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ECT in schizophrenia: a review of the evidence

Published online by Cambridge University Press:  03 December 2018

Sandeep Grover*
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Swapnajeet Sahoo
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Anjumoni Rabha
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Raman Koirala
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
*
Author for correspondence: Sandeep Grover, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail: drsandeepg2002@yahoo.com

Abstract

Electroconvulsive therapy (ECT) was initially used for the treatment of schizophrenia, but over the years with the advent of antipsychotics, its use in schizophrenia has been limited. Treatment guidelines vary in their recommendations for the use of ECT in schizophrenia. The usual indications of its use among patients with schizophrenia include treatment resistance, to augment pharmacotherapy, to manage catatonia, suicidal behaviour, severe agitation and clozapine-resistant schizophrenia. Available literature, including meta-analysis and systematic reviews, suggest that ECT is a safe and effective treatment in patients with schizophrenia. However, despite the available evidence, it is highly underutilised and is often used as one of the last resort among patients with schizophrenia. This review focuses on the indications of use of ECT in schizophrenia, studies evaluating its effectiveness, efficacy in certain special situations like first episode schizophrenia, adolescents, catatonia etc., predictors of response to ECT in schizophrenia and influence of various ECT-related parameters on efficacy/effectiveness among patients with schizophrenia. From the review, it can be concluded that ECT is not only is beneficial as an augmenting strategy in treatment-resistant schizophrenia but also can be used effectively in patients with schizophrenia in various other situations.

Type
Review Article
Copyright
© Scandinavian College of Neuropsychopharmacology 2018 

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References

1. Pagnin, D, DeQueiroz, V, Pini, S and Cassano, GB (2004) Efficacy of ECT in depression: a meta-analytic review. J ECT 20, 1320.Google Scholar
2. Kellner, CH, Fink, M, Knapp, R, Petrides, G, Husain, M, Rummans, T, Mueller, M, Bernstein, H, Rasmussen, K, O’connor, K, Smith, G, Rush, AJ, Biggs, M, McClintock, S, Bailine, S Malur, C (2005) Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry 162, 977982.Google Scholar
3. Cerletti, U (1950) Old and new information about electroshock. Am J Psychiatry 107, 8794.Google Scholar
4. Swartz, CM (2009) Electroconvulsive and Neuromodulation Therapies. New York: Cambridge University Press.Google Scholar
5. Thompson, JW and Blaine, JD (1987) Use of ECT in the United States in 1975 and 1980. Am J Psychiatry 144, 557562.Google Scholar
6. Runck, B (1985) NIMH report. Consensus panel backs cautious use of ECT for severe disorders. Hosp Community Psychiatry 36, 943946.Google Scholar
7. Leiknes, KA, Jarosh-von Schweder, L and Høie, B (2012) Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav 2, 283344.Google Scholar
8. Xiang, Y-T, Ungvari, GS, Correll, CU, Chiu, HF, Lai, KY, Wang, CY, Si, TM, Lee, EH, He, YL, Yang, SY, Chong, MY, Kua, EH, Fujii, S, Sim, K, Yong, MK, Trivedi, JK, Chung, EK, Udomratn, P, Chee, KY, Sartorius, N, Tan, CH and Shinfuku, N (2015) Use of electroconvulsive therapy for Asian patients with schizophrenia (2001–2009): trends and correlates. Psychiatry Clin Neurosci 69, 489496.Google Scholar
9. American Psychiatric Association (2001) The Practice of ECT: Recommendations for Treatment, Training and Privileging, 2nd ed. Washington DC: American Psychiatric Press.Google Scholar
