电抽搐治疗与躁狂发作后再入院时间的关系。

Association between electroconvulsive therapy and time to readmission after a manic episode.

机构信息

University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.

出版信息

Acta Psychiatr Scand. 2024 Jul;150(1):22-34. doi: 10.1111/acps.13689. Epub 2024 Apr 11.

DOI:10.1111/acps.13689

PMID:38604233

Abstract

OBJECTIVE

The majority of patients hospitalized for treatment of a manic episode are readmitted within 2 years despite maintenance treatment. Electroconvulsive therapy (ECT) has been associated with lower rehospitalization rates in some psychiatric conditions, but its association with readmission after a manic episode has not been investigated. Therefore, the aim of this study was to determine whether the time to readmission in patients with mania treated with ECT was longer than in patients not treated with ECT and whether there were subgroups of patients that benefited more.

METHODS

This was a nationwide register-based, observational study. All patients diagnosed with bipolar disorder, manic episode, admitted to any hospital in Sweden between 2012 and 2021 were included. Patients contributed data to the study for every admission. All admissions were followed up until psychiatric readmission, death, or the end of the study (December 31, 2021). Association between ECT and time to readmission was analyzed. A paired samples model was performed for 377 patients with at least two admissions for mania, treated with ECT at one admission and without ECT at the other admission. Times to readmission were analyzed.

RESULTS

A total of 12,337 admissions were included; mean (SD) age 47.7 (17.2), 5443 (44.1%) men. Readmission rate within 1 year was 54.6%. ECT was administered in 902 (7.3%) admissions. Within 30 days after admission, 182 out of 894 (20.4%) patients treated with ECT versus 2105 out of 11,305 (18.6%) patients treated without ECT were readmitted. There was no association between ECT and time to readmission (aHR 1.00, 95% CI 0.86-1.16, p = 0.992) in the model with all admissions. The paired samples model included 754 admissions (377 patients), mean (SD) age during admission without ECT was 45.6 (16.5), and with ECT 46.6 (16.4), 147 (39.0%) were men. In that model, readmission rate within 30 days for treatment with ECT was 19.0%, and for treatments without ECT, 24.1% (aHR 0.75, 95% CI 0.55-1.02, p = 0.067).

CONCLUSION

Readmission rates after inpatient treatment of mania were high. ECT was not significantly associated with longer time to readmission, but there was a trend toward a protective effect of ECT when admissions with and without ECT were compared within the same patients.

摘要

目的

尽管进行了维持治疗，但大多数因躁狂发作住院治疗的患者在 2 年内仍会再次入院。电惊厥疗法（ECT）已被证明可降低某些精神疾病的再入院率，但尚未研究其与躁狂发作后再入院的关联。因此，本研究旨在确定接受 ECT 治疗的躁狂症患者的再入院时间是否长于未接受 ECT 治疗的患者，以及是否存在获益更多的亚组患者。

方法

这是一项全国范围内基于登记的观察性研究。所有在 2012 年至 2021 年间在瑞典任何一家医院因双相情感障碍、躁狂发作住院的患者均纳入研究。每位患者的每次入院均为研究提供数据。所有入院均随访至精神科再入院、死亡或研究结束（2021 年 12 月 31 日）。分析 ECT 与再入院时间之间的关系。对至少两次因躁狂发作入院的 377 名患者进行了配对样本模型分析，这些患者在一次入院时接受了 ECT 治疗，另一次入院时未接受 ECT 治疗。分析再入院时间。

结果

共纳入 12337 例入院，平均（SD）年龄为 47.7（17.2）岁，5443 例（44.1%）为男性。1 年内的再入院率为 54.6%。902 例（7.3%）入院中给予了 ECT。在入院后 30 天内，接受 ECT 治疗的 894 名患者中有 182 名（20.4%）和接受无 ECT 治疗的 11305 名患者中有 2105 名（18.6%）再次入院。在包括所有入院的模型中，ECT 与再入院时间之间无关联（调整后危险比 1.00，95%CI 0.86-1.16，p=0.992）。配对样本模型纳入了 754 例入院（377 例患者），无 ECT 入院时的平均（SD）年龄为 45.6（16.5）岁，ECT 为 46.6（16.4）岁，147 例（39.0%）为男性。在该模型中，ECT 治疗后 30 天内的再入院率为 19.0%，无 ECT 治疗的再入院率为 24.1%（调整后危险比 0.75，95%CI 0.55-1.02，p=0.067）。