A.RAJAGOPALAN1, X.W.TAN1, D.MARTIN2, L.JIMMY1, P.C.TOR1
Institute of Mental Health1, The Black Dog Institute2
The effects of electroconvulsive therapy (ECT) on cognition in schizophrenia are variable. This study examined schizophrenia patients who improved and deteriorated in cognition post-ECT, to identify factors that may predict cognitive outcomes.
Patients with schizophrenia/schizoaffective disorder being treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and January 2018, were assessed on the Montreal Cognitive Assessment (MoCA), Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) pre-ECT and post-ECT. Patients with clinically significant improvement, deterioration or no change in MoCA scores were compared on demographics, concurrent clinical treatment and ECT parameters.
125 patients were analysed; 57 (45.6%), 36 (28.8%) and 32 (25.6%) showed improvements, deterioration and no change in cognition respectively, Age [β:0.06, 95% CI:1.01-1.12, p=0.021] and Benzodiazepine administration [β:5.94, 95% CI:1.40-25.29, p=0.016] predicted MoCA deterioration. Lower pre-ECT MoCA predicted MoCA improvement [β:-0.17, 95% CI:0.77-0.93, p<0.001]. All patients showed improvements in GAF, BPRS and BPRS subscale scores, except for the MoCA deterioration group, who did not show statistically significant improvement in negative symptom scores.
The majority of patients with schizophrenia demonstrate improved cognition with ECT. Patients with poor cognition pre-ECT are more likely to see improvement post-ECT. Advanced age and benzodiazepine administration may be risk factors for cognitive deterioration. Finally, improvements in cognition may be associated with improvements in negative symptoms.