Antipsychotic Selection in Combination with Electroconvulsive Therapy for Acute Schizophrenia: Differential Efficacy and Safety Profiles from a Real World Study

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However, direct comparisons of the efficacy and safety of different antipsychotic agents when administered alongside ECT remain limited. Methods: A total of 465 individuals with acute-phase schizophrenia were included in the analysis. All participants underwent six sessions of bitemporal ECT delivered over a two-week period. The primary endpoint was the reduction rate of the Positive and Negative Syndrome Scale total score (PANSS-TRR). Secondary outcomes included reduction rates for the PANSS positive symptom subscale (PANSS-PRR), negative symptom subscale (PANSS-NRR), and general psychopathology subscale (PANSS-GRR). Treatment safety was evaluated using the UKU Side Effect Rating Scale (UKU) and the Gastrointestinal Symptom Rating Scale (GSRS). Results: Significant symptomatic improvement was observed in all treatment groups following the ECT course. After adjustment for confounding variables, the specific antipsychotic agent agent significantly influenced outcomes across all PANSS reduction measures (all p<0.001).Relative to ECT alone, most antipsychotic-ECT combinations demonstrated greater efficacy in reducing overall and positive symptom severity. The combinations of clozapine-ECT, quetiapine-ECT, and ziprasidone-ECT showed the largest adjusted mean differences in PANSS-TRR (MD >43, p0.05). Pairwise comparisons further indicated that amisulpride-ECT was associated with smaller improvements in PANSS-TRR compared with clozapine-ECT, risperidone-ECT, and quetiapine-ECT. Conclusion: Among patients with acute-phase schizophrenia, both the therapeutic effectiveness and tolerability of antipsychotic medications combined with ECT differed depending on the specific agent used. These results may inform individualized treatment selection; however, randomized controlled trials are required to further validate these observations. Trial registration : Chinese Clinical Trial Registry: ChiCTR2500101865. Registered on 30 April 2025. (retrospectively registered). Schizophrenia Electroconvulsive therapy Antipsychotics Efficacy Safety Figures Figure 1 Figure 2 Introduction Schizophrenia is a chronic psychiatric disorder affecting approximately 1% of the global population and imposing a substantial burden on healthcare systems worldwide( 1 , 2 ). The disorder is characterized by a heterogeneous clinical presentation that includes positive symptoms (such as hallucinations and delusions), negative symptoms (including social withdrawal and reduced motivation), and general psychopathological manifestations like anxiety and cognitive impairment( 3 ). Antipsychotic medications remain the cornerstone of treatment. However, their therapeutic effects often emerge gradually. This delayed onset can be problematic in acutely hospitalized patients, particularly those exhibiting severe psychomotor agitation, violent behavior, or catatonic features, where rapid symptom stabilization is essential to prevent harm to themselves or others( 3 ). Electroconvulsive therapy (ECT) is a well-established adjunctive treatment approach for schizophrenia( 4 ). While it is widely recognized for its role in treatment-resistant schizophrenia (TRS), ECT is also frequently used in clinical practice for patients experiencing severe acute exacerbations who require rapid symptom control, including those with agitation, aggression, or catatonia( 3 ). In China, ECT is commonly applied in such circumstances and is incorporated into routine clinical practice guidelines( 5 ). The therapeutic effects of ECT are believed to involve the induction of controlled seizures that modulate neural circuits and neurotransmitter systems involved in psychiatric symptomatologys( 6 – 8 ). Evidence from prior studies indicates that combining ECT with antipsychotic medications can accelerate symptomatic improvement in individuals with schizophrenia( 9 ). Nevertheless, most previous research has focused primarily on the combination of clozapine and ECT in patients with treatment-resistant schizophrenia( 9 – 11 ), Comparatively little evidence is available regarding the effectiveness of ECT combined with other antipsychotic agents during the acute phase of schizophrenia. This gap in knowledge is clinically important because antipsychotic drugs differ considerably in their pharmacological properties, including dopamine D2 receptor binding affinity, serotonin 5-HT2A antagonism, and interactions with other neurotransmitter systems( 12 , 13 ). These pharmacodynamic differences may influence both treatment efficacy and adverse effect profiles when these medications are used alongside ECT. To address these issues, the present multicenter real-world study was designed to compare the efficacy and safety of eight commonly prescribed antipsychotic medications administered in combination with ECT, as well as ECT alone, in patients with schizophrenia. The goal was to generate clinically relevant evidence derived from real-world observational data to help inform individualized treatment decision-making. Materials and Methods Study Design and Participants This multicenter prospective observational study was performed at three psychiatric hospitals in Sichuan Province, China, between 2018 and 2024. Eligibility criteria included: (1) age between 18 and 65 years; (2) diagnosis of schizophrenia according to DSM-5 criteria; (3) stable dosing of one of the eight study antipsychotics during the ECT course, or absence of antipsychotic treatment; (4) baseline PANSS total score ≥60; and (5) Han Chinese ethnicity. Exclusion criteria were: (1) organic mental disorders; (2) neurological diseases or brain injury; (3) substance abuse within the previous six months; (4) ECT treatment within the past six months; (5) severe physical illness; and (6) inability to provide informed consent. As shown in Figure 1, among the 496 patients initially screened, 465 met the eligibility criteria and were subsequently included in the final analysis. Twenty-eight individuals were excluded because they were receiving two or more antipsychotic medications or were treated with rarely prescribed agents (haloperidol, perphenazine, lurasidone, or perphenazine hydrochloride hydrate). An additional three participants were excluded because their PANSS reduction rates were considered statistical outliers (>3 standard deviations from the mean). Participants were divided into nine groups based on the use and type of antipsychotic medication (as shown in Figure 1): Sulpiride-ECT (n = 21), Ziprasidone-ECT (n = 16), Clozapine-ECT (n = 55), Risperidone-ECT (n = 202), Quetiapine-ECT (n = 31), Olanzapine-ECT (n = 52), Amisulpride-ECT (n = 32), Aripiprazole-ECT (n = 22), and ECT-alone (n = 34). Patients were assessed with the PANSS at baseline and following ECT intervention, and the reduction rate was computed for further analysis. The study protocol was approved by the institutional ethics committees of the participating centers and registered in the Chinese Clinical Trial Registry (ChiCTR2500101865). Treatment Protocols All antipsychotic medications were administered in closed inpatient wards under direct nursing supervision, and oral cavity checks were performed to ensure treatment adherence. Participants continued their established antipsychotic regimens during the ECT treatment course. All patients underwent six sessions of bitemporal ECT administered over a two-week period using a Thy Matron IV device, consistent with Chinese clinical practice guidelines(14, 15). Anesthesia was induced with etomidate (0.16-0.2 mg/kg) in combination with succinylcholine (1.0 mg/kg). Atropine sulfate (0.01 ml/kg) was administered pre-procedure to reduce airway secretions. The initial electrical stimulus dose was set at approximately two-thirds of the patient’s age and subsequently adjusted based on seizure adequacy. Information regarding concomitant medications, including mood stabilizers, antidepressants, and sleep medications, was recorded for all participants. Symptoms Reduction Rate The Positive and Negative Syndrome Scale (PANSS) was administered at two time points: T1 (the day before the first ECT session, 3:00-6:00 PM), and T2 (the morning following the final ECT session, 8:00-11:00 AM). Four indices of symptom improvement were calculated: the total score reduction rate (PANSS-TRR), positive symptom reduction rate (PANSS-PRR), negative symptom reduction rate (PANSS-NRR), and general psychopathology reduction rate (PANSS-GRR). The PANSS-TRR was calculated as: Side effect evaluation Adverse effects were evaluated after completion of the six ECT sessions using the UKU Side Effect Rating Scale (UKU)(16) and and the Gastrointestinal Symptom Rating Scale (GSRS)(17, 18). Statistical Analysis Descriptive statistics were used to summarize demographic and clinical characteristics. Differences among treatment groups were assessed using one-way ANOVAs for continuous variables and chi-square tests for categorical variables. For the primary analysis, analyses of covariance (ANCOVAs) were performed with PANSS reduction rates (TRR, PRR, NRR, and GRR) as dependent variables and antipsychotic treatment group as the fixed factor. Covariates included age, sex, age at onset, duration of illness, education level, log-transformed chlorpromazine equivalent dose (CPZeq), concomitant medications (mood stabilizers, antidepressants, and sleep medications), tobacco use, and alcohol use. When significant main effects were detected, post-hoc pairwise comparisons were conducted using Bonferroni correction. All statistical analyses were performed using SPSS 21.0, and a two-tailed significance level of α = 0.05 was applied. Results 1. Baseline Characteristics of the Study Population A total of 465 participants were included across nine treatment groups (eight antipsychotic-ECT combination groups and one ECT-alone group). The demographic and clinical characteristics are presented in Table 1. Baseline demographic and clinical characteristics differed significantly across groups (Table 1). Significant variation was observed in several demographic variables, including age ( F =3.307, p=0.001) and level of urbanization (χ²=16.60, p=0.035). Clinical characteristics also differed among