Rabheru K, Persad E
University of Western Ontario, London.
Can J Psychiatry. 1997 Jun;42(5):476-84. doi: 10.1177/070674379704200503.
Many patients with major psychiatric disorders who are severely ill, medication-resistant, or medication-intolerant respond more reliably and quickly to a course of electroconvulsive therapy (ECT). The management of such patients after successful treatment with ECT is of significant importance given the high rate of relapse and recurrence of these disorders. The unmet clinical need to maintain the mental health of these seriously ill patients at an optimal level has revived the interest in ECT as an alternative prophylactic treatment.
We review the historical background of ECT and the literature that supports its use as a prophylactic treatment in various disorders and special populations. A clinical summary outlining its efficacy, acceptability, risks, cost-effectiveness, and medicolegal aspects is followed by a guide for prescribing ECT for prophylactic reasons.
Continuation and maintenance ECT (C/MECT) has been found to be efficacious, safe, well tolerated, and cost-effective. Its greatest impact has been in reducing relapse, recurrence, and rehospitalization, particularly in the management of recurrent mood disorders in the elderly. The elderly are usually refractory or intolerant to pharmacotherapy but have a good response to ECT during the index episode. Parkinson's disease (PD), schizophrenia, and obsessive-compulsive disorder (OCD), as well as affective disorders coexisting with dementia, neurological disorder, or mental retardation, have also been reported to respond to C/MECT. The outcome depends greatly on rate of compliance. Cognitive risk of C/MECT need to be further studied because the literature to date consists mostly of case reports and anecdotal evidence. Controlled studies with well-defined outcome measurements are needed.
When planning a rational approach to the care of patients with major psychiatric disorders, clinicians should carefully consider ECT along with other alternatives.
许多患有严重精神疾病、药物难治或药物不耐受的患者对电休克治疗（ECT）疗程的反应更可靠、更迅速。鉴于这些疾病的高复发率，成功接受ECT治疗后对这类患者的管理至关重要。将这些重症患者的心理健康维持在最佳水平这一未满足的临床需求，重新激发了人们对ECT作为一种替代预防性治疗方法的兴趣。
我们回顾了ECT的历史背景以及支持其在各种疾病和特殊人群中用作预防性治疗的文献。在概述其疗效、可接受性、风险、成本效益和法医学方面的临床总结之后，给出了出于预防原因开具ECT处方的指南。
已发现持续和维持性ECT（C/MECT）有效、安全、耐受性良好且具有成本效益。其最大的影响在于减少复发、再发和再住院，特别是在老年复发性情绪障碍的管理方面。老年人通常对药物治疗难治或不耐受，但在首次发作期间对ECT反应良好。帕金森病（PD）、精神分裂症和强迫症（OCD），以及与痴呆症、神经系统疾病或智力障碍共存的情感障碍，也据报道对C/MECT有反应。结果在很大程度上取决于依从率。C/MECT的认知风险需要进一步研究，因为迄今为止的文献大多由病例报告和轶事证据组成。需要进行具有明确结果测量的对照研究。
在规划对患有严重精神疾病患者的合理护理方法时，临床医生应与其他替代方法一起仔细考虑ECT。
