@article{ref1,
title="Electroconvulsive therapy in medication-nonresponsive patients with mixed mania and bipolar depression",
journal="Journal of clinical psychiatry",
year="2001",
author="Ciapparelli, A. and Dell'Osso, L. and Tundo, A. and Pini, S. and Chiavacci, M. C. and Di Sacco, I. and Cassano, G. B.",
volume="62",
number="7",
pages="552-555",
abstract="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.<p /><p>Language: en</p>",
language="en",
issn="0160-6689",
doi="10.4088/jcp.v62n07a09",
url="http://dx.doi.org/10.4088/jcp.v62n07a09"
}