电休克治疗用于精神分裂症的激越症状:随机对照试验的meta分析（英文）

背景:躁动在精神分裂症治疗中是一个重大挑战。电休克疗法(ECT)对各种精神疾病是一种快速、有效、和安全的治疗,但ECT对精神分裂症的躁动治疗的相关meta分析还尚未报道。目标:系统地评估单一使用ECT或ECT合并使用其他抗精神病药物(APs)的对精神分裂症的躁动治疗的有效性和安全性。方法:进行随机对照试验(RCT)的系统文献搜索。两名独立评估者筛选研究、提取结果数据与现有数据的安全性、进行质量评估和数据合成。采用建议、评估、开发、和评价的工作组等级(GRADE)来判断主要成果的证据的总体水平。结果:一共确定了中国有七个RCTs,包括ECT单一使用(4个RCTs有5个治疗组,n=240)和ECT-APs合并使用(3个RCTs,n=240)。研究对象平均年龄34.3(4.5)岁,平均治疗时间为4.3(3.1)周。所有7个RCTs非盲法,并且根据Jadad量表7项RCTs均被评为低质量。样本的Meta分析发现与APs单一治疗相比,单一使用ECT或ECT-APs合并使用阳性和阴性症状量表(PANSS)的躁动子因子评分改善均无显著性差异(ECT单一使用:weighted mean difference(WMD)=-0.90,95%confidence interval(CI):(-2.91,1.11),p=0.38;ECT-APs合并使用:WMD=-1.34,(95%CI:-4.07,1.39),p=0.33)。然而,PANSS总分(WMD=-7.13,I~2=0%,p=0.004)和兴奋子因子评分(WMD=-1.97,p0.0001)、ECT治疗14天后的PANSS总分(WMD=-7.13,I~2=0%,p=0.004)和第7天和第14天的兴奋子因子评分(WMD=-1.97to-1.92,p=0.002 to 0.0001)均显示单一使用ECT优于APs单一治疗。ECT-APs合并治疗结束时(WMD=-10.40,p=0.03)和治疗后7天(WMD=-5.01,p=0.02)的PANSS总分显示均优于APs单药治疗。头痛(p=0.0001,number-needed-to-harm(NNH)=3,95%CI=2-4)是唯一的ECT单一治疗后不良反应,并且ECT单一治疗组比APs单药治疗发生的更频繁。根据GRADE方法,主要结果的证据水平被评为"非常低"(37.5%)和"低"(50%)。结论:基于中国7个RCTs合并的数据发现ECT单一治疗或ECT-APs合并治疗在精神分裂症患者的躁动治疗中并没有优势。然而,ECT单一治疗或ECT-APs合并治疗均与PANSS总分减低显著有关。需要高质量的RCTs验证目前的解释。     

电休克在急性精神分裂症治疗中的作用

电休克治疗对精神分裂症的疗效存在着争议，本文观察300例在抗精神病药物治疗中合并电休克治疗是否对控制本病急性症状有所差别。结果提示：合并治疗较有效地在指定时期中控制兴奋、拒食、木僵或幻觉。故有针对地应用ECT仍有助益。     

单侧电休克治疗精神分裂症的对照研究

目的 比较双侧与单侧ＥＣＴ的优点及局限性，方法在心、脑电图持续监护下，采用双 与单侧有抽搐ＥＣＴ对６０例住院精神分裂症２进行治疗对照研究。结果 不同电极放置的ＥＣＴ临床疗效无明显差异，而对记忆的损害以双侧组为重，其他副作用和脑电图改变却以双侧组较轻，结论 两咱电极放置ＥＣＴ的适应证不尽相同。     

无抽搐电休克治疗精神分裂症的疗效观察

为观察无抽搐电休克治疗 (ＭＥＣＴ)在治疗精神分裂症中次数与疗效的关系 ,进行本研究。1　对象和方法将 1999年 6月 1日～ 2 0 0 1年 5月 10日接受ＭＥＣＴ的10 0例精神分裂症住院患者随机分成两组 ,Ａ组治疗次数≥ 6次 ,Ｂ组治疗次数 <6次 ,各 5 0例。均符合国际疾病分类第10版和中国精神疾病分类方案与诊断标准第 2版修订本诊断标准 ,排除电休克 (ＥＣＴ)禁忌证。简明精神病评定量表(ＢＰＲＳ)评分≥ 35分。Ａ组 5 0例 ,其中男 2 4例 ,女 2 6例 ;年龄 15～ 6 0岁 ,平均(2 6 4± 9 0 )岁 ;病程 0 1～ 2 8 0年 ,平均 (5 4± 7 1)年 ;偏…     