groups, including duration of illness ( F =4.552, p<0.001) and baseline PANSS subscale scores for positive symptoms ( F =2.631, p=0.008) and negative symptoms ( F =2.824, p=0.005). In addition, chlorpromazine-equivalent antipsychotic dosage (CPZeq) varied significantly between groups ( F =18.639, p<0.001). Differences were also observed in the use of concomitant medications such as antidepressants, mood stabilizers, and sleep medications (all p<0.05). To account for the baseline imbalances identified above, a series of one-way ANCOVAs were conducted to examine the effect of the treatment group on PANSS reduction rates (PANSS-TRR, PRR, NRR, GRR), adjusting for potential confounders including age, gender, urbanization, education, disease course, baseline PANSS scores, chlorpromazine equivalent doses, and concomitant medications (Table 2). After controlling for all covariates, the main effect of the treatment group remained statistically significant across all four outcome measures. We found that the drug group had a significant effect on the improvement rate of PANSS-TRR (F(8, 443) = 5.097, p < 0.001, partial η² = 0.084), with gender (p = 0.027) and alcohol use (p = 0.005) also emerging as significant covariates. The type of antipsychotic medication likewise exerted a significant main effect on PANSS-PRR (F(8, 443) = 4.407, p < 0.001, partial η² = 0.074). Among the covariates, baseline PANSS-P score showed the strongest influence (p < 0.001, partial η² = 0.240), followed by alcohol use (p = 0.021) and log-transformed chlorpromazine equivalent dose (p = 0.030). A significant effect of treatment group was also observed for PANSS-NRR (F(8, 443) = 3.604, p < 0.001, partial η² = 0.061). Baseline PANSS-N score emerged as the dominant covariate (p < 0.001, partial η² = 0.135), with alcohol use (p = 0.006) and gender (p = 0.037) also contributing significantly. Similarly, a significant group difference was found for PANSS-GRR (F(8, 443) = 4.263, p < 0.001, partial η² = 0.071), with baseline PANSS-G score (p < 0.001, partial η² = 0.111) and alcohol use (p = 0.022) identified as significant covariates. In summary, after rigorous adjustment for confounding variables, the type of antipsychotic medication used in combination with ECT was found to be a significant determinant of symptomatic improvement across all PANSS subdomains. Baseline symptom severity and alcohol use consistently emerged as important predictors of treatment outcomes. 2. Overall Efficacy of Antipsychotic-ECT Combinations As depicted in Figure 2, substantial symptom improvement was observed across all treatment groups following completion of the ECT course. The distribution of PANSS reduction rate measures, including PANSS-TRR, PANSS-PRR, PANSS-NRR, and PANSS-GRR, met the assumptions of normality. After adjustment for relevant covariates (Table 2), the specific antipsychotic medication administered in conjunction with ECT was found to significantly influence treatment outcomes. 3. Comparative Efficacy Relative to ECT-Alone To determine the additional benefit of combining antipsychotic therapy with ECT, each combination regimen was compared with the ECT-alone group (Table 3). For overall symptom reduction (PANSS-TRR), most combination therapies demonstrated significantly greater efficacy than ECT alone. The largest adjusted mean differences were observed for clozapine-ECT (MD=46.41, p=0.008), quetiapine-ECT (MD=45.95, p=0.015), and ziprasidone-ECT (MD=43.53, p=0.007). Significant improvements were also identified for sulpiride-ECT, risperidone-ECT, and aripiprazole-ECT (all p<0.05). In contrast, the differences for olanzapine-ECT (MD=30.49, p=0.082) and amisulpride-ECT (MD=22.58, p=0.249) did not reach statistical significance. A comparable pattern was observed for positive symptom improvement (PANSS-PRR). All antipsychotic-ECT combinations, with the exception of olanzapine-ECT and amisulpride-ECT, produced significantly greater reductions than ECT monotherapy. Among these, quetiapine-ECT (MD=38.53, p=0.008) and risperidone-ECT (MD=34.47, p=0.010) demonstrated particularly strong effects. For negative symptoms and general psychopathological symptoms (PANSS-NRR and PANSS-GRR), none of the combination therapies achieved statistically significant superiority compared with ECT alone (all p>0.05), although most groups exhibited numerically higher reduction rates. 4. Head-to-Head Comparisons Between Antipsychotic-ECT Combinations Direct pairwise comparisons were conducted to evaluate differences in efficacy among the antipsychotic-ECT regimens (Table 4). Among these treatments, the amisulpride-ECT combination consistently demonstrated relatively weaker therapeutic effects across several symptom domains. Specifically, amisulpride-ECT produced significantly smaller reductions in total PANSS scores compared with clozapine-ECT (MD=24.38, p=0.006), risperidone-ECT (MD=21.72, p=0.003), and quetiapine-ECT (MD=23.83, p=0.020). Similar findings were observed across other symptom dimensions, particularly when compared with risperidone-ECT (PANSS-PRR: MD=15.95, p=0.008; PANSS-NRR: MD=19.11, p=0.021; PANSS-GRR: MD=15.32, p=0.002). Additionally, amisulpride-ECT showed lower efficacy than clozapine-ECT for general psychopathology symptoms (PANSS-GRR: MD=15.10, p=0.024). Olanzapine-ECT also demonstrated a tendency toward comparatively lower efficacy. For example, reductions in total symptoms and general psychopathology were significantly smaller than those observed with risperidone-ECT (PANSS-TRR: MD=13.50, p=0.048; PANSS-GRR: MD=10.50, p=0.008). However, several of these differences did not remain statistically significant after Bonferroni correction. 5. Safety Profile The incidence and distribution of treatment-emergent adverse effects differed across the treatment groups, although severe adverse events were uncommon overall (Table 5). The quetiapine-ECT group exhibited the highest overall frequency of side effects (58.1%), with particularly high rates of autonomic symptoms (74.2%) and psychiatric adverse effects (77.4%). Elevated rates were also observed in the clozapine-ECT group (49.1%) and the risperidone-ECT group (47.7%). Among these, clozapine was associated with the highest prevalence of gastrointestinal symptoms (52.7%). Intermediate rates of adverse effects were observed in the sulpiride-ECT (43.8%), amisulpride-ECT (45.0%), and aripiprazole-ECT (40.9%) groups. In contrast, the olanzapine-ECT (32.7%) and ziprasidone-ECT (31.3%) groups demonstrated relatively favorable tolerability among the combination therapies. The lowest overall incidence of side effects occurred in the ECT-alone group (25.9%). Across all treatment groups, high-severity adverse reactions were rare. Discussion This multicenter real-world study compared eight antipsychotic-ECT combination regimens with ECT monotherapy in patients with acute-phase schizophrenia. The findings revealed significant variability in therapeutic outcomes across the different combinations, indicating that the choice of antipsychotic for augmentation may meaningfully influence the clinical effectiveness of ECT. Substantial symptom improvement was observed across all treatment groups following the ECT course. After adjusting for potential confounders, the type of antipsychotic medication combined with ECT remained a significant determinant of treatment response across all PANSS reduction measures (all p < 0.001, Table 2 ). These findings indicate that the magnitude of benefit from ECT augmentation may differ depending on the pharmacological agent used. Relative to ECT alone, most antipsychotic-ECT regimens produced greater reductions in overall and positive symptoms, although the magnitude of improvement differed across medications. The combinations involving clozapine, quetiapine, and ziprasidone demonstrated the largest reductions in total PANSS scores (MD > 43, p < 0.05, Table 3 ). The robust performance of clozapine combined with ECT is consistent with prior evidence supporting this strategy in treatment-resistant schizophrenia( 10 , 19 ), and the present findings suggest that similar benefits may extend to patients in the acute phase of illness. The enhancement provided by combination therapy appeared most pronounced for positive symptom domains. Most antipsychotic-ECT regimens produced greater reductions in positive symptoms compared with ECT monotherapy, a clinically meaningful finding given the importance of rapidly controlling delusions and agitation in acutely ill patients( 3 ). In contrast, none of the combinations showed a statistically significant advantage over ECT alone for negative symptoms or general psychopathological symptoms (all p > 0.05, Table 3 ). This pattern may reflect the relatively brief two-week ECT course used in this study, which may be insufficient to substantially influence these more persistent symptom domains. Alternatively, the limited improvement in negative symptoms may indicate that pharmacological augmentation provides minimal additional benefit for these features during the acute stage of treatment. The biological mechanisms responsible for the enhanced effects of antipsychotic-ECT combinations remain incompletely understood, but several explanations are plausible. ECT and antipsychotic medications may influence overlapping neural circuits, particularly within the prefrontal cortex, striatum, and thalamus, potentially enabling a more comprehensive normalization of dysregulated brain activity( 20 – 22 ). ECT has also been proposed to transiently alter blood-brain barrier permeability, which could facilitate greater central nervous system penetration of antipsychotic drugs and increase receptor occupancy( 15 , 23 ). Furthermore, ECT is known to induce neuroplastic processes, including increased synaptic remodeling, elevated brain-derived neurotrophic factor (BDNF) expression, and hippocampal neurogenesis ( 24 – 29 ). These neurobiological changes may create a permissive environment for adaptive responses to antipsychotic treatment. Additional mechanistic studies incorporating neuroimaging, pharmacokinetic measurements, and molecular biomarkers are needed to better clarify these interactions. Direct pairwise comparisons revealed additional differences in effectiveness among the antipsychotic-ECT regimens. Notably, the amisulpride-ECT combination consistently produced smaller reductions in