Electroconvulsive Therapy for Treatment-Resistant Schizophrenia

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

Schizophr Bull. 2019;45(4):730-732.

Background

Electroconvulsive therapy (ECT) involves the induction of a seizure by the administration of an electrical stimulus via electrodes usually placed bilaterally on the scalp and was introduced as a treatment for schizophrenia in 1938. However, ECT is a controversial treatment with concerns about long-term side effects such a memory loss. Therefore, it is important to determine its clinical efficacy and safety for people with schizophrenia who are not responding to their treatment.

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Table 1. Summary of Findings: ECT Plus Standard Care Vs Standard Care for Treatment-Resistant Schizophrenia
Outcomes	Anticipated Absolute Effects^a (95% CI)		Relative Effect (95% CI)	No. of Participants (Studies)	Quality of the Evidence (GRADE)	Comments
Patient or population:people with treatment-resistant schizophrenia Settings: hospital Intervention: ECT plus standard care Comparison:standard care
	Risk With Placebo (No Treatment)	Risk With ECT (Add-on)
Response to treatment (medium term) Clinically important response to treatment as defined by each study Follow-up: 8–12 weeks	308 per 1000	635 per 1000 (539 to 746)	RR 2.06 (1.75 to 2.42)	819 (9 studies)	⊕⊕⊕⊖ moderate^b
Cognitive functioning (short term)—memory deterioration Follow-up: 3–4 weeks	0 per 1000	13 per 1000(1 to 219)	RR 27(1.67 to 437.68)	72 (1 study)	⊕⊖⊖⊖ very low^b,c,d	Data for predefined outcome "clinically important change" not reported
Satisfaction and acceptability of treatment (medium term)—leaving the study early Follow-up: 8–12 weeks	23 per 1000	27 per 1000 (9 to 82)	RR 1.18 (0.38 to 3.63)	354 (3 studies)	⊕⊖⊖⊖ very low^a,d
Mental state (medium term)—total scores (BPRS, high = poor) Follow-up: 8–12 weeks	The mean mental state—average scores (BPRS, high = poor, medium term) was 33.4	MD 11.18 lower(12.61–9.76 lower)	—	345 (2 studies)	⊕⊕⊖⊖Low ^b,c	Data for predefined outcome "clinically important change" not reported
General functioning (medium term)—average scores (GAF, high = good) Follow-up: 12 weeks–6 months	The mean mental state—average scores (GAF, high = good, medium term) was 47.3.	MD 10.66 higher(6.98–14.34 higher)	—	97 (2 studies)	⊕⊖⊖⊖ very low ^b,c,e,f	Data for predefined outcome "clinically important change" not reported
Service use—hospitalization	See comment	See comment	See comment	See comment	See comment	No studies reported this outcome, so there is no evidence to support or refute benefits of the intervention.
Adverse event/effect(s)—death	See comment	See comment	See comment	See comment	See comment	No studies reported this outcome, so there is no evidence to support or refute benefits of the intervention
*

Note: BPRS, Brief Psychiatric Rating Scale; CI, confidence interval; ECT, electroconvulsive therapy; GAF, Global Assessment of Functioning; MD, mean difference; RR, risk ratio. GRADE Working Group grades of evidence. High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
^bDowngraded by one level due to risk of bias: high risk of bias with blinding of participants and personnel.
^cDowngraded by one level due to indirectness: scores from scale were employed as a surrogate index of the intended outcome.
^dDowngraded by two levels due to imprecision: low event rate.
^eDowngraded by one level due to heterogeneity.
^fDowngraded by one level due to imprecision: small sample size.

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Electroconvulsive Therapy for Treatment-Resistant Schizophrenia

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