A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias.

The aim of this study was to compare prisoners (n = 772), community adults (n = 1201), university students (n = 2080), and adolescents (n = 472) on four sets of psychopathic traits (affective responsiveness, cognitive responsiveness, interpersonal manipulation, and egocentricity), using a psychopathy measure which does not index criminal/antisocial behaviorthe Psychopathic Personality Traits Scale. Another aim was to examine patterns of co-occurrence between psychopathic personality traits among offending and non-offending populations. ANOVA results indicated significant differences between the four groups on all PPTS dimensions. Adolescents demonstrated greater deficits in affective and cognitive responsiveness than the remaining groups of participants. Prisoners had elevated deficits in cognitive responsiveness, compared with university students and community adults. University students scored higher on interpersonal manipulation than adolescents and prisoners, and higher on egocentricity than community adults and prisoners. Latent profile analysis revealed four distinct classes of psychopathic traits among all samples, although not all classes were qualitatively equivalent across samples. Low psychopathy groups were identified for all samples. There were clear high psychopathy groups for prisoners and university students, with approximately 7% of prisoners and students belonging in the groups. This finding indicates that past research could have over-estimated the prevalence of psychopathy in forensic populations due to inclusion of criminal behavior items in psychopathy assessment.

ObjectiveElectroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression.MethodsData were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression – Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio‐demographic and clinical factors and response.ResultsResponse was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive‐compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate.ConclusionElectroconvulsive therapy for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive‐compulsive disorder or personality disorder, and less prior pharmacologic treatment.

IMPORTANCEKnowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. OBJECTIVE To investigate the response to ECT in patients with manic episodes. DESIGN, SETTING, AND PARTICIPANTS This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021.EXPOSURES Patients treated with ECT for a mania were identified from the Q-ECT. MAIN OUTCOMES AND MEASURESResponse to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT.Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response. RESULTS Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessivecompulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness. CONCLUSIONS AND RELEVANCEThis study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.

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