The journal of ECT · 2026
A Transdiagnostic Study of Electroconvulsive Therapy (ECT) Response in Patients with Different Indications for Repeat ECT Courses.
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Mahmood Shakran, Tan Xiao Wei, Chen Birong, Tor Phern Chern
Аннотация
AIM: This study examines early ECT response and correlations between repeat ECT courses, focusing on patients whose treatment indications changed between courses.
METHODS: Our retrospective observational study included patients from the Institute of Mental Health (Singapore) who underwent at least 2 ECT courses for different indications between March 2017 and May 2023. For each course, the MADRS and BPRS scores were assessed 1 to 2 days before the first ECT session and after the sixth. Pearson correlation and paired t tests were employed to analyze the relationship between responses to the first and second ECT courses, along with 6 additional clinical outcome assessments (GAF, VAS, CGI-S, US, Q-LES-Q-SF, and MoCA) spanning illness severity, quality-of-life, and cognition.
RESULTS: Twenty-five patients were included. Psychosis was the most common indication for the first course and mania for the second. Overall, early response rates were 38.9% for the first course and 42.1% for the second, with no significant correlation between responses across courses ( P = 0.229). Notably, no patients with catatonia responded to acute treatment in the first course, even when indications changed in the second. Strong correlations were found for global illness severity (CGI-S, r = 0.519, P = 0.023) and quality-of-life (US, r = 0.935, P < 0.001) across the 2 courses.
CONCLUSION: Changes in ECT indications between courses suggested a poorer prognosis, but those who showed improvement in global illness severity and quality-of-life tended to experience similar benefits in subsequent ECT courses. Given the lack of correlation between symptom-specific early response across courses, a poor early response in a previous ECT course should not preclude patients from future ECT when clinically indicated.
METHODS: Our retrospective observational study included patients from the Institute of Mental Health (Singapore) who underwent at least 2 ECT courses for different indications between March 2017 and May 2023. For each course, the MADRS and BPRS scores were assessed 1 to 2 days before the first ECT session and after the sixth. Pearson correlation and paired t tests were employed to analyze the relationship between responses to the first and second ECT courses, along with 6 additional clinical outcome assessments (GAF, VAS, CGI-S, US, Q-LES-Q-SF, and MoCA) spanning illness severity, quality-of-life, and cognition.
RESULTS: Twenty-five patients were included. Psychosis was the most common indication for the first course and mania for the second. Overall, early response rates were 38.9% for the first course and 42.1% for the second, with no significant correlation between responses across courses ( P = 0.229). Notably, no patients with catatonia responded to acute treatment in the first course, even when indications changed in the second. Strong correlations were found for global illness severity (CGI-S, r = 0.519, P = 0.023) and quality-of-life (US, r = 0.935, P < 0.001) across the 2 courses.
CONCLUSION: Changes in ECT indications between courses suggested a poorer prognosis, but those who showed improvement in global illness severity and quality-of-life tended to experience similar benefits in subsequent ECT courses. Given the lack of correlation between symptom-specific early response across courses, a poor early response in a previous ECT course should not preclude patients from future ECT when clinically indicated.