Electroconvulsive therapy combined with antipsychotic therapy in the treatment of acute schizophrenia inpatients: symptom profile of the clinical response

Abstract

OBJECTIVE: The aim of the study was to examine the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic (AP) medication on symptom profile in patients with a diagnosis of schizophrenia who had received acute psychiatric inpatient treatment. METHODS: In this prospective study, patients were evaluated for inclusion in the study who were diagnosed with schizophrenia according to DSM-IV diagnostic criteria and were to receive ECT. The patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression-Improvement (CGI-I) sub-scale before the first session ECT, once following every two subsequent sessions and after the final session. RESULTS: The patients showed significant improvements in BPRS scores at each evaluation compared with their scores at baseline, and a significant clinical improvement was found on the CGI-I sub-scale at the end of treatment. Across all SAPS sub-scores, significant decreases were found, and the symptoms related to hallucinations and positive formal thought disorder showed the most rapid response to treatment. Across all SANS sub-scores, significant decreases were found, and affective flattening or blunting symptoms responded most rapidly to treatment. CONCLUSION: One of the most important findings in the present study of hospitalized patients with acute schizophrenia was the good response to treatment, which provided significant improvements in both positive and negative symptoms. The most rapid response to treatment was found for hallucinations, positive formal thought disorder, and affective flattening or blunting symptoms. The most important limitation of our study may be the small number of cases. In future, well-standardized studies using a double-blinded, comparative, prospective design and including a sufficient number of patients are needed.

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

“…From the 35 included publications investigating the effect of ECT on schizophrenia, 16 were prospective interventional studies (Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010;Ipekcioglu et al, 2018;Jia et al, 2019;Kho et al, 2004;Li et al, 2016;Masoudzadeh et al, 2007;Pawełczyk et al, 2014aPawełczyk et al, , 2014bPetrides et al, 2015;Tang & Ungvari, 2001Zhang et al, 2012), two naturalistic observation studies (Kim et al, 2018;Usta Saglam et al, (Bansod et al, 2018), one retrospective controlled study (Jia et al, 2019) and one retrospective chart review (Xiang et al, 2015). Six literature reviews (Chanpattana, 2007;Chanpattana & Andrade, 2006;Dokucu, 2015;Hasan et al, 2015b;Lehnhardt et al, 2012;Remington et al, 2016), two systematic reviews (Sinclair et al, 2019;Tharyan & Adams, 2005) and two meta-analyses (Ahmed et al, 2017;Zheng et al, 2016), giving an overview of some aspects of the effect of ECT on schizophrenia, were also included in this review.…”

“…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). Five of these prospective interventional studies also used a controlled study design (Li et al, 2016;Petrides et al, 2015;Tang & Ungvari, 2002;Zhang et al, 2012), but these studies were limited by control groups with patients who refused ECT and instead only received pharmacotherapy.…”

“…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.…”

“…Electroconvulsive therapy (ECT) was introduced by Cerletti and Bini in 1938 as a therapy for schizophrenia and is today mainly used in severe major depression (Cerletti & Bini, 1938;Chanpattana & Andrade, 2006;Chanpattana & Chakrabhand, 2001a;Fink, 1994;Moeller et al, 2017). ECT is a so-called somatic treatment that uses electrical stimulation to induce seizures while patients receive anaesthesia and muscle relaxant (Canadian Agency for Drugs and Technologies in Health, 2014;Ding & White, 2002;Ipekcioglu et al, 2018). The use of ECT for schizophrenia declined after the emergence of effective pharmacological treatment for positive symptoms during the 1960s and 1970s (Chanpattana & Andrade, 2006;Fink & Sackeim, 1996).…”