ECT in schizophrenia: a review of the evidence

2018 ◽  
Vol 31 (03) ◽  
pp. 115-127 ◽  
Author(s):  
Sandeep Grover ◽  
Swapnajeet Sahoo ◽  
Anjumoni Rabha ◽  
Raman Koirala
Keyword(s):  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Suicidal Behaviour ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
First Episode ◽  
Treatment Resistant ◽  
Predictors Of Response ◽  
First Episode Schizophrenia

AbstractElectroconvulsive 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.

scholarly journals Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses

2016 ◽  
Vol 46 (15) ◽  
pp. 3231-3240 ◽  
Author(s):  
J. Lally ◽  
O. Ajnakina ◽  
M. Di Forti ◽  
A. Trotta ◽  
A. Demjaha ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
First Episode ◽  
Early Age ◽  
Treatment Resistant ◽  
Total Study Population ◽  
Illness Onset ◽  
Schizophrenia Spectrum ◽  
First Episode Schizophrenia ◽  
First Contact ◽  
The Relationship

BackgroundClozapine remains the only evidence-based antipsychotic for treatment-resistant schizophrenia (TRS). The ability to predict which patients with their first onset of schizophrenia would subsequently meet criteria for treatment resistance (TR) could help to diminish the severe functional disability which may ensue if TR is not recognized and correctly treated.MethodThis is a 5-year longitudinal assessment of clinical outcomes in a cohort of 246 first-episode schizophrenia spectrum patients recruited as part of the NIHR Genetics and Psychosis (GAP) study conducted in South London from 2005 to 2010. We examined the relationship between baseline demographic and clinical measures and the emergence of TR. TR status was determined from a review of electronic case records. We assessed for associations with early-, and late-onset TR, and non-TR, and differences between those TR patients treated with clozapine and those who were not.ResultsSeventy per cent (n= 56) of TR patients, and 23% of the total study population (n= 246) were treatment resistant from illness onset. Those who met criteria for TR during the first 5 years of illness were more likely to have an early age of first contact for psychosis (<20 years) [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.25–4.94] compared to those with non-TR. The relationship between an early age of first contact (<20 years) and TR was significant in patients of Black ethnicity (OR 3.71, 95% CI 1.44–9.56); and patients of male gender (OR 3.13 95% CI 1.35–7.23).ConclusionsFor the majority of the TR group, antipsychotic TR is present from illness onset, necessitating increased consideration for the earlier use of clozapine.

Treatment Resistance: A Time-Based Approach For Early Identification in First Episode Samples

2018 ◽  
Author(s):  
Kara Dempster ◽  
Ross Norman ◽  
Lena Palaniyappan
Keyword(s):  
Early Intervention ◽  
Treatment Response ◽  
Intervention Program ◽  
Negative Symptoms ◽  
Treatment Resistance ◽  
First Episode ◽  
Symptom Improvement ◽  
Treatment Resistant ◽  
Early Intervention Program ◽  
First Episode Schizophrenia

Background: Although approximately 1/3 of individuals with schizophrenia are Treatment Resistant (TR), identifying these subjects prospectively for early intervention remains challenging. The Treatment Response and Resistance in Psychosis (TRIPP; Howes et al, 2017) working group recently published consensus guidelines defining lack of response as a &lt;20% improvement in symptoms. However, it is unclear whether these criteria are sensitive in First Episode Schizophrenia (FES). Method: Patients experiencing a first episode of psychosis referred to the Prevention and Early Intervention Program for Psychosis (PEPP) in London, Canada were followed-up with longitudinal symptom assessments. We evaluated two improvement thresholds for ‘probable TR’ classifications; &lt;20% (as per TRIPP) and &lt;50% to identify subjects satisfying ‘probable TR’ based on positive, negative, and total symptom domains.Results: Using the criterion of &lt;50% total, or &lt;20% negative symptom improvement,resulted in ‘probable TR’ rates of 37% and 33% respectively, with notable overlap between the 2criteria (77% satisfying both). Using a 20% cut-off for positive and total symptomsresulted in very low rates of ‘probable TR’. Logistic regression analyses demonstrated that poorpremorbid functioning, longer duration of untreated illness, and limited treatment response atmonths one and two were significantly associated with probable TR (&lt;50% totalsymptom improvement).Conclusions: Our results suggest that probable TR may be identified at 6 months after FESusing a time-based approach only by including negative symptoms (either alone, with a 20%improvement threshold, or in addition to positive symptoms, with a total 50%threshold) in the definition.

scholarly journals Neuropsychological differences between treatment-resistant and treatment-responsive schizophrenia: a meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
Edward Millgate ◽  
Olga Hide ◽  
Stephen M Lawrie ◽  
Robin M Murray ◽  
James H MacCabe ◽  
...  
Keyword(s):  
Effect Size ◽  
Verbal Memory ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Sampling Strategy ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Memory And Learning ◽  
Visual Spatial

