1
|
Riera-Serra P, Navarra-Ventura G, Castro A, Gili M, Salazar-Cedillo A, Ricci-Cabello I, Roldán-Espínola L, Coronado-Simsic V, García-Toro M, Gómez-Juanes R, Roca M. Clinical predictors of suicidal ideation, suicide attempts and suicide death in depressive disorder: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2024; 274:1543-1563. [PMID: 38015265 PMCID: PMC11422269 DOI: 10.1007/s00406-023-01716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
Patients with depressive disorders are especially prone to suicide risk. Among the clinical predictors of suicidality, those specifically related to depressive disorders have not been accurately detailed. Our aim was to conduct a systematic review and meta-analysis of studies reporting longitudinal predictors of suicidal ideation, suicide attempts and suicide death within depression, including diagnostic subtypes, symptoms, clinical course, and assessment scales. A systematic search of the literature between 2001 and 2022 identified 4422 references, among which 19 studies providing 45 different predictors of suicidality met the inclusion criteria. Random effects meta-analyses were performed for 22 predictors, three for suicidal ideation, eleven for suicide attempts and eight for suicide death. Heterogeneity and publication bias were inspected through I2 tests and Egger's tests respectively. Meta-analysis results showed that severity of hopelessness predicted suicidal ideation and suicide attempts. History of suicide attempts, suicidal ideation, severe depression, and psychotic symptoms predicted subsequent suicide attempts and suicide death. Time to full remission and sleep disturbances were also found as relevant predictors of future suicide behaviours. This review specifies which predictors of suicidality within the clinical features of depression will help clinicians and policy makers to better prevent suicide risk in patients with depressive disorders. Further longitudinal studies are needed to reliably assess the predictive ability of our results and to analyse other possible clinical predictors to prevent suicidality, especially with regard to suicidal ideation.
Collapse
Affiliation(s)
- Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Angie Salazar-Cedillo
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Balearic Islands Health Services (IB-SALUT), Primary Care Research Unit of Mallorca, Palma, Balearic Islands, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Lorenzo Roldán-Espínola
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Mauro García-Toro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Rocío Gómez-Juanes
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| |
Collapse
|
2
|
Desai Boström AE, Cars T, Hellner C, Lundberg J. Adolescent and Adult Transitions From Major Depressive Disorder to Bipolar Disorder. JAMA Psychiatry 2024; 81:863-869. [PMID: 38809562 PMCID: PMC11137653 DOI: 10.1001/jamapsychiatry.2024.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/17/2024] [Indexed: 05/30/2024]
Abstract
Importance Bipolar disorder (BD) often first appears in adolescence after onset of major depressive disorder (MDD), but diagnosis and treatment are commonly delayed. This delay is a concern because untreated BD is associated with adverse long-term outcomes, a more recurrent disease course and difficult-to-treat illness, and suicide attempts and deaths. Objective To examine the association of age at MDD onset with early transition to BD and the subsequent use of psychiatric inpatient services as a severity indicator. Design, Setting, and Participants This retrospective cohort study analyzed comprehensive data sourced from the Stockholm MDD Cohort data from 1997 to 2018, which encompass both outpatient and inpatient care. Individuals with an initial MDD episode from January 1, 2010, to December 31, 2013, who transitioned to BD by December 31, 2018, were identified. Data were analyzed between September 5 and December 28, 2023. Exposures Post MDD assessments included a depression severity index, comorbidities, psychotherapy, psychotropic drugs, and electroconvulsive therapy. Main Outcomes and Measures The main outcome was the transition from MDD to BD, dichotomized as occurring early (within 3 years of MDD onset) or late (3 years after MDD onset). Secondary outcomes encompassed the use of psychiatric inpatient services post transition and patterns of medication usage. A robust propensity score matching framework was used to estimate outcomes. Results The final balanced cohort included 228 individuals, with an equal distribution between adults (n = 114; mean [SD] age, 24.5 [6.3] years; 96 female [84.2%]; 20 experiencing an early transition to BD [17.5%]) and youths (n = 114; mean [SD] age, 15.3 [1.6] years; 93 female [81.6%]; 8 experiencing an early transition to BD [7.0%]). Youths were substantially less likely to transition early (odds ratio, 0.42; 95% CI, 0.20-0.88; P = .02), despite having more outpatient visits (mean [SD] visits per month, 1.21 [1.07] vs 0.97 [0.98] for adults; P = .01). Both groups experienced substantially reduced inpatient care following a BD diagnosis, concurring with a marked decline in antidepressant use without increased lithium use. Conclusions and Relevance These findings suggest that adolescents may experience delayed BD progression and that diagnosis substantially reduced inpatient care in all age groups, which coincided with a reduction in the use of antidepressants. These findings may inform pharmacologic strategies in patients with first-episode MDD at risk for BD.
Collapse
Affiliation(s)
- Adrian E Desai Boström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | | | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
3
|
Mahmood S, Tan X, Chen B, Tor PC. The influence of age on ECT efficacy in depression, mania, psychotic depression and schizophrenia: A transdiagnostic analysis. J Psychiatr Res 2024; 177:203-210. [PMID: 39032274 DOI: 10.1016/j.jpsychires.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
AIM ECT use is variable across age groups. We aim to investigate the effect of age on ECT response among patients with depression, psychotic depression, mania and schizophrenia. METHODS Our retrospective observational study included patients from the Institute of Mental Health (Singapore) who were initiated on ECT (March 2017-February 2023). MADRS and BPRS scores were assessed 1-2 days before the first ECT and after the 6th session. The association between age group and ECT response was analyzed by ANOVA and generalized linear regression. A one-way sensitivity analysis was performed with age as a continuous variable. RESULTS 166 (15.7%) patients were "young-age (≤26 years)", 634 (60%) patients were in the "middle-age (27-59 years)" group and 256 (24.3%) were "old-age (≥60 years)". The association between older age and post-ECT improvement in patients with depression was significant in the categorical age analysis but it did not persist in the sensitivity analysis. No significant association between age and ECT response was noted in patients with bipolar disorder and schizophrenia as evidenced by both categorical and continuous age analyses. In a small subgroup with psychotic depression, younger patients improved significantly more than older patients post-ECT. CONCLUSION Patients with unipolar or bipolar depression, mania, or schizophrenia, regardless of age, respond favourably to ECT. Other associated factors such as psychomotor and psychotic symptoms, disease severity and number of failed pharmacotherapies should be considered in predicting ECT response. Younger patients with psychotic depression may respond better to ECT.
Collapse
Affiliation(s)
| | - Xiaowei Tan
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Birong Chen
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Phern Chern Tor
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| |
Collapse
|
4
|
Popiolek K, Arnison T, Bejerot S, Fall K, Landén M, Nordenskjöld A. Association between electroconvulsive therapy and time to readmission after a manic episode. Acta Psychiatr Scand 2024; 150:22-34. [PMID: 38604233 DOI: 10.1111/acps.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
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.
Collapse
Affiliation(s)
- Katarzyna Popiolek
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tor Arnison
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Katja Fall
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
5
|
Lee SH, Hyung WSW, Youn CE, Chi S, Youn H, Lee MS, Han C, Jeong HG. Trends in Electroconvulsive Therapy Utilization in South Korea: Health Insurance Review Data From 2008 to 2018. Psychiatry Investig 2024; 21:691-700. [PMID: 39089694 PMCID: PMC11298272 DOI: 10.30773/pi.2024.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE The study aimed to analyze and clinically correlate 10-year trends in the demographic characteristics of patients receiving electroconvulsive therapy (ECT) to provide an overview of ECT utilization in South Korea. METHODS Using health insurance claims data from 2008 to 2018 retrieved from Health Insurance Review and Assessment Service database in South Korea, we identified individuals undergoing ECT based on procedural codes. Descriptive analysis evaluated baseline clinical characteristics, and trend analysis used a linear regression model. RESULTS The prevalence of ECT increased by 240.49% (0.405/105 inhabitants in 2008 to 0.974/105 inhabitants in 2018). The increasing trend was more pronounced in younger and older patients. The proportion of women consistently exceeded that of men. A rise in the proportion of patients with affective disorders, and a decrease in the proportion of psychotic disorders was observed. More antidepressants and atypical antipsychotics were prescribed to patients undergoing ECT. The proportion of ECT sessions conducted in large hospital inpatient settings also decreased during the observation period. Despite increasing global trends, ECT prevalence in South Korea remains significantly lower than worldwide rates. CONCLUSION This study demonstrated an increasing trend of ECT across a wide range of population demographics and in more accessible settings. The comparatively low prevalence of ECT in Korea compared to other countries might be attributed to insufficient mental health literacy and the stigma associated with ECT. Given the elevated suicide rates in Korea, more extensive adoption of ECT appears imperative.
