Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression
Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression
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DOI：
10.1111/bdi.12589
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发表时间：
2018-09-01
影响因子：
5.4
通讯作者：
Chien, Wu-Chien
中科院分区：
文献类型：
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作者：
Liang, Chih-Sung;Chung, Chi-Hsiang;Chien, Wu-Chien
目的长期以来，电休克疗法 (ECT) 一直被认为可以减少情感障碍患者的自杀倾向。然而，ECT 接受者是病情最严重和有自杀倾向的患者，他们没有资格参加头对头随机对照试验。需要进行大规模研究来调查 ECT 与精神药物治疗的抗自杀效果。方法采用全国范围的回顾性队列研究设计。数据来自台湾国民健康保险研究数据库。 2000年1月1日至2013年12月31日期间，对接受ECT的单相情感障碍或双相情感障碍住院患者（n=487）进行自杀事件观察。非 ECT 对照队列由按年龄、性别和诊断随机匹配（比例为 1:4）的接受精神药物治疗的住院患者组成。结果考虑到潜在的混杂因素后，调整后的风险比 (HR) 为 0.803，表明 ECT 接受者的自杀风险比对照个体低 19.7%。单相情感障碍患者的分层特定调整 HR 为 0.79 (P=.041)，双相情感障碍患者为 0.923 (P=.254)。对双相情感障碍患者进一步按情感状态分层后，双相抑郁患者的调整HR为0.805（P=.046），双相躁狂患者为1.048（P=.538），混合双相情感状态为0.976（P=.126）。然而，ECT在治疗双相躁狂和混合状态患者时缺乏优越的抗自杀作用。
ObjectivesElectroconvulsive therapy (ECT) has long been believed to reduce suicidal tendencies in patients with affective disorders; however, ECT recipients, who constitute the most severely ill and suicidal patients, are not eligible to participate in head-to-head randomized controlled trials. Large-scale studies are required to investigate the anti-suicidal effects of ECT vs psychopharmacotherapy.MethodsA nationwide retrospective cohort study design was used. Data were obtained from the Taiwan National Health Insurance Research Database. Inpatients with unipolar disorder or bipolar disorder who received ECT (n=487) were observed from 1 January 2000 to 31 December 2013 for suicide events. The non-ECT control cohort consisted of inpatients with psychopharmacotherapy randomly matched (ratio, 1:4) by age, sex, and diagnosis.ResultsAfter potential confounds had been accounted for, the adjusted hazard ratio (HR) was 0.803, indicating that ECT recipients showed a 19.7% lower risk of suicide than control individuals. The stratum-specific adjusted HR was 0.79 in patients with unipolar disorder (P=.041) and 0.923 in patients with bipolar disorder (P=.254). Upon further stratification of the patients with bipolar disorder by their affective states, the adjusted HR was 0.805 (P=.046) for bipolar depression, 1.048 for bipolar mania (P=.538), and 0.976 for mixed bipolar state (P=.126).ConclusionsCompared with psychopharmacotherapy, ECT exerted superior anti-suicidal effects in patients with unipolar disorder and bipolar depression; however, there was a lack of superior anti-suicidal effects of ECT in the treatment of patients with bipolar mania and mixed state.