title: Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis--a case-control study.
abstract: OBJECTIVE
  Previous studies have demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis.
  
  
  METHODS
  This case-control study was conducted in inpatients aged 13-20 years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated.
  
  
  RESULTS
  Between March 2004 and November 2009, 112 eligible patients were allocated to control (n=38) and ECT (n=74) group. Additional ECT treatment significantly reduced hospital stay compared to controls (23.2±8.2 days versus 27.3±9.3 days, mean±SD, P=0.018). Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR)=1.961, P=0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls.
  
  
  CONCLUSIONS
  ECT is an effective and safe intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be considered as an early psychosis intervention.
authors.affiliation: Department of Psychiatry, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Zhang-Jin
authors.initials: ZJ
authors.lastname: Zhang
authors.forename: Yun-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Hua-Ning
authors.initials: HN
authors.lastname: Wang
authors.forename: Huai-Hai
authors.initials: HH
authors.lastname: Wang
authors.forename: Yun-Yun
authors.initials: YY
authors.lastname: Xue
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Feng
authors.forename: Qing-Rong
authors.initials: QR
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017286:Polysomnography; D011618:Psychotic Disorders / Q000628:therapy*; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000628:therapy*; D012895:Sleep, REM / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents