Electroconvulsive Therapy and Time to Psychiatric Readmission in Schizophrenia

There is evidence that electroconvulsive therapy (ECT) can augment the effects of antipsychotics in schizophrenia. However, there is limited evidence from Western populations on whether ECT reduces the risk of relapse compared to non-ECT treatment in schizophrenia. This study aimed to compare time to psychiatric readmission or suicide among inpatients with schizophrenia treated with or without ECT, as well as those receiving index series with or without continuation ECT (C-ECT).

Register-based study utilizing data from Swedish nationwide registers. Patients with schizophrenia who received both inpatient ECT and non-ECT treatment between 2011 and 2020 were included. Each patient served as their own control, contributing one admission with and without ECT. Admissions with or without ECT, as well as index series with or without C-ECT, were compared in univariate Cox regression analyses regarding time to psychiatric readmission or suicide within 30 days, 90 days, 180 days, and 1 year from discharge.

A total of 351 patients were included. Of these patients, 64.1% were male and the mean (SD) age was 48.2 (14.4) years. ECT was associated with longer time to readmission or suicide compared to non-ECT treatment within 30 days (HR: 0.66; 95% CI: 0.50-0.87; p = 0.003), 90 days (HR: 0.70; 95% CI: 0.56-0.87; p = 0.001), 180 days (HR: 0.68; 95% CI: 0.56-0.82; p = < 0.001), and 1 year from discharge (HR: 0.77; 95% CI: 0.65-0.91; p = 0.003). Furthermore, 15 patients received C-ECT, which was associated with longer time to readmission or suicide compared to index series without C-ECT within 90 days (HR: 0.13; 95% CI: 0.02-0.91; p = 0.040) and 180 days from discharge (HR: 0.26; 95% CI: 0.08-0.81; p = 0.021).

This study suggests that ECT can be associated with a longer time to relapse compared to non-ECT treatment in schizophrenia.