La unidad de electroterapia ambulatoria del INSM H. Delgado - H. Noguchi. Tres años de funcionamiento (1995-1998) / Ambulatory electroconvulsive therapy unit at NIMH H. Delgado - H. Noguchi assessment of three years (1995-1998)

RESUMEN

La unidad de electroconvulsivoterapia (ECT) ambulatoria del INSM HD-HN, durante el periodo 1995-98 atendió a 102 pacientes (damas, 66.7% y varones, 34.3%); el 60% estaba entre los 18 y 29 años de edad. Los principales diagnósticos psiquiátricos (DSM III-R) fueron esquizofrenia paranoide (63.7%) y depresiva mayor (12.7%). El tiempo de enfermedad para ambas condiciones fueron mayor de 5 años (60.0% y 53.9% respectivamente). La medicación previa a la ECT fue en su mayoría antipsicóticos clásicos orales (53.9% y de depósito (21.6%), y antidepresivos (11.8%) con su respuesta no satisfactoria para la condición patológica. El número de sesiones más frecuentemente aplicada entre 9 y 12 (48.0%). Más de 18 pacientes (1766%) reiteraban ECT; el 77.8% de ellos había recibido una serie previa. La respuesta a ECT ambulatoria fue registrada como satisfactoria en 60 pacientes (58.8%), parcial en 22 (21.6%) y pobre en 8 (7.8%); hubo deserción precoz en 12 de ellos (11.8%); sólo se usó anestésico (Ketamina) en 4 de ellos (3.9%). Se concluye que la ECT ambulatoria continúa siendo un método de tratamiento efectivo en la esquizofrenia resistente a fármacos y en el trastorno depresivo mayor, mostrando una prioridad inversa en el uso reportado en la bibliografía internacional. Las ventajas parecen ser el bajo costo y escaso riesgo de mortalidad; se recomienda seguimiento a largo plazo de estos pacientes.

ABSTRACT

A total of 102 out patients received Electroconvulsive therapy (ECT) during period 1995 to 1998 in ambulatory ECT Unit at NIMH HD-HN. There were mostly females (66.7%); than males (34.3%), aged predominantly between 18 to 29 years (60%). The most frequent disorders, according DSM-III-R were paranoid schizophrenia (63.7%), and major depression (12.7%). For both conditions, the length of illness was more than five years (60.0% and 53.9% respectfully); classic antipsychotic p. o (53.9%) and depot ones (21.6%) as well as antidepressant were be given previous to ECT, with no satisfactory response for illness. An average of 9 to 12 ECT sessions was applied (48.0%). More than 18 patients (17.6%) has been received ECT at any time. 77.8% of them received at least one full ECT. In this study, successful response to ambulatory ECT registered in 60 patients (58.8%, partially successful in 22 patients (21.6%), and poor response in 8 patients 87.8%); premature rejection was registered in 12 patients (11.8%). The use of anesthetic (Ketamine) was reported only in 4 of studied patients. The author arrives at the conclusion that ambulatory ECT goes on as a therapy mostly in case of schizophrenia resistant to neuroleptics and then for major depression, which shows as inverse tendency according reports in international literature. A low cost and minimal mortal risk looks to be principal advantages of ambulatory ECT, although the author suggests a long term assessment and a following for patients who received this form of therapy.