Safety of electroconvulsive therapy in the context of physiological and medical complexity: A state‐of‐the art review
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Abstract Medical contraindications and complications pose challenges for electroconvulsive therapy (ECT). Most published reports are scattered across various physiological systems and individual disease conditions. This review aimed to evaluate the literature on physiological and medical complexities during ECT and discuss risk mitigation strategies in a comprehensive review. We searched PubMed and Embase for contraindications and precautions during ECT with relevant MeSH terms and appraised previous reviews on the same topic. The results suggest that mortality directly attributed to ECT is extremely rare. Instances of fatalities, including fetal deaths, have been reported after ECT in the presence of recent myocardial infarction, deep vein thrombosis, intracranial aneurysm and tumors, pheochromocytoma, sepsis, and pregnancy. However, there are no definite conclusions or consensus on attributions of the outcomes to ECT in all cases because of the time lag between the treatment and deaths and confounding factors. The risks can be mitigated with safety protocols, adequate stakeholder communication, collaboration with anesthetists and specialists, consultation‐liaison services, and ECT education. Overall, ECT remains a relatively safe treatment even in the presence of medical and physiological complexities. In rare instances, certain medical conditions may indicate a high risk for ECT, where practitioners avoid the treatment or administer it with precautions if the risk‐benefit ratio favors its use.The aim of the study was to assess efficacy and safety of electroconvulsive therapy.43 patients included into the study were hospitalised in The Institute of Psychiatry and Neurology and received all together over 400 bilateral electroconvulsive procedures. Most of the patients (N = 25) were qualified for electroconvulsive therapy due to treatment resistant depression (58.1%). Six patients: 2 with catatonia and 4 with depression had life saving indications for electroconvulsive therapy. Three patients (7%) were excluded from electroconvulsive therapy, following 1 or 2 electroconvulsive procedures. Forty patients continued electroconvulsive therapy.There were no complications and serious adverse events in patients who continued electroconvulsive therapy. Generally, electroconvulsive therapy was well tolerated and treatment had been cut down in only one case due to adverse events and high risk related to the procedure. Transient cardiac arrhythmias (10% of patients) were the most often occurring adverse events and patients (35%) mostly reported headaches. We observed remission in 22 patients (58%) and improvement in 14 patients (35%) following electroconvulsive treatment. Only 4 patients (10%) had no benefit after a series of electroconvulsive procedures. Electroconvulsive treatment was most effective in patients with catatonia (80% patients had full recovery) and in depressive patients with bipolar disorder (73% patients had full recovery).Electroconvulsive procedures were safe and effective. Electroconvulsive treatment was most effective in catatonic patients with schizophrenia and in depressive patients with bipolar disorder.
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電気痙攣療法（electroconvulsive therapy：以下ECT）は，うつ病，統合失調症などで，自殺が差し迫っている症例などで，早急な改善が望まれる場合の唯一無二の方法である．安全性の観点から，麻酔薬，筋弛緩薬を使用する修正型ECT（modified-ECT）が行われている．m-ECTは，一般病院を中心に行われてきたが，最近では精神科病院でも行われる．平成30（2018）年度より，ECTの麻酔管理料の加算が行われるようになった．麻酔科医によるECTの有害事象への対応やハイリスク症例への対応が求められている．今後安全性をより高めるために，精神科と麻酔科，精神科病院と一般病院の医療連携が望まれる．
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Electroconvulsive therapy has been described as a mood stabilizer, as it is effective in all stages of bipolar disorder. Electroconvulsive therapy–induced mania is a known and potentially dangerous risk of treating bipolar depression with electroconvulsive therapy and there are no established guidelines for the management of electroconvulsive therapy–induced mania. We report a case of electroconvulsive therapy–induced mania where electroconvulsive therapy was continued as the sole, effective antimanic agent, which is the first described case in literature.
