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ORIGINAL STUDY

Effectiveness of Electroconvulsive Therapy and Associated


Cognitive Change in Schizophrenia
A Naturalistic, Comparative Study of Treating Schizophrenia With
Electroconvulsive Therapy
Phern-Chern Tor, MBBS, DFD, MMed, FAMS,* Jiangbo Ying, MB,* New Fei Ho, PhD,*
Mingyuan Wang, BSoc,* Donel Martin, MClinNeuro, PhD,†‡ Chai Pin Ang, MBBS,* Chunzhen Tan, MD,*
Lee Shen Yap, MBChB,* Vincent John Magat Lu, MD,* Brett Simpson, MBBS, FRANZCP,‡§
Yee Ming Mok, MB BCh BAO, DIP, MMed, FAMS,* and Colleen Loo, MBBS, FRANZCP, MD†‡

depression, whereas in Asia, it is primarily used for the treatment


Objective: There is limited evidence regarding the relative treatment of psychotic disorders.10–13
effectiveness and cognitive effects of different types of electroconvulsive Although there is an evidence base for the use of various
therapy (ECT) in schizophrenia. In this study, we sought to determine the types of ECT for depression14–17 (bitemporal, bifrontal, right uni-
overall effectiveness and compare the symptomatic and cognitive out- lateral, and ultrabrief right unilateral), evidence regarding the
comes of patients with schizophrenia who received different modalities relative efficacy and cognitive profile of different types of ECT
of ECT treatment. in schizophrenia draws mostly from reports decades ago and is
Methods: Patients received 1 of 4 of the following ECT modalities: scant.18–21 A Cochrane review of ECT in schizophrenia concluded
bitemporal ECT with age-based dosing, right unilateral ECT with seizure that ECT is efficacious in the acute and continuation treatment of
threshold–based dosing, bitemporal ECT with seizure threshold–based schizophrenia in combination with antipsychotics, and that bilat-
dosing, and bifrontal ECT with seizure threshold–based dosing ECT. The eral and unilateral ECT are equally efficacious, with possible
Brief Psychiatric Rating Scale (BPRS) and Montreal Cognitive Assess- transient cognitive adverse effects.3 A more recent study of
ment (MoCA) were administered to 62 patients before and after the schizophrenia suggests superior efficacy and cognitive adverse
ECT course. effect profile of bifrontal over bitemporal ECT.1 In depression,
Results: There was a significant improvement in both the total and psy- ultrabrief right unilateral (RUL) ECT demonstrates similar efficacy
chotic subscales of BPRS and MoCA scores across the patients after the to brief pulse RUL ECT,17 but with reduced cognitive adverse ef-
course of ECT. The global improvements in both BPRS and MoCA scores fects, addressing the main drawback of ECT.22 Certain forms of
after ECTwere not influenced by the type of ECT administered. Age-based ECT (sine wave, bitemporal, high dose) are known to cause short
dosing, however, was associated with poorer memory outcomes posttreat- term anterograde amnesia lasting for up to a few weeks23,24 and
ment. The overall symptomatic response rate, defined as 40% or more slowing of reaction time and retrograde amnesia,22 although this
reduction in the psychotic subscale of BPRS, was 64.5%. The response is not uniformly observed.25,26 Little is known about the symp-
rates did not significantly differ between the 4 types of ECT. tomatic response and cognitive effects of varying ECT pulse
Conclusions: Our present findings suggest that an acute course of width in schizophrenia.
ECT is effective in schizophrenia and may have cognitive benefits for To guide practice and optimize ECT treatment in schizo-
some patients. phrenia, studies on the effectiveness and cognitive outcomes
Key Words: schizophrenia, electroconvulsive therapy, of age-based versus empirical seizure threshold–based dosing
electrode placement, effectiveness, cognition and different electrode placements are needed. Hence in the present
study, we aimed to examine the effectiveness and cognitive out-
(J ECT 2017;00: 00–00)
comes of ECT treatment of schizophrenia in a real-world hospital
setting. We first sought to examine the change in symptomatic
E lectroconvulsive therapy (ECT) is a safe and effective treat-
ment for schizophrenia1–3 and mood disorders.4 However,
usage of ECT around the world is highly variable, both in indi-
response before and after the course of ECT across patients
with schizophrenia. We then examined whether the response
and cognitive outcomes differed among the 4 ECT modalities.
cation for ECT and type of ECT administered (eg, commonly
Electroconvulsive therapy was given using an age-based dosing
bitemporal in Europe and right unilateral in Australia).5 In many
approach for the past 30 years at the hospital, until ECT services
developed countries,6–9 ECT is primarily used for the treatment of
were revamped in 2015 to move from this one-size-fits-all approach
to an individualized seizure threshold–based approach27,28 with a
From the *General Psychiatry, Institute of Mental Health, Buangkok View,
Singapore; †Black Dog Institute, Randwick; ‡School of Psychiatry, University
range of electrode placements (bitemporal, bifrontal, right unilat-
of New South Wales, Sydney; and §Older Adult Mental Health Service, St eral) and pulse parameters (0.5 or 1 millisecond pulse width).
George Hospital, Kogarah, New South Wales, Australia.
Received for publication February 4, 2017; accepted April 3, 2017.
Reprints: Phern Chern Tor, MBBS, DFD, MMed, FAMS, General Psychiatry, MATERIALS AND METHODS
Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical
Park, 539747, Singapore (e‐mail: phern_chern_tor@imh.com.sg). The Singapore Institute of Mental Health (IMH) is the only
The authors have no conflicts of interest or financial disclosures to report. tertiary psychiatric hospital in Singapore, and it has 1900 inpatient
Supplemental digital contents are available for this article. Direct URL citations beds, approximately 40,000 outpatients, and treats approximately
appear in the printed text and are provided in the HTML and PDF versions
of this article on the journal’s Web site (www.ectjournal.com).
80% of the national load of patients with schizophrenia. Clini-
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. cal records in IMH indicate that ECT is prescribed primarily for
DOI: 10.1097/YCT.0000000000000422 schizophrenia (47%) with schizoaffective disorder (20.3%),

