Electroconvulsive therapy combats treatment-resistant schizophrenia

By Eleanor McDermid, Senior medwireNews Reporter

The use of electroconvulsive therapy (ECT) improves the chances of a treatment response in patients with continued schizophrenia symptoms despite use of antipsychotic medication, a randomised trial shows.

In the trial, 20 patients with treatment-resistant schizophrenia continued stable treatment with an atypical antipsychotic while also receiving open-label ECT three times a week for 4 weeks and twice a week for a further 4 weeks.

During this time, 50.0% met the response criteria of at least a 40% reduction in symptoms on the symptom subscale of the Brief Psychiatric Rating Scale (BPRS), a Clinical Global Impressions (CGI)-severity rating of less than 3, and a CGI-improvement rating of 2 or less. Rating was performed by clinicians who were not aware of treatment allocation.

A further 19 patients continued with atypical antipsychotic medication for 8 weeks without response before crossing over to the ECT group, at which point 47.4% responded to treatment.

“The finding that must be emphasized here is that in this group of patients with severe treatment-resistant symptoms, 50% responded with the demanding 40% reduction in symptoms criterion, and 60% responded with conventional response criteria”, say lead study author Georgios Petrides (The Zucker Hillside Hospital, New York, USA) and colleagues.

“These are among the highest response rates ever recorded in this patient population”, they write in The American Journal of Psychiatry.

Prior to randomisation, the patients had treatment resistance to at least two typical antipsychotic drugs and at least moderate symptoms on one or more psychotic items on the BPRS. The team excluded patients with prominent affective symptoms, so that any benefit of ECT would not be attributable to its known effects on mood symptoms.

ECT did not improve negative symptoms, which the researchers say “precludes the attribution of response to the improvement of negative symptoms that may often be misinterpreted as depressive symptoms and vice versa.”

There were no safety concerns, such as prolonged or spontaneous seizures. One patient was removed from the trial due to an increase in involuntary jerky movements, but electroencephalographic studies indicated this was not caused by seizure activity.

Patients initially had fairly low Mini-Mental State Examination scores, at an average of 22.6. These did not change after ECT, which the team says “may reflect the fact that some aspects of cognitive function improved as a result of decreased disorganization, thus counteracting the expected transient memory impairment often seen with ECT.”

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