Thomsen Rasmus Bengt, Salagre Estela, Rohde Christopher, Østergaard Søren Dinesen
Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Bipolar Disord. 2024 Dec;26(8):785-792. doi: 10.1111/bdi.13485. Epub 2024 Aug 12.
Electroconvulsive therapy (ECT) is an effective treatment for bipolar disorder, but relapse following a successful ECT series is common. We aimed to identify clinical and sociodemographic characteristics associated with the risk of relapse following ECT in bipolar disorder.
Using data from nationwide Danish registers, we identified all patients receiving their first ECT series with an indication diagnosis of bipolar disorder between 2006 and 2018. We then followed these patients for relapse, defined as either psychiatric admission or a new ECT series, for 6 months following ECT. Associations between clinical and sociodemographic characteristics and relapse were examined via multivariable Cox proportional-hazards regression, yielding adjusted hazard rate ratios (aHRR).
Of the 1473 patients receiving ECT for bipolar disorder (62% females, mean age = 53 years), 34% met the relapse criterion. The following characteristics were associated with an elevated risk of relapse; age <40 (aHRR = 1.54, 95% CI = 1.05-2.26); being a pensioner (aHRR = 1.73, 95% CI = 1.29-2.32), indication diagnosis for ECT being psychotic mania (aHRR = 1.63, 95% CI = 1.16-2.28), psychotic bipolar depression (aHRR = 1.37, 95% CI = 1.06-1.80), mixed episode (aHRR = 1.51, 95% CI = 1.13-2.02), or other bipolar episodes (aHRR = 1.68, 95% CI = 1.28-2.21); and treatment with antipsychotics prior to the course of ECT (aHRR = 1.32, 95% CI = 1.04-1.67).
Patients with bipolar disorder face a particularly high risk of relapse following ECT if they present with the following characteristics when initiating ECT: age <40, being a pensioner, having received treatment with an antipsychotic before initiating ECT, or having psychotic bipolar depression, psychotic mania, mixed episodes, or other bipolar episodes as the indication for ECT. These findings may guide relapse monitoring following ECT in bipolar disorder.
电休克治疗（ECT）是双相情感障碍的一种有效治疗方法，但在成功完成一系列ECT治疗后复发很常见。我们旨在确定与双相情感障碍患者ECT治疗后复发风险相关的临床和社会人口学特征。
利用丹麦全国登记处的数据，我们确定了2006年至2018年间所有接受首次ECT治疗且适应症诊断为双相情感障碍的患者。然后，我们对这些患者进行随访，观察ECT治疗后6个月内的复发情况，复发定义为精神科住院或新的ECT治疗系列。通过多变量Cox比例风险回归分析临床和社会人口学特征与复发之间的关联，得出调整后的风险率比值（aHRR）。
在1473例接受ECT治疗的双相情感障碍患者中（62%为女性，平均年龄 = 53岁），34%符合复发标准。以下特征与复发风险升高相关：年龄<40岁（aHRR = 1.54，95%CI = 1.05 - 2.26）；退休人员（aHRR = 1.73，95%CI = 1.29 - 2.32），ECT的适应症诊断为精神病性躁狂（aHRR = 1.63，95%CI = 1.16 - 2.28）、精神病性双相抑郁（aHRR = 1.37，95%CI = 1.06 - 1.80）、混合发作（aHRR = 1.51，95%CI = 1.13 - 2.02）或其他双相发作（aHRR = 1.68，95%CI = 1.28 - 2.21）；以及在ECT疗程前使用抗精神病药物治疗（aHRR = 1.32，95%CI = 1.04 - 1.67）。
双相情感障碍患者在开始ECT治疗时若具有以下特征，则在ECT治疗后复发风险特别高：年龄<40岁、退休人员、在开始ECT治疗前接受过抗精神病药物治疗、或ECT的适应症为精神病性双相抑郁、精神病性躁狂、混合发作或其他双相发作。这些发现可能为双相情感障碍患者ECT治疗后的复发监测提供指导。