Collapse
Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Won Seok William Hyung
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chae En Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Suhyuk Chi
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| |
Collapse
|
6
|
Strandberg P, Nordenskjöld A, Bodén R, Ekman CJ, Lundberg J, Popiolek K. Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study. J ECT 2024; 40:88-95. [PMID: 38048154 DOI: 10.1097/yct.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions. METHODS This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale-Self-report (MADRS-S) score. Secondary outcome was response defined as a 50% or greater decrease in the MADRS-S score. Subgroup analyses were performed to identify factors that predicted differential responses between rTMS and ECT. Continuous and categorical variables were analyzed using paired-samples t tests and McNemar tests, respectively. RESULTS In total, 138 patients across 19 hospitals were included. The MADRS-S score after ECT and rTMS was reduced by 15.0 and 5.6 ( P = 0.0001) points, respectively. Response rates to ECT and rTMS were 38% and 15% ( P = 0.0001), respectively. Electroconvulsive therapy was superior across all subgroups classified according to age and severity of depression. CONCLUSIONS Our results suggest that ECT is more effective than rTMS in treating depression among patients who have received both interventions. Age and baseline depression severity did not predict who would similarly benefit from rTMS and ECT.
Collapse
Affiliation(s)
| | - Axel Nordenskjöld
- Department of Psychiatry, University Health Care Research Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala
| | - Carl Johan Ekman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Katarzyna Popiolek
- Department of Psychiatry, University Health Care Research Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro
| |
Collapse
|
7
|
Ghori ETR, Zuberi MAW, Dave T, Shaikh VF. Addressing the stigma and promoting awareness: Electroconvulsive therapy in Pakistan. Health Sci Rep 2024; 7:e2197. [PMID: 38863731 PMCID: PMC11165167 DOI: 10.1002/hsr2.2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Affiliation(s)
| | | | - Tirth Dave
- Department of MedicineBukovinian State Medical UniversityChernivtsiUkraine
| | | |
Collapse
|
8
|
Hedna K, Jonson M, Sigström R, Levinsson A, Nordenskjöld A, Waern M. Suicidal behavior and all-cause mortality in depressed older adults aged 75+ treated with electroconvulsive therapy: A Swedish register-based comparison study. Int J Geriatr Psychiatry 2024; 39:e6102. [PMID: 38767969 DOI: 10.1002/gps.6102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is effective in treating late-life depression. There is limited research on suicidal behavior and all-cause mortality in the oldest old after ECT. METHODS Older adults aged 75 years and above who had been inpatients for moderate to severe depression between January 1, 2011, and December 31, 2017, were included in the study. We used exact and propensity score matching to balance groups. We compared suicidal behavior (fatal and non-fatal) and all-cause mortality in those who had received ECT and those with other depression treatments. RESULTS Of the study population, 1802 persons who received ECT were matched to 4457 persons with other treatments. There were no significant differences in the risk of suicidal behavior between groups, (within 3 months: odds ratio 0.73; 95% confidence intervals (CI), 0.44-1.23, within 4 months to 1 year: aOR 1.34; 95% CI, 0.84-2.13). All-cause mortality was lower among ECT recipients compared to those who had received other treatments, both within 3 months (aOR, 0.35; 95% CI, 0.23-0.52), and within 4 months to 1 year (aOR 0.65; 95% CI, 0.50-0.83). CONCLUSIONS Compared to other depression treatments, ECT is not associated with a higher risk of suicidal behavior in patients aged 75 and above. ECT is associated with lower all-cause mortality in this age group, but we advise caution regarding causal inferences.
Collapse
Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna Väst AB, Gothenburg, Sweden
| | - Mattias Jonson
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Sigström
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cognition and Old Age Psychiatry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Levinsson
- Department of Social Medicine and Public Health, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal-CRCHUM, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
| |
Collapse
|
9
|
Havlik JL, Wahid S, Teopiz KM, McIntyre RS, Krystal JH, Rhee TG. Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023. Curr Psychiatry Rep 2024; 26:176-213. [PMID: 38386251 DOI: 10.1007/s11920-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. RECENT FINDINGS Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.
Collapse
Affiliation(s)
- John L Havlik
- Yale University School of Medicine, New Haven, CT, USA
| | - Syed Wahid
- The University of Chicago, Chicago, IL, USA
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Public Health Sciences, University of Connecticut, Farmington, CT, USA.
| |
Collapse
|
10
|
Arnone D, Karmegam SR, Östlundh L, Alkhyeli F, Alhammadi L, Alhammadi S, Alkhoori A, Selvaraj S. Risk of suicidal behavior in patients with major depression and bipolar disorder - A systematic review and meta-analysis of registry-based studies. Neurosci Biobehav Rev 2024; 159:105594. [PMID: 38368970 DOI: 10.1016/j.neubiorev.2024.105594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024]
Abstract
Suicide is a health priority and one of the most common causes of death in mood disorders. One of the limitations of this type of research is that studies often establish rates of suicide behaviors in mood disorders by using diverse comparison groups or simply monitoring cohort of patients over a time period. In this registry-based systematic review, national registers were identified through searches in six academic databases, and information about the occurrence of suicide behaviors in mood disorders was systematically extracted. Odds ratios were subsequently calculated comparing rates of death by suicide in mood disorders in comparison with age and period matched rates of death by suicide in the general population obtained from country-wide national registers. The aim was to provide the most recent summary of epidemiological and clinical factors associated to suicide in mood disorders whilst calculating the likelihood of death by suicide in mood disorders in comparison with non-affected individuals according to national databases. The study follows the Preferred Reporting Guidelines for Systematic Reviews and Meta-analyses and was prespecify registered on Prospero (CRD42020186857). Results suggest that patients with mood disorders are at substantially increased risk of attempting and dying by suicide. Several epidemiological, clinical and social factors are reported to be associated with clinical populations at risk of suicide. Meta-analyses of completed deaths by suicide suggest that the likelihood for dying by suicide in mood disorders is 8.62 times higher in major depression and 8.66 times higher in bipolar disorder with higher number of untoward events in women compared to men in both conditions. The likelihood of dying by suicide in major depressive disorders is higher in the first year following discharge. Clinical guidelines might consider longer periods of monitoring following discharge from hospital. Overall, due to the higher risk of suicide in mood disorders, efforts should be made to increase detection and prevention whilst focusing on reducing risk in the most severe forms of illness with appropriate treatment to promote response and remission at the earliest convenience.
Collapse
Affiliation(s)
- Danilo Arnone
- Centre for Affective Disorders, Psychological Medicine, King's College London, London, United Kingdom; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Sendhil Raj Karmegam
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | | | - Fatima Alkhyeli
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Lamia Alhammadi
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shama Alhammadi
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal Alkhoori
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Intra-Cellular Therapies, Inc, USA
| |
Collapse
|
11
|
Ferrea S, Petrides G, Ehrt-Schäfer Y, Angst J, Seifritz E, Olbrich S, Schoretsanitis G. Outcomes of electroconvulsive therapy in patients with depressive symptoms with versus without comorbid personality disorders/traits: A systematic review and meta-analysis. Acta Psychiatr Scand 2024; 149:18-32. [PMID: 37899505 DOI: 10.1111/acps.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
AIMS To assess electroconvulsive therapy (ECT) outcomes in patients affected by depressive symptoms with versus without additional comorbid personality disorders/traits. METHODS We identified observational studies investigating ECT clinical outcomes in patients affected by depressive symptoms with versus without comorbid personality disorders/traits in Embase/Medline in 11/2022. Our protocol was registered with PROSPERO (CRD42023390833). Study quality was evaluated using the Newcastle-Ottawa-Scale. Our primary outcomes were ECT response and remission rates. Meta-regression analyses included effects of in/outpatient percentages, age, number of ECT sessions, and electrode placement; subgroup analyses included the assessment methods for personality disorders/traits. We performed sensitivity analyses after excluding poor-quality studies. RESULTS A total of 20 studies (n = 11,390) were included in our analysis. Patients with comorbid personality disorders/traits had lower remission rates (OR = 0.42, 95% CI = 0.31, 0.58, p < 0.001) with substantial heterogeneity (I2 = 93.0%) as well as lower response rates (OR = 0.35, 95% CI = 0.24, 0.51, n = 5129, p < 0.001) with substantial heterogeneity (I2 = 93.0%) compared with patients without comorbid personality disorders/traits. Relapse rates were higher in patients with versus without comorbid personality disorders/traits (OR = 3.23, 95% CI = 1.40, 7.45, k = 4, n = 239, p = 0.006) with moderate heterogeneity (I2 = 75.0%) and post-ECT memory impairment was more frequent in patients with versus without comorbid personality disorders/traits (OR = 1.41, 95% CI = 1.36, 1.46, k = 4, n = 471, p < 0.001) with minimal heterogeneity (I2 = 0.0%). Dropout rates were higher in patients with versus without comorbid personality disorders/traits (OR = 1.58, 95% CI = 1.13, 2.21, k = 3, n = 6145, p = 0.008). CONCLUSIONS Patients with comorbid personality disorders/traits treated with ECT are reported to have lower response and remission rates and higher rates of side effects and relapse rates compared with patients without personality disorders/traits.
