Kaster Tyler S, Daskalakis Zafiris J, Blumberger Daniel M
Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Clin Psychiatry. 2017 Apr;78(4):e383-e389. doi: 10.4088/JCP.16m10686.
To determine the clinical effectiveness and cognitive impact of electroconvulsive therapy (ECT) in a large clinical sample of patients with schizophrenia and explore factors associated with treatment response and transient cognitive impairment.
We examined the clinical records of 144 patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who were treated at an academic mental health hospital from October 2009 to August 2014. These patients received 171 acute courses of ECT; we attempted to determine their treatment response and transient cognitive impairment from ECT. We explored the impact of various factors including ECT indication, clinical characteristics, medication during ECT, and technical parameters on treatment response and transient cognitive impairment.
Treatment with ECT resulted in a 76.7% response rate. Factors associated with a better response to ECT were absence of treatment with antiepileptic medication (17.9% vs 3.9%, P = .007), a previous good response to ECT (36.4% vs 15.4%, P = .017), and primary indication for ECT referral other than failed pharmacotherapy (89.7% vs 69.8%, P = .012). Factors not associated with treatment response included age, clozapine treatment, and benzodiazepine treatment (P > .05). Treatment with ECT caused transient cognitive impairment in 9% of treatment courses; no demographic or clinical factors were associated with cognitive impairment.
This work demonstrates the effectiveness of ECT for schizophrenia treatment and several factors associated with treatment response. The rate of transient cognitive impairment is lower than expected based on the rate of cognitive impairment seen in ECT for depression. ECT appears to be an effective treatment option for schizophrenia that is tolerated by the majority of patients.
在大量精神分裂症患者的临床样本中确定电休克治疗（ECT）的临床疗效和认知影响，并探索与治疗反应及短暂认知障碍相关的因素。
我们查阅了2009年10月至2014年8月在一家学术性心理健康医院接受治疗的144例诊断为精神分裂症或分裂情感性障碍的患者的临床记录。这些患者接受了171个急性ECT疗程；我们试图确定他们对ECT的治疗反应和短暂认知障碍。我们探讨了包括ECT适应症、临床特征、ECT期间用药以及技术参数等各种因素对治疗反应和短暂认知障碍的影响。
ECT治疗的有效率为76.7%。与ECT反应较好相关的因素包括未使用抗癫痫药物治疗（17.9%对3.9%，P = 0.007）、既往对ECT反应良好（36.4%对15.4%，P = 0.017）以及ECT转诊的主要适应症不是药物治疗失败（89.7%对69.8%，P = 0.012）。与治疗反应无关的因素包括年龄、氯氮平治疗和苯二氮䓬类药物治疗（P > 0.05）。ECT治疗在9%的疗程中导致短暂认知障碍；没有人口统计学或临床因素与认知障碍相关。
这项研究证明了ECT治疗精神分裂症的有效性以及与治疗反应相关的几个因素。短暂认知障碍的发生率低于基于ECT治疗抑郁症时所见认知障碍发生率的预期。ECT似乎是大多数患者能够耐受的一种有效的精神分裂症治疗选择。
