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Rehospitalization and suicide following electroconvulsive therapy for bipolar depression: A population-based register study
Örebro University, School of Medical Sciences.
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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2018 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 226, p. 146-154Article in journal (Refereed) Published
Abstract [en]

Background: Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide.

Methods: This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT. Other national registers provided data on psychopharmacotherapy, socio-demographic factors, and causes of death. The endpoint was the composite of rehospitalization for any psychiatric disorder, suicide attempt or completed suicide (RoS). Cox regression was used to calculate hazard ratios in univariate and multivariate models.

Results: Data from 1255 patients were analyzed. The mean period of follow-up was 346 days.

A total of 29%, 41%, and 52% of patients reached RoS at 3, 6, and 12 months post-discharge. A history of multiple psychiatric admissions, lower age, and post-discharge treatment with antipsychotics or benzodiazepines was associated with RoS.

Limitations: Indication bias may have affected the results.

Conclusions: A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 226, p. 146-154
National Category
Neurology Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-62810DOI: 10.1016/j.jad.2017.09.030ISI: 000414329000020PubMedID: 28982047Scopus ID: 2-s2.0-85030308357OAI: oai:DiVA.org:oru-62810DiVA, id: diva2:1160174
Note

Funding Agency:

Region Örebro County 

Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2024-03-21Bibliographically approved
In thesis
1. Electroconvulsive therapy for bipolar disorder
Open this publication in new window or tab >>Electroconvulsive therapy for bipolar disorder
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims This thesis aimed to investigate 1. the effectiveness of electroconvulsivetherapy (ECT) in bipolar depression and mania in real-life settings; 2. the prognostic factors of response to ECT; 3. readmission ratesand risk factors after the acute phase of bipolar disorder; and 4. the association between ECT and readmission rate in mania.

Methods This thesis includes four nationwide register studies. Data came from several national registers linked by personal identity numbers.

Results Response was achieved in 80.2% of ECT-treated patients with bipolardepression and 84.4% of ECT-treated patients with mania. Younger age was associated with a lower response rate to ECT in depressive episodes. Patients aged 16–30 years had a lower chance of responding than patients aged 31–40 years, 61–70, and 71–80 years. Response to ECT in mania was associated with the severity of symptoms. Patients who were markedly ill, severely ill, and among the most extremely ill had a higher chance of responding than patients with mild to moderate illness. Relapse within 3, 6, and 12 months after bipolar depression was reached by 29%, 41%, and 52% of patients, respectively. After manic episodes, 30%, 41%, and 55% of patients were readmitted within 3, 6, and 12 months, respectively. Treatment with ECT was not associated with a longer time to readmission after a manic episode than other treatments.

Conclusions Over 80% of patients with bipolar depression and mania responded to ECT. In depressive episodes, patients at lower ages had a lower chance of achieving response after ECT, and in mania, patients with more severe symptoms had a higher chance of responding to ECT. The readmission rate after both manic and depressive episodes was high. There was no significant difference between time to readmission in patients treated with and without ECT during index admission for mania.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 81
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 288
Keywords
electroconvulsive therapy, bipolar disorder, treatment outcome, response, rehospitalization, readmission
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-111220 (URN)9789175295497 (ISBN)9789175295503 (ISBN)
Public defence
2024-04-19, Örebro universitet, Campus USÖ, Tidefeltsalen, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
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Supervisors
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-04-16Bibliographically approved

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Popiolek, KatarzynaBrus, OleNordenskjöld, Axel

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