Continuation ECT: Relapse prevention in affective disorders
ABSTRACT Relapse rates after the acute treatment of affective disorders with drugs or electroconvulsive therapy (ECT) are high (often 50-95%), despite preventive pharmacotherapy. In practice, some patients receive continuation and maintenance ECT after successful treatment of the index episode with ECT. We reviewed the charts of patients with affective illnesses who received continuation ECT (C-ECT) in our inpatient service from 1985 to 1991. In 33 courses of C-ECT, mean intertreatment interval was 10.1 days and the average duration of treatment was 10 weeks. One-year follow-up was available for 21 patients. Seven (33%) patients relapsed and needed re-admission within 1 year. The relapse rate for the patients with delusional depression was 42%, lower than the 95% reported for patients with delusional depression maintained on continuation pharmacotherapy before the C-ECT program started in our facility. No single factor examined was a significant predictor of relapse except C-ECT, which exhibited a sustained prophylactic effect for the year after the index episode.
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ABSTRACT: Electroconvulsive therapy (ECT) is an effective treatment for major mental illnesses. It is used to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options have proven ineffective. Relapse rates following ECT are high and leading to early readmission. Objective: To study the early readmission rate in patients had received ECT and its relation with age, gender, race and clinical diagnosis. Methods: This is a retrospective descriptive study of patients who had received ECT in 1-year period. Subjects were identified from the ECT record book. Case notes of these patients were then traced and reviewed. Clinical diagnosis and demographic data were collected. Patients readmitted within 6 months after being discharged were identified. The data was compared for the readmitted and not readmitted group. Result: A total of 156 subjects who had received ECT were included in this study. Mean age was 40 years old, 51% were female and the main diagnosis was bipolar affective disorder (42.9%). Early readmission rate was 30.1%. Mean time to relapse was 5.3 months. Chi Square analysis indicated that younger age was significantly associated with early readmission among ECT patients. Conclusion: ECT patients had high early readmission rate. Adequate post ECT psychosocial intervention and pharmacotherapy may help to reduce the readmission rate.12/2010; 18(1).
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ABSTRACT: Für Patienten, die an psychiatrischen Erkrankungen leiden und auf medikamentöse Therapien nur unzureichend ansprechen oder diese nicht vertragen, stellt die Elektrokrampftherapie eine wirksichere Behandlung dar, die meist zu einer raschen Besserung der Krankheitssymptome führt. Bei diesen zumeist schwer erkrankten Patienten ist der Kliniker besonders gefordert, Rückfälle nach Möglichkeit zu verhindern. Der Einsatz der Elektrokrampftherapie in der Rezidivprophylaxe stellt hier eine interessante Option dar, obwohl bislang nur wenige kontrollierte Studien über die Wirksamkeit dieser Therapieform in der Langzeitbehandlung depressiver und anderer psychiatrischer Erkrankungen vorliegen. Insgesamt deutet vieles darauf hin, dass diese ambulant anwendbare Therapieform wirksicher und nebenwirkungsarm ist und zu einer deutlichen Abnahme der Hospitalisierungsraten führt. Vor allem bei älteren Patienten und bei Patienten, die sich bereits in der Akutbehandlung als auf medikamentöse Therapien refraktär erwiesen haben, sollte die Langzeit-Elektrokrampftherapie als Rezidivprophylaxe ernsthaft erwogen werden. Bei Morbus Parkinson ist die Elektrokrampftherapie als Erhaltungs-therapie kaum etabliert, obwohl ihre Wirksamkeit in zahlreichen Studien nachgewiesen werden konnte. Kontrollierte Studien zu Inzidenz, Ausmaß und Verlauf etwaiger kognitiver Störungen unter Langzeit-Elektrokrampftherapie sind noch ausständig. Electroconvulsive therapy is a reliable and safe option for patients with psychiatric disorders who are resistant or intolerant to medication as these patients usually respond quickly to this form of treatment. For clinicians, the management of these often severely ill patients is an important challenge given the high rate of relapse of these disorders. Maintenance electroconvulsive therapy is an interesting treatment option for these patients. Until now, only few controlled studies exist about the long-term outcome of this treatment in depressive disorders and other psychiatric disorders. Altogether, this form of outpatient prophylactic therapy has been found to be safe, well tolerated, and efficacious in relapse prevention. Moreover, it has been found to reduce hospitalization rates. Particularly in the elderly, and in patients who have been shown to be refractory to medication regimens, maintenance electroconvulsive therapy should be seriously considered as a means to reduce the risk of recurrence of illness. In Parkinson’s disease maintenance electroconvulsive therapy is not widely established although its usefulness has been documented in numerous studies. First-line evidence data on incidence, dimensions and outcome of cognitive side effects under maintenance electroconvulsive therapy is still warranted.Wiener klinische Wochenschrift 05/2003; 115(9):281-290. DOI:10.1007/BF03040333 · 0.79 Impact Factor