Naturalistic comparative study of outcome and cognitive effects of unmodified electro-convulsive therapy in schizophrenia, mania and severe depression in Nigeria.

BACKGROUND: Although unmodified electro-convulsive therapy (ECT) is widely used in Nigeria for schizophrenia, mania and severe depression failing to respond to adequate pharmacotherapy in the short-term, there are no prospective studies on its efficacy and side effects.

OBJECTIVE: To compare the efficacy of electro-convulsive therapy and standard pharmacotherapy in the treatment of schizophrenia, mania and severe depression.

DESIGN: A prospective open label study.

METHOD: Seventy subjects (mean age, 29.4) with mean duration of illness, 50.6 months, and diagnosis of schizophrenia (37.1%), mania (28.6%), severe depression (30%) and schizo-affective disorder (4.3%), were assessed pre-ECT and at seven other intervals in six months, using the Brief Psychiatric Rating Scale (BPRS), the Mini-Mental State Examination (MMSE) and other cognitive test batteries. They were compared with a matched group of patients who received only pharmacotherapy.

RESULTS: Although the ECT group had suffered more treatment resistant disorders, there was full clinical recovery in two months, when all were discharged. The group had significantly shortened duration of hospitalisation, after commencement of ECT. Hence ECT facilitated recovery in this potentially drug treatment resistant psychotic subjects. Although frequency of complaints of subjective memory difficulty increased during ECT and normalised at follow up, objective tests showed steady cognitive improvement with clinical recovery. Complaints of muscle pain (31.4%), post-ECT confusion (15.7%) and post-ECT headache (20%) in the first week of treatment, were not evident at follow up.

CONCLUSION: Unmodified ECT combined with pharmacotherapy was safe and effective with non-enduring subjective memory difficulty for this potentially drug treatment resistant group of psychotic patients.