Alterations in the Prescription of Psychotropic Drugs After Electroconvulsive Therapy Immediately in Patients with Schizophrenia

Introduction: Electroconvulsive therapy (ECT) and antipsychotic polypharmacy (APP) have been utilized frequently for patients with schizophrenia, particularly for treatment-resistant cases in clinical practice. The prevalence of APP and high-dose antipsychotics is high in Japan, although they are associated with an increased risk for various adverse effects. The aims of this study were to evaluate the prescription patterns of antipsychotics and other psychotropic drugs before and after ECT in patients with schizophrenia. Methods: This was a retrospective clinical chart review of 49inpatients with schizophrenia hospitalized at St. Marianna University School of Medicine Hospital in Japan. We reviewed the types of medication (antipsychotics, antiparkinsonian drugs, and benzodiazepines) and compared their dose before and after modified ECT (m-ECT). Results: The mean dose of antipsychotics significantly decreased after m-ECT (risperidone equivalent; 11.0 ± 7.0 to 9.0 ± 3.7 mg/day; P=0.008). The mean number of antipsychotics significantly decreased from 2.1 ± 1.2 to 1.6 ± 0.6 (P=0.002). In addition, the mean dose of antiparkinsonian drugs significantly decreased after m-ECT (biperiden equivalent; 3.1 ± 1.7 to 1.8 ± 2.4 mg/day; P=0.007), although there were no significant changes in the mean dose of benzodiazepines. Discussion: There was a significant decrease in the dose and number of antipsychotic drugs and in the dose of antiparkinsonian drugs after m-ECT. The results suggest that m-ECT may be a useful treatment option to optimize high-dose antipsychotics and antiparkinsonian drugs as well as APP in patients with schizophrenia.