J ECT. 2025 Nov 26. doi: 10.1097/YCT.0000000000001210. Online ahead of print.
ABSTRACT
BACKGROUND: Electroconvulsive therapy (ECT) is a widely used treatment for schizophrenia, particularly for acute psychosis, treatment resistance, severe self-harm, and catatonia. Modifying pulse width to a brief pulse (0.5 to 2.0 ms) has emerged as a promising method to minimize adverse cognitive effects traditionally associated with ECT. Newer ECT devices allow shorter stimulus, termed ultra-brief pulse (<0.5 ms). However, the available literature lacks sufficient comparative trials assessing the differences in cognitive adverse effects and clinical efficacy between brief pulse and ultra-brief pulse ECT in patients with schizophrenia.
AIM: To test if there is a significant difference between cognitive adverse effects and efficacy of ultra-brief pulse and brief pulse bitemporal ECT.
METHODS: A prospective, hospital-based, randomized single-blind design was used. Forty-two patients diagnosed with schizophrenia were randomly allocated to ultra-brief pulse (0.3 ms) and brief pulse (0.5 ms) bitemporal ECT groups. ECT was administered thrice weekly under anaesthesia, at 2.5 times the seizure threshold. Clinical efficacy and cognitive functioning were assessed using PANSS, CGI, CDSS, MMSE, and Hindi MoCA, both at baseline and following 1 to 2 days after the first and eighth ECT sessions.
RESULTS: Forty patients completed the study. Both groups showed a significant reduction in PANSS subscale scores over time, with no significant difference between them. Similarly, while MoCA and MMSE scores changed significantly within each group, no group-wise difference was found regarding cognitive side effects.
CONCLUSIONS: Ultra-brief pulse bitemporal ECT does not confer significant advantages over brief pulse bitemporal ECT in terms of cognitive side effects or efficacy in schizophrenia.
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