Aoki Nobuatsu, Tajika Aran, Suwa Taro, Kawashima Hirotsugu, Yasuda Kazuyuki, Shimizu Toshiyuki, Uchinuma Niina, Tominaga Hirotaka, Tan Xiao Wei, Koh Azriel H K, Tor Phern Chern, Nikolin Stevan, Martin Donel, Kato Masaki, Loo Colleen, Kinoshita Toshihiko, Furukawa Toshi A, Takekita Yoshiteru
Department of Neuropsychiatry, Faculty of Medicine, Kansai Medical University, Osaka, 570-8506, Japan.
Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, 2031, Australia.
Schizophr Bull. 2024 Oct 4. doi: 10.1093/schbul/sbae169.
Evidence regarding schizophrenia relapse following acute electroconvulsive therapy (ECT) is sparse compared with that for depression, and we have no clear consensus on relapse proportions. We aimed to provide longitudinal information on schizophrenia relapse following acute ECT.
This systematic review and meta-analysis included randomised controlled trials (RCTs) and observational studies on post-acute ECT relapse and rehospitalization for schizophrenia and related disorders. For the primary outcome, we calculated the post-acute ECT pooled relapse estimates at each timepoint (3, 6, 12, and 24 months post-acute ECT) using a random effects model. For subgroup analyses, we investigated post-acute ECT relapse proportions by the type of maintenance therapy.
Among a total of 6413 records, 29 studies (3876 patients) met our inclusion criteria. The risk of bias was consistently low for all included RCTs (4 studies), although it ranged from low to high for observational studies (25 studies). Pooled estimates of relapse proportions among patients with schizophrenia responding to acute ECT were 24% (95% CI: 15-35), 37% (27-47), 41% (34-49), and 55% (40-69) at 3, 6, 12, and 24 months, respectively. When continuation/maintenance ECT was added to antipsychotics post-acute ECT, the 6-month relapse proportion was 20% (11-32).
Relapse occurred mostly within 6 months post-acute ECT for schizophrenia, particularly within the first 3 months. Relapse proportions plateaued after 6 months, although more than half of all patients could be expected to relapse within 2 years. Further high-quality research is needed to optimise post-acute ECT treatment strategies in patients with schizophrenia.
与抑郁症相比，关于急性电休克治疗（ECT）后精神分裂症复发的证据较少，且我们对复发比例尚无明确共识。我们旨在提供急性ECT后精神分裂症复发的纵向信息。
本系统评价和荟萃分析纳入了关于精神分裂症及相关障碍急性ECT后复发和再次住院的随机对照试验（RCT）和观察性研究。对于主要结局，我们使用随机效应模型计算急性ECT后各时间点（急性ECT后3、6、12和24个月）的急性ECT后合并复发估计值。对于亚组分析，我们按维持治疗类型调查急性ECT后复发比例。
在总共6413条记录中，29项研究（3876例患者）符合我们的纳入标准。所有纳入的RCT（4项研究）的偏倚风险始终较低，尽管观察性研究（25项研究）的偏倚风险从低到高不等。对急性ECT有反应的精神分裂症患者的复发比例合并估计值在3、6、12和24个月时分别为24%（95%CI：15 - 35）、37%（27 - 47）、41%（34 - 49）和55%（40 - 69）。急性ECT后在抗精神病药物基础上加用连续性/维持性ECT时，6个月时的复发比例为20%（11 - 32）。
精神分裂症急性ECT后复发大多发生在6个月内，尤其是前3个月内。6个月后复发比例趋于平稳，尽管预计超过一半的患者会在2年内复发。需要进一步开展高质量研究以优化精神分裂症患者急性ECT后的治疗策略。
