Predictors of response to electroconvulsivetherapy
Keywords:
electroconvulsive therapy, efficacy, predictors of responseAbstract
Electroconvulsive therapy (ECT)is the oldest method still used in psychiatric treatments. Due to small amount of randomized clin-ical trials there is little agreement about precise efficacy (most often determined in the range of 50-80%) and clinically useful predictors of acute ECT outcomes in individual patients. Factors such as index episode duration equal or longer than one year, fewer failed antide-pressant treatments, previous successful ECT course, presence of suicidal thoughts, good response to initial therapy (first three treatments) and postictal suppression are considered as significantly predictive by most authors. Contrarily, medication resistance, chronic depression/dysthymia and personality disorders especially borderline personality disorder are regarded as predictors of nonremission. Data on such factors as: psychotic or hypochondriac features, concurrent antidepressant medication, and baseline severity are contradictory. The existing literature suggests that combination of ECT and antipsychotic treatment is a useful option for patients with medication-resistant schizophrenia or when rapid global improvement of clinical condition is desired. The tolerability of ECT is not influenced by concomitant neuroleptic medication. Variables such as age, gender, and comorbidity of somatic diseases do not affect the effectiveness of ECT, although the first two in combination with certain parameters of EEG are useful in adjusting the dose of electrical impulse, thereby improving the effectiveness of individual seizures. Isolating the biological variability among the neurophysiological and neuroimaging factors, that predisposes to positive or negative clinical response to ECT would allow optimization of individual treatments and thus improve the safety of therapy and reduce its costs.
References
1. Passione R. Italian Psychiatry in an International Context: Ugo-Cerletti and the Case of Electroshock. History of Psychiatry, 2004; 15(1): 83-104.
2. Hese R.T., Zyss T. Leczenie elektrowstrząsami w praktyce klinicznej. Wrocław; Urban & Partner: 2007.
3. Abrams R. Electroconvulsive Therapy. Wyd. IV. Oksford; Oxford University Press: 2002.
4. Pużyński S., Kalinowski A., Kiejna A., Koszewska I., Landowski J., Masiak M., Rybakowski J., Rzewuska M., Wciórka J. Standardy i algorytmy postępowania terapeutycznego w zaburzeniach afektywnych. Farmakoter. Psychiat. Neurol, 1998; 2: 15-27.
5. RybakowskiJ., Pużyński S., Wciórka J. P. red. Psychiatria t. 2. Wrocław; Elsevier Urban & Partner: 2011.
6. Kalinowski A. Elektrowstrząsy. W: Bilikiewicz A., Pużyński S., Rybakowski J., Wciórka J. P. red. Psychiatria t. III. Wrocław; Elsevier Urban & Partner: 2003, 188-196.
7. Antunes P.B., Rosa M.A., Belmonte-de-Abreu P.S., Lobato M.I., Fleck M.P. Electroconvulsive therapy in major depression: current aspects. Rev Bras Psiquiatr, 2009; 31 Suppl 1: S26-33.
8. Tharyan P., Adams C.E. Electroconvulsive therapy for schizophrenia.Cochrane Database Syst Rev, 2005; 2:CD000076.
9. Read J., Bentall R. The effectiveness of electroconvulsive therapy: a literature review. EpidemiolPsichiatrSoc, 2010; 19(4): 333-347.
10. Berger R.L., Celli B.R., Meneghetti A.L., Bagley P.H., Wright C.D., Ingenito E.P., Gray A., Snider G.L. Limitations of randomized clinical-trials for evaluating emerging operations: the case of lung volume reduction surgery. Ann ThoracSurg, 2001; 72(2): 649-657.
11. Hannan E.L. Randomized clinicaltrials and observational studies: guidelines for assessing respective strengths and limitations. JACC CardiovascInterv, 2008; 1(3): 211-7
12. Azuma H., Fujita A., Sato K., Arahata K., Otsuki K., Hori M., Mochida Y., Uchida M., Yamada T., Akechi T., Furukawa T.A. Postictal cardiovascular response predicts therapeutic efficacy of electro-convulsive therapy for depression. Psychiatry ClinNeurosci, 2007; 61(3): 290-294.
13. Shapira B., Tubi N., Lerer B. Balancing speed of response to ECT in major depression and adverse cognitive effects: role of treatment schedule. J ECT, 2000; 16(2): 97-109.
14. Loo C., Simpson B., MacPherson R. Augmentation strategies in electroconvulsive therapy. J ECT, 2010; 26(3): 202-207.
15. Rich C.L., Spiker D.G., Jewell S.W., Neil J.F., Black N.A. The efficiency of ECT: I Response rate in depressive episodes.Psychiatry Res, 1984; 11(3): 167-176.
16. Mayur P.M., Gangadhar B.N., Janakiramaiah N., Subbakrishna D.K. Motor seizure monitoring during electroconvulsive therapy. Br J Psychiatry, 1999; 174: 270-272.