total PANSS scores compared with clozapine-ECT, risperidone-ECT, and quetiapine-ECT (Table 4 ). A similar pattern was observed across several symptom domains. Olanzapine-ECT also tended to demonstrate relatively lower efficacy, including significantly smaller improvements in general psychopathological symptoms compared with risperidone-ECT (p = 0.008, Table 4 ). Together, these findings suggest that the pharmacological properties of the antipsychotic agent may meaningfully influence the therapeutic benefit achieved when combined with ECT. In this cohort, clozapine and risperidone appeared to provide comparatively stronger augmentation effects. The reasons underlying these differences remain uncertain but may be related to variations in receptor binding characteristics. Clozapine and risperidone display broad receptor profiles, including strong antagonism at serotonin 5-HT2A receptors, which may interact favorably with ECT-induced changes in neurotransmitter systems such as dopamine, serotonin, glutamate, and GABA( 6 – 8 , 12 , 13 ). In contrast, amisulpride is a relatively selective antagonist of dopamine D2 and D3 receptors, potentially limiting its capacity to influence the broader neurochemical systems affected by ECT ( 12 ). In addition, ECT has been shown to modulate dopaminergic signaling( 30 ), affects glutamatergic neurotransmission( 31 ), and BDNF expression( 32 ). Antipsychotics capable of enhancing these processes may therefore exhibit greater therapeutic synergy. Future research employing neuroimaging techniques and biomarker analyses could help clarify these pharmacodynamic interactions. The covariate analysis identified several factors associated with variability in treatment outcomes. Alcohol consumption was consistently associated with greater symptom improvement across all PANSS domains (p < 0.05), a finding consistent with recent observations reported by Xie et al.( 33 ). Although the biological explanation remains unclear, it is possible that overlapping neurobiological pathways influenced by both alcohol exposure and ECT, such as dopaminergic and glutamatergic signaling, may contribute to this effect( 34 , 35 ). Baseline symptom severity emerged as the strongest predictor of subsequent improvement, particularly for positive symptoms (partial η²=0.240). Patients presenting with more severe baseline symptomatology tended to demonstrate larger reductions following treatment. In addition, higher antipsychotic doses showed a modest association with greater reductions in total and positive symptoms, consistent with a possible dose-response relationship that merits further investigation. Evaluation of adverse effects revealed a complex association between treatment efficacy and tolerability. Clozapine-ECT and risperidone-ECT were among the more effective combinations but were associated with relatively higher rates of side effects (49.1% and 47.7%, respectively; Table 4 ). Quetiapine-ECT also demonstrated considerable efficacy but had the highest overall incidence of adverse events (58.1%), particularly involving autonomic and psychiatric symptoms. In contrast, ziprasidone-ECT and olanzapine-ECT exhibited comparatively favorable safety profiles among the combination regimens, with side effect rates of 31.3% and 32.7%, respectively. However, the clinical efficacy of olanzapine-ECT appeared somewhat more modest relative to other combinations. These findings highlight the importance of individualized therapeutic decision-making. Clinicians must weigh the need for rapid symptom control against the potential risk of treatment-related adverse effects when selecting an antipsychotic agent to combine with ECT. Limitations Several limitations of this study should be considered when interpreting the findings. First, owing to the observational design, causal relationships cannot be definitively established, despite the use of multivariable adjustments to control for potential confounders. Although we statistically adjusted for a wide range of demographic, clinical, and treatment-related variables, including antipsychotic dosage and concomitant medications, the possibility of residual confounding by indication or unmeasured factors, like treatment adherence prior to admission, illness insight, or psychosocial support, cannot be entirely ruled out. Second, the ECT regimen consisted of a fixed course of six bitemporal sessions delivered over two weeks. While this protocol reflects routine clinical practice for acute-phase treatment in China, it may not represent the full therapeutic potential of ECT, particularly for symptom domains that may require longer treatment courses, such as negative symptoms or general psychopathology. Therefore, the lack of significant advantage for combination therapies over ECT alone in these domains should be interpreted with caution, and future studies with extended ECT courses are needed to clarify whether delayed benefits emerge. Third, the sample sizes varied considerably across treatment groups, which reflects real-world prescribing patterns but also resulted in relatively small subgroups for certain antipsychotics (e.g., ziprasidone-ECT, n = 16; sulpiride-ECT, n = 21). This imbalance may have limited the statistical power to detect clinically meaningful differences for these agents and increased the risk of type II error in pairwise comparisons. Findings related to smaller groups should therefore be regarded as exploratory and warrant confirmation in larger, preferably prospective cohorts. Fourth, the absence of long-term follow-up data prevents evaluation of the durability of treatment response, the risk of relapse, and the trajectory of late-emerging adverse effects. Given that schizophrenia is a chronic condition, the sustainability of symptom improvement and functional recovery beyond the acute phase is of critical clinical importance. Fifth, the study population was restricted to Han Chinese inpatients recruited from three psychiatric centers in Sichuan Province. This homogeneity may enhance internal validity but limits the generalizability of our findings to other ethnic, geographic, or outpatient populations. Differences in genetic background, healthcare systems, and cultural attitudes toward ECT could influence both treatment efficacy and tolerability. Finally, despite the inclusion of commonly prescribed antipsychotics, several agents (e.g., paliperidone, haloperidol, lurasidone) were not represented in sufficient numbers to allow analysis, and all combination therapies were evaluated in the context of acute inpatient treatment. Whether similar comparative effectiveness profiles would emerge during maintenance therapy or in treatment-resistant populations remains to be determined. Conclusion In summary, this multicenter study indicates that both the effectiveness and tolerability of antipsychotic-ECT combination therapy in acute-phase schizophrenia vary according to the antipsychotic agent used. Combinations involving clozapine, quetiapine, or risperidone may provide stronger symptom reduction when rapid clinical stabilization is required, although the higher adverse effect burden observed with quetiapine-ECT warrants careful consideration. For patients in whom tolerability is a primary concern, ziprasidone-ECT and olanzapine-ECT appear to offer more favorable safety profiles, though the efficacy of olanzapine-ECT may be comparatively modest. These results may assist clinicians in tailoring individualized treatment strategies for acute schizophrenia. Nevertheless, larger randomized controlled trials with extended follow-up are needed to confirm these findings and to further elucidate the biological mechanisms underlying the interaction between ECT and antipsychotic medications. Abbreviations ECT Electroconvulsive therapy PANSS Positive and Negative Syndrome Scale TRR Total score reduction rate (PANSS-TRR) PRR Positive symptom subscale score reduction rate NRR Negative symptom subscale score reduction rate GRR General psychopathology subscale score reduction rate UKU UKU Side Effect Rating Scale GSRS Gastrointestinal Symptom Rating Scale BDNF Brain-derived neurotrophic factor GABA Gamma-aminobutyric acid 5- HT₂A 5-hydroxytryptamine 2A receptor D2 Dopamine D2 receptor D3 Dopamine D3 receptor TRS treatment-resistant schizophrenia MD Denotes the adjusted mean difference (first group minus second group) ANCOVA Analyses of covariance CPZeq Chlorpromazine equivalent dose Declarations Conflict of Interest declaration No conflict of interest Acknowledgments and Funding This study was supported in part by a grant from National Natural Science Foundation of China (82001414, BX), Sichuan Provincial Department of Science and Technology (2023NSFSC0124, and 2022YFS0615), Luzhou Science and Technology Bureau-Southwest Medical University (2021LZXNYD-D04), Luzhou Science and Technology Bureau (2022-SYF-96, 2022-ZRK-186), Zigong Science and Technology Bureau (2024-NKY-01-05), High quality development project of Zigong City Hospital (ZG-PT-2023-026), Youth Project of Southwest Medical University (LXWQ-2022QN084). Author Contributions Statement T.W. and Y.L. contributed equally to this work and share first authorship. They were responsible for data collection, data analysis, and manuscript writing. M.Y., Y.W., H.Y., S.F., J.L., H.X., and J.R. contributed to data collection and patient recruitment at the participating centers. J.Z., B.X., and K.L. conceptualized and designed the study. They also contributed to data interpretation, manuscript revision, supervised the project, and provided critical intellectual input. All authors reviewed and approved the final version of the manuscript for submission. Data available The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Clinical trial number ChiCTR2500101865 Human Ethics and Consent to Participate declarations All procedures were carried out in accordance with the Declaration of Helsinki and all the Institutional Ethics Committees (Fourth People’s Hospital of Yibin, Zigong mental health center Fifth People’s Hospital of Zigong and Luzhou mental health center) approved the study. Consent to Participate declarations All participants in this study gave written informed consent to participate. Consent to Publish declaration Not applicable. References Borelli CM, Solari H. Schizophrenia. Jama. 2019;322(13):1322. McCutcheon RA, Reis Marques T, Howes OD. Schizophrenia-An Overview. JAMA psychiatry. 