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Tor et al Journal of ECT • Volume 00, Number 00, Month 2017

depression (20.4%), and mania (6.8%) being the other examined 2 outcomes for symptomatic response, as defined by
major indications. (1) change in BPRS scores pre- and post-ECT across the patients
Patients were referred to the ECT service by psychiatrists and (2) the proportion of patients who showed an improvement of
who diagnosed schizophrenia using clinical assessments based 40% or more from pretreatment scores based on the psychotic
on Diagnostic and Statistical Manual of Mental Disorders, symptom subscale.2,33,34 The primary cognitive outcome was
Fourth/Fifth Edition (DSM-IV/DSM-V) or International Statistical performance on the Montreal Cognitive Assessment (MoCA
Classification of Diseases, 10th Revision (ICD-10) criteria. Patients Singaporean versions of the MoCA35,36 in the local languages
were typically referred for treatment of psychotic symptoms, which [English, Chinese, Malay, and Tamil] were used). Alternate forms
had not responded adequately to pharmacological treatment and as of the English MoCA forms were used for post-ECT testing. We
a result, were too unwell for discharge back to the community. The examined the change in total MoCA scores from pre- to post-ECT.
number of sessions of ECT prescribed was determined by the Changes in anterograde memory were additionally reported using
treating psychiatrist based on the patient's clinical response. Data the MoCA delayed recall subtest.
from patients with schizoaffective disorder or substance-induced The BPRS ratings were completed by ECT medical officers
psychosis were not examined. who underwent rating training using standardized training videos
under the supervision of P.C.T. Intraclass correlation, as defined
Electroconvulsive Therapy by (MSrater − MSerror)/[MSrater + (average number of patients per
rater − 1)*MSerror], between the BPRS raters was 0.77, where
Before 2015, standard ECT treatment at IMH consisted of
MS indicates mean square. The MoCA was administered by
bitemporal ECT administered 3 times per week, using disposable
ECT nurses. These nurses were trained by P.C.T and D.M., a
adhesive type electrodes; dosing was determined by the refer-
registered neuropsychologist.
ring psychiatrist using an “age minus 10% (50.4 mC)” dosing
The following baseline clinical and demographic variables
method.29 Increases in dosing were made based on reductions
were extracted from the electronic patient records: type of ECT
in seizure duration or electroencephalogram quality, which usu-
(BT-AB, RUL-ST, BT-ST, and BF-ST), initial seizure threshold,
ally meant a 5% to 10% machine power increase in energy levels.
daily dose of concurrent antipsychotic treatment (expressed as
A revamp of ECT services in 2015 consisted of several major
chlorpromazine equivalents) given during ECT,37 lifetime duration
changes. Individualized dosing based on each patient's empiri-
of illness (months), age, sex, and post-ECT MoCA and BPRS scores.
cally determined seizure threshold was used, rather than the
The duration of current episode of schizophrenia is known to cor-
age-based (age − 10%) dosing method.29 Electroconvulsive
relate with response to ECT38 but was not available for analysis.
therapy continued to be delivered using a Thymatron System IV
Ethics approval for data access, analysis, and report was ob-
(Somatics, LLC) and used either a bitemporal, right unilateral
tained from the local institutional research ethics board.
(d’Elia position30), or bifrontal electrode positioning.31 Bitemporal
ECT was delivered at 0.5 millisecond pulse width, and Bifrontal