Collapse
Affiliation(s)
- Stefano Ferrea
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Georgios Petrides
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
- The Hofstra Northwell School of Medicine, Hempstead, New York, USA
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Yamina Ehrt-Schäfer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Sebastian Olbrich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
- The Hofstra Northwell School of Medicine, Hempstead, New York, USA
| |
Collapse
|
12
|
Luo X, Zhang Z, Shi X, He C, Wang J, Wu Q, Huang G. Arts therapies for mental disorders in COVID-19 patients: a comprehensive review. Front Public Health 2023; 11:1289545. [PMID: 38111478 PMCID: PMC10726037 DOI: 10.3389/fpubh.2023.1289545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Background and objective The COVID-19 global pandemic has necessitated the urgency for innovative mental health interventions. We performed a comprehensive review of the available literature on the utility and efficacy of arts therapies in treating mental health problems, with special emphasis on their deployment during the COVID-19 pandemic, aiming to provide some evidence for the application of this therapy. Methods The potential studies were systematically sourced from five authoritative databases: PubMed, Embase, the Cochrane Library, Web of Science, and the CNKI database. The evaluation of these studies was conducted based on stringent criteria, including validity, suitability, therapeutic potential, and consistency. Each piece of included literature was meticulously scored in accordance with these criteria, thus ensuring the inclusion of only the most robust studies in this review. The data from these Randomized Controlled Trials (RCTs) were carefully extracted using the PICO(S) framework, ensuring a comprehensive and systemic approach to data collection. In order to emphasize the variability in the effects of differing arts therapies on COVID-19-induced psychiatric disturbances, the sourced literature was systematically categorized and scrutinized based on distinct modalities. Results Out of the 7,250 sourced articles, 16 satisfied the inclusion conditions. The therapies were predominantly meditation (n = 7), supplemented by individual studies on color therapy (n = 3), music therapy (n = 2), and single studies on horticultural therapy, dance therapy, mindfulness and music therapy, and yoga and music therapy (n = 4 collectively). These various forms of arts therapies had a positive short to medium-term impact on the mental health of COVID-19 patients. Besides improving patients' physical and mental health, these therapies can also be employed to mitigate mental health issues among healthcare professionals. Conclusion The COVID-19 pandemic has profound and long-lasting implications for public mental health. Diverse forms of arts therapies are potentially effective in addressing related psychiatric symptoms. The integration of artificial intelligence might further enhance the efficacy and scalability of arts therapies in future implementations.
Collapse
Affiliation(s)
- Xuexing Luo
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Zheyu Zhang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Xiaojun Shi
- Department of Hepatology, The 4th People's Hospital of Qinghai Province, Xining, Qinghai, China
| | - Caihong He
- Operation Management Centre, Guangzhou Wanqu Cooperative Institute of Design, Guangzhou, Guangdong, China
| | - Jue Wang
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, Guangdong, China
| | - Qibiao Wu
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, Guangdong, China
| | - Guanghui Huang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau SAR, China
| |
Collapse
|
13
|
Luccarelli J, Humphrey D, McCoy TH, Henry ME, Mueller M, Seiner SJ. Changes in self-reported suicidal ideation during treatment with electroconvulsive therapy: A retrospective cohort study. Acta Psychiatr Scand 2023; 148:553-560. [PMID: 37643775 PMCID: PMC10843260 DOI: 10.1111/acps.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Suicidal ideation (SI) is common in patients with depressive symptoms, who are the most common recipients of electroconvulsive therapy (ECT). We sought to quantify changes in self-reported SI occurring during treatment with ECT, and to identify factors associated with persistence of SI in patients beginning treatment with SI. METHOD Retrospective, single-center cohort study of patients receiving ECT and who self-reported symptoms using Quick Inventory of Depressive Symptomatology (QIDS) prior to ECT and after treatment #5 or #10. Changes in QIDS-reported SI over the course of ECT were calculated, and logistic regression models were performed to assess factors associated with reporting SI at the end of treatment. RESULTS 2554 provided baseline and follow-up SI scores, of whom, 1931 (75.6%) endorsed SI at baseline. There was a reduction in SI with ECT treatment (McNemar's test; df = 1, Χ2 = 803.7; p < 0.001), and in adjusted models 64.0% of individuals with baseline SI reported resolution of SI with ECT treatment, while 3.3% without baseline SI reported SI at the end of treatment. Higher baseline SI severity and outpatient treatment were associated with a higher odds of persistent SI among individuals beginning treatment with SI. CONCLUSION Electroconvulsive therapy treatment was associated with reductions in self-reported SI. These results support the use of ECT in the treatment of patients with SI, but further research is needed to determine the effects of ECT on suicidal behavior.
Collapse
Affiliation(s)
- James Luccarelli
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Daniel Humphrey
- College of Nursing, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC
| | - Thomas H. McCoy
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Michael E. Henry
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC
| | - Stephen J. Seiner
- Harvard Medical School, 25 Shattuck Street, Boston MA
- McLean Hospital, 115 Mill Street, Belmont MA
| |
Collapse
|
14
|
De Schuyteneer E, Giltay E, Vansteelandt K, Obbels J, Van den Eynde L, Verspecht S, Verledens C, Hebbrecht K, Sienaert P. Electroconvulsive therapy improves somatic symptoms before mood in patients with depression: A directed network analysis. Brain Stimul 2023; 16:1677-1683. [PMID: 37952571 DOI: 10.1016/j.brs.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The recent network perspective of depression conceptualizes depression as a dynamic network of causally related symptoms, that contrasts with the traditional view of depression as a discrete latent entity that causes all symptoms. Electroconvulsive therapy (ECT) is an effective treatment for severe depression, but little is known about the temporal trajectories of symptom improvement during a course of ECT. OBJECTIVE To gain insight into the dynamics of depressive symptoms in individuals treated with ECT. METHODS The Quick Inventory of Depressive Symptomatology (QIDS) was used to assess symptoms twice a week in 68 participants with a unipolar or bipolar depression treated with ECT, with an average of 12 assessments per participant. Dynamic time warping (DTW) was used to analyze individual time series data, which were subsequently aggregated to calculate a directed symptom network and the in- and out-strength for each symptom. RESULTS Participants had a mean age of 49.6 (SD = 12.8) and 60% were female. Somatic symptoms (e.g., decreased weight) and suicidal ideation showed the highest out-strength values, indicating that their improvement tended to precede improvements in mood symptoms, which showed high in-strength. Sad mood had the highest in-strength, and thus appeared to be the last symptom to improve during ECT treatment (p < 0.001). CONCLUSION This study addresses a gap in the existing literature on ECT, by first analysing the temporal trajectories of symptoms within individual patients and subsequently aggregating them to the group level. The results show that somatic symptoms tend to improve before mood symptoms during ECT.
Collapse
Affiliation(s)
- Emma De Schuyteneer
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium; Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Erik Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Department of Public Health and Primary Care, Health Campus the Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Kristof Vansteelandt
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Jasmien Obbels
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Liese Van den Eynde
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Shauni Verspecht
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Chelsea Verledens
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Kaat Hebbrecht
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium
| |
Collapse
|
15
|
Liu J, Jia F, Li C, Yuan H, Yang H, Yang R, Yue Y, Zhang G, Zhang X, Ye G, Li Z, Du X, Zhang X. Association between body mass index and suicide attempts in Chinese patients of a hospital in Shanxi district with first-episode drug-naïve major depressive disorder. J Affect Disord 2023; 339:377-383. [PMID: 37393956 DOI: 10.1016/j.jad.2023.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE In patients with major depressive disorder (MDD), the relationship between body mass index (BMI) and risk of suicide attempts (SA) remains unclear, and findings are controversial. The aim of this study was to investigate the relationship between BMI and SA in a Chinese population with first-episode drug-naïve (FEDN) MDD. METHODS A total of 1718 patients with FEDN MDD were enrolled in this cross-sectional study. Their socio-demographic characteristics as well as anthropometric data were collected. The 17-item Hamilton Rating Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) were used to assess the severity of depression and anxiety symptoms in all participants. Thyroid hormones, lipid profile, and fasting blood glucose (FBG) were measured. A history of suicide attempts was verified based on medical records and interviews with patients and their family members. Multiple logistic regression analysis was used to estimate the association between BMI and the risk of SA. Threshold effects were examined by a two-piecewise logistic regression model. RESULTS Multiple logistic regression analysis showed that BMI was independently and negatively correlated with SA (OR = 0.91, 95%CI: 0.85 to 0.98, P = 0.01) in patients with FEDN MDD after adjusting for covariates. Smoothing plots also revealed a non-linear (L-shaped) relationship between BMI and SA, and a two-piecewise logistic regression model was used to calculate the inflection point of BMI as 22.1 kg/m2. On the left of the inflection point, a negative association between BMI and SA was detected (OR = 0.54, 95%CI: 0.42 to 0.70, P < 0.001), while no significant association was observed on the right side of the inflection point (OR = 1.01, 95%CI: 0.93 to 1.10, P = 0.75). CONCLUSIONS Our results suggest that lower BMI is associated with a higher risk of recent SA in Chinese patients with FEDN MDD, especially in those with BMI below 22.1 kg/m2.