2020;77(2):201-10. Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT). Acta psychiatrica Scandinavica. 2020;141(4):304-15. Sinclair DJ, Zhao S, Qi F, Nyakyoma K, Kwong JS, Adams CE. Electroconvulsive therapy for treatment-resistant schizophrenia. 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Trends Neurosci. 2019;42(3):205-20. McCutcheon R, Beck K, Jauhar S, Howes OD. Defining the Locus of Dopaminergic Dysfunction in Schizophrenia: A Meta-analysis and Test of the Mesolimbic Hypothesis. Schizophrenia bulletin. 2018;44(6):1301-11. Repple J, Meinert S, Bollettini I, Grotegerd D, Redlich R, Zaremba D, et al. Influence of electroconvulsive therapy on white matter structure in a diffusion tensor imaging study. Psychol Med. 2020;50(5):849-56. Van Den Bossche MJA, Emsell L, Dols A, Vansteelandt K, De Winter FL, Van den Stock J, et al. Hippocampal volume change following ECT is mediated by rs699947 in the promotor region of VEGF. Transl Psychiatry. 2019;9(1):191. Vanicek T, Kranz GS, Vyssoki B, Komorowski A, Fugger G, Höflich A, et al. Repetitive enhancement of serum BDNF subsequent to continuation ECT. Acta psychiatrica Scandinavica. 2019;140(5):426-34. de Bartolomeis A, De Simone G, Ciccarelli M, Castiello A, Mazza B, Vellucci L, et al. Antipsychotics-Induced Changes in Synaptic Architecture and Functional Connectivity: Translational Implications for Treatment Response and Resistance. Biomedicines. 2022;10(12). Joshi SH, Espinoza RT, Pirnia T, Shi J, Wang Y, Ayers B, et al. Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biological psychiatry. 2016;79(4):282-92. Jezsó B, Kálmán S, Farkas KG, Hathy E, Vincze K, Kovács-Schoblocher D, et al. Haloperidol, Olanzapine, and Risperidone Induce Morphological Changes in an In Vitro Model of Human Hippocampal Neurogenesis. Biomolecules. 2024;14(6). Kodama M, Fujioka T, Duman RS. Chronic olanzapine or fluoxetine administration increases cell proliferation in hippocampus and prefrontal cortex of adult rat. Biological psychiatry. 2004;56(8):570-80. Ji GJ, Li J, Liao W, Wang Y, Zhang L, Bai T, et al. Neuroplasticity-Related Genes and Dopamine Receptors Associated with Regional Cortical Thickness Increase Following Electroconvulsive Therapy for Major Depressive Disorder. Mol Neurobiol. 2023;60(3):1465-75. Huang YJ, Lane HY, Lin CH. New Treatment Strategies of Depression: Based on Mechanisms Related to Neuroplasticity. Neural Plast. 2017;2017:4605971. Ramnauth AD, Maynard KR, Kardian AS, Phan BN, Tippani M, Rajpurohit S, et al. Induction of Bdnf from promoter I following electroconvulsive seizures contributes to structural plasticity in neurons of the piriform cortex. Brain Stimul. 2022;15(2):427-33. Xie H, Ma R, Yu M, Wang T, Chen J, Liang J, et al. History of tobacco smoking and alcohol use can predict the effectiveness of electroconvulsive therapy in individuals with schizophrenia: A multicenter clinical trial. Journal of psychiatric research. 2024;180:1-7. Boileau I, Assaad JM, Pihl RO, Benkelfat C, Leyton M, Diksic M, et al. Alcohol promotes dopamine release in the human nucleus accumbens. Synapse. 2003;49(4):226-31. Rosenquist PB, Miller B, Pillai A. The antipsychotic effects of ECT: a review of possible mechanisms. The journal of ECT. 2014;30(2):125-31. Tables Tables 1 to 5 are available in the supplementary files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Apr, 2026 Reviews received at journal 28 Apr, 2026 Reviews received at journal 09 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers invited by journal 01 Apr, 2026 Editor invited by journal 26 Mar, 2026 Editor assigned by journal 25 Mar, 2026 Submission checks completed at journal 25 Mar, 2026 First submitted to journal 12 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9103028","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618425116,"identity":"aa767858-ab72-4532-bc1d-8df38518d7ba","order_by":0,"name":"Tingting Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYBACxgY2CANMJTAwyLGxtx8gSosEG4gN1GLMx3MmgYA9UC1g7UAicZ6EgwFeDcz9x9Ikfu6oreOTbr/+4OGO2vQ2CaD7flRsw+2wGWnHJHvPHJdgkzlT2JB45nhum3TjAcaeM7fxaGFvu8HbdkyCTSInsSGx7Vhum8yBBGbGNjxa+o+33fyLpCWdTSLBAL+WhrRjt3nbaoBa0g8CtdQkENYyIy39t2zbAck2iRzGGYltBwzbgIF8EJ9fDPuPGRu+bavjl5+R/uDjz7Y6efn29oMPflTg0dIApg4DMY8BlMHAcACneiCQh1B1QMz+AMoYBaNgFIyCUYAKAJLPXdcsP/lXAAAAAElFTkSuQmCC","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":true,"prefix":"","firstName":"Tingting","middleName":"","lastName":"Wang","suffix":""},{"id":618425118,"identity":"f3a909a9-bf1b-42e8-9e85-f7c4bed396d9","order_by":1,"name":"Yang Lu","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Lu","suffix":""},{"id":618425122,"identity":"a3a05782-a5e2-49d2-880b-22b3862c61b7","order_by":2,"name":"Minglan Yu","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Minglan","middleName":"","lastName":"Yu","suffix":""},{"id":618425123,"identity":"3cbc8ec0-4dba-490b-b632-8b1543167b12","order_by":3,"name":"Yi Wang","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Wang","suffix":""},{"id":618425127,"identity":"08ed570f-9948-42e1-8188-fa8cc8987780","order_by":4,"name":"Hao Yu","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Yu","suffix":""},{"id":618425128,"identity":"e667ffe3-359a-4caa-9026-f43459299ba0","order_by":5,"name":"Shuangshuang Feng","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shuangshuang","middleName":"","lastName":"Feng","suffix":""},{"id":618425133,"identity":"e41e01e6-213e-42f6-962e-260a31de32a5","order_by":6,"name":"Junfan Liang","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Junfan","middleName":"","lastName":"Liang","suffix":""},{"id":618425135,"identity":"a8f90aa2-4bdb-45bd-814f-a73d5671aaf2","order_by":7,"name":"Hongcheng Xie","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hongcheng","middleName":"","lastName":"Xie","suffix":""},{"id":618425138,"identity":"a850ee11-290f-45b2-bd5c-be77bb15e003","order_by":8,"name":"Jiajun Ren","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiajun","middleName":"","lastName":"Ren","suffix":""},{"id":618425144,"identity":"f6a50405-3f2b-4735-a7ce-fdd45a702293","order_by":9,"name":"Jin Zhang","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Zhang","suffix":""},{"id":618425146,"identity":"80a18de9-4d88-4f44-9ae3-d16249672276","order_by":10,"name":"Bo Xiang","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Xiang","suffix":""},{"id":618425149,"identity":"a00d4482-1861-4b44-becd-6a621e0f374b","order_by":11,"name":"Kezhi Liu","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kezhi","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2026-03-12 09:38:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9103028/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9103028/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106347923,"identity":"1c5dc15f-cb71-4b93-b520-bbfcdd31fb50","added_by":"auto","created_at":"2026-04-07 16:43:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114504,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of study design and analytical procedures. A total of 496 patients with schizophrenia were screened across three psychiatric centers in Sichuan Province, China. Following exclusion of ineligible participants, 465 patients were included in the final analysis. Participants were grouped according to the antipsychotic medication they were receiving at the time of ECT (sulpiride-ECT, ziprasidone-ECT, clozapine-ECT, risperidone-ECT, quetiapine-ECT, olanzapine-ECT, amisulpride-ECT, aripiprazole-ECT, and ECT-alone groups). All patients underwent a standardized course of six bitemporal ECT sessions over two weeks. Efficacy was assessed using PANSS reduction rates (TRR, PRR, NRR, GRR), and safety was evaluated using UKU and GSRS scales.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9103028/v1/88b76a0278fd4c27444b5a5a.png"},{"id":106403285,"identity":"d66d01e1-d274-426f-8370-45f36ed54eda","added_by":"auto","created_at":"2026-04-08 09:14:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":414886,"visible":true,"origin":"","legend":"\u003cp\u003ePANSS scores before and after ECT, along with their reduction rates. \u003cstrong\u003eA\u003c/strong\u003e Changes in PANSS Total Score and Reduction Rate (PANSS-TRR) Before and After ECT; \u003cstrong\u003eB\u003c/strong\u003e Changes in PANSS Positive Symptom Subscale Score and Reduction Rate (PANSS-PRR) Before and After ECT; \u003cstrong\u003eC\u003c/strong\u003e Changes in PANSS Negative Symptom Subscale Score and Reduction Rate (PANSS-PRR) Before and After ECT ; \u003cstrong\u003eD\u003c/strong\u003e Changes in PANSS General Psychopathological Symptom Subscale Score and Reduction Rate (PANSS-PRR) Before and After ECT. The 9 groups are: Sulpiride-ECT, Ziprasidone-ECT, Clozapine-ECT, Risperidone-ECT, Quetiapine-ECT, Olanzapine-ECT, Amumolapine-ECT, Aripiprazole-ECT, and ECT-alone.