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Eletroconvulsivoterapia de continuação e manutenção em doentes com esquizofrenia : um estudo retrospetivo
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Introdução: A eletroconvulsivoterapia (ECT) consiste numa estimulação elétrica transcraniana usada para induzir uma crise convulsiva com efeitos terapêuticos, indicada no tratamento de esquizofrenia e outros transtornos psiquiátricos. Existe um crescente corpo de evidência que demonstra que a ECT associada a farmacoterapia é mais eficaz do que ambas as abordagens isoladas no tratamento agudo da esquizofrenia. No entanto, manter a remissão após ECT de indução permanece um desafio. A ECT de continuação ou manutenção (C/M-ECT) torna-se, por isso, de especial importância, mas é ainda alvo de estigmatização. É necessária mais evidência que reconfirme os benefícios e segurança da C/M-ECT e que fundamente orientações clínicas consistentes. Este estudo procurou, assim, avaliar a efetividade da associação de C/M-ECT com farmacoterapia, em comparação com psicofármacos em monoterapia, na prevenção de recidiva e recorrência em indivíduos com esquizofrenia.
Materiais e Métodos: O presente trabalho consistiu num estudo observacional retrospetivo. A população compreendeu 28 doentes com o diagnóstico de esquizofrenia submetidos a ECT de indução na ULS Santa Maria. Para cada doente, recolheram-se dados demográficos e clínicos através do respetivo processo hospitalar, posteriormente analisados no IBM® SPSS®. A admissão ao serviço de urgência foi o outcome primário utilizado como indicador de recidiva ou recorrência.
Resultados e Conclusões: Da população em estudo, apenas 6 (21,4%) doentes foram submetidos a C/M-ECT. Durante o período de observação, 10 (35,7%) doentes, foram admitidos no Serviço de Urgência, dos quais 80,0% estava sob farmacoterapia isolada e 20,0% com C/M-ECT. Do grupo tratado com psicofármacos isoladamente, 63,6% não foi ao SU, face a 66,7% no grupo com C/M-ECT. Não se observaram, no entanto, diferenças estatisticamente significativas. Propõem-se que estes resultados tenham sido principalmente condicionados por limitações do estudo. A análise realizada foi ainda assim relevante para reavaliar a prática da ECT em Portugal e neste hospital. É fundamental que sejam desenhados mais estudos para um maior corpo de evidência.
Introduction: Electroconvulsive therapy (ECT) consists of a transcranial electrical stimulation used to induce a convulsive seizure with therapeutic effects, for the treatment of schizophrenia and other psychiatric disorders. There is a growing body of evidence demonstrating that ECT combined with pharmacotherapy is more effective than either approach alone in the acute treatment of schizophrenia. However, sustaining remission after induction ECT remains a challenge. Continuation or maintenance ECT (C/M-ECT) is, therefore, of particular importance, but still faces stigmatization. More evidence is needed to confirm the benefits and safety of C/M-ECT and to establish consistent clinical guidelines. This study aimed to evaluate the effectiveness of combining C/M-ECT with pharmacotherapy compared to psychotropic drugs alone in preventing relapse and recurrence in schizophrenia. Materials and Methods: This work was an observational retrospective study. The population included 28 patients with the diagnosis of schizophrenia who underwent induction ECT at ULS Santa Maria. Demographic and clinical data were collected from medical records and analyzed using IBM® SPSS®. Admission to the emergency department was the primary outcome used as an indicator of relapse or recurrence. Results and Conclusions: Within the studied population, only 6 (21,4%) patients received C/M-ECT in addition to the pharmacological treatment. During the follow-up, 10 (35,7%) patients were admitted to the emergency department, of which 80,0% were on pharmacological treatment alone and 20,0% were on C/M-ECT. Among patients treated with psychotropic drugs alone, 63,6% did not visit the emergency department, compared to 66,7% in the C/M-ECT group. However, no statistically significant differences were observed. We suggest that these results were primarily influenced by study limitations. Nevertheless, the analysis was relevant for reassessing the practice of ECT in Portugal and at this hospital. Further studies are essential to build a more substantial body of evidence.
Introduction: Electroconvulsive therapy (ECT) consists of a transcranial electrical stimulation used to induce a convulsive seizure with therapeutic effects, for the treatment of schizophrenia and other psychiatric disorders. There is a growing body of evidence demonstrating that ECT combined with pharmacotherapy is more effective than either approach alone in the acute treatment of schizophrenia. However, sustaining remission after induction ECT remains a challenge. Continuation or maintenance ECT (C/M-ECT) is, therefore, of particular importance, but still faces stigmatization. More evidence is needed to confirm the benefits and safety of C/M-ECT and to establish consistent clinical guidelines. This study aimed to evaluate the effectiveness of combining C/M-ECT with pharmacotherapy compared to psychotropic drugs alone in preventing relapse and recurrence in schizophrenia. Materials and Methods: This work was an observational retrospective study. The population included 28 patients with the diagnosis of schizophrenia who underwent induction ECT at ULS Santa Maria. Demographic and clinical data were collected from medical records and analyzed using IBM® SPSS®. Admission to the emergency department was the primary outcome used as an indicator of relapse or recurrence. Results and Conclusions: Within the studied population, only 6 (21,4%) patients received C/M-ECT in addition to the pharmacological treatment. During the follow-up, 10 (35,7%) patients were admitted to the emergency department, of which 80,0% were on pharmacological treatment alone and 20,0% were on C/M-ECT. Among patients treated with psychotropic drugs alone, 63,6% did not visit the emergency department, compared to 66,7% in the C/M-ECT group. However, no statistically significant differences were observed. We suggest that these results were primarily influenced by study limitations. Nevertheless, the analysis was relevant for reassessing the practice of ECT in Portugal and at this hospital. Further studies are essential to build a more substantial body of evidence.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Esquizofrenia Eletroconvulsivoterapia Recidiva Recorrência Psiquiatria