Electroconvulsive Therapy as a Corrector for Certain Side Effects of Antipsychotic Therapy

The discovery of the first typical antipsychotics in the 1950s had revolutionized the treatment of many severe mental illnesses. This discovery opened the door for radical humanization and deinstitutionalization of the whole psychiatry. It also served as an impetus for the emergence of a new science, called psychopharmacology. This signaled the beginning of an era of widespread use of psychopharmacotherapy in psychiatry. However, the use of typical antipsychotics has been associated with many side effects, including severe ones, such as severe extrapyramidal syndrome, neuroleptic-induced deficit syndrome, cognitive impairment, and neuroleptic malignant syndrome. This necessitated the development of methods for correction or treatment of such side effects.

Over the past decades, a number of new antipsychotics have been synthesised and approved for clinical use. Those new drugs are considered to belong to the group of so-called «atypical antipsychotics». This group, as a whole, has an improved tolerance and safety profile compared to older, conventional antipsychotics. In particular, these new drugs less often cause exactly the aforementioned side effects. Nevertheless, the problem of antipsychotic side effects and their correction is still far from being resolved. Some patients experiencing certain side effects from antipsychotic therapy do not get adequate relief from the standard pharmacological correction of those side effects.

This fact stimulated our interest in the study of the possibilities of using electroconvulsive therapy as an alternative or adjuvant method for the correction of some side effects that can arise during antipsychotic therapy. In this article, we thoroughly discuss the existing evidence base regarding the effectiveness and safety of the use of electroconvulsive therapy as a corrector for certain side effects that can occur during antipsychotic therapy.

1. Kadiyala PK, Kadiyala LD. Anaesthesia for electroconvulsive therapy: An overview with an update on its role in potentiating electroconvulsive therapy. Indian J Anaesth. 2017; 61(5): 373-380. doi: 10.4103/ija.IJA_132_17

2. Sundsted KK, Burton MC, Shah R, Lapid MI. Preanesthesia medical evaluation for electroconvulsive therapy: a review of the literature. J ECT. 2014; 30: 35-42. doi: 10.1097/YCT.0b013e3182a3546f

3. Bartolommei N, Lattanzi L, Callari A, Cosentino L, Luchini F, Mauri M. Catatonia: a critical review and therapeutic recommendations. Journal of Psychopathology. 2012; 18: 234-246.

4. Hoirisch-Clapauch S, Mezzasalma MA, Nardi AE. Pivotal role of tissue plasminogen activator in the mechanism of action of electroconvulsive therapy. J Psychopharmacol. 2014; 28(2): 99105. doi: 10.1177/0269881113507639

5. Medda P, Toni C, Perugi G. The mood-stabilizing effects of electroconvulsive therapy. J ECT. 2014; 30: 275-282. doi: 10.1097/YCT.0000000000000160

6. Lambrecq V, Villega F, Marchal C, Michel V, Guehl D, Rotge JY, Burbaud P. Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy. Seizure. 2012; 21(9): 661-664. doi: 10.1016/j.seizure.2012.07.010

7. Marynych IN, Bykov YuV, Nezhinskiy BV. The use of electroconvulsive therapy for the correction of affective disorders in alcoholic patients to stabilize remission. URL: https://psychoreanimatology.org/modules/articles/article.php?id=43 (In Russ.)

8. Marynych IN, Bykov YuV, Nezhinskiy BV. The use of electroconvulsive therapy and atropine coma therapy in the course of treatment of severe forms of alcohol dependence. URL: https://psycho-reanimatology.org/modules/articles/article.php?id=51 (In Russ.)

9. Marynych IN, Bykov YuV, Nezhinskiy BV. Therapeutic efficacy of electroconvulsive therapy in the early withdrawal period of alcohol abuse disorder. URL: https://psychoreanimatology.org/modules/articles/article.php?id=44 (In Russ.)

10. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev. 2005; 2: CD000076. doi: 10.1002/14651858.CD000076.pub2

11. Singh A, Kar SK. How electroconvulsive therapy works?: Understanding the neurobiological mechanisms. Clin Psychopharmacol Neurosci. 2017; 15(3): 210-221. doi: 10.9758/cpn.2017.15.3.210

12. Nelson AI. Electroconvulsive therapy in psychiatry, addiction medicine and neurology. Moscow: BINOM. Laboratoriya znaniy; 2005. (In Russ.)

