A Pilot Study on Daily Intensive ECT over 8 Days Improved Positive and Negative Symptoms and General Psychopathology of Patients with Treatment-Resistant Schizophrenia up to 4 Weeks after Treatment

Abstract

Objective: For patients with treatment-resistant schizophrenia (TRS) who do not respond to drug therapy, electroconvulsive therapy (ECT) is often employed as an additional treatment. The aims of the present study were to investigate to what extent an 8-day daily ECT treatment might reduce symptoms of schizophrenia among patients with TRS both in the short term (end of the treatment) and medium term, that is 4 and 12 weeks after the treatment. Methods: Fourteen patients with TRS based on DSM-5 criteria took part in the present study. ECT consisted of daily sessions for 8 consecutive days. At baseline, at the end of the intervention, and 4 and 12 weeks after study completion, trained psychiatrists assessed the patients’ disease severity (positive and negative symptoms; psychopathology) and cognitive functions. Results: Disease symptoms (positive and negative symptoms; psychopathology) became reduced from baseline to the end of the intervention and to 4 weeks after treatment. Twelve weeks after the intervention symptoms again increased. Cognitive functions decreased from baseline to the end of the study and 4 weeks after treatment. However, by 12 weeks after the intervention, cognitive functions had returned to baseline levels. Conclusion: The pattern of results suggests that an intensive 8-day daily course of ECT reduced psychiatric symptoms (positive and negative symptoms, psychopathology) in both the short and medium term among patients with TRS. The increase in symptoms between 4 and 12 weeks following intervention suggests that booster sessions of ECT could be beneficial.

Electroconvulsive therapy for negative symptoms in schizophrenia: a literature review from 2000 to 2021

“…In two of the studies, the assessors were blinded (Davarinejad et al, 2019;Petrides et al, 2015) and only one study was double-blinded with sham treatment (Masoudzadeh et al, 2007). Of the prospective interventional studies, 15 were considered openlabel studies as they did not mention blinding (Bansod et al, 2018;Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010;Ipekcioglu et al, 2018;Kho et al, 2004;Kim et al, 2018;Li et al, 2016;Pawełczyk et al, 2014aPawełczyk et al, , 2014bTang & Ungvari, 2001Zhang et al, 2012).…”

“…Two publications (Pawełczyk et al, 2014a(Pawełczyk et al, , 2014b) focused on the effectiveness of ECT on TRS patients with dominant negative symptoms. Other inclusion criteria included illness length of at least two (Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010;Davarinejad et al, 2019;Petrides et al, 2015) or three years (Tang & Ungvari, 2002, a minimum score of 37 points at the Brief Psychiatric Rating Scale (BPRS) (Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010), at least six months of continuous hospitalization, ability and willingness to give informed consent (Tang & Ungvari, 2002 or history of previous ECT response (Ipekcioglu et al, 2018).…”

“…Exclusion criteria were less heterogeneous between the studies, with eleven of them excluding patients with a severe medical disorder in which ECT is contra-indicated or current use of alcohol or substance abuse (Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010;Davarinejad et al, 2019;Ipekcioglu et al, 2018;Jia et al, 2019;Kim et al, 2018;Pawełczyk et al, 2014aPawełczyk et al, , 2014bPetrides et al, 2015;Tang & Ungvari, 2002Xiang et al, 2015;Zhang et al, 2012). The ages of the patients in the included publications ranged from 15 to 75 years.…”

“…Some studies also decreased the weekly frequency of ECT according to the patient's condition treatment response (Chanpattana & Kramer, 2003;Kim et al, 2017;Kim et al, 2018). In one study (Davarinejad et al, 2019), 8-day daily treatment with ECT was investigated. The overall number of acute ECT sessions varied among the studies between 8 to 20 sessions.…”

“…In 14 of the 21 studies, the ECT protocols specified bilateral electrode placement (Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010;Ipekcioglu et al, 2018;Kim et al, 2018;Li et al, 2016;Pawełczyk et al, 2014aPawełczyk et al, , 2014bPetrides et al, 2015;Tang & Ungvari, 2001Usta Saglam et al, 2020;Zhang et al, 2012), while four specified unilateral use of the electrodes (Davarinejad et al, 2019;Jia et al, 2019;Kho et al, 2004;Masoudzadeh et al, 2007). The focus of Bansod et al (2018) was to compare three groups with different electrode placement options (i.e.…”