Skip to main navigation menu Skip to main content Skip to site footer

No. 2 (2024)

PSYCHOPHARMACOTHERAPY

Contemporary View on the Effectiveness of Electroconvulsive Therapy in the Treatment of Patients with Schizophrenia

https://doi.org/10.21265/PSYPH.2024.31.31.002

Published 2024-06-30

  • D.I. Malin

D.I. Malin
Moscow Research Institute of Psychiatry — branch of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation

Abstract

This review provides an analysis of contemporary publications on the issue of the effectiveness of electroconvulsive therapy (ECT) in the treatment of patients with schizophrenia. It has been established that ECT in combination with antipsychotic drugs is an effective and safe method of treating patients with treatment-resistant forms of schizophrenia, including resistance to clozapine. The greatest effect is achieved when ECT is performed during treatment with high doses of clozapine. Among second-generation antipsychotics, combination therapy with olanzapine showed greater effectiveness. Continuation of maintenance ECT in remission can reduce the number of disease relapses from 90 to 40%. Bilateral bitemporal and bifrontal ECT are most often used in the treatment of patients with schizophrenia; the latter is equally effective but causes less cognitive impairment. The influence of such parameters as power and pulse configuration on the effectiveness and safety of ECT remains unclear, which requires further study.

Keywords

electroconvulsive therapy, treatment-resistant schizophrenia, antipsychotics in combination with electroconvulsive therapy, clozapine in combination with electroconvulsive therapy

PDF (Русский)