10. National Institute for Clinical Excellence (2003) Guidance on the use of electroconvulsive therapy. Technology Appraisal 59. London: NICE.Google Scholar
11. Scott, AIF (2005) The ECT Handbook: The Third Report of the Royal College of Psychiatrists’ Special Committee of ECT. RCPsych Publications.Google Scholar
12. Lehman, AF, Lieberman, JA, Dixon, LB, McGlashan, TH, Miller, AL, Perkins, DO and Kreyenbuhl, J (2004) American Psychiatric Association; Steering Committee on Practice Guidelines. Comment in Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry, 161:156.Google Scholar
13. Galletly, C, Castle, D, Dark, F, Humberstone, V, Jablensky, A, Killackey, E, Kulkarni, J, McGorry, P, Nielssen, O and Tran, N (2016) Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 50, 410472.Google Scholar
14. Grover, S, Chakrabarti, S, Kulhara, P and Avasthi, A (2017) Clinical Practice Guidelines for Management of Schizophrenia. Indian J Psychiatry 59, S19S33.Google Scholar
15. Pompili, M, Lester, D, Dominici, G, Longo, L, Marconi, G, Forte, A, Serafini, G, Amore, M and Girardi, P (2013) Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res 146, 19.Google Scholar
16. Tharyan, P and Adams, CE (2005) Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev 18, (2): CD000076.Google Scholar
17. Painuly, N and Chakrabarti, S (2006) Combined use of electroconvulsive therapy and antipsychotics in schizophrenia: the Indian evidence. A review and a meta-analysis. J ECT 22, 5966.Google Scholar
18. Agarwal, A and Winny, GC (1985) Role of ECT phenothiazine combination in schizophrenia. Indian J Psychiatry 27, 233236.Google Scholar
19. Wang, W, Pu, C, Jiang, J, Cao, X, Wang, J, Zhao, M LI, C (2015) Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis. Shanghai Arch Psychiatry 27, 206219.Google Scholar
20. Zheng, W, Cao, X-L, Ungvari, GS, Xiang, YQ, Guo, T, Liu, ZR, Wang, YY, Forester, BP9, Seiner, SJ and Xiang, YT (2016) Electroconvulsive therapy added to non-clozapine antipsychotic medication for treatment resistant schizophrenia: meta-analysis of randomized controlled trials. PLOS ONE 11, e0156510.Google Scholar
21. Zheng, W, Xiang, Y-Q, Ungvari, GS, Ng, CH, Chiu, HF, Liu, ZR, Cao, XL, Guo, T, Wang, HH, Seiner, SJ and Xiang, YT (2016) Electroconvulsive therapy alone for schizophrenia: a meta-analysis of randomized, single-blind, controlled trials [RETRACTED]. J ECT Published Online First: 03. https://doi.org/10.1097/YCT.0000000000000319.Google Scholar
22. Lally, J, Tully, J, Robertson, D, Stubbs, B, Gaughran, F and MacCabe, JH (2016) Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: a systematic review and meta-analysis. Schizophr Res 171, 215224.Google Scholar
23. Grover, S, Hazari, N and Kate, N (2015) Combined use of clozapine and ECT: a review. Acta Neuropsychiatr 27, 131142.Google Scholar
24. Grover, S, Chakrabarti, S, Hazari, N and Avasthi, A (2017) Effectiveness of electroconvulsive therapy in patients with treatment resistant schizophrenia: a retrospective study. Psychiatry Res 249, 349353.Google Scholar
25. Petrides, G, Malur, C and Braga, RJ et al. (2015) Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry 172, 5258.Google Scholar
26. Miller, DH, Clancy, J and Cumming, E (1953) A comparison between unidirectional current nonconvulsive electrical stimulation given with Reiter’s machine, standard alternating current electro-shock (Cerletti method), and pentothal in chronic schizophrenia. Am J Psychiatry 109, 617620.Google Scholar
27. England, ML, Öngür, D, Konopaske, GT and Karmacharya, R (2011) Catatonia in psychotic patients: clinical features and treatment response. J Neuropsychiatry ClinNeurosci 23, 223226.Google Scholar
28. Girish, K and Gill, NS (2003) Electroconvulsive therapy in lorazepam non-responsive catatonia. Indian J Psychiatry 45, 2125.Google Scholar
29. Taylor, P and Fleminger, JJ (1980) ECT for schizophrenia. Lancet 1, 13801382.Google Scholar
