Psychiatry and Psychological Syndromes

Objective: To assess the relative efficacies of different treatment methodologies, Clozapine plus ECT and common typical and atypical antipsychotics plus electroconvulsive therapy (ECT), against Treatment Resistant Schizophrenia and provide evidence for therapeutically superior drug.

 

Design: Systematic review and meta-analysis of information generated from the different studies and medical trials that have assessed the efficacies of Clozapine and other antipsychotics in concurrence with ECT treatment for patients with symptoms of Treatment Resistant Schizophrenia. The present study attempted at refining previous meta-analysis studies on Schizophrenia by including more number of studies and comparing them statistically, taking a step further from only the systematic reviews.

 

Subjects: 1184 patients in 24 studies reporting the usage of ECT augmentation either for Clozapine or common antipsychotics such as Flupentixol, Chlorpromazine, Risperidone, Sulpiride, Olanzapine and Loxapine.

 

Main Outcome Measures: The change between the pre-treatment and post-treatment scores of the psychometric scales (BPRS and PANSS) used for the evaluation of patient’s mental state.

 

Results: The present meta-analysis drew its conclusions from the pre- and post-treatment scores of psychometric scales from 17 studies selected out of the 24 studies in systematic review, upon which the results were reported by the studies. The studies reporting, the pre and post treatment scores using either BPRS or PANSS scales were selected. Such an analysis yielded important information about the extent of improvement shown by the participants subjected to the augmentation treatment across different studies. The analysis was conducted separately for the Clozapine and non-Clozapine group of studies, to compare their treatment efficacy. The effect size values were used to assess the difference between the pre and post test scores, which indicated the efficacy and sensitivity of the treatment. The larger the value of effect size, larger was the difference and higher was the efficacy of ECT plus drug augmentation procedure. The overall effect size (standard difference in means) for non-Clozapine and Clozapine groups was 0.891 and 1.504, respectively. This indicated the higher efficacy of combined Clozapine and ECT procedure in the treatment of Schizophrenia, as compared to other antipsychotics.

 

Conclusion: ECT augmentation technique was found to be effective in reduction of psychometric scale scores and the resultant improvement was better. ECT augmentation with Clozapine showed promising results in treatment of Treatment Resistant Schizophrenia followed by Flupentixol.