Effectiveness of electroconvulsive therapy in community settings
Effectiveness of electroconvulsive therapy in community settings
复制标题
DOI：
10.1016/j.biopsych.2003.09.015
复制
发表时间：
2004-02-01
影响因子：
10.6
通讯作者：
Sackeim, HA
中科院分区：
文献类型：
--
作者：
Prudic, J;Olfson, M;Sackeim, HA
背景：临床试验表明，电痉挛疗法（ECT）是治疗重度抑郁症最有效的方法，但其在社区环境中的有效性尚未得到检验。在一项涉及7家医院347名患者的前瞻性、自然主义研究中，研究了ECT后立即和24周随访期的临床结果与患者特征和治疗变量的关系。结果：这些部位在患者特征和电痉挛治疗上有显著差异，但在临床结果上没有差异。相比之下，ECT的缓解率预期为70%-90%，根据标准，缓解率为30.3%-46.7%。较长的发作持续时间、共病性人格障碍和分裂情感性障碍与较差的预后相关。缓解者随访复发率为64.3%。复发在精神病性抑郁症或合并症I轴或II轴疾病患者中更为常见。在随访期间，只有23.4%的ECT未缓解者持续缓解。在社区环境中，ECT的缓解率大大低于临床试验。提供者经常在结束电痉挛治疗过程时认为患者已完全受益，但正式评估显示明显的残余症状。不使用ECT治疗的患者预后较差；这强调了通过这种方式实现最大改进的必要性。
Background: Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined.Methods. In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables.Results: The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. in contrast to the 70%-90% remission rates expected with ECT remission rates, depending on criteria, were 30.3%-46.7%.. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters bad sustained remission during follow-up.Conclusions. The remission rate with, ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.