ECT in Patients With Comorbid Personality Disorder: New Systematic review and Meta-Analysis
Out on PubMed, from authors in Switzerland and New York, is this review:
Outcomes of electroconvulsive therapy in patients with depressive symptoms with versus without comorbid personality disorders/traits: A systematic review and meta-analysis.
Acta Psychiatr Scand. 2023 Oct 29. doi: 10.1111/acps.13631. Online ahead of print.PMID: 37899505 Review.
Aims: To assess electroconvulsive therapy (ECT) outcomes in patients affected by depressive symptoms with versus without additional comorbid personality disorders/traits.
Methods: We identified observational studies investigating ECT clinical outcomes in patients affected by depressive symptoms with versus without comorbid personality disorders/traits in Embase/Medline in 11/2022. Our protocol was registered with PROSPERO (CRD42023390833). Study quality was evaluated using the Newcastle-Ottawa-Scale. Our primary outcomes were ECT response and remission rates. Meta-regression analyses included effects of in/outpatient percentages, age, number of ECT sessions, and electrode placement; subgroup analyses included the assessment methods for personality disorders/traits. We performed sensitivity analyses after excluding poor-quality studies.
Results: A total of 20 studies (n = 11,390) were included in our analysis. Patients with comorbid personality disorders/traits had lower remission rates (OR = 0.42, 95% CI = 0.31, 0.58, p < 0.001) with substantial heterogeneity (I2 = 93.0%) as well as lower response rates (OR = 0.35, 95% CI = 0.24, 0.51, n = 5129, p < 0.001) with substantial heterogeneity (I2 = 93.0%) compared with patients without comorbid personality disorders/traits. Relapse rates were higher in patients with versus without comorbid personality disorders/traits (OR = 3.23, 95% CI = 1.40, 7.45, k = 4, n = 239, p = 0.006) with moderate heterogeneity (I2 = 75.0%) and post-ECT memory impairment was more frequent in patients with versus without comorbid personality disorders/traits (OR = 1.41, 95% CI = 1.36, 1.46, k = 4, n = 471, p < 0.001) with minimal heterogeneity (I2 = 0.0%). Dropout rates were higher in patients with versus without comorbid personality disorders/traits (OR = 1.58, 95% CI = 1.13, 2.21, k = 3, n = 6145, p = 0.008).
Conclusions: Patients with comorbid personality disorders/traits treated with ECT are reported to have lower response and remission rates and higher rates of side effects and relapse rates compared with patients without personality disorders/traits.
Keywords: ECT; electroconvulsive therapy; major depressive disorders; mood disorders; personality disorders; personality traits.
The review is here.
And from the text:
And from the text:
This is a nicely presented review with a thoughtful discussion. The results are well known and unsurprising, but nonetheless helpful to be documented in the literature. Once again, patient selection for ECT and the related issue of setting realistic outcome expectations are key to optimal ECT practice.
The below comment is from Dr. William V. McCall:
ReplyDeleteYou may have already seen our recent commentary on this topic (below) where we address the practical. logistical implications of lower response rate in people with borderline personality. Namely, that ECT docs should consider being explicit about the lower response rate when consenting persons with this disorder. Setting proper expectations before treatment might offset later complaints about how the treatment did not deliver what the patients' expected. or at a minimum, adding this to the consent process could protect the doctor from frivolous lawsuits
McCall WV, House A, Rosenquist PB. Reflections: Psychological Risks With Borderline Personality Disorder in Electroconvulsive Therapy. J ECT. 2023 Jul 20. doi: 10.1097/YCT.0000000000000948. Epub ahead of print. PMID: 37530756.