维持电惊厥治疗(M-ECT)被认为是严重情绪和精神障碍的有效复发预防策略。M-ECT应该持续多长时间,以及停药后的结果没有得到充分研究。在我们的三级精神病医院,在COVID-19大流行开始时,M-ECT治疗被暂停。我们旨在确定突然停药M-ECT后6个月的复发率和复发时间,并评估患者和治疗特征对复发风险的影响。
81例M-ECT突然中断的患者接受了6个月的前瞻性随访,或直到复发(即,入院,重新启动ECT,改变药物治疗,或自杀(企图)。我们使用多变量Cox比例风险模型来评估患者和治疗特征对复发风险的影响。
36例患者(44.44%)在M-ECT突然停药后6个月内复发。以前有更多的急性ECT疗程,诊断为精神障碍(与重度抑郁症或躁郁症相比),停药时M-ECT治疗间隔时间较短与复发风险增加显著相关.
几乎一半的患者复发,与成功的急性ECT疗程后的复发率相似。停药时M-ECT治疗间隔时间较短的患者似乎风险增加,以及被诊断为精神病的患者,与情绪障碍患者相比。
Maintenance electroconvulsive therapy (M-ECT) is considered an effective relapse prevention strategy in severe mood and psychotic disorders. How long M-ECT should be continued, and what the outcome is after its discontinuation has not been adequately studied. In our tertiary psychiatric hospital, M-ECT treatments were suspended at the start of the COVID-19 pandemic. We aimed to determine the 6-month relapse rate and time to relapse after abrupt discontinuation of M-ECT and to assess the impact of patient and treatment characteristics on the risk of relapse.
Eighty-one patients whose M-ECT was discontinued abruptly were followed up prospectively for 6 months, or until relapse (i.e., hospital admission, restart of ECT, change of pharmacotherapy, or suicide (attempt)). We used multivariable Cox proportional hazards models to assess the impact of patient and treatment characteristics on the risk of relapse.
Thirty-six patients (44.44%) relapsed within 6 months following abrupt discontinuation of M-ECT. A greater number of previous acute ECT courses, a diagnosis of psychotic disorder (compared with major depressive disorder or bipolar disorder), and a shorter interval between M-ECT treatments at the time of discontinuation were significantly associated with increased risk of relapse.
Almost half of the patients relapsed, similar to the relapse rate after a successful acute course of ECT. Patients with a shorter interval between M-ECT treatments at the time of discontinuation seem to be at increased risk, as well as patients with a diagnosis of psychotic disorder, compared to patients with mood disorders.