maintenance electroconvulsive therapy

维持电惊厥治疗
  • 文章类型: Journal Article
    未经批准:对药物或治疗耐药的精神疾病患者的可用治疗选择有限。维持电惊厥治疗(M-ECT)是一种既定的选择,但文献有限。这项研究检查了M-ECT在大型三级护理精神病院中的使用情况,及其与患者的社会人口统计学和临床特征相关。
    UNASSIGNED:在印度南部半城市的三级护理精神病学中心进行了回顾性图表审查,并对数据进行了分析。
    未经证实:在研究期间共有171名患者接受了ECT,其中只有5名患者接受了M-ECT治疗。这些患者被诊断为治疗抵抗,并且大部分患有精神分裂症。他们距离医院不到30公里。他们接受了常规治疗,但仍然有残留症状,没有功能恢复,需要护理人员的高水平支持。
    UNASSIGNED:我们的研究支持M-ECT治疗严重精神疾病的有效性,并强调了接受这种治疗方式的患者的特征。考虑到似乎与坚持有关的各种心理社会问题,可以提出建议。
    UNASSIGNED: The available treatment options for patients with drug or treatment-resistant psychiatric disorders are limited. Maintenance electroconvulsive therapy (M-ECT) is an established option, but the literature available is limited. This study examined the utilization of M-ECT in a large tertiary care psychiatric facility, and its correlates with the socio-demographic and clinical profile of patients.
    UNASSIGNED: A retrospective chart review was performed in a tertiary care psychiatry center based in semi-urban South India, and data was analyzed.
    UNASSIGNED: A total of 171 patients received ECT in the study period, of which only five patients were on M-ECT. These patients were diagnosed as treatment-resistant and were mostly suffering from schizophrenia. They were located less than 30 km from the hospital. They were on regular treatment but continued to have residual symptoms without functional recovery and required a high level of support from caregivers.
    UNASSIGNED: Our study supports the effectiveness of M-ECT for the treatment of severe psychiatric disorders and highlights the profile of patients who have received this modality of treatment. It can be suggested with consideration of various psycho-social issues which seem to be related to adherence.
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  • 文章类型: Journal Article
    目的:描述被诊断为发育迟缓和紧张症的混合青少年和年轻成人患者组14周内的自然主义临床课程,当维持电惊厥治疗(M-ECT)的频率降低时,继发于2020年COVID-19大流行限制。方法:参与者被诊断为紧张症,在一家专门诊所接受治疗.他们(n=9),F=5,M=4,年龄在16至21岁之间;由于机构限制,ECT频率在2020年3月底降低。两名父母/照顾者因担心COVID-19传播而选择停止ECT。大多数(n=8)因一定程度的智力残疾(ID)而发育迟缓。在虚拟访问期间,以三点量表对可观察到的症状进行评分。结果:所有病例均经历了临床上显著的下降。运动症状恶化(躁动,侵略,缓慢,反复自我伤害,刻板印象,言语缺陷)在前3周内出现,在14周的观察期内持续存在,并且比神经营养症状更频繁(食欲,失禁,sleep).四名参与者恶化,需要再次住院,这4人中有2人需要胃造口术喂食管。结论:在观察期间,所有9例患者均出现中度和重度症状;药物调整无效;在每个参与者的基线时间表恢复M-ECT,通常到第7周,在某些病例中导致了渐进性改善,但这种改善不足以阻止4例患者再次住院.总之,在COVID-19相关限制的情况下,当M-ECT急剧减少时,观察到快速恶化。
    Aim: Describe naturalistic clinical course over 14 weeks in a mixed adolescent and a young-adult patient group diagnosed with developmental delays and catatonia, when the frequency of maintenance electroconvulsive therapy (M-ECT) was reduced secondary to 2020 COVID-19 pandemic restrictions. Methods: Participants were diagnosed with catatonia, and were receiving care in a specialized clinic. They (n = 9), F = 5, and M = 4, ranged in age from 16 to 21 years; ECT frequency was reduced at end of March 2020 due to institutional restrictions. Two parents/caregivers elected to discontinue ECT due to concern for COVID-19 transmission. Majority (n = 8) were developmentally delayed with some degree of intellectual disability (ID). Observable symptoms were rated on a three point scale during virtual visits. Results: All cases experienced clinically significant decline. Worsening of motor symptoms (agitation, aggression, slowness, repetitive self-injury, stereotypies, speech deficits) emerged within the first 3 weeks, persisted over the 14 week observation period and were more frequent than neurovegetative symptoms (appetite, incontinence, sleep). Four participants deteriorated requiring rehospitalization, and 2 among these 4 needed a gastrostomy feeding tube. Conclusion: Moderate and severe symptoms became apparent in all 9 cases during the observation period; medication adjustments were ineffective; resuming M-ECT at each participant\'s baseline schedule, usually by week 7, resulted in progressive improvement in some cases but the improvement was insufficient to prevent re-hospitalization in 4 cases. In summary, rapid deterioration was noted when M-ECT was acutely reduced in the setting of COVID-19 related restrictions.