References

  1. Мосолов С.Н. Некоторые актуальные теоретические проблемы диагностики, классификации, нейробиологии и терапии шизофрении: сравнение зарубежного и отечественного подходов // Журнал неврологии и психиатрии имени C.C. Корсакова. – 2010. – Т. 110, № 6. – С. 4–11.
  2. Saha S., Chant D., Welham J., McGrath J. A systematic review of the prevalence of schizophrenia // PLoS Med. – 2005. – Vol. 2 (5). – e141. – https://doi.org/10.1371/journal.pmed.0020141
  3. McGrath J., Saha S., Chant D., Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality // Epidemiol Rev. – 2008. – Vol. 30. – Pp. 67–76. – https://doi.org/10.1093/epirev/mxn001
  4. Мосолов С.Н., Цукарзи Э.Э. Психофармакотерапия. Шизофрения // Психиатрия: национальное руководство / под ред. Ю.А. Александровского, Н.Г. Незнанова. – М.: ГЭОТАР-Медиа, 2018. – С. 299–328.
  5. Hasan A., Falkai P., Wobrock T., Lieberman J. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance // World J Biol Psychiatry. – 2012. – Vol. 13. – Pp. 318–378. – https://doi.org/10.3109/15622975.2012.696143
  6. Nucifora F.C., Jr, Woznica E., Lee B.J. et al. Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives // Neurobiol Dis. – 2019. – Vol. 131. – Art. 104257. – https://doi.org/10.1016/j.nbd.2018.08.016
  7. Correll C.U., Howes O.D. Treatment-Resistant Schizophrenia: Definition, Predictors, and Therapy Options // J Clin Psychiatry. – 2021. – Vol. 82 (5). – Art. MY20096AH1C. – https://doi.org/10.4088/JCP.MY20096AH1C
  8. Kane J.M., Correll C.U. The Role of Clozapine in Treatment-Resistant Schizophrenia // JAMA Psychiatry. – 2016. – Vol 73 (3). – Pp. 187–188. – https://doi.org/10.1001/jamapsychiatry.2015.2966
  9. Samara M.T., Dold M., Gianatsi M. et al. Efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia: A network meta-analysis // JAMA Psychiatry. – 2016. – Vol. 73 (3). – Pp. 199–210. – https://doi.org/10.1001/jamapsychiatry.2015.2955
  10. Nucifora F.C., Jr, Woznica E., Lee B.J. et al. Treatment resistant schizophrenia: Clinical, biological, and therape.utic perspectives // Neurobiol Dis. – 2019. – Vol. 131. – Art. 104257. – https://doi.org/10.1016/j.nbd.2018.08.016
  11. Кирилочев О.О. Осложнения терапии клозапином: актуализация информации // Современная терапия психических расстройств. – 2023. – № 3. – С. 12–20. – https://doi.org/10.21265/PSYPH.2023.11.37.002
  12. Кекелидзе З.И., Мосолов С.Н., Цукарзи Э.Э., Оленева Е.В. Применение электросудорожной терапии в психиатрической практике. Учебно-методическое пособие для врачей. – М., 2019. – 32 с.
  13. Мосолов С.Н., Егоров А.Ю., Скоромец Т.А. и др. Нелекарственные методы биологической терапии в психиатрии // Психиатрия: национальное руководство под ред. Ю.А. Александровского, Н.Г. Незнанова. – М.: ГЭОТАР-Медиа, 2018. – С. 952–995.
  14. Малин Д.И., Малина Д.Д. Синдром фебрильной кататонии при критических состояниях в психиатрии // Социальная и клиническая психиатрия. – 2019. – № 1. – С. 82–90.
  15. Kaliora S.C., Zervas I.M., Papadimitriou G.N. Electroconvulsive therapy: 80 years of use in psychiatry // Psychiatriki. – 2018. – Vol. 29 (4). – Pp. 291–302. – https://doi.org/10.22365/jpsych.2018.294.291
  16. Meduna L. Versuche über die biologische Beeinflussung des Ablaufes der Schizophrenia, I: Campher- und Cardiazolkrämpfe // Zeitschr Gesamte Neurolog Psychiatr. – 1935. – Vol. 152. – S. 235–262.
  17. Fink M. Meduna and the origins of convulsive therapy // Am J Psychiatry. – 1984. – Vol. 141 (9). – Pp. 1034–1041. – https://doi.org/10.1176/ajp.141.9.1034
  18. Singh A., Kar S.K. How Electroconvulsive Therapy Works? Understanding the Neurobiological Mechanisms // Clin Psychopharmacol Neurosci. – 2017. – Vol. 15 (3). – Pp. 210– 221. – https://doi.org/10.9758/cpn.2017.15.3.210
  19. Belge J.B., Constant E. Les effets neuroplastiques de la sismothérapie [The neuroplastic effects of electroconvulsive therapy] // Rev Med Liege. – 2022. – Vol. 77 (9). – Pp. 527–531.
  20. Ousdal O.T., Brancati G.E., Kessler U. et al The neurobiological effects of electroconvulsive therapy studied through magnetic resonance: What have we learned, and where do we go? // Biological Psychiatry. – 2022. – Vol. 91 (6). – Pp. 540–549. – https://doi.org/10.1016/j.biopsych.2021.05.023