现代电休克治疗精神分裂症的疗效比较结果

目的 探讨现代电休克对精神分裂症的疗效及副作用。方法 将入组病例随机分为两组，并分别实施现代电休克与传统电休克治疗。采用临床疗效、简明精神病评定量表(BPRS)及韦氏记忆量表(WMS)为评定工具，以分别评定两组疗效及副作用。结果 现代电休克与传统电休克的疗效相当，但前者副作用较小，对记忆无明显影响，后者对记忆影响持续2周以上。结论 由于现代电休克疗效较好，副作用较小，患者易于接受，作者认为可替代传统电休克治疗。     

电休克治疗对儿童精神分裂症的疗效和安全性分析

分析了在四川大学华西医院精神科对儿童精神分裂症使用ECT的情况 ,并与使用药物治疗儿童精神分裂症的疗效和副反应等进行对照分析 ,现报道于后。1　对象和方法对象为四川大学华西医院精神科 1995年 6月～ 2 0 0 0年 6月住院的所有符合ICD - 10精神分裂症诊断标准、年龄≤ 15岁的病人 5 6例 ,并分成ECT治疗组 (17例 )和药物治疗组 (39例 )。分别观察两组有关的一般临床资料、临床核心症状、疗效和副反应等。有关数据采用SPSS8 0统计软件包在微机上进行统计分析。2　结　　果2 1　一般临床资料比较　ECT组年龄 12～ 15岁 ,平均为(14 …     

无抽搐电休克治疗难治性精神分裂症临床观察

目的:了解无抽搐电休克治疗(MECT)对难治性精神分裂症的疗效与不良反应。方法:对39例难治性精神分裂症患者在原服用抗精神病药基础上合并MECT治疗,分别于合并治疗前后采用阳性与阴性症状量表(PANSS)及副反应量表(TESS),韦氏记忆量表(WMS)评定疗效及不良反应。结果:合并MECT后PANSS评分明显降低(P<0.01),WMS评分在治疗结束后1d明显降低,1周及2周时恢复。结论:MECT对难治性精神分裂症有效,不良反应少。     

电休克治疗对精神分裂症患者血浆高香草酸的影响

目的:探讨无痉挛电休克治疗(MECT)对精神分裂症患者多巴胺(DA)代谢产物高香草酸(HVA)的影响。方法:33例精神分裂症住院患者纳入研究,电休克治疗次数6～12次。应用阳性和阴性症状量表(PANSS)评定疗效,以高效液相紫外分光检测法测定患者治疗前后的血浆高香草酸(HVA)的含量。结果:患者治疗前、中、后HVA的含量差异有统计学意义(F=18.17,P=0.000),HVA含量与PANSS阴性症状和阳性症状评分均存在相关关系(r=0.560,0.373,P<0.05)。结论:电休克治疗前后HVA水平的变化与疗效相关,电休克治疗的机制之一是通过改变患者DA代谢发挥作用。     

无抽搐电休克治疗难治性精神分裂症的临床研究

目的 了解无抽搐电休克治疗（MECT）对难治性精神分裂症（TRS）的疗效与不良反应。方法 对78例TRS患者在原服用抗精神病药物基础上合并MECT治疗,分别于合并治疗前后采用阳性与阴性症状量表（PANSS）、副反应量表（TESS）、韦氏记忆量表（WMS）评定疗效及不良反应。结果 合并MECT后省PANSS评分明显降低（P〈0.01）WMS评分在治疗结束后1d明显降低,1周及2周时恢复。结论 MECT对TRS有效,不良反应少。     

A systematic review and meta-analysis of randomized controlled trials of adjunctive ketamine in electroconvulsive therapy: Efficacy and tolerability

BackgroundElectroconvulsive therapy (ECT) remains one of the most effective tools in the psychiatric treatment armamentarium, particularly for refractory depression. Yet, there remains a subset of patients who do not respond to ECT or for whom clinically adequate seizures cannot be elicited, for whom ketamine has emerged as a putative augmentation agent.MethodsWe searched EMBASE, PsycINFO, CENTRAL, and MEDLINE from 1962 to April 2014 to identify randomized controlled trials evaluating ketamine in ECT (PROSPERO #CRD42014009035). Clinical remission, response, and change in depressive symptom scores were extracted by two independent raters. Adverse events were recorded. Drop-outs were assessed as a proxy for acceptability. Meta-analyses employed a random effects model.ResultsData were synthesized from 5 RCTs, representing a total of 182 patients with major depressive episodes (n = 165 Major Depressive Disorder, n = 17 Bipolar Disorder). ECT with ketamine augmentation was not associated with higher rates of clinical remission (Risk Difference (RD) = 0.00; 95%CI = −0.08 to 0.10), response (RD = −0.01; 95%CI = −0.11 to 0.08), or improvements in depressive symptoms (SMD = 0.38; 95%CI = −0.41 to 1.17). Ketamine augmentation was associated with higher rates of confusion/disorientation/prolonged delirium (OR = 6.59, 95%CI: 1.28–33.82, NNH = 3), but not agitation, hypertension or affective switches.ConclusionOur meta-analysis of randomized controlled trials of ketamine augmentation in the ECT setting suggests a lack of clinical efficacy, and an increased likelihood of confusion. Individuals for whom adequate seizures or therapeutic response cannot be obtained have not been studied using randomized controlled designs. Additional research is required to address the role of ketamine in this population.     