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  • 文章类型: Journal Article
    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.
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  • 文章类型: Case Reports
    一名32岁的女性患有精神分裂症和持续性听觉言语幻觉(AVHs),导致持续的自杀念头和抑郁,接受急性电休克疗法(ECT)治疗,然后在氯氮平基础上增加维持ECT(M-ECT)治疗7年。虽然一般的精神病理学和AVHs最初使用ECT和氯氮平略有减少,她的AVHs和自杀念头主观上并未减少.当3年的M-ECT,她的声音急剧下降,并在此后2年内保持了改善。总共进行了91次ECT会话。每日氯氮平剂量从325mg降至200mg,血浆水平仍高于350ng/ml;没有明显的认知副作用。总之,我们报告了一例病例,显示长期M-ECT治疗3年后持续性AVHs突然急剧减少.
    A 32-year-old woman with schizophrenia and persistent auditory verbal hallucinations (AVHs), which caused continuous suicidal thoughts and depression, was treated with electroconvulsive therapy (ECT) of an acute course followed by maintenance ECT (M-ECT) augmented onto clozapine for 7 years. Although the general psychopathology and AVHs initially reduced slightly with ECT and clozapine, her AVHs and suicidal thoughts did not decrease subjectively. When 3 years of M-ECT, her voices declined sharply, and improvement was maintained for 2 years thereafter. A total 91 ECT sessions were performed. The daily clozapine dose was decreased from 325 to 200 mg and plasma levels remained higher than 350 ng/ml; there were no noticeable cognitive side effects. In summary, we report a case showing a sudden sharp reduction in persistent AVHs after 3 years of long-term M-ECT.
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  • 文章类型: Journal Article
    电惊厥疗法(ECT)已被建议作为一种治疗方法,用于增强对单独使用氯氮平反应不佳的患者对氯氮平的反应,并且还建议维持ECT(M-ECT)以维持改善。进行了长达2年的回顾性研究,以探讨M-ECT是否有利于长期维持急性ECT引起的症状缓解。绘制每位患者的阳性和阴性综合征量表(PANSS),并使用线性混合效应模型进行比较。共随访了38例患者,并分为三组:(1)单用氯氮平(CZP,n=15),(2)仅急性ECT(A-ECT,n=11),和(3)急性ECT与M-ECT(M-ECT,n=12)。M-ECT组维持期ECT疗程的平均次数和间隔时间分别为39.0±26.7和15.6±8.4天,分别。M-ECT组的斜率最终下降,但A-ECT组的水平逐渐恢复到ECT前的水平。没有观察到持续或严重的不良反应。总之,A-ECT增强了氯氮平的效果,但M-ECT是维持症状改善所必需的。
    Electroconvulsive therapy (ECT) has been suggested as a treatment for augmenting the response to clozapine in patients that do not respond well to clozapine alone and maintenance ECT (M-ECT) had also been recommended to sustain improvement. This retrospective study of up to 2 years of observation was conducted to explore whether M-ECT is beneficial for long-term maintenance of the symptom remission elicited by acute ECT. Positive and Negative Syndrome Scale (PANSS) were plotted for each patient and compared using a linear mixed-effect model. A total of thirty-eight patients were followed and classified into three groups: (1) clozapine alone (CZP, n = 15), (2) acute ECT only (A-ECT, n = 11), and (3) acute ECT with M-ECT (M-ECT, n = 12). The mean number and interval of ECT sessions during the maintenance period in the M-ECT group were 39.0 ± 26.7 and 15.6 ± 8.4 days, respectively. The slope of the M-ECT group eventually declined, but that of the A-ECT group gradually increased back to the pre-ECT level. No persistent or serious adverse effects were observed. In conclusion, A-ECT augmented the effect of clozapine, but M-ECT was required for sustaining symptom improvement.
