Clinical effectiveness and speed of response of electroconvulsive therapy in treatment‐resistant schizophrenia

Abstract

Aim Although electroconvulsive therapy (ECT) has been shown to be efficacious for patients with treatment‐resistant schizophrenia, there has been limited evidence on the rate of response, cognition, and quality‐of‐life outcomes. The primary aims of the present study were thus to examine the effectiveness and speed of response to ECT in a naturalistic retrospective cohort in patients with treatment‐resistant schizophrenia. Methods We performed a retrospective database analysis. The primary effectiveness outcome was defined as an improvement of ≥40% from pretreatment scores based on the Brief Psychiatric Rating Scale (BPRS) Psychotic Symptom subscale. Data were included for analysis for all patients with a primary DSM‐5 diagnosis of schizophrenia that was treatment‐resistant and who had had an acute course of ECT initiated for the treatment of schizophrenia between 1 July 2016 and 1 December 2016. Results A total of 50 inpatients were included for analysis. The present study revealed that 50% of patients showed at least a 40% reduction in BPRS Psychotic Symptom subscale scores after completion of ECT and that 16.7% of patients responded after the first three sessions, 39.3% after six sessions, 46.4% after nine sessions, and 50% after 12 sessions. The greatest improvement in BPRS scores was between the third and sixth ECT sessions. BPRS scores, Clinical Global Impression, Montreal Cognitive Assessment, and Global Assessment of Functioning showed significant improvement. There was no significant difference in quality‐of‐life outcomes. Conclusion Utilizing modern techniques in treatment‐resistant schizophrenia, this study demonstrates the real‐world effectiveness and rate of response of patients receiving ECT.

Electroconvulsive Therapy in a Time of Coronavirus Disease

“…In 2015 IMH moved from a one-size-fits-all approach (age based dosing with bitemporal electrode placement) to an individualized seizure threshold titration based approach 31,32 with a range of electrode placements (Bitemporal, Bifrontal, Right unilateral) and pulse parameters (Brief or Ultrabrief pulsewidth) using the CARE network system to collect ECT data 33 . Treatment results at IMH for ECT have been comparable with international norms [34][35][36] . ECT was conducted over 3.5 days a week with an average of 15 treatments per half day session.…”

When to consider electroconvulsive therapy (ECT)

“…Recent literature has focused on ECT as an addon treatment for patients with treatment-resistant schizophrenia, including clozapine-resistant patients (28,29). While there is considerable clinical trial, case series, and case report material to support the use of an acute course of ECT in patients with schizophrenia (30)(31)(32)(33)(34)(35)(36), the totality of the evidence has been inadequate to convince either the US FDA (18) or the Cochrane Database that ECT should be among the standard treatments: 'Moderate-quality evidence indicates that relative to standard care, ECT has a positive effect on mediumterm clinical response for people with treatment-resistant schizophrenia.…”

Comparison of the Clinical and Treatment Characteristics of Patients Undergoing Electroconvulsive Therapy for Catatonia Indication in the Context of Gender

“…17 In a review by Pinna et al 18 about clinical and biological markers of response to ECT, although it is mentioned that there are studies showing that male patients with depression respond faster to ECT, it is reported that there is more evidence in the literature that the response to ECT in depression does not differ in terms of gender. 18 In a retrospective study, the data of 176 patients (women: 39) who received bilateral temporal ECT were examined and it was reported that there was no difference in response rates to ECT in the context of diagnosis and gender 13 In a retrospective study by Chan et al, 19 in which they examined the speed of response to ECT and the clinical efficacy of ECT in 50 patients diagnosed with schizophrenia who were resistant to treatment; it was found that age, gender, disease duration, inadequate response to clozapine use, the total number of ECT sessions applied did not cause a significant difference in terms of response to ECT, and there was no factor with significant correlation with the response rate to treatment. When the findings of our study were combined with the literature data, it was interpreted that the gender factor should not be considered as a guiding or predictive factor in response to ECT.…”