Systematic reviews related to this topic

loading
6 References (6 articles) loading Revert Studify

Systematic review

Unclassified

Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis

blocked
Journal Schizophrenia research
Year 2016
Links Pubmed DOI

This article is included in 2 Broad syntheses 28 Broad syntheses (2 references)

This article includes 28 Primary studies 28 Primary studies (28 references)

Loading references information
The primary aim of this systematic review and meta-analysis was to assess the proportion of patients with Treatment Resistant Schizophrenia (TRS) that respond to ECT augmentation of clozapine (C+ECT). We searched major electronic databases from 1980 to July 2015. We conducted a random effects meta-analysis reporting the proportion of responders to C+ECT in RCTs and open-label trials. Five clinical trials met our eligibility criteria, allowing us to pool data from 71 people with TRS who underwent C+ ECT across 4 open label trials (n=32) and 1 RCT (n=39). The overall pooled proportion of response to C+ECT was 54%, (95% CI: 21.8-83.6%) with some heterogeneity evident (I(2)=69%). With data from retrospective chart reviews, case series and case reports, 192 people treated with C+ECT were included. All studies together demonstrated an overall response to C+ECT of 66% (95% CI: 57.5-74.3%) (83 out of 126 patients responded to C+ECT). The mean number of ECT treatments used to augment clozapine was 11.3. 32% of cases (20 out of 62 patients) with follow up data (range of follow up: 3-468weeks) relapsed following cessation of ECT. Adverse events were reported in 14% of identified cases (24 out of 166 patients). There is a paucity of controlled studies in the literature, with only one single blinded randomised controlled study located, and the predominance of open label trials used in the meta-analysis is a limitation. The data suggests that ECT may be an effective and safe clozapine augmentation strategy in TRS. A higher number of ECT treatments may be required than is standard for other clinical indications. Further research is needed before ECT can be included in standard TRS treatment algorithms.

Systematic review

Unclassified

Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis.

blocked
Authors Wang W , Pu C , Jiang J , Cao X , Wang J , Zhao M , Li C
Journal Shanghai archives of psychiatry
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 22 Broad syntheses (1 reference)

This article includes 22 Primary studies 22 Primary studies (22 references)

Loading references information
BACKGROUND: The efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and electroconvulsive therapy (ECT) remain uncertain. AIMS: Conduct systematic review and meta-analysis of available literature in English and Chinese about ECT in the treatment of refractory schizophrenia. METHODS: English and Chinese databases were searched for studies published prior to May 20, 2015 regarding the efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and ECT. Two researchers selected and evaluated studies independently using pre-defined criteria. Review Manager 5.3 software was used for data analysis. RESULTS: A total of 22 randomized control studies, 18 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 18 of the 22 studies with a pooled sample of 1394 individuals found that compared to treatment with antipsychotic medications alone, combined treatment with antipsychotic medications and ECT had significantly higher rates of achieving study-specific criteria of 'clinical improvement' (RR=1.25, 95%CI=1.14-1.37). Based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, the quality of evidence for this assessment of efficacy was 'moderate'. However, the proportion of participants who experienced headache during the treatment was significantly higher in the combined treatment group (RR=9.10, 95%CI=3.97-20.86, based on a pooled sample of 517 from 8 studies) and the proportion who experienced memory impairment was also higher in the combined treatment group (RR=6.48, 95%CI=3.54-11.87, based on a pooled sample of 577 from 7 studies). The quality of evidence about these adverse events was rated as 'very low'. CONCLUSIONS: There are very few high quality randomized controlled clinical trials about the combination of antipsychotic medications and ECT in the treatment of refractory schizophrenia. This meta-analysis found that the combination of antipsychotic medications and ECT could improve psychiatric symptoms in patients with refractory schizophrenia, but the incomplete methodological information provided for most of the studies, publication bias (favoring studies with better outcomes in the combined treatment group), and the low quality of evidence about adverse outcomes, cognitive impairment, and overall functioning raise questions about the validity of the results.

Systematic review

Unclassified

Indications for electroconvulsive treatment in schizophrenia: a systematic review.

Journal Schizophrenia research
Year 2013
Links Pubmed DOI

This article is included in 1 Broad synthesis 31 Broad syntheses (1 reference)

This article includes 31 Primary studies 31 Primary studies (31 references)

