An Interventional Study on the Clinical Usefulness and Outcomes of Electroconvulsive Therapy in Medication-Resistant Mental Disorders

Abstract

BackgroundResistance to recommended medications has been an issue in dealing with a number of psychiatric ailments, and it is showing up as an ongoing challenge for contemporary mental health experts. Resistant psychiatric disorders not only increase the morbidity of patients suffering from such severe conditions but also intensify the problems of their caretakers. This has vigorously started to cause the costs to increase for healthcare services. Thanks to electroconvulsive therapy (ECT), we now have an effective method that is proving to be a fruitful final course of action in this micro-epidemic of resistant psychiatric diseases. However, the medical literature of case reports or studies in this niche is scarce. Also, no such comprehensive study has been carried out in the Southeast Asian region to date for the assessment of the effectiveness of electroconvulsive therapy in patients with medication-resistant psychiatric disorders.AimTo assess the effectiveness of ECT in medication-resistant psychiatric patients at the post-ECT course, three-month follow-up, and six-month follow-up.Materials and methodsThe study was a prospective and interventional study (without controls) conducted in the Institute of Mental Health and Neurosciences (IMHANS), Srinagar, India. Fifty-six patients with pharmacotherapy-resistant psychiatric disorders were included in the study. The patients were assessed at the end of the ECT course, at the three-month follow-up, and at the six-month follow-up by the Clinical Global Impression (CGI), Montgomery Asberg Depression Rating Scale (MADRS), Young Manic Rating Scale (YMRS) and the Yale-Brown Obsessive Compulsive Scale (YBOCS). Improvement was defined with the help of the CGI subscale by comparing the position of the patient at admission to the projected condition with ECT.Statistical analysisAnalysis of Variance (ANOVA) was used for analysis of the quantitative data. For the pair-wise comparison of the groups, the post hoc tests were used. Pearson’s chi-square test was used for analysis of qualitative data. A p-value of < 0.05 was considered to be statistically significant, and all the data analysis was done using SPSS Version 20.0.ResultsThe CGI scale revealed that statistically significant improvement occurred in patients at the end of ECT course, at the three-month follow-up as well as at the six-month follow-up.ConclusionECT should be used for the treatment of pharmacotherapy-resistant psychiatric patients and the benefits can be seen even six months after an ECT course completion. Further work in this field should focus on educating the general public about the usefulness of ECT in the treatment of resistant mental illnesses. The myths related to the so-called psychiatric assault from ECT should be removed.

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

“…The only cohort study of ECT was a retrospective review reporting a mean symptom improvement of 42% following treatment, and 35% improvement 12 months later [38]. Pooled together, the case studies for OCD revealed a response rate of 79% (11/14); within those who responded, symptom improvement of 43-95% was achieved [39][40][41][42][43].…”

“…Quantitative follow-up outcomes were reported in 43% of case studies (6/14 patients). In one study [41], three out of five patients were responders following treatment; only one remained a responder at 3-and 6-month follow-up, according to the clinical global impression (CGI) scale (not YBOCS). Another patient relapsed to baseline twice following consecutive cycles of ECT [42].…”

Challenges in defining treatment‐resistant mania in adults: A systematic review

“…Also, according to our definition of TRM, a mood stabilizer and an antipsychotic can, but do not have to, have been prescribed concurrently. This is a compromise based on the literature we reviewed (see Table 1): focusing on the 18 articles published since 2000 that are not case reports, seven define TRM based on one failed medication trial 10,48,58,59,63,64,65 ; five define TRM based on two failed medication trials 15,47,53,54,66 ; four define TRM based on three or more failed medication trials 17,46,55,60 ; and, while some mention that medications can be given sequentially or in combination (like we do), only two require a failed combination 45,56 . In this context, we considered whether we should require that a mood stabilizer and an antipsychotic had been used in combination to define TRM.…”

“…Our search identified eight open-label clinical trials [49][50][51][52][53][54][55][56] that enrolled three to 22 participants with BD, with four trials also involving participants with other diagnoses. 51,52,54,56 Four trials required a minimum severity of mania based on a scale [52][53][54][55] and six trials required a minimum duration of treatment.…”

Electroconvulsive therapy for obsessive-compulsive disorder: A retrospective study

“…Due to this, ECT has a certain effect on OCD patients, but it has a less significant effect on refractory patients. The use of ECT has also been associated with significant improvements in refractory OCD in many cases (24)(25)(26)(27)(28)(29)(30)(31).…”