Chaudhary Ankit, Maggu Gaurav, Chaudhury Suprakash, Saldanha Daniel
Department of Psychiatry, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
Department of Psychiatry, Jaipur National University Institute for Medical Sciences and Research Centre, Jagatpura, Jaipur, Rajasthan, India.
Ind Psychiatry J. 2025 Jan-Apr;34(1):67-75. doi: 10.4103/ipj.ipj_131_23. Epub 2023 Dec 14.
The memory-related side-effects rank among the strongest reasons for hostility against Modified Electroconvulsive Therapy (MECT). Most of the studies comparing the Unilateral v/s Bilateral Electrode placements on memory have been conducted on patients with depression while very few studies have been conducted on patients with psychosis in the Indian population.
To compare the effects of right unilateral (RU/L) and bilateral (B/L) MECT on the severity of symptoms as well as memory in patients with psychosis after the fourth session and two weeks after the final session of the MECT.
One hundred patients having a psychotic illness were randomized into either RU/L or B/L group. Comprehensive psychopathological rating scale (CPRS), clinical global impressions scale (CGI-S), and PGI-memory scale were applied before starting of MECT, after four sessions of MECT and two weeks after the last session of ECT.
The results show similar symptomatic improvement in patients receiving RU/L and B/L MECT and the results persisted beyond the therapy sessions. But, in the case of RU/L-MECT group, the deterioration in memory was less as compared to the B/L-MECT group. Both groups had no significant difference in psychopathology and its severity (CPRS and CGI). Both groups were significantly different in memory side effects after the fourth session and two weeks after the last session. Both groups showed a consistent downward trend in psychopathology and its severity. The consistent fall in the total PGI scores remained even after two weeks of the final session in the B/L group (total of six points as compared to baseline) while it came to baseline levels in the RU/L group. Both groups differed significantly in total PGI scores after the fourth session and two weeks after the final session.
This study points toward a favorable outcome in the case of therapeutic response with MECT without any significant difference between both types of electrode placements and even after stopping MECT, the improvement appears to be stable over time. Although, there was a side-effect of memory impairment, it appears to be for a shorter duration and it improves with time. The side-effect profile of RU/L electrode placement is lower as compared to bilateral placement. In the post-MECT period, the patients receiving MECT with RU/L electrode placement showed better improvement in memory functions.
与记忆相关的副作用是反对改良电休克治疗（MECT）的最主要原因之一。大多数比较单侧与双侧电极放置对记忆影响的研究是在抑郁症患者中进行的，而在印度人群中，针对精神病患者的此类研究非常少。
比较右侧单侧（RU/L）和双侧（B/L）MECT对精神病患者在MECT第四疗程后以及最后一个疗程后两周的症状严重程度和记忆的影响。
100例患有精神疾病的患者被随机分为RU/L组或B/L组。在MECT开始前、MECT四个疗程后以及ECT最后一个疗程后两周，应用综合精神病理学评定量表（CPRS）、临床总体印象量表（CGI-S）和PGI记忆量表。
结果显示，接受RU/L和B/L MECT的患者在症状改善方面相似，且这种改善在治疗疗程结束后仍持续存在。但是，与B/L-MECT组相比，RU/L-MECT组的记忆衰退程度较小。两组在精神病理学及其严重程度（CPRS和CGI）方面无显著差异。两组在第四疗程后以及最后一个疗程后两周的记忆副作用方面有显著差异。两组在精神病理学及其严重程度方面均呈现出持续下降的趋势。B/L组在最后一个疗程两周后，PGI总分仍持续下降（与基线相比总共下降6分），而RU/L组则恢复到基线水平。两组在第四疗程后以及最后一个疗程后两周的PGI总分有显著差异。
本研究表明，MECT治疗反应良好，两种电极放置方式之间无显著差异，甚至在停止MECT后，随着时间推移改善效果似乎稳定。虽然存在记忆损害的副作用，但似乎持续时间较短且会随时间改善。与双侧放置相比，RU/L电极放置的副作用较小。在MECT后阶段，接受RU/L电极放置MECT的患者在记忆功能方面显示出更好的改善。
