Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.
OBJECTIVE
Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days.


METHODS
A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT.


RESULTS
Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01).


CONCLUSIONS
Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.
From the *Abarbanel Mental Health Center, Bat-Yam; †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; and ‡Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
Assaf
A
Shelef
Doron
D
Mazeh
Uri
U
Berger
Yehuda
Y
Baruch
Yoram
Y
Barak
D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D003865:Major Depressive Disorder / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000628:therapy; D012959:Socioeconomic Factors; D016896:Treatment Outcome