Ispitivanje efekta elektrokonvulzivne terapije na kognitivne i mnestičke funkcije kod osoba sa depresijom

Abstract

Cilj ove studije bio je da se utvrdi anterogradni efekat elektrokonvulzivne terapije (EKT) na kognitivne i mnestičke funkcije upotrebom odabranih testova iz Cambridge Neuropsychological Test Automated Battery (CANTAB), kod osoba sa depresijom (major depresivni poremećaj – MDP). Ispitanici su hospitalno lečeni u Klinici za psihijatriju Vojnomedicinske akademije. EKT je bio indikovan jer su prethodno ovi ispitanici imali nezadovoljavajući terapijski odgovor na najmanje dva različita antidepresiva (ispunjavaju kriterijume terapijske rezistencije). Ukupno 30 osoba sa dijagnozom MDP, tretirano je EKT uporedo sa njihovom prethodnom medikamentoznom terapijom. Procene afektivnog statusa vršene su instrumentima kliničke procene: Hamiltonova skala za procenu depresivnosti (HAMD), Skala depresivnosti, anksioznosti i stresa (DASS-42) i Skala opšteg kliničkog utiska (CGI), dok je za opšte ispitivanje kognitivnog statusa korišćena Mala skala procene mentalnog stanja (MMSE). Za precizniju procenu pojedinih aspekata kognitivnog statusa - memorije i egzekutivnih funkcija, rađeni su neuropsihološki testovi: Odloženo sparivanje prema uzorku - Delayed matching to sample (DMS), Učenje parova - Paired associates learning (PAL), Prostorna rekognicija - Spatial recognition memory (SRM), Figuralna rekognicija - Pattern recognition memory (PRM) i Test planiranja i radne memorije - One Touch Stockings of Cambridge (SOC). Isptivanja su rađena prospektivno, u tri etape: pre početka primene EKT (T0), neposredno po završetku serije EKT (T1) i mesec dana nakon EKT (T2). Rezultati su diskutovani u svetlu različitih podataka u vezi efikasnosti EKT u lečenju major depresije, kao i u vezi efekta EKT na kognivne i mnestičke funkcije. Rezultati istraživanja su sadržani u sledećim zaključcima: 1. Elektorkonvulzivna terapija je efikasan tretman za lečenje major depresivnog poremećaja. 2. Tokom lečenja elektrokonvulzivnom terapijom nisu zabležena pogoršanja u kognitivnim i mnestičkim funkcijama. 3. Deficit kognitivnih funkcija koji je povezan sa samom bolešću tj. akutnom fazom depresije, poboljšava se tokom oporavka od depresije i lečenja EKT i to u domenu vizuelne memorije i učenja (PAL) i brzini započinjanja rešavanja problema (jedne od egzekutivnih funkcija). Ovo je prva studija u Srbiji kojom su trenutno najpouzdanijim metodama testiranja kognicije praćeni efekti EKT na memoriju i egzekutivne funkcije. Potvrđen je nalaz iz svetske literature i prakse u vezi sa efikasnošću EKT u lečenju MDP. Pored toga pokazano je da se deficit kognitivnih funkcija koji je povezan sa akutnom fazom depresije, poboljšava tokom oporavka od depresije i lečenja EKT i to u domenu vizuelne memorije i učenja (PAL) i brzine započinjanja rešavanja problema (jedne od egzekutivnih funkcija). Aktuelni nalazi daju važne informacije za kliničku praksu tj. za efikasnije i sigurnije lečenja depresivnog poremećaja za sada nedovoljno korišćenom metodom lečenja – elektrokonvulzivnom terapijom.

The aim of this study was to evaluate the anterograde effect of bitemporal electroconvulsive therapy (ECT) on cognitive and mnestic functions using tests selected from the Cambridge Neuropsychological Test Automated Battery (CANTAB), in persons with major depressive disorder - MDD. The patients were hospitalized at the Department of Psychiatry, Military Medical Academy, after unsatisfactory responses to at least two different antidepressants (they fulfilled the criteria for treatment resistance), thus the indication for ECT was met. Thirty patients diagnosed with treatment resistant major depression, were treated with ECT, in paralel with psychopharmacotherapy based on the doctors’ choice. Clinical evaluation was done using the following rating scales: Hamilton Depression Rating Scale (HAMD), Depression Anxiety Stress Scale (DASS-42), Clinical global impression scale (CGI), and Mini-Mental State Examination (MMSE) for general examination of the cognitive status. To assess specific aspects of the cognitive status i.e. memory and executive functions, following neuropsychological tests were used: Delayed matching to sample (DMS), Paired associate learning (PAL), Spatial recognition memory (SRM), Pattern recognition memory (PRM), One Touch Stockings of Cambridge (SOC). The assesment was performed before ECT (T0), immediately after a course of ECT (T1) and a month after ECT (T2). The results are discussed in the light of various data on the efficacy of ECT in treatment major depression, and about the effect ЕCT on the cognitive and mnestic functions. The research results are contained in the following conclusions: 1. ECT showed strong antidepressant effect in patients with MDD 2. During the treatment, electroconvulsive therapy was not observed deterioration in the performance on any cognitive test 3. It has been shown that cognitive deficits associated with the acute phase of depression, improve during the recovery from depression treated with ECT, particularly in a field of visual memory and learning (PAL) and initial thinking time during the problem solving task (one of the executive functions) This is the first study in Serbia, which utilized the most reliable method of testing cognitive functions, to assess effects of ECT on memory and executive functions related to ECT treatment. Literature about efficacy of ECT in the treatment of MDD, was confirmed for the first time in Serbia. In addition, it has been shown that cognitive deficits associated with the disease, i.e. the acute phase of depression, improve during the recovery from depression treated with ECT, particularly in a field of visual memory and learning (PAL) and initial thinking time during the problem solving task (one of the executive functions). The current findings provide an important information for the clinical practice, ie. for the more effective and safer treatment approaches of depressive disorder utilizing currently underused method of treatment - electroconvulsive therapy.