Collapse
Affiliation(s)
- Junjun Liu
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China; Nanjing Meishan Hospital, Nanjing 210041, PR China
| | - Fennan Jia
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Chuanwei Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | | | - Haidong Yang
- The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang 222003, PR China
| | - Ruchang Yang
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Yan Yue
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Guangya Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Gang Ye
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Xiangdong Du
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100000, PR China.
| |
Collapse
|
16
|
Nöhles VB, Bermpohl F, Falkai P, Reif-Leonhard C, Jessen F, Adli M, Otte C, Meyer-Lindenberg A, Bauer M, Rubarth K, Anghelescu IG, Rujescu D, Correll CU. Patient characteristics, validity of clinical diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D): design, procedures and outcomes. BMC Psychiatry 2023; 23:744. [PMID: 37828493 PMCID: PMC10571442 DOI: 10.1186/s12888-023-05230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Suicidality, ranging from passive suicidal thoughts to suicide attempt, is common in major depressive disorder (MDD). However, relatively little is known about patient, illness and treatment characteristics in those with co-occurring MDD and suicidality, including the timing of and factors associated with the offset, continuation or reemergence of suicidality. Here, we present the background, rationale, design and hypotheses of the Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study, an investigator-initiated, observational study, funded by Janssen-Cilag GmbH. METHODS/RESULTS OASIS-D is an eight-site, six-month, cohort study of patients aged 18-75 hospitalized with MDD. Divided into three sub-studies and patient populations (PPs), OASIS-D will (i) systematically characterize approximately 4500 consecutively hospitalized patients with any form of unipolar depressive episode (PP1), (ii) evaluate the validity of the clinical diagnosis of moderate or severe unipolar depressive episode with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and present suicidality (at least passive suicidal thoughts) present ≥ 48 h after admission with the Sheehan-Suicide Tracking Scale (S-STS), assessing also predictors of the diagnostic concordance/discordance of MDD in around 500 inpatients (PP2), and (iii) characterize and prospectively follow for 6 months 315 inpatients with a research-verified moderate or severe unipolar depressive episode and at least passive suicidal thoughts ≥ 48 h after admission, evaluating treatment and illness/response patterns at baseline, hospital discharge, 3 and 6 months. Exploratory objectives will describe the association between the number of days with suicidality and utilization of outpatient and inpatient care services, and structured assessments of factors influencing the risk of self-injurious behavior without suicidal intent, and of continuous, intermittent or remitted suicidality during the 6-month observation period. CONCLUSION Despite their frequency and clinical relevance, relatively little is known about patient and treatment characteristics of individuals with MDD and suicidality, including factors moderating and mediating the outcome of both MDD and suicidality. Results of the OASIS-D study are hoped to improve the understanding of the frequency, correlates and 6-month naturalistic treatment and outcome trajectories of different levels of suicidality in hospitalized adults with MDD and suicidality. TRIAL REGISTRATION NCT04404309 [ClinicalTrials.gov].
Collapse
Affiliation(s)
- Viktor B Nöhles
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus St. Hedwig Hospital, Berlin, Germany
| | - Peter Falkai
- Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kerstin Rubarth
- Institute of Medical Informatics, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ion-George Anghelescu
- Clinic for Psychiatry, Psychosomatics and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| |
Collapse
|
17
|
Liu J, Li Z, Jia F, Yuan H, Zhou Y, Xia X, Yang R, Wu Y, Zhang X, Ye G, Du X, Zhang X. Gender differences in the association between body mass index and recent suicide attempts in Chinese patients with first-episode drug-naïve major depressive disorder. Sci Rep 2023; 13:16033. [PMID: 37749148 PMCID: PMC10519950 DOI: 10.1038/s41598-023-43166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Abstract
Controversial evidence exists on the relationship between body mass index (BMI) and suicide attempts (SA) in patients with major depressive disorder (MDD). This cross-sectional study aimed to explore the association between BMI and SA in first-episode drug-naïve (FEDN) MDD patients in China. The study was conducted from 2016 to 2018 in Taiyuan, China. Univariate and multivariate logistic regression analyzed the BMI-SA association, with subgroup analysis for gender. Threshold effects were examined using two-piecewise regression. In males, BMI was significantly associated with SA (OR = 0.84, 95% CI 0.74-0.94, P = 0.003) after full adjustment, but not in females (OR = 0.97, 95% CI 0.89-1.06, P = 0.541). The interaction with gender was significant (P for interaction < 0.05). Smoothing plots revealed an L-shaped BMI-SA relationship in both genders, with BMI inflection points at 27.3 kg/m2 in males and 21.4 kg/m2 in females. Below the inflection points, BMI is negatively associated with SA in males (OR = 0.75, 95% CI 0.66-0.86, P < 0.001) and females (OR = 0.48, 95% CI 0.32-0.72, P < 0.001). Above the inflection points, no association existed for both genders (all P > 0.05). Results showed an L-shaped nonlinear BMI-SA relationship in FEDN MDD patients but differing BMI inflection points between genders, thus contributing to effective prevention programs for suicide.
Collapse
Affiliation(s)
- Junjun Liu
- Nanjing Meishan Hospital, Nanjing, 210041, People's Republic of China
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
- Medical College of Soochow University, Suzhou, 215137, People's Republic of China
| | - Zhe Li
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
| | - Fengnan Jia
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
- Medical College of Soochow University, Suzhou, 215137, People's Republic of China
| | - Hsinsung Yuan
- Nanjing Meishan Hospital, Nanjing, 210041, People's Republic of China
| | - Yue Zhou
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
- Xuzhou Medical University, Xuzhou, 221004, People's Republic of China
| | - Xingzhi Xia
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
- Xuzhou Medical University, Xuzhou, 221004, People's Republic of China
| | - Ruchang Yang
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
- Medical College of Soochow University, Suzhou, 215137, People's Republic of China
| | - Yuxuan Wu
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
- Medical College of Soochow University, Suzhou, 215137, People's Republic of China
| | - Xiaobin Zhang
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
| | - Gang Ye
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China
| | - Xiangdong Du
- Department of Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, People's Republic of China.
- Medical College of Soochow University, Suzhou, 215137, People's Republic of China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100000, People's Republic of China.
| |
Collapse
|
18
|
Shi X, Zhao Y, Yang H, Xu X, Fang Y, Yu X, Tan Q, Li H, Sun G, Wu H, Wang P, Yang J, Zhu X, Wang G, Zhang L. Factors associated with hospitalization times and length of stay in patients with bipolar disorder. Front Psychiatry 2023; 14:1140908. [PMID: 37275983 PMCID: PMC10235542 DOI: 10.3389/fpsyt.2023.1140908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Aim Appraise the clinical features and influencing factors of the hospitalization times and length of stay in bipolar disorder (BD) patients. Methods This is a multicenter, observational, cohort study of patients diagnosed of type I or type II bipolar disorder. Five hundred twenty outpatients in seven hospitals from six cities in China were recruited from February 2013 to June 2014 and followed up using a continuous sampling pattern. The research included a retrospective period of 12 months and the prospective period of 9 months. The demographic and clinical features of the patients were collected. The influencing factors that could affect the length of stay (number of days spent in the hospital in the prospective period) were analyzed by poisson's regression and the hospitalization times (times of hospitalization in the prospective and retrospective period) was analyzed by general linear model. The selected variables included gender, age, years of education, occupational status, residence status, family history of mental disease, comorbid substance abuse, comorbid anxiety disorder, times of suicide (total suicide times that occurred in the retrospective and prospective period), polarity of the first mood episode, and BD type(I/II). Results Poisson's regression analysis showed that suicide times [Incidence Rate Ratio (IRR) = 1.20, p < 0.001], use of antipsychotic (IRR = 0.62, p = 0.011), and use of antidepressant (IRR = 0.56, p < 0.001) were correlated to more hospitalization times. Linear regression analysis showed that BD type II (β = 0.28, p = 0.005) and unemployment (β = 0.16, p = 0.039) which might mean longer duration of depression and poor function were correlated to longer length of stay. However, patients who experienced more suicide times (β = -0.21, p = 0.007) tended to have a shorter length of stay. Conclusion Overall, better management of the depressive episode and functional rehabilitation may help to reduce the length of stay. BD patients with more hospitalization times were characterized by higher risk of suicide and complex polypharmacy. Patients at high risk of suicide tended to have inadequate therapy and poor compliance, which should be assessed and treated adequately during hospitalization. Clinical trial registration www.ClinicalTrials.gov, Identifier: NCT01770704.
