Symptomatic predictors of ECT response in medication-nonresponsive manic patients.
BACKGROUND
Relations between pretreatment symptom ratings and ECT outcome were examined in acute manic patients admitted at a state psychiatric center who were nonresponsive to medication.


METHODS
One or 2 days after undergoing pretreatment clinical ratings, patients were randomly assigned to intensive pharmacotherapy, right unilateral ECT, left unilateral ECT, or bilateral ECT. Patients who failed to respond to any of the first three treatment conditions were assigned to crossover bilateral ECT. Patients who failed to respond to a primary treatment condition other than bilateral ECT but refused crossover bilateral ECT and those in whom ECT was terminated due to an organic brain syndrome were not considered for this study. No psychotropic drugs were prescribed for 4-7 days before, or during, the course of ECT. Of the 24 patients who entered the study, 18 patients completed the protocol. Based on independent clinical assessments by two research psychiatrists, a favorable treatment response was defined as a complete recovery from manic episode that was sustained for 1 week during which no psychotropic medications were prescribed.


RESULTS
ECT nonresponders were significantly more angry, irritable, and suspicious than ECT responders. Severity of mania and depression ratings at baseline were not related to ECT response.


CONCLUSIONS
Symptoms associated with poor response to ECT may overlap with those that have been reported to predict nonresponse to treatment with lithium. Our evidence also may support the view that differential symptom patterns may predict treatment outcomes to ECT and carbamazepine, respectively, in manic patients who do not respond to treatment with lithium or neuroleptics.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, N.Y.
D B
DB
Schnur
S
S
Mukherjee
H A
HA
Sackeim
C
C
Lee
S D
SD
Roth
D000328:Adult; D000818:Animals; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D007839:Functional Laterality; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D051381:Rats; D012720:Severity of Illness Index
D014150:Antipsychotic Agents; D008094:Lithium