Table 3.
Systematic review of studies administering non-clozapine augmented with ECT.
| Author (Year, Place) | Age (mean± SD) | Design | Number of patients | Setting | General anesthesia, electrode placement, seizure threshold | Duration of Illness (mean± SD in years) | Dosage of Drug (mg/day) | Mean number of treatments | Scales used for Evaluation | Result |
|---|---|---|---|---|---|---|---|---|---|---|
| Chanpattana et al. (2000, Thailand) | 32.2 ± 7.2 | Open-label trial | Total = 21 | Inpatient and Outpatient | General anesthesia, bilateral electrodes, seizure threshold: NA | 10.8 ± 6.2 | Flupenthixol = 12- 24 | 11.4 ± 5 | Psychotic: BPRS | Overall improvement was seen as BPRS score were found to be reduced from 50.5 ± 9.1 to 14.2 ± 7.8 at the end of Phase 2 |
| Chanpattana et al. (2000, Thailand) | 1ST* = 35.1 ± 8.3; 2ST = 35.2 ± 8.2; 4ST = 33.5 ± 7.4 | Randomized, double-blind | Total = 62; 1ST-Remitter = 11;Non-remitters = 10 2ST-Remitter = 11;Non-remitters = 10 4ST- Remitter = 11;Non-remitters = 9 | NA | General anesthesia, bilateral electrodes, seizure threshold: Baseline: 1ST = 75.4 ± 30; 2ST = 79.5 ± 23.4; 4ST = 81.2 ± 28.7 Tenth: 1ST = 184.3 ± 95.2; 2ST = 188.9 ± 105.5; 4ST = 229.5 ± 75.3 Increment: 1ST = 107.5 ± 84.8; 2ST = 108.8 ± 111; 4ST = 147.8 ± 86, empirical titration technique | 1ST = 15.7 ± 7.9; 2ST = 14.0 ± 7.3; 4ST = 12.9 ± 5.5 | Flupenthixol 1ST = 22.9 ± 2.4; 2S = 23.1 ± 2.2; 4ST = 23.1 ± 2.2 | At first improvement: 1ST = 13.6 ± 5.0; 2ST = 7.5 ± 3.8; 4ST = 4.2 ± 1.5 At the end of the study: 1ST = 18.6 ± 5; 2ST = 12.5 ± 3.8; 4ST = 9.2 ± 1.5 | Psychotic: BPRS | Overall improvement was seen as BPRS scores for the three groups 1ST, 2ST, & 4ST were found to be reduced by 62.6%, 60.8% & 65.6% from baseline scores of 51.8 ± 10.7, 48.7 ± 7.2 & 47.9 ± 6.1 respectively. |
| Chanpattana & Chakrabhand et al. (2001, Thailand) | Responders = 31.9; Non-responders = 37.1 | Clinical Trial | Total = 293; Responder = 160; Non-responders = 133 | Inpatient and outpatient | General anesthesia, bilateral electrodes, Initial seizure threshold: women: 93.6 ± 32.3; men: 94.2 ± 35.3; Responders: Women: 89.1 ± 35.8; men: 92.2 ± 37.0; non-responders: women: 97.6 ± 27.3; men: 90.6 ± 33.0; empirical titration technique | Responders = 11; Non-responders = 16.6 | Flupenthixol 12 mg/day during the first week then increased to 24 mg/day. | Responders = 12.5; Non-responders = 20.2 | Psychotic: BPRS | Significant reduction was observed in the values of different parameters of BPRS profile. There was a marked improvement in positive symptoms, but the negative symptoms showed limited improvement. |
| Chanpattana & Sackeim et al. (2010, Thailand) | Responders = 31.9; Non-responders = 36.7 | Clinical Trials | Total = 253; Responders = 138; Non-responders = 115 | Inpatient and outpatient | General anesthesia, bilateral electrode, initial seizure threshold: responders: 94.5; non-responders: 94.9, empirical titration technique. | Responders = 10.9; Non-Responders = 16.2 | Flupenthixol Responders = 21.5; Non-responders = 22.1 | Responders = 12.5; Non-responders = 20.2 | Psychotic: BPRS | Improvement in BPRS scores was observed with females showing greater extent of improvement than males. |
