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Brus, Ole
Publications (10 of 32) Show all publications
Brus, O., Cao, Y., Carlborg, A., Engström, I., von Knorring, L. & Nordenskjöld, A. (2024). Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial. Journal of ECT
Open this publication in new window or tab >>Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial
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2024 (English)In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112Article in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111028 (URN)10.1097/YCT.0000000000000983 (DOI)38232249 (PubMedID)
Funder
Region Örebro County
Note

Uppsala-Örebro Regional Research Council and Research Committee of Örebro County Council, Örebro, Sweden, supported the research

Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-01-30Bibliographically approved
Sagerfors, M., Jakobsson, H., Wretenberg, P., Brus, O. & Möller, M. (2023). Treatment and outcome of AO/OTA type C distal radius fractures: 12 199 fractures from the Swedish Fracture Register. Acta Orthopaedica Belgica, 89(2), 241-247
Open this publication in new window or tab >>Treatment and outcome of AO/OTA type C distal radius fractures: 12 199 fractures from the Swedish Fracture Register
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2023 (English)In: Acta Orthopaedica Belgica, ISSN 0001-6462, Vol. 89, no 2, p. 241-247Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine the epidemiology, treatment, and patient-reported outcome of AO/OTA type C distal radius fractures (DRF) using data from a large national fracture register. We used prospectively collected data from the Swedish Fracture Register covering all AO/OTA type C DRFs registered between April 2012 and December 2018. Data on fracture type, epidemiology, trauma-mechanism, and treatment had been recorded by the treating physician. Patients had been sent an outcome questionnaire including EQ-VAS, EQ-5D, and the SMFA at the time of injury and 12 months after. A total of 12 199 cases with AO/OTA type C fracture were identified. AO/OTA type C1 fracture was most common, with 5400 cases, followed by AO type C2 with 4304 and AO/OTA type C3 with 2495. Cast treatment and surgical treatment with volar locking plate fixation were the most common treatments. Patient-reported outcome measures worsened significantly one year after the fracture, and 56% reported moderate problems with pain and discomfort one year after the fracture. Patients treated with a volar plate reported a significantly larger deterioration in EQ-5D outcome compared to patients treated with a cast. No treatment method was found to be superior. A good outcome after a type C fracture is possible, but many patients do not recover completely. Our findings indicate a relatively better self-reported outcome for patients treated with a cast, but as treatment was not randomized the clinical relevance is unclear.

Place, publisher, year, edition, pages
Belgian Society of Orthopaedics and Traumatology, 2023
Keywords
Distal radius fracture, Epidemiology, Swedish fracture register, AO, OTA type C, patient -reported outcome measures
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-110865 (URN)10.52628/89.2.11473 (DOI)001124240400003 ()37924540 (PubMedID)2-s2.0-85174386730 (Scopus ID)
Funder
Region Örebro County, 939040
Available from: 2024-01-22 Created: 2024-01-22 Last updated: 2024-01-22Bibliographically approved
Brus, O. (2022). Prognostic factors of electroconvulsive therapy for depression. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Prognostic factors of electroconvulsive therapy for depression
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 52
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 254
Keywords
Electroconvulsive therapy, unipolar depression, bipolar depression, outcome, memory, relapse, remission, register-based cohort study
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-95780 (URN)9789175294193 (ISBN)
Public defence
2022-02-18, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2021-12-07 Created: 2021-12-07 Last updated: 2022-02-03Bibliographically approved
Sienaert, P., Brus, O., Lambrichts, S., Lundberg, J., Nordanskog, P., Obbels, J., . . . Nordenskjöld, A. (2022). Suicidal ideation and ECT, ECT and suicidal ideation: a register study. Acta Psychiatrica Scandinavica, 146(1), 74-84
Open this publication in new window or tab >>Suicidal ideation and ECT, ECT and suicidal ideation: a register study
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2022 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 146, no 1, p. 74-84Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2022
Keywords
ECT, electroconvulsive therapy, suicidal ideation
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-97984 (URN)10.1111/acps.13425 (DOI)000770371100001 ()35279825 (PubMedID)2-s2.0-85126461504 (Scopus ID)
Funder
Region Örebro County
Available from: 2022-03-14 Created: 2022-03-14 Last updated: 2023-12-08Bibliographically approved
Ahmad, I., Sandberg, M., Brus, O., Ekman, C. J., Hammar, Å., Landén, M., . . . Nordenskjöld, A. (2022). Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy. Nordic Journal of Psychiatry, 76(2), 96-103
Open this publication in new window or tab >>Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy
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2022 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 76, no 2, p. 96-103Article in journal (Refereed) Published
Abstract [en]

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 Åsberg 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.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Electroconvulsive therapy, data accuracy, registries
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-93511 (URN)10.1080/08039488.2021.1939416 (DOI)000681210600001 ()34346852 (PubMedID)2-s2.0-85111864447 (Scopus ID)
Note

Funding agencies:

Region Örebro County ALF

Nyckelfonden at Örebro University Hospital

Available from: 2021-08-10 Created: 2021-08-10 Last updated: 2023-12-08Bibliographically approved
Ntouniadakis, E., Brus, O. & Von Beckerath, M. (2021). Dyspnea Index: An upper airway obstruction instrument; translation and validation in Swedish. Clinical Otolaryngology, 46(2), 380-387
Open this publication in new window or tab >>Dyspnea Index: An upper airway obstruction instrument; translation and validation in Swedish
2021 (English)In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 46, no 2, p. 380-387Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVE: Upper airway dyspnea is a challenging condition in which assessing the discomfort experienced by the patient is essential. There are three patient-reported outcome (PRO) instruments developed particularly for this patient group, none of which is available in Swedish. The aim of this study was to translate the Dyspnea Index (DI) into Swedish and validate the instrument for use in the Swedish-speaking population by investigating its basic psychometric properties.

