Notice bibliographique
Résumé
Editor—The editorial by Young et al on the treatment of bipolar affective disorder makes no reference to the benefits of electroconvulsive therapy (ECT).1 The authors do a disservice to their patients and to the BMJ's readers by neglecting to mention ECT and by overstating the benefits of new treatments that have not been tested sufficiently. The merits of ECT in resolving both mania and depression were so well documented by 1940 that they justified its widespread, worldwide acceptance.2,3 A review of literature published over five decades found that 66% of patients went into remission or showed marked clinical improvement of bipolar affective disorders when treated with ECT.4 A retrospective review of patients who had been matched for age, sex, and severity of illness contrasted the efficacy of the therapy in patients with mania with those later treated with chlorpromazine. All of the 28 patients treated with ECT responded to treatment but only 18 of 28 treated with chlorpromazine responded. All 10 patients who had not responded to chlorpromazine were later treated with ECT and all responded, suggesting that ECT is superior. Another study comparing ECT, lithium, and chlorpromazine for treatment of chronic mania found that outcomes were equivalent. A comparison of the efficacy of ECT and lithium over eight weeks in patients with a suboptimal response to lithium alone found that ECT was superior. Patients with mania whose treatment with lithium or neuroleptics was unsuccessful were treated either with ECT or a combination of lithium and haloperidol: 59% had a complete remission with ECT but none who received the combined medication went into remission. The efficacy of ECT in patients with delirious mania is well documented in case reports, and it is often a life saving option. Anticonvulsant agents were introduced into the treatment of mania partly because of their ability to raise seizure thresholds. The efficacy of ECT in raising seizure thresholds is well established. There are no studies comparing ECT with any of the treatments for bipolar disorder recommended in the editorial (anticonvulsant drugs or anticonvulsants with antipsychotic drugs or lithium, or both). Ignoring the benefits of ECT while asserting that other unproved non-pharmacological treatments “are emerging” relies more on hope than on evidence. The efficacy of ECT in relieving bipolar affective disorders has been shown, and its use should be considered in patients with the severe forms of the illness, and those with rapid cycling, delirious mania, and mania that has been resistant to treatment (that is, two adequate trials of medication of no longer than six weeks each have failed). The authors' call for additional evidence should include studies of ECT.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,007 | 0,011 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,009 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».