Hai-Ti Lin1,2, Shi-Kai Liu3,4, Ming H Hsieh1,2, Yi-Ling Chien1,2, I-Ming Chen1,2, Shih-Cheng Liao1,2, Hui-Ju Tsai5,6, Chi-Shin Wu1,2. 1. Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan. 2. College of Medicine, National Taiwan University, Taipei, Taiwan. 3. Centre for Addiction and Mental Health, Toronto, ON, Canada. 4. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 5. Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. 6. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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.
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 schizophrenicpatients was associated with a reduced rate of psychiatric re-hospitalization.
Authors: Brady G Case; David N Bertollo; Eugene M Laska; Lawrence H Price; Carole E Siegel; Mark Olfson; Steven C Marcus Journal: Biol Psychiatry Date: 2012-10-08 Impact factor: 13.382
Authors: Itziar Flamarique; Josefina Castro-Fornieles; Juan Miguel Garrido; Elena de la Serna; Alexandre Pons; Miguel Bernardo; Inmaculada Baeza Journal: J Clin Psychopharmacol Date: 2012-12 Impact factor: 3.153