超短右单侧电惊厥疗法治疗老年期双相情感障碍。

Ultra-brief right unilateral electroconvulsive therapy for the treatment of late-life bipolar disorder.

机构信息

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory Brain Health Center, 12 Executive Park Drive, Atlanta, GA, 30322, USA.

出版信息

J Affect Disord. 2021 Jul 1;290:197-201. doi: 10.1016/j.jad.2021.04.028. Epub 2021 Apr 25.

DOI:10.1016/j.jad.2021.04.028

PMID:34004401

Abstract

BACKGROUND

Bipolar Affective Disorder (BPAD) accounts for 10-25% of all mood disorders in the geriatric population and 5% of all inpatient admissions to geropsychiatric units. Electroconvulsive therapy (ECT) is an effective treatment for all phases of BPAD, though only a few studies have focused on BPAD in the geriatric population. This study examines the safety and efficacy of ultra-brief right unilateral (UBRUL) ECT for patients with late-life bipolar depression (BD).

METHODS

A retrospective chart review was conducted of patients with late-life BD who received UBRUL ECT treatments. Symptomatic response was measured using pre- and post-ECT Quick Inventory of Depressive Symptomatology (QIDS-SR16) and Beck Depression Inventory (BDI-II) scores. Clinical improvement and cognitive change were measured using Clinical Global Impression-Improvement (CGI-I) and Electroconvulsive Cognitive Assessment (ECCA) scores.

RESULTS

Twenty-Seven elderly patients (mean age 69.1 ± 7.7 years) were included in the analysis. Baseline QIDS-SR16 was 17.3 ± 5.3 and BDI-II 30.0 ± 9.2. 80.0% (16/20) and 57.1% (4/7) of patients achieved response (50.0% decline) in their QIDS-SR16 and BDI-II scores, respectively. Remission rates in QIDS-SR16 (post-ECT scores ≤5) and BDI-II (post-ECT scores ≤12) were 65.0% (13/20) and 42.9% (3/7), respectively. Mean QIDS-SR16 and BDI-II scores were reduced by a statistically significant 68.2% and 50.5%, respectively (two-tailed, paired p-values <0.01) after ECT. CGI-I of ≤2 was attained by 85.2% (23/27) of patients. 85.7% (12/14) of patients saw no change or improvement in ECCA scores.

LIMITATIONS

Inherent complications of chart review regarding quality, availability, and homogeny of data.

CONCLUSIONS

UBRUL ECT is a safe and effective treatment for patients presenting with late-life BD.

摘要

背景

双相情感障碍（BPAD）占老年人群中所有情绪障碍的 10-25%，占老年精神科住院患者的 5%。电抽搐治疗（ECT）是治疗 BPAD 所有阶段的有效方法，尽管只有少数研究关注老年人群中的 BPAD。本研究检查了超短右单侧（UBRUL）ECT 治疗老年期双相抑郁（BD）患者的安全性和有效性。

方法

对接受 UBRUL ECT 治疗的老年期 BD 患者进行回顾性图表审查。使用治疗前后的抑郁症状快速清单（QIDS-SR16）和贝克抑郁量表（BDI-II）评分来衡量症状反应。使用临床总体印象-改善（CGI-I）和电抽搐认知评估（ECCA）评分来衡量临床改善和认知变化。

结果

共纳入 27 例老年患者（平均年龄 69.1 ± 7.7 岁）进行分析。基线 QIDS-SR16 为 17.3 ± 5.3，BDI-II 为 30.0 ± 9.2。QIDS-SR16（下降 50%）和 BDI-II（下降 50%）评分分别有 80.0%（16/20）和 57.1%（4/7）的患者达到反应。QIDS-SR16（ECT 后评分≤5）和 BDI-II（ECT 后评分≤12）的缓解率分别为 65.0%（13/20）和 42.9%（3/7）。ECT 后，QIDS-SR16 和 BDI-II 评分分别显著降低 68.2%和 50.5%（双侧，配对 p 值<0.01）。CGI-I≤2 的患者占 85.2%（23/27）。ECCA 评分无变化或改善的患者占 85.7%（12/14）。