Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania.
Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania.
复制标题
临床和人口统计学特征与对躁狂症电动性治疗的反应的关联。
DOI：
10.1001/jamanetworkopen.2022.18330
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
作者：
本队列研究探讨了躁狂症患者电休克治疗的结局以及临床和人口统计学特征与反应的相关性。什么样的结果与电休克治疗（ECT）躁狂症相关，什么样的患者特征与有益的结果相关？在这项队列研究中，571例接受ECT治疗的躁狂症患者中，84%有反应。没有焦虑和强迫症共病的病情更严重的患者有显着更高的应答率。这项研究发现，ECT与躁狂症的改善有关，特别是对患有严重疾病且无合并症的患者有较高的应答率。电休克疗法（ECT）治疗躁狂发作的有效性的知识是基于临床经验，但经验证据是稀缺的。此外，与躁狂患者ECT反应相关的预后因素知之甚少。探讨电休克治疗躁狂发作的疗效。这项全国性的、基于登记的观察性队列研究是使用瑞典精神科住院患者的数据进行的，这些患者向瑞典国家ECT质量登记处（Q-ECT）报告了数据。考虑纳入2012年至2019年期间在瑞典任何医院住院并接受ECT治疗躁狂发作的患者（605人）。结果，临床总体印象改善量表（CGI-I）评分，可在571例患者。从几个国家登记的数据相结合，以确定临床和社会人口因素。数据分析于二零二一年四月至九月进行。通过Q-ECT识别接受ECT治疗躁狂症的患者。对ECT的反应定义为CGI-I评分为1（非常改善）或2（非常改善）。缓解定义为ECT后1周内临床总体印象严重程度量表（CGI-S）评分为1（参考范围或未患病）或2（轻微患病）。采用单变量和多变量回归模型研究社会人口学因素、精神药理学和合并症与疗效的关系。在571例接受ECT治疗的躁狂症患者中（211例[37.0%]男性;中位[IQR]年龄为46 [31 - 59]岁），482例患者（84.4%）对ECT有反应。共病焦虑和强迫症（OCD）与ECT反应的低比值相关（校正比值比[aOR]，0.48; 95%CI，0.25 - 0.90和aOR，0.17; 95%CI，0.06 - 0.56）。根据CGI-S评分，显著疾病（aOR，2.93; 95% CI，1.23 - 7.00）、重度疾病（aOR，2.60; 95% CI，1.06 - 6.34）或最严重疾病（aOR，7.94; 95% CI，2.16 - 29.21）患者的缓解几率高于轻度或中度疾病患者。这项研究发现，ECT与临床环境中躁狂症的改善有关，特别是在患有严重疾病的患者和那些没有共病焦虑或强迫症的患者中有较高的应答率。
This cohort study examines the outcomes of electroconvulsive therapy and the association of clinical and demographic characteristics with response in patients with mania. What outcomes are associated with electroconvulsive therapy (ECT) for mania, and what patient characteristics are associated with beneficial outcomes? In this cohort study of 571 patients with mania who were treated with ECT, 84% responded. Patients with more severe conditions without comorbidities of anxiety and obsessive-compulsive disorder had a significantly higher response rate. This study found that ECT was associated with improvement for mania, with especially high response rates for patients with severe illness and no comorbidities. Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. To investigate the response to ECT in patients with manic episodes. This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021. Patients treated with ECT for a mania were identified from the Q-ECT. Response to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT. Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response. Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessive-compulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness. This study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.
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