Bağcaz Arda, Başar Koray
From the Department of Psychiatry, Başkent University Faculty of Medicine.
Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.
J ECT. 2023 Mar 1;39(1):15-22. doi: 10.1097/YCT.0000000000000864. Epub 2022 Jun 11.
The study aimed to investigate the effectiveness of maintenance electroconvulsive therapy (mECT) with respect to the hospitalization duration, number of hospitalizations, and major and minor treatment changes with a mirror-image study design.
Medical charts of patients who received at least a 3-month-long course of mECT were reviewed. The records of 36 patients (17 with psychotic disorders, 19 with affective disorders) were retrospectively examined for 2 periods with the same duration; during the mECT (post-mECT) and before the mECT (pre-mECT). The hospitalization duration, the number of hospitalizations, and major and minor treatment changes, which were assumed to provide information on the effectiveness of the interventions, were recorded and compared between these periods. Statistical analysis was performed using generalized estimating equation models conducted with age, diagnostic category, and observation time as covariates. In addition, the relapse and recurrence rates and time to relapse/recurrence were analyzed.
Comparison of pre-mECT and post-mECT periods revealed that mECT, applied in an individualized schedule combined with pharmacotherapy, was associated with a lower frequency ( P < 0.001; rate ratio [RR], 0.161; 95% confidence interval [CI], 0.087-0.297), shorter duration of hospitalization ( P < 0.001; RR, 0.123; 95% CI, 0.056-0.271), and lower number of major treatment changes ( P = 0.007; RR, 0.522; 95% CI, 0.324-0.840), irrespective of diagnoses. The relapse/recurrence rates were similar in the 2 diagnostic categories ( P = 1.000; 26.3% vs 29.4%).
Maintenance ECT should be increasingly considered an important treatment modality in patients with affective and psychotic disorders after an effective course of ECT.
本研究旨在采用镜像研究设计，探讨维持性电休克治疗（mECT）在住院时间、住院次数以及主要和次要治疗变化方面的有效性。
回顾了接受至少为期3个月mECT疗程患者的病历。对36例患者（17例患有精神障碍，19例患有情感障碍）的记录进行了回顾性检查，分为两个时长相同的时期；mECT期间（mECT后）和mECT之前（mECT前）。记录并比较这两个时期的住院时间、住院次数以及主要和次要治疗变化，这些被认为可提供干预有效性的信息。使用以年龄、诊断类别和观察时间作为协变量的广义估计方程模型进行统计分析。此外，还分析了复发率、再发率以及复发/再发时间。
mECT前和mECT后时期的比较显示，以个体化方案联合药物治疗应用的mECT与较低频率（P<0.001；率比[RR]，0.161；95%置信区间[CI]，0.087 - 0.297）、较短住院时间（P<0.001；RR，0.123；95%CI，0.056 - 0.271）以及较少的主要治疗变化次数（P = 0.007；RR，0.522；95%CI，0.324 - 0.840）相关，与诊断无关。两个诊断类别中的复发/再发率相似（P = 1.000；26.3%对29.4%）。
在有效疗程的电休克治疗后，维持性电休克治疗应越来越被视为情感障碍和精神障碍患者的一种重要治疗方式。
