Status message

Not the entire site translated, but only to "Journal"

Сlinical Predictors of the Effectiveness of Electroconvulsive Therapy in Therapeutically Resistant Schizophrenia

Сlinical Predictors of the Effectiveness of Electroconvulsive Therapy in Therapeutically Resistant Schizophrenia

E.V. Oleneva, P.V. Ryvkin, S.N. Mosolov

Moscow Research Institute of Psychiatry – Branch of the V.P. Serbsky National Medical Research Center of Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia


The issue of clinical prediction of the effectiveness of electroconvulsive therapy (ECT) in cases of therapeutic resistance, which occurs in almost a third of patients with schizophrenia, is particularly relevant due to the lack of absolute contraindications to use of it, its good tolerability, and the possible presence of other mechanisms of influence on resistance, in addition to the effect directly on dopaminergic neurotransmitter systems.
Materials and methods. The study involved 38 patients with therapeutically resistant schizophrenia who, in accordance with the Protocol, underwent a course of ECT (6-14 sessions) against the background of drug treatment with atypical antipsychotics (clozapine and olanzapine) in constant dosages (clozapine 300–800 mg/day, olanzapine 15–30 mg/day). TRS meant a slight decrease in the severity of productive disorders or a complete absence of positive dynamics after previous treatment with two neuroleptics of different pharmacological groups for 6–8 weeks in medium-therapeutic or maximum permissible doses. Correlation and regression statistical analyses were performed to identify features that are predictive of the ECT effect.

Results. The positive effect of ECT was significantly correlated with the basic values of such items on the PANSS scale as arousal, dullness of affect, emotional isolation, communication difficulties, mannerism, depression, and inhibition. The following significant variables were obtained in the reverse step-by-step multiple regression: emotional detachment, mannerism, and arousal. Besides, there was a statistically significant relationship a negative correlation between disease duration and the reduction in symptoms on PANSS in excess of 50 %, and a positive correlation between disease duration and value of the item “suspicion” of the scale of PANSS. Conclusions. negative clinical predictors of ECT use in therapeutically resistant schizophrenia may be a significant duration of the disease and a large proportion of paranoid symptoms in the structure of the pathological condition. Positive prognostic factors are the relative short duration of the disease with the presence of depressive, catatonic and negative symptoms in the clinical picture.

СONTACT: OlenevaE.V.,

CITATION: Oleneva E.V., Ryvkin P.V., Mosolov S.N. Сlinical predictors of the effectiveness of electroconvulsive therapy in therapeutically resistant schizophrenia // Sovrem. ter. psih. rasstrojstv [Current Therapy of Mental Disorders]. – 2021. – No. 2. – Pр. 11–18. – DOI: 10.21265/PSYPH.2021.57.2.002

CONFLICT OF INTEREST: the authors declare no conflict of interest.

It appears your Web browser is not configured to display PDF files. Download adobe Acrobat or click here to download the PDF file.


