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Citation
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Ciapparelli A, Dell'Osso L, Tundo A, Pini S, Chiavacci MC, Di Sacco I, Cassano GB. J. Clin. Psychiatry 2001; 62(7): 552-555. |
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Abstract
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BACKGROUND: The aim of this study was to investigate the effectiveness of electroconvulsive therapy (ECT) in medication-nonresponsive patients with mixed mania and bipolar depression.
METHOD: Forty-one patients with mixed mania (DSM-IV diagnosis of bipolar I disorder, most recent episode mixed) and 23 patients with bipolar depression (DSM-IV diagnosis of bipolar I disorder, most recent episode depressed) consecutively assigned to ECT treatment were included in this study. Subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impressions-Severity of Illness scale (CGI-S). Assessments were carried out the day before starting ECT, 48 hours after completion of the third session (T1), and a week after the last session of ECT (T2).
RESULTS: Both groups received an equal number of ECT sessions (mean +/- SD = 7.2 +/- 1.7 vs. 7.3 +/- 1.6). In both groups, within-group comparisons showed that there was a significant reduction in CGI-S score (mixed mania, p <.0001 at T1 and T2; bipolar depression, p <.01 at T1, p <.0001 at T2), MADRS total score (both groups, p <.0001 at T1 and T2), BPRS total score (mixed mania, p <.0001 at T1 and T2; bipolar depression, p <.001 at T1, p <.0001 at T2), and BPRS activation factor score (mixed mania, p <.0001 at T1 and T2; bipolar depression, NS at T1, p <.01 at T2). Between-group comparisons revealed that patients with mixed mania showed significantly greater decrease in MADRS score (p <.001) and a greater proportion of responders (CGI-S) than patients with bipolar depression at endpoint (56% [N = 23] vs. 26% [N = 6], p =.02). Patients with mixed mania showed a greater reduction in suicidality, as measured by MADRS score, than patients with bipolar depression (p <.02).
CONCLUSION: In our study, ECT was associated with a substantial reduction in symptomatology, in both patients with mixed mania and those with bipolar depression. However, the mixed mania group exhibited a more rapid and marked response as well as a greater reduction in suicidal ideation. Response to ECT was not influenced by the presence of delusions.
Language: en |