Abstract Antipsychotic treatment resistance affects up to a third of individuals with schizophrenia. Of those affected, 70–84% are reported to be treatment resistant from the outset. This raises the possibility that the neurobiological mechanisms of treatment resistance emerge before the onset of psychosis and have a neurodevelopmental origin. Neuropsychological investigations can offer important insights into the nature, origin and pathophysiology of treatment-resistant schizophrenia (TRS), but methodological limitations in a still emergent field of research have obscured the neuropsychological discriminability of TRS. We report on the first systematic review and meta-analysis to investigate neuropsychological differences between TRS patients and treatment-responsive controls across 17 published studies (1864 participants). Five meta-analyses were performed in relation to (1) executive function, (2) general cognitive function, (3) attention, working memory and processing speed, (4) verbal memory and learning, and (5) visual−spatial memory and learning. Small-to-moderate effect sizes emerged for all domains. Similarly to previous comparisons between unselected, drug-naïve and first-episode schizophrenia samples v. healthy controls in the literature, the largest effect size was observed in verbal memory and learning [dl = −0.53; 95% confidence interval (CI) −0.29 to −0.76; z = 4.42; p < 0.001]. A sub-analysis of language-related functions, extracted from across the primary domains, yielded a comparable effect size (dl = −0.53, 95% CI −0.82 to −0.23; z = 3.45; p < 0.001). Manipulating our sampling strategy to include or exclude samples selected for clozapine response did not affect the pattern of findings. Our findings are discussed in relation to possible aetiological contributions to TRS.

scholarly journals Treatment Resistance: A Time-Based Approach for Early Identification in First Episode Psychosis

2021 ◽  
Vol 11 (8) ◽  
pp. 711
Author(s):  
Kara Dempster ◽  
Annie Li ◽  
Priyadharshini Sabesan ◽  
Ross Norman ◽  
Lena Palaniyappan
Keyword(s):  
Ecological Validity ◽  
Treatment Resistance ◽  
Positive Symptom ◽  
First Episode ◽  
Symptom Reduction ◽  
Symptom Change ◽  
Global Functioning ◽  
Episode Psychosis ◽  
First Episode Schizophrenia

Although approximately 1/3 of individuals with schizophrenia are Treatment Resistant (TR), identifying these subjects prospectively remains challenging. The Treatment Response and Resistance in Psychosis working group defines <20% improvement as an indicator of TR, though its utility in First Episode Schizophrenia (FES) remains unknown. In a prospective cohort of FES (n = 129) followed up for 5 years, we evaluated two improvement thresholds for ‘probable TR’; <20% and <50% based on positive, negative, and total symptoms. We ascertained (1) the ecological validity (i.e., the ability to identify an expected subgroup of 1/3rd of patients); (2) the predictive validity (i.e., ability to predict poor global functioning) and (3) the clinical utility (association with clozapine use at the 5th year). Using the criteria of a total symptom reduction of <50% or negative symptom reduction of <20% resulted in ‘probable TR’ rates of 37% and 33%, respectively. Using <20% positive or total symptoms criteria resulted in very low rates, indicating minimal utility in FES. <50% total symptom criterion best predicted the global functioning over 5 years. Clozapine use was only predicted by positive symptom criterion. Prospective characterization of TRS is possible at 6 months after FES through a time-based approach using a 50% threshold for symptom change in treatment-adherent patients.

Predictors of response in treatment-resistant schizophrenia – a meta-analysis

2019 ◽  
Vol 29 ◽  
pp. S121
Author(s):  
A. Seppälä ◽  
J. Pylvänäinen ◽  
J. Miettunen ◽  
M. Isohanni ◽  
I. Corripio ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Treatment Resistant ◽  
Predictors Of Response

Relationship Between Duration of Untreated Psychosis and Outcome in First-Episode Schizophrenia: A Critical Review and Meta-Analysis

2005 ◽  
Vol 162 (10) ◽  
pp. 1785-1804 ◽  
Author(s):  
Diana O. Perkins ◽  
Hongbin Gu ◽  
Kalina Boteva ◽  
Jeffrey A. Lieberman
Keyword(s):  
Critical Review ◽  
Meta Analysis ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
First Episode Schizophrenia

Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

2019 ◽  
Vol 49 (15) ◽  
pp. 2463-2474 ◽  
Author(s):  
Sarah E. Herniman ◽  
Kelly Allott ◽  
Lisa J. Phillips ◽  
Stephen J. Wood ◽  
Jacqueline Uren ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Disorder ◽  
Meta Analysis ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Pooled Prevalence ◽  
Meta Regression ◽  
Spectrum Disorders ◽  
First Episode Schizophrenia

AbstractBackgroundDespite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.MethodsThis systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.ResultsForty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.ConclusionsAt least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.

scholarly journals Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

2017 ◽  
Vol 47 (11) ◽  
pp. 1981-1989 ◽  
Author(s):  
A. Demjaha ◽  
J. M. Lappin ◽  
D. Stahl ◽  
M. X. Patel ◽  
J. H. MacCabe ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Age At Onset ◽  
Treatment Resistance ◽  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Illness Onset ◽  
Episode Psychosis

BackgroundWe examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.MethodThe study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.ResultsFrom the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.ConclusionsThe striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

scholarly journals 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) ◽  
pp. e00429 ◽  
Author(s):  
Saeed Ahmed ◽  
Ali Mahmood Khan ◽  
Hema Madhuri Mekala ◽  
Hema Venigalla ◽  
Rizwan Ahmed ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Meta Analysis ◽  
Treatment Resistant ◽  
Combined Use
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