ECT beyond unipolar major depression: systematic review and metaanalysis of electroconvulsive therapy in bipolar depression.Objective: In this systematic review and meta-analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 1660 citations were identified through five electronic databases. Nineteen articles met final inclusion criteria for meta-analysis. Results: The pooled response and remission rates with ECT in MDD were 74.2% (n = 1246/1680) and 52.3% (n = 850/1626), respectively. In BDD, they were 77.1% (n = 437/567) and 52.3% (n = 275/377), respectively. Although response rates to ECT were statistically higher in BDD (OR = 0.73, 95% CI: 0.56-0.95, P = 0.02), remission rates were similar (OR = 0.91, 95% CI: 0.65-1.26, P = 0.56). Individuals with BDD vs. MDD required fewer number of ECT sessions to achieve response (SMD = À0.23, 95% CI: À0.44 to À0.023, P = 0.03). There were no significant moderator effects identified. Conclusion: Response rates and speed of response are higher in individuals with BDD; however, remission rates are equivalent. These findings support increased utilization of ECT in individuals with treatment-refractory BDD. Summations• Electroconvulsive therapy is more effective for treating individuals with bipolar vs. unipolar major depression in terms of clinical response, but it was found to be equally effective for achieving remission. Moreover, a smaller number of ECT sessions was needed to achieve clinical response in BDD vs. MDD patients. Considerations• Studies reporting on remission rates were generally heterogeneous in assessing clinical outcomes. A variety of rating scales were applied for measuring response and remission rates. As well, there was a lack of data on outpatients. Furthermore, this meta-analysis synthesized non-randomized study designs rather than randomized controlled trials.

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Patients' perceived control constructs are important factors moderating health-related behaviors. We established the psychometric properties of the Spanish version of the Form C Multidimensional Health Locus of Control Scale (C-MHLC) and assessed the usefulness of these measures in the clinical setting. A cross-sectional survey querying about patients' health locus of control (HLOC) beliefs was offered to 607 psychiatric outpatients, of whom 507 accepted. The C-MHLC scale and the General Perceived Self-Efficacy Scale were completed. The psychiatric patients believe that their psychiatrist plays a crucial role in improving their state of health. The men scored higher than the women in internal dimension; the women scored higher in other people external dimension. Age, treatment time, and number of psychoactive drugs used showed significant differences in HLOC dimensions. Self-efficacy correlated positively with internal dimension and negatively with external dimensions. The results showed the validity of the four-factor structure of the Spanish version of the C-MHLC.

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The knowledge of control constructs beliefs in psychiatric outpatients could allow the psychiatrist to predict noncompliance, monitor patient progression more closely, and individualize patient education in an effort to increase treatment adherence in patients who have difficulties adhering to treatment plans.