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Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT) at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP) were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02). Thirtyfour percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5%) reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients. Keywords: Electroconvulsive therapy, treatment outcome, psychiatric somatic therapies, treatment, general hospital psychiatry. ResumoObjetivo: Descrever o perfil sociodemográfico e clínico de pacientes submetidos a eletroconvulsoterapia (ECT) em um hospital geral universitário. Método: Neste estudo retrospectivo, foram revisados os prontuários de todos os pacientes submetidos a ECT entre janeiro de 1988 e janeiro de 2008 na unidade psiquiátrica do hospital geral da Universidade Estadual de Campinas (UNICAMP). Os pacientes/familiares foram contatados por telefone para a coleta de dados de seguimento. Resultados: Um total de 200 prontuários foram revisados. A maioria dos pacientes era do sexo feminino, com uma idade média de 39 anos e história de hospitalização psiquiátrica prévia. As principais indicações para ECT foram depressão e catatonia. Complicações foram observadas em menos de metade dos casos, e a maioria delas teve caráter temporário e não grave. Houve resultado psiquiátrico favorável em 89,7% dos pacientes, especialmente os catatônicos (100%, p = 0,02). Trinta e nove por cento dos casos foram contatados por telefone, a uma média de 8,5 anos decorridos entre o procedimento e o contato. Entre estes, três (1,5%) relataram transtornos amnésticos persistentes e 73% consideraram a ECT um bom tratamento. Conclusão: A ECT foi realizada de acordo com diretrizes internacionais. Na grande maioria dos casos, efeitos indesejáveis foram temporários e não graves. A resposta à ECT foi positiva na maioria dos casos, especialmente em pacientes catatônicos. Descritores: Eletroconvulsoterapia, resultado de tratamento, tratamentos somáticos em psiquiatria, tratamento, unidad...

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BackgroundTreatment Resistant Schizophrenia (TRS) and Non-Treatment Resistant Schizophrenia (NTRS) may represent different biological subtypes of schizophrenia but there are few studies which investigated the distinction between these groups in terms of psychopathology. In the present study, we used both Exploratory (EFA) and Confirmatory (CFA) Factor Analyses to investigate symptom dimensions in TRS in comparison with NTRS using the Positive and Negative Syndrome Scale (PANSS).MethodsData from 1429 patients who participated in the PATTERN study a Non- Intervention Prospective Study of Patients with Persistent Symptoms of Schizophrenia) was used. TRS was defined by proxy, based on the use of clozapine (TRS) whereas NTRS used non-clozapine antipsychotics (NTRS). EFA methods included the extraction of principal components and the Varimax rotation. The number of factors was chosen based on the Kaiser criterion. Factors items were considered valid when loadings were greater or equal to 0.5. The fit to the data was evaluated by CFA in comparison with well established PANSS models using fit indexes such as: NNFI (Non-Normed Fit Index), NFI (Normed fit Index), CFI (Comparative Fit Index), RMEA (Root-Mean-Square Error of Approximation). SPSS 23.0 and R version 3.2.2 were used for statistical analyses.ResultsDemographic data showed that, when compared with NTRS, patients with TRS showed an earlier age of onset, a longer duration of illness, higher PANSS positive scores, a higher duration of persistent positive and negative symptoms. There were no differences between groups in terms of the duration of untreated psychosis. The EFA yielded almost the same five-factor structure in both groups namely Negative, Positive, Affective, Disorganized/Cognitive and Excitation factors. CFA showed that both models do not fit completely to the data when compared with well known PANSS factor analytical models.DiscussionData from a large cross-national sample of 1429 patients of the Pattern study showed that TRS and NTRS patients have an almost identical factor structure when evaluated by the PANSS. These results are similar to a previous study with a smaller sample which has evaluated the dimensions of the PANSS in patients with refractory schizophrenia.

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Objectives: To describe the socio-demographic and clinical characteristics, complications and therapeutic response of patients treated with ECT in the Psychiatric Unit of the General Hospital from University of Campinas-Brazil (1993-2007). Methods: All medical records of the patients who underwent ECT were reviewed and compiled for subsequent statistical analysis by SPSS program.

BackgroundPrincipal component analyses (PCA) studies show that schizophrenia symptoms are usually grouped into five domains. However, to infer a latent dimensional structure, confirmatory factor analysis (CFA) is more appropriate than PCA. Most CFA studies addressing the five-factor model yielded poor fit indices. One single study achieved a good fit using a multilevel CFA structure with the interviewers as level. Other possible reasons for sample heterogeneity and subsequent poor model adjustments, such as differences in patients’ clinical profiles across clinical units and clinical staging, were not measured in this study. We aimed to replicate the effect of the CFA multilevel analyses and evaluate the possible influence of other heterogeneity sources as levels, i.e., clinical staging, on the Positive and Negative Syndrome Scale (PANSS) five-factor structure.Methods700 patients with schizophrenia at four different centers had their PANSS analyzed. A Confirmatory Factor Analysis (CFA) was conducted using the following fit index: Comparative Fit Index (CFI) and Non-Normed Fit Index (NNFI) >0.95, the Root Mean Square Errors of Approximation (RMSEA) <0.06, and Weighted Root Mean Square Residual (WRMR) <1.0. Thereafter, we performed multilevel analyses considering the following levels: i) centers, ii) interviewers and iii) clinical staging for schizophrenia (first episode, treatment-resistant schizophrenia and non-treatment resistant schizophrenia).ResultsThe mean (SD) age was 34.9 (10.3) years, mean age of onset was 21.7 (7.5), mean duration of illness means was 13.2 (9.7) years, and 64.3% of the sample was male. The CFA model without multilevel analyses yielded poor fit indices: RMSEA = 0.102 (90% CI: 0.097 – 0.107; Cfit was <0.001), CFI = 0.921 and NNFI = 0.906 and WRMR = 1.952. When the multilevel analysis was applied, all models reached an acceptable fit: i) centers: RMSEA = 0.044 (90% CI: 0.038 – 0.049; CFit = 0.964), CFI = 0.981, NNFI = 0.977, and WRMR = 1.860; ii) interviewers: RMSEA = 0.047 (90% CI: 0.041 – 0.053; CFit = 0.765), CFI = 0.947, NNFI = 0.938, and WRMR = 1.531; iii) clinical stage: RMSEA = 0.052 (90% CI: 0.046 – 0.058; CFit = 0.274), CFI = 0.988, NNFI = 0.985, and WRMR = 2.433.DiscussionGood CFA model fits were only achieved when the multilevel structure was applied. Besides the bias generated by data collection (i.e., local of data collection and raters), the clinical staging is a potential source of variability to consider in schizophrenia dimensional structure. As dimensional approaches gain relevance to reduce heterogeneity in schizophrenia and to investigate their biological substrates, reliable methods to address latent dimensions are required.