Using electronic patient-reported measures to characterize symptoms and improvement in inpatient psychiatric units.

Patient-reported measures are an important tool in personalizing care and monitoring clinical outcomes. This work presents results from the routine collection of self-report measures from individuals (n = 753) admitted to depression and anxiety inpatient units at McLean Hospital. 93.7% participated in the Clinical Measurement Initiative (CMI) between September 2020 and February 2022 on the most established unit. The average time between admission and discharge measures was 12.6 days and an attrition rate of 10.4% was observed on this unit. Missingness of discharge assessments was unrelated to symptom severity or comorbidities. We discuss the feasibility of deploying patient-reported measures as part of routine care in an inpatient psychiatric setting. Systematic evaluation of potential treatment modifiers (e.g., personality disorder, trauma history, and substance misuse) may be valuable in better serving those impacted by psychiatric illness.

Treatment Outcomes of Electroconvulsive Therapy for Depressed Patients With and Without Borderline Personality Disorder: A Retrospective Cohort Study.

BACKGROUND: Electroconvulsive therapy (ECT) is the gold-standard treatment for refractory depression. Borderline personality disorder (BPD) is generally considered a poor predictor of treatment response. We sought to assess symptom-severity outcomes among depressed patients with (BPD+) and without (BPD-) comorbid BPD undergoing acute phase ECT. METHODS: The study sample consisted of at least moderately depressed patients who received an acute course of ECT from January 2011 to December 2016 at an academic, freestanding psychiatric hospital. Participants completed a DSM-IV-validated BPD screening instrument at baseline. Measures of DSM-IV depressive symptom severity from the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) were taken serially on 4 occasions. Outcomes of interest comprised total QIDS-SR score trajectory, QIDS-SR suicidality subscore, and symptom cluster subscores posited to differentiate response among antidepressant treatments. RESULTS: Of the 693 individuals who met study inclusion criteria, 145 (20.9%) screened positive for BPD. Overall, ECT was associated with significant improvement of depressive symptoms (χ²1 = 504.8, P < .0001). Despite differing from BPD- individuals on key baseline features, BPD+ individuals responded to ECT with similar improvement in overall depression severity (χ²1 = 0.22, P = .64), suicidality (χ²1 = 1.63, P = .20), and core emotional (χ²1 = 0.63, P = .43), sleep (χ²1 = 0.20, P = .65), and atypical (χ²1 = 1.30, P = .25) symptoms after 15 treatments. Post hoc analysis indicated a slightly less robust overall response among the BPD+ group by the 15th treatment. CONCLUSIONS: Acute course ECT benefits depressed patients with or without comorbid BPD, although patients with BPD may exhibit less pronounced improvement over time.