Clinical Effectiveness of Electroconvulsive Therapy in a University Hospital Setting / 신경정신의학

ABSTRACT

OBJECTIVES: Electroconvulsive therapy (ECT) has become useful in psychiatric practice. This study was conducted to describe the clinical practice of ECT, including indications, efficacy, and side effects, in patients treated with modified unilateral or bilateral ECT. METHODS: The clinical records of patients treated with ECT during the period of January 2002 to December 2013 were evaluated retrospectively. A total of 107 patients (83 unilateral and 24 bilateral) were included in the analysis. Diagnostic categories treated were schizophrenia (46.7%), major depression (42.1%), bipolar disorder (9.3%), and obsessive-compulsive disorder (1.9%). Right unilateral or bilateral ECT was administered with brief pulse stimulation using modified ECT. Severity of illness and clinical improvement were measured using the Clinical Global Impressions (CGI) Scale. RESULTS: A positive response to ECT was found in 56.1% according to response criteria of the CGI-Improvement (CGI-I) score of 1 or 2. Response rates (based on CGI-I < or =2) for schizophrenia, major depression, bipolar disorder, and obsessive-compulsive disorder were 48.0%, 62.2%, 70.0%, and 50.0%, respectively (p=0.42). Although unilateral and bilateral ECT did not differ in rates of response, bilateral ECT resulted in more rapid onset of improvement. Bilateral ECT showed association with more adverse side effects (unilateral 31.3% vs. bilateral 70.8%). CONCLUSION: ECT is a highly effective and safe therapeutic option in the treatment of psychiatric illness, particularly in major mood disorder and schizophrenia. The use of ECT in a university hospital psychiatric unit in South Korea reflects similar results to those described in the international literature.