EUROPEAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY
Summary Goals: Clinically useful predictors of response to electroconvulsive therapy (ECT), especially in the case of bipolar depression, are warranted. The aim of this study was to explore associations between the response and its known and hypothesized correlates. Methods: Six hundred and seventy bipolar depressed patients treated with ECT were included in the study. The association between response (CGI-I ≤ 2) and mean seizure duration, number of treatments, age, sex, bipolar subtype, episode duration, HAM-D and YMRS scores, abnormalities Psychomotor and psychotic symptoms assessed using BPRS-EV were assessed by means of univariate and multivariate logistic regression models, including quadratic and/or linear effects of continuous variables. Results: Four hundred and eighty-three patients (72%) responded. Among known correlates of response, significant quadratic effects were found for seizure duration and number of treatments, while a linear association was confirmed for episode duration. Among the putative correlates, severe motor delay, tension or agitation, hyperactivity, and guilty delusions were significantly associated with responding (p < .01) and a significant quadratic effect was found for the YMRS score (p < .01). ). Conclusion: Bipolar depressed patients with severe psychomotor disorders, mood-congruent delusions, and severe mixed features are highly sensitive to ECT. A significant improvement in response prediction is expected when considering these clinical characteristics. |
One of the largest studies of patients with intractable bipolar disorder has shown that ECT (electroconvulsive therapy) was able to reduce the risk of suicide by 84% in high-risk patients, while also providing effective treatment to about 72% of those. patients.
Bipolar disorder , in which patients are emotionally unstable and can experience very severe mood swings, is among the most common mental health disorders. It affects around 1% of Europeans, which means that approximately 5 million Europeans suffer.
Bipolar disorder can cause mixed states of mania and depression; This combination can lead to an increased risk of suicide, as sufferers may simultaneously experience symptoms of depression (such as feelings of guilt and worthlessness) and symptoms of mania (such as increased activity and the tendency to act without second thought). times). Most patients can control the condition with prescription medications, but nearly a third of patients resist treatment.
Now, the largest study in history to follow bipolar patients and treatment from a single center has confirmed that ECT can reduce the risk of suicide and allow the majority of patients affected by treatment-resistant bipolar illness to return to a more normal life. This work is presented at the ECNP conference, following partial publication in the peer-reviewed journal The World Journal of Biological Psychiatry*.
Between January 2006 and July 2019, 670 patients were referred to the psychiatry clinic of the University of Pisa for ECT treatment for bipolar disorder. Dr Giulio Emilio Brancati, from the Department of Clinical and Experimental Medicine at the University of Pisa, said: “ECT was invented in Italy, but despite this, there are very few clinics in Italy currently offering the treatment. Many patients who have failed other treatments are referred to the Pisa clinic, which is why we were able to collect so much data from a single clinic."
The treatment showed great success in treating bipolar patients, with remission rates of more than 60% for the characteristic symptoms of bipolar "mixed states", such as emotional hyperactivity, motor hyperactivity, aggressiveness and persecutory delusions, lack of cooperation, catatonia and associated movement disorders.
"Most importantly, 77 of our patients were classified as at severe risk for suicide . After treatment, only 2 remained at severe risk, while 65 showed no risk at all. This is an 84% decrease in suicide. "after ECT treatment. We have not found this level of acute improvement with any other treatment," said Giulio Brancati. He continued:
"This is a real-life study , not a clinical trial. A formal trial would have been difficult and probably unethical in these patients, many of whom were seriously ill. They were typically referred to us only after multiple treatment failures. treatment, so most of these patients were running out of treatment options. When we sampled the patients who came to us, we found that about 93% had tried and failed with drug treatment, 88% had failed with 2 different medications. In fact, on average, every patient who came to us had tried 5 different drugs, without success."
The public tends to have a negative view of ECT, largely based on media representation of the very different psychiatric world of the 1950s, but patients and psychiatrists are generally positive about the effects of ECT under conditions of mental health that would otherwise be untreatable or difficult to treat.
Modern ECT is administered under general anesthesia and can lead to rapid recovery from major depression (the main side effect is a possible transient loss of recent memory). It is typically administered 2 to 3 times a week, with 6 to 16 treatments needed to show a positive effect.
The use of ECT overall has recently dropped by about a third in the US. This is despite the success of the treatment and the willingness of famous sufferers, such as Carrie Fisher, to come forward and talk about their treatment. Although ECT was invented in Italy, use of the technique is extremely restricted, resulting in Italy having fewer specialized ECT centers than most other countries of comparable size.
"ECT is used for major depression , but much less so for the other phases of bipolar disorder, especially so-called mixed states, which have lower visibility. We find that many patients with treatment-resistant catatonic and mixed bipolar states are misdiagnosed like having schizophrenia. These patients should be given a chance through appropriate treatment," said Giulio Brancati.
Commenting, Dr Henricus Ruhe, Psychiatrist at Radboudumc Netherlands and Chair of the ECNP Abstract and Poster Committee, said:
"This study shows once again that ECT can be a life-saving treatment and patients suffering from difficult-to-treat mood disorders such as bipolar disorder should not be withheld. Although we must recognize the adverse effects such as memory deficits (mostly temporary), these results show how well and often how fast the response to ECT can be.
This effectiveness generally outweighs the adverse effects in these seriously ill patients, who might otherwise suffer for much longer or receive no effective treatment.
Unfortunately, despite long-term evidence, ECT is still considered a controversial treatment by the general public and the media, but so are many patients and families. This is also the case in Italy, where very few centers can offer ECT today. This prejudice against modern ECT unfairly stigmatizes both patients and psychiatry, and denies treatment to seriously ill patients."
