PMID- 35556138
OWN - NLM
STAT- MEDLINE
DCOM- 20220623
LR  - 20230513
IS  - 1745-1701 (Electronic)
IS  - 0586-7614 (Print)
IS  - 0586-7614 (Linking)
VI  - 48
IP  - 4
DP  - 2022 Jun 21
TI  - Comparison of Acute Followed by Maintenance ECT vs Clozapine on Psychopathology 
      and Regional Cerebral Blood Flow in Treatment-Resistant Schizophrenia: A 
      Randomized Controlled Trial.
PG  - 814-825
LID - 10.1093/schbul/sbac027 [doi]
AB  - BACKGROUND AND HYPOTHESIS: In treatment-resistant schizophrenia (TRS), Clozapine 
      is only approved treatment with undesirable side-effects, warranting better 
      alternatives. Our hypothesis is acute followed by maintenance Electroconvulsive 
      Therapy (M-ECT) will be comparable in efficacy and safety to Clozapine in TRS. 
      STUDY DESIGN: In this open-label trial, 60 TRS patients were randomized equally 
      to M-ECT (following an acute-course) or Clozapine. Positive and Negative Syndrome 
      Scale (PANSS), Clinical Global Impression Schizophrenia Scale (CGI-SCH), Montreal 
      Cognitive Assessment (MoCA), and Global assessment of functioning (GAF) were 
      measured and compared within and between the groups at baseline, 6 weeks, 12 
      weeks, and 24 weeks. SPECT-CT brain was done at baseline and 24 weeks to compare 
      the changes in regional cerebral perfusion between the groups and correlate with 
      the changes in the outcome-measures. 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].
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the 
      Maryland Psychiatric Research Center. All rights reserved. For permissions, 
      please email: journals.permissions@oup.com.
FAU - Mishra, Biswa Ranjan
AU  - Mishra BR
AUID- ORCID: 0000-0003-0537-9454
AD  - Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), 
      Bhubaneswar, Odisha, India.
FAU - Agrawal, Kanhaiyalal
AU  - Agrawal K
AD  - Department of Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), 
      Bhubaneswar, Odisha, India.
FAU - Biswas, Tathagata
AU  - Biswas T
AD  - Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), 
      Bhubaneswar, Odisha, India.
FAU - Mohapatra, Debadatta
AU  - Mohapatra D
AD  - Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), 
      Bhubaneswar, Odisha, India.
FAU - Nath, Santanu
AU  - Nath S
AD  - Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), 
      Deoghar, Jharkhand, India.
FAU - Maiti, Rituparna
AU  - Maiti R
AD  - Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), 
      Bhubaneswar, Odisha, India.
LA  - eng
SI  - ClinicalTrials.gov/NCT03807882
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Schizophr Bull
JT  - Schizophrenia bulletin
JID - 0236760
RN  - 0 (Antipsychotic Agents)
RN  - J60AR2IKIC (Clozapine)
SB  - IM
MH  - *Antipsychotic Agents/pharmacology/therapeutic use
MH  - Cerebrovascular Circulation
MH  - *Clozapine/pharmacology/therapeutic use
MH  - *Electroconvulsive Therapy/adverse effects
MH  - Humans
MH  - *Schizophrenia/drug therapy
MH  - Schizophrenia, Treatment-Resistant
MH  - Treatment Outcome
PMC - PMC9212098
OTO - NOTNLM
OT  - M-ECT
OT  - PANSS
OT  - RCT
OT  - SPECT-CT brain
OT  - TRS
OT  - antipsychotic
EDAT- 2022/05/14 06:00
MHDA- 2022/06/24 06:00
PMCR- 2023/05/12
CRDT- 2022/05/13 17:02
PHST- 2022/05/14 06:00 [pubmed]
PHST- 2022/06/24 06:00 [medline]
PHST- 2022/05/13 17:02 [entrez]
PHST- 2023/05/12 00:00 [pmc-release]
AID - 6584931 [pii]
AID - sbac027 [pii]
AID - 10.1093/schbul/sbac027 [doi]
PST - ppublish
SO  - Schizophr Bull. 2022 Jun 21;48(4):814-825. doi: 10.1093/schbul/sbac027.