Collapse
Affiliation(s)
- Xiaoning Shi
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yingying Zhao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Haichen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Shenzhen, Guangdong Province, China
| | - Xiufeng Xu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Yu
- The Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Institute of Mental Health (The Sixth Hospital), Ministry of Health (Peking University), Beijing, China
| | - Qingrong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Huichun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guangqiang Sun
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hang Wu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Pengfei Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jie Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xuequan Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| |
Collapse
|
19
|
Guillen A, Abbott CC, Deng ZD, Huang Y, Pascoal-Faria P, Truong DQ, Datta A. Impact of modeled field of view in electroconvulsive therapy current flow simulations. Front Psychiatry 2023; 14:1168672. [PMID: 37275969 PMCID: PMC10232815 DOI: 10.3389/fpsyt.2023.1168672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Background The field of view (FOV) considered in MRI-guided forward models of electroconvulsive therapy (ECT) are, as expected, limited to the MRI volume collected. Therefore, there is variation in model extent considered across simulation efforts. This study examines the impact of FOV on the induced electric field (E-field) due to two common electrode placements: right unilateral (RUL) and bilateral (BL). Methods A full-body dataset was obtained and processed for modeling relevant to ECT physics. Multiple extents were derived by truncating from the head down to four levels: upper head (whole-brain), full head, neck, and torso. All relevant stimulation and focality metrics were determined. The differences in the 99th percentile peak of stimulation strength in the brain between each extent to the full-body (reference) model were considered as the relative error (RE). We also determine the FOV beyond which the difference to a full-body model would be negligible. Results The 2D and 3D spatial plots revealed anticipated results in line with prior efforts. The RE for BL upper head was ~50% reducing to ~2% for the neck FOV. The RE for RUL upper head was ~5% reducing to subpercentage (0.28%) for the full-head FOV. As shown previously, BL was found to stimulate a larger brain volume-but restricted to the upper head and for amplitude up to ~480 mA. To some extent, RUL stimulated a larger volume. The RUL-induced volume was larger even when considering the neural activation threshold corresponding to brief pulse BL if ECT amplitude was >270 mA. This finding is explained by the BL-induced current loss through the inferior regions as more FOV is considered. Our result is a departure from prior efforts and raises questions about the focality metric as defined and/or inter-individual differences. Conclusion Our findings highlight that BL is impacted more than RUL with respect to FOV. It is imperative to collect full-head data at a minimum for any BL simulation and possibly more. Clinical practice resorts to using BL ECT when RUL is unsuccessful. However, the notion that BL is more efficacious on the premise of stimulating more brain volume needs to be revisited.
Collapse
Affiliation(s)
- Alexander Guillen
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | | | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, United States
| | - Yu Huang
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | - Paula Pascoal-Faria
- Department of Mathematics ESTG and CDRSP Polytechnic Institute of Leiria, Leiria, Portugal
| | - Dennis Q. Truong
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
- City College of New York, New York, NY, United States
| |
Collapse
|
20
|
Zilles-Wegner D, Sartorius A. [Electroconvulsive Therapy in the New National Guideline Depression: Effectiveness, Evidence, and Grade of Recommendation]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:209-212. [PMID: 37192610 DOI: 10.1055/a-2046-5279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In comparison to the previous version, the new national guideline 'Unipolar Depression' comprises more differentiated statements and recommendations regarding the use of electroconvulsive therapy (ECT). In principle, this is most welcome, as it clarifies the particular significance of ECT in different clinical situations. In parallel, this differentiation of recommendations depending on the presence of specific features of depressive disorders (e. g., psychotic symptoms, suicidality) led to different grades of recommendations for ECT. This may be correct and rational under the strict methodology of a guideline process, but nevertheless may appear confusing and contradictory in clinical practice. This article describes the relationships and putative discrepancies between the effectiveness of ECT, scientific evidence, and grading of guideline recommendations with comments on these for clinical practice from experts' point of view.
Collapse
Affiliation(s)
- David Zilles-Wegner
- Klinik für Psychiatrie and Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Alexander Sartorius
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
| |
Collapse
|
21
|
Yu RQ, Zhang ZJ, Chen RS, Wang XY, Li X, Dai LQ, Li ZL. Electroconvulsive therapy-induced neuroimaging alterations measured by cerebral blood flow in adolescents with major depressive disorder. J Affect Disord 2023; 327:385-390. [PMID: 36758871 DOI: 10.1016/j.jad.2023.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a novel treatment strategy for adolescents with major depressive disorder (MDD). However, its related neurobiological changes associated with ECT remain undetermined. OBJECTIVE To elucidate the impact of ECT on the regional cerebral blood flow (CBF), and to identify alterations in the CBF associated with clinical outcomes in adolescents with MDD. METHODS Fifty-two treatment-naive adolescents who had experienced their first episode of MDD and 36 healthy controls (HCs) were recruited. To assess baseline parameters, all subjects were scanned with arterial spin labeling resting-state functional magnetic resonance imaging (ASL-fMRI) at the beginning of the study. Subsequently, 27 MDD adolescents were re-scanned after 2 weeks after ECT. CBF imaging was used for the prediction of specific clinical outcomes. Lastly, the associations between alterations seen on brain imaging alterations after ECT and ECT clinical efficacy (ΔHAMD scores) were determined. RESULTS Relative to HCs, adolescents with MDD exhibited reduced CBF in the left medial superior frontal gyrus (SFGmed) (cluster = 243, peak t = -3.9373, and P < 0.001) and augmented CBF in the right percental gyrus (PerCG) (cluster = 321, peak t = 4.3332, and P < 0.001) at baseline. Following ECT, MDD adolescents exhibited reduced CBF in the right fusiform gyrus (FFG) (cluster = 309, peak t = -4.346, and P < 0.001) and left hippocampus (HIP) (cluster = 290, peak t = -4.706, and P < 0.001), and enhanced CBF in the left orbital part of the inferior frontal gyrus (ORBinf) (cluster = 214, peak t = 4.073, and P < 0.001). Correlation analysis suggested an inverse association between ΔHAMD scores and CBF values in the left ORBinf (R2 = 0.196, P = 0.021). CONCLUSIONS It was found that ECT resulted in alterations in CBF in specific brain areas, highlighting the significance of ORBinf in ECT pathophysiology in MDD adolescents.
Collapse
Affiliation(s)
- Ren-Qiang Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhu-Jun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Rong-Sheng Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xing-Yu Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lin-Qi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| |
Collapse
|
22
|
Spanggård A, Rohde C, Østergaard SD. Risk factors for suicide among patients having received treatment with electroconvulsive therapy: A nationwide study of 11,780 patients. Acta Psychiatr Scand 2023; 147:333-344. [PMID: 36744379 DOI: 10.1111/acps.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/30/2022] [Accepted: 01/29/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite the putative anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide due to the severity of their underlying mental illness. We aimed to quantify this risk and to identify risk factors for suicide among patients receiving ECT. METHODS Using nationwide Danish registers, we identified all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. Firstly, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Secondly, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional hazards regression. RESULTS A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients having received ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR) = 44.48, 95%CI = 31.12-63.59). Among those having received ECT, the following characteristics were associated with suicide: Male sex (adjusted HRR (AHRR) = 2.32, 95%CI = 1.63-3.30), medium-term higher education (AHRR = 2.64, 95%CI = 1.57-4.44); long-term higher education (AHRR = 3.16, 95%CI = 1.68-5.94), history of substance use disorder (AHRR = 1.51, 95%CI = 1.01-2.26) and history of intentional self-harm/suicide attempt (AHRR = 4.18, 95%CI = 2.76-6.32). CONCLUSIONS Those who are male, have obtained medium-/long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide following ECT. These findings may guide clinical initiatives to reduce suicides.
