ECT vs Clozapine: LTE in Asian Journal of Psychiatry


Out on PubMed, from authors in India, is this LTE:

Is ECT better than clozapine for treatment-resistant schizophrenia?

Uppinkudru C, Sreeraj VS, Arumugham SS, Praharaj SK, Goyal N, Sinha P, Thirthalli J.Asian J Psychiatr. 2023 Oct 11;90:103798. doi: 10.1016/j.ajp.2023.103798. Online ahead of print.PMID: 37871364
 
The LTE is here:


This is a thoughtful LTE that is mostly about methodological issues with the Mishra study in Schizophrenia Bulletin in 2022 (please see below). 
Documentation of the role of ECT in the treatment of schizophrenia remains a very important issue, given that the FDA could not conclude that ECT was clearly indicated, based on the current literature, despite the fact that worldwide, schizophrenia is the number one indication for ECT.
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Comparison of Acute Followed by Maintenance ECT vs Clozapine on Psychopathology and Regional Cerebral Blood Flow in Treatment-Resistant Schizophrenia: A Randomized Controlled Trial.
Mishra BR, Agrawal K, Biswas T, Mohapatra D, Nath S, Maiti R.Schizophr Bull. 2022 Jun 21;48(4):814-825. doi: 10.1093/schbul/sbac027.PMID: 35556138 

Study results: The PANSS-T scores changes from baseline over the observation-points were significant in both M-ECT and clozapine groups (P < .001), with comparatively better reduction with M-ECT (P < .001). Similar trends were observed in PANSS subscales, CGI-SCH and GAF in both groups, with significantly better improvement with M-ECT over the study-period. After 24 weeks, there was significantly better perfusion with M-ECT in bilateral prefrontal and temporal cortices (P < .05). With M-ECT, a positive correlation was found between changes in PANSS-P scores and left-lateral Temporal cortical perfusion (r = .465, P = .017).

Conclusions: Acute followed by M-ECT was more effective than clozapine over 6 months in reducing the positive and negative symptoms, general psychopathology, illness-severity, and improving the global functionality in TRS [clinicaltrials.gov: NCT03807882].

Comments

  1. RayFOctober 30, 2023 at 5:05 PM

    This is a very important topic, given that ECT is woefully underutilized for psychosis in the US. Hopefully, future ISEN and APA meetings will give this the attention it deserves.

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