Clinical outcome of maintenance electroconvulsive therapy in comorbid Posttraumatic Stress Disorder and major depressive disorder
Clinical outcome of maintenance electroconvulsive therapy in comorbid Posttraumatic Stress Disorder and major depressive disorder
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DOI：
10.1016/j.jpsychires.2018.08.023
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发表时间：
2018-10-01
影响因子：
4.8
通讯作者：
Atre-Vaidya, Nutan
中科院分区：
文献类型：
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作者：
Ahmadi, Naser;Moss, Lori;Atre-Vaidya, Nutan
背景：创伤后应激障碍（PTSD）和重性抑郁障碍（MDD）是一种普遍存在且经常共病的疾病。大约42-48%的PTSD患者也符合MDD的诊断标准。已发现维持性电休克治疗（mECT）可有效预防MDD复发。本研究探讨了mECT在治疗MDD合并和不合并PTSD.Methods共病综合征的疗效：本回顾性研究包括36例患者，26例MDD和10例MDD和PTSD共病每月接受mECT平均为1.5年。平均年龄为52 ± 14岁，25%为女性。采用临床总体印象严重程度量表（CGI-S）评估mECT治疗后PTSD和MDD症状的变化。结果：在mECT治疗前，单纯MDD组与合并MDD和PTSD组的CGI-S评分、HRV差异无统计学意义（P > 0.05）。mECT治疗12个月后，HRV显著增加，（平均差异：10.9 95%CI 4.8-20.3，p = 0.001）和总体CGI-S降低（平均差异：3.5，95% CI 3.3-3.6，p = 0.001）]，创伤后应激障碍（平均差异：3.4，95%CI 3.2-3.6，p = 0.001）]和MDD（平均差异：3.8，95%CI 3.5-3.9，p = 0.001）]症状（p < 0.05）。没有精神病住院治疗或自杀发生在任何patient.Conclusions：维持ECT与改善HRV，减少抑郁症和PTSD症状，和一个有利的临床结果。
Background: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are prevalent and frequently comorbid. Approximately 42-48% of patients with PTSD also meet diagnostic criteria for MDD. Maintenance electroconvulsive therapy (mECT) has been found to be efficacious for the prevention of recurrence of MDD. This study investigated the efficacy of mECT in the treatment of MDD with and without comorbid syndromal PTSD.Methods: This retrospective study includes 36 patients, 26 with MDD and 10 with comorbid MDD & PTSD receiving monthly mECT for a mean of 1.5 years. The mean age was 52 +/- 14 years and 25% were female. The change in PTSD and MDD symptoms in response to mECT was assessed using Clinical Global Impression Severity Scale (CGI-S). Heart rate variability (HRV), 12-month hospitalization rate, suicide rate and all-cause mortality in response to mECT were assessed and compared between groups using repeated generalized linear regression (GLM) analysis.Results: At mECT baseline, there were no statistically significant differences in CGI-S scores, HRV between patients with MDD alone and those with comorbid MDD and PTSD (P > 0.05). After 12-months of mECT, a significant increase in HRV (mean difference: 10.9 95%CI 4.8-20.3, p = 0.001) and decrease in CGI-S overall (mean difference: 3.5, 95% CI 3.3-3.6, p = 0.001)], PTSD (mean difference: 3.4, 95% CI 3.2-3.6, p = 0.001)], and MDD (mean difference: 3.8, 95% CI 3.5-3.9, p = 0.001)] symptoms in both groups were noted (p < 0.05). No psychiatric hospitalization or suicide occurred in any of the patients.Conclusions: Maintenance ECT is associated with improved HRV, reduction of both major depression and PTSD symptoms, and a favorable clinical outcome.