ECTwas delivered at 1.0 millisecond pulse width, both at 1.5 times Statistics
seizure threshold. The longer pulse width was selected for bifrontal To test for differences in clinical and demographic baseline
ECT compared with bitemporal ECT, because of demonstrated data between the groups receiving different types of ECT, analyses
efficacy in previous studies (Phutane et al1). Right unilateral of variance was performed.
ECT was delivered at 0.5 millisecond pulse width at 5 times seizure Mixed analysis of covariance (ANCOVA) examined (1) whether
threshold. The anesthetic used was propofol, which was dosed completing an ECT course affected symptom (BPRS scores) or
at 1 mg/kg. cognitive outcomes (MoCA scores) and (2) whether the change
After the revamp in 2015, the type of ECT treatment was in outcomes differed depending on the type of ECT administered
changed, although at any one time the default treatment protocol (BT-AB, RUL-ST, BT-ST, and BF-ST). Between-subjects factor
was 1 type of ECT for all patients. In the first change, the default was ECT type (BT-AB, RUL-ST, BT-ST, and BF-ST) and within-
type of ECT was switched from bitemporal age-based dosage subjects factor was time (pre-ECT and post-ECT). Covariates were
(BT-AB; 0.5 millisecond pulse width) to right unilateral seizure age, sex, duration of illness, antipsychotic dose, and number of
threshold–based dosage (RUL-ST; 0.5 millisecond pulse width) ECT sessions. For analysis of MoCA scores, post-ECT BPRS
due to the well-established cognitive benefits of RUL-ST over was an additional covariate. Where the ANCOVAs yielded signif-
bitemporal ECT.14 An interim analysis of effectiveness showed icant results, follow-up tests examined where the between-group
a trend for RUL-ST to be less effective than BT-AB ECT. Hence, differences occurred. Paired-samples t tests also examined changes
the ECT modality for schizophrenia was changed to bitemporal in symptom and cognitive outcomes across the course of ECT,
seizure threshold–based dosing (BT-ST; 0.5 millisecond pulse within each type of ECT modality. The proportion of patients in
width). Subsequently, the ECT modality was changed to bifrontal each ECT group who had 40% or more improvement in BPRS
seizure threshold–based dosing (BF-ST; 1.0 millisecond pulse psychotic subscale (“responders”) was compared using a χ2 test.
width) after the team became aware of a recent trial suggesting Only available data were analyzed, and missing data was not imputed.
superiority of BF-ST over BT-ST in schizophrenia.1 Data were Significance was set at a threshold of P value less than 0.05,
reported from December 2014 to May 2016, and each type of ECT and all analyses were completed using the Statistical Program for
was the default protocol at the hospital for approximately 4 months. Social Sciences Version 14 (SPSS; Chicago, IL).

Outcome Measures RESULTS


During the study, ratings (symptom and cognitive) were per-
formed at 1 to 2 days before and 1 to 2 days after the acute course Patient and Treatment Characteristics
of ECT. The primary effectiveness outcome was assessed by the Of a total of 99 patients treated during the study period,
Brief Psychiatric Rating Scale (BPRS32; subscale for psychotic 62 patients were included in the final analysis because they had
symptoms [hallucinatory behavior, suspiciousness, conceptual complete pre- and post-ECT BPRS data. There were no statistically
disorganization, and unusual thought content] and overall scores significant differences in age, sex, duration of illness, chlorproma-
[which included negative and disorganized subscales]). We zine equivalent dosage, number of ECT sessions, or baseline BPRS

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Journal of ECT • Volume 00, Number 00, Month 2017 ECT in Schizophrenia: A Naturalistic Study

between patients who received the different types of ECT either for DISCUSSION
the total sample (99 patients) (Supplementary Table 1, http://links.
lww.com/JECT/A58), or those with complete data (62 patients) This retrospective analysis of the effect of ECT in schizo-
(Table 1). Analyses were subsequently restricted to patients phrenia in a real world clinical setting showed that ECT was an ef-
who had complete pre- and post-ECT BPRS data. Patients re- fective treatment with rapid onset of action for schizophrenia,
ceiving RUL-ST received fewer ECT treatments than patients decreasing symptom burden. Different ECT modalities were
receiving BF-ST. equally effective in eliciting symptomatic improvement, and there
was indication of global cognitive improvement in some patients.
Age-based dosing, however, was associated with poorer memory
outcomes posttreatment.
Effectiveness To our knowledge, this is the first report of the comparative
A significant main effect of time was found, with the overall effectiveness of bitemporal ECT (aged-based and seizure threshold–
estimate for the post-ECT BPRS scores (adjusted mean = 32.06) based, 0.5 millisecond pulse width), bifrontal ECT (1.0 millisecond
being significantly lower than the pre-ECT BPRS scores (adjusted pulse width) and right unilateral ECT (0.5 millisecond pulse width)
mean = 45.34). There was no main effect of ECT type (F [3, and demonstrates the equal effectiveness of these different modalities
53] = 1.64, P = 0.19, η2 = 0.085), and no interaction between time of ECT in schizophrenia. Almost two thirds of the patients re-
and ECT type (F [3, 53] = 0.422, P = 0.738, η2 = 0.023). Paired sponded to ECT, which is comparable with a recent study that
samples t test showed that ECT significantly improved BPRS total showed a 50% response rate in clozapine-resistant patients
score and psychotic subscale score for all 4 types of ECT with schizophrenia.2
(Table 2). A total of 64.5% of patients showed 40% reduction of Contrary to the literature assessing cognitive adverse effects
BPRS psychotic subscale on average within 10 sessions of ECT of ECT in depression, we found an improvement of MoCA scores
(or approximately 3.5 weeks of treatment), and the response after ECT, which is evident across all 4 ECT types. The finding of
rates did not significantly differ between the 4 types of ECT. equivalent cognitive gains with RUL-ST ECT as compared with
BT-ST is unexpected in view of the established cognitive superior-
ity of RUL-ST ECT compared with BT-ST.39–41 However, these
studies were conducted in depressed patients and based on com-
Cognitive Outcomes parisons of RUL and BT ECT given with a 1.0-millisecond pulse
The mixed ANCOVA revealed a significant main effect of width. The existing literature comparing RUL and BT electrode
time (F [1, 38] = 9.625, P = 0.04, η2 = 0.202), with the overall es- placement in schizophrenia18–21 did not suggest significant differ-
timate for the post-ECT MoCA scores (adjusted mean = 20.91) ences in cognitive outcomes, but this may have been because of
being significantly higher than the pre-ECT MoCA scores (ad- the older type of ECT used (sine-wave ECT) and lack of standard-
justed mean = 16.94). There was no main effect of ECT type (F ized cognitive assessment. Our differing results may therefore re-
[3, 38] = 2.045, P = 0.124, η2 = 0.139), and no interaction be- flect the different patient population treated, that is RUL ECT may
tween time and ECT type (F [3, 38] = 0.339, P = 0.797, not have superior cognitive outcomes in patients with schizophre-
η2 = 0.026). Paired samples t test showed that ECT significantly nia, which is plausible given that schizophrenia and depression
improved MoCA scores in the BT-ST group. In contrast, in the differ in the profile of cognitive deficits.42–45 Furthermore, it is
BT-AB group, there was a significant decrease in anterograde possible that use of a 0.5-millisecond pulse width, which results
memory as assessed by the delayed recall subscale at post-ECT in more focal stimulation,46 mitigated the cognitive adverse effects
from 37.6 % (SD, 38.6) to 11.8% (SD, 22.4; P < 0.05; Table 3). typically associated with bitemporal stimulation, such that the

TABLE 1. Patient Demographic, Clinical, and Treatment Variables for the Sample by Type of ECT