1. Rossler W., Salize H.J., van Os J., Riecher-Rossler A. Bremya shizofrenii i psikhoticheskikh rasstroistv v stranakh Evrosoyuza (rasshirennyi referat) // Psikhiatriya i psikhofarmakoterapiya imeni P.B. Gannushkina. – 2006. – T. 11, № 2. – S. 53–57.
2. Mosolov S.N., Potapov A.V., Tsukarzi E.E. Standartizirovannye kliniko-funktsional'nye kriterii terapevticheskoi remissii pri shizofrenii: metod. ukazaniya. M.: FGBU «NMITsPN im. V.P. Serbskogo» MZ RF, 2017. – 73 s.
3. Jääskeläinen E. et al. Predictors of response in treatment-resistant schizophrenia – a meta-analysis /// European Neuropsychopharmacology. – 2019. –Vol. 29, Suppl. 1. – P. 121. – DOI: 10.1016/j.euroneuro.2018.11.228
4. Lehman A.F., Lieberman J.A., Dixon L.B., McGlashan T.H., Miller A.L., Perkins D.O., Kreyenbuhl J. Practice guideline for the treatment of patients with schizophrenia, second edition // The American Journal of Psychiatry. – 2004. – Vol. 161, Suppl. 2. – Pp. 1–56.
5. Kinon B.J. The group of treatment resistant schizophrenias. Heterogeneity in treatment resistant schizophrenia (TRS) // Front Psychiatry. – 2019. – Vol. 9. – P. 757. – DOI: 10.3389/fpsyt.2018.00757
6. Demjaha A., Egerton A., Murray R.M., Kapur S., Howes O.D., Stone J.M., McGuire P.K. Antipsychotic treatment resistance in schizophrenia associated with elevated glutamate levels but normal dopamine function // Biol Psychiatry. – 2014. – Vol. 75 (5). – Pp. 11–13.
7. Meltzer H. Y. Treatment-resistant schizophrenia – the role of clozapine // Current Medical Research and Opinion. – 1997. – Vol. 14, no. 1. – Pp. 1–20.
8. Mosolov S.N., Tsukarzi E.E., Oleneva E.V., Alfimov P.V. Sovremennye metody preodoleniya terapevticheskoi rezistentnosti pri shizofrenii // Biologicheskie metody terapii psikhicheskikh rasstroistv. Dokazatel'naya meditsina – klinicheskoi praktike / pod red. S.N. Mosolova. – M.: Sotsial'no-politicheskaya mysl', 2012. – S. 102–117.
9. Alfimov P.V., Oleneva E.V., Mosolov S.N. Prognosticheskie faktory terapevticheskoi effektivnosti klozapina pri shizofrenii // Sovremennaya terapiya psikhicheskikh rasstroistv. – 2013. – № 2. – S. 21–29.
10. Goldstein M.E., Anderson V.M., Pillai A., Kydd R.R., Russell B.R. Glutamatergic neurometabolites in clozapine-responsive and -resistant schizophrenia // Int J Neuropsychopharmacol. – 2015. - Vol. 18 (6). – pyu117. – DOI: 10.1093/ijnp/pyu117
11. Ivanov M. V., Zubov D. S. Primenenie elektrosudorozhnoi terapii pri rezistentnoi shizofrenii: biologicheskie pokazateli effektivnosti i bezopasnosti // Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. – 2019. – T. 119, № 3. – S. 92–97.
12. Fink M. ECT and clozapine in schizophrenia // J ECT. – 1998. – Vol. 14. – Pp. 223–226.
13. Andrade C., Arumugham S.S., Thirthalli J. Adverse effects of electroconvulsive therapy // Psychiatr Clin North Am. – 2016. –Vol. 39 (3). – Pp. 513–530.
14. Kekelidze Z.I., Mosolov S.N., Tsukarzi E.E., Oleneva E.V. Primenenie elektrosudorozhnoi terapii v psikhiatricheskoi praktike: ucheb.-metod. posobie dlya vrachei. M.: Natsional'nyi meditsinskii issledovatel'skii tsentr psikhiatrii i narkologii imeni V.P. Serbskogo, 2019. 32 s.
15. Mosolov S.N., Egorov A.Yu., Skoromets T.A., Tsukarzi E.E., Gorelik A.L., Naryshkin A.G., Anichkov A.D., Polyakov Yu.I. Nelekarstvennye metody biologicheskoi terapii v psikhiatrii // Psikhiatriya: natsional'noe rukovodstvo / pod red. N.G. Neznanova, Yu.A. Aleksandrovskogo. – M.: GEOTAR-Media, 2018. S. 952–995. 
16. Pawelczyk T., Kołodziej-Kowalska E., Pawełczyk A., Rabe-Jabłon´ska J. Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms // Psychiatry Res. – 2014. – Vol. 220 (1–2). – Pp. 175–180. – DOI: 10.1016/j.psychres.2014.07.071
17. Chanpattana W., Sackeim H. Electroconvulsive therapy in treatment-resistant schizophrenia: Prediction of response and the nature of symptomatic improvement // J ECT. –2010. – Vol. 26 (4). – Pp. 289–298.
18. Zervas I.M., Theleritis C., Soldatos C.R. Using ECT in schizophrenia: A review from a clinical perspective // World J Biol Psychiatry. – 2012. – Vol. 13. – Pp. 96–105.
19. Johns C.A., Thompson J.W. Adjunctive treatments in schizophrenia: Pharmacotherapies and electroconvulsive therapy // Schizophr Bull. – 1995. – Vol. 21. – Pp. 607–619.
20. Kristensen D. et al. Electroconvulsive therapy for treating schizophrenia: A chart review of patients from two catchment areas // European Archives of Psychiatry and Clinical Neuroscience. – 2011. – Vol. 261. – Pp. 425–432.