Loading references information
BACKGROUND: Electroconvulsive therapy (ECT) is a medical treatment that is most effective for mood disorders (Bipolar Disorder and Major Depression). It has also been shown to be an effective treatment for schizophrenia accompanied by catatonia, extreme depression, mania and other affective components. ECT is currently under-used in many psychiatric settings due to its stigmatized perception by patients and mental health professionals. However, many unanswered questions remain regarding its role in the management of patients with schizophrenia. AIM: Evaluate the main indications of ECT in subjects suffering from schizophrenia. OBJECTIVES: Investigate the efficacy and the main indications of ECT in the treatment of schizophrenic patients, evaluate its effects in the short-term and the long-term, compare ECT treatment with pharmacotherapy, and assess the effects of treatment with ECT. METHODS: A systematic review of the literature was conducted on the use of ECT for schizophrenia. Thirty one articles from peer-reviewed journals were identified, and the most relevant articles were selected for this review. RESULTS: The most common indication for using ECT for schizophrenia patients was to augment pharmacotherapy, while the most common accompanying symptoms were, in order, catatonia, aggression and suicide. Catatonic patients responded significantly better to ECT than patients with any other subtype of schizophrenia. The combination of ECT with pharmacotherapy can be useful for drug-resistant patients. The use of an ECT-risperidone combination or ECT-clozapine combination in patients non-responsive to prior pharmacotherapy was found to be most effective. CONCLUSIONS: This review indicates that ECT, combined with pharmacotherapy, may be a viable option for a selected group of patients with schizophrenia. In particular, the use of ECT is recommended for drug-resistant patients, for schizophrenic patients with catatonia, aggression or suicidal behavior, and when rapid global improvement and reduction of acute symptomatology are required.

Systematic review

Unclassified

Electroconvulsive therapy use in adolescents: a systematic review.

Journal Annals of general psychiatry
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 22 Broad syntheses (1 reference)

This article includes 22 Primary studies 22 Primary studies (22 references)

Loading references information
BACKGROUND: Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents. METHODS: Systematic review, performed in November 2012, conformed to the PRISMA statement. RESULTS: From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure. CONCLUSIONS: ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies.

Systematic review

Unclassified

Clozapine resistance: Augmentation strategies

Journal European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology
Year 2012
Links Pubmed DOI www.epistemonikos.org

This article is included in 2 Broad syntheses 59 Broad syntheses (2 references)

This article includes 60 Primary studies 59 Primary studies (60 references)

Loading references information
Background: Clozapine (CLZ) is not effective in more than 50% of treatment-resistant schizophrenic patients. In these cases, several pharmacological strategies are used in clinical practice, with different levels of evidence for both safety and efficacy. Objectives: In the present paper we critically reviewed literature data regarding the efficacy and safety of adjunctive agents in CLZ-resistant schizophrenics. The following classes of agents were considered: 1) antipsychotics, 2) antidepressants, 3) mood stabilizers, 4) other agents (e.g. fatty acid supplement and glutamatergic agents), 5) electroconvulsive therapy (ECT). For lamotrigine and risperidone sufficient data were available to perform a meta-analysis. Methods: A Medline literature search covering a 20-year period was performed. For the meta-analysis, data were entered and analyzed with the Cochrane Collaboration Review Manager Software (RevMan version 5). Results: 62 pertinent studies were identified, including 1556 schizophrenic or schizoaffective patients. Among treatments investigated, there is evidence for CLZ augmentation with 1) amisulpride and aripiprazole, 2) mirtazapine and 3) ethyl eicosapentaenoic acid (E-EPA). Although promising, ECT augmentation needs further validation. The meta-analyses did not support either the use of risperidone or lamotrigine as CLZ adjunct. Conclusion: Overall, there is scarce evidence of efficacy and safety as regards adjunctive strategies for CLZ-resistant patients. However, several limitations do not allow to draw any definitive conclusion; among these we underline the small sample size of clinical trials, the variable definitions of CLZ resistance, the heterogeneity of outcome measures and methodological designs. © 2011 Elsevier B.V. and ECNP.

Systematic review

Unclassified

Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia.

Journal Clinical neuropharmacology
Year 2006
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 7 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 7 Broad syntheses (1 reference)

This article includes 7 Primary studies 7 Primary studies (7 references)

Loading references information
OBJECTIVE: The aim of this article is to critically review all published studies regarding the efficacy and safety of the concurrent administration of clozapine (CLZ) and electroconvulsive therapy (ECT) in CLZ-resistant schizophrenic or schizoaffective patients. METHOD: A MEDLINE search from January 1980 to July 2005 was conducted. RESULTS: One open-label trial and 6 case studies were located, comprising 21 schizophrenic and 1 schizo affective patients (12 men and 10 women) with a mean age of 41.9 years. The duration and dosage of CLZ monotherapy before ECT were reported at least 12 weeks and 300 mg/d, respectively, in 10 patients (45.4%). Plasma CLZ levels before ECT were assessed in 12 patients (54.5%), in which only 7 (31.8%) were reported to be higher than 350 ng/mL. The CLZ dosage during ECT ranged from 200 to 900 mg/d (mean, 518.2 +/- 203.3 mg/d). The number of ECT sessions ranged from 2 to 20 (mean, 11.5 +/- 5.4). Application of electrodes was unilateral in 7 patients, bilateral in 10 patients, and mixed in 2 patients. Sixteen patients (72.7%) showed marked improvement whereas 6 patients (27.3%) had moderate, minimal, or no improvement. No predictors of outcome could be isolated. Side effects reported by 5 patients (22.7%) were nausea, tachycardia, hypertension, memory problems, and confusion. Ten patients (45.4%) relapsed during follow-up. Substantial improvement persisted beyond 4 months in only 5 patients (22.7%). CONCLUSION: Preliminary evidence exists for the safety and short-term efficacy of the concurrent administration of CLZ and ECT in CLZ-resistant schizophrenic or schizoaffective patients.