Electroconvulsive Therapy for Treatment-Resistant Schizophrenia

Diarmid J. M. Sinclair; Sai Zhao; Fang Qi; Kazare Nyakyoma; Joey S. W. Kwong; Clive E. Adams

Disclosures

Schizophr Bull. 2019;45(4):730-732. 

In This Article

Main Results

We included 15 studies involving 1285 participants (1264 completers with an age range of 18–46 years) with treatment-resistant schizophrenia. We rated most studies (14/15, 93.3%) as at high risk of bias due to issues related to the blinding of participants and personnel. Our main outcomes of interest were: (1) clinically important response to treatment; (2) clinically important change in cognitive functioning; (3) leaving the study early; (4) clinically important change in general mental state; (5) clinically important change in general functioning; (6) number hospitalized; and (7) death. No trial reported data on death.

The included trials reported useable data for four comparisons: ECT plus standard care compared with sham-ECT added to standard care; ECT plus standard care compared with antipsychotic added to standard care; ECT plus standard care compared with standard care; and ECT alone compared with antipsychotic alone.

For the comparison ECT plus standard care vs sham-ECT plus standard care, only average endpoint BPRS (Brief Psychiatric Rating Scale) scores from one study were available for mental state; no clear difference between groups was observed (short term; MD = 3.60, 95% CI = −3.69 to 10.89; participants = 25; studies = 1; very low-quality evidence). One study reported data for service use, measured as number readmitted; there was a clear difference favoring the ECT group (short-term; RR = 0.29, 95% CI = 0.10 to 0.85; participants = 25; studies = 1; low-quality evidence).

When ECT plus standard care was compared with antipsychotics (clozapine) plus standard care, data from one study showed no clear difference for clinically important response to treatment (medium term; RR = 1.23, 95% CI = 0.95 to 1.58; participants = 162; studies = 1; low-quality evidence). Clinically important change in mental state data was not available, but average endpoint BPRS scores were reported. A positive effect for the ECT group was found (short-term BPRS; MD = −5.20, 95% CI = −7.93 to −2.47; participants = 162; studies = 1; very low-quality evidence).

When ECT plus standard care was compared with standard care, more participants in the ECT group had a clinically important response (medium term; RR = 2.06, 95% CI = 1.75 to 2.42; participants = 819; studies = 9; moderate-quality evidence). Data on clinically important change in cognitive functioning were not available, but data for memory deterioration were reported. Results showed that adding ECT to standard care may increase the risk of memory deterioration (short term; RR = 27.00, 95% CI = 1.67 to 437.68; participants = 72; studies = 1; very low-quality evidence). There were no clear differences between groups in satisfaction and acceptability of treatment, measured as leaving the study early (medium term; RR = 1.18, 95% CI = 0.38 to 3.63; participants = 354; studies = 3; very low-quality evidence). Only average endpoint scale scores were available for mental state (BPRS) and general functioning (Global Assessment of Functioning). There were clear differences in scores, favoring ECT group for mental state (medium term; MD = −11.18, 95% CI = −12.61 to −9.76; participants = 345; studies = 2; low-quality evidence) and general functioning (medium term; MD = 10.66, 95% CI = 6.98 to 14.34; participants = 97; studies = 2; very low-quality evidence).

For the comparison ECT alone vs antipsychotics (flupenthixol) alone, only average endpoint scale scores were available for mental state and general functioning. Mental state scores were similar between groups (medium-term BPRS; MD = −0.93, 95% CI = −6.95 to 5.09; participants = 30; studies = 1; very low-quality evidence); general functioning scores were also similar between groups (medium-term Global Assessment of Functioning; MD = −0.66, 95% CI = −3.60 to 2.28; participants = 30; studies = 1; very low-quality evidence).

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