| Goswami et al. (2003, India) | ECT = 29.8 ± 8.54; Sham-ECT = 29.1 ± 5.7 | Randomized, Double blind, Controlled | Total = 25; ECT + Chlorpromazine = 15; Sham-ECT + Chlorpromazine = 10 | NA | General anesthesia, Bilateral electrode, seizure threshold- 50 to 200% | ECT = 7.6; Sham-ECT = 6.9 | Chlorpromazine = 500 mg/day | Psychotic: BPRS | Both the groups showed a reduction in the BPRS scores with ECT group showing the slightly higher level of score reduction, 44 ± 7.6 from 55 ± 7.2.CGI scores improved only for the ECT group from baseline 4.9 to 4.13 in week 4. ECT + drug treatment is better | |
| Hirose et al. (2001, Japan) | 29.5 ± 8.959(calculated) | Open trials | Total = 10 (males only) | Inpatient | Anesthesia: NA, bilateral electrode placement, seizure threshold: NA | 9.85 ± 8.794 (calculated) | Risperidone = 6.2 ± 2.097 (calculated) | 6.6 ± 1.712 (calculated) | Psychotic: BPRS | A significant reduction in the HS from the baseline value of 6.6 ± 0.16 to 1.1 ± 0.1. PS score reduced from 13.2 ± 2.6 to 4.1 ± 0.11. |
| Ravanic et al. (2009, Serbia) | Sulpiride = 38.52; Risperidone = 33.30; Olanzapine = 33.6 | Open labeled Active control | Total = 70; Sulpiride = 17; Risperidone = 26; Olanzapine = 27 | Outpatient | Anesthesia: NA, unilateral electrode, seizure threshold: NA | Sulpiride group = 10.43; Risperidone group = 7.1; Olanzapine group = 9.08 (calculated) | Sulpiride = 294.52; Risperidone = 6.32; Olanzapine = 6.82 | Sulpiride = 2.5; Risperidone = 6.32; Olanzapine = 6.82 | Psychotic: PANSS | The PANSS scores for general psychopathology reduced from 55.88 ± 14.28 to 25.13 ± 6.03 for Sulpiride, 55.78 ± 15.62 to 20.81 ± 5.85 for Risperidone, and 56.11 ± 16.27 to 19.23 ± 5.19 for Olanzapine. As observed from the score change, Olanzapine is the most effective of all the drugs. |
| Sarita et al. (1998, India) | 18-45 | Double-blind randomized Controlled study | Total = 36; ECT + Drug = 24; Sham ECT + Drug = 12 | NA | NA | > 2 | Group 1: unilateral ECT + haloperidol = 14.2 mg; Group2: bilateral ECT+ haloperidol = 14.6 mg; Sham ECT + Drug = 18.3 | 3 | Psychotic: BPRS | There was a reduction in BPRS scores of the ECT and Sham-ECT groups. However, not very significant differences in the treatment result were observed. |
| Chanpattana & Kramer et al. (2003, Thailand) | 32 ± 6.4 | Open trials | PHASE 1 Total = 59; Responders = 52; Non-responders = 7 | NA | Anesthesia: NA, bilateral electrode, seizure threshold: NA, titration | NA | Phase 1 − Flupenthixol 12 to 24 mg |
12.3 ± 4.5 | Psychotic: BPRS | Significant results were obtained regarding the improvement of condition. Reduction in BPRS scores from Baseline = 48.5 ±7.3 to Endpoint = 17.1 ± 9.9; |
| 32 ± 6.4 | Open trial | PHASE 2 Total = 52; Responders = 46; Dropouts = 6 | NA | Anesthesia: NA, bilateral electrode, seizure threshold: NA, titration | 9.9 ± 5.1 | Phase 2 − Flupenthixol 23.1 ± 2.2 |
24.6 ± 2.4 | |||
| Chanpattana et al. (1999, Thailand) | PHASE 1 Responders = 33.2 ± 8.0; Non-responders = 38.6 ± 7.2 | Open trials | PHASE 1 Total = 101; Responders = 58; Non-responders = 43 | Inpatient and outpatient | General anesthesia, Bilateral electrode seizure threshold: NA | PHASE 1 Responders = 12.4 ± 6.7; Non- responders = 18.1 ± 7.7 | PHASE 1- Flupenthixol Responders = 21.0 ± 4.2; Non-responders = 23.6 ± 3.8 | PHASE 1 Responders = 13.9 ± 4.8; Non-responders = 20.4 ± 0.8 | Psychotic: BPRS | PHASE 1 Reduction in the BPRS scores of responders from baseline score of 49.1 ± 9.6 to 18.7 ± 7.2 at the end of phase I of the treatment was observed. |