30. Brandon, S, Cowley, P, McDonald, C, Neville, P, Palmer, R and Wellstood-Eason, S (1985) Leicester ECT trial: results in schizophrenia. Br J Psychiatry 146, 177183.Google Scholar
31. Witton, K (1962) Efficacy of ECT following prolonged use of psychotropic drugs. Am J Psychiatry 119, 79.Google Scholar
32. Smith, K, Surphlis, W, Gynther, M and Shimkunas, A (1967) ECT-chlorpromazine and chlorpromazine compared in the treatment of schizophrenia. J Nerv Ment Dis 144, 284290.Google Scholar
33. Johns, CA and Thompson, JW (1995) Adjunctive treatments in schizophrenia: pharmacotherapies and electroconvulsive therapy. Schizophr Bull 21, 607619.Google Scholar
34. Chanpattana, W and Chakrabhand, ML (2001) Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia: prediction of outcome. Psychiatry Res 105, 107115.Google Scholar
35. Sarkar, P, Andrade, C, Kapur, B, Das, P, Sivaramakrishna, Y, Harihar, C, Pandey, A, Anand, A and Dharmendra, MS (1994) An exploratory evaluation of ECT in haloperidol-treated DSM-IIIR schizophreniform disorder. Convuls Ther 10, 271278.Google Scholar
36. Zhang, Z-J, Chen, Y-C, Wang, H-N, Wang, HH, Xue, YY, Feng, SF and Tan, QR (2012) Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis–a case-control study. Schizophr Res 13, 97103.Google Scholar
37. Adhikari, S (2014) Electroconvulsive therapy in first episode schizophrenia – experiences from Nepal. J Psychiatrists’ Assoc Nepal 3, 3540.Google Scholar
38. Uçok, A and Cakir, S (2006) Electroconvulsive therapy in first-episode schizophrenia. J ECT 22, 3842.Google Scholar
39. Suzuki, K, Awata, S, Takano, T, Ebina, Y, Takamastu, K, kajiwara, T, Ito, K, Shindo, T, Funakoshi, S and Matsuoka, (2006) Improvement of psychiatric symptoms after electroconvulsive therapy in young adults with intractable first-episode schizophrenia and schizophreniform disorder. Tohoku J Exp Med 210, 213220.Google Scholar
40. Flamarique, I, Castro-Fornieles, J, Garrido, JM, de la Serna, E, Pons, A, Bernardo, M and Baeza, I (2012) Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination? J ClinPsychopharmacol 32, 756766.Google Scholar
41. Grover, S, Malhotra, S, Varma, S, Chakrabarti, S, Avasthi, A and Mattoo, SK (2013) Electroconvulsive therapy in adolescents: a retrospective study from north India. J ECT 29, 122126.Google Scholar
42. Chanpattana, W (2000) Maintenance ECT in treatment-resistant schizophrenia. J Med Assoc Thai 83, 657662.Google Scholar
43. Zervas, IM, Theleritis, C and Soldatos, CR (2012) Using ECT in schizophrenia: a review from a clinical perspective. World J Biol Psychiatry 13, 96105.Google Scholar
44. Andrade, C and Kurinji, S (2002) Continuation and maintenance ECT: a review of recent research. J ECT 18, 149158.Google Scholar
45. Lévy-Rueff, M, Gourevitch, R, Lôo, H, Olié, J-P and Amado, I (2010) Maintenance electroconvulsive therapy: An alternative treatment for refractory schizophrenia and schizoaffective disorders. Psychiatry Res 175, 280283.Google Scholar
46. Chanpattana, W, Chakrabhand, ML, Sackeim, HA, Kitaroonchai, W, Kongsakon, R, Techakasem, P, Buppanharun, W, Tuntirungsee, Y and Kirdcharoen, N (1999) Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT 15, 178192.Google Scholar
47. Suzuki, K, Awata, S, Takano, T, Ebina, Y, Iwasaki, H and Matsuoka, H (2005) Continuation electroconvulsive therapy for relapse prevention in middle-aged and elderly patients with intractable catatonic schizophrenia. Psychiatry Clin Neurosci 59, 481489.Google Scholar
48. Koehler, K and Sauer, H (1983) First rank symptoms as predictors of ECT response in schizophrenia. Br J Psychiatry 142, 280283.Google Scholar
49. Chanpattana, W and Sackeim, HA (2010) Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT 26, 289298.Google Scholar
