Effects of electroconvulsive therapy on cognition and quality of life in schizophrenia

Abstract

Introduction: The effects of electroconvulsive therapy (ECT) on quality of life (QoL), and its relationship with symptom and cognitive change remains unclear. We aim to examine the association of QoL changes with psychiatric symptom and cognitive changes among patients with schizophrenia who underwent ECT. Methods: This is a retrospective cohort study of 132 patients who received ECT from July 2017 to December 2019. Sociodemographic and clinical characteristics were obtained from medical records. Changes in QoL, psychiatric symptoms and cognition function were examined after 6 sessions of ECT. Generalised linear regression was used to examine the associations of Brief Psychiatric Rating Scale (BPRS) scores and Montreal Cognitive Assessment (MoCA) scores with QoL as measured by EQ-5D scores. Results: The mean (standard error) improvements after ECT were statistically significant for the assessment scales of EQ-5D utility score: 0.77 (0.02) to 0.89 (0.02), P<0.001; EuroQol-5-Dimension (EQ-5D) visual analogue scale score: 66.82 (2.61) to 73.05 (1.93), P=0.012; and EQ-5D subdomain scores. Both improvement in BPRS (adjusted β coefficient -0.446, 95% confidence interval [CI] -0.840 to -0.052) and MoCA (adjusted β 12.068, 95% CI 0.865 to 12.271) scores were significantly associated with improvement in EQ-5D utility scores after adjustment for sociodemographic and clinical characteristics. Improvement of BPRS scores (psychiatric symptoms) was significantly associated with improvement of the patients’ mental health that was assessed by EQ-5D subdomain scores of pain (adjusted β coefficient 0.012, 95% CI 0.004 to 0.021) and anxiety (adjusted β coefficient 0.013, 95% CI 0.002 to 0.024). Improvement of MoCA scores (cognitive function) was significantly associated with patients’ physical health as assessed by EQ-5D subdomain score of usual activity (adjusted β coefficient -0.349, 95% CI -0.607 to -0.09). Conclusion: ECT was associated with an overall improvement of QoL among patients with schizophrenia. The improvement of psychiatric symptoms was found to be significantly associated with better mental health while the improvement of cognitive function was associated with better physical health. Keywords: Cognitive function, electroconvulsive therapy, psychiatric symptoms, quality of life, schizophrenia