Abstract
Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state.
Highlights
Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology
Our study aims to report our experience in using acute phase Electroconvulsive Therapy (ECT) for the purpose of relieving acute symptoms in patients with mixed affective states that previously failed to respond to pharmacotherapy, adding scientific evidence to this underexplored field of knowledge
This paper is intended as a reflection about the practice of our department in the treatment of patients with bipolar disorder, especially in what concerns their referral to the ECT unit
Summary
Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Our results support the effectiveness of ECT in patients experiencing a mixed affective state. Mixed states are known to be associated with worse prognosis than depressive or manic forms of bipolar disorder [3]. Comorbidities such as substance abuse, traumatic brain injury, and other neuropsychiatric and brain development impairments seem to facilitate the emergence of mixed states [4]. Some other unofficial classifications were created that comprised broader criteria to diagnose mixed state entities [12,13,14] They generally require a minimum of two or three symptoms of opposed polarity within a major affective episode. Clinical validity and utility of entities such as dysphoric mania or hypomania, depression with flight of ideas, or excited depression have been substantially confirmed on empirical grounds [12, 14]
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