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Elektrokonvulsionstherapie an der Klinik für Psychiatrie und Psychotherapie der Universität München

Entwicklung in den Jahren 1995–2002

Electroconvulsive therapy at the Department of Psychiatry and Psychotherapy, University of Munich

Development during the years 1995–2002

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Zusammenfassung

Hintergrund

Die Elektrokonvulsionstherapie (EKT) stellt noch immer die bislang effektivste somatische Therapie depressiver und schizophrener Erkrankungen dar. Dies betrifft vor allem die derzeitige Hauptindikation pharmakotherapieresistenter Störungsbilder.

Patienten und Methoden

In einer retrospektiven Untersuchung wurden 4803 Behandlungssitzungen bei 445 Patienten ausgewertet. Zielparameter waren Wirksamkeit und Verträglichkeit der Behandlung sowie neurophysiologische Wirksamkeitsparameter in Abhängigkeit von allgemeinen Behandlungsmodalitäten.

Ergebnisse

Die Entwicklung der letzten 7 Jahre zeigt, dass sich der Bedarf an EKT-Behandlungsplätzen deutlich erhöht hat. Die Zahl der Behandlungen hat sich im Beobachtungszeitraum mehr als verdoppelt, obwohl der Bedarf auch hierdurch nicht vollständig abgedeckt werden konnte. Wie nach neueren wissenschaftlichen Erkenntnissen zur Verbesserung der Behandlungseffizienz erforderlich, wurden vor allem bei der unilateralen EKT zunehmend höhere Stimulationsenergien eingesetzt. Trotzdem konnte eine rückläufige Rate an unerwünschten kognitiven Wirkungen beobachtet werden. Gemessen an der besseren Verträglichkeit der Behandlung und an prospektiven neurophysiologischen Wirksamkeitsindizes hat sich die Behandlungsqualität in den letzten Jahren erheblich verbessert. Allerdings ist die Behandlungseffizienz auf gleichbleibend hohem Niveau stabil geblieben. Dies ist möglicherweise auf eine stärkere Selektion von Patienten mit einer ausgeprägten Pharmakotherapieresistenz zurückzuführen.

Schlussfolgerung

Die EKT stellt somit nach wie vor eine wichtige Option in der Behandlung pharmakotherapieresistenter depressiver und schizophrener Störungsbilder dar und hat trotz aller Fortschritte in der Psychopharmakotherapie nicht an Bedeutung verloren.

Summary

Background

So far, electroconvulsive therapy (ECT) has been proven to be a reliable and the most effective somatic treatment of depression or schizophrenia. This holds especially true for disturbances, which are refractory to pharmacological treatments.

Patients and methods

We evaluated 4803 treatments in 445 patients. Main outcome criteria were efficacy and tolerability of treatment. Moreover, prospectively recorded neurophysiological parameters that might influence treatment outcome and treatment modalities and were assessed in a retrospective study design.

Results

During the last 7 years developmental changes show an increasing call for ECT treatment. Despite not being able to satisfy all demands the number of treatments more than doubled during the time period investigated. According to the latest scientific knowledge, especially in unipolar ECT, higher stimulation energy has been used to provide better treatment efficacy. Nevertheless, this was accompanied by a lower incidence of cognitive side effects. Due to the better tolerability of the treatment and the prospective neurophysiological indices, it appears that treatment quality has improved in recent years. Overall treatment efficacy was not improved, but could be maintained on a stable high level. This is presumably due to a stronger negative selection of patients with more pharmacotherapy-refractory disturbances.

Conclusion

ECT still represents an important option in the treatment of therapy-resistant depression and schizophrenia despite recent progress in neuropsychopharmacology.

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Danksagung

Bei den Doktorandinnen Melanie Brosch, Ines Noack, Katrin Pietschmann und Yvonne Steng möchten wir uns für die Erfassung der vorgestellten Daten, bei den Kollegen der Arbeitsgruppe Tobias Deiml, Robin Ella, Daniela Eser, Cornelius Schüle und Peter Zwanzger für die Durchführung der EKT-Behandlungen und bei Monika Ertl, Beate Licher und Klaus Neuner für die Planung und Organisation der Behandlungsabläufe bedanken.

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  1. Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München

    T. C. Baghai, A. Marcuse, H.-J. Möller & R. Rupprecht

  2. Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Nußbaumstraße 7, 80336, München, Deutschland

    T. C. Baghai

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  1. T. C. Baghai
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Baghai, T.C., Marcuse, A., Möller, HJ. et al. Elektrokonvulsionstherapie an der Klinik für Psychiatrie und Psychotherapie der Universität München. Nervenarzt 76, 597–612 (2005). https://doi.org/10.1007/s00115-004-1813-5

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