Collapse
Affiliation(s)
- Anders Spanggård
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
23
|
Gonda X, Dome P, Serafini G, Pompili M. How to save a life: From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide. Pharmacol Ther 2023; 244:108390. [PMID: 36940791 DOI: 10.1016/j.pharmthera.2023.108390] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, suicide is a highly complex biopsychosocial phenomenon, and in spite of several suicidal models developed in recent years and a high number of suicide risk factors identified, we still have neither a sufficient understanding of underpinnings of suicide nor adequate management strategies to reduce its prevalence. The present paper first overviews the background of suicidal behavior including its epidemiology, prevalence, age and gender correlations and its association with neuropsychiatric disorders as well as its clinical assessment. Then we give an overview of the etiological background, including its biopsychosocial contexts, genetics and neurobiology. Based on the above, we then provide a critical overview of the currently available intervention options to manage and reduce risk of suicide, including psychotherapeutic modalities, traditional medication classes also providing an up-to-date overview on the antisuicidal effects of lithium, as well as novel molecules such as esketamine and emerging medications and further molecules in development. Finally we give a critical overview on our current knowledge on using neuromodulatory and biological therapies, such as ECT, rTMS, tDCS and other options.
Collapse
Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
24
|
Hsieh MH. Electroconvulsive therapy for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:69-90. [PMID: 37806717 DOI: 10.1016/bs.pbr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Electroconvulsive therapy (ECT), the oldest brain stimulation procedure in psychiatry, is associated with rapid response and remission in majority of patients with resistant, severe, and sometimes life-threatening depression. ECT has been included as an essential component in the definition of treatment-resistant depression (TRD) to display the course and diversification of TRD. On the other hand, ECT remains the treatment of choice for the most severe incapacitating forms of TRD and is a cost-effective treatment. In this chapter, we reviewed some essential studies, meta-analysis, and expert guidelines regarding ECT in TRD. ECT should not be considered as a treatment of last resort, and its administration should be considered on the basis of individual patient and illness factors. The clinical role of ECT vs other neurostimulation treatments for TRD, that is, repetitive transcranial magnetic stimulation, were also explored. Much effort has been directed toward the clinical and basic research about mechanisms of action of ECT in depression. A thorough understanding of the neurobiological effects of ECT may increase our understanding of its therapeutic effects, ultimately leading to improved patient care. We also showed that the distinct mechanisms of ECT in biological treatments of major depressive disorder (MDD) and some recent approaches to understand this most common psychiatric disorder. ECT should remain a standard part of modern psychiatric medicine. We recommend a more careful and thoughtful application of this traditional but effective technology.
Collapse
Affiliation(s)
- Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| |
Collapse
|
25
|
Neurostimulation as a treatment for mood disorders in patients: recent findings. Curr Opin Psychiatry 2023; 36:14-19. [PMID: 36449728 DOI: 10.1097/yco.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW The use of neurostimulation to treat mood disorders dates back to the 1930s. Recent studies have explored various neurostimulation methods aimed at both restoring a healthy brain and reducing adverse effects in patients. The purpose of this review is to explore the most recent hypotheses and clinical studies investigating the effects of stimulating the brain on mood disorders. RECENT FINDINGS Recent work on brain stimulation and mood disorders has focused mainly on three aspects: enhancing efficacy and safety by developing new approaches and protocols, reducing treatment duration and chances of relapse, and investigating the physiological and pathological mechanisms behind treatment outcomes and possible adverse effects.This review includes some of the latest studies on both noninvasive techniques, such as transcranial magnetic stimulation, magnetic seizure therapy, transcranial direct current stimulation, transcranial alternating current stimulation, electroconvulsive treatment, and invasive techniques, such as deep brain stimulation and vagus nerve stimulation. SUMMARY Brain stimulation is widely used in clinical settings; however, there is a lack of understanding about its neurobiological mechanism. Further studies are needed to understand the neurobiology of brain stimulation and how it can be used to treat mood disorders in their diversity, including comorbidities with other illnesses.
Collapse
|
26
|
Lindblad L, Nordenskjöld A, Otterbeck A, Nordenskjöld AM. Risk factors for mortality of medical causes within 30 days of electroconvulsive therapy. J Affect Disord 2023; 320:527-533. [PMID: 36209782 DOI: 10.1016/j.jad.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is used to treat severe psychiatric disorders and is associated with reduced risk of suicide and all-cause mortality in patients with severe depression. We investigated the causes of death occurring shortly after ECT and identified potential risk factors for medical causes of death. METHODS Patients treated with ECT between 2012 and 2018 were included in this Swedish register-based study. Multivariate binary logistic regression was used to calculate odds ratios for covariates to determine potential predictors of 30-day mortality. RESULTS Of the 20,225 included patients, 93 (0.46 %) died of suicide and 123 (0.61 %) died of medical causes after ECT. Cardiovascular disease was the most common medical cause of death (n = 49, 40 %). An older age, a Charlson Comorbidity Index of 1 or more, atrial fibrillation, kidney disease, reflux disease, dementia, and cancer were associated with increased risk of death by medical causes. LIMITATIONS Real-life observational studies based on registry data may demonstrate associations, but cannot determine causality. If medical records had been available, we would be better able to determine if deaths were due to the ECT, anesthesia, pre-existing medical conditions, or the mental disorder. CONCLUSIONS ECT appears to be a low-risk medical procedure. Older individuals with severe somatic diseases have the highest risk of death and extra measures should be considered to optimize their medical health during the pre-ECT workup, and during and after ECT.
Collapse
Affiliation(s)
- L Lindblad
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - A Nordenskjöld
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden
| | - A Otterbeck
- Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A M Nordenskjöld
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| |
Collapse
|
27
|
Nikolin S, Owens K, Francis-Taylor R, Chaimani A, Martin DM, Bull M, Sackeim HA, McLoughlin DM, Sienaert P, Kellner CH, Loo C. Comparative efficacy, cognitive effects and acceptability of electroconvulsive therapies for the treatment of depression: protocol for a systematic review and network meta-analysis. BMJ Open 2022; 12:e068313. [PMID: 36549738 PMCID: PMC9772645 DOI: 10.1136/bmjopen-2022-068313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There have been important advances in the use of electroconvulsive therapy (ECT) to treat major depressive episodes. These include variations to the type of stimulus the brain regions stimulated, and the stimulus parameters (eg, stimulus duration/pulse width). Our aim is to investigate ECT types using a network meta-analysis (NMA) approach and report on comparative treatment efficacy, cognitive side effects and acceptability. METHOD We will conduct a systematic review to identify randomised controlled trials that compared two or more ECT protocols to treat depression. This will be done using the following databases: Embase, MEDLINE PubMed, Web of Science, Scopus, PsycINFO, Cochrane CENTRAL and will be supplemented by personal contacts with researchers in the field. All authors will be contacted to provide missing information. Primary outcomes will be symptom severity on a validated continuous clinician-rated scale of depression, cognitive functioning measured using anterograde verbal recall, and acceptability calculated using all-cause drop-outs. Secondary outcomes will include response and remission rates, autobiographical memory following a course of ECT, and anterograde visuospatial recall.Bayesian random effects hierarchical models will compare ECT types. Additional meta-regressions may be conducted to determine the impact of effect modifiers and patient-specific prognostic factors if sufficient data are available. DISCUSSION This NMA will facilitate clinician decision making and allow more sophisticated selection of ECT type according to the balance of efficacy, cognitive side effects and acceptability. ETHICS This systematic review and NMA does not require research ethics approval as it will use published aggregate data and will not collect nor disclose individually identifiable participant data. PROSPERO REGISTRATION NUMBER CRD42022357098.
Collapse
Affiliation(s)
- Stevan Nikolin
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Kieran Owens
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohan Francis-Taylor
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Anna Chaimani
- Research Center of Epidemiology (CRESS-UMR1153), INSERM, INRA, Universite de Paris, Paris, France
| | - Donel M Martin
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Michael Bull
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Harold A Sackeim
- Department of Psychiatry, Columbia University, New York, New York, USA
| | | | - Pascal Sienaert
- Department of Neurosciences, KU Leuven Psychiatric University Hospital KU Leuven, Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen Loo
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| |
Collapse
|
28
|
Salinas FV. Contemporary Anesthetic Evaluation and Management for Electroconvulsive Therapy. Adv Anesth 2022; 40:201-221. [PMID: 36333048 DOI: 10.1016/j.aan.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Electroconvulsive therapy (ECT) is a medical treatment most often used in patients with severe major depression that has not responded to other treatments. ECT is also indicated for patients with other severe psychiatric conditions, including bipolar disorder, schizophrenia, schizoaffective disorders, catatonia, and neuroleptic malignant syndrome. Contemporary "modified ECT" involves inducing general anesthesia with neuromuscular blockade before inducing the therapeutic seizure. The goal of this review is to combine an evidence-based update with the experience of the author's institution to provide a practical approach to anesthetic care for the patient undergoing ECT.
