Effectiveness of the Combined Antipsychotic and Electroconvulsive Therapy (ECT) in Patients with First Episode Psychosis

Aim: This is a naturalistic controlled study to assess the efficacy of electroconvulsive therapy (ECT) as an augmentation strategy in patients with first episode psychosis (FEP). Subjects and methods: Sixty-five patients diagnosed with FEP according to DSM-IV -TR were included. Patients with affective psychosis and/or any other major psychiatric disorders or neurological disorders were excluded. Fifty patients were allocated to ECT group treated with combined antipsychotics and ECT therapy, with maximum 12 sessions, and 15 patients were allocated to non ECT group treated by antipsychotic medications only. Severity of symptoms and treatment response of the subjects in both groups were measured using Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) at admission and discharge, and the percentage of change in the scores of both groups were compared. Results: At baseline, the ECT group showed significantly higher severity of symptoms. At the endpoint both groups had a significant decrease from basal score, yet the ECT group showed highly statistically significant difference as regard the percentage of change as scored by the BPRS, CGI, and total PANSS and all its subscales. These differences were more pronounced in positive vs. negative symptoms. Conclusion: The combination of ECT and antipsychotic medications could be an effective early psychosis intervention and showed better results than antipsychotic drugs used alone. However, in contrast to our expectation it did not decrease the duration of hospitalization.