The Effects of Continuation-Maintenance Electroconvulsive Therapy on Reducing Hospital Re-Admissions in Patients with Treatment-Resistant Schizophrenia

Abstract

ObjectiveContinuation-maintenance electroconvulsive therapy (C/M-ECT) is used to prevent relapse or recurrence in patients with severe mental illnesses. We aimed to investigate the effect of C/M-ECT on reducing hospital re-admissions in patients with treatment-resistant schizophrenia.MethodsWe applied a mirror-image design by retrospectively examining re-hospitalization rates of 18 patients with schizophrenia spectrum disorders. We compared the numbers of psychiatric admissions during the actual period over which C/M-ECT was administered with the same period prior to the beginning of C/M-ECT.ResultsThe number of psychiatric admissions was reduced significantly during C/M-ECT (0.33±0.77) compared with that of the same period prior to C/M-ECT (2.67±1.33) (Wilcoxon signed rank Z=−3.663; p<0.001).ConclusionThis finding shows that C/M-ECT augmentation could successfully reduce the re-hospitalization rates in patients with treatment-resistant schizophrenia.

Clinical Outcomes after Clozapine Discontinuation in Patients with Schizophrenia: A Systematic Review

“…Previous studies showed ECT as an effective treatment option for patients with TRS 39 40 41 . In addition, an RCT included in one of those previous meta-analyses demonstrated that ECT plus ziprasidone was not inferior to clozapine plus ziprasidone 40 .…”

Mirror-Image Comparison of Maintenance Electroconvulsive Treatment Effectiveness in Affective and Psychotic Disorders

“…The findings of this study conform to earlier studies exploring the number and duration of hospitalizations in heterogeneous diagnostic groups (Table 4). Most of the retrospective naturalistic studies were mirror-image studies, [23][24][25][26][27][28][29][30][31][32][33][34] whereas a few retrospective studies had control groups comprising patients taking maintenance pharmacotherapy. 28,30,35 These studies reported a lower number and shorter duration of hospitalization during mECT not only for patients with unipolar depression 30 but also for the patients presenting with depressive symptoms diagnosed as bipolar or schizoaffective disorder.…”

“…16 Although limited in number, studies reporting the efficiency of mECT in schizophrenia have been conducted lately. 25,34,40,41 Although limited data have been reported on schizophrenia, ECT augmentation in medication resistance has been recommended for patients with a partial response to clozapine or patients who cannot tolerate clozapine, which is shown to be effective in antipsychoticrefractory patients with schizophrenia. 10,40,42,43 Although prospective studies have failed to show a higher efficacy of mECT as monotherapy than that of pharmacotherapy for relapse prevention after the acute ECT, 44 they showed that mECT augmentation was associated with a longer time to relapse than pharmacotherapy alone.…”

“…The findings of this study conform to earlier studies exploring the number and duration of hospitalizations in heterogeneous diagnostic groups (Table 4). Most of the retrospective naturalistic studies were mirror-image studies, 23–34 whereas a few retrospective studies had control groups comprising patients taking maintenance pharmacotherapy 28,30,35 …”

“…Although limited in number, studies reporting the efficiency of mECT in schizophrenia have been conducted lately 25,34,40,41 . Although limited data have been reported on schizophrenia, ECT augmentation in medication resistance has been recommended for patients with a partial response to clozapine or patients who cannot tolerate clozapine, which is shown to be effective in antipsychotic-refractory patients with schizophrenia 10,40,42,43 .…”