Quality of Life after ECT in Bipolar Manic Patient

Abstract

Bipolar disorder is a mental disorder with periods of depression and periods of elevated mood. The elevated mood is significant and is known as mania or hypomania, depending on its severity, or whether symptoms of psychosis are present or not. During mania an individual behaves or feels abnormally energetic, happy or irritable. Individuals often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced during manic phases. During periods of depression there may be crying, a negative outlook on life, and poor eye contact with others. Functioning varies over time along a spectrum from good to fair to poor. During periods of major depression or mania (in BPI), functioning was on average poor, with depression being more persistently associated with disability than mania. Functioning between episodes was on average good – more or less normal. Sub threshold symptoms were generally still substantially impairing, however, except for hypomania (below or above threshold) which was associated with improved functioning. ECT is a treatment that has generated considerable controversy since its introduction in 1938. It predates the era of modern psychopharmacology by more than a decade, and initially gained acceptance because of its perceived benefits in the context of few alternatives and lack of emphasis on clinical trials. ECT combined with pharmacotherapy, may be a viable option for a selected group of patients with bipolar patient. In particular, the use of ECT is recommended for aggression or suicidal behavior, and when rapid global improvement and reduction of acute symptomatology are required. This study tested the hypothesis that ECT could improve QOL in patients with Bipolar affective disorder. Hence the aim of this study was to compare quality of life using PCASEE quality of life scale in manic patients received medications and ECT versus those who received medications only after 2 and 4 weeks. Second aim was to assess the effect of ECT on short term outcome in the same groups. Recruitment of 25 patients diagnosed as bipolar affective disorder manic episode from inpatient department of Institute of Psychiatry - Ain Shams University. Patient's age between 18-50 years. All patients received antipsychotic drugs (either Risperidone or Olanzapine) in addition to mood stabilizer (NA valproate). This group received 6 session of ECT. Another 25 group of age, sex and clinically matched the first group included as comparative group that received only pharmacotherapy (same medications) All patients in both groups were assessed at day 0 After 2week and then after 4week later using PCASSE, GAF, YMRS, CGI-S, CGI-I. The results obtained revealed, no statistically significant differences regarding (PCASEE, GAF.YMRS, CGI) between patients who received ECT versus those who didn’t at the onset of the study, but after 2 weeks there were highly statistically significant differences between CTG and PTG group regarding YMRS2 PCASEE2 GAF2 CGI-S2andCGI-I2. According to remission criteria 13(52%) enter into remission in CTG while 0(0%) in PTG. Further follow up, patient were assessed after 4 weeks and there were highly statistically significant difference