Electroconvulsive therapy in single manic episodes: a case series

Objective: To evaluate the effectiveness of electroconvulsive therapy in the treatment of Bipolar I Disorder patients with a single manic episode. Method: In a retrospective study we reviewed medical records of inpatients who had been admitted to treat a single manic episode of Bipolar I Disorder at Noor University Hospital, Isfahan, Iran between September 2004 and December 2008. Results: Out of a total of 275 single episode manic patients, 39 underwent ECT. Male/ female ratios were 19/20 (48.7% vs. 51.3%) for the ECT series and 137/99 (58% vs. 42%) for the exclusive pharmacological treatment series (p>0.05). Mean age of patients in the ECT series (23.64 +/- 8.00) was significantly lower than the pharmacological treatment series (27.65 +/- 11.30, p = 0.008). The mean length of stay (LOSs) for the ECT series (20.0 +/- 7.90) was significantly higher than the other group (14.63 +/- 9.84, p = 0.001). The mean time to first administered ECT (tECT) was 4.35 +/- 3.79. There was no significant difference between the mean LOSs of the pharmacologic treatment series and the mean "LOSs minus tECT"(LOS-tECT) variable (16.57 +/- 8.43) in the ECT series (p>0.05). The mean duration from the onset of the symptoms to time of admission was 19.22 +/- 3.53 for the ECT series. Catatonia was the indication for application of ECT in one patient (2.6%), while 25 (64.10%) received ECT because of aggressive behavior. The proportion of patients administered chemical and physical restraints before ECT (77%) significantly dropped (7.7%) after ECT administration (p<0.001). Conclusion: ECT is an effective, safe, and probably underused treatment method for single episode manic patients. Reducing the time until commencement of ECT should be considered, even in a single manic episode.