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9103028/v1/93ba993bda1b09feda50edbd.png"},{"id":106405654,"identity":"54e175fe-d6b0-460d-bf44-2ea341824b37","added_by":"auto","created_at":"2026-04-08 09:28:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1205455,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9103028/v1/54859aa5-9563-4517-9749-71a1f155857e.pdf"},{"id":106347922,"identity":"d99c8dcc-febd-4019-97c2-4c35106f9722","added_by":"auto","created_at":"2026-04-07 16:43:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":63567,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-9103028/v1/e5bc4469684cb9e3aa124b0e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Antipsychotic Selection in Combination with Electroconvulsive Therapy for Acute Schizophrenia: Differential Efficacy and Safety Profiles from a Real World Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchizophrenia is a chronic psychiatric disorder affecting approximately 1% of the global population and imposing a substantial burden on healthcare systems worldwide(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The disorder is characterized by a heterogeneous clinical presentation that includes positive symptoms (such as hallucinations and delusions), negative symptoms (including social withdrawal and reduced motivation), and general psychopathological manifestations like anxiety and cognitive impairment(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Antipsychotic medications remain the cornerstone of treatment. However, their therapeutic effects often emerge gradually. This delayed onset can be problematic in acutely hospitalized patients, particularly those exhibiting severe psychomotor agitation, violent behavior, or catatonic features, where rapid symptom stabilization is essential to prevent harm to themselves or others(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eElectroconvulsive therapy (ECT) is a well-established adjunctive treatment approach for schizophrenia(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While it is widely recognized for its role in treatment-resistant schizophrenia (TRS), ECT is also frequently used in clinical practice for patients experiencing severe acute exacerbations who require rapid symptom control, including those with agitation, aggression, or catatonia(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In China, ECT is commonly applied in such circumstances and is incorporated into routine clinical practice guidelines(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The therapeutic effects of ECT are believed to involve the induction of controlled seizures that modulate neural circuits and neurotransmitter systems involved in psychiatric symptomatologys(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Evidence from prior studies indicates that combining ECT with antipsychotic medications can accelerate symptomatic improvement in individuals with schizophrenia(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Nevertheless, most previous research has focused primarily on the combination of clozapine and ECT in patients with treatment-resistant schizophrenia(\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), Comparatively little evidence is available regarding the effectiveness of ECT combined with other antipsychotic agents during the acute phase of schizophrenia. This gap in knowledge is clinically important because antipsychotic drugs differ considerably in their pharmacological properties, including dopamine D2 receptor binding affinity, serotonin 5-HT2A antagonism, and interactions with other neurotransmitter systems(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These pharmacodynamic differences may influence both treatment efficacy and adverse effect profiles when these medications are used alongside ECT.\u003c/p\u003e \u003cp\u003eTo address these issues, the present multicenter real-world study was designed to compare the efficacy and safety of eight commonly prescribed antipsychotic medications administered in combination with ECT, as well as ECT alone, in patients with schizophrenia. The goal was to generate clinically relevant evidence derived from real-world observational data to help inform individualized treatment decision-making.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis multicenter prospective observational study was performed at three psychiatric hospitals in Sichuan Province, China, between 2018 and 2024. Eligibility criteria included: (1) age between 18 and 65 years; (2) diagnosis of schizophrenia according to DSM-5 criteria; (3) stable dosing of one of the eight study antipsychotics during the ECT course, or absence of antipsychotic treatment; (4) baseline PANSS total score \u0026ge;60; and (5) Han Chinese ethnicity. Exclusion criteria were: (1) organic mental disorders; (2) neurological diseases or brain injury; (3) substance abuse within the previous six months; (4) ECT treatment within the past six months; (5) severe physical illness; and (6) inability to provide informed consent. As shown in Figure 1, among the 496 patients initially screened, 465 met the eligibility criteria and were subsequently included in the final analysis. Twenty-eight individuals were excluded because they were receiving two or more antipsychotic medications or were treated with rarely prescribed agents (haloperidol, perphenazine, lurasidone, or perphenazine hydrochloride hydrate). An additional three participants were excluded because their PANSS reduction rates were considered statistical outliers (\u0026gt;3 standard deviations from the mean). Participants were divided into nine groups based on the use and type of antipsychotic medication (as shown in Figure 1): Sulpiride-ECT (n = 21), Ziprasidone-ECT (n = 16), Clozapine-ECT (n = 55), Risperidone-ECT (n = 202), Quetiapine-ECT (n = 31), Olanzapine-ECT (n = 52), Amisulpride-ECT (n = 32), Aripiprazole-ECT (n = 22), and ECT-alone (n = 34). Patients were assessed with the PANSS at baseline and following ECT intervention, and the reduction rate was computed for further analysis. The study protocol was approved by the institutional ethics committees of the participating centers and registered in the Chinese Clinical Trial Registry (ChiCTR2500101865).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment Protocols\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll antipsychotic medications were administered in closed inpatient wards under direct nursing supervision, and oral cavity checks were performed to ensure treatment adherence. Participants continued their established antipsychotic regimens during the ECT treatment course. All patients underwent six sessions of bitemporal ECT administered over a two-week period using a Thy Matron IV device, consistent with Chinese clinical practice guidelines(14, 15). Anesthesia was induced with etomidate (0.16-0.2 mg/kg) in combination with succinylcholine (1.0 mg/kg). Atropine sulfate (0.01 ml/kg) was administered pre-procedure to reduce airway secretions. The initial electrical stimulus dose was set at approximately two-thirds of the patient\u0026rsquo;s age and subsequently adjusted based on seizure adequacy. Information regarding concomitant medications, including mood stabilizers, antidepressants, and sleep medications, was recorded for all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSymptoms Reduction Rate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Positive and Negative Syndrome Scale (PANSS) was administered at two time points: T1 (the day before the first ECT session, 3:00-6:00 PM), and T2 (the morning following the final ECT session, 8:00-11:00 AM). Four indices of symptom improvement were calculated: the total score reduction rate (PANSS-TRR), positive symptom reduction rate (PANSS-PRR), negative symptom reduction rate (PANSS-NRR), and general psychopathology reduction rate (PANSS-GRR). The PANSS-TRR was calculated as:\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSide effect evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdverse effects were evaluated after completion of the six ECT sessions using the UKU Side Effect Rating Scale (UKU)(16) and and the Gastrointestinal Symptom Rating Scale (GSRS)(17, 18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used to summarize demographic and clinical characteristics. Differences among treatment groups were assessed using one-way ANOVAs for continuous variables and chi-square tests for categorical variables. For the primary analysis, analyses of covariance (ANCOVAs) were performed with PANSS reduction rates (TRR, PRR, NRR, and GRR) as dependent variables and antipsychotic treatment group as the fixed factor. Covariates included age, sex, age at onset, duration of illness, education level, log-transformed chlorpromazine equivalent dose (CPZeq), concomitant medications (mood stabilizers, antidepressants, and sleep medications), tobacco use, and alcohol use. When significant main effects were detected, post-hoc pairwise comparisons were conducted using Bonferroni correction. All statistical analyses were performed using SPSS 21.0, and a two-tailed significance level of \u0026alpha; = 0.05 was applied.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eBaseline Characteristics of the Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 465 participants were included across nine treatment groups (eight antipsychotic-ECT combination groups and one ECT-alone group). The demographic and clinical characteristics are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBaseline demographic and clinical characteristics differed significantly across groups (Table 1). Significant variation was observed in several demographic variables, including age (\u003cem\u003eF\u003c/em\u003e=3.307, p=0.001) and level of urbanization (\u0026chi;\u0026sup2;=16.60, p=0.035). Clinical characteristics also differed among groups, including duration of illness (\u003cem\u003eF\u003c/em\u003e=4.552, p\u0026lt;0.001) and baseline PANSS subscale scores for positive symptoms (\u003cem\u003eF\u003c/em\u003e=2.631, p=0.008) and negative symptoms (\u003cem\u003eF\u003c/em\u003e=2.824, p=0.005). In addition, chlorpromazine-equivalent antipsychotic dosage (CPZeq) varied significantly between groups (\u003cem\u003eF\u003c/em\u003e=18.639, p\u0026lt;0.001). Differences were also observed in the use of concomitant medications such as antidepressants, mood stabilizers, and sleep medications (all p\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo account for the baseline imbalances identified above, a series of one-way ANCOVAs were conducted to examine the effect of the treatment group on PANSS reduction rates (PANSS-TRR, PRR, NRR, GRR), adjusting for potential confounders including age, gender, urbanization, education, disease course, baseline PANSS scores, chlorpromazine equivalent doses, and concomitant medications (Table 2).