A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities
A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities
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DOI：
10.1001/archpsyc.57.5.425
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发表时间：
2000-05-01
影响因子：
--
通讯作者：
Clark, J
中科院分区：
文献类型：
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作者：
Sackeim, HA;Prudic, J;Clark, J
背景：关于右侧单侧（RUL）和双侧（BL）电休克治疗（ECT）的使用一直存在争议。虽然RUL ECT结果不太严重的短期和长期的认知影响，有关注，它是有效性低于BL ECT.Methods：在一项双盲研究中，80名抑郁症患者随机RUL ECT，与电剂量50%，150%，或500%以上的癫痫发作阈值，或BL ECT，与电剂量150%以上的阈值。在ECT治疗前、治疗中、治疗后即刻和治疗后2个月对抑郁严重程度和认知功能进行评估。与基线相比，应答者有至少60%的症状评分减少1周后ECT，并监测复发1 year.Results：高剂量的RUL和BL ECT的反应率（65%）和约两倍的有效低剂量（35%）或中等剂量（30%）的单边ECT。在随机化阶段后的一周内，BL ECT在几项顺行和逆行记忆测量中比任何剂量的单侧ECT造成更大的损害。ECT后两个月，逆行性遗忘功能障碍在BL ECT治疗的患者中最大。62名对ECT有反应的患者中有33名（53%）复发，无治疗组差异。复发率是更大的患者谁没有足够的药物治疗前ECT和谁有更严重的抑郁症状后ECT.Conclusion：右侧单侧ECT高剂量是一个强大的形式BL ECT的有效，但产生不太严重和持久的认知影响。
Background: Controversy persists about the use of right unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT). While RUL ECT results in less severe short-term and long-term cognitive effects, there is concern that it is less efficacious than BL ECT.Methods: In a double-blind study, 80 depressed patients were randomized to RUL ECT, with electrical dosages 50%, 150%, or 500% above the seizure threshold, or BL ECT, with an electrical dosage 150% above the threshold. Depression severity and cognitive functioning were assessed before, during, immediately after, and 2 months after ECT. Compared with baseline, responders had at least a 60% reduction in symptom scores 1 week after ECT, and were monitored for relapse for 1 year.Results: High-dosage RUL and BL ECT were equivalent in response rate (65%) and approximately twice as effective as low-dosage (35%) or moderate-dosage (30%) unilateral ECT. During the week after the randomized phase, BL ECT resulted in greater impairment than any dosage of unilateral ECT in several measures of anterograde and retrograde memory. Two months after ECT, retrograde amnestic deficits were greatest among patients treated with BL ECT. Thirty-three (53%) of the 62 patients who responded to ECT relapsed, without treatment group differences. The relapse rate was greater in patients who had not responded to adequate pharmacotherapy prior to ECT and who had more severe depressive symptoms after ECT.Conclusion: Right unilateral ECT at high dosage is as effective as a robust form of BL ECT, but produces less severe and persistent cognitive effects.