Die Wirkung der EKT bei pharmakoresistenten affektiven und schizophreniformen Störungen

Abstract

In this work is displayed the retrospective analysis of 50 courses of ECT consisting of 427 ECT units, carried out in a period of one year in the Department of Psychiatry and Psychotherapy of Universitätsmedizin Göttingen. The courses of ECT were analysed using medical reports for clinical and electrophysiological parameters. The progression of the diseases is considered as drug-resistant. The procedure of the ECT happened under specific stimulation patterns using average impedance. The minimum duration of the convulsions described in the literature was achieved in average. By this can be said, appropriate stimulation conditions were fulfilled. The viewed patients were classified in three groups. The first group considers the entire patient group. The patients in the second group suffering from schizophrenia (n = 8 courses of ECT, n = 66 ECT units) and in the third group the ones with affective disorders (n = 42 courses of ECT, n = 361 ECT units) are subsumed. On overall average the patients received 9 ECT units per course of ECT within a treatment period of 25 days. The results of this study are showing that the ECT is an effective form of therapy in the treatment of affective disorders and schizophrenia. Within the group analysis can be found, in the affective as well as in the schizophrenic patterns of the disorders, an improvement in the comparison between the pre and post data collection in the relevant scales (MMSE, HAMD-21, GAF, CDSS, PANSS) took place. On a statistical basis the improvement is significant in most of the scales. When considering the overall situation (condition?) in the GAF scale 35 out of 50 patients increased by 20% and 17 out of 50 increased by 50%. On average the cognition of the whole group of patients is, considered the MMSE-scale post ECT, within standard range. The improvement of the depression is best displayed using the analysis of the HAMD-21: 17 out of 42 patients were responders and 8 of 42 achieved remission. The antipsychotic effects of ECT are visible in the improvement for ≥ 20% in the score of the PANSS for seven out of eight patients. In the differentiated consideration of the ECT records and electrophysiological parameters is clear that the mainly as poor in side effects specified LART stimulation was carried out. This is consistent to the current literature (n = 319 out of 427 ECT units). The stimulation intensity increased significantly in all three groups from the beginning to the end of all respective ECT units of the ECT course. In respect of the duration of the motoric convulsion, it happened a significant reduction in all of the three groups. On the other hand it was not significant in the electroencephalographic convulsion activity. Overall these results make the anticonvulsive effect of the ECT clear. Noticeable is that the anaesthetic Methohexital and the muscle relaxant Succinylcholin was administered in increased dosage per kg body weight than in literature indicated. Further gathered electrophysiological parameters are in standard range, if it is already defined, but showed an inconsistent overall picture. The extensive research of specific literature confirms the interpretation of the electrophysiological parameters is being discussed controversially. There is a considerable need for research in this subject. This should lead to the development of conventions of key quality parameters. Also remarkable is: the ECT treatment took place for the group with schizophrenia the first time after more than 17 years of documented duration of their diseases. In the group with affective disorders the first course of ECT took place after more than 9 years of duration of their diseases. The reason for this is quite likely the common practice to execute the ECT as "therapy of last choice". This could mean that a disproportionately high amount of patients are suffering from particularly severe courses of the disease. The pre ECT scales confirm this thesis. Despite the good effectiveness in both examined clinical pictures, in daily clinical practice the big majority is carried out at patients with affective disorders. The reason could be regional peculiarities or a late indication in treatment algorithm. There is a need for action, paying special attention to de-stigmatize the ECT, the scientific analysis of the mode of action and continuative crossover diagnosis in research the ECT. The results of this work show clearly, the ECT is an effective therapeutic procedure and should applied earlier in the progression of affective disorders and schizophrenia diseases. Ideally should this considered in established ECT guidelines.