Effectiveness of Electroacupuncture and Electroconvulsive Therapy as Additional Treatment in Hospitalized Patients With Schizophrenia: A Retrospective Controlled Study.

Jie Jia,Qing-Rong Tan,Zhang-Jin Zhang,Xin-Jing Yang,Jun Shen,Qiang-Ju Wu,Fei-Hu Liu,Hui Zhang,Hua-Ning Wang,Hei Kiu Wong

doi:10.3389/fpsyg.2019.02306

Abstract

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA + ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA + ECT groups had markedly greater clinical response rate than controls on SAPS [72.7 and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3 and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% vs. 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia.Clinical Trial Registration: http://www.chictr.org.cn/showprojen.aspx?proj=38901, identifier ChiCTR1900023563.

Highlights

Schizophrenia is a severe and highly disabling mental disorder that affects about 0.3% of the world population (Charlson et al, 2018)
Over the past two decades, electroconvulsive therapy (ECT) has been increasingly utilized in the clinical practice of psychiatry in China, where ECT often serves as adjunctive therapy with antipsychotic drugs (Tang et al, 2012)
The majority of patients were treated with olanzapine and risperidone in either monotherapy or combination regimens, as these two drugs are the most commonly prescribed antipsychotic agents in acute and longterm treatment of schizophrenia in China (Li et al, 2015)

Summary

Introduction

Schizophrenia is a severe and highly disabling mental disorder that affects about 0.3% of the world population (Charlson et al, 2018). Different antipsychotic drugs have been demonstrated to be differentially associated with weight gain (Leucht et al, 2013). These have led to an increasing desire of seeking non-pharmacological alternatives that could enhance efficacy and reduce related side effects. Since electroconvulsive therapy (ECT) was introduced in 1950s, it has been widely used in the treatment of psychotic disorders (Ali et al, 2019; Grover et al, 2019). One recent meta-analysis suggests that additional ECT has a positive effect on mid-term clinical response for patients with treatment-resistant schizophrenia (Sinclair et al, 2019). ECT is frequently associated with adverse effects, such as headache and transient global amnesia (Andrade et al, 2016)

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Conclusion