The Effects of Electroconvulsive Therapy Augmentation of Antipsychotic Treatment on Cognitive Functions in Patients With Treatment-Resistant Schizophrenia

Ćusa, Bjanka Vuksan; Klepac, Nataša; Jakšić, Nenad; Bradaš, Zoran; Božičević, Marija; Palac, Natalia; Šagud, Marina

doi:10.1097/yct.0000000000000463

Cited by 20 publications

(14 citation statements)

References 23 publications

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“…In a before–after study of 31 patients, Vuksan and colleagues found no neurocognitive domains were impaired and post ECT there was an improvement in the domains of executive functioning and immediate and delayed verbal memory. 12 This finding is supported by a further study by Pawelczyk, who found in a small study of 27 patients with treatment-resistant schizophrenia, that post ECT there was no decline in attention, working memory or executive function. 13 Moreover, two studies have found that ECT increases quality of life in patients with schizophrenia, suggesting a safe and effective treatment.…”

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confidence: 66%

Revisiting the role of electroconvulsive therapy in schizophrenia: Where are we now?

Teodorczuk

Emmerson

Robinson

2019

Australas Psychiatry

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Objective: The purpose of this opinion article is to review the recent evidence base in relation to the role of electroconvulsive therapy (ECT) in the management of patients with schizophrenia. Specifically, we explore the efficacy and safety of ECT. Furthermore, consideration is given to the profile of patients who benefit most from ECT, the role of maintenance ECT and what happens when ECT is not given. Conclusion: Our brief review of the evidence suggests that clinical practice in developing countries has not kept up with the growing literature supporting ECT use in schizophrenia. As such, we advocate that ECT should not be a treatment of last resort. Rather, it should be considered more readily as an add-on therapy when there has been a poor response to antipsychotic medications or concerns exist about side effects. Further research is needed into the efficacy of maintenance ECT.

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confidence: 66%

Revisiting the role of electroconvulsive therapy in schizophrenia: Where are we now?

Teodorczuk

Emmerson

Robinson

2019

Australas Psychiatry

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“…Likewise, negative symptoms of schizophrenia were less severe in female patients carrying the high activity COMT variants (rs740603 (G)-rs4818 (G) haplotype), but this effect was not observed in male patients with schizophrenia ( Li et al, 2012 ). If this finding will be confirmed in larger studies and meta-analyses, women with schizophrenia who are carriers of the COMT rs4680 and rs4818 low-activity haplotypes, might require different treatment approach, such as early clozapine initiation ( Siskind et al, 2017 ), clozapine augmentation with different antiepileptic drugs ( Zheng et al, 2017 ), or electroconvulsive therapy (ECT) ( Vuksan et al, 2018 ).…”

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confidence: 99%

Haplotypic and Genotypic Association of Catechol-O-Methyltransferase rs4680 and rs4818 Polymorphisms and Treatment Resistance in Schizophrenia

et al. 2018

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Treatment-resistant schizophrenia (TRS) continues to be a challenge. It was related to different factors, including alterations in the activity of brain dopaminergic system, which could be influenced by the dopamine-degrading enzyme, catechol-O-methyltransferase (COMT). Variants of the COMT gene have been extensively studied as risk factors for schizophrenia; however, their association with TRS has been poorly investigated. The aim of the present study was to determine the haplotypic and genotypic association of COMT rs4680 and rs4818 polymorphisms with the presence of TRS. Overall, 931 Caucasian patients diagnosed with schizophrenia (386 females and 545 males) were included, while 270 participants met the criteria for TRS. In males, no significant haplotypic and genotypic associations between COMT rs4680 and rs4818 polymorphisms and TRS were detected. However, genotypic analyses demonstrated higher frequency of COMT rs4680 AA genotype carriers compared to G-allele carriers (p = 0.033) and higher frequency of COMT rs4818 CC genotype carriers than G-allele carriers (p = 0.014) in females with TRS. Haplotype analyses confirmed that the presence of the G allele in females was associated with lower risk of TRS. In women with TRS, the high activity G-G/G-G haplotype was rare, while carriers of other haplotypes were overrepresented (p = 0.009). Such associations of COMT rs4680 and rs4818 high-activity (G variants), as well as G-G/G-G haplotype, with the lower risk of TRS in females, but not in males, suggest significant, but sex-specific influence of COMT variants on the development of treatment-resistance in patients with schizophrenia. However, due to relatively low number of females, those findings require replication in a larger sample.

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“…Cusa et al [29] published a prospective, open study to evaluate the effects of ECT augmentation of antipsychotics on cognitive functions in patients with TRS. Thirty-one patients were included and evaluated on both clinical (PANSS and CGI) and cognitive (California Verbal Learning Test Second Edition, Benton Visual Retention Test, Wechsler Adult Intelligence Scale and Stroop) measures before and after completion of a course of ECT.…”

Section: Resultsmentioning

confidence: 99%

Electroconvulsive Therapy and Schizophrenia: A Systematic Review

Ali¹,

Mathur²,

Malhotra³

et al. 2019

Complex Psychiatry

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Electroconvulsive therapy (ECT) is a remarkably effective treatment for major depressive disorder, but is less commonly utilized for treatment of psychotic disorders. Recent literature indicates that ECT can be a useful strategy for a wide range of psychotic disorders, including treatment-resistant schizophrenia. The purpose of this review is to examine the extant literature on ECT in schizophrenia with a primary focus on its efficacy, its impact on cognitive function, the role of maintenance ECT, and the potential role of neuroimaging biomarkers to provide more precise ECT treatment strategies. We evaluated the available literature, with a particular focus on prospective, randomized trials. Our review suggests that ECT can be an effective treatment strategy in this severely ill patient population. Studies suggest that while ECT in schizophrenia is a safe treatment modality, the potential for cognitive impairment must always be carefully weighed. The use and investigation of new biomarker strategies for the pharmacological treatment of schizophrenia, and the extension of these approaches to ECT are also discussed.

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The Effects of Electroconvulsive Therapy Augmentation of Antipsychotic Treatment on Cognitive Functions in Patients With Treatment-Resistant Schizophrenia

Abstract: Notwithstanding some limitations of this study, the combination of ECT and antipsychotics has improved several neurocognitive domains, without evidence of worsening of any cognitive functions.

Cited by 20 publications

References 23 publications

Revisiting the role of electroconvulsive therapy in schizophrenia: Where are we now?

Revisiting the role of electroconvulsive therapy in schizophrenia: Where are we now?

Haplotypic and Genotypic Association of Catechol-O-Methyltransferase rs4680 and rs4818 Polymorphisms and Treatment Resistance in Schizophrenia

Electroconvulsive Therapy and Schizophrenia: A Systematic Review

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