Collapse
Affiliation(s)
- Francis V Salinas
- Swedish Medical Center, Seattle and Issaquah, Washington, USA; Medical Director of Anesthesia Services and Interventional Platform-Swedish Issaquah Hospital, Issaquah, Washington, USA.
| |
Collapse
|
29
|
Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
Collapse
Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
| | | | | |
Collapse
|
30
|
Lafrenière S, Gholi-Zadeh-Kharrat F, Sirois C, Massamba V, Rochette L, Brousseau-Paradis C, Patry S, Gagné C, Lemasson M, Gariépy G, Mérette C, Rahme E, Lesage A. The 5-year longitudinal diagnostic profile and health services utilization of patients treated with electroconvulsive therapy in Quebec: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:629-639. [PMID: 36163429 DOI: 10.1007/s00127-022-02369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Electroconvulsive therapy (ECT) is effective for treating several psychiatric disorders. However, only a minority of patients are treated with ECT. It is of primary importance to characterize their profile for epidemiological purposes and to inform clinical practice. We aimed to characterize the longitudinal profile of psychopathology and services utilization of patients first treated with ECT. METHODS We conducted a population-based comparative study using data from a national administrative database in Quebec. Patients who received a first ECT between 2002 and 2016 were compared to controls who were hospitalized in psychiatry but did not receive ECT. We performed descriptive analyses to compare psychiatric diagnoses, domains of psychopathology (internalizing, externalizing and thought/psychotic disorders), medical services and medication use in the 5 years prior to the ECT or hospitalization. RESULTS 5 080 ECT patients were compared with 179 594 controls. Depressive, anxiety, bipolar and psychotic disorders were more frequent in the ECT group. 96.2% of ECT patients had been diagnosed with depression and 53.8% with a primary psychotic disorder. In the ECT group, 1.0% had been diagnosed exclusively with depression and 47.0% had disorders from that belong to all three domains of psychopathology. Having both internalizing and thought/psychotic disorders was associated with an increased likelihood of receiving ECT vs having internalizing disorders alone (unadjusted OR = 2.93; 95% CI = 2.63, 3.26). All indicators of mental health services utilization showed higher use among ECT patients. CONCLUSION Our results provide robust evidence of complex longitudinal psychopathology and extensive services utilization among ECT patients.
Collapse
Affiliation(s)
- Simon Lafrenière
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada. .,Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada.
| | - Fatemeh Gholi-Zadeh-Kharrat
- Department of Electrical Engineering and Computer Engineering, Université Laval, Quebec, Qc, Canada.,Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | - Caroline Sirois
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada.,Faculty of Pharmacy, Université Laval, Quebec, Qc, Canada.,Centre of Excellence on Aging of Quebec, VITAM Research Centre on Sustainable Health, Quebec City, Qc, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | | | - Simon Patry
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada.,Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada
| | - Christian Gagné
- Computer Vision and Systems Laboratory, Université Laval, Quebec, Qc, Canada
| | - Morgane Lemasson
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada
| | - Geneviève Gariépy
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.,Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada
| | - Chantal Mérette
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada.,CERVO Research Centre, Quebec City, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Qc, Canada
| | - Alain Lesage
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada.,Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada
| |
Collapse
|
31
|
Can electrical interventions be helpful in treating mood disorders in patients diagnosed with personality disorders? Case report and literature review. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: The main indication for electrical interventions remains mood disorders. Depressive disorders have high comorbidity, which is one factor in poorer remission and higher suicide risk. Borderline personality disorder is characterized by a variety of psychopathology, in particular the presence of mood swings, impulsive behaviour, and difficulties in maintaining stable interpersonal relationships. An extremely serious clinical problem is the occurrence of episodes of self-harm and suicidal behaviour in these patients. Comorbidity in affective disorders increases the risk of suicide and also reduces the likelihood of achieving symptomatic remission.
Material and methods: A case report of a patient with a major depressive episode and suicidal tendencies with coexisting borderline personality disorder who received electrical treatments with good results is presented and literature from the last 10 years is reviewed using the keywords: borderline personality disorder, depression, electroconvulsive therapy, suicide.
Results: The results of several studies indicate that electrical treatments are partially effective in patients suffering from depressive disorders and borderline personality disorder.
Conclusions: The case of the patient described, as well as data from the literature, suggest that further research is needed into the use of electrical interventions in patients with mood disorders and comorbidity, and their use may be considered in them as a potentially good therapeutic method. The use of ECT in a patient with comorbid personality disorder reflects an individualized treatment approach; however, there is a need for further research in this area, especially in the context of long-term treatment effects.
Collapse
|
32
|
Xu P, Sun Y. Risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder: Implication for nursing care. Medicine (Baltimore) 2022; 101:e29713. [PMID: 35960126 PMCID: PMC9371559 DOI: 10.1097/md.0000000000029713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The incidence of suicide in patients with depressive order is much higher than other population. We aimed to evaluate the current status and risk of suicidal attempt in patients with the melancholic subtype of depressive disorder, to provide evidence for the clinical management and nursing care of depressive disorder. Patients diagnosed as the melancholic subtype of depressive disorder and treated in our hospital from June 1, 2018 to August 31, 2021 were included. The characteristics of included patients were collected and analyzed. Pearson correlation analysis and logistic regression analysis with odd ratio and 95% confidence interval were conducted to analyze the influencing factors of suicidal attempt in patients with the melancholic subtype of depressive disorder. A total of 446 patients with melancholic subtype of depressive disorder were included, the incidence of suicidal attempt was 18.83%. Pearson correlation analysis indicated that gender (R = 0.611), alcohol drinking (R = 0.719), living situation (R = 0.812), number of previous admission to hospital (R = 0.547), sleep disorder (R = 0.612) and frequent depressive episodes (R = 0.559) were all correlated with the suicidal attempt in patients with melancholic subtype of depressive disorder (all P < 0.05). Logistic regression analysis showed that female (OR 3.115, 95%CI 2.493-3.906), alcohol drinking(OR 1.946, 95%CI 1.684-2.763), living alone (OR 2.401, 95%CI 1.915-3.008), number of previous admission to hospital ≥ 3 (OR 2.342, 95%CI 1.601-2.742), sleep disorder (OR 1.821, 95%CI 1.328-2.215) and frequent depressive episodes (OR 3.128, 95%CI 2.421-3.779) were the independent risk factors of suicidal attempt (all P < 0.05). Suicidal attempt is common in the patients with melancholic subtype of depressive disorder, and there are many related risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder.
Collapse
Affiliation(s)
- Pengfei Xu
- Department of Psychiatry, Tianjin Anding Hospital
| | - Ying Sun
- Department of Psychiatry, Tianjin Anding Hospital
- *Correspondence: Ying Sun, No. 13, Liulin Road, Hexi District, Tianjin, China (e-mail: )
| |
Collapse
|
33
|
Al-Wandi A, Holmberg C, Landén M, Nordenskjöld A. A systematic review and meta-analysis of maintenance treatment for psychotic depression. Nord J Psychiatry 2022; 76:442-450. [PMID: 34665684 DOI: 10.1080/08039488.2021.1990997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To perform a systematic review on the use of maintenance treatment to prevent relapse and recurrence in patients with psychotic unipolar or bipolar depression. METHODS We conducted an electronic search in December 2019 (and an updated search in July 2021) of four databases (PubMed, Embase, PsycINFO, and Cochrane) to identify controlled studies comparing the relapse rates of patients receiving maintenance treatment for psychotic unipolar depression and psychotic bipolar depression. A meta-analysis was made that included three studies comparing antidepressant (AD) and antipsychotic (AP) combination therapy with AD monotherapy. We used the GRADE tool to assess the quality of evidence. RESULTS We included five randomized controlled trials fulfilling the inclusion criteria, making three comparisons: (a) AD + AP versus AD monotherapy; (b) AD + AP versus AP monotherapy; (c) AD + electroconvulsive therapy versus AD monotherapy. The included studies only examined patients with psychotic unipolar depression. The largest included study reported a statistically significant advantage of AD + AP compared with AD monotherapy. We made a meta-analysis of the three studies comparing AD + AP combination therapy with AD monotherapy, which included 195 patients and 56 events. The meta-analysis did not show a statistically significant difference between these treatments. CONCLUSIONS Contrary to the finding of the largest study, we did not find a statistically significant difference between AD + AP combination therapy and AD monotherapy in the meta-analysis. There is insufficient evidence to support the superiority of any treatment modality as maintenance treatment for psychotic depression. Further studies are required.
