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. 2010 Jan;52(Suppl1):S317–S340. doi: 10.4103/0019-5545.69261

Table 3.

Comparative efficacy studies of first generation antipsychotics vs. electroconvulsive therapy/electroconvulsive therapy and first generation antipsychotic in schizophrenia

Authors Duration (in weeks) Sample size/scale/design Medication (s) in mgs Outcome
Dutta Ray[39] CPZ vs. CPZ + ECT vs. ECT

  • Combination of these two forms of treatment gave better results than when either of their use singly
Chatterjee and Bhushan[40] 1-4 month N = 76; Open label TRZ + ECT + IMN (in new cases) vs. TRZ

  • 20 out of 25 new cases showed considerable improvement in 2-3 weeks

  • 27 out of 51 old cases showed good response
Dutta Ray and Kapur[41] Follow-up 6-18 months N = 200; Psychotic subjects CPZ + ECT

  • Better chances of response to combination treatment, if the duration of illness is less than 1 year, patients are young and have an acute onset of illness

  • 37% of the subjects were classified as cured, 41.5% as relieved and 21.5% as unrelieved

  • Family history of mental illness was poor prognostic factor whereas gender and past h/o psychiatric illness had no bearing on the treatment response
Bagadia et al.[1] 4 N = 300; Schiz Group matching on the basis of prognosis IST vs. ECT 6-10 vs. CPZ 600-2400 vs. TFP 15-60 TFD 2-6 vs. FFX 3-15

  • Improvement in the ECT group was better and faster than all other groups

  • 90% of the subjects improved with ECT (80% improved completely, 2% improved markedly, 8% improved moderately) compared to 60-78% in other groups

  • In the ECT group all the subjects with very good, good and fair prognosis improved completely
Janakiramaiah and Subbakrishna[42] 6 N = 44; SBRCT, RP, CGIS CPZ 300 CPZ 300 + ECT

  • There was no significant difference between the two group on RP scale or CGIS at the end of 6 weeks

  • ECT + CPZ group was significantly better than CPZ alone on the RP scale positive and negative scores at the end of 2nd week
Janakiramaiah et al.[43] 6 N = 60; RDC Schiz, SBRCT, Consecutive sampling, BPRS, ESRS, CGI CPZ 300 mg vs. CPZ 500 mg vs. CPZ 300 mg + ECT vs. CPZ 500 mg + ECT

  • CPZ 300 mg better than CPZ 500 mg/day

  • ECT/CPZ combinations (300 mg CPZ + ECT and 500 mg CPZ + ECT) did not offer any remarkable therapeutic advantage over 500 mg of chlorpromazine except at week 1, when the 500 mg CPZ + ECT group was better than all the other three treatment groups
Natani et al. 1983[44] 3 N = 90; ICD-9 Schiz Comparative trial RCT, RP, PDRS, CDCS HPL 15 vs. ECT vs. HPL 15 + ECT

  • All three treatment methods effective in management of schizophrenia

  • In terms of reduction in total scores on RP and PDRS, subjects who received ECT + HPL were significantly better after 1st and 2nd week, but the difference was not significant after 3rd week

  • Similar trends were observed in areas of ‘general appearance and behavior,’ ‘thought and thought processes’ and ‘affect and mood’
Gangadhar[45] N = 35; Functional Psychosis Neuroleptic vs. Neuroleptic +ECT

  • Subjects who had received ≥2 ECTs had less EPS as compared to those not receiving ECT
Bagadia et al.[46] 3 N = 78; DBRCT Real ECT + PBO vs. Simulated ECT + CPZ 300‑900

  • Similar improvement observed in both the groups on total BPRS score, various BPRS factor scores and CGI
Agarwal and Winny[47] 4 N = 58; DBCT, BPRS, Three phases 1- CPZ only 4 weeks-non responders-received additional ECTfollow-up-4 CPZ 600-1200 + Simulated ECT vs. CPZ + ECT

  • At the end of first four weeks (Part-1 of the trial), 28 of the 58 subjects showed a reduction of more than 50% in their BPRS score, rest (30 subjects) were assigned to either ECT or simulated ECT

  • Patients in both groups improved significantly

  • No difference between the ECT and simulated ECT groups in response rate during the treatment phase or at follow-up of 1 month after stopping ECT

  • Subject receiving ECT showed significantly better improvement on BPRS score of depression at the end of follow-up. There was no difference in any other domain
Abraham and Kulhara[48] 26 N = 22; RDC Schiz, DBRCT BPRS, CGIS TFP + Simulated ECT vs. TFP + ECT

  • The ECT group showed more rapid improvement than the simulated ECT group, but by 12th week scores for both the groups were similar and did not show any significant difference thereafter till 26th week
Sarkar et al.[49] 6 months N = 30; DBRCT HPL 15 mg + true ECT vs. HPL + sham ECT

  • Efficacy similar in both groups
Goswami et al.[50] N = 31; DSM IV, DBRCT; TRS, BPRS, CGI CPZ + Sham ECT vs. CPZ + ECT

  • Significant decrease in BPRS score in the ECT group from 2nd week onwards (after 6 ECTs) and no significant decrease in the sham ECT group

  • No difference between the two groups in CGI score, need for rescue medications and total daily dose of AP

  • Relatives favored ECT treatment for greater comfort and satisfaction

  • Re-hospitalization rates were less in the ECT group

CPZ - Chlorpromazine; ECT - Electroconvulsive therapy; TRZ - Thioridazine; IMN - Imipramine; Schiz - Schizophrenia; IST - Insulin subcoma therapy; TFP - Trifluoperazine; TFD - Trifluperidol; FFX - Fluphenthixol; SBRCT - Single blind randomized controlled trial; RP - Rockland and polin scale; CGI-S - Clinical global impression severity; RDC - Research diagnostic criteria; BPRS - Brief psychiatric rating scale; ESRS - Extrapyramidal symptoms rating scale; CGI - Clinical global impression scale; RCT - Randomised controlled trial; PDRS - Psychiatric disability rating scale; CDCS - Composite diagnostic checklist of schizophrenia; HPL - Haloperidol; EPS - Extrapyramidal symptoms; DBRCT - Double blind randomized controlled trial; PBO - Placebo; DBCT - Double blind controlled trial; TFP - Trifluoperazine; TRS - Treatment resistant schizophrenia