  21. Ali S.A., Mathur N., Malhotra A.K, Braga R.J. Electroconvulsive Therapy and Schizophrenia: A Systematic Review // Mol Neuropsychiatry. – 2019. – Vol. 5 (2). – Pp. 75–83. – https://doi.org/10.1159/000497376
  22. Sinclair D.J., Zhao S., Qi F., Nyakyoma K. et al. Electroconvulsive therapy for treatment-resistant schizophrenia // Cochrane Database Syst Rev. – 2019. – Vol. 3 (3). – CD011847. – https://doi.org/10.1002/14651858.CD011847.pub2
  23. Taylor P., Fleminger J.J. ECT for schizophrenia // Lancet. – 1980. – Vol. 28 (8183). – Pp. 1380–1282. – https://doi.org/10.1016/s0140-6736(80)92653-7
  24. Tharyan P., Adams C.E. Electroconvulsive therapy for schizophrenia // Cochrane Database Syst Rev. – 2005. – Apr (2). – CD000076. – https://doi.org/10.1002/14651858.CD000076.pub2
  25. Janakiramaiah N., Channabasavanna S.M., Murthy N.S. ECT/chlorpromazine combination versus chlorpromazine alone in acutely schizophrenic patients // Acta Psychiatr Scand. – 1982. – Vol. 66 (6). – Pp. 464–470. – https://doi.org/10.1111/j.1600-0447.1982.tb04504.x
  26. Goswami U., Kumar U., Singh B. Efficacy of Electroconvulsive Therapy in Treatment Resistant Schizophreinia : A double-blind study // Indian J Psychiatry. – 2003. – Vol. 45 (1). – Pp. 26–29.
  27. Agarwal A., Winny G.C. Role of ECT-Phenothiazine combination in schizophrenia // Indian J Psychiatry. – 1985. – Vol. 27 (3). – Pp. 233–236.
  28. Brandon S., Cowley P., McDonald C. et al. Leicester ECT trial: results in schizophrenia // Br J Psychiatry. – 1985. – Vol.146. – Pp. 177–183. – https://doi.org/10.1192/bjp.146.2.177
  29. Abraham K.R., Kulhara P. The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study // Br J Psychiatry. – 1987. – Vol. 151. – Pp. 152– 155. – https://doi.org/10.1192/bjp.151.2.152
  30. Sarkar P., Andrade C., Kapur B. et al. An exploratory evaluation of ECT in haloperidol-treated DSM-IIIR schizophreniform disorder // Convuls Ther. – 1994. – Vol. 10 (4). – Pp. 271–278.
  31. Saha S., Chant D., Welham J., McGrath J. A systematic review of the prevalence of schizophrenia // PLoS Med. – 2005. – Vol. 2 (5). – e141. – https://doi.org/10.1371/journal.pmed.0020141
  32. Ukpong D.I., Makanjuola R.O., Morakinyo O. A controlled trial of modified electroconvulsive therapy in schizophrenia in a Nigerian teaching hospital // West Afr J Med. – 2002. – Vol. 21 (3). – Pp. 237–240. – https://doi.org/10.4314/wajm.v21i3.28039
  33. Chanpattana W., Chakrabhand M.L., Sackeim H.A. et al. Continuation ECT in treatment-resistant schizophrenia: a controlled study // J ECT. – 1999. – Vol. 15 (3). – Pp. 178–192.
  34. Fink M. ECT and clozapine in schizophrenia // J ECT. – 1998. – Vol. 14 (4). – Pp. 223–226.
  35. Masoudzadeh A., Khalilian A.R. Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients // Pak J Biol Sci. – 2007. – Vol. 10 (23). – Pp. 4287–4290. – https://doi.org/10.3923/pjbs.2007.4287.4290
  36. Kim H.S., Kim S.H., Lee N.Y. et al. Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia // Psychiatry Investig. – 2017. – Vol. 14 (1) – Pp. 58–62. – https://doi.org/10.4306/pi.2017.14.1.58
  37. Ahmed S., Khan A.M., Mekala H.M. et al. Combined use of electroconvulsive therapy and antipsychotics (both clozapine and non-clozapine) in treatment resistant schizophrenia: A comparative meta-analysis // Heliyon. – 2017. – Vol. 3 (11). – e00429. – https://doi.org/10.1016/j.heliyon.2017.e00429
  38. Lally J., Tully J., Robertson D. et al. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis // Schizophr Res. – 2016. – Vol. 171 (1–3). – Pp. 215–224. – https://doi.org/10.1016/j.schres.2016.01.024
  39. Masoudzadeh A., Khalilian A.R. Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients // Pak J Biol Sci. – 2007. – Vol. 10 (23). – Pp. 4287–4290. – https://doi.org/10.3923/pjbs.2007.4287.4290
  40. Petrides G., Malur C., Braga R.J. et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study // Am J Psychiatry. – 2015. – Vol. 172 (1). – Pp. 52–58. – https://doi.org/10.1176/appi.ajp.2014.13060787
