Objective: To describe the clinical effectiveness and cognitive effects of ECT in a large clinical sample of patients with schizophrenia and explore factors.

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Presentation transcript:

Objective: To describe the clinical effectiveness and cognitive effects of ECT in a large clinical sample of patients with schizophrenia and explore factors associated with treatment response and adverse cognitive effects. Background: There is limited evidence describing the clinical effectiveness of electroconvulsive therapy (ECT) in patients with schizophrenia. Many studies describing its use employed older equipment combined with first generation antipsychotics that do not reflect current clinical practice. Methods: We examined the clinical records of 144 patients with a clinical diagnosis of schizophrenia or schizoaffective disorder, who received 171 acute courses of ECT, and determined treatment response (TR) and adverse cognitive effects (ACE). We explored the impact of various factors associated with TR and ACE; including ECT indications, clinical characteristics, medication during ECT and technical parameters. Results: Treatment with ECT resulted in a 76.7% response rate. Factors associated with TR were lack of concomitant anti-epileptic medication (17.9% vs 3.9%, p=0.0071), a previous good response to ECT (36.4% vs 15.4%, p=0.0174), and primary indication for ECT other than failed pharmacotherapy (89.7% vs 69.8%, p=0.0174). Factors not associated with TR included age (p=0.1355), clozapine treatment (p=0.8552), and benzodiazepine treatment (p=0.4887). Treatment with ECT was associated with clinically detectable ACE in 9% of patients and no other clinical factors were associated with ACE. Conclusion: This work demonstrates the clinical effectiveness of ECT for the treatment of schizophrenia. Several clinical factors may be associated with TR. The rate of clinically detectable ACE was lower than expected based upon the rates of ACE when ECT is used for patients with depression. While ECT appears to be an effective treatment option for schizophrenia, further comparative effectiveness research is needed in this population to delineate its role in clinical practice. Table 2. ECT treatment details of the treatment cohort (n=171) ECT Indication a Failed pharmacotherapy (%)125 (73.1) Prior good response to ECT (%)54 (31.5) Suicidality (%)28 (16.3) Failed continuation maintenance pharmacotherapy (%)26 (15.2) Violent behaviour (%)23 (13.4) Intolerance of adequate pharmacotherapy (%)20 (11.7) Patient preference (%)16 (9.3) ECT Electrode Placement BL (%)147 (86.0) BL  RUL (%)5 (2.9) RUL (%)11 (6.4) RUL  BL (%)8 (4.7) Multiple Treatment Courses Two Courses (%)23 (13.4) Three Courses (%)4 (2.3) Other Mean number of treatments ± SD [Min-Max]12.2 ± 6.5 [1 - 38] Previous ECT (%)72 (42.1) Referred for maintenance treatment (%)77 (45.0) Discharged within 31 days of treatment completion (%)73 (44.8) Table 1. Patient demographic and treatment features of the treatment cohort (n=171) Demographic/Clinical Age ± SD [Max-Min] (years)45 ± 14.0 [ ] Male gender (%)105 (61.4) Schizophrenia Diagnosis (%)100 (58.4) Schizoaffective Diagnosis (%)71 (41.5) Lacked capacity to consent to ECT (%)102 (59.6) Medications Oral/Depot antipsychotic (%)169 (98.8) Depot antipsychotic (%)56 (32.7) Clozapine antipsychotic (%)82 (47.9) Benzodiazepine use (%) a 33 (19.3) Antidepressant treatment (%)51 (29.8) Mood stabilizer/AED treatment (%)24 (14.0) Treatment Setting Inpatient (%)163 (95.3) Voluntary Inpatient (%) b 82 (50.2) Outpatient (%)8 (4.7) ECT Augmentation in Schizophrenia: Clinical Effectiveness and Cognitive Impact - A Large Retrospective Review Tyler Kaster MD 1,2, Jeff Daskalakis MD PhD 1,2, Daniel Blumberger MD MSc 1,2 1. Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario 2. Department of Psychiatry, University of Toronto, Toronto, Ontario P6-056 a includes both regular and intermittent use b percentage is calculated based on total number of inpatients (n=163) a total percentages are greater than 100% because some patients may had multiple indications for ECT Table 3. Factors associated with treatment response to ECT (n=168) Treatment Response (n=129) Non-treatment response (n=39) P-value Referral Indication Failed pharmacotherapy (%)90 (69.8)35 (89.7)0.012 Prior good response to ECT (%)47 (36.4)6 (15.4)0.017 Suicidality (%)20 (15.5)8 (20.5)0.47 Failed continuation maintenance pharmacotherapy (%)21 (16.3)5 (12.8)0.80 Violent behaviour (%)19 (14.7)4 (10.3)0.60 Intolerance of adequate pharmacotherapy (%)14 (10.9)6 (15.4)0.41 Patient preference (%)12 (9.3)4 (10.3)1 Demographic/Clinical Mean age (years) Schizophrenia diagnosis (%)72 (55.8)26 (66.7)0.27 Catatonia (%)7 (5.4)3 (7.7)0.70 Medications during ECT Clozapine (%)62 (48.1)20 (51.3)0.85 Mood Stabilizer/AED (%)14 (10.9)10 (25.6)0.034 AED (%)5 (3.9)7 (17.9)0.007 Lithium (%)9 (7.0)5 (12.8)0.32 Benzodiazepine use (%)23 (17.8)9 (23.1)0.49 Benzodiazepine dose >= 2mg lorazepam equivalent (%)8 (6.2)4 (10.3)0.48 ECT Characteristics First treatment course (%)105 (81.4)36 (92.3)0.14 Mean number of treatments <=6 Treatments (%)25 (19.4)9 (23.1)0.65 BL Treatment (%)114 (88.4)39 (100)0.02 Table 4. Factors associated with cognitive impairment after ECT (n=89) No cognitive impairment (n=81) Cognitive impairment (n=8)P-value Demographic/Clinical Mean age (years) Medications Mood Stabilizer/AED (%)10 (12.3)0 (0)0.59 AED (%)4 (4.9)0 (0)1 Lithium (%)8 (9.9)0 (0)1 Benzodiazepine use (%)15 (18.5)0 (0)0.34 Benzodiazepine dose >=2mg lorazepam equivalent (%)7 (8.6)0 (0)1 ECT Characteristics Mean number of treatments <=6 Treatments (%)12 (14.8)0 (0)0.59 BL Treatment (%)71 (87.7)8 (100)0.59 Disclosures TSK receives research support from the University of Toronto. ZJD has received research and equipment in-kind support for an investigator-initiated study through Brainsway Inc. ZJD has also served on the advisory board for Hoffmann-La Roche Limited and Merck and received speaker support from Sepracor and Eli Lilly. DMB receives non-salary operating funds and in-kind equipment support from Brainsway Ltd. for an investigator-initiated study. He is the site principal investigator for several sponsor-initiated clinical trials from Brainsway Ltd. He receives in-kind equipment support from Tonika/Magventure for an investigator-initiated study. He receives grant support from NIH, CIHR, Brain Canada and the Temerty Family.