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

Area of Science:

• Psychiatry
• Clinical Neuroscience

Background:

• The majority of patients hospitalized for manic episodes face readmission within two years, even with maintenance treatment.
• Electroconvulsive therapy (ECT) has demonstrated reduced rehospitalization in other psychiatric conditions, but its impact on mania readmission is not well-established.

Purpose of the Study:

• To investigate if Electroconvulsive therapy (ECT) increases the time to psychiatric readmission for patients experiencing a manic episode.
• To identify patient subgroups that may experience greater benefit from ECT regarding readmission rates.

Main Methods:

• A nationwide, register-based observational study in Sweden (2012-2021) included all patients hospitalized for a manic episode.
• Analysis involved all admissions, followed by a paired samples model comparing ECT vs. non-ECT admissions within the same patients.

Main Results:

• Out of 12,337 admissions, 7.3% received ECT. Overall, ECT was not significantly associated with time to readmission (aHR 1.00).
• In a paired analysis of 377 patients, ECT admissions showed a trend towards lower 30-day readmission rates (19.0% vs. 24.1%, aHR 0.75), though not statistically significant (p=0.067).

Conclusions:

• Readmission rates following inpatient treatment for mania are high.
• While not statistically significant, Electroconvulsive therapy (ECT) demonstrated a trend towards a protective effect against psychiatric readmission in patients with mania, particularly when analyzed within-individual comparisons.