背景:鉴于文献中可获得的矛盾数据,本系统综述的目的是研究边缘性人格障碍(BPD)的诊断方法对接受电惊厥治疗(ECT)的重度抑郁症患者急性期反应和早期复发风险的影响.
方法:在2023年3月根据PRISMA标准在PubMed-Medline数据库中进行了系统的文献综述之后,使用关键字算法(\“电惊厥疗法\”[网状]或电惊厥疗法)和(\“边缘性人格障碍\”[网状]或边缘性人格障碍)鉴定了47篇文章。本系统评价中用于选择文章的纳入标准是:(1)研究BPD对接受ECT治疗的重度抑郁症患者(>18岁)的急性反应和/或早期复发风险的影响的文章。(2)根据国际分类的诊断标准,通过经过验证的筛查测试和/或系统的精神病学访谈来诊断BPD和重度抑郁症。(3)任何类型的研究(横截面,纵向,prospective,回顾性,介入性和实验性),(4)用英语或法语写的文章,(5)2000年1月以后发表的文章。在两位作者根据这些纳入标准对47篇文章进行评估后,本系统综述纳入了7项研究,这些研究调查了通过系统的精神病学访谈或筛查试验诊断的BPD对接受ECT治疗的主要抑郁症患者的急性期反应和早期复发风险的影响.
结果:与通过筛查测试诊断BPD的三项研究不同,通过系统的精神病学访谈诊断BPD的4项研究表明,在接受ECT治疗的主要抑郁症患者中,这种人格障碍对急性反应或早期复发风险有负面影响.然而,纳入本系统综述的所有研究均提供低水平的科学证据(横断面流行病学研究和回顾性队列研究).
结论:尽管需要更好的科学质量研究,本系统综述的结果似乎表明,在ECT前评估期间通过系统的精神病学访谈筛查BPD,并在共患BPD的情况下建立适当的治疗策略,可能是有前景的选择,可以使接受ECT治疗的重度抑郁症患者获得更好的急性应答和更好的预防早期复发.
BACKGROUND: Given the contradictory data available in the literature, the aim of this systematic
review was to investigate the impact of the diagnostic method for borderline personality disorder (BPD) on the acute response and the risk of early relapse in major depressed individuals treated with electroconvulsive therapy (ECT).
METHODS: After a systematic literature
review performed during March 2023 in the PubMed-Medline database according to the PRISMA criteria, 47 articles were identified using the keyword algorithm (\"Electroconvulsive Therapy\" [Mesh] or electroconvulsive therapy) and (\"Borderline Personality Disorder\" [Mesh] or borderline personality disorder). The inclusion criteria applied for the selection of articles in this systematic
review were: (1) articles investigating the impact of BPD on the acute response and/or the risk of early relapse in major depressed individuals (> 18 years old) treated with ECT, (2) diagnosis of BPD and major depressive disorder by validated screening tests and/or systematic psychiatric interviews based on diagnostic criteria of international classification, (3) any type of study (cross-sectional, longitudinal, prospective, retrospective, interventional and experimental), (4) articles written in English or French, and (5) articles published after January 2000. After assessment of the 47 articles based on these inclusion criteria by two authors, seven studies investigating the impact of BPD diagnosed by systematic psychiatric interview or screening tests on the acute response and the risk of early relapse in major depressed individuals treated with ECT were included in this systematic
review.
RESULTS: Unlike the three studies diagnosing BPD by screening tests, the four studies diagnosing BPD by systematic psychiatric interview demonstrated a negative impact of this personality disorder on the acute response or the risk of early relapse in major depressed individuals treated with ECT. However, all studies included in this systematic
review presented a low level of scientific evidence (cross-sectional epidemiological studies and retrospective cohort studies).
CONCLUSIONS: Despite the need for studies of better scientific quality, the results of this systematic review seem to indicate that screening for BPD by systematic psychiatric interview during the pre-ECT assessment and the establishment of adequate therapeutic strategies in case of comorbid BPD could be promising options to allow better acute response and better prevention of early relapses in major depressed individuals treated with ECT.