Erika Martínez-Amorós1, Pilar Serra2, Ximena Goldberg1, Lara Urraca2, Diego J Palao1, Mikel Urretavizcaya3, Narcís Cardoner4. 1. Departamento de Salud Mental, Hospital Universitario Parc Taulí de Sabadell, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, España. 2. Departamento de Salud Mental, Hospital Universitario Parc Taulí de Sabadell, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España. 3. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, España; Departamento de Psiquiatría, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Grupo de Neurociencias-Psiquiatría y Salud Mental, Departamento de Ciencias Clínicas, Escuela de Medicina, Universitat de Barcelona, Barcelona, España. 4. Departamento de Salud Mental, Hospital Universitario Parc Taulí de Sabadell, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, España. Electronic address: ncardoner@tauli.cat.
Abstract
INTRODUCTION: Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS: Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS: Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS: The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse.
INTRODUCTION: Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS: Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS: Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS: The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse.
Authors: Pascal Sienaert; Simon Lambrichts; Leen Popleu; Elke Van Gerven; Satya Buggenhout; Filip Bouckaert Journal: Am J Geriatr Psychiatry Date: 2020-04-22 Impact factor: 4.105