Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Cliníc de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de investigación biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain.
Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Cliníc de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de investigación biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain; Universitat de Barcelona, Spain.
J Affect Disord. 2022 Feb 1;298(Pt A):58-64. doi: 10.1016/j.jad.2021.10.052. Epub 2021 Oct 27.
Maintenance electroconvulsive therapy (mECT) is underused in the treatment of bipolar disorder (BD). We aimed to study the real-life effectiveness of mECT in BD.
Naturalistic 3-year mirror-image study in individuals diagnosed with BD who underwent mECT at a tertiary hospital. Intra-subject comparisons of psychiatric hospitalization were performed using McNemar test. Days and number of psychiatric hospitalizations before and during mECT were compared through wilcoxon signed-rank test. Mean annual days and mean annual number of psychiatric hospitalizations per patient were compared by means of the rate ratio (RR) estimation through a generalized estimating equation (GEE) model.
A total of 43 patients were included and 37 required psychiatric hospitalization during the study. The use of mECT showed an effectiveness of 62.2% for preventing psychiatric hospitalizations (p<0.01). We found significant reduction in days and number of psychiatric hospitalizations during mECT compared to before mECT (p<0.01). Comparison of the 3-year period before/during mECT showed a reduction in mean annual days (RR=0.14; 95%CI: 0.07-0.29) and mean annual number (RR=0.24; 95%CI: 0.13-0.43) of psychiatric hospitalizations, without substantial changes for adjusted models for gender and age of onset of the illness.
The main limitations of this study consisted of the mirror-image retrospective naturalistic study design, the relatively small sample size, and possibly patient selection bias.
mECT reduced the number of psychiatric hospitalizations and hospitalization days in BD. The use of mECT outlines a mood stabilizing effect in BD. This naturalistic study supports the effectiveness of mECT in BD across several mood states.
维持性电抽搐治疗（mECT）在双相情感障碍（BD）的治疗中未得到充分应用。我们旨在研究 mECT 在 BD 中的实际疗效。
对在一家三级医院接受 mECT 的 BD 患者进行了为期 3 年的自然镜像研究。使用 McNemar 检验对精神病住院情况进行了个体内比较。通过 Wilcoxon 符号秩检验比较了 mECT 前后的天数和精神病住院次数。通过广义估计方程（GEE）模型的率比（RR）估计，比较了每位患者的平均年住院天数和平均年住院次数。
共纳入 43 例患者，研究期间 37 例需要住院治疗。mECT 的使用对预防精神病住院的有效性为 62.2%（p<0.01）。与 mECT 前相比，我们发现 mECT 期间的住院天数和次数显著减少（p<0.01）。mECT 前后 3 年期间的比较显示，平均年住院天数（RR=0.14；95%CI：0.07-0.29）和平均年住院次数（RR=0.24；95%CI：0.13-0.43）减少，但性别和发病年龄的调整模型没有实质性变化。
本研究的主要局限性在于镜像回顾性自然研究设计、样本量相对较小以及可能存在患者选择偏倚。
mECT 减少了 BD 的精神病住院次数和住院天数。mECT 的使用在 BD 中具有稳定情绪的作用。这项自然研究支持 mECT 在 BD 中对多种情绪状态的有效性。
