Impacts of Electroconvulsive Therapy on 1-Year Outcomes in Patients With Schizophrenia: A Controlled, Population-Based Mirror-Image Study

Abstract

Objectives: Despite the decline in the use of electroconvulsive therapy (ECT) in patients with schizophrenia, ECT augmentation is still recommended for those with poor response to standard pharmacological intervention. However, the effectiveness of augmentation of antipsychotics with ECT on long-term clinical outcomes needs to be verified in an expanded sample.

Methods: Patients who were hospitalized for schizophrenia and received ECT for the first time during that hospitalization were identified from the total population health insurance database in Taiwan between 2002 and 2011. A comparison group was randomly selected and matched by age, gender, calendar year of hospitalization, and duration of hospitalization. Using a mirror-image design, the changes in rates of psychiatric and overall hospitalization, length of hospital stay, number of emergency department visits, and direct medical costs across the 1-year pre- and post-treatment periods were examined.

Results: A total of 2074 patients with the same number of comparison participants were included in the analysis. The rate of re-hospitalization decreased significantly in the ECT group during the 1-year post-treatment period, while there was no significant difference in the comparison group. Correspondingly, the total medical expenses increased significantly in the non-ECT group, but not in the ECT group. Notably, the reduction in the psychiatric re-hospitalization rate in the ECT group was more pronounced among those treated with clozapine or a medium-high average daily dose of antipsychotics.

Conclusion: This 1-year mirror-image analysis indicated that augmentation of antipsychotics with ECT in schizophrenic patients was associated with a reduced rate of psychiatric re-hospitalization.

Fig. 1.

Mirror-image design.

Fig. 2.

The odds ratios of psychiatric hospitalization in post-treatment period compared to those in pretreatment periods, subgroup analysis by patients’ characteristics. Note: P-value for the modifying effect was determined by the interactions between treatment and patient’s characteristics (age groups, gender, etc.) in conditional logistic regression. If P-value <.05, this would indicate that the patient’s characteristics had a significant impact on the differences in the change of the rate of psychiatric hospitalization between pre- and post-treatment.