\u003c/p\u003e\n\u003cp\u003eAfter controlling for all covariates, the main effect of the treatment group remained statistically significant across all four outcome measures. We found that the drug group had a significant effect on the improvement rate of PANSS-TRR (F(8, 443) = 5.097, p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.084), with gender (p = 0.027) and alcohol use (p = 0.005) also emerging as significant covariates. The type of antipsychotic medication likewise exerted a significant main effect on PANSS-PRR (F(8, 443) = 4.407, p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.074). Among the covariates, baseline PANSS-P score showed the strongest influence (p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.240), followed by alcohol use (p = 0.021) and log-transformed chlorpromazine equivalent dose (p = 0.030). A significant effect of treatment group was also observed for PANSS-NRR (F(8, 443) = 3.604, p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.061). Baseline PANSS-N score emerged as the dominant covariate (p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.135), with alcohol use (p = 0.006) and gender (p = 0.037) also contributing significantly. Similarly, a significant group difference was found for PANSS-GRR (F(8, 443) = 4.263, p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.071), with baseline PANSS-G score (p \u0026lt; 0.001, partial \u0026eta;\u0026sup2; = 0.111) and alcohol use (p = 0.022) identified as significant covariates. In summary, after rigorous adjustment for confounding variables, the type of antipsychotic medication used in combination with ECT was found to be a significant determinant of symptomatic improvement across all PANSS subdomains. Baseline symptom severity and alcohol use consistently emerged as important predictors of treatment outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Overall Efficacy of Antipsychotic-ECT Combinations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs depicted in Figure 2, substantial symptom improvement was observed across all treatment groups following completion of the ECT course. The distribution of PANSS reduction rate measures, including PANSS-TRR, PANSS-PRR, PANSS-NRR, and PANSS-GRR, met the assumptions of normality. After adjustment for relevant covariates (Table 2), the specific antipsychotic medication administered in conjunction with ECT was found to significantly influence treatment outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Comparative Efficacy Relative to ECT-Alone\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the additional benefit of combining antipsychotic therapy with ECT, each combination regimen was compared with the ECT-alone group (Table 3). For overall symptom reduction (PANSS-TRR), most combination therapies demonstrated significantly greater efficacy than ECT alone. The largest adjusted mean differences were observed for clozapine-ECT (MD=46.41, p=0.008), quetiapine-ECT (MD=45.95, p=0.015), and ziprasidone-ECT (MD=43.53, p=0.007). Significant improvements were also identified for sulpiride-ECT, risperidone-ECT, and aripiprazole-ECT (all p\u0026lt;0.05). In contrast, the differences for olanzapine-ECT (MD=30.49, p=0.082) and amisulpride-ECT (MD=22.58, p=0.249) did not reach statistical significance. A comparable pattern was observed for positive symptom improvement (PANSS-PRR). All antipsychotic-ECT combinations, with the exception of olanzapine-ECT and amisulpride-ECT, produced significantly greater reductions than ECT monotherapy. Among these, quetiapine-ECT (MD=38.53, p=0.008) and risperidone-ECT (MD=34.47, p=0.010) demonstrated particularly strong effects. For negative symptoms and general psychopathological symptoms (PANSS-NRR and PANSS-GRR), none of the combination therapies achieved statistically significant superiority compared with ECT alone (all p\u0026gt;0.05), although most groups exhibited numerically higher reduction rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Head-to-Head Comparisons Between Antipsychotic-ECT Combinations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDirect pairwise comparisons were conducted to evaluate differences in efficacy among the antipsychotic-ECT regimens (Table 4). Among these treatments, the amisulpride-ECT combination consistently demonstrated relatively weaker therapeutic effects across several symptom domains. Specifically, amisulpride-ECT produced significantly smaller reductions in total PANSS scores compared with clozapine-ECT (MD=24.38, p=0.006), risperidone-ECT (MD=21.72, p=0.003), and quetiapine-ECT (MD=23.83, p=0.020). Similar findings were observed across other symptom dimensions, particularly when compared with risperidone-ECT (PANSS-PRR: MD=15.95, p=0.008; PANSS-NRR: MD=19.11, p=0.021; PANSS-GRR: MD=15.32, p=0.002). Additionally, amisulpride-ECT showed lower efficacy than clozapine-ECT for general psychopathology symptoms (PANSS-GRR: MD=15.10, p=0.024). Olanzapine-ECT also demonstrated a tendency toward comparatively lower efficacy. For example, reductions in total symptoms and general psychopathology were significantly smaller than those observed with risperidone-ECT (PANSS-TRR: MD=13.50, p=0.048; PANSS-GRR: MD=10.50, p=0.008). However, several of these differences did not remain statistically significant after Bonferroni correction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Safety Profile\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence and distribution of treatment-emergent adverse effects differed across the treatment groups, although severe adverse events were uncommon overall (Table 5). The quetiapine-ECT group exhibited the highest overall frequency of side effects (58.1%), with particularly high rates of autonomic symptoms (74.2%) and psychiatric adverse effects (77.4%). Elevated rates were also observed in the clozapine-ECT group (49.1%) and the risperidone-ECT group (47.7%). Among these, clozapine was associated with the highest prevalence of gastrointestinal symptoms (52.7%). Intermediate rates of adverse effects were observed in the sulpiride-ECT (43.8%), amisulpride-ECT (45.0%), and aripiprazole-ECT (40.9%) groups. In contrast, the olanzapine-ECT (32.7%) and ziprasidone-ECT (31.3%) groups demonstrated relatively favorable tolerability among the combination therapies. The lowest overall incidence of side effects occurred in the ECT-alone group (25.9%). Across all treatment groups, high-severity adverse reactions were rare.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicenter real-world study compared eight antipsychotic-ECT combination regimens with ECT monotherapy in patients with acute-phase schizophrenia. The findings revealed significant variability in therapeutic outcomes across the different combinations, indicating that the choice of antipsychotic for augmentation may meaningfully influence the clinical effectiveness of ECT.\u003c/p\u003e \u003cp\u003eSubstantial symptom improvement was observed across all treatment groups following the ECT course. After adjusting for potential confounders, the type of antipsychotic medication combined with ECT remained a significant determinant of treatment response across all PANSS reduction measures (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings indicate that the magnitude of benefit from ECT augmentation may differ depending on the pharmacological agent used.\u003c/p\u003e \u003cp\u003eRelative to ECT alone, most antipsychotic-ECT regimens produced greater reductions in overall and positive symptoms, although the magnitude of improvement differed across medications. The combinations involving clozapine, quetiapine, and ziprasidone demonstrated the largest reductions in total PANSS scores (MD\u0026thinsp;\u0026gt;\u0026thinsp;43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The robust performance of clozapine combined with ECT is consistent with prior evidence supporting this strategy in treatment-resistant schizophrenia(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and the present findings suggest that similar benefits may extend to patients in the acute phase of illness. The enhancement provided by combination therapy appeared most pronounced for positive symptom domains. Most antipsychotic-ECT regimens produced greater reductions in positive symptoms compared with ECT monotherapy, a clinically meaningful finding given the importance of rapidly controlling delusions and agitation in acutely ill patients(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In contrast, none of the combinations showed a statistically significant advantage over ECT alone for negative symptoms or general psychopathological symptoms (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This pattern may reflect the relatively brief two-week ECT course used in this study, which may be insufficient to substantially influence these more persistent symptom domains. Alternatively, the limited improvement in negative symptoms may indicate that pharmacological augmentation provides minimal additional benefit for these features during the acute stage of treatment.\u003c/p\u003e \u003cp\u003eThe biological mechanisms responsible for the enhanced effects of antipsychotic-ECT combinations remain incompletely understood, but several explanations are plausible. ECT and antipsychotic medications may influence overlapping neural circuits, particularly within the prefrontal cortex, striatum, and thalamus, potentially enabling a more comprehensive normalization of dysregulated brain activity(\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). ECT has also been proposed to transiently alter blood-brain barrier permeability, which could facilitate greater central nervous system penetration of antipsychotic drugs and increase receptor occupancy(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Furthermore, ECT is known to induce neuroplastic processes, including increased synaptic remodeling, elevated brain-derived neurotrophic factor (BDNF) expression, and hippocampal neurogenesis (\u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). These neurobiological changes may create a permissive environment for adaptive responses to antipsychotic treatment. Additional mechanistic studies incorporating neuroimaging, pharmacokinetic measurements, and molecular biomarkers are needed to better clarify these interactions.\u003c/p\u003e \u003cp\u003eDirect pairwise comparisons revealed additional differences in effectiveness among the antipsychotic-ECT regimens. Notably, the amisulpride-ECT combination consistently produced smaller reductions in total PANSS scores compared with clozapine-ECT, risperidone-ECT, and quetiapine-ECT (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A similar pattern was observed across several symptom domains. Olanzapine-ECT also tended to demonstrate relatively lower efficacy, including significantly smaller improvements in general psychopathological symptoms compared with risperidone-ECT (p\u0026thinsp;=\u0026thinsp;0.008, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Together, these findings suggest that the pharmacological properties of the antipsychotic agent may meaningfully influence the therapeutic benefit achieved when combined with ECT. In this cohort, clozapine and risperidone appeared to provide comparatively stronger augmentation effects.