50. Pawełczyk, T, Kołodziej-Kowalska, E, Pawełczyk, A and Rabe-Jabłońska, J (2014) Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms. Psychiatry Res 220, 175180.Google Scholar
51. Hustig, H and Onilov, R (2009) ECT rekindles pharmacological response in schizophrenia. Eur Psychiatry 24, 521525.Google Scholar
52. Suzuki, K, Awata, S and Matsuoka, H (2004) One-year outcome after response to ECT in middle-aged and elderly patients with intractable catatonic schizophrenia. J ECT 20, 99106.Google Scholar
53. Shibasaki, C, Takebayashi, M, Fujita, Y and Yamawaki, S (2015) Factors associated with the risk of relapse in schizophrenic patients after a response to electroconvulsive therapy: a retrospective study. Neuropsychiatr Dis Treat 11, 6773.Google Scholar
54. El-Islam, M, Ahmed, S and Erfan, M (1970) The effect of unilateral ECT on schizophrenic delusions and hallucinations. Br J Psychiatry 117, 447448.Google Scholar
55. Wessels, W (1972) A comparative study of the efficacy of bilateral and unilateral electroconvulsive therapy with thioridazine in acute schizophrenia. S Afr Med J 46, 890892.Google Scholar
56. Doongaji, D, Jeste, D, Saoji, N, Kane, P and Ravindranath, S (1973) Unilateral versus bilateral ECT in schizophrenia. Br J Psychiatry 123, 7379.Google Scholar
57. Bagadia, V, Abhyankar, R, Pradhan, P and Shah, L (1988) Reevaluation of ECT in schizophrenia: right temporoparietal versus bitemporal electrode placement. Convulsive Ther 4, 215220.Google Scholar
58. Phutane, VH, Thirthalli, J, Muralidharan, K, Naveen Kumar, C, Keshav Kumar, J and Gangadhar, BN (2013) Double-blind randomized controlled study showing symptomatic and cognitive superiority of bifrontal over bitemporal electrode placement during electroconvulsive therapy for schizophrenia. Brain Stimul 6, 210217.Google Scholar
59. Chanpattana, W, Chakrabhand, ML, Buppanharun, W and Sackeim, HA (2000) Effects of stimulus intensity on the efficacy of bilateral ECT in schizophrenia: a preliminary study. Biol Psychiatry 48, 222228.Google Scholar
60. Thirthalli, J, Kumar, CN, Bangalore, RP and Gangadhar, BN (2009) Speed of response to threshold and suprathreshold bilateral ECT in depression, mania and schizophrenia. J Affect Disord 117, 104107.Google Scholar
61. Chanpattana, W, Kitaroonchai, W, Prasertsuk, Y, Chakrabhand, ML and Choovanichvong, S (1999) Effects of twice versus thrice weekly electroconvulsive therapy in schizophrenia. J Med Assoc Thai 82, 477482.Google Scholar
62. Datto, CJ (2000) Side effects of electroconvulsive therapy. Depress Anxiety 12, 130134.Google Scholar
63. Kim, HS, Kim, SH, Lee, NY, Youn, T, Lee, JH, Chung, S, Kim, YS and Chung, IW (2017) Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia. Psychiatry Investig, 14, 5862.Google Scholar
64. Taylor, DM, Smith, L, Gee, SH and Nielsen, J (2012) Augmentation of clozapine with a second antipsychotic - a meta-analysis. ActaPsychiatrScand 125, 1524.Google Scholar
65. Tiihonen, J, Wahlbeck, K and Kiviniemi, V (2009) The efficacy of lamotrigine in clozapine-resistant schizophrenia: a systematic review and meta-analysis. Schizophr Res 109, 1014.Google Scholar
66. Rogóż, Z (2013) Combined treatment with atypical antipsychotics and antidepressants in treatment-resistant depression: preclinical and clinical efficacy. Pharmacol Rep 65, 15351544.Google Scholar
67. Tsai, GE and Lin, P-Y (2010) Strategies to enhance N-methyl-D-aspartate receptor-mediated neurotransmission in schizophrenia, a critical review and meta-analysis. Curr Pharm Des 16, 522537.Google Scholar
68. Ogino, S, Miyamoto, S, Miyake, N and Yamaguchi, N (2014) Benefits and limits of anticholinergic use in schizophrenia: focusing on its effect on cognitive function. Psychiatry Clin Neurosci 68, 3749.Google Scholar
69. Chew, ML, Mulsant, BH and Pollock, BG et al. (2006) A model of anticholinergic activity of atypical antipsychotic medications. Schizophr Res 88, 6372.Google Scholar
