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Electroconvulsive therapy for agitation in schizophrenia: metaanalysis of randomized controlled trials
Gu X.1; Zheng W.3; Guo T.6; Ungvari G.S.2; Chiu H.F.K.5; Cao X.5; D'Arcy C.4; Meng X.7; Ning Y.1; Xiang Y.10
2017-02-01
Source PublicationShanghai Archives of Psychiatry
ISSN10020829
Volume29Issue:1Pages:1-14
AbstractBackground: Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. Aims: To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Methods: Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Results: Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I=0%, p=0.004) and its excitement sub-score (WMD=-1.97, p<0.0001) as well as the PANSS total score at 14 days (WMD=-7.13, I2=0%, p=0.004) and its excitement sub-score at 7 and 14 days (WMD=-1.97 to -1.92, p=0.002 to 0.0001) after ECT. The ECT-APs combination was superior to APs monotherapy with respect to the PANSS total score at treatment endpoint (WMD=-10.40, p=0.03) and 7 days (WMD=-5.01, p=0.02). Headache (number-needed-to-harm (NNH)=3, 95%CI=2-4) was more frequent in the ECT alone group compared to AP monotherapy. According to the GRADE approach, the evidence levels of main outcomes were rated as "very low" (37.5%) and "low" (50%).Conclusion: Pooling of the data based on 7 RCTs from China found no advantage of ECT alone or ECT-APs combination in the treatment of agitation related outcomes in schizophrenia patients. However, ECT alone or ECT-APs combination were associated with significant reduction in the PANSS total score. High-quality RCTs are needed to confirm the current interpretations.
KeywordAgitation Electroconvulsive therapy Headache, meta-analysis Schizophrenia
DOI10.11919/j.issn.1002-0829.217003
URLView the original
Language英語
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Document TypeJournal article
CollectionUniversity of Macau
Affiliation1.The Second Affiliated Hospital of Xinxiang Medical University
2.University of Western Australia
3.Guangzhou Medical University
4.University of Saskatchewan
5.Chinese University of Hong Kong
6.Capital Medical University China
7.McGill University, Douglas Mental Health University Institute
8.University of Notre Dame Australia
9.Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital
10.Universidade de Macau
Recommended Citation
GB/T 7714
Gu X.,Zheng W.,Guo T.,et al. Electroconvulsive therapy for agitation in schizophrenia: metaanalysis of randomized controlled trials[J]. Shanghai Archives of Psychiatry,2017,29(1):1-14.
APA Gu X..,Zheng W..,Guo T..,Ungvari G.S..,Chiu H.F.K..,...&Xiang Y..(2017).Electroconvulsive therapy for agitation in schizophrenia: metaanalysis of randomized controlled trials.Shanghai Archives of Psychiatry,29(1),1-14.
MLA Gu X.,et al."Electroconvulsive therapy for agitation in schizophrenia: metaanalysis of randomized controlled trials".Shanghai Archives of Psychiatry 29.1(2017):1-14.
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