Manic patients receiving ECT in a Brazilian sample

Background: Characterization of manic inpatients receiving electroconvulsive therapy (ECT) has not been done. Methods: The charts of 425 consecutive admissions of 269 inpatients treated for manic or mixed episodes, between 1996 and 2000, in a Brazilian private psychiatric hospital were reviewed. A logistic model was built to determine the predictors of use of ECT for mania. Median total length of stay (LOS) and LOS deducted from the delay until ECT was started were compared between ECT and non-ECT admissions. The risk of readmission was estimated using Cox’s regression. Results: Significant predictors of ECT prescription were: history of previous admission (OR=4.09), psychotic features (OR=1.60), female gender (OR=2.04), married (OR=1.79), and treatment by a psychiatrist who assisted more than 20 manic inpatients in the index period (OR=1.97). Co-morbidity with cardiovascular disease was negatively associated with ECT use (OR=0.49). Median LOS after starting ECT was similar to that of non-ECT admissions (12 vs. 13 days). ECT reduced (HR=0.678) and previous psychiatric admissions increased (HR=2.320) the risk of readmission after a manic episode. Limitations: Only one hospital was included in this study. Conclusions: The presence of psychotic features and violent behavior during manic episodes and indicators of chronicity of bipolar illness (history of previous admissions, duration of disease) were predictors of ECT use for the treatment of mania. Suicidality was not associated with the use of ECT for mania. LOS after ECT was started was similar to LOS of non-ECT admissions. The use of ECT for mania reduced the risk of readmission.