Does adjunctive electro-convulsive therapy improve the speed of treatment response in schizophrenia? A systematic review and week-by-week meta-analyses of controlled clinical trials

IF 3.5 2区医学 Q1 PSYCHIATRY

Schizophrenia Research Pub Date : 2025-09-17 DOI:10.1016/j.schres.2025.08.018

Makarand Pantoji, Srinivas Balachander, Palash Prajapati, Shyam Sundar Arumugham, Ganesan Venkatasubramanian, Jagadisha Thirthalli

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引用次数: 0

Abstract

Background

Electroconvulsive therapy (ECT) is sometimes recommended in patients with schizophrenia to hasten clinical response. However, there is limited research comparing the speed of response between ECT in combination with antipsychotic medication versus antipsychotics alone. We conducted a systematic review and meta-analyses of week-by-week clinical response to examine whether ECT augmentation leads to faster improvement in psychotic symptoms in patients with schizophrenia.

Methods

We searched PubMed/Medline and Cochrane Library for controlled trials which compared the combination of ECT and antipsychotic drugs (ECT + AP) with antipsychotic drugs alone (AP) in patients with schizophrenia. We performed a pairwise random-effects meta-analysis for each time point. Hedge's g was used as the effect size estimate. A multivariate mixed-effects meta-analysis was performed to test whether the response speed was different between the groups.

Results

Of a total of 4899 search results, 12 studies were included. In five of them, the authors reported that the ECT + AP group responded faster. Pairwise meta-analysis for each week showed that ECT + AP group was significantly superior to the AP group at week 1 [g = 0.897 (95 % CI 0.236–1.557)], week 2 [g = 0.986 (95 % CI 0.273–1.700)], and week 4 [g = 1.587 (95 % CI 0.180–2.995)], but not after that. The multivariate mixed-effects meta-analysis also showed a significant Group*Week interaction [B = 0.17(95 % CI 0.10–0.24), p < 0.001].

Conclusions

ECT augmentation in schizophrenia, given its potential for faster response, may have some advantage in acutely ill patients, particularly those requiring hospitalization and needing rapid symptom resolution.

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辅助电痉挛治疗是否能提高精神分裂症的治疗反应速度？对照临床试验的系统回顾和每周荟萃分析。

背景：电痉挛疗法（ECT）有时被推荐用于精神分裂症患者，以加速临床反应。然而，比较ECT联合抗精神病药物与单独抗精神病药物的反应速度的研究有限。我们对每周的临床反应进行了系统回顾和荟萃分析，以检验ECT增强是否能更快地改善精神分裂症患者的精神病症状。方法：检索PubMed/Medline和Cochrane Library，检索比较ECT联合抗精神病药物（ECT + AP）与单独抗精神病药物（AP）治疗精神分裂症患者的对照试验。我们对每个时间点进行两两随机效应荟萃分析。使用Hedge’s g作为效应量估计。采用多变量混合效应meta分析检验两组间反应速度是否存在差异。结果：在4899个检索结果中，纳入了12项研究。在其中的5例中，作者报告说ECT + AP组反应更快。各周的两两荟萃分析显示，ECT + AP组在第1周[g = 0.897 (95% CI 0.236-1.557)]、第2周[g = 0.986 (95% CI 0.273-1.700)]和第4周[g = 1.587 (95% CI 0.180-2.995)]显著优于AP组，之后则无显著差异。多变量混合效应荟萃分析也显示了显著的组与周相互作用[B = 0.17(95% CI 0.10-0.24), p]。结论：ECT增强治疗精神分裂症，鉴于其潜在的更快的反应，可能对急症患者有一些优势，特别是那些需要住院治疗和需要快速缓解症状的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Schizophrenia Research 医学-精神病学

CiteScore

7.50

自引率

8.90%

发文量

429

审稿时长

10.2 weeks

期刊介绍： As official journal of the Schizophrenia International Research Society (SIRS) Schizophrenia Research is THE journal of choice for international researchers and clinicians to share their work with the global schizophrenia research community. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest readership! Schizophrenia Research''s time to first decision is as fast as 6 weeks and its publishing speed is as fast as 4 weeks until online publication (corrected proof/Article in Press) after acceptance and 14 weeks from acceptance until publication in a printed issue. The journal publishes novel papers that really contribute to understanding the biology and treatment of schizophrenic disorders; Schizophrenia Research brings together biological, clinical and psychological research in order to stimulate the synthesis of findings from all disciplines involved in improving patient outcomes in schizophrenia.