Development of the comprehensive treatment system for intractable midle-aged and elderly severe depression

对于难治性中老年抑郁症，急性电痉挛治疗一个疗程的短期有效率超过80%，电痉挛治疗后6个月缓解率约为50%。在那些在ECT后6个月内复发的患者中，一个疗程的继续ECT有大约50%的6个月缓解率。年龄与短期缓解率和6个月缓解率无关。然而，同时的医疗状况有与电痉挛后残余症状严重程度相关的趋势。在难治性中老年紧张性精神分裂症患者中，急性电痉挛治疗一个疗程的短期有效率为100%，电痉挛治疗后6个月缓解率低于50%。在那些在ECT后6个月内复发的患者中，一个疗程的继续ECT有大约60%的6个月缓解率。老年抑郁症和紧张症伴药物耐药或不耐受，可能具有严重的临床特征，常伴有危及生命的医疗状况，急性状态恢复后极易复发。因此，应在充分考虑病理生理的基础上设计长期综合治疗策略。本研究证明了该综合治疗系统的短期和长期疗效，该系统位于一所大学医院，专门用于当地医疗机构的难治性老年精神障碍。

In the intractable middle-aged and elderly depression, a course of acute ECT had more than 80% of short-term response rate, and about 50% of 6-month remission rate after ECT. In those patients with relapse within 6 months after ECT, a course of continuation ECT had about 50% of 6-month remission rate. Age was associated with neither short-term response rate nor 6-month remission rate. However, concurrent medical condition had tendency toward association with severity of residual symptoms after ECT. In the intractable middle-aged and elderly catatonic schizophrenia, a course of acute ECT had 100% of short-term response rate and less than 50% of 6-month remission rate after ECT. In those patients with relapse within 6 months after ECT, a course of continuation ECT had about 60% of 6-month remission rate.Elderly depression and catatonia with medication resistance or intolerance are likely to have severe clinical features, often with life-threatened medical conditions and with highly relapse vulnerability after recovery from acute state. Thus, long-term comprehensive treatment strategy should be designed under the sufficient pathophysiological consideration. This study demonstrated the short-and long-term efficacy of the comprehensive treatment system which was located in a university hospital and dedicated for intractable elderly mental disorders in local medical facilities.