DESIGN: A prospective instrument validation study.

SETTING: Tertiary referral center.

PARTICIPANTS: Fifty-three (n=53) patients with upper airway dyspnea and 19 healthy controls.

MAIN OUTCOME MEASURES: The questionnaire was translated into Swedish (swDI) with a forward-backward method. Reliability, repeatability, responsiveness and construct validity were assessed by asking the subjects to complete the swDI, a visual analog scale (VAS) at exertion and at rest and the Voice Handicap Index (VHI).

RESULTS: The swDI showed excellent internal consistency (Cronbach's α: 0.85) and repeatability (interclass correlation coefficient: 0.87 and Pearson's r: 0.89) in the patient group. No ceiling effect was observed (maximum score achieved was 39; 85% of the patients scored ≤36). SwDI scores moderately correlated with VAS at exertion (r: 0.59) and at rest (r: 0.42), yet poorly with the VHI (r: 0.36). The effect size (ES) was 3.8.

CONCLUSIONS: The swDI is a valid, robust and reliable questionnaire for self-assessment in Swedish-speaking patients with upper airway obstruction. A future anchor-based longitudinal study is needed to assess the smallest detectable change (SDC) and minimum important change (MIC) that were not estimated in our study.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
Dyspnea Index, Patient Reported Outcome Measures, laryngotracheal stenosis, paradoxical vocal fold movement, quality of life, upper airway obstruction, validation
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:oru:diva-87840 (URN)10.1111/coa.13682 (DOI)000604255700001 ()33277799 (PubMedID)2-s2.0-85099043741 (Scopus ID)
Note

Funding Agency:

Research Committee of the Region Örebro län 

Available from: 2020-12-07 Created: 2020-12-07 Last updated: 2024-01-02Bibliographically approved
Kalling, S., Brus, O., Landén, M., Lundberg, J., Nordanskog, P. & Nordenskjöld, A. (2021). Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder. Nordic Journal of Psychiatry, 75(3), 201-206
Open this publication in new window or tab >>Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder
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2021 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 75, no 3, p. 201-206Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Acute polymorphic psychotic disorder, electroconvulsive therapy, relapse prevention
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-86799 (URN)10.1080/08039488.2020.1834617 (DOI)000583456600001 ()33095086 (PubMedID)2-s2.0-85094123479 (Scopus ID)
Note

Funding Agency:

Centre for Clinical Research Sormland  75602

Available from: 2020-10-26 Created: 2020-10-26 Last updated: 2021-04-22Bibliographically approved
Sönnerqvist, C., Brus, O. & Olivecrona, M. (2021). Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children. European Journal of Trauma and Emergency Surgery, 47(4), 1163-1173
Open this publication in new window or tab >>Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children
2021 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 47, no 4, p. 1163-1173Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.

METHODS: We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study" by Kuppermann et al. (Lancet 374(9696):1160-1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.

RESULTS: We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.

CONCLUSION: Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2021
Keywords
CT, Children, Guidelines, Traumatic brain injury, Validation
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-78969 (URN)10.1007/s00068-019-01288-x (DOI)000574084200001 ()31907552 (PubMedID)2-s2.0-85077542057 (Scopus ID)
Note

Funding Agencies:

Örebro University  

United States Department of Health & Human Services

United States Health Resources & Service Administration (HRSA)

 

Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2021-08-16Bibliographically approved
Stenmark, L., Popiolek, K., Bodén, R., Brus, O., Hammar, Å., Landén, M., . . . Nordenskjöld, A. (2020). Predictors of Treatment Response to Electroconvulsive Therapy in Schizophrenia: A Nationwide Registry-Based Study. Schizophrenia Bulletin Open, 1(1), Article ID sgaa019.
Open this publication in new window or tab >>Predictors of Treatment Response to Electroconvulsive Therapy in Schizophrenia: A Nationwide Registry-Based Study
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2020 (English)In: Schizophrenia Bulletin Open, ISSN 2632-7899, Vol. 1, no 1, article id sgaa019Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Oxford University Press, 2020
National Category
Medical and Health Sciences Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-83290 (URN)10.1093/schizbullopen/sgaa019 (DOI)2-s2.0-85141848249 (Scopus ID)
Note

sgaa019

Available from: 2020-06-16 Created: 2020-06-16 Last updated: 2023-12-08Bibliographically approved
Popiolek, K., Bejerot, S., Brus, O., Hammar, Å., Landén, M., Lundberg, J., . . . Nordenskjöld, A. (2019). Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors. Acta Psychiatrica Scandinavica, 140(3), 196-204
Open this publication in new window or tab >>Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors
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2019 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 196-204Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression.

METHODS: Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response.

RESULTS: Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate.

CONCLUSION: ECT for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Bipolar disorders, bipolar depression, electroconvulsive therapy, prognosis
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75577 (URN)10.1111/acps.13075 (DOI)000480263900003 ()31334829 (PubMedID)2-s2.0-85070454601 (Scopus ID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-11-15Bibliographically approved
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