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Abstract：
Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a \"mirror image\" design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5-10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.
摘要：
背景和目的：1967年，S.Mentzos首次将短周期范围内不稳定的混合发作或相反情感两极之间的快速切换描述为复杂的多态状态，躁狂和抑郁症状混沌重叠。众所周知的例子包括抗抑郁药引起的躁狂/轻躁狂和快速/超快速/超拉迪安循环，当临床医生观察到几乎连续的混合状态，躁狂或抑郁症状的优势不断变化时。在这些情况下实现稳定缓解是具有挑战性的，几乎没有基于证据的治疗数据。当情绪稳定剂无效时，电惊厥治疗（ECT）已被建议。目标：在回顾了现有文献中的证据后，本文介绍了我们对超快循环双相障碍（BD）和不稳定混合状态患者的ECT疗效和耐受性的临床经验。材料和方法：我们进行了公开的，为期一年的观察性前瞻性研究，采用“镜像”设计，包括30例接受长期情绪稳定剂治疗的快速和超快速循环BD患者（18例接受碳酸锂，丙戊酸盐为6，卡马西平为6），效果有限。规定了双边ECT课程（5-10个疗程）以恢复情绪稳定。结果：在12例（40％）有无效情绪稳定剂治疗史的患者中，ECT非常有效，这些患者达到并维持了缓解；除1例接受卡马西平治疗的患者和2例接受丙戊酸治疗的患者外，所有患者均接受锂治疗。9名患者（30％）显示部分反应（卡马西平1名，丙戊酸盐2名），9名患者（30％）根本没有改善（卡马西平4名，丙戊酸盐2名）。对于整个样本，情感发作的持续时间从ECT前一年的36.05±4.32周显着减少到ECT后一年的21.74±12.14周（p<0.001）。根据DSM-5说明符，具有混合和/或紧张性特征的抑郁发作与更好的急性ECT反应和/或ECT后的长期情绪稳定剂治疗结果相关。结论：ECT可被认为是控制快速和超快速循环双相患者情绪不稳定的有用选择。需要进一步的随机试验来证实这些结果。
