Does catatonic schizophrenia improve faster with electroconvulsive therapy than other subtypes of schizophrenia?
OBJECTIVE
Electroconvulsive therapy (ECT) is generally recommended for treating catatonic schizophrenia. Non-catatonic schizophrenia patients also receive ECT. We compared the speed of response to ECT among patients with catatonic and other subtypes of schizophrenia.


METHODS
Consecutive schizophrenia patients referred for ECT within 3 months of starting antipsychotic treatment were studied (19 with catatonic and 34 with non-catatonic schizophrenia). Nurse's Observation Scale for Inpatient Evaluation (NOSIE-30) and Clinical Global Impression (CGI) were used to rate improvement. Referring psychiatrists stopped ECTs based on clinical impression of improvement. Total number of ECTs was taken as an indirect measure of speed of response. NOSIE-30 scores were compared using repeated measures analysis of variance.


RESULTS
Catatonic schizophrenia patients required significantly fewer ECTs to achieve clinically significant improvement. There was a significant group x occasion effect in NOSIE scores, suggesting faster response to ECT in the catatonia group (F=41.6; P<0.001). Survival analysis suggested that patients with catatonic schizophrenia required significantly fewer ECTs (one less session on an average) to achieve clinical improvement (Log-rank statistic =5.31; P=0.02).


CONCLUSIONS
Catatonic schizophrenia responds faster to ECT than non-catatonic schizophrenia. However, the magnitude of the difference is modest.
Thirthalli
Jagadisha
J
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India. jagatth@yahoo.com
Phutane
Vivek H
VH
Muralidharan
Kesavan
K
Kumar
Channaveerachari Naveen
CN
Munishwar
Bharat
B
Baspure
Prashant
P
Gangadhar
Bangalore N
BN
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology; D010054:Brief Psychiatric Rating Scale; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012560:Schizophrenia, Catatonic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012720:Severity of Illness Index; D055815:Young Adult