Relapse Common 6-Month Post Electroconvulsive Therapy for Schizophrenia

Nobuatsu Aoki

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Relapse among patients with schizophrenia after acute electroconvulsive therapy (ECT) is common after 6 months, according to recent findings, and over 50% of all such patients can be expected to relapse within 2 years.¹

The investigators who reached this conclusion had sought to provide longitudinal information regarding schizophrenia relapses in the period after acute ECT treatment. Their systematic review and meta-analysis was led by Nobuatsu Aoki of the department of neuropsychiatry at Kansai Medical University in Osaka, Japan.

It was noted by Aoki et al. that understanding relapse is critically important for management of this condition, adding that there had been a lack of consistent findings on medium- to long-term schizophrenia relapse proportion shifts in the period after acute ECT.²

“To properly evaluate the benefits of acute ECT in treating schizophrenia, we conducted the first systematic review and meta-analysis reporting medium- to long-term relapse and rehospitalization proportions following acute ECT,” Aoki and colleagues wrote.¹

Trial Design

The investigators carried out a comprehensive literature search, during which they implemented the PubMed, Embase, Web of Science, and Cochrane Library databases as well as repositories like ClinicalTrials.gov for relevant unpublished studies. They looked at research published in English from the inception of each database up to March 2024.

The research team’s strategy for searches utilized keywords including “electroconvulsive therapy” and “schizophrenia,” in addition to words or phrases deemed to be related or synonymous. To maintain thoroughness, the team reviewed reference lists of pertinent research.

Only the most recent or the largest trials were assessed in circumstances during which multiple reports referenced the same research or overlapping patient populations. Such instances included situations in which research had been published in different years or covering overlapping periods in national observational studies.

The investigators’ literature search was carried out independently by 2 researchers, both of whom screened the abstracts and titles with the aim of identifying eligible works. They would resolve disagreements between them either using consensus or by consulting with a third investigator.

The research team’s criteria for eligibility were implemented during the screening period. Full texts of potentially relevant research were examined.

In the team’s primary analysis, they calculated pooled estimates of schizophrenia relapse following acute ECT at the 3, 6, 12, and 24-month marks. To do so, they utilized a random effects model. Subgroup analyses were conducted to evaluate relapse rates based on the type of maintenance therapy used in the post-acute ECT period.

Major Findings

Overall, there were 6413 records evaluated by the investigators and 29 studies with 3876 subjects that met their criteria for inclusion in the analysis. They reported that the risk of bias was consistently found to be low for all 4 RCTs. The investigators did add that it still ranged from low to high for observational research, of which there were 25 studies.

In the research team’s pooled estimates of relapse proportions among individuals known to have schizophrenia responding to acute ECT, they concluded that there were 24% (95% CI: 15-35), 37% (27-47), 41% (34-49), and 55% (40-69) at the 3, 6, 12, and 24-month marks, respectively. Additionally, the team found that if continuation or maintenance ECT was included along with antipsychotic drugs in the post-acute ECT period, the 6-month relapse proportion was shown to be 20% (11-32).

“The findings of this study have important implications for expected outcomes following acute ECT for patients with schizophrenia,” they concluded.

References

1. ^{Aoki N, Tajika A, Takekita Y, et al. Relapse Following Electroconvulsive Therapy for Schizophrenia: A Systematic Review and Meta-analysis, Schizophrenia Bulletin, 2024;, sbae169, https://doi.org/10.1093/schbul/sbae169.}
2. ^{Ward HB, Szabo ST, Rakesh G. Maintenance ECT in schizophrenia: a systematic review. Psychiatry Res. 2018;264:131–142.}