成功进行电休克治疗后导致重度抑郁症复发的因素：一项回顾性队列研究。
Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy: A retrospective cohort study.
作者信息
Kurimoto Naoki, Inagaki Takahiko, Aoki Takashi, Kadotani Hiroshi, Kurimoto Fujiki, Kuriyama Kenichi, Yamada Naoto, Ozeki Yuji
机构信息
Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan.
Department of Psychiatry, Shigasato Hospital, Otsu 520-0006, Shiga, Japan.
出版信息
World J Psychiatry. 2021 Oct 19;11(10):841-853. doi: 10.5498/wjp.v11.i10.841.
BACKGROUND
Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD.
AIM
To investigate the diagnostic factors and treatment strategies associated with depression relapse.
METHODS
We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.
RESULTS
Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study. Compared with the MDD participants, more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission (65.6% 15.1%, < 0.001; relative risk = 4.35, 95%CI: 2.19-8.63, < 0.001). Twenty-nine patients experienced relapses during the three-year follow-up. In 21 (72.4%, 21/29) patients with relapse, the diagnosis was changed from MDD to BP. The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients (9.63 ± 10.4 mo 3.38 ± 3.77 mo, = 0.022); for most patients, the interval was less than one month. The relative risk of depressive symptoms based on diagnostic changes was 4.35 (95% confidence interval: 2.19-8.63, < 0.001), and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756 (95%CI: 0.562-0.895, = 0.007).
CONCLUSION
It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.
背景
电休克治疗（ECT）用于治疗重度抑郁症（MDD）。即使ECT治疗成功，且随后给予了充分的MDD药物治疗，仍常观察到复发情况。
目的
研究与抑郁症复发相关的诊断因素和治疗策略。
方法
我们分析了复发、从MDD到双相情感障碍（BP）的诊断变化以及初始ECT治疗后的关系。我们对滋贺医科大学医院的85例患者进行了为期3年的预后回顾性研究。基于从MDD到BP的诊断变化计算抑郁症状复发的相对风险。绘制受试者工作特征（ROC）曲线，以评估基于首次ECT疗程与抑郁症状复发之间的持续时间从MDD到BP的诊断变化的预测准确性。
结果
85例最初诊断为MDD并成功接受ECT治疗的患者纳入研究。与MDD参与者相比，更多的BP患者经历复发，需要继续和/或维持ECT以维持缓解（65.6%对15.1%，P<0.001；相对风险=4.35，95%CI：2.19 - 8.63，P<0.001）。29例患者在三年随访期间经历复发。在21例（72.4%，21/29）复发患者中，诊断从MDD变为BP。BP患者从首次ECT疗程到复发的持续时间比MDD患者短（9.63±10.4个月对3.38±3.77个月，P = 0.022）；对于大多数患者，间隔时间少于1个月。基于诊断变化的抑郁症状相对风险为4.35（95%置信区间：2.19 - 8.63，P<0.001），基于复发持续时间检测诊断变化的ROC曲线下面积为0.756（95%CI：0.562 - 0.895，P = 0.007）。
结论
对于早期复发的患者，怀疑为BP并将治疗策略从MDD改为BP可能有益。
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