Overall (N = 62), BT-AB (n = 25), RUL-ST (n = 15), BT-ST (n = 11), BF-ST (n = 11),
mean (SD) mean (SD) mean (SD) mean (SD) mean (SD) P*
Age, y 43.74 (14.02) 47.04 (10.82) 43.93 (14.84) 39.91 (14.92) 39.82 (18.07) 0.388
Age range, y 15–69 20–65 21–69 19–66 15–68 NA
Sex 0.588
Male, n (%) 26 (41.9) 8 (32.0) 8 (53.3) 5 (45.5) 5 (45.5)
Female, n (%) 36 (58.1) 17 (68.0) 7 (46.7) 6 (54.5) 6 (54.5)
Duration of illness, mo 112.7 (90.7) 112.6 (87.8) 102.4 (78.1) 120.8 (124.2) 118.9 (86.5) 0.956
CPZ equivalent, mg 670.5 (436.3) 826.5 (575.9) 574.4 (314.9) 584.8 (234.9) 532.7 (259.4) 0.140
No. ECT 9.8 (3.4) 9.5 (3.4) 8.0 (3.3)† 11.3 (1.9) 11.6 (3.8)† 0.021
Initial ECT seizure threshold 19.0 (15.8) NA 9.6 (3.1)† 17.2 (7.9)‡ 33.2 (20.6)†‡ 0.001
(% machine energy)
Initial ECT dosage (% machine energy) 42.0 (21.9) 39.5 (18.3) 48.7 (10.9)† 27.8 (10.9)†‡ 50.0 (38.3)‡ 0.048
Final ECT dosage (% machine energy) 53.5 (24.1) 51.9 (21.5) 59.7 (18.0) 33.3 (12.9) 59.1 (34.9) 0.116
Propofol dosage (mg) 55.4 (11.9) 52.7 (9.4) 55.7 (8.6) 62.2 (19.2) 54.6 (12.1) 0.249
Suxamathonium dosage, mg 29.5 (10.2) 29.5 (9.9) 28.7 (9.5) 35.0 (15.0) 25.9 (4.9) 0.253
*Comparisons between different types of ECT in patients with complete data.
†‡Between-group differences: items marked with the same symbols are statistically different from each other at P = 0.05.
CPZ indicates chlorpromazine.

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Tor et al Journal of ECT • Volume 00, Number 00, Month 2017

TABLE 2. Brief Psychiatric Rating Scale Scores Pre-/Post-ECT by ECT Type

Overall (N = 62), BT-AB (n = 25), RUL-ST (n = 15), BT-ST (n = 11), BF-ST (n = 11)
mean (SD) mean (SD) mean (SD) mean (SD) M (SD)
Pre-ECT BPRS 45.7 (11.8) 47.4 (12.8) 44.1 (11.4) 42.4 (12.2) 47.3 (10.1)
Post-ECT BPRS 31.7 (8.1)* 32.0 (7.6)* 29.2 (8.0)* 29.4 (4.1)* 36.9 (10.7)*
Improvement in BPRS 13.9 (13.6) 15.4 (13.2) 14.9 (14.9) 13.0 (12.1) 10.4 (15.4)
Pre-ECT psychotic subscale 10.7 (6.4) 10.0 (6.5) 10.9 (6.1) 10.5 (6.3) 12.0 (7.1)
Post-ECT psychotic subscale 5.3 (4.1)* 4.9 (2.8)* 5.3 (4.5)* 4.8 (3.6)* 6.8 (6.1)*
Response to ECT (40% improvement)† 40 (64.5%) 15 (60%) 10 (66.7%) 8 (72.7%) 7 (63.6%)
Response to ECT (20% improvement)‡ 47 (75.8%) 19 (76%) 12 (80%) 8 (72.7%) 8 (72.7%)
Pre-ECT Depression subscale 5.5 (5.4) 5.4 (6.9) 6.3 (4.4) 4.9 (4.2) 5.4 (4.3)
Post-ECT depression subscale 3.7 (2.7)* 3.0 (2.3)* 4.5 (2.4) 3.1 (1.8) 4.7 (4.2)
Pre-ECT negative subscale 8.9 (4.1) 9.6 (4.0) 8.6 (4.1) 8.6 (4.5) 7.8 (4.0)
Post-ECT negative subscale 6.2 (2.7) 6.9 (2.8)* 5.1 (2.3)* 5.5 (1.4) 7.1 (3.3)
Pre-ECT paranoid subscale 4.2 (1.5) 4.7 (2.5) 3.8 (1.9) 4.2 (1.8) 3.5 (1.8)
Post-ECT paranoid subscale 2.5 (1.5) 2.6 (1.7)* 2.5 (1.4)* 1.9 (0.7)* 2.9 (1.6)
Pre-ECT mania subscale 4.7 (2.1) 4.9 (2.4) 4.7 (1.9) 4.3 (1.7) 4.6 (2.2)
Post-ECT mania subscale 3.5 (1.4)* 3.5 (1.7)* 3.7 (1.7) 3.1 (0.3) 3.5 (0.9)
*Post-ECT scores that were statistically significantly different from pre-ECT scores within the same ECT group at P = 0.05.
†40% decrease in psychotic subscale.
‡20% decrease in psychotic subscale.

