针对痴呆症的侵略和激动的电疗法:以探索性的元分析和伦理视角进行系统审查
Sarah Kayser1, Andreas Fallgatter1, Florian Funer2
1Department of Psychiatry and Psychotherapy (SK, AF), University of Tuebingen, Tuebingen, Baden-Württemberg, Germany; German Center for Mental Health (SK, AF), University of Tuebingen, Tuebingen Site, Tuebingen, Germany.
概括
电疗法 (ECT) 提供了一种安全有效的最后手段来治疗痴呆症中的攻击性和动荡性,在大多数患者中在几周内显著改善. 当其他方法失败时,这种疗法可以快速缓解行为症状.
科学领域:
- 老年精神病学是一门精神病学专业.
- 神经科学是一个神经科学.
- 临床治疗学 临床治疗学
背景情况:
- 痴呆症 (BPSD) 的行为和心理症状,包括侵略性和激动性,难以治疗,并且往往对传统疗法具有抗性.
- 现有的BPSD治疗方法对脆弱的老年人有很大的风险,需要探索替代干预措施.
研究的目的:
- 系统地审查电疗法 (ECT) 的临床证据,以控制痴呆症患者的攻击性和激动性.
- 评估ECT作为耐火性BPSD治疗的疗效,安全性和耐受性.
主要方法:
- 按照PRISMA指南进行了系统审查,搜索主要数据库 (PubMed,EMBASE,Cochrane图书馆) 相关的临床研究.
- 包括的研究包括病例报告,系列,观察队列,图表审查和随机试验协议,分析患者特征,ECT参数,结果和不良事件的数据.
- 进行了探索性随机效应元分析,以汇集临床响应率.
主要成果:
- 涉及206名患者的13项研究符合纳入标准,大多数患者表现出临床相关的改善.
- 聚合分析表明临床响应比例为77.7% (95% CI 71.0%-83.3%),通常在2-4次治疗内观察到改善.
- 电电疗通常耐受良好,有轻微的,短暂的副作用,没有报告与治疗相关的死亡或严重并发症.
结论:
- 电疗法 (ECT) 似乎是一种快速,有效和相对安全的选择,用于治疗痴呆症中耐火性侵略和激动.
- 当其他治疗方法无效或适得其反时,ECT可以作为严重BPSD的宝贵的最后手段干预.
- 需要进一步的高质量,前性和道德合理的受控研究来证实这些发现并指导临床实践.
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