Rehospitalization rate after continued electroconvulsive therapy--a retrospective chart review of patients with severe depression.
BACKGROUND
Electroconvulsive therapy, ECT, is an effective acute treatment for severe depression. Today ECT is usually discontinued when the patient's depressive symptoms abate, although relapse is common. Some studies suggest that continuation ECT (cECT) may prevent relapse of depression, but there are few studies available.


OBJECTIVE
The aim of this study was to describe the need for inpatient care before, during and after cECT.


METHODS
A retrospective chart review was conducted of all patients (n=27) treated with cECT between 2005 and 2007 at Örebro University Hospital, Sweden. All patients were severely depressed at the initiation of index ECT. The DSM-IV diagnoses were major depression (n=19), bipolar depression (n=5) or schizoaffective depression (n=3).


RESULTS
The hospital day quotient was lower (HDQ=15) during cECT (mean duration ± standard deviation=104 ± 74 days) than during the 3 years prior to cECT (HDQ=26). The rehospitalization rate was 43% within 6 months and 58% within 2 years after the initiation of cECT. Seven patients were rehospitalized while on cECT.


CONCLUSIONS
The need for inpatient care was reduced during cECT. However, rehospitalization was common. At the initiation of the cECT, the patients were improved by the index ECT. Also cECT was often terminated after rehospitalization, which contributed to the lowered hospital day quotient during cECT. Randomized clinical trials are needed to establish the efficacy of cECT.


CONCLUSIONS
Relapses and recurrences in depressed patients are common after ECT treatment. The results indicate that continuation ECT combined with pharmacotherapy might be an alternative treatment strategy.
Nordenskjöld
Axel
A
Department of Psychiatry, Örebro County Council, Örebro, Sweden. axel.nordenskjold@orebroll.se
von Knorring
Lars
L
Engström
Ingemar
I
D000328:Adult; D000368:Aged; D000648:Amnesia, Retrograde / Q000209:etiology; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003211:Concurrent Review; D003266:Continuity of Patient Care; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome
D000928:Antidepressive Agents