Electroconvulsive therapy: clinical experience at the Instituto Mexicano de Psiquiatria 1995-1998.

Electroconvulsive therapy (ECT) is a useful and safe option for certain psy chiatric disorders. This study describes the clinical experience with ECT a long 44 months at the Institute Mexicano de Psiquiatria. The clinical recor ds were retrospectively evaluated in order to obtain specific data about tw o main variables: its efficacy and its side effects in patients treated wit h ECT from February 1995 to October 1998. A total of 114 patients were incl uded in the analysis. The mean age was 34.80 +/- 13.75 years, from which 78 % were females, and 7.5 % were 60 years old or older. The mean number of E CT sessions was 9.21 +/- 2.49 and the mean time of each seizure was 25.84+/ -5.79 seconds. The mean energy level administered in the first session was 3.3 +/- 1.4 (approximately 2.2 Joules), and the mean time of the last one w as 5.3 +/- 1.5 (approximately 46.2 Joules). Indications for ECT were: failu re of the pharmacological and psychotherapeutic treatment (66 %), a high ri sk situation (23 %), a previous good response to ECT (7 %) and intolerant s ide effects with pharmacotherapy (4 %). The diagnostic categories according to the DSM IV criteria, treated with EC T, were: major depressive episode (MDE) (34 %), MDE with psychotic symptoms (16 %), schizophrenia (18 %), manic episode (ME) (12 %), other psychotic d isorders (11 %) and mental disorders (psychotic or affective) due to a gene ral medical condition (10 %). A positive response to ECT, that is, a 50 % reduction in the total score of the respective clinical rating scale during the hospitalization time, was obtained in 72.22 % of the patients. More than 80 % of the subjects with MD E and ME showed a positive response to ECT, and 90 % of MDE patients with p sychotic symptoms showed a specially high response to ECT. However, the mag nitude of the positive response to ECT in psychotic MDE patients was not di fferent from that of not psychotic depressed patients treated with ECT In contrast, 31.25 % of the schizophrenic patients and 66.66 % of those wit h other psychotic disorders showed clinical improvement. During electrical stimulus and immediately after, mild and transitory side effects were observed in 12 % of the sample, specially an increase in heart rate. Side effects were present during hours or days after ECT sessions in 97.67 % of the patients. Cognitive disturbances, such as recent memory def icit, were the ones most often observed. Only 1.86 % of the depressed patie nts switched to hipomanic episode during ECT trail. Systolic blood pressure increased significantly after each ECT session in about 15.55 mm Hg, and d iastolic blood pressure increased in about 10.98 mm Hg. ECT is used in thir d level psychiatric units in Mexico City in a similar way as describes in o ther cities and in the worldwide bibliography.