70. Henstra, MJ, Jansma, EP, Van derVelde, N, Swart, EL, Stek, ML and Rhebergen, D (2017) Acetylcholinesterase inhibitors for electroconvulsive therapy-induced cognitive side effects: a systematic review. Int J Geriatr Psychiatry 32, 522531.Google Scholar
71. Pompili, M, Lester, D, Dominici, G, Longo, L, Marconi, G, Forte, A, Serafini, G, Amore, M and Girardi, P (2013) Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res 146, 19.Google Scholar
72. Taylor, P and Fleminger, JJ (1980) ECT for schizophrenia. Lancet 1, 13801382.Google Scholar
73. Brandon, S, Cowley, P, McDonald, C, Neville, P, Palmer, R and Wellstood-Eason, S (1985) Leicester ECT trial: results in schizophrenia. Br J Psychiatry 146, 177183.Google Scholar
74. Abrams, R (1967) Daily Administration of Unilateral ECT. AJP 124, 384386.Google Scholar
75. Petrides, G, Malur, C, Braga, RJ, Bailine, SH, Schooler, NR, Malhotra, AK, Kane, JM, Sanghani, S, Goldberg, TE, John, M and Mendelowitz, A (2015) Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry 172, 5258.Google Scholar
76. Grover, S, Hazari, N, Chakrabarti, S and Avasthi, A. Augmentation of Clozapine with ECT: Observations from India. 2015. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14091170 (accessed 21 Jul 2018).Google Scholar
77. Kim, HS, Kim, SH, Lee, NY, Youn, T, Lee, JH, Chung, S, Kim, YS and Chung, IW (2017) Effectiveness of electroconvulsive therapy augmentation on clozapine-resistant schizophrenia. Psychiatry Investig 14, 5862.Google Scholar
78. Sarkar, P, Andrade, C, Kapur, B, Das, P, Sivaramakrishna, Y, Harihar, C, Pandey, A, Anand, A and Dharmendra, MS (1994) An exploratory evaluation of ECT in haloperidol-treated DSM-IIIR schizophreniform disorder. ConvulsTher 10, 271278.Google Scholar
79. Fink, M and Sackeim, HA (1996) Convulsive therapy in schizophrenia? Schizophr Bull 22, 2739.Google Scholar
80. Uçok, A and Cakir, S (2006) Electroconvulsive therapy in first-episode schizophrenia. J ECT 22, 3842.Google Scholar
81. Zhang, Z-J, Chen, Y-C, Wang, H-N, Wang, HH, Xue, YY, Feng, SF and Tan, QR (2012) Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis–a case-control study. Schizophr Res 137, 97103.Google Scholar
82. Adhikari, SR (2014) Electroconvulsive therapy in first episode schizophrenia – experiences from Nepal. J Psychiatrists’ Association of Nepal 3, 3540.Google Scholar
83. England, ML, Ongür, D, Konopaske, GT and Karmacharya, R (2011) Catatonia in psychotic patients: clinical features and treatment response. J Neuropsychiatry Clin Neurosci 23, 223226.Google Scholar
84. Miller, DH, Clancy, J and Cumming, E (1953) A comparison between unidirectional current nonconvulsive electrical stimulation given with Reiter’s machine, standard alternating current electro-shock (Cerletti method), and pentothal in chronic schizophrenia. Am J Psychiatry 109, 617620.Google Scholar
85. Rey, J and Walter, G (1997) Half a century of ECT use in young people. AJP 154, 595602.Google Scholar
86. Chanpattana, W (2000) Maintenance ECT in treatment-resistant schizophrenia. J Med Assoc Thai 83, 657662.Google Scholar
87. Chanpattana, W, Chakrabhand, ML, Sackeim, HA, Kitaroonchai, W, Kongsakon, R, Techakasem, P, Buppanharun, W, Tuntirungsee, Y and Kirdcharoen, N (1999) Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT 15, 178192.Google Scholar
88. Lévy-Rueff, M, Gourevitch, R, Lôo, H, Olié, J-P and Amado, I (2010) Maintenance electroconvulsive therapy: an alternative treatment for refractory schizophrenia and schizoaffective disorders. Psychiatry Res 175, 280283.Google Scholar
89. Shibasaki, C, Takebayashi, M, Fujita, Y and Yamawaki, S (2015) Factors associated with the risk of relapse in schizophrenic patients after a response to electroconvulsive therapy: a retrospective study. Neuropsychiatr Dis Treat 11, 6773.Google Scholar