21. Komissarov A. G. Dinamika vegetativnogo statusa i klinicheskikh proyavlenii u bol'nykh shizofreniei pri provedenii elektrosudorozhnoi terapii // Mater. 7-i mezhdistsiplinar. konf. po biologicheskoi psikhiatrii «Stress i povedenie». – M., 2003. – S. 82–83.
22. Thomann P.A., Wolf R.C., Nolte H.M., Hirjak D., Hofer S., Seidl U. et al. Neuromodulation in response to electroconvulsive therapy in schizophrenia and major depression // Brain Stimul. – 2017. – Vol. 10 (3). – Pp. 637–644.
23. Huang H., Jiang Y., Xia M., Tang Y., Zhang T., Cui H. et al. Increased resting-state global functional connectivity density of default mode network in schizophrenia subjects treated with electroconvulsive therapy // Schizophr Res. – 2018. – Vol. 197. – Pp. 192–199.
24. Breier A. Clozapine treatment of outpatients with schizophrenia: Outcomes and long-term response patterns // Hosp Community Psychiat. – 1993. – Vol. 44. – Pp. 1145–1149.
25. Biologicheskie metody terapii psikhicheskikh rasstroistv. Dokazatel'naya meditsina – klinicheskoi praktike / pod red. S.N. Mosolova. M.: Sotsial'no-politicheskaya mysl', 2012. – 1073 s.
26. Mosolov S.N. Rezistentnost' k psikhofarmakoterapii i metody ee preodoleniya // Psikhiatriya i psikhofarmakoterapiya. – 2002. – T. 4, № 4. – S. 132–136.
27. Zelenina E.V. Olanzapin u bol'nykh shizofreniei s priznakami terapevticheskoi rezistentnosti // Psikhiatriya i psikhofarmakoterapiya. – 2002. – T. 4, № 4. – C. 145–147.
28. Oleneva E.V., Mosolov S.N., Tsukarzi E.E., Alfimov P.V. Kombinirovannoe primenenie EST i atipichnykh antipsikhotikov pri terapevticheski rezistentnoi shizofrenii // XVI S"ezd psikhiatrov Rossii. Vseros. nauch.-prakt. konf. s mezhdunar. uchastiem «Psikhiatriya na etapakh reform: problemy i perspektivy»: tez. / otv. red. N.G. Neznanov. – M.: MNIIP – filial FMITsPiN im. V.P. Serbskogo, 2015. – S. 459.
29. Hasan A., Falkai P., Wobrock T. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance // World J Biol Psychiatry. – 2012. – Vol. 13 (5). – Pp. 318–378.
30. Kay S.R, Fiszbein A., Opler L.A. The positive and negative syndrome scale (PANSS) for schizophrenia // Schizophr Bull. – 1987. – Vol. 13 (2). – Pp. 261–276. – DOI: 0.1093/schbul/13.2.261
31. Mosolov S.N. Shkaly psikhometricheskoi otsenki simptomatiki shizofrenii i kontseptsiya pozitivnykh i negativnykh rasstroistv. – M.: Novyi tsvet, 2001. – 238 c.
32. Guy W. ECDEU Assessment Manual for Psychopharmacology. – Rockville, Md.: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976. – 603 p.
33. Kalachnik J. Medication monitoring procedures: Thou shall, here's how // K.D. Gadow & A.D. Poling (eds.). Pharmacotherapy and mental retardation. – Boston: College-Hill, 1985. – Pp. 231–268.
34. Kane J., Honingfeld G., Singer J. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine // Arch Gen Psychiat. – 1988. – Vol. 45. – Pp. 789–796.
35. Karlson A., Lekrub'e I., Mosolov S.N. Dofaminovaya teoriya patogeneza shizofrenii. – London: Taylor & Francis, 2004. – 188 s.
36. Andreasen N.C. Negative symptoms in schizophrenia: Definition and reliability // Archives of General Psychiatry. – 1982. – Vol. 39. – Pp. 784–788.
37. Mosolov S.N., Yaltonskaya P.A. Razvitie kontseptsii, klassifikatsiya i klinicheskaya differentsiatsiya negativnykh simptomov pri shizofrenii // Sovremennaya terapiya psikhicheskikh rasstroistv. – 2020. – № 1. – S. 2–15.
38. Austin S.F. et al. Long-term trajectories of positive and negative symptoms in first episode psychosis: A 10 year follow-up study in the OPUS cohort // Schizophr Res. – 2015. – Vol. 168. – Pp. 84–91.
39. Mosolov S.N., Tsukarzi E.E. Psikhofarmakoterapiya shizofrenii // Psikhiatriya: natsional'noe rukovodstvo / pod red. N.G. Neznanova, Yu.A. Aleksandrovskogo. – M.: GEOTAR-Media, 2018. – 624 s. 
40. Marder S.R., Davis J.M., Chouinard G. The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials // J Clin Psychiatry. – 1997. – Vol. 58, no. 12. – Pp. 538–546.
41. Addington D., Addington J., Maticka-Tyndale E. Specificity of the Calgary Depression Scale for Schizophrenia // Schizophrenia Research. – 1994. – Vol. 11. – Pp. 239–244.
42. Chiappelli J., Nugent K.L., Thangavelu K. et al. Assessment of trait and state aspects of depression in schizophrenia // Schizophr Bull. – 2014. – Vol. 40, no. 1. – Pp. 132–142.
43. Tollefson G., Sanger T. Negative symptoms: A path analytic approach to a double-blind, placebo- and haloperidol-controlled clinical trial with olanzapine // Am J Psychiatry. – 1997. – Vol. 154. – Pp. 466–474