年龄较大的患者反应率和缓解率最高。PDAS 在 ECT 过程中显著降低：在终点时，81.5%的患者表现出明显的反应，63.9%的患者达到缓解。
PDAS 确实能准确预测（精神病性）抑郁症患者对 ECT 的反应和缓解，在年龄较大的患者中最为明显，但似乎并没有明显优于简单验证精神病症状的存在。这可能是由于天花板效应，因为 ECT 在精神病性抑郁症患者中非常有效。
ClinicalTrials.gov：标识符：NCT02562846。