| ECT = 32.7 ± 8.4; ECT + drug = 36.7 ± 8.2; Drug = 33 ± 6.8 | PHASE2; Total = 45; ECT(I) = 15; ECT(II) + Flupenthixol = 15; Flupenthixol (III) = 15 |
Inpatient and outpatient | General anesthesia, Bilateral electrode seizure threshold: NA | ECT = 11.9 ± 6.8 ECT + drug = 13.7 ± 5.5; Drug = 14.2 ± 6.4 | Phase 2 − ECT = 0; ECT + Flupenthixol = 22.0 ± 3.7; Flupenthixol = 22.4 ± 2.7 | Significant reduction in the BPRS scores was observed in patients receiving the combination of drug and ECT, from 44.9 ± 8.2 at entry to 16.7 ± 5.9 at the end for treatment I, 51.4 ± 9.0 to 14.1 ± 7.9 for treatment II and 49.0 ± 8.6 to 18.1 ± 4.2 for treatment III. | ||||
| Sajatovic et al. (1993, USA) | 28.9 ± 7.6 | Open trial | Total = 9; ECT + Loxapine Responders = 5; Non-responders = 4 | Inpatient | Anesthesia: NA, Unilateral and bilateral electrode placement, seizure threshold: NA | 10.4 ± 3.8 (calculated) | Loxapine = 36.7 ± 36.1 | 7.9 ± 2.3 | Psychotic: BPRS | Change in BPRS score from baseline = 51.6 ± 12.7 to endpoint = 35.8 ± 9.7 in 5 patients. 4 proved to be Non-responders |
| Chanpattana et al. (2000, Thailand) | Responders = 32.4 ± 7.9; Non-Responders = 38.4 ± 7.2 | Open trial | Total = 93; Responders = 56; Non-responders = 37 | NA | General anesthesia, bilateral electrode placement, seizure threshold − based on Thymatron and MECTA default settings | Responders = 12.00 ± 6.4; Non- responders = 18.0 ±7.9 | Flupenthixol; Responders = 22.8 ± 2.7; Non-responders = 23.1 ±3.0 | Responders = 13.1 ± 4.3; Non-responders = 20.3 ± 0.9 | Psychotic: BPRS | BPRS scores reduced by 62.4 ± 16.7% from an initial score of 48.7 ± 9.1. |
| Ukpong et al. (2002, Nigeria) | ECT = 27.7 ± 10.3 Sham-ECT = 24.3 ± 5.5 | Double-blind randomized control study | Total = 20; ECT+ Chlorpromazine = 11 (2); Sham-ECT+ Chlorpromazine = 9 (2) | Inpatient and outpatient | General anesthesia, bilateral electrode placement, seizure threshold: NA | ECT = 8.4 ± 9.19; Sham-ECT = 5.0± 6.0 | Chlorpromazine; ECT + Drug = 306.5; Sham ECT + drug = 285 | 12 for both groups | Psychotic: BPRS | Reduction in BPRS scores occurred for both the groups- ECT + Drug − Baseline = 22.33 ± 7.83, Endpoint = 1 ± 3; Sham ECT + Drug– Baseline = 19.43 ±7.28, Endpoint = 1.29 ±3.42 |
| Chanpattana & Chakrabhand et al. (2001, Thailand) | Weekly = 30.1 ± 7.5; Biweekly = 33 ± 6.2; Triweekly = 28.7 ± 7.3 | Open trial | Total = 32; Weekly ECT = 8; Biweekly ECT = 17; Triweekly ECT = 7 | NA | Anesthesia: NA bilateral electrode, seizure threshold: NA, empiric titration method | Weekly = 13.6 ± 6.0; Biweekly + 11.7 ± 5.5; Triweekly = 7.7 ± 3.6 | Flupenthixol Weekly = 21 ± 5.6; Biweekly = 22.2 ± 3.5; Triweekly = 18.9 ± 4.1 |
Weekly = 15 ± 4.5; Biweekly = 11 ± 3.7; Triweekly = 13.4 ± 7.2 | Psychotic: BPRS | Reduction in BPRS scores of selected items of the rating scale, besides the positive and negative symptoms. |
*Seizure Threshold.
*NA: not available.