\u003c/p\u003e \u003cp\u003eThe reasons underlying these differences remain uncertain but may be related to variations in receptor binding characteristics. Clozapine and risperidone display broad receptor profiles, including strong antagonism at serotonin 5-HT2A receptors, which may interact favorably with ECT-induced changes in neurotransmitter systems such as dopamine, serotonin, glutamate, and GABA(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In contrast, amisulpride is a relatively selective antagonist of dopamine D2 and D3 receptors, potentially limiting its capacity to influence the broader neurochemical systems affected by ECT (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In addition, ECT has been shown to modulate dopaminergic signaling(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), affects glutamatergic neurotransmission(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and BDNF expression(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Antipsychotics capable of enhancing these processes may therefore exhibit greater therapeutic synergy. Future research employing neuroimaging techniques and biomarker analyses could help clarify these pharmacodynamic interactions.\u003c/p\u003e \u003cp\u003eThe covariate analysis identified several factors associated with variability in treatment outcomes. Alcohol consumption was consistently associated with greater symptom improvement across all PANSS domains (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), a finding consistent with recent observations reported by Xie et al.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Although the biological explanation remains unclear, it is possible that overlapping neurobiological pathways influenced by both alcohol exposure and ECT, such as dopaminergic and glutamatergic signaling, may contribute to this effect(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Baseline symptom severity emerged as the strongest predictor of subsequent improvement, particularly for positive symptoms (partial η\u0026sup2;=0.240). Patients presenting with more severe baseline symptomatology tended to demonstrate larger reductions following treatment. In addition, higher antipsychotic doses showed a modest association with greater reductions in total and positive symptoms, consistent with a possible dose-response relationship that merits further investigation.\u003c/p\u003e \u003cp\u003eEvaluation of adverse effects revealed a complex association between treatment efficacy and tolerability. Clozapine-ECT and risperidone-ECT were among the more effective combinations but were associated with relatively higher rates of side effects (49.1% and 47.7%, respectively; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Quetiapine-ECT also demonstrated considerable efficacy but had the highest overall incidence of adverse events (58.1%), particularly involving autonomic and psychiatric symptoms. In contrast, ziprasidone-ECT and olanzapine-ECT exhibited comparatively favorable safety profiles among the combination regimens, with side effect rates of 31.3% and 32.7%, respectively. However, the clinical efficacy of olanzapine-ECT appeared somewhat more modest relative to other combinations. These findings highlight the importance of individualized therapeutic decision-making. Clinicians must weigh the need for rapid symptom control against the potential risk of treatment-related adverse effects when selecting an antipsychotic agent to combine with ECT.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eSeveral limitations of this study should be considered when interpreting the findings. First, owing to the observational design, causal relationships cannot be definitively established, despite the use of multivariable adjustments to control for potential confounders. Although we statistically adjusted for a wide range of demographic, clinical, and treatment-related variables, including antipsychotic dosage and concomitant medications, the possibility of residual confounding by indication or unmeasured factors, like treatment adherence prior to admission, illness insight, or psychosocial support, cannot be entirely ruled out.\u003c/p\u003e \u003cp\u003eSecond, the ECT regimen consisted of a fixed course of six bitemporal sessions delivered over two weeks. While this protocol reflects routine clinical practice for acute-phase treatment in China, it may not represent the full therapeutic potential of ECT, particularly for symptom domains that may require longer treatment courses, such as negative symptoms or general psychopathology. Therefore, the lack of significant advantage for combination therapies over ECT alone in these domains should be interpreted with caution, and future studies with extended ECT courses are needed to clarify whether delayed benefits emerge.\u003c/p\u003e \u003cp\u003eThird, the sample sizes varied considerably across treatment groups, which reflects real-world prescribing patterns but also resulted in relatively small subgroups for certain antipsychotics (e.g., ziprasidone-ECT, n\u0026thinsp;=\u0026thinsp;16; sulpiride-ECT, n\u0026thinsp;=\u0026thinsp;21). This imbalance may have limited the statistical power to detect clinically meaningful differences for these agents and increased the risk of type II error in pairwise comparisons. Findings related to smaller groups should therefore be regarded as exploratory and warrant confirmation in larger, preferably prospective cohorts.\u003c/p\u003e \u003cp\u003eFourth, the absence of long-term follow-up data prevents evaluation of the durability of treatment response, the risk of relapse, and the trajectory of late-emerging adverse effects. Given that schizophrenia is a chronic condition, the sustainability of symptom improvement and functional recovery beyond the acute phase is of critical clinical importance.\u003c/p\u003e \u003cp\u003eFifth, the study population was restricted to Han Chinese inpatients recruited from three psychiatric centers in Sichuan Province. This homogeneity may enhance internal validity but limits the generalizability of our findings to other ethnic, geographic, or outpatient populations. Differences in genetic background, healthcare systems, and cultural attitudes toward ECT could influence both treatment efficacy and tolerability.\u003c/p\u003e \u003cp\u003eFinally, despite the inclusion of commonly prescribed antipsychotics, several agents (e.g., paliperidone, haloperidol, lurasidone) were not represented in sufficient numbers to allow analysis, and all combination therapies were evaluated in the context of acute inpatient treatment. Whether similar comparative effectiveness profiles would emerge during maintenance therapy or in treatment-resistant populations remains to be determined.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this multicenter study indicates that both the effectiveness and tolerability of antipsychotic-ECT combination therapy in acute-phase schizophrenia vary according to the antipsychotic agent used. Combinations involving clozapine, quetiapine, or risperidone may provide stronger symptom reduction when rapid clinical stabilization is required, although the higher adverse effect burden observed with quetiapine-ECT warrants careful consideration. For patients in whom tolerability is a primary concern, ziprasidone-ECT and olanzapine-ECT appear to offer more favorable safety profiles, though the efficacy of olanzapine-ECT may be comparatively modest. These results may assist clinicians in tailoring individualized treatment strategies for acute schizophrenia. Nevertheless, larger randomized controlled trials with extended follow-up are needed to confirm these findings and to further elucidate the biological mechanisms underlying the interaction between ECT and antipsychotic medications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eECT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectroconvulsive therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePANSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePositive and Negative Syndrome Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal score reduction rate (PANSS-TRR)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePositive symptom subscale score reduction rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNegative symptom subscale score reduction rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral psychopathology subscale score reduction rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUKU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUKU Side Effect Rating Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGSRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGastrointestinal Symptom Rating Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBDNF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBrain-derived neurotrophic factor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGABA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGamma-aminobutyric acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e5- HT₂A\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e5-hydroxytryptamine 2A receptor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eD2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDopamine D2 receptor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eD3\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDopamine D3 receptor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etreatment-resistant schizophrenia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDenotes the adjusted mean difference (first group minus second group)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANCOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalyses of covariance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPZeq\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChlorpromazine equivalent dose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments and Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported in part by a grant from National Natural Science Foundation of China (82001414, BX), Sichuan Provincial Department of Science and Technology (2023NSFSC0124, and 2022YFS0615), Luzhou Science and Technology Bureau-Southwest Medical University (2021LZXNYD-D04), Luzhou Science and Technology Bureau (2022-SYF-96, 2022-ZRK-186), Zigong Science and Technology Bureau (2024-NKY-01-05), High quality development project of Zigong City Hospital (ZG-PT-2023-026), Youth Project of Southwest Medical University (LXWQ-2022QN084).