Electroconvulsive therapy for obsessive-compulsive disorder: clinical efficacy and predictive role of inflammatory markers

TL;DR

This study finds that electroconvulsive therapy (ECT) is effective for treating obsessive-compulsive disorder (OCD), with seizure duration during ECT being a key predictor of treatment success.

Contribution

The study identifies seizure duration as a significant predictor of ECT efficacy in OCD and explores the potential role of inflammatory markers like the neutrophil-to-monocyte ratio.

Findings

73% of OCD patients responded positively to ECT.

Seizure duration during ECT was independently associated with treatment efficacy.

Baseline neutrophil-to-monocyte ratio showed potential predictive value but was not statistically significant in multivariate analysis.

Abstract

This retrospective study aimed to evaluate the clinical efficacy of electroconvulsive therapy (ECT) in patients with obsessive-compulsive disorder (OCD) and identify potential predictive factors, focusing on inflammatory markers to optimize therapeutic outcomes.

We retrospectively analyzed clinical data from 63 OCD patients who received ECT from January 2010 to August 2024. Clinical demographics, ECT parameters, and baseline blood cell counts were extracted from electronic medical records. Inflammatory indices were calculated accordingly. The Clinical Global Impressions-Improvement scale (CGI-I) was utilized to assess treatment outcomes. Patients were categorized into responders and non-responders based on CGI-I scores. Logistic regression analysis determined predictors of ECT efficacy, and the receiver operating characteristic (ROC) curve assessed the predictive capability of these factors.

Among the 63 patients, 46 (73.0%) responded positively to ECT. Responders had significantly more ECT sessions (Z = - 3.03, P = 0.002), longer seizure durations (Z = -2.40, P = 0.016), and higher baseline neutrophil-to-monocyte ratio (NMR) values (T = 2.76, P = 0.008) compared to non-responders. Logistic regression analysis demonstrated seizure duration was independently associated with efficacy (OR = 1.206, P = 0.019), while baseline NMR did not achieve statistical significance in the multivariate analysis (OR = 1.264, P = 0.063). ROC analysis indicated that seizure duration has significant predictive capability (AUC = 0.696; sensitivity 63.0%, specificity 71.6%).

ECT is clinically effective for OCD, seizure duration was significantly associated with treatment outcomes. Although baseline NMR was not statistically significant in multivariate analysis, it holds potential predictive value, possibly limited by sample size and study design. Future larger-scale, prospective studies are warranted.

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