Association between electroconvulsive therapy and time to readmission after a manic episode

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-04-11 DOI:10.1111/acps.13689

Katarzyna Popiolek, Tor Arnison, Susanne Bejerot, Katja Fall, Mikael Landén, Axel Nordenskjöld

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Abstract

Objective

The majority of patients hospitalized for treatment of a manic episode are readmitted within 2 years despite maintenance treatment. Electroconvulsive therapy (ECT) has been associated with lower rehospitalization rates in some psychiatric conditions, but its association with readmission after a manic episode has not been investigated. Therefore, the aim of this study was to determine whether the time to readmission in patients with mania treated with ECT was longer than in patients not treated with ECT and whether there were subgroups of patients that benefited more.

Methods

This was a nationwide register-based, observational study. All patients diagnosed with bipolar disorder, manic episode, admitted to any hospital in Sweden between 2012 and 2021 were included. Patients contributed data to the study for every admission. All admissions were followed up until psychiatric readmission, death, or the end of the study (December 31, 2021). Association between ECT and time to readmission was analyzed. A paired samples model was performed for 377 patients with at least two admissions for mania, treated with ECT at one admission and without ECT at the other admission. Times to readmission were analyzed.

Results

A total of 12,337 admissions were included; mean (SD) age 47.7 (17.2), 5443 (44.1%) men. Readmission rate within 1 year was 54.6%. ECT was administered in 902 (7.3%) admissions. Within 30 days after admission, 182 out of 894 (20.4%) patients treated with ECT versus 2105 out of 11,305 (18.6%) patients treated without ECT were readmitted. There was no association between ECT and time to readmission (aHR 1.00, 95% CI 0.86–1.16, p = 0.992) in the model with all admissions. The paired samples model included 754 admissions (377 patients), mean (SD) age during admission without ECT was 45.6 (16.5), and with ECT 46.6 (16.4), 147 (39.0%) were men. In that model, readmission rate within 30 days for treatment with ECT was 19.0%, and for treatments without ECT, 24.1% (aHR 0.75, 95% CI 0.55–1.02, p = 0.067).

Conclusion

Readmission rates after inpatient treatment of mania were high. ECT was not significantly associated with longer time to readmission, but there was a trend toward a protective effect of ECT when admissions with and without ECT were compared within the same patients.

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电休克疗法与躁狂发作后再次入院时间的关系

目标大多数因躁狂发作而住院治疗的患者尽管接受了维持治疗，但仍会在两年内再次入院。在某些精神疾病中，电休克疗法（ECT）与降低再入院率有关，但其与躁狂发作后再入院的关系尚未得到研究。因此，本研究旨在确定接受电休克疗法治疗的躁狂症患者再次入院的时间是否长于未接受电休克疗法治疗的患者，以及是否存在获益更多的亚组患者。2012年至2021年期间，瑞典任何一家医院收治的所有被诊断为双相情感障碍、躁狂发作的患者均被纳入研究范围。患者为每次入院提供数据。研究人员对所有入院患者进行随访，直至患者再次入院、死亡或研究结束（2021 年 12 月 31 日）。研究分析了电痉挛疗法与再入院时间之间的关系。对至少两次因躁狂症入院、一次入院时接受电痉挛疗法治疗、另一次入院时未接受电痉挛疗法治疗的377名患者进行了配对样本模型分析。结果共纳入 12337 例入院患者；平均（标清）年龄为 47.7（17.2）岁，其中 5443 例（44.1%）为男性。一年内再入院率为 54.6%。902例（7.3%）入院患者接受了电痉挛疗法治疗。在入院后30天内，894名接受电痉挛疗法治疗的患者中有182人（20.4%）再次入院，而11305名未接受电痉挛疗法治疗的患者中有2105人（18.6%）再次入院。在所有入院患者的模型中，电痉挛疗法与再入院时间之间没有关联（aHR 1.00，95% CI 0.86-1.16，p = 0.992）。配对样本模型包括 754 例入院患者（377 例），未使用 ECT 时的平均年龄（标清）为 45.6（16.5）岁，使用 ECT 时为 46.6（16.4）岁，其中 147 例（39.0%）为男性。在该模型中，接受 ECT 治疗的患者 30 天内再入院率为 19.0%，未接受 ECT 治疗的患者 30 天内再入院率为 24.1%（aHR 0.75，95% CI 0.55-1.02，p = 0.067）。ECT与再入院时间的延长并无明显关联，但如果对同一患者进行有ECT和无ECT入院的比较，则ECT有保护作用的趋势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.