Randomized, double-blind, sham-controlled trial to evaluate the efficacy and tolerability of electroconvulsive therapy in patients with clozapine-resistant schizophrenia

Is There an Optimal Electrode Placement for Patients With Schizophrenia Undergoing Electroconvulsive Therapy?

ABSTRACT

Electroconvulsive therapy (ECT) is a recognized treatment option for patients with schizophrenia, especially when patients do not respond adequately to antipsychotic medication or when rapid response is needed in severe cases. The 3 common electrode placements, namely, bitemporal, bifrontal and right unilateral (RUL) modalities, have all been described by various studies to be efficacious in symptom reduction. However, the optimal electrode placement with the greatest success rate in the treatment of schizophrenia has yet to be ascertained. Furthermore, the benefit of switching ECT modalities after poor response to the initial electrode placement has not been well studied. Hence, to illustrate the twin issues of the optimal ECT modality as well as the effect of switching ECT modalities after initial nonresponse in patients with schizophrenia, we describe 2 distinct patients who underwent multiple courses of bifrontal and RUL ECT, but only responded well to bifrontal ECT. This is possibly due to the patients' anatomical differences as well as varying brain stimulation patterns produced by the different electrode placements. Thus, we believe that the prescription of ECT in patients with schizophrenia should be individualized, and a switch to a different ECT modality should be strongly considered if there is a lack of response to a particular modality.

Promoting safer and wider worldwide use of clozapine

This issue focuses on the past, the present and the future of clozapine. Of the 43 clozapine articles, nine are historical articles dealing with the past, 29 deal with the present and five with laboratory assays which may influence its future use. These 43 articles include 219 different authors from 56 countries/regions and five continents.

Development, validation and clinical utility of short-term adverse-effects of electroconvulsive therapy (SAVE) checklist

Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. However, it has many cognitive and non-cognitive adverse effects (AEs). There are lacunae in the literature on systematic assessment of non-cognitive AEs. There is a need for a standard, comprehensive and specific clinical tool to evaluate this. Hence, a checklist of short-term AEs of ECT (SAVE) with a 2-phase assessment was developed. Content validation was done using 15 experts' ratings and predefined content validity ratio and index (CVR and CVI) in a two-stage modified Delphi method. The checklist had a good CVR and CVI with a final tool of 39 items. The tool was sensitive and identified the non-cognitive AEs after ECT. Cardiovascular and musculoskeletal systems displayed the highest incidence. Many participants exhibited delayed recovery in orientation, gait, and stance, highlighting a necessity for meticulous monitoring. SAVE is the first standardised tool to assess short-term ECT-related AEs systematically. This checklist likely identifies clinically significant incidences of adverse effects. Its regular use may enhance the safety of ECT and patient comfort by supporting early identification and intervention for AEs. However, given the transient nature of AEs, further studies are needed to determine their predictive validity for long-term consequences.