SynthesisPloS one2016
Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials.
Synthesis in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 4 syntheses or guidelines pooled it, 72 citations in OpenAlex.
- Non-Clozapine interventions in treatment-resistant schizophrenia: a systematic review and meta-analysis.Molecular psychiatry · 2026Pooled it
- Theta Burst Stimulation Protocols for Schizophrenia: A Systematic Review and Network Meta-Analysis.JAMA network open · 2024Pooled it
- Electroconvulsive therapy for treatment-resistant schizophrenia.The Cochrane database of systematic reviews · 2019Pooled it
- Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention.Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)Pooled it
- Comparison of Acute Followed by Maintenance ECT vs Clozapine on Psychopathology and Regional Cerebral Blood Flow in Treatment-Resistant Schizophrenia: A Randomized Controlled Trial.Schizophrenia bulletin · 2022Trial
- Electroconvulsive Therapy and Time to Psychiatric Readmission in Schizophrenia.Acta psychiatrica Scandinavica · 2026Observational
- [Electroconvulsive therapy for decades-long treatment-resistant schizoaffective disorder: remission and restoration of decision-making capacity].Der Nervenarzt · 2026Article
- Pharmacological treatment of schizophrenia: Japanese Expert Consensus 2025.Schizophrenia (Heidelberg, Germany) · 2026Article
- Schizophrenia.Nature reviews. Disease primers · 2025Review
- Non-invasive brain stimulation augmentation therapy for treatment-resistant schizophrenia: a systematic review and network meta-analysis.EClinicalMedicine · 2025Article
- Efficacy of electroconvulsive therapy in treating auditory verbal hallucinations in a deaf patient with schizophrenia: A case report.World journal of psychiatry · 2025Article
- A Review of Clinical Advances and Challenges in Clozapine-Induced Myocarditis.Neuropsychiatric disease and treatment · 2025Review
- Non-invasive brain stimulation for treatment-resistant schizophrenia: protocol of a systematic review and network meta-analysis.Systematic reviews · 2024Article
- [Management of treatment resistance-Treatment-resistant schizophrenia].Der Nervenarzt · 2024Review
- A woman with schizophrenia who died due to Takotsubo cardiomyopathy occurring after electroconvulsive therapy.BMC psychiatry · 2024Article
- European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia.European psychiatry : the journal of the Association of European Psychiatrists · 2022Review
- Dopaminergic dysfunction and excitatory/inhibitory imbalance in treatment-resistant schizophrenia and novel neuromodulatory treatment.Molecular psychiatry · 2022Review
- Managing treatment resistance in schizophrenia: A joint study in Hong Kong and Singapore.Frontiers in psychiatry · 2022Article
- Paliperidone to Treat Psychotic Disorders.Neurology international · 2021Review
- Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation.Psychiatry investigation · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 6 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I2 = 62%), separating the two groups as early as weeks 1–2 with an SMD of -0.58 (p<0.00001; I2 = 0%); (2) study-defined response (RR = 1.48, p<0.0001) with an NNT of 6 (CI = 4–9) and remission rate (RR = 2.18, p = 0.0002) with an NNT of 8 (CI = 6–16); (3) PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009). Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3) studies. The ECT-antipsychotic combination caused more headache (p = 0.02) with an NNH of 6 (CI = 4–11) and memory impairment (p = 0.001) with an NNH of 3 (CI = 2–5). The use of ECT to augment antipsychotic treatment (clozapine excepted) can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache. Trial Registration: CRD42014006689 (PROSPERO).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.