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  • 文章类型: Journal Article
    OBJECTIVE: The efficacy of electroconvulsive therapy (ECT) has been established in psychiatric disorders but the high rate of relapse is a critical problem. The current study sought preventative factors associated with relapse after a response to ECT in a continuum of four major psychiatric disorders.
    METHODS: The records of 255 patients with four psychiatric disorders (83 unipolar depression, 60 bipolar depression, 91 schizophrenia, 21 schizoaffective disorder) were retrospectively reviewed.
    RESULTS: The relapse-free rate of all patients at 1 year was 56.3% in the four psychiatric disorders without a difference. As a result of univariate analysis, three items could be considered as preventative factors associated with relapse: a small number of psychiatric symptom episodes before an acute course of ECT, the use of mood stabilizers, and the use of maintenance ECT. Multivariate analysis was performed, keeping age, sex, and diagnosis constant in addition to the three items, and small number of psychiatric symptom episodes before an acute course of ECT (P = 0.003), the use of lithium (P = 0.025), the use of valproate (P = 0.027), and the use of maintenance ECT (P = 0.001) were found to be significant preventative measures against relapse.
    CONCLUSIONS: The use of mood stabilizers, such as lithium and valproate, and maintenance ECT could be shared preventive factors associated with relapse after a response to ECT in four major psychiatric disorders.
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  • 文章类型: Journal Article
    Acute course of electroconvulsive therapy is effective in inducing remission from depression, but recurrence rate is unacceptably high following termination of electroconvulsive therapy despite continued pharmacotherapy. Continuation electroconvulsive therapy and maintenance electroconvulsive therapy have been studied for their efficacy in preventing relapse and recurrence of depression. The purpose of this meta-analysis was to examine the efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy in preventing relapse and recurrence of depression in comparison to antidepressant pharmacotherapy alone.
    We searched MEDLINE, Embase, PsycINFO, clinicaltrials.gov and Cochrane register of controlled trials from the database inception to December 2016 without restriction on language or publication status for randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. Two independent Cochrane reviewers extracted the data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. The risk of bias was assessed using four domains of the Cochrane Collaboration Risk of Bias Tool. Outcomes were pooled using random effect model. The primary outcome was relapse or recurrence of depression.
    Five studies involving 436 patients were included in the meta-analysis. Analysis of the pooled data showed that continuation electroconvulsive therapy and maintenance electroconvulsive therapy, both with pharmacotherapy, were associated with significantly fewer relapses and recurrences than pharmacotherapy alone at 6 months and 1 year after a successful acute course of electroconvulsive therapy (risk ratio = 0.64, 95% confidence interval = [0.41, 0.98], p = 0.04, risk ratio = 0.46, 95% confidence interval = [0.21, 0.98], p = 0.05, respectively). There was insufficient data to perform a meta-analysis of stand-alone continuation electroconvulsive therapy or maintenance electroconvulsive therapy beyond 1 year.
    There are only a few randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. The preliminary and limited evidence suggests the modest efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy with concomitant pharmacotherapy in preventing relapse and recurrence of depressive episodes for 1 year after the remission of index episode with the acute course of electroconvulsive therapy.
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