cognitive advantage of RUL ECT was no longer apparent. An- the 4 periods, there was no demographic difference between the
other consideration is whether the equivalence of cognitive out- patients receiving the 4 types of ECT, and the cohorts of patients
comes was observed because BT-ST ECT was more effective, assigned to different types of ECT were from the same referral
with cognitive improvements associated with symptom improve- base and treated relatively closely in time (over a 17-month period).
ment leading to overall superior outcomes. However, results do Nevertheless, there could have been a positive rater bias as the raters
not support this interpretation, because there was no difference were aware that the patients were receiving ECT. Another major
in symptom efficacy between RUL-ST and BT-ST ECT. limitation is that because of incomplete longitudinal data, the
The lack of superiority in cognitive outcomes of BF-ST over sample size for each type of ECT was small with just over
BT-ST, as might have been expected given the results of,1 is most 10 patients in some groups, which means that our study may have
likely explained by the longer pulse width used for BF-ST been underpowered for detecting differences between the 4 types
(1.0 millisecond) compared with BT-ST (0.5 millisecond) in this of ECT in symptomatic and cognitive outcomes. Information on
study. Shorter pulse widths potentially allow for more focused years of education for subjects was not available and could not
stimulation46 and lesser cognitive adverse effects.47 On the other be included as a covariate. Further studies, ideally randomized
hand, one may have expected greater symptom reduction with controlled trials of different ECT modalities with a larger sample
BF-ST compared with BT-ST given the previous results of size, will be required to substantiate our findings.
Phutane et al.1 The reasons for this discrepancy are not clear,
and may reflect a lack of power in this study to detect differences.
There are several limitations to this naturalistic study, the CONCLUSIONS
most important being that data on outcomes of the 4 types of In conclusion, ECT is an effective treatment for treatment-
ECT studied were collected in sequential cohorts. Notwithstand- resistant schizophrenia, resulting in symptomatic improvement
ing, we note that there was no selection bias for the type of ECT and global cognitive benefits in some patients. In this study, there
received, as at any 1 point in time only 1 type of ECT was used was no difference in outcomes between the 4 types of ECT
to treat schizophrenia for all patients, the same small team of assessed. Almost two thirds of patients with schizophrenia responded
doctors and nurses conducted the ECT and assessments across to ECT after approximately 10 treatments.

TABLE 3. Cognitive Outcomes Pre-/Post-ECT by ECT Type

Overall (n = 48), BT-AB (n = 17), RUL-ST (n = 10), BT-ST (n = 10), BF-ST (n = 11),
mean (SD) mean (SD) mean (SD) mean (SD) mean (SD)
Pre-ECT MoCA (n = 48) 16.8 (9.1) 15.9 (7.9) 16.2 (9.0) 16.3 (11.0) 19.5 (10.0)
Post-ECT MoCA 20.7 (6.0)* 17.5 (3.6) 18.8 (8.5) 24.0 (5.0)* 24.5 (3.3)
Improvement in MoCA post-ECT 3.9 (9.2) 1.5 (7.8) 2.6 (9.4) 7.7 (9.3) 5.0 (10.7)
Pre-ECT recall (MoCA) 2.20 (2.09) 1.88 (1.93) 1.81 (2.09) 2.63 (2.13) 2.80 (2.44)
Post-ECT recall (MoCA) 1.89 (1.96) 0.59 (1.12)* 1.80 (2.10) 3.25 (1.39) 3.10 (2.02)
*Post-ECT scores that were statistically significantly different from pre-ECT scores within the same ECT group at P = 0.05.

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Journal of ECT • Volume 00, Number 00, Month 2017 ECT in Schizophrenia: A Naturalistic Study

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