Neuroprotective Effect of Modified Electroconvulsive Therapy for Schizophrenia

Gan, Jing; Duan, Hongbo; Cheng, Zhengxiang; Yang, Jia-ming; Zhu, Xiquan; Cun-you, Gao; Zhao, Long; Liang, Xuejun

doi:10.1097/nmd.0000000000000652

Cited by 18 publications

(8 citation statements)

References 38 publications

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“…Three studies examined the changes in brain metabolites using MRS ( Table 2 ). Two independent studies (n=34 and n= 10) revealed changes of N-acetyl-aspartate/creatinine (NAA/ Cr) ratio in the left PFC and the left thalamus [ 39 , 40 ]. Another study showed an increase in medial prefrontal γ-aminobutyric acid (GABA) levels (n=14) [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation

Moon

Kim

Lho

et al. 2021

Psychiatry Investig

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Objective Electroconvulsive therapy (ECT) has been the most potent treatment option for treatment-resistant schizophrenia (TRS). However, the underlying neural mechanisms of ECT in schizophrenia remain largely unclear. This paper examines studies that investigated structural and functional changes after ECT in patients with schizophrenia. Methods We carried out a systematic review with following terms: ‘ECT’, ‘schizophrenia’, and the terms of various neuroimaging modalities. Results Among the 325 records available from the initial search in May 2020, 17 studies were included. Cerebral blood flow in the frontal, temporal, and striatal structures was shown to be modulated (n=3), although the results were divergent. Magnetic resonance spectroscopy (MRS) studies suggested that the ratio of N-acetyl-aspartate/creatinine was increased in the left prefrontal cortex (PFC; n=2) and left thalamus (n=1). The hippocampus and insula (n=6, respectively) were the most common regions of structural/functional modulation, which also showed symptom associations. Functional connectivity of the default mode network (DMN; n=5), PFC (n=4), and thalamostriatal system (n=2) were also commonly modulated. Conclusion Despite proven effectiveness, there has been a dearth of studies investigating the neurobiological mechanisms underlying ECT. There is preliminary evidence of structural and functional modulation of the hippocampus and insula, functional changes in the DMN, PFC, and thalamostriatal system after ECT in patients with schizophrenia. We discuss the rationale and implications of these findings and the potential mechanism of action of ECT. More studies evaluating the mechanisms of ECT are needed, which could provide a unique window into what leads to treatment response in the otherwise refractory TRS population.

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Section: Resultsmentioning

confidence: 99%

Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation

Moon

Kim

Lho

et al. 2021

Psychiatry Investig

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“…The proportion of costs attributed to inpatient care varied from country to country, depending on the organization of mental health services [ 5 ]. Regarding the cost composition, the non-medication treatment costs occupied the biggest proportion of inpatient costs for schizophrenia patients, which included modified electroconvulsive therapy [ 26 ], transcranial magnetic stimulation therapy [ 27 ], recreational therapy [ 28 ], individual psychotherapy [ 29 ], and group psychotherapy [ 30 ] during hospitalization. The medication costs were found to be the smallest part (10.9%) for inpatients.…”

Section: Discussionmentioning

confidence: 99%

Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China

Zhang

Sun

Zhang

et al. 2018

Int J Ment Health Syst

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BackgroundSchizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China.MethodsThis was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients’ sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted.ResultsA total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia.ConclusionsThe direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.

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“…Recent neuroimaging studies have shown an association of ECT in schizophrenia with increase in GM volume within the medial temporal lobe (amygdala, hippocampus, and insula) (45) and increased global functional connectivity density among key regions within default mode network (precuneus and medial prefrontal cortex) (46). ECT exerts therapeutic efficacy via elevating the concentration of N-acetylaspartate in the left prefrontal cortex and thalamus, indicating an antipsychotic effects through neuroprotective mechanism (47). In a sample of schizophrenia and depression, ECT reveals both disorder-specific and transdiagnostic effects.…”

Section: Discussionmentioning

confidence: 99%

Neuroanatomical Features That Predict Response to Electroconvulsive Therapy Combined With Antipsychotics in Schizophrenia: A Magnetic Resonance Imaging Study Using Radiomics Strategy

Cui

Gong

et al. 2020

Front. Psychiatry

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Objective: Neuroimaging-based brain signatures may be informative in identifying patients with psychosis who will respond to antipsychotics. However, signatures that inform the electroconvulsive therapy (ECT) health care professional about the response likelihood remain unclear in psychosis with radiomics strategy. This study investigated whether brain structure-based signature in the prediction of ECT response in a sample of schizophrenia patients using radiomics approach.Methods: This high-resolution structural magnetic resonance imaging study included 57 patients at baseline. After ECT combined with antipsychotics, 28 and 29 patients were classified as responders and non-responders. Features of gray matter were extracted and compared. The logistic regression model/support vector machine (LRM/SVM) analysis was used to explore the predictive performance. Results:The regularized multivariate LRM accurately discriminated responders from nonresponders, with an accuracy of 90.91%. The structural features were further confirmed in the validating data set, resulting in an accuracy of 87.59%. The accuracy of the SVM in the training set was 90.91%, and the accuracy in the validation set was 91.78%. Conclusion:Our results support the possible use of structural brain feature-based radiomics as a potential tool for predicting ECT response in patients with schizophrenia undergoing antipsychotics, paving the way for utilization of markers in psychosis.

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Neuroprotective Effect of Modified Electroconvulsive Therapy for Schizophrenia

Cited by 18 publications

References 38 publications

Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation

Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation

Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China

Neuroanatomical Features That Predict Response to Electroconvulsive Therapy Combined With Antipsychotics in Schizophrenia: A Magnetic Resonance Imaging Study Using Radiomics Strategy

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