Clinical Characteristics of Inpatients with Schizophrenia Spectrum Disorder Treated with Electroconvulsive Therapy: A Population-Level Cross-Sectional Study: Titre: Caractéristiques cliniques des patients hospitalisés présentant un trouble du spectre de la schizophrénie et traités par électrochocs : Une étude de population transversale.

Autor:	Kaster TS; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Babujee A; ICES, Toronto, ON, Canada., Sharpe I; ICES, Toronto, ON, Canada., Rhee TG; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA., Gomes T; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada., Kurdyak P; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Foussias G; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Wijeysundera D; Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada., Blumberger DM; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Vigod SN; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.; Women's College Hospital, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	Canadian journal of psychiatry. Revue canadienne de psychiatrie [Can J Psychiatry] 2024 Nov 11, pp. 7067437241290181. Date of Electronic Publication: 2024 Nov 11.
DOI:	10.1177/07067437241290181
Abstrakt:	Objective: Electroconvulsive therapy (ECT) is an evidence-based treatment for schizophrenia when anti-psychotic medications do not sufficiently control symptoms of psychosis or rapid response is required. Little is known about how it is used in routine clinical practice. The aim of this study was to identify the association of demographic and clinical characteristics with administration of ECT for schizophrenia spectrum disorders (SSD). Methods: Among psychiatric inpatients with a diagnosis of SSD in Ontario, Canada (2006-2023), patient-level socio-demographic and clinical characteristics were described in those who did and did not receive ECT. We used multi-variable logistic regression to assess the association between patient-level characteristics and administration of ECT during index hospitalization. Results: From 164,632 admissions, 2,168 (1.3%) involved exposure to ≥1 inpatient ECT procedure. Compared to those not receiving ECT, those receiving ECT were older, had higher rates of pre-admission medication use, medical and psychiatric comorbidities, outpatient mental health service use, but lower rates of substance use disorders. In the multi-variable logistic regression model, patient-level characteristics most strongly associated with receiving inpatient ECT were the presence of catatonia (odds ratio [OR]: 5.83; 95% confidence interval [95% CI]: 4.01-8.46), comorbid depression (OR: 2.49; 95% CI: 2.07-2.98), obsessive-compulsive disorder (OR: 2.16; 95% CI: 1.55-3.00), while characteristics most strongly associated with not receiving inpatient ECT were myocardial infarction (OR: 0.44; 95% CI: 0.20-0.95) and family conflict towards patient (OR: 0.47; 95% CI: 0.31-0.71). Neither severity of psychotic symptoms, non-command auditory hallucinations nor delusions were associated with administration of ECT. Conclusions: While characteristics associated with the use of ECT are generally consistent with the indications for ECT (e.g., catatonia, mood disorders), ECT is rarely used amongst individuals with SSD. Severity of psychotic symptoms was not associated with the use of inpatient ECT suggesting an opportunity to increase the use of ECT in this population. Competing Interests: Declaration of Conflicting InterestsTSK receives research support from the Canadian Institutes of Health Research (CIHR), the Patient-Centered Outcomes Research Institute (PCORI) and the AFP Innovation Fund. GR was supported in part by the National Institute on Aging (NIA) (#R21AG070666; R21AG078972), the National Institute of Mental Health (#R21MH117438), the National Institute on Drug Abuse (#R21DA057540), and the Institute for Collaboration on Health, Intervention, and Policy (InCHIP) of the University of Connecticut. TGR serves as a review committee member for Patient-Centered Outcomes Research Institute (PCORI) and Substance Abuse and Mental Health Services Administration (SAMHSA) and has received honoraria payments from PCORI and SAMHSA. TGR has also served as a stakeholder/consultant for PCORI and received consulting fees from PCORI. TGR serves as an advisory committee member for International Alliance of Mental Health Research Funders (IAMHRF). TG was supported by a Canada Research Chair in Drug Policy Research and Evaluation and has received grant support for a research programme outside of the present manuscript from the Ontario Ministry of Health. GF has been involved in research sponsored by Medicure Inc., and Neurocrine Bioscience, has received consultant fees from Roche and has received speaker fees from Roche, Lundbeck and Novartis. DMB receives research support from CIHR, NIMH (R01MH112815; R21MH128815 and R01MH1192850), Brain Canada and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. He was the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also received in-kind equipment support from Magventure for two investigator-initiated studies. He received medication supplies for an investigator-initiated trial from Indivior. He is a scientific advisor for Sooma Medical. He is the Co-Chair of the Clinical Standards Committee of the Clinical TMS Society (unpaid). SNV receives royalties from Up To Date for authorship of materials on depression and pregnancy. AB, IS, PK, and DW declare that they have no conflicts of interest.
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