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Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania
Örebro University, School of Medical Sciences. University Health Care Research Centre.
Örebro University, School of Medical Sciences. University Health Care Research Centre.ORCID iD: 0000-0002-3587-6075
Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. University Health Care Research Centre.ORCID iD: 0000-0001-7454-3065
2022 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, no 6, article id e2218330Article in journal (Refereed) Published
Abstract [en]

Importance: Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood.

Objective: To investigate the response to ECT in patients with manic episodes.

Design, Setting, and Participants: This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021.

Exposures: Patients treated with ECT for a mania were identified from the Q-ECT.

Main Outcomes and Measures: Response to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT. Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response.

Results: Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessive-compulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness.

Conclusions and Relevance: This study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.

Place, publisher, year, edition, pages
American Medical Association , 2022. Vol. 5, no 6, article id e2218330
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-99778DOI: 10.1001/jamanetworkopen.2022.18330ISI: 000815225800004PubMedID: 35737387Scopus ID: 2-s2.0-85133101068OAI: oai:DiVA.org:oru-99778DiVA, id: diva2:1677724
Available from: 2022-06-28 Created: 2022-06-28 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)
Opponent
Supervisors
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-04-16Bibliographically approved

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Popiolek, KatarzynaBejerot, SusanneNordenskjöld, Axel

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