Factors associated with early and late response to electroconvulsive therapy

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2023-02-06 DOI:10.1111/acps.13537

Kamber L. Hart, Thomas H. McCoy Jr., Michael E. Henry, Stephen J. Seiner, James Luccarelli

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引用次数: 3

Abstract

Objective

Electroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, yet more research is needed to examine predictors of treatment response, and factors associated with response in patients not initially improving with treatment. This study reports factors associated with time to response (early vs. late) to ECT in a real-world setting.

Methods

This was a retrospective, single-center cohort study of patients endorsing moderate to severe depressive symptoms using the Quick Inventory of Depressive Symptomatology (QIDS; QIDS>10). Response was defined as 50% or greater decrease in QIDS score from baseline. We used logistic regression to predict response at treatment #5 (early response) as well as after treatment #5 (late response) and followed patients through ECT discontinuation or through treatment #20.

Results

Of the 1699 patients included in this study, 555 patients (32.7%) responded to ECT treatment at treatment #5 and 397 (23.4%) responded after treatment #5. Among patients who did not respond by treatment #5, those who switched to brief pulse width ECT from ultrabrief pulse ECT had increased odds of response after treatment #5 compared with patients only receiving ultrabrief pulse (aOR = 1.55, 95% CI: 1.16–2.07). Additionally, patients with less improvement in QIDS from baseline to treatment #5 had decreased odds of response after treatment #5 (aOR = 0.97, 95% CI = 0.97–0.98).

Conclusion

Among depressed patients treated with ECT, response occurred in 56.0% of patients by treatment #20. Patient receiving ultrabrief pulse ECT at baseline and who did not respond by treatment #5 had greater odds of subsequent response if switched to brief pulse ECT than if continued with ultrabrief pulse.

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与电休克治疗早期和晚期反应相关的因素

目的电惊厥治疗(ECT)是治疗重度抑郁症状的有效方法，但尚需进一步研究治疗反应的预测因素，以及治疗初期未改善患者反应的相关因素。本研究报告了现实环境中ECT反应时间(早期和晚期)的相关因素。方法:本研究是一项回顾性、单中心队列研究，采用抑郁症状快速量表(QIDS;QIDS> 10)。应答定义为QIDS评分较基线下降50%或以上。我们使用逻辑回归来预测第5次治疗时(早期反应)和第5次治疗后(晚期反应)的反应，并对患者进行ECT停药或第20次治疗的随访。在本研究纳入的1699例患者中，555例(32.7%)患者在第5次治疗时对ECT治疗有反应，397例(23.4%)患者在第5次治疗后有反应。在第5次治疗无反应的患者中，与仅接受超短脉冲治疗的患者相比，那些从超短脉冲ECT切换到短脉冲宽度ECT的患者在第5次治疗后的反应几率增加(aOR = 1.55, 95% CI: 1.16-2.07)。此外，从基线到第5次治疗，QIDS改善较少的患者在第5次治疗后的缓解几率降低(aOR = 0.97, 95% CI = 0.97 - 0.98)。结论在接受ECT治疗的抑郁症患者中，第20次治疗的有效率为56.0%。在基线时接受超短脉冲电痉挛治疗的患者，如果在第5次治疗中没有反应，那么切换到短脉冲电痉挛治疗比继续使用超短脉冲电痉挛治疗有更大的后续反应几率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.