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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Updated: Jun 11, 2025

Electroconvulsive Seizures in Rats and Fractionation of Their Hippocampi to Examine Seizure-induced Changes in Postsynaptic Density Proteins
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Relapse Following Electroconvulsive Therapy for Schizophrenia: A Systematic Review and Meta-analysis.

Nobuatsu Aoki1,2,3, Aran Tajika4, Taro Suwa5

  • 1Department of Neuropsychiatry, Faculty of Medicine, Kansai Medical University, Osaka, 570-8506, Japan.

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Summary

Schizophrenia relapse after electroconvulsive therapy (ECT) is common, with over half of patients relapsing within two years. Relapse risk is highest in the first six months, especially the initial three months post-acute ECT.

Keywords:
electroconvulsive therapymeta-analysisrehospitalisationrelapseschizophreniasystematic review

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Area of Science:

  • Psychiatry
  • Neurology
  • Clinical Psychology

Background:

  • Limited evidence exists on schizophrenia relapse rates after acute electroconvulsive therapy (ECT).
  • A clear consensus on relapse proportions following ECT for schizophrenia is lacking.
  • This study addresses the need for longitudinal data on schizophrenia relapse post-acute ECT.

Purpose of the Study:

  • To provide longitudinal information on schizophrenia relapse following acute electroconvulsive therapy (ECT).
  • To quantify relapse proportions at various time points after acute ECT for schizophrenia.
  • To investigate the impact of maintenance therapy on relapse rates.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
  • Inclusion of studies on post-acute ECT relapse and rehospitalization for schizophrenia and related disorders.
  • Calculation of pooled relapse estimates at 3, 6, 12, and 24 months using a random effects model.

Main Results:

  • 29 studies (3876 patients) were included, with low risk of bias in RCTs.
  • Pooled relapse proportions at 3, 6, 12, and 24 months were 24%, 37%, 41%, and 55%, respectively.
  • The 6-month relapse proportion was 20% when continuation/maintenance ECT was combined with antipsychotics.

Conclusions:

  • Schizophrenia relapse post-acute ECT predominantly occurs within the first 6 months, particularly the first 3 months.
  • Relapse rates stabilize after 6 months, but over 50% of patients relapse within 2 years.
  • Further research is required to optimize post-acute ECT treatment strategies for schizophrenia.