Electroconvulsive therapy is associated with lower readmission rates in patients with schizophrenia

BackgroundElectroconvulsive therapy is an important somatic treatment for severe mental disorders with established efficacy and safety. However, data on the relationship between ECT and the readmission rate of patients with schizophrenia are scarce. This study will explore the association between the administration of ECT and readmission rates using a machine learning method.MethodsInpatient medical records from the year of 2016 in one large psychiatric hospital in Beijing, China, were analyzed using a machine learning algorithm to determine the most important variables affecting readmission of patients with schizophrenia.ResultsThe medical records of 2131 inpatients with schizophrenia were reviewed. 1099 patients were followed up within 3 months of their index admission (642 ECT cases and 457 non-ECT cases) and 1032 patients were followed up within 6 months (596 ECT cases and 436 non-ECT cases) after discharge. The 3- and 6-month readmission rates in the ECT group (11.37% and 17.94%, respectively) were significantly lower than that of the patients who did not receive ECT (18.79% and 29.36%, respectively, both p < 0.001). The risk of readmission was significantly associated with male sex, older age, being married, having a lower income, a shorter inpatient length of stay, and receiving specific antipsychotic medications including olanzapine, paliperidone, clozapine, and haloperidol during the index admission. In the ECT group, patients who received 9 or more treatments were significantly less likely to be readmitted.ConclusionReceiving ECT may be associated with a lower risk of readmission in patients with schizophrenia.     

Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials

The purpose of this study was to examine the efficacy of cognitive behavioral therapy (CBT) for anxiety-related disorders based on randomized placebo-controlled trials. We included 41 studies that randomly assigned patients (N = 2,843) with acute stress disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder (PD), posttraumatic stress disorder (PTSD), or social anxiety disorder (SAD) to CBT or a psychological or pill placebo condition. Findings demonstrated moderate placebo-controlled effects of CBT on target disorder symptoms (Hedges’ g = 0.56), and small to moderate effects on other anxiety symptoms (Hedges’ g = 0.38), depression (Hedges’ g = 0.31), and quality of life (Hedges’ g = 0.30). Response rates in CBT compared to placebo were associated with an odds ratio of 2.97. Effects on the target disorder were significantly stronger for completer samples than intent-to-treat samples, and for individuals compared to group CBT in SAD and PTSD studies. Large effect sizes were found for OCD, GAD, and acute stress disorder, and small to moderate effect sizes were found for PTSD, SAD, and PD. In PTSD studies, dropout rates were greater in CBT (29.0%) compared to placebo (17.2%), but no difference in dropout was found across other disorders. Interventions primarily using exposure strategies had larger effect sizes than those using cognitive or cognitive and behavioral techniques, though this difference did not reach significance. Findings demonstrate that CBT is a moderately efficacious treatment for anxiety disorders when compared to placebo. More effective treatments are especially needed for PTSD, SAD, and PD.     

Electroconvulsive therapy in pregnant patients

Objectives

In this study, the aim was to evaluate the clinical characteristics of patients that received electroconvulsive therapy (ECT) during pregnancy due to psychiatric disorders, evaluate the safety and efficacy of ECT in pregnant women, and evaluate the overall status of mothers and babies during the postpartum period.

Methods

The study included 33 patients who were admitted as inpatients with the indication of ECT due to pregnancy and concurrent psychiatric disorders.

Results

Upon ECT administration, a complete response to treatment was seen in 84.21% of patients with major depression (n= 16), a partial response to treatment in 15.78% of patients (n= 3), a complete response to treatment in 91.66% of patients with bipolar disorder (n= 11), a partial response to treatment in 8.33% of the patients(n= 1), and a full response to treatment in 50% of patients with schizophrenia (n= 1) and a partial response to treatment in 50% of patients with schizophrenia (n= 1) were obtained. We had after birth information of 27 infants from total 33. It was learned that two of them had disease, one was stillbirth and 24 of them did not have any health problems.

