TOPLINE:

Electroconvulsive therapy (ECT) was associated with a significantly longer time to hospital readmission or suicide than non-ECT treatment in patients with schizophrenia, with risk reductions observed up to 1 year post-discharge, a new study showed.

METHODOLOGY:

• Researchers used data from Swedish nationwide registers of more than 300 patients with schizophrenia (mean age, 48 years; 64% men) who received both inpatient ECT and non-ECT treatment between 2011 and 2020 (median hospitalizations during the study period, 5).
• Each participant served as their own control, with researchers selecting one admission with ECT and one without ECT per patient for comparison.
• Patients received a median of seven sessions per ECT treatment series. Electrode placement during the first session was unilateral in 50% of patients, bitemporal in 21%, bifrontal in 3%, and unknown in 26%, with similar placement locations during the last session.
• Researchers compared the time to psychiatric readmission or suicide within 30, 90, and 180 days and 1 year of discharge in admissions with or without ECT. Patients were followed from discharge until readmission, death, or end of the study, whichever came first.

TAKEAWAY:

• Readmission rates following ECT vs non-ECT admissions were 23.9% vs 34.5% within 30 days, 40.7% vs 52.4% within 90 days, 52.7% vs 67.0% within 180 days, and 70.1% vs 76.4% within 1 year of discharge.
• ECT was associated with a longer time to readmission or suicide than non-ECT treatment within 30 days (hazard ratio [HR], 0.66; P = .003), 90 days (HR, 0.70; P = .001), 180 days (HR, 0.68; P < .001), and 1 year (HR, 0.77; P = .003) of discharge.
• Readmission rates ranged from 6.7% within 30 days to 73.3% within 1 year for the subgroup of 15 participants who received continuous ECT (C-ECT). C-ECT was linked to a longer time to readmission or suicide than an index series of patients without C-ECT within 90 days (HR, 0.13; P = .04) and 180 days (HR, 0.26; P = .02) of discharge.
• Subgroup analyses showed that patients who had previously tried three to five antipsychotics had superior outcomes within 30 and 90 days of discharge when treated with vs without ECT, but those who had tried up to two antipsychotics did not. Those who received clozapine within 100 days before admission had superior outcomes within 90 days of discharge when treated with ECT vs without ECT.

IN PRACTICE:

“It may be particularly beneficial to try ECT in those with an insufficient response to three or more antipsychotics or clozapine,” the investigators wrote.

“Further studies of the effects of ECT on rates of relapse, readmission, or suicide in schizophrenia are needed,” they added.

SOURCE:

The study was led by Linnea Stenmark, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. It was published online on June 5 in Acta Psychiatrica Scandinavica.

LIMITATIONS:

Relapse factors in schizophrenia, such as attitude toward treatment, medication side effects, or medication adherence, were not available. Length of stay and admission differences may have affected the results, and the number of patients receiving C-ECT was small. Additionally, patients receiving ECT may have had more severe symptoms than when they received non-ECT treatment.

DISCLOSURES:

The study was funded by Region Örebro and Nyckelfonden at Örebro University Hospital. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.