  41. Wang G., Zheng W., Li X.B. et al. ECT augmentation of clozapine for clozapine-resistant schizophrenia: A meta-analysis of randomized controlled trials // J Psychiatr Res. – 2018. – Vol. 105. – Pp. 23–32. – https://doi.org/10.1016/j.jpsychires.2018.08.002
  42. Gu X., Zheng W., Guo T. et al. Electroconvulsive Therapy for Agitation in Schizophrenia: Metaanalysis of Randomized Controlled Trials // Shanghai Arch Psychiatry. – 2017. – Vol. 29 (1). – Pp. 1–14. – https://doi.org/10.11919/j.issn.1002-0829.217003
  43. Lin H.T., Liu S.K., Hsieh M.H. et al. Impacts of electroconvulsive therapy on 1-year outcomes in patients with schizophrenia: A controlled, population-based mirror-image study // Schizophr Bull. – 2018. – Vol. 44 (4). – Pp. 798–806. – https://doi.org/10.1093/schbul/sbx136
  44. Zheng W., Cao X.L, Ungvari G.S. Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials // PLoS One. – 2016. – Vol. 1 (6). – e0156510. – https://doi.org/10.1371/journal.pone.0156510
  45. Ravanić D.B., Pantović M.M., Milovanović D.R. et al. Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia // Psychiatr Danub. – 2009. – Vol. 21 (2). – Pp. 179–186.
  46. Оленева Е.А., Цукарзи Э.Э., Мосолов С.Н. Комбинированное применение ЭСТ и атипичных антипсихотиков у больных шизофренией, резистентных к терапии // Социальная и клиническая психиатрия. – 2007. – № 4. – С. 28–33.
  47. Оленева Е.В., Цукарзи Э.Э., Мосолов С.Н. Прогноз эффективности комбинированного применения ЭСТ и атипичных антипсихотиков дибензодиазепинового ряда у резистентных к фармакотерапии больных шизофренией // Биологические методы терапии психических расстройств (доказательная медицина клинической практике) / под ред. С.Н. Мосолова. – М.: Социально-политическая мысль, 2012. – С. 1001–1014.
  48. Gannon L., Reynolds J., Mahon M. et al. High-dose olanzapine in treatment-resistant schizophrenia: A systematic review // Ther Adv Psychopharmacol. – 2023. – Vol. 13. – e20451253231168788. – https://doi.org/10.1177/20451253231168788
  49. Rabheru K. Maintenance electroconvulsive therapy (M-ECT) after acute response: examining the evidence for who, what, when, and how? // J ECT. – 2012. – Vol. 28 (1). – Pp. 39–47. – https://doi.org/10.1097/YCT.0b013e3182455758
  50. Yang Y., Cheng X., Xu Q. et al. The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function // Arq Neuropsiquiatr. – 2016. – Vol. 74 (10). – Pp. 823–828. – https://doi.org/10.1590/0004-282X20160130.
  51. Isserles M., Remington J., Kaster T.S. et al.Clinical Effectiveness of Maintenance Electroconvulsive Therapy in Patients with Schizophrenia: A Retrospective Cohort Study // J ECT. – 2020. – Vol. 36 (1). – Pp. 42-46. – https://doi.org/10.1097/YCT.0000000000000613
  52. Wessels WH. A comparative study of the efficacy of bilateral and unilateral electroconvulsive therapy with thioridazine in acute schizophrenia // S Afr Med J. – 1972. – Vol. 46 (26). – Pp. 890–892
  53. Kumar C., Keshav Kumar J., Gangadhar B.N. Double-blind randomized controlled study showing symptomatic and cognitive superiority of bifrontal over bitemporal electrode placement during electroconvulsive therapy for schizophrenia // Brain Stimul. – 2013. – Vol. 6 (2). – Pp. 210–217. – https://doi.org/10.1016/j.brs.2012.04.002
  54. Bansod A., Sonavane S.S., Shah N.B. et al. Randomized, Nonblind, Naturalistic Comparison of Efficacy and Cognitive Outcomes With Right Unilateral, Bifrontal, and Bitemporal Electroconvulsive Therapy in Schizophrenia // J ECT. – 2018. – Vol. 34 (1). – Pp. 26–30. – https://doi.org/10.1097/YCT.0000000000000454
  55. Tor P.C., Ying J., Ho N.F. et al. Effectiveness of Electroconvulsive Therapy and Associated Cognitive Change in Schizophrenia: A Naturalistic, Comparative Study of Treating Schizophrenia With Electroconvulsive Therapy // J ECT. – 2017. – Vol. 33 (4). – Pp. 272– 277. – https://doi.org/10.1097/YCT.0000000000000422
  56. Pisvejc J., Hyrman V., Sikora J, et al. A comparison of brief and ultrabrief pulse stimuli in unilateral ECT // J ECT. – 1998. – Vol. 14 (2). – Pp. 68–75.

Downloads

Download data is not yet available.