Ma Yarong, Rosenheck Robert, Ye Biyu, Fan Ni, He Hongbo
Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
Brain Behav. 2020 Jul;10(7):e01654. doi: 10.1002/brb3.1654. Epub 2020 May 13.
Electroconvulsive therapy (ECT) is an effective treatment for patients with mood disorders and is most often used for treatment-resistant cases. This study aimed to examine the effectiveness of ECT in a real-world treatment sample in a Chinese psychiatric hospital which included both treatment-resistant and nontreatment-resistant patients.
An observational study of symptom outcomes from admission to the time of discharge was conducted with 37 inpatients diagnosed with unipolar or bipolar depression treated with ECT. Symptom severity was assessed with the 17-item Hamilton Rating Scales for Depression (HRSD-17) and treatment-resistance with the Maudsley Staging Model (MSM). Stratifying at the MSM median admission characteristics and symptom change was compared between patients who were treatment-resistant (n = 18) and who were not (n = 19). The outcome difference between groups was compared using analyses of covariance adjusted for baseline characteristics including symptom severity, followed by linear regression to identify factors associated symptom improvement in the entire sample.
The sample (n = 37) showed moderate treatment-resistance (MSM = 7.30 ± 1.13) at admission and both groups received 8.3 ± 2 ECT sessions. The treatment-resistant group had a smaller proportion of bipolar patients and more severe symptoms, but showed no significant difference from the nontreatment-resistant group in HDRS-17 scores at the time of discharge (adjusted means = 6.23 ± 1.00 vs. 5.94 ± 0.97, Partial η = 0.001, p = .845). Baseline symptom severity was the strongest correlate of reduction in HDRS-17 scores (β = 0.891, p < .001).
Symptom change with ECT in depression did not differ by level of treatment-resistance but was greatest among those with more severe baseline symptoms. Correlates of ECT effectiveness should be further evaluated in stratified randomized trials.
电休克治疗（ECT）是治疗情绪障碍患者的一种有效方法，最常用于难治性病例。本研究旨在检验ECT在中国一家精神病医院的真实世界治疗样本中的有效性，该样本包括难治性和非难治性患者。
对37例接受ECT治疗的诊断为单相或双相抑郁症的住院患者进行了一项从入院到出院的症状转归观察性研究。使用17项汉密尔顿抑郁评定量表（HRSD - 17）评估症状严重程度，使用莫兹利分期模型（MSM）评估治疗抵抗性。以MSM中位数入院特征进行分层，比较难治性患者（n = 18）和非难治性患者（n = 19）之间的症状变化。使用协方差分析比较两组间的结局差异，并对包括症状严重程度在内的基线特征进行调整，随后进行线性回归以确定整个样本中与症状改善相关的因素。
样本（n = 37）入院时显示出中度治疗抵抗性（MSM = 7.30 ± 1.13），两组均接受了8.3 ± 2次ECT治疗。难治性组双相情感障碍患者比例较小且症状更严重，但出院时在HDRS - 17评分上与非难治性组无显著差异（调整后均值 = 6.23 ± 1.00 vs. 5.94 ± 0.97，偏η² = 0.001，p = 0.845）。基线症状严重程度是HDRS - 17评分降低的最强相关因素（β = 0.891，p < 0.001）。
ECT治疗抑郁症时症状变化不因治疗抵抗程度而异，但在基线症状更严重的患者中变化最大。ECT有效性的相关因素应在分层随机试验中进一步评估。
