Background: The efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and electroconvulsive therapy (ECT) remain uncertain.
Aims: Conduct systematic review and meta-analysis of available literature in English and Chinese about ECT in the treatment of refractory schizophrenia.
Methods: English and Chinese databases were searched for studies published prior to May 20, 2015 regarding the efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and ECT. Two researchers selected and evaluated studies independently using pre-defined criteria. Review Manager 5.3 software was used for data analysis.
Results: A total of 22 randomized control studies, 18 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 18 of the 22 studies with a pooled sample of 1394 individuals found that compared to treatment with antipsychotic medications alone, combined treatment with antipsychotic medications and ECT had significantly higher rates of achieving study-specific criteria of 'clinical improvement' (RR=1.25, 95%CI=1.14-1.37). Based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, the quality of evidence for this assessment of efficacy was 'moderate'. However, the proportion of participants who experienced headache during the treatment was significantly higher in the combined treatment group (RR=9.10, 95%CI=3.97-20.86, based on a pooled sample of 517 from 8 studies) and the proportion who experienced memory impairment was also higher in the combined treatment group (RR=6.48, 95%CI=3.54-11.87, based on a pooled sample of 577 from 7 studies). The quality of evidence about these adverse events was rated as 'very low'.
Conclusions: There are very few high quality randomized controlled clinical trials about the combination of antipsychotic medications and ECT in the treatment of refractory schizophrenia. This meta-analysis found that the combination of antipsychotic medications and ECT could improve psychiatric symptoms in patients with refractory schizophrenia, but the incomplete methodological information provided for most of the studies, publication bias (favoring studies with better outcomes in the combined treatment group), and the low quality of evidence about adverse outcomes, cognitive impairment, and overall functioning raise questions about the validity of the results.
背景: 抗精神病药物合并电抽搐治疗 (electroconvulsive therapy, ECT)对难治性精神分裂症患者的疗效和安全性还不确定。.
目的: 对电抽搐治疗在难治性精神分裂症中的应用的相关中英文文献进行系统综述和 meta 分析。.
方法: 在中英文数据库中检索2015年5月20日前发表的关于抗精神病药物合并ECT治疗难治性精神分裂症疗效和安全性的研究。由两名研究人员根据预先设定的标准独立筛选和评估文献。采用Review Manager 5.1软件进行数据分析。.
结果: 共纳入 22 项随机对照研究，其中在中国大陆开展的研究有 18 项。本研究对 22 项研究中的18项研究共 1394 例样本进行 meta 分析后发现，相比于单独使用抗精神病药物，抗精神病药物合并 ECT 治疗达到各研究特定的“ 临床改善” 标准的比例要显著高 (RR=1.31, 95%CI=1.22-1.41)。根据推荐 GRADE 分级的评估、制定和评价标准 (Grades of Recommendaton, Assessment, Development, and evaluation, GRADE)，该疗效评估的证据质量是“中等”。但是，在治疗过程中出现头痛的参与者比例在合并治疗组中显著更高（RR=9.10, 95%CI=3.97-20.86，基于 8 项研究 517 例样本）。合并治疗组中出现记忆受损的患者的比例也高（RR=6.48，95% CI=3.54-11.87，基于 7 项研究 577 例样本）。这些不良反应的证据质量被评定为“非常低”.
结论: 有关抗精神病药物合并ECT治疗难治性精神分裂症的高质量随机对照临床试验很少。该meta分析发现，抗精神病药物合并ECT可以改善难治性精神分裂症患者的精神症状，但大多数研究提供的方法学信息不全，存在发表偏倚（更偏向于合并治疗组结果相对好的研究），有关不良反应、认知受损和整体功能的证据质量较低，这使我们需要对结果的效度有所质疑。.
中文全文: 本文全文中文版从2015年10月26日起在htp://dx.doi.org/10.11919/j.issn.1002-0829.215093可供免费阅览下载.
Keywords: antipsychotic medication; electroconvulsive therapy; meta-analysis; refractory schizophreinia; systematic review.