Electroconvulsive theraphy in psychotic patients : interface between perceived stress, anxiety and depression and the clinical outcome ; Electroconvulsoterapia em pacientes psicóticos : interface entre o stress percebido, ansiedade e depressão e resultado clínico

Dissertação de mestrado em Ciências da Saúde ; Electroconvulsive therapy (ECT) continues to be considered an effective treatment of psychotic patients with hallucinatory and delusional symptoms resistant to antipsychotic medication. Several studies have evaluated the effectiveness of ECT in major depression as well as the effect of cortisol in the evolution and prognosis of those patients. However, studies that evaluate the evolution of the delusional and hallucinatory schizophrenic patients, psychotic depression and schizoaffective psychotic patients treated with ECT and its correlation with the salivary cortisol are scarce. Moreover, stress plays a significant role in modulation of mental disorders, and the hypothalamic-pituitary-adrenal (HPA) axis regulates the biological mechanisms of stress. In this project we have assessed the clinical evolution of patients in three diagnostic groups, namely patients psychotic depression, schizoaffective disorder and schizophrenia before and after ECT. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychotic symptoms, the Perceived Stress scale (PSS) to evaluate perceived stress, the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression and salivary cortisol levels to evaluate the HPA axis function. The results of our study demonstrate that ECT is effective and a valuable therapeutic option which could be useful as adjunctive therapy in psychotic patients refractory to antipsychotics agents. There was a noticeable improvement in the PANSS, HADS and PSS scores after ECT in all psychotic patients in our study. Moreover, this study shows the effectiveness of ECT in chronic psychotic patients, while most studies have studied first psychotic episodes. The decrease of salivary cortisol after ECT in our study suggests that it may impact in the HPA axis, improving its function. However, the mechanism by which it can improve HPA axis function remains unclear. Finally, the correlations between variables revealed that the HADS score ...