Examining the clinical effectiveness of continuation and maintenance electroconvulsive therapy in schizophrenia

Journal article

George, Rachna, Krishnan, Vijay, Talbot, Daniel, Elhindi, James, Mayur, Prashanth and Harris, Anthony. (2024). Examining the clinical effectiveness of continuation and maintenance electroconvulsive therapy in schizophrenia. Asian Journal of Psychiatry. 92, p. Article 103895. https://doi.org/10.1016/j.ajp.2023.103895
AuthorsGeorge, Rachna, Krishnan, Vijay, Talbot, Daniel, Elhindi, James, Mayur, Prashanth and Harris, Anthony
Abstract

Objective
There are few studies that examine the effectiveness of Continuation/Maintenance Electroconvulsive Therapy (C/M-ECT) in schizophrenia, despite the documented effectiveness of acute ECT treatment. We aimed to investigate the clinical effectiveness of C/M-ECT for in-patients with Schizophrenia in a naturalistic setting. We examined the medical records of 46 in-patients who were diagnosed with Schizophrenia and had received C/M-ECT belonging to non-acute extended care service in a public psychiatry hospital in Sydney, Australia. The focus of analysis was on 138 treatment cycles (71 acute only cycles and 67 acute-continuation/maintenance cycles) across 45 subjects. A linear mixed effects model was used to describe the change in clinical global impression-severity (CGI-S) over time 4 time points viz., pre-post acute and pre-post continuation/maintenance ECT.

Results
Acute-only cycles and acute-continuation/maintenance cycles had identical pre- (M = 5, C.I. = 4–6), post-cycle CGI-S scores, and identical CGI-S difference scores (M = 0, C.I. = −1 – 1). Broadly in each continuation/maintenance cycle, we observed an initial sharp decrease in CGI-S scores followed by a logarithmic increase in scores over time, with satisfactory CGI-S score maintenance observed for approximately 6 months. Bitemporal ECT influenced CGI-S across maintenance ECT (p < 0.05) indicating smaller declines in CGI-S scores over time.

Conclusion
In schizophrenia, C/M ECT preserves effects on illness severity for at least upto 6 months following an acute course of ECT. Bitemporal ECT vis a vis other electrode positions differentiated clinical severity over time.

Keywordsschizophrenia; ECT; continuation ECT; maintenance ECT; naturalistic; bitemporal ECT
Year2024
JournalAsian Journal of Psychiatry
Journal citation92, p. Article 103895
PublisherElsevier B.V.
ISSN1876-2018
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ajp.2023.103895
PubMed ID38157717
Scopus EID2-s2.0-85181074902
Page range1-4
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online25 Dec 2023
Publication process dates
Accepted23 Dec 2023
Deposited13 Jun 2025
Additional information

© 2024 Elsevier B.V. All rights reserved.

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