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Monitoring Daily Affective Symptoms and Memory Function Using Interactive Voice Response in Outpatients Receiving Electroconvulsive Therapy

Fazzino, Tera L. MA*†‡; Rabinowitz, Terry MD, DDS, MS*†§; Althoff, Robert R. MD, PhD*†‡∥; Helzer, John E. MD*†

doi: 10.1097/YCT.0b013e3182972bbb
Original Studies

Objective: Recently, there has been a gradual shift from inpatient-only electroconvulsive therapy (ECT) toward outpatient administration. Potential advantages include convenience and reduced cost. But providers do not have the same opportunity to monitor treatment response and adverse effects as they do with inpatients. This can obviate some of the potential advantages of outpatient ECT, such as tailoring treatment intervals to clinical response. Scheduling is typically algorithmic rather than empirically based. Daily monitoring through an automated telephone, interactive voice response (IVR), is a potential solution to this quandary.

Methods: To test feasibility of clinical monitoring via IVR, we recruited 26 patients (69% female; mean age, 51 years) receiving outpatient ECT to make daily IVR reports of affective symptoms and subjective memory for 60 days. The IVR also administered a word recognition task daily to test objective memory. Every seventh day, a longer IVR weekly interview included questions about suicidal ideation.

Results: Overall daily call compliance was high (mean, 80%). Most participants (96%) did not consider the calls to be time-consuming. Longitudinal regression analysis using generalized estimating equations revealed that participant objective memory functioning significantly improved during the study (P < 0.05). Of 123 weekly IVR interviews, 41 reports (33%) in 14 patients endorsed suicidal ideation during the previous week.

Conclusions: Interactive voice response monitoring of outpatient ECT can provide more detailed clinical information than standard outpatient ECT assessment. Interactive voice response data offer providers a comprehensive, longitudinal picture of patient treatment response and adverse effects as a basis for treatment scheduling and ongoing clinical management.

From the *Department of Psychiatry, University of Vermont College of Medicine; †Fletcher Allen Health Care; Departments of ‡Psychology, §Family Medicine, and ∥Pediatrics, University of Vermont College of Medicine, Burlington, VT.

Received for publication February 8, 2013; accepted April 5, 2013.

Reprints: Tera L. Fazzino, MA, Health Behavior Research Center, Department of Psychiatry, University of Vermont, UHC Campus 457OH3, 1 S Prospect St, Burlington, VT 05401 USA (e-mail:

Dr Althoff receives grant or research support from the National Institute of Mental Health (K08MH082116) and the Klingenstein Third Generation Foundation. He has received honoraria from Oakstone Medical Publishing for CME presentations.

Ms Fazzino and Dr Helzer are supported from the National Institute of Alcohol Abuse and Alcoholism (R01-AA11954).

The authors have no conflicts of interest or financial disclosures to report.

© 2013 by Lippincott Williams & Wilkins