• ECT
• follow-up
• older-aged bipolar patients

Background: Over 25% of Bipolar Disorder (BD) patients are elderly. The category of older-aged bipolar patients (OABD), including both early-onset and late-onset cases, has been coined to define what is often referred to as "geriatric bipolar disorder." We can no longer view OABD as a special population nor extrapolate management recommendations based on experience with mixed-age groups. Major affective episodes in this demographic are associated with high morbidity and mortality, requiring urgent interventions. Electroconvulsive Therapy (ECT) is a highly effective first-line treatment for severe clinical conditions such as treatment-resistant depression, mixed states, and mania, with response rates ranging from 70% to over 90%. A naturalistic follow-up study in this specific population is crucial to identify predictive factors of response, relapse, or favorable course.
Aim of the study: The aim of this study is to evaluate response rates to ECT in older-aged bipolar patients (≥ 55 years) who experienced a major affective episode (depression, mixed state, or mania) and to analyze the course of the mood disorder over a follow-up period of at least 6 months in terms of final outcomes and remission rates.
Materials and methods: This naturalistic and observational study was conducted on a cohort of 30 treatment-resistant patients who underwent bilateral ECT between January 2007 and March 2023. All patients were assessed before and after the ECT course using the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression scale (CGI). A retrospective chart review was performed using clinical records from the outpatient service of the Department of Psychiatry at the University of Pisa to evaluate long-term outcomes following ECT. Mental status during follow-up visits was recorded using the Longitudinal Interval Follow-Up Evaluation (LIFE) methodology.
Results: Patients with sustained remission or limited residual symptoms after ECT showed significantly longer episode durations, higher chronicity rates, lower MMSE scores prior to ECT, lower rates of residual symptoms at follow-up entry, and a lower percentage of the total follow-up time with major symptoms compared to those with predominant residual symptoms (p < 0.05).
Conclusion: To the best of our knowledge, this study is one of the first to investigate the mood course of 30 patients diagnosed with OABD, treated with ECT, and followed in a naturalistic manner for at least 6 months. ECT should be considered for elderly patients with BD, and factors such as greater chronicity, the presence of psychotic features, lower MMSE scores before ECT, fewer residual symptoms at follow-up entry, and a lower percentage of the total follow-up time with major symptoms may serve as positive predictive indicators of better outcomes.