الکتروشوک درمانی واکنش های ضد جنون در نوجوانان مبتلا به روان پریشی اپیزود اول را بهبود می بخشد؛مطالعه مورد-شاهدی

Objective Previous studies have demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis. Method This case–control study was conducted in inpatients aged 13–20 years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated. Results Between March 2004 and November 2009, 112 eligible patients were allocated to control (n = 38) and ECT (n = 74) group. Additional ECT treatment significantly reduced hospital stay compared to controls (23.2 ± 8.2 days versus 27.3 ± 9.3 days, mean ± SD, P = 0.018). Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR) = 1.961, P = 0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls. Conclusions ECT is an effective and safe intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be considered as an early psychosis intervention.

With the dramatic socioeconomic and demographic transformation of modern life, the prevalence of various mental illnesses has sharply risen in the adolescent population (Srinath et al., 2010). Psychotic disorders are a relatively common psychiatric condition occurred in adolescents, with an estimated prevalence of 0.5% (Remschmidt and Theisen, 2005). Although new generation antipsychotic agents are the mainstay of the treatment of adolescent psychosis, a majority of patients present with moderate to severe impairment at onset, do not obtain full remission from pharmacotherapy, and eventually develop relapse and to follow a chronic course (Fraguas et al., 2011 and Masi and Liboni, 2011). Moreover, young patients are more susceptible to the adverse effects of antipsychotics compared to adults (Fraguas et al., 2011). These shortcomings have led to a growing demand for development of alternative strategies to improve antipsychotic response in early psychosis. Electroconvulsive therapy (ECT) is a well-accepted brain stimulation therapy that has been confirmed to be effective in treating adults with pharmacotherapy-resistant neuropsychiatric conditions (Chakrabarti et al., 2010), including schizophrenia (Tharyan and Adams, 2005). The use of ECT in adolescents was first reported in 1942 (Heuyer and Bour, 1942). Although ECT may be underutilized in adolescents due to ethical concerns and unrealistic fears, a large number of case reports indicate that ECT is an effective and safe procedure in the treatment of adolescents with intractable mood disorders, catatonia, and schizophrenia (Consoli et al., 2010 and Shoirah and Hamoda, 2011). In 2004, the American Academy of Child and Adolescent Psychiatry (AACAP) published practice parameters for the use of ECT in adolescents, defining its indications in terms of diagnosis, severity and refractoriness of symptoms (Ghaziuddin et al., 2004). Despite this, little is known about the clinical efficacy and tolerability of ECT as an early intervention in first-episode young patients. As a useful electrophysiological measure, polysomnography (PSG) has been widely applied in the investigation of various neuropsychiatric disorders and therapeutic response (Monti and Monti, 2004 and Krystal et al., 2008). It has been shown that abnormal PSG manifestation is associated with the psychopathology of schizophrenia and antipsychotic effects are associated with the improvement of abnormal PSG variables (Monti and Monti, 2004). We therefore have reason to hypothesize that additional ECT could produce more rapid and greater improvement than antipsychotics alone on clinical symptoms and PSG profiles in adolescents with first-episode psychosis. To test this hypothesis, a case–control trial was designed to compare the efficacy, tolerability, and changes in PSG profiles in the patients treated with antipsychotics combined with and without ECT intervention. Polysomnographic correlates of clinical variables were also examined.