17. Shapira B., Lidsky D., Gorfine M., Lerer B.J. Electroconvulsive therapy and resistant depression: clinical implications of seizure threshold. Clin Psychiatry, 1996; 57(1): 32-38.
18. Van der Wurff F.B., Stek M.L., Hoogendijk W.L., Beekman A.T. Electroconvulsive therapy for the depressed elderly. Cochrane Database Syst Rev, 2003;(2): CD003593.
19. Mitchell A.J., Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. Am J Psychiatry, 2005;162(9): 1588-1601.
20. Vanelle J.M. Predictive factors of response to electronarcosis. Encephale, 1991; 17 Spec No 3: 399-404.
21. Loo C.K., Mahon M., Katalinic N., Lyndon B., Hadzi-Pavlovic D.J. Predictors of response to ultrabrief right unilateral electroconvulsive therapy. Affect Disord, 2011; 130(1-2): 192-197.
22. Kho K.H., Zwinderman A.H., Blansjaar B.A. Predictors for the efficacy of electroconvulsive therapy: chart review of a naturalistic study.J Clin Psychiatry, 2005; 66(7): 894-899.
23. Tsuchiyama K., Nagayama H., Yamada K., Isogawa K., Katsuragi S., Kiyota A. Predicting efficacy of electroconvulsive therapy in major depressive disorder. Psychiatry ClinNeurosci, 2005; 59(5): 546-550.
24. Dombrovski A.Y., Mulsant B.H., Haskett R.F., Prudic J., Begley A.E., Sackeim H.A. Predictors of remission after electro-convulsive therapy in unipolar major depression. J Clin Psychiatry, 2005; 66(8): 1043-1049.
25. Feske U., Mulsant B.H., Pilkonis P.A., Soloff P., Dolata D., Sackeim H.A., Haskett R.F. Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder. Am J Psychiatry, 2004; 161(11): 2073-2080.
26. de Vreede I.M., Burger H., van Vliet I.M. Prediction of effectiveness of electroconvulsive therapy in major depression with routinely collected data.TijdschrPsychiatr, 2006; 48(8): 619-625.
27. Chanpattana W., Sackeim H.A. Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT, 2010; 26(4): 289-298.
28. Nothdurfter C., Eser D., Schüle C., Zwanzger P., Marcuse A., Noack I., Möller H.J., Rupprecht R., Baghai T.C. The influence of concomitant neuroleptic medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry, 2006; 7(3): 162-170.
29. Baghai T.C., Marcuse A., Brosch M., Schüle C., Eser D., Nothdurfter C., Steng Y., Noack I., Pietschmann K., Möller H.J., Rupprecht R. The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry, 2006; 7(2): 82-90.
30. Stek M.L., Beekman A.T., Verwey B. Electroconvulsive therapy in late life depression: a review.TijdschrGerontolGeriatr, 1997; 28(3): 106-112.
31. Chanpattana W., Chakrabhand M.L. Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia: prediction of outcome.Psychiatry Res, 2001; 105(1-2): 107-115.
32. Kimball J.N., Rosenquist P.B., Dunn A., McCall V. Prediction of antidepressant response in both 2.25xthreshold RUL and fixed high dose RUL ECT. J Affect Disord, 2009; 112(1-3): 85-91.
33. Azuma H., Fujita A., Sato K., Arahata K., Otsuki K., Hori M., Mochida Y., Uchida M., Yamada T., Akechi T., Furukawa TA. Postictal suppression correlates with therapeutic efficacy for depression in bilateral sine and pulse wave electroconvulsive therapy.Psychiatry ClinNeurosci, 2007; 61(2): 168-173.
34. Oudega M.L., van Exel E., Wattjes M.P., Comijs H.C., Scheltens P., Barkhof F., Eikelenboom P., de Craen A.J., Beekman A.T., Stek M.L. White matter hyperintensities, medial temporal lobe atrophy, cortical atrophy, and response to electroconvulsive therapy in severely depressed elderly patients. J Clin Psychiatry, 2011; 72(1): 104-112.
35. Frodl T., Meisenzahl E.M., Möller H.J. Value of diagnostic imaging in evaluation of electroconvulsive therapy.Nervenarzt, 2004; 75(3): 227-233.
36. Griskova I., Dapsys K., Andruskevicius S., Ruksenas O. Does electro-convulsive therapy (ECT) affect cognitive components of auditory evoked P300? ActaNeurobiolExp (Wars), 2005; 65(1): 73-77.
37. Ancy J., Gangadhar B.N., Janakiramaiah N. "Normal' P300 amplitude predicts rapid response to ECT in melancholia. J Affect Disord, 1996; 41(3): 211-215.
38. Nurminen M., Valkonen-Korhonen M., Mervaala E., Pääkkönen A., Partanen J., Viinamäki H., Lehtonen J. Enhanced attention-dependent auditory processing by electroconvulsive therapy in psychotic depression.J ECT, 2005; 21(1): 19-24.
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