Terapia Electroconvulsiva y Estimulación Magnética Transcraneal Repetitiva en pacientes con esquizofrenia: una revisión sistemática / Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in patients with schizophrenia: a systematic review

Cuando la esquizofrenia no responde satisfactoriamente a tratamiento farmacológico, alcanzar una terapia efectiva para el paciente es una tarea bastante frustrante para el médico psiquiatra. Es en este contexto que la terapia electroconvulsiva y la estimulación magnética transcraneal repetitiva han tomado fuerza en la investigación clínica, a pesar de los grandes cuestionamientos sobre su efectividad y mala reputación. Se realizó una revisión sistemática de la literatura en las principales bases de datos disponibles. Concluyendo que ambas terapias demuestran ser herramientas útiles en el tratamiento de la esquizofrenia resistente a tratamiento farmacológico, así como también complementarias a los antipsicóticos

When schizophrenia does not respond satisfactorily to pharmacological treatment, achieving effective therapy for the patient is quite a frustrating task for the psychiatrist. It is in this context that electroconvulsive therapy and repetitive transcranial magnetic stimulation have gained strength in clinical research, despite huge questions about its success and bad reputation. A systematic review of the literature was conducted in the main available databases. Concluding that both specific therapies will be useful tools in the treatment of schizophrenia resistant to pharmacological treatment, as well as complementary to antipsychotics.

The use of electroconvulsive therapy and the length of stay of psychiatric inpatients at King Chulalongkorn Memorial Hospital, Thai Red Cross Society.

BACKGROUND: Electroconvulsive therapy (ECT) is the effective treatment in psychiatric patients. However, the controversies about the risk and benefit limit the use of this procedure. Some efficacies of ECT may be interesting to use in hospitalized patients such as rapid onset, risk reduction but it may increase the length of stay (LOS) in previous study. OBJECTIVES: To study the use of ECT in hospitalized psychiatric patients in the aspect of indication , diagnosis and the length of stay. MATERIAL AND METHOD: From August to September 2004, all 51 cases of psychiatric inpatient medical records were studied. The top five of diagnosis were schizophrenia (49%), bipolar disorder (23.5%), acute psychosis (7.8%), depressive disorder (5.9%) and dementia (5.9%). ECT was performed in 22 cases (43.1%). RESULTS: The average length of stay was 21.5 +/- 14.5 days. The mean LOS of the ECT group 25.9 +/- 15.8 days was not quite longer compared with 17.8 +/- 12.7 days of the Non ECT group comparison between the ECT group (64%) and the non ECT group (36%) of schizophrenia, the LOS of each group was 27.3 +/- 16.7 and 16.9 +/- 8.8 days which was also not significant. LOS of ECT of the bipolar group (20%) and the non ECT bipolar group (80%) was 10.5 +/- 4.9 and 23.0 +/- 18.3 days which was not statistically significant (p = 0.39). There were 3 major indications for ECT such as a severe violence case, suicidal case, refractory case with the mean LOS of 19.9 +/- 10.9, 17.5 +/- 12.8, 43.3 +/- 21.2 and 31.7 +/- 8.3 days subsequently. The patients who had the refractory indication had a longer length of stay than other indications. CONCLUSION: Overall average length of stay was not longer in the ECT group. The ECT group had a longer length of stay than the non ECT group in the refractory treatment case only. ECT can be used in a psychiatric ward with the efficacy of its indication without prolonged length of stay.

Características clínicas e demográficas de um grupo de pacientes em uso de eletroconvulsoterapia / Clinical and demographic characteristics of a sample of patients treated with electroconvulsive therapy

Ojetivo: Avaliar o perfil demográfico e algumas características clínicas de uma amostra de pacientes em tratamento eletroconvulsioterápico em um hospital psiquiátrico universitário, no período de janeiro a outubro de 2003. Métodos: Um questionário semi-estruturado foi aplicado a médicos residentes e especializandos que indicaram ECT no período de janeiro a outubro de 2003. Além das características demográficas dos pacientes, foram obtidas as seguintes variáveis: diagnóstico psiquiátrico; co-morbidades clínicas e psiquiátricas; indicação para realização de ECT; tempo de internação até a indicação de ECT; e história pregressa do uso e resposta a essa terapêutica. Resultados: Quanto ao diagnóstico psiquiátrico, 37,5 por cento dos pacientes tinham o diagnóstico de transtorno bipolar do humor (TB), episódio atual maníaco; 3,1 por cento, TB, episódio atual depressivo; e 34,4 por cento, esquizofrenia. Além disso, mais da metade dos pacientes apresentava co-morbidades clínicas e/ou psiquiátricas. A principal indicação para a realização da ECT foi a de refratariedade aos psicofármacos. A maioria dos pacientes recebeu indicação de ECT após 60 dias de internação. Conclusões: Há algumas diferenças entre as indicações de ECT em nossa amostra e aquelas observadas em países desenvolvidos. Estudos futuros devem permitir parâmetros clínicos, mais claros, para indicação da ECT.