Home Mind & Brain 10-Year Study Highlights Efficacy and Demographic Patterns in Electroconvulsive Therapy at Romania’s Largest Psychiatric Hospital

10-Year Study Highlights Efficacy and Demographic Patterns in Electroconvulsive Therapy at Romania’s Largest Psychiatric Hospital

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A comprehensive 10-year retrospective study has provided valuable insights into the socio-demographic and clinical profiles of patients undergoing electroconvulsive therapy (ECT) at Romania’s largest psychiatric hospital. This extensive research, conducted at the Professor Dr Alexandru Obregia Clinical Psychiatric Hospital in Bucharest, aimed to evaluate the effectiveness of ECT and its association with pharmacological treatments among a diverse patient population.

The findings were published in the journal Biomedicines.

The study encompassed 249 patients aged between 18 and 73 years who received ECT between January 2013 and December 2023. These patients were treated for various severe mental health conditions, including recurrent depressive disorder, schizophrenia, bipolar affective disorder, and schizoaffective disorder. The primary indications for ECT included treatment resistance, persistent suicidal ideation, and catatonia.

Recurrent depression emerged as the most frequent diagnosis, accounting for 38.55% of cases, followed by schizophrenia at 28.91%. The data revealed significant differences in the sociodemographic profiles and clinical characteristics of patients requiring re-hospitalisation post-ECT compared to those who did not.

Floris Petru Iliuta, PhD, an assistant professor at Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, explained study’s motivation: “The motivation behind our study was to explore the efficacy and demographic patterns of electroconvulsive therapy (ECT) in treating severe psychiatric conditions such as depression, mania, schizophrenia, and schizoaffective disorder. Despite ECT’s proven effectiveness, especially in cases resistant to conventional treatments or involving acute symptoms, there is considerable variation in its practice and acceptance globally.”

Patients requiring re-hospitalisation after ECT were predominantly male, aged between 25 and 44, and primarily diagnosed with schizophrenia. These patients underwent a greater number of ECT sessions, typically ranging from seven to twelve. Conversely, those not needing further hospitalisation were mainly females aged 45 to 64, diagnosed with recurrent depressive disorder, and typically required four to six ECT sessions.

The study highlighted that 61.84% of the patients received ECT due to treatment resistance, while 21.68% were treated for persistent suicidal ideation and 16.86% for catatonia. It was noted that ECT proved particularly effective for elderly patients, significantly reducing depressive symptoms and suicidal ideation.

“The study aimed to provide a comprehensive perspective on ECT’s benefits, risks, and utilisation in Romania, where centralised data collection is lacking,” Iliuta explained. “By investigating patient profiles, appropriate indications, outcomes, and adverse effects, we sought to enhance understanding and optimise ECT protocols, ultimately improving patient care.”

The research adhered to stringent ethical standards, with informed consent obtained from all patients or their legal representatives. The ECT sessions were done with a brief-pulse square-wave device while the patients were asleep and with standard bifrontotemporal electrode placements for both sides. Sessions were typically held three times a week and continued until patients achieved remission or showed a plateau in symptom improvement.

Prior to ECT, all psychotropic medications were adjusted or withdrawn, and comprehensive medical evaluations were performed to assess the risks. The procedure involved administering anaesthesia and muscle relaxants to prevent serious complications, with patients’ vital signs closely monitored throughout the treatment.

The effectiveness of ECT was measured based on clinical psychiatric evaluations, with a significant proportion of patients experiencing marked improvement. Among the 249 patients, 55.40% did not require further hospital admissions post-ECT, indicating a substantial therapeutic benefit.

Patients who adhered to post-ECT psychotropic treatment regimens, particularly those continuing with antidepressants or benzodiazepines, showed lower readmission rates. This finding underscores the importance of sustained pharmacological support following ECT to maintain the therapeutic gains.

“Our study revealed significant differences between patients who required hospital readmission post-ECT and those who did not,” Iliuta noted. “Those needing readmission were typically younger males with schizophrenia, requiring more ECT sessions and consistent antipsychotic medication. In contrast, older females with recurrent depressive disorder required fewer sessions and showed significant symptom improvement. These findings underscore the importance of personalised post-ECT care and medication management to reduce readmission rates. Tailored treatment plans considering demographic and clinical characteristics can optimise ECT’s effectiveness and improve patient outcomes. This approach highlights the need for continuous monitoring and individualised care strategies to enhance ECT’s therapeutic benefits.”

Despite its comprehensive nature, the study acknowledged several limitations. The retrospective design prevented direct patient assessments using structured clinical interviews or rating scales to measure ECT effectiveness. Additionally, there may have been some variability in the diagnoses because they came from various psychiatrists. The study’s findings are also specific to a single institution, limiting their generalizability to other settings within Romania or internationally.

To address these limitations, the authors recommend future prospective studies with larger sample sizes and comparative analyses across different psychiatric centres. Such research would provide a more robust understanding of ECT’s efficacy and help standardise treatment protocols across diverse patient populations.

Discussing future plans, Iliuta shared: “Our future plans involve conducting prospective studies to further investigate the demographic differences in ECT response and outcomes. We aim to implement and evaluate individualised ECT protocols based on specific patient characteristics. Enhancing training for healthcare providers on the latest ECT techniques and establishing centralised databases for tracking ECT usage and outcomes in Romania are also priorities. These initiatives will facilitate ongoing research and continuous improvement in ECT practices, ultimately optimising treatment outcomes and minimising adverse events for individuals with severe mental illness.”

The study’s findings affirm the significant therapeutic role of ECT in managing severe psychiatric disorders, particularly for patients with treatment-resistant conditions or acute suicidal ideation. By delineating distinct patient profiles based on demographic and clinical characteristics, the research offers valuable insights for optimising ECT protocols and improving patient outcomes.

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