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT.W. and Y.L. contributed equally to this work and share first authorship. They were responsible for data collection, data analysis, and manuscript writing. M.Y., Y.W., H.Y., S.F., J.L., H.X., and J.R. contributed to data collection and patient recruitment at the participating centers. J.Z., B.X., and K.L. conceptualized and designed the study. They also contributed to data interpretation, manuscript revision, supervised the project, and provided critical intellectual input. All authors reviewed and approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData available\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChiCTR2500101865\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were carried out in accordance with the Declaration of Helsinki and\u0026nbsp;all the Institutional Ethics Committees (Fourth People’s Hospital of Yibin, Zigong mental health center Fifth People’s Hospital of Zigong and Luzhou mental health center) approved the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants in this study gave written informed consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBorelli CM, Solari H. 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The American journal of psychiatry. 2003;160(3):577-9.\u003c/li\u003e\n\u003cli\u003eXia M, Wang J, Sheng J, Tang Y, Li C, Lim K, et al. Effect of Electroconvulsive Therapy on Medial Prefrontal \u0026gamma;-Aminobutyric Acid Among Schizophrenia Patients: A Proton Magnetic Resonance Spectroscopy Study. The journal of ECT. 2018;34(4):227-32.\u003c/li\u003e\n\u003cli\u003eDeakin JF, Owen F, Cross AJ, Dashwood MJ. Studies on possible mechanisms of action of electroconvulsive therapy; effects of repeated electrically induced seizures on rat brain receptors for monoamines and other neurotransmitters. Psychopharmacology. 1981;73(4):345-9.\u003c/li\u003e\n\u003cli\u003eAli SA, Mathur N, Malhotra AK, Braga RJ. Electroconvulsive Therapy and Schizophrenia: A Systematic Review. Molecular neuropsychiatry. 2019;5(2):75-83.\u003c/li\u003e\n\u003cli\u003eMishra BR, Agrawal K, Biswas T, Mohapatra D, Nath S, Maiti R. 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. 2022;48(4):814-25.\u003c/li\u003e\n\u003cli\u003eLally J, Tully J, Robertson D, Stubbs B, Gaughran F, MacCabe JH. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis. Schizophrenia research. 2016;171(1-3):215-24.\u003c/li\u003e\n\u003cli\u003eHuhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, Peter N, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet (London, England). 2019;394(10202):939-51.\u003c/li\u003e\n\u003cli\u003eSeeman P, Lee T. Antipsychotic drugs: direct correlation between clinical potency and presynaptic action on dopamine neurons. 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Psychometric development of the Gastrointestinal Symptom Rating Questionnaire (GSRQ) demonstrated good validity. J Clin Epidemiol. 2015;68(10):1176-83.\u003c/li\u003e\n\u003cli\u003eKistler BM, Biruete A, Chapman-Novakofski K, Wilund KR. The Relationship Between Intradialytic Nutrition and Gastrointestinal Symptoms Using a Modified Version of the Gastrointestinal Symptom Rating Scale. J Ren Nutr. 2018;28(2):129-34.\u003c/li\u003e\n\u003cli\u003eAhmed S, Khan AM, Mekala HM, Venigalla H, Ahmed R, Etman A, et al. Combined use of electroconvulsive therapy and antipsychotics (both clozapine and non-clozapine) in treatment resistant schizophrenia: A comparative meta-analysis. Heliyon. 2017;3(11):e00429.\u003c/li\u003e\n\u003cli\u003eJiang Y, Duan M, He H, Yao D, Luo C. Structural and Functional MRI Brain Changes in Patients with Schizophrenia Following Electroconvulsive Therapy: A Systematic Review. Curr Neuropharmacol. 2022;20(6):1241-52.\u003c/li\u003e\n\u003cli\u003eMcCutcheon RA, Abi-Dargham A, Howes OD. Schizophrenia, Dopamine and the Striatum: From Biology to Symptoms. Trends Neurosci. 2019;42(3):205-20.\u003c/li\u003e\n\u003cli\u003eMcCutcheon R, Beck K, Jauhar S, Howes OD. Defining the Locus of Dopaminergic Dysfunction in Schizophrenia: A Meta-analysis and Test of the Mesolimbic Hypothesis. Schizophrenia bulletin. 2018;44(6):1301-11.\u003c/li\u003e\n\u003cli\u003eRepple J, Meinert S, Bollettini I, Grotegerd D, Redlich R, Zaremba D, et al. Influence of electroconvulsive therapy on white matter structure in a diffusion tensor imaging study. Psychol Med. 2020;50(5):849-56.\u003c/li\u003e\n\u003cli\u003eVan Den Bossche MJA, Emsell L, Dols A, Vansteelandt K, De Winter FL, Van den Stock J, et al. Hippocampal volume change following ECT is mediated by rs699947 in the promotor region of VEGF. Transl Psychiatry. 2019;9(1):191.\u003c/li\u003e\n\u003cli\u003eVanicek T, Kranz GS, Vyssoki B, Komorowski A, Fugger G, H\u0026ouml;flich A, et al. Repetitive enhancement of serum BDNF subsequent to continuation ECT. Acta psychiatrica Scandinavica. 2019;140(5):426-34.\u003c/li\u003e\n\u003cli\u003ede Bartolomeis A, De Simone G, Ciccarelli M, Castiello A, Mazza B, Vellucci L, et al. Antipsychotics-Induced Changes in Synaptic Architecture and Functional Connectivity: Translational Implications for Treatment Response and Resistance. Biomedicines. 2022;10(12).\u003c/li\u003e\n\u003cli\u003eJoshi SH, Espinoza RT, Pirnia T, Shi J, Wang Y, Ayers B, et al. Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biological psychiatry. 2016;79(4):282-92.\u003c/li\u003e\n\u003cli\u003eJezs\u0026oacute; B, K\u0026aacute;lm\u0026aacute;n S, Farkas KG, Hathy E, Vincze K, Kov\u0026aacute;cs-Schoblocher D, et al. Haloperidol, Olanzapine, and Risperidone Induce Morphological Changes in an In Vitro Model of Human Hippocampal Neurogenesis. Biomolecules. 2024;14(6).\u003c/li\u003e\n\u003cli\u003eKodama M, Fujioka T, Duman RS. Chronic olanzapine or fluoxetine administration increases cell proliferation in hippocampus and prefrontal cortex of adult rat. Biological psychiatry. 2004;56(8):570-80.\u003c/li\u003e\n\u003cli\u003eJi GJ, Li J, Liao W, Wang Y, Zhang L, Bai T, et al. Neuroplasticity-Related Genes and Dopamine Receptors Associated with Regional Cortical Thickness Increase Following Electroconvulsive Therapy for Major Depressive Disorder. Mol Neurobiol. 2023;60(3):1465-75.\u003c/li\u003e\n\u003cli\u003eHuang YJ, Lane HY, Lin CH. New Treatment Strategies of Depression: Based on Mechanisms Related to Neuroplasticity. Neural Plast. 2017;2017:4605971.\u003c/li\u003e\n\u003cli\u003eRamnauth AD, Maynard KR, Kardian AS, Phan BN, Tippani M, Rajpurohit S, et al. Induction of Bdnf from promoter I following electroconvulsive seizures contributes to structural plasticity in neurons of the piriform cortex. Brain Stimul. 2022;15(2):427-33.\u003c/li\u003e\n\u003cli\u003eXie H, Ma R, Yu M, Wang T, Chen J, Liang J, et al. History of tobacco smoking and alcohol use can predict the effectiveness of electroconvulsive therapy in individuals with schizophrenia: A multicenter clinical trial. Journal of psychiatric research. 2024;180:1-7.\u003c/li\u003e\n\u003cli\u003eBoileau I, Assaad JM, Pihl RO, Benkelfat C, Leyton M, Diksic M, et al. Alcohol promotes dopamine release in the human nucleus accumbens. Synapse. 2003;49(4):226-31.\u003c/li\u003e\n\u003cli\u003eRosenquist PB, Miller B, Pillai A. The antipsychotic effects of ECT: a review of possible mechanisms. The journal of ECT. 2014;30(2):125-31.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the supplementary files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schizophrenia, Electroconvulsive therapy, Antipsychotics, Efficacy, Safety","lastPublishedDoi":"10.21203/rs.3.rs-9103028/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9103028/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eElectroconvulsive therapy (ECT) used in combination with antipsychotic medications is an important therapeutic strategy for the management of acute episodes of schizophrenia. However, direct comparisons of the efficacy and safety of different antipsychotic agents when administered alongside ECT remain limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 465 individuals with acute-phase schizophrenia were included in the analysis. All participants underwent six sessions of bitemporal ECT delivered over a two-week period. The primary endpoint was the reduction rate of the Positive and Negative Syndrome Scale total score (PANSS-TRR). Secondary outcomes included reduction rates for the PANSS positive symptom subscale (PANSS-PRR), negative symptom subscale (PANSS-NRR), and general psychopathology subscale (PANSS-GRR). Treatment safety was evaluated using the UKU Side Effect Rating Scale (UKU) and the Gastrointestinal Symptom Rating Scale (GSRS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSignificant symptomatic improvement was observed in all treatment groups following the ECT course. After adjustment for confounding variables, the specific antipsychotic agent agent significantly influenced outcomes across all PANSS reduction measures (all p\u0026lt;0.001).Relative to ECT alone, most antipsychotic-ECT combinations demonstrated greater efficacy in reducing overall and positive symptom severity. The combinations of clozapine-ECT, quetiapine-ECT, and ziprasidone-ECT showed the largest adjusted mean differences in PANSS-TRR (MD \u0026gt;43, p\u0026lt;0.05). In contrast, amisulpride-ECT and olanzapine-ECT did not show significant superiority over ECT monotherapy in total symptom reduction (p\u0026gt;0.05). Pairwise comparisons further indicated that amisulpride-ECT was associated with smaller improvements in PANSS-TRR compared with clozapine-ECT, risperidone-ECT, and quetiapine-ECT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Among patients with acute-phase schizophrenia, both the therapeutic effectiveness and tolerability of antipsychotic medications combined with ECT differed depending on the specific agent used. These results may inform individualized treatment selection; however, randomized controlled trials are required to further validate these observations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e: Chinese Clinical Trial Registry: ChiCTR2500101865. Registered on 30 April 2025. 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