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- Brus, Ole, 1982-, et al.
(author)
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Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial
- 2024
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In: Journal of ECT. - : Lippincott Williams & Wilkins. - 1095-0680 .- 1533-4112.
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Journal article (peer-reviewed)abstract
- OBJECTIVES: This study aimed to compare the long-term effects of maintenance electroconvulsive therapy (M-ECT) with medication and medication only in patients with depression.METHODS: A randomized controlled trial of 1 year of M-ECT with medication or medication only investigated relapse/recurrence among 56 patients in remission after electroconvulsive therapy (ECT) for depression was conducted. The results of the first year are published already and showed a significant advantage of M-ECT with medication.The current study was a long-term follow-up. When the randomized treatment allocation ended, medication was continued in both groups but M-ECT was terminated. Patients were followed for up to 10 years via Swedish national registers until the study endpoint of a new psychiatric diagnosis as an inpatient, suicide, suspected suicide, or death of another cause. Time to relapse was compared between the M-ECT with medication group and the medication-only group using Kaplan-Meier estimates.RESULTS: The median follow-up time was 6.5 years for the M-ECT and medication group and 3.1 years for the medication-only group. One year after randomization 22 patients remained in the M-ECT and medication group, and 14 patients remained in the medication-only group. Relapse patterns between the treatment groups after the completion of M-ECT seemed to be similar according to visual inspection.CONCLUSIONS: This long-term follow-up study suggests that most of the benefit achieved during the treatment period with M-ECT is maintained over several years, but the small sample size, with accompanying large statistical imprecision, makes the results uncertain. More long-term studies of M-ECT are required.Trial registration: ClinicalTrials.gov identifier: NCT00627887.
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- Nordenskjöld, Axel, 1977-, et al.
(author)
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Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder : a population based cohort study
- 2013
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In: Nordic Journal of Psychiatry. - Oxfordshire, United Kingdom : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 67:5, s. 326-333
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Journal article (peer-reviewed)abstract
- Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.
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- Wilhelmsson Göstas, Mona, 1950-, et al.
(author)
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Changes in attachment styles and interpersonal problems after different forms of psychotherapy
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Other publication (other academic/artistic)abstract
- Attachment theorists and researchers have argued that psychotherapy may be an opportunity to revise insecure attachment styles, enabling more flexibility in interpersonal relationships. Attachment theory was developed to understand human reactions to life stressors, such as loss and separation. The term attachment style reflects a person’s most typical internal working models to seek proximity in relationships. This study examines whether self-reported attachment styles measured by the Attachment Style Questionnaire (ASQ) changed after a course of either cognitive behavioural (CBT) or psychodynamic oriented psychotherapy (PDT) in a clinical sample of psychotherapy patients (n= 111). One aim was to examine changes related to differences in gender, age, diagnoses, therapy method and number of sessions. Another aim was to examine whether changes correlated with changes in interpersonal problems measured by the Inventory of Interpersonal Problems (IIP). Results showed an increase in security in attachment styles that correlated with a decrease in interpersonal problems. No differences between therapy methods were found. The age group 26 to 39 reported greater security and less avoidance compared to patients over 40. Patients who attended between 11 and 25 sessions scored higher as regards security compared to those with 1-10 sessions but there was no difference for those with more than 25 sessions. The study supports results from a few other studies that psychotherapy increases the attachment-related security of patients. As an increase in security is associated with a decrease in interpersonal problems, attachment styles can be perceived as mediating factors in psychotherapy outcome irrespective of psychotherapy orientation.
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