Objective:

To investigate the factors influencing the initial seizure duration during modified electroconvulsive therapy (MECT) in patients under 30 years old with mental disorders and propose optimized initial treatment parameters for this population.

Approach:

• Study Population: Included 287 patients under 30 years old diagnosed with depression, bipolar disorder, or schizophrenia, who underwent their first MECT.
• Data Processing: Used one-hot encoding for categorical variables and Z-score normalization for continuous variables. SMOTE was applied to balance the dataset.
• Model Construction: A random forest classification model with five-fold cross-validation was used to analyze feature importance.

Key Findings:

• The model achieved average precision of 76.9%, recall of 75.1%, and F1-score of 74.4%.
• Age, energy percentage, and etomidate dose were the core influencing factors, contributing over 79% of explanatory power.
• Disease type, antiepileptic drug usage, and gender had minimal impacts on seizure duration.

Interpretation:

For patients under 30 years old, age, energy percentage, and etomidate dose were identified as critical predictors of ideal seizure time during initial MECT.

Limitations:

• The study is retrospective and conducted at a single center, which may limit generalizability.
• The sample size may not fully represent the diverse population of patients under 30 with mental disorders.

Conclusion:

The initial energy percentage should be set to 1/3–2/5 of the patient’s age, combined with etomidate dose adjustment, to optimize seizure duration.