ECT For Negative Symptoms in Schizophrenia: New Study From Singapore

 Out on PubMed, from researchers in Singapore and Australia, is this study:

The Impact of Electroconvulsive Therapy on Negative Symptoms in Schizophrenia and Their Association with Clinical Outcomes.

Tan X, Martin D, Lee J, Tor PC.Brain Sci. 2022 Apr 25;12(5):545. doi: 10.3390/brainsci12050545.PMID: 35624932 

The abstract is copied below:

Objective: The treatment efficacy of electroconvulsive therapy (ECT) for negative symptoms amongst patients with schizophrenia remains unclear. In this study, we aim to examine the effects of ECT on negative symptoms in schizophrenia and their association with other clinical outcomes, including cognition and function.

Methods: This is a retrospective data analysis of patients with schizophrenia/schizoaffective disorder treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and December 2019. Clinical outcomes were assessed by the Brief Psychiatric Rating Scale (BPRS), the Montreal Cognitive Assessment (MoCA), and Global Assessment of Function (GAF). Changes in scores were compared with repeated measures analysis of variance. Sequential structural modelling was utilized to examine the pathway relationships between changes in negative symptoms, global functioning, and cognition functioning after ECT.

Results: A total of 340 patients were analysed. Hence, 196 (57.6%), 53 (15.5%), and 91 (26.7%) showed improvements, no change, and deterioration in negative symptoms, respectively. ECT-induced improvement of negative symptoms was significantly associated with improvement of global functioning (direct effect correlation coefficient (r): -0.496; se: 0.152; p = 0.001) and cognition function (indirect effect r: -0.077; se: 0.037; p = 0.035). Moreover, having capacity to consent, more severe baseline negative symptoms, lithium prescription, and an indirect effect of voluntary admission status via consent capacity predicted ECT associated negative symptoms improvement.

Conclusion: ECT is generally associated with improvements of negative symptoms in people with schizophrenia, which correlate with improvements of overall function. Possible novel clinical predictors of negative symptom improvement have been identified and will require further research and validation.

Keywords: cognitive function; electroconvulsive therapy; negative symptoms; schizophrenia.

The article is here.

And from the text:

This is an interesting retrospective study with a good sample size (n=340), looking at change in negative symptoms in patients with schizophrenia. Clinical wisdom has it that ECT benefits positive symptoms more than negative, so this is quite instructive. Over half of the sample showed improvement in negative symptoms, and interestingly, about a quarter showed some worsening of negative symptoms. Overall, the results were encouraging for symptom improvement, as well as better functioning and better cognition.

Once again, the overarching message is that ECT is a helpful treatment for patients with schizophrenia; Asian nations recognize this, but the rest of the world is reluctant to acknowledge this clinical reality.

Followers of the ECT for schizophrenia literature will enjoy a full and careful read of this paper, ~20 minutes.