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Tesi etd-10242019-160421

Type of thesis
Corsi integrativi di I livello
Author
BRANCATI, GIULIO EMILIO
URN
etd-10242019-160421
Title
Predictors of response to electroconvulsive therapy (ECT) in patients affected by depression or mixed states
Structure
Cl. Sc. Sperimentali - Medicina
Course
SCIENZE MEDICHE - Laurea Magistrale in Medicina e chirurgia (LM/41)
Committee
relatore ANGELONI, DEBORA
Relatore Prof. PERUGI, GIULIO
Membro Prof. COCEANI, FLAVIO
Keywords
  • catatonia
  • ECT
  • electroconvulsive therapy
  • major depression
  • melancholia
  • mixed state
  • motor disturbance
  • psychosis
  • psychotic symptoms
Exam session start date
;
Availability
parziale
Abstract
Background: The efficacy of ECT in the treatment of severe mood disorders has been repeatedly confirmed and has been widely recognized by the international guidelines. However, clinically useful predictors of response and remission are lacking.<br><br>Methods: 727 depressed and mixed patients treated with ECT were included in the study. Response (CGI-I ≤ 2) and remission (HAM-D ≤ 7 and YMRS ≤ 12) rates were computed. BPRS-EV items were taken into consideration to assess ECT efficacy on single symptoms or signs severity. Univariate logistic regression, backward stepwise logistic regression and LASSO regression were used to identify robust predictors of response and remission.<br><br>Results: Overall, 72.9% of patients responded to ECT and 29.8% completely remitted. Severe symptoms (BPRS-EV item score ≥ 5) showed response rates ranging between 85.1% and 100%. Remission (BPRS-EV item score ≤ 2) was observed in 28.8% to 84.6% of patients, depending on the psychopathological construct investigated, with the highest rate for suicidality. Unipolar illness, bipolar mixed episode, motor disturbances and excitatory features were associated with positive outcomes. Episode length and negative symptoms negatively predicted response and remission from the episode. Differential effects of psychotic symptoms were observed, with guilt and persecutory delusions being associated with positive outcomes, and somatic concern and hallucinations with negative ones.<br><br>Conclusions: ECT showed a high rate of response both in depressed and mixed patients and should be considered a first-line treatment for the most severe mood-disordered patients, especially in the case of high risk of suicide, melancholic, catatonic and excitatory features.
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