13. Malhotra AK, Litman RE, Pickar D. Adverse effects of antipsychotic drugs. Drug Saf. 1993; 9(6): 429-436. doi: 10.2165/00002018-199309060-00005

14. Saltz BL, Robinson DG, Woerner MG. Recognizing and managing antipsychotic drug treatment side effects in the elderly. Prim Care Companion. J Clin Psychiatry. 2004; 6(Suppl 2): 14-19.

15. Carlson HE, Correll CU. Adverse effects of antipsychotics and mood stabilizers. Psychiatric times. 2007; 25(1). URL: https://www.psychiatrictimes.com/adverse-effects-antipsychotics-and-mood-stabilizers

16. Morrison P, Meehan T, Stomski NJ. Australian case managers' perceptions of mental health consumers use of antipsychotic medications and associated side-effects. Int J Ment Health Nurs. 2015; 24(2): 104-111. doi: 10.1111/inm.12118

17. McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res. 2005; 80(1): 19-32. doi: 10.1016/j.schres.2005.07.014

18. Miranda PJ, DeFronzo RA, Califf RM, Guyton JR. Metabolic syndrome: definition, pathophysiology, and mechanisms. Am Heart J. 2005; 149(1): 33-45. doi: 10.1016/j.ahj.2004.07.013

19. Stomski NJ, Morrison P, Meyer A. Antipsychotic medication side effect assessment tools: A systematic review. Aust N Z J Psychiatry. 2016; 50(5): 399-409. doi: 10.1177/0004867415608244

20. Lader M. Some adverse effects of antipsychotics: Prevention and treatment: Current concepts and future prospects. J Clin Psychiatry Suppl. 1999; 60(S12): S18-S21.

21. Ascher-Svanum H, Zhu B, Faries DE, Lacro JP, Dolder CR, Peng X. Adherence and persistence to typical and atypical antipsychotics in the naturalistic treatment of patients with schizophrenia. Patient Prefer Adherence. 2008; 2: 67-77. doi: 10.2147/ppa.s2940

22. Chapman SC, Horne R. Medication nonadherence and psychiatry. Curr Opin Psychiatry. 2013; 26(5): 446-452. doi: 10.1097/YCO.0b013e3283642da4

23. Carlini ELDA, Nappo SA. The pharmacovigilance of psychoactive medications in Brazil. Braz J Psychiatry. 2003; 25(4): 200-205. doi: 10.1590/s1516-44462003000400004

24. Hamer S, Haddad PM. Adverse effects of antipsychotics as outcome measures. Br J Psychiatry Suppl. 2007; 191(S50): s64-s70. doi: 10.1192/bjp.191.50.s64

25. Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 4th edition. Cambridge, United Kingdom: Cambridge University Press; 2013.

26. Stahl SM. Stahl's Essential Psychopharmacology: Case studies. Volume 2. Cambridge, United Kingdom: Cambridge university press; 2015.

27. Stahl SM. Stahl's Essential Psychopharmacology: Prescriber's Guide. Cambridge, United Kingdom: Cambridge University Press; 2017.

28. Mukherjee S, Debsikdar V. Absence of neuroleptic-induced parkinsonism in psychotic patients receiving adjunctive electroconvulsive therapy. Convuls Ther. 1994; 10(1): 53-58.

29. Factor SA, Molho ES, Brown DL. Combined clozapine and electroconvulsive therapy for the treatment of drug-induced psychosis in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 1995; 7(3): 304-307. doi: 10.1176/jnp.7.3.304

30. Vela L, Jimenez Moron D, Sanchez C, Pareja JA, Baron M. Camptocormia induced by atypical antipsychotics and resolved by electroconvulsive therapy. Mov Disord. 2006; 21(11): 1977-1980. doi: 10.1002/mds.21101

31. Baez MA, Avery J. Improvement in drug-induced parkinsonism with electroconvulsive therapy. Am J Geriatr Pharmacother. 2011; 9(3): 190-193. doi: 10.1016/j.amjopharm.2011.04.005

32. Bekker RA, Bykov YuV. Akathisia: a clinical analysis of the pathology with authors' recommendations and a literature review. URL: https://con-med.ru/