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Objective: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice. Method: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients’ perception, mechanism of action, technique and cognitive impairment. Results: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment. Conclusion: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes. Descriptors: Electroconvulsive therapy; Brain-derived neurotrophic factor; Depression; Quality of life; Treatment outcome
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1938년 이탈리아 로마대학의 Cerletti와 Bini가 전기를 통 하여 경련을 유발하는 전기경련치료(electroconvulsive therapy, 이하 ECT)를 개발한 이후 ECT 시술 방법의 많은 변 화와 발전이 이루어지면서, 현재는 ECT가 정신질환의 생물 학적 치료 방법 중에서 약물치료를 제외하고 임상에서 가장 효과적이고 안전하게 사용되고 있다. 정신질환의 약물치료 나 다른 치료 방법들이 빈약했던 1930년대에 처음 소개된 ECT가 당시에는 정신의학계의 폭발적인 관심을 받았으며, 점차 조현병 및 우울증뿐만 아니라 다른 정신질환에까지도 광범위하게 ECT가 시술되기도 하였다. 그러나, 80여 년 가까 이 경과한 지금에는 초기에 비하여 ECT 시술 빈도가 많이 감소하였으며, 극단적으로 ECT는 아주 오래되고 효과가 제 한된 역사 속의 치료법 중 하나 정도로 인식되고 있기도 하다. 우리나라에서도 수십 년 전에는 ECT를 많이 시술하였지만, 현재는 외국에 비해서도 시술 빈도가 매우 낮은 편으로 정 신질환의 치료에서 겨우 명맥만을 유지하고 있다. 외국에서는 1980년대 후반부터 본격화된 근거기반의학 (evidence-based medicine)의 영향으로 ECT의 임상적 효과 가 재평가를 받게 되면서부터 기술 개발과 함께 ECT 시술 이 다시 증가하게 되었지만, 우리나라에서는 아직도 이러 한 움직임이 나타나지 않고 있다. 국내의 한 자료에 의하면 세계 최고의 자살률을 보이고 있는 우리나라에서 1년 동안 ECT 시술을 받는 환자 수가 300명 미만인데, 거의 대부분의 환자들이 약물치료에만 의존하고 있다는 안타까운 현실을 말하는 것이다. 특히 아쉬운 것은 현재 우리나라는 새롭게 발 전된 방식의 개인 맞춤형 ECT를 시술할 수 있는 발전된 ECT 기기와 마취 기법을 확보하고 있음에도 불구하고, 교육 환경 과 관심이 부족하여 대부분의 의료기관에서는 ECT 기법에 대한 체계적이고 전문적인 교육과 훈련이 부족한 상태에서 일회성으로 ECT가 시술되고 있으며 소수의 의료기관에서만 정규적으로 시행되고 있다는 사실이다. 다양한 정신과적인 문제들로 고통받고 있는 많은 환자들에게 보다 안전하고 효 REVIEW ARTICLE
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Article Abstract Objective: To assess the efficacy of electroconvulsive therapy (ECT) in DSM-5 obsessive-compulsive-related disorders (OCRDs) and conditions subsumed under an "extended" OCD spectrum, including tic disorders and self-injurious behaviors. Data Sources: A systematic search of the MEDLINE, Web of Science, Scopus, and LILACS databases and other sources was performed between June 6 and July 2, 2017. Search terms included (Autis*) AND (ECT OR electroconvulsive), (Self-injur*) AND (ECT OR electroconvulsive), (Tic* OR Tourette) AND (ECT OR electroconvulsive), (Body Dysmorphic Disorder OR Dysmorphophobi*) AND (ECT OR electroconvulsive), (Hoard*) AND (ECT OR electroconvulsive), (Trichotillomani*) AND (ECT OR electroconvulsive), (Skin Picking OR Excoriation) AND (ECT OR electroconvulsive), (Grooming) AND (ECT OR electroconvulsive), (Kleptomani*) AND (ECT OR electroconvulsive), and (Pyromani*) AND (ECT OR electroconvulsive). No search restrictions (ie, date, language, or document type) were used. Study Selection: Fifty-two records that described the individual responses of OCRDs to ECT (involving 69 patients) were selected. Data Extraction: Clinical data and responses of individual cases were recorded. Data from responders were compared to nonresponders. Results: All records were case reports or case series; there were no randomized controlled trials. Of the 69 OCRD participants who had undergone ECT, a positive response was reported in 73.4% of the cases (including 44.0% of the BDD, 74.1% of the tic disorder, and 85.7% of the self-injurious behavior patients). At follow-up, the majority of responders who had abstained from further ECT had experienced relapse. However, a positive response was obtained in all participants who received a new course of ECT. Patients who responded positively to ECT were likely to report previous unsuccessful treatment with antipsychotics (P < .001) and antidepressants (P = .007). Conclusions: The finding that more than 70% of the reviewed cases showed some response to ECT should not be considered unequivocal evidence of its efficacy in OCRDs. The available evidence suggests that a randomized controlled trial of ECT in OCRDs may be warranted, particularly in severe tic disorders and self-injurious behaviors.
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Electroconvulsive therapy is a method of treating mental disorders that is still used today. It is thanks to electroconvulsive therapy that high rates of remission are achieved in patients. The main clinical indications for electroconvulsive therapy are severe depression with a high risk of suicide, life-threatening somatic conditions due to depression. Electroconvulsive therapy is usually used in the first and second trimesters of pregnancy as a last-line method of choice if there are convincing indications for its administration, to quickly eliminate the symptoms. When performing electroconvulsive therapy, the risks of using anesthesia, side effects, severity of the somatic condition, as well as the risks of not using this therapy are evaluated. Although electroconvulsive therapy is considered to be a safe and effective method for treating mental patients if necessary measures are taken to reduce potential risks, it is extremely rarely used to treat women with mental disorders during pregnancy and the postpartum period.
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Seizure threshold
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Objective: Gender difference is a significant determinant of treatment response. As in pharmacological agents, knowledge about this difference is also important for electroconvulsive therapy as an effective treatment modality. The current study aimed to examine the gender differences in terms of indications for electroconvulsive therapy, responses to treatment, and side effects that occur during its application.Methods: The hospital records of 176 adult patients (39 females and 137 males) having undergone bilateral temporal electroconvulsive therapy under anesthesia between 2007 and 2012 were examined retrospectively.Results: The mean age of women was higher than that of men, and the duration of hospitalization was longer in men. There was a significant difference between the genders in terms of the indications of electroconvulsive therapy. Major depression as a diagnosis and suicidal thoughts as an indication were more common in women, while catatonia was more common in men. The most frequent side effects were cardiovascular side effects and allergic reactions. No significant difference was determined in the response rates of the patients to electroconvulsive therapy according to their diagnosis and genders.Conclusion: Our results once again demonstrated that electroconvulsive therapy is a highly effective treatment in both genders. Some gender differences exist in terms of indication and diagnosis, although there was no difference in terms of response to electroconvulsive therapy. There is a need for prospective studies to identify the reasons for these differences.
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