| 1. |
- Ahmad, I., et al.
(författare)
-
Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy
- 2022
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 76:2, s. 96-103
-
Tidskriftsartikel (refereegranskat)abstract
- Background The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. Aim This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. Materials and methods From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery angstrom sberg Depression Rating Scale between the Q-ECT and the patient record. Results A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. Conclusions We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.
|
|
| 2. |
- Brus, Ole, 1982-, et al.
(författare)
-
Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial
- 2024
-
Ingår i: Journal of ECT. - : Lippincott Williams & Wilkins. - 1095-0680 .- 1533-4112.
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 3. |
- Brus, Ole, 1982-
(författare)
-
Prognostic factors of electroconvulsive therapy for depression
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is a severe disorder that can be difficult to treat. One approach to treating depression is electroconvulsive therapy (ECT), whereby electricity is administered through electrodes fastened to the patient’s head. This procedure is effective, however not all patients respond. Moreover, ECT can induce side effects, such as memory problems. In addition, even after achieving remission patients are likely to relapse at a later date. Thus, it is important to optimize ECT in terms of treatment effectiveness while minimizing its side effects. A further crucial issue is to prevent relapses by developing effective follow-up treatments. This thesis encapsulates four studies with the following goals: 1) to identify which factors that are associated with the worsening of subjective memory, 2) to identify factors that are associated with remission, 3) to quantify the effect of lithium on relapse after ECT for unipolar depression, 4) to investigate whether the difference in time to relapse between continuation ECT (C-ECT) with medication and medication alone during the first year of treatment changes over 10 years following the end of C-ECT treatment in patients with depression.The studies were performed using the Swedish national register data. The first two studies used the outcomes of subjective memory worsening and remission respectively. The third and fourth studies used time to relapse as the outcome.Several factors were associated with the outcomes: in the first, second, and third studies, it was found that older patients were associated with a positive outcome. In both the second and fourth studies, psychotic depression and not having anxiety disorder were associated with positive outcomes. The third study showed that patients who used lithium were less likely to relapse: the hazard ratio with 95% confidence interval among lithium users compared to non-lithium users was 0.84 (0.75–0.93). The fourth study indicated that the beneficial effect of C-ECT and medication compared with medication alone during the first year post-ECT was maintained for several years.In conclusion, it is important to identify factors that are associated with beneficial treatment, and the studies conducted for this thesis contribute to such knowledge.
|
|
| 4. |
- Kalling, Styrbjörn, et al.
(författare)
-
Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder
- 2021
-
Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 75:3, s. 201-206
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Acute polymorphic psychotic disorder (APPD) without symptoms of schizophrenia is a serious psychiatric condition. APPD can be effectively treated with electroconvulsive therapy (ECT), but little is known about relapse prevention after ECT for APPD.MATERIALS AND METHODS: This was a retrospective register-based study conducted with 97 patients with APPD (ICD-10 diagnosis F23.0). We estimated the rates of readmission and suicide, and the prognostic factors of these outcomes after ECT. We combined data from several national Swedish registers and used Cox's regression analysis to identify demographic factors, disease characteristics, and relapse preventive treatments that predicted time to readmission or suicide (relapse). Data registered between 2011 and 2016 were used in the study.RESULTS: Twenty percent of cases relapsed within a year. Thereafter, relapse rate was low. Two cases died during follow-up, whereof one by suicide. Anxiolytic treatment, lamotrigine treatment, and having more than four previous psychiatric hospital admissions were associated with shorter time to relapse. The most robust of these associations was between anxiolytics and relapse risk.CONCLUSIONS: The first year after discharge from APPD is the period associated with the highest risk of relapse. Having many previous admissions was associated to relapse risk after ECT for APPD. The associations between anxiolytics, lamotrigine, and relapse are uncertain and might be influenced by indication bias.
|
|
| 5. |
- Sienaert, Pascal, et al.
(författare)
-
Suicidal ideation and ECT, ECT and suicidal ideation : a register study
- 2022
-
Ingår i: Acta Psychiatrica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-690X .- 1600-0447. ; 146:1, s. 74-84
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Although electroconvulsive therapy (ECT) is anti-suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT.METHODS: This population-based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥ 4 on the last item of the Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline.RESULTS: In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre-treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS-S-score, and younger age were associated with persistent SI.CONCLUSION: The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non-psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.
|
|
| 6. |
- Stenmark, Linnea, et al.
(författare)
-
Predictors of Treatment Response to Electroconvulsive Therapy in Schizophrenia : A Nationwide Registry-Based Study
- 2020
-
Ingår i: Schizophrenia Bulletin Open. - : Oxford University Press. - 2632-7899. ; 1:1
-
Tidskriftsartikel (refereegranskat)abstract
- Up to 30% of patients with schizophrenia respond insufficiently to antipsychotic drugs. Electroconvulsive therapy (ECT) has been reported to effectively augment the effects of antipsychotics in some of these patients. To date, there are few established predictors of treatment response to ECT in patients with schizophrenia. The primary aim was to determine the response rate to ECT in patients with schizophrenia. The secondary aim was to investigate predictors of treatment response. All patients admitted to any Swedish hospital for schizophrenia from 2011 to 2017, who were treated with ECT while in inpatient care, were included in the Swedish National Quality Registry for ECT (Q-ECT), and were assessed using the Clinical Global Impression – Improvement (CGI-I) scale after treatment were included. CGI-I scores of 1 or 2 were considered a response to treatment. Multiple national registries were used to obtain information on demographics and clinical variables. The study included 285 patients who were concurrently treated with antipsychotic drugs. The response rate to ECT was 73.0%. Among those patients with outcome data, treatment with long-acting injectable antipsychotics was predictive of a better response, whereas comorbid substance use disorders were predictive of a worse response. This study provides new evidence on predictors of who might respond among patients with schizophrenia treated by ECT. Additional studies of ECT in schizophrenia are needed.
|
|
