Article type
Year
Abstract
Objective: This study compared the results and conclusions of a systematic review of electroconvulsive therapy (ECT) for people with schizophrenia (Tharyan & Seifas, Cochrane Library 1997, issue 1) with the clinical use of ECT for people with schizophrenia in India.
Methods: The Indian Journal of Psychiatry (1990-1997), abstracts of papers presented at the National conference of the Indian Psychiatric Society (1990-1997), and chapters on ECT in textbooks of psychiatry by Indian authors were hand searched and cross-referenced for articles pertaining to the use of ECT for people with schizophrenia in India.
Results: The systematic review included twelve trials spanning five decades of which six trials were from India. The review found that treatment with ECT was significantly more likely to result in clinical global improvement at the end of the course of treatment than placebo/sham ECT (OR 0.48: 99% CI 0.26-0.90: NNT = 5.85). The review also found that the combination of ECT and antipsychotic drugs increases the rate and extent of clinical improvement in the short term though the evidence is not strong (OR 0.39; 99% CI 0.15 - 1.03). Data regarding improvement in the medium to long term is limited. The review suggested that ECT may be used as an adjunct to antipsychotic medication for those who show a limited response to medication alone though this is an area that needs further enquiry. The hand search of Indian literature revealed that ECT in combination with antipsychotics is widely used in India for people with schizophrenia by 75% of psychiatrists who use ECT in their clinical practice. The indications for its use are to manage acute exacerbations of illness, to hasten symptomatic improvement and for those who show a limited response to medication alone. Limited evidence from retrospective studies suggest that the improvement with ECT is maintained in the medium term. No prospective trials of ECT for those with schizophrenia have been undertaken in this decade. The role of ECT versus newer antipsychotics such as clozapine as second line treatment for those who show a limited response to medication alone remains unclear.
Discussion: The widespread use of ECT in India for those with schizophrenia lacks a strong research base. A prospective collaborative trial comparing the addition of ECT to antipsychotics versus clozapine is being initiated for those with schizophrenia who respond poorly to conventional antipsychotics alone.
Methods: The Indian Journal of Psychiatry (1990-1997), abstracts of papers presented at the National conference of the Indian Psychiatric Society (1990-1997), and chapters on ECT in textbooks of psychiatry by Indian authors were hand searched and cross-referenced for articles pertaining to the use of ECT for people with schizophrenia in India.
Results: The systematic review included twelve trials spanning five decades of which six trials were from India. The review found that treatment with ECT was significantly more likely to result in clinical global improvement at the end of the course of treatment than placebo/sham ECT (OR 0.48: 99% CI 0.26-0.90: NNT = 5.85). The review also found that the combination of ECT and antipsychotic drugs increases the rate and extent of clinical improvement in the short term though the evidence is not strong (OR 0.39; 99% CI 0.15 - 1.03). Data regarding improvement in the medium to long term is limited. The review suggested that ECT may be used as an adjunct to antipsychotic medication for those who show a limited response to medication alone though this is an area that needs further enquiry. The hand search of Indian literature revealed that ECT in combination with antipsychotics is widely used in India for people with schizophrenia by 75% of psychiatrists who use ECT in their clinical practice. The indications for its use are to manage acute exacerbations of illness, to hasten symptomatic improvement and for those who show a limited response to medication alone. Limited evidence from retrospective studies suggest that the improvement with ECT is maintained in the medium term. No prospective trials of ECT for those with schizophrenia have been undertaken in this decade. The role of ECT versus newer antipsychotics such as clozapine as second line treatment for those who show a limited response to medication alone remains unclear.
Discussion: The widespread use of ECT in India for those with schizophrenia lacks a strong research base. A prospective collaborative trial comparing the addition of ECT to antipsychotics versus clozapine is being initiated for those with schizophrenia who respond poorly to conventional antipsychotics alone.