Collapse
Affiliation(s)
- Ahmed Al-Wandi
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Mikael Landén
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
34
|
Sienaert P, Brus O, Lambrichts S, Lundberg J, Nordanskog P, Obbels J, Verspecht S, Vansteelandt K, Nordenskjöld A. Suicidal ideation and ECT, ECT and suicidal ideation: A register study. Acta Psychiatr Scand 2022; 146:74-84. [PMID: 35279825 PMCID: PMC9313798 DOI: 10.1111/acps.13425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although electroconvulsive therapy (ECT) is anti-suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT. METHODS This population-based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥4 on the last item of the Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline. RESULTS In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre-treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS-S-score, and younger age were associated with persistent SI. CONCLUSION The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non-psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.
Collapse
Affiliation(s)
- Pascal Sienaert
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Ole Brus
- Clinical Epidemiology and BiostatisticsFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Simon Lambrichts
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Johan Lundberg
- Department of Clinical NeuroscienceCenter for Psychiatry ResearchKarolinska Institute and Stockholm County CouncilSweden
| | - Pia Nordanskog
- Center for Social and Affective NeuroscienceDepartment of Clinical and Experimental MedicineFaculty of Health SciencesLinköping University and Department of PsychiatryRegion ÖstergötlandSweden
| | - Jasmien Obbels
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Shauni Verspecht
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Kristof Vansteelandt
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Axel Nordenskjöld
- University Health Care Research CentreFaculty of Health and Medical SciencesÖrebro UniversityÖrebroSweden
| |
Collapse
|
35
|
Abstract
The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for one another when we are suffering in this way. This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization and service users who have suffered negative consequences of physical treatments that modify brain functions in ways that are not well-understood.
Collapse
Affiliation(s)
- John Read
- School of Psychology, University of East London, London E15 4LZ, UK
| | | |
Collapse
|
36
|
Kaster TS, Blumberger DM, Gomes T, Sutradhar R, Wijeysundera DN, Vigod SN. Risk of suicide death following electroconvulsive therapy treatment for depression: a propensity score-weighted, retrospective cohort study in Canada. Lancet Psychiatry 2022; 9:435-446. [PMID: 35487236 DOI: 10.1016/s2215-0366(22)00077-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies examining the risk of suicide death after treatment with electroconvulsive therapy have been confounded and the resulting uncertainty around the risk-benefit profile of electroconvulsive therapy might contribute to its underuse. We aimed to compare the risk of death by suicide after psychiatric hospitalisation among individuals with depression who had been exposed to electroconvulsive therapy with those who had not. METHODS This was a propensity score-weighted, retrospective cohort study using linked population-level administrative health data for adults with depression who had been admitted to a designated psychiatric bed in Ontario, Canada for more than 3 days between April 1, 2007 and Dec 31, 2017. Electroconvulsive therapy exposure was defined as one or more physician billing procedure codes during hospitalisation. The primary outcome was death by suicide identified using administrative health records within 365 days following discharge. We used cause-specific Cox proportional hazards model to estimate the cause-specific hazard ratio (csHR) for electroconvulsive therapy-exposed and electroconvulsive therapy-unexposed individuals. Secondary outcomes were non-suicide death and all-cause mortality. FINDINGS In the analytic cohort, there were 67 327 psychiatric hospitalisation records (27 231 men and 40 096 women; mean age 45·1 years [SD 16·8; range 18-103]), of whom 4982 were exposed to electroconvulsive therapy and 62 345 were not exposed to electroconvulsive therapy. No ethnicity data were available. In propensity-score weighted analyses, electroconvulsive therapy was associated with a significantly reduced risk of suicide death (csHR 0·53 [95% CI 0·31-0·92]). Accounting for non-suicide death as a competing risk had no effect on the findings. Electroconvulsive therapy was also associated with a significantly reduced risk of all-cause mortality (0·75 [0·58-0·97]), but not non-suicide death (0·83 [0·61-1·12]). INTERPRETATION Among individuals admitted to hospital with depression, electroconvulsive therapy is associated with a significantly reduced risk of death by suicide in the year after discharge. This study reinforces the importance of electroconvulsive therapy, particularly for people with severe depression. FUNDING Norris Scholars Award, Department of Psychiatry, University of Toronto, and the Canadian Institutes for Health Research.
Collapse
Affiliation(s)
- Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Tara Gomes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
37
|
Meechan CF, Laws KR, Young AH, McLoughlin DM, Jauhar S. ECT is evidence-based - a commentary on depression: why drugs and electricity are not the answer. Psychol Med 2022; 52:1416-1418. [PMID: 35674232 DOI: 10.1017/s003329172200085x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- C F Meechan
- Woodland View Hospital, Irvine, Ayrshire & Arran, UK
| | - K R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - A H Young
- Psychological Medicine, Centre for Affective Disorders, IoPPN, King's College, London, UK
| | - D M McLoughlin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - S Jauhar
- Psychological Medicine, Centre for Affective Disorders, IoPPN, King's College, London, UK
| |
Collapse
|
38
|
Affiliation(s)
- Randall T Espinoza
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
| | - Charles H Kellner
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
| |
Collapse
|
39
|
Individual response to electroconvulsive therapy is not correlated between multiple treatment courses. J Affect Disord 2022; 298:256-261. [PMID: 34742999 PMCID: PMC8709707 DOI: 10.1016/j.jad.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) effectively treats depressive disorders, but many patients will have subsequent relapses. While some guidelines suggest prior response to ECT is an indication for ECT in a subsequent mood episode, it is unknown whether response to ECT is correlated between treatment courses. This study explores whether response to ECT at a first treatment correlates with response to treatment in a second independent ECT course. METHODS Single-center retrospective cohort of patients receiving two different ECT treatment courses between 2011 and 2020 and who self-reported depression symptoms using the Quick Inventory of Depressive Symptomatology (QIDS) at baseline and following treatment #5. RESULTS 286 patients received two independent ECT series during the study period, of whom 153 received at least 5 treatments in both series. Patients had similar QIDS scores at the start of each treatment series (Pearson's correlation, r = 0.58, p <0.001), but the change in QIDS following 5 ECT treatments was not correlated between series for individual patients (Pearson's correlation, r = 0.083, p = 0.31). In multivariate analyses, change in QIDS was similar for both treatment series, but patients were less likely to receive 5 treatments in the second treatment series. LIMITATIONS retrospective cohort cannot control for factors influencing access to repeat ECT treatment CONCLUSIONS: While on average final QIDS score was the same following two independent treatment courses, for individual patients the change in depression symptoms was not correlated between treatment series. Further research is needed to identify factors that may predict longitudinal ECT response.
Collapse
|
40
|
Wang W, Guo X, Kang L, Zhang N, Ma S, Cheng J, Fang L, Liu Z. The Influence of Family-Related Factors on Suicide in Major Depression Patients. Front Psychiatry 2022; 13:919610. [PMID: 35845470 PMCID: PMC9283679 DOI: 10.3389/fpsyt.2022.919610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the influence of family-related factors on suicide-related behaviors of patients with major depression disorder, and to provide scientific evidence for effective preventive measures. METHODS A total of 852 outpatients at Renmin Hospital of Wuhan University were enrolled in this cross-sectional study from April 2019 to January 2021. The general demographic information and family-related information of the patients were collected via a general information questionnaire, the Family Assessment Device, the Egna Minnen av Barndoms Uppfostran, and the Childhood Trauma Questionnaire. RESULTS Participants without suicide-related behaviors accounted for 10.45% of the total sample, those with suicidal ideation accounted for 47.54%, those with suicidal plans accounted for 24.77% and with suicidal attempts for 17.25%. Patients with major depression disorder who have lower education level, who were separated from their parents, who have severely impaired family function, who experienced childhood abuse, and whose parents adopted apathetic and severe child-rearing styles had a higher risk of suicide-related behaviors. In the multivariate regression model, degree of major depression disorder, education and child-rearing style were independent risk factors for suicide-related behaviors. CONCLUSION Patients with major depression disorder who have been separated from their parents, have severely impaired family function, were abused in childhood or have been exposed to improper childrearing styles have a greater risk of suicide. Family-related factors play a predictive role in suicide in patients with major depression disorder. More attention should be paid to family-related factors to reduce the occurrence of suicidal ideation and attempt.
Collapse
Affiliation(s)
- Wei Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Guo
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijun Kang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Nan Zhang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Cheng
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Fang
- Department of Psychiatry, Jingmen No. 2 People's Hospital, Jingmen, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
41
|
Kellner CH. Electroconvulsive Therapy: Stayin' Alive, Stayin' Well. Acta Psychiatr Scand 2021; 144:215-217. [PMID: 34397107 DOI: 10.1111/acps.13352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/24/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|