Electroconvulsive therapy combined with antipsychotic therapy in the treatment of acute schizophrenia inpatients: symptom profile of the clinical response

Abstract

OBJECTIVE: The aim of the study was to examine the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic (AP) medication on symptom profile in patients with a diagnosis of schizophrenia who had received acute psychiatric inpatient treatment. METHODS: In this prospective study, patients were evaluated for inclusion in the study who were diagnosed with schizophrenia according to DSM-IV diagnostic criteria and were to receive ECT. The patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression–Improvement (CGI-I) sub-scale before the first session ECT, once following every two subsequent sessions and after the final session. RESULTS: The patients showed significant improvements in BPRS scores at each evaluation compared with their scores at baseline, and a significant clinical improvement was found on the CGI-I sub-scale at the end of treatment. Across all SAPS sub-scores, significant decreases were found, and the symptoms related to hallucinations and positive formal thought disorder showed the most rapid response to treatment. Across all SANS sub-scores, significant decreases were found, and affective flattening or blunting symptoms responded most rapidly to treatment. CONCLUSION: One of the most important findings in the present study of hospitalized patients with acute schizophrenia was the good response to treatment, which provided significant improvements in both positive and negative symptoms. The most rapid response to treatment was found for hallucinations, positive formal thought disorder, and affective flattening or blunting symptoms. The most important limitation of our study may be the small number of cases. In future, well-standardized studies using a double-blinded, comparative, prospective design and including a sufficient number of patients are needed.