Conclusions

ECT administration during pregnancy to treat psychiatric disorders was found to be an effective treatment method. No risk of preterm birth in mothers treated with ECT during pregnancy was detected.     

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke.DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, Wan Fang, Weipu Information Resources System, Chinese Biomedical Literature Database, Pub Med, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy(traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index.RESULTS: A total of 16 prospective randomized controlled trials(379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm(weighted mean difference(WMD) = 10.822; 95% confidence intervals(95% CI): 7.419–14.226), the action research-arm test(WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement(WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index(WMD = 10.706; 95% CI: 4.417–16.966). CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.     

Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials

Objective: The present meta-analysis evaluates the efficacy of group psychotherapy for post-traumatic stress disorder (PTSD) in adults directly compared to no treatment or active treatments examined in randomized controlled trials (RCTs). Method: Electronic databases were searched for eligible studies. Effects on PTSD symptoms, depression, and anxiety were extracted. Between- and within-group effect sizes (Hedges’ g) were calculated using a random-effects model. Data were adjusted to account for dependencies among observations in groups. Results: Twenty RCTs were included comprising 2244 individuals. Results showed significant effects of group psychotherapy in reducing symptoms of PTSD compared to no-treatment control groups (k?=?13; g?=?0.70; 95% CI: 0.41; 0.99). No significant differences in efficacy were found between group psychotherapy and other active treatments (k?=?8; g?=?0.13; 95% CI: ?0.16; 0.42). Moderator analyses confirmed gender and trauma type as important moderators of within-treatment effects for PTSD. Conclusions: Group treatments are associated with improvements in symptoms of PTSD. Particularly, the efficacy of exposure-based cognitive-behavioral group therapy (group CBT) is empirically well demonstrated. Still little is known about the effects of group treatment approaches other than CBT and the comparative efficacy to alternative treatments such as individual therapy or pharmacotherapy.

Clinical or Methodological Significance of this Article: This review provides an empirical base for group therapy as a viable treatment alternative for future PTSD practice guidelines. Although less is known about its comparative efficacy to alternative PTSD treatments such as individual therapy or pharmacotherapy, sufficient evidence exists to recommend group therapy (particularly exposure-based group CBT) for those who might not be able to access alternative treatments. Trauma type and gender proved to be important moderators of group treatment outcome. The results further indicate that the evidence base of recommendations for group therapy in current international treatment guidelines needs to be updated.     

Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials

Yoga has become a popular approach to improve emotional health. The aim of this review was to systematically assess and meta-analyze the effectiveness and safety of yoga for anxiety. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through October 2016 for randomized controlled trials (RCTs) of yoga for individuals with anxiety disorders or elevated levels of anxiety. The primary outcomes were anxiety and remission rates, and secondary outcomes were depression, quality of life, and safety. Risk of bias was assessed using the Cochrane tool. Eight RCTs with 319 participants (mean age: 30.0–38.5 years) were included. Risk of selection bias was unclear for most RCTs. Meta-analyses revealed evidence for small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference [SMD] = −0.43; 95% confidence interval [CI] = −0.74, −0.11; P = .008), and large effects compared to active comparators (SMD = −0.86; 95% CI = −1.56, −0.15; P = .02). Small effects on depression were found compared to no treatment (SMD = −0.35; 95% CI = −0.66, −0.04; P = .03). Effects were robust against potential methodological bias. No effects were found for patients with anxiety disorders diagnosed by Diagnostic and Statistical Manual criteria, only for patients diagnosed by other methods, and for individuals with elevated levels of anxiety without a formal diagnosis. Only three RCTs reported safety-related data but these indicated that yoga was not associated with increased injuries. In conclusion, yoga might be an effective and safe intervention for individuals with elevated levels of anxiety. There was inconclusive evidence for effects of yoga in anxiety disorders. More high-quality studies are needed and are warranted given these preliminary findings and plausible mechanisms of action.     

Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia

Objective This open label study describes the efficacy of electroconvulsive therapy (ECT) as adjunctive treatment in clozapine nonresponders suffering from schizophrenia. Method The results of clozapine and ECT treatment in 11 clozapine nonresponders suffering from schizophrenia are reported in terms of remission and relapse. Results Eight patients had a remission with this combination treatment. After remission of symptoms five patients had a relapse. Three of the five patients who relapsed had a second successful ECT course and remained well with maintenance ECT and clozapine. No evidence for adverse effects was found. Conclusion Adjunctive ECT can be efficacious in clozapine nonresponders suffering from schizophrenia.