The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

Abstract

Objective:To evaluate the effect of maintenance modified electroconvulsive therapy (MECT) on schizophrenic patients. Methods: From June 2012 to June 2014, 62 patients with schizophrenia, who had recovered from a successful course of acute MECT, were recruited. Thirty-one patients received maintenance MECT and risperidone, as the experimental group. Another 31 patients were enrolled in the control group, and received risperidone only. The effects on cognitive functions, clinical symptoms and relapse rate were determined. Results: Patients in the experimental group had a lower relapse rate and longer relapse-free survival time than the controls. Relative to the baseline evaluation, patients showed statistically significant improvement in verbal memory and visual memory. At the final assessment, the scores of verbal and visual memory were remarkably lower in the experimental group than the controls but there was no significant difference in other tests. Conclusion: Maintenance MECT plus medication is superior to medication alone in preventing relapse and improving cognitive function.Keywords: schizophrenia; electroconvulsive therapy; risperidone; cognition. RESUMO Objetivo:Avaliar o efeito da manutenção de eletroconvulsoterapia modificada (ECTM) em pacientes com esquizofrenia. Métodos: Entre junho de 2012 a junho de 2014, 62 pacientes, com esquizofrenia e que apresentaram recuperação bem-sucedida após ECTM aguda, foram recrutados. Um grupo experimental de trinta e um pacientes recebeu ECTM de manutenção e risperidona. Os demais pacientes foram incluídos no grupo controle, recebendo apenas a risperidona. Determinou-se os efeitos sobre as funções cognitivas, os sintomas clínicos e a taxa de recidiva. Resultados: Os pacientes do grupo experimental tiveram menor taxa de recidiva e maior tempo de sobrevida livre de recidiva do que os do grupo controle. Em relação à avaliação inicial, os pacientes apresentaram melhora estatisticamente significativa da memória verbal e da memória visual. Na avaliação final, os escores de memória verbal e visual foram extraordinariamente menores no grupo experimental do que no grupo controle, mas não se observou diferenças significativas em outros testes. Conclusão: A ECTM de manutenção combinada à medicação é superior ao uso apenas de medicação na prevenção de recidivas e na melhora da função cognitiva.

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

“…44 In another prospective study, the rate of surviving without relapse or recurrence for 1 year was 86% for the combination (ECT + risperidone) group, significantly higher than the only-medication group. 45 Consistent with previous studies, the present findings of relapse/recurrence rates support the beneficial role of mECT. However, it is not possible to suggest the superiority of ECT to another maintenance method because of the lack of a control group.…”

“…In a prospective study investigating the short-term effect of mECT on PD, even though the relapse rate was as high as 40% for the combination group (ECT + flupenthixol), it was still lower than the pharmacotherapy group 44 . In another prospective study, the rate of surviving without relapse or recurrence for 1 year was 86% for the combination (ECT + risperidone) group, significantly higher than the only-medication group 45 . Consistent with previous studies, the present findings of relapse/recurrence rates support the beneficial role of mECT.…”

“…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. 44,45 Evidence suggests that mECT may be effective in schizophrenia to maintain clinical stability for patients who respond to ECT augmentation. 46 In a prospective study investigating the short-term effect of mECT on PD, even though the relapse rate was as high as 40% for the combination group (ECT + flupenthixol), it was still lower than the pharmacotherapy group.…”

“…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 . 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 44,45 . Evidence suggests that mECT may be effective in schizophrenia to maintain clinical stability for patients who respond to ECT augmentation 46 .…”

Electroconvulsive Therapy and Schizophrenia: A Systematic Review

“…Yang et al [33] conducted a randomized open trial with 62 patients considered as responders to an acute course of ECT for schizophrenia. Patients were assigned to either receive risperidone alone or risperidone and ECT augmentation.…”