Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder

Abstract

Purpose

Acute polymorphic psychotic disorder (APPD) without symptoms of schizophrenia is a serious psychiatric condition. APPD can be effectively treated with electroconvulsive therapy (ECT), but little is known about relapse prevention after ECT for APPD.

Materials and methods

This was a retrospective register-based study conducted with 97 patients with APPD (ICD-10 diagnosis F23.0). We estimated the rates of readmission and suicide, and the prognostic factors of these outcomes after ECT. We combined data from several national Swedish registers and used Cox’s regression analysis to identify demographic factors, disease characteristics, and relapse preventive treatments that predicted time to readmission or suicide (relapse). Data registered between 2011 and 2016 were used in the study.

Results

Twenty percent of cases relapsed within a year. Thereafter, relapse rate was low. Two cases died during follow-up, whereof one by suicide. Anxiolytic treatment, lamotrigine treatment, and having more than four previous psychiatric hospital admissions were associated with shorter time to relapse. The most robust of these associations was between anxiolytics and relapse risk.

Conclusions

The first year after discharge from APPD is the period associated with the highest risk of relapse. Having many previous admissions was associated to relapse risk after ECT for APPD. The associations between anxiolytics, lamotrigine, and relapse are uncertain and might be influenced by indication bias.

Keywords:

• Acute polymorphic psychotic disorder
• relapse prevention
• electroconvulsive therapy

Acknowledgments

The authors thank all staff at the Centre for Clinical Research Sörmland, Eskilstuna, for their tutoring in statistics and SPSS.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on contributors

Styrbjörn Kalling, MD at the Psychiatric clinic of Eskilstuna.

Ole Brus, MSc at Örebro University.

Johan Lundberg, PhD and senior physician at the Section of mood disorders at the Northern Stockholm Psychiatry Clinic.

Pia Nordanskog, PhD and assistant professor at the University of Linköping.

Mikael Landén, PhD and senior physician at the Region of Västra Götaland.

Axel Nordenskjöld is an PhD and senior physician at the Psychiatric Clinic of Örebro.

Ole, Johan, Pia, Mikael and Axel are involved in the work with the Swedish National Quality Register for ECT and have published previous work on affective disorders.

Additional information

Funding

This work was supported by the Centre for Clinical Research Sörmland [grant no. 75602].