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Symptomatic predictors of ECT response in medication-nonresponsive manic patients
D B Schnur1, S Mukherjee, H A Sackeim
1Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, N.Y.
The Journal of Clinical Psychiatry
|February 1, 1992
Summary
Patients with acute mania who were angry, irritable, and suspicious showed poorer response to electroconvulsive therapy (ECT). These symptoms may predict nonresponse to other treatments like lithium.
Area of Science:
- Psychiatry
- Neuroscience
- Clinical Psychology
Background:
- Investigated the relationship between pretreatment symptoms and electroconvulsive therapy (ECT) outcomes in acute manic patients.
- Focused on patients unresponsive to prior medication treatments.
- Examined patients admitted to a state psychiatric center.
Purpose of the Study:
- To determine if specific pretreatment symptom ratings predict ECT response in medication-nonresponsive acute manic patients.
- To identify symptom patterns associated with treatment outcomes in bipolar disorder.
Main Methods:
- Patients received pretreatment clinical ratings before randomization to pharmacotherapy, right unilateral ECT, left unilateral ECT, or bilateral ECT.
- Crossover to bilateral ECT was offered for nonresponders.
- Response was defined as complete recovery sustained for one week without psychotropic medication.
Main Results:
- Electroconvulsive therapy (ECT) nonresponders exhibited significantly higher levels of anger, irritability, and suspicion compared to ECT responders.
- Baseline severity ratings for mania and depression did not correlate with ECT response.
- Symptom profiles differentiated treatment outcomes.
Conclusions:
- Pretreatment anger, irritability, and suspicion may indicate poor response to ECT in acute mania.
- These symptoms might also predict nonresponse to lithium treatment.
- Differential symptom patterns could guide treatment selection between ECT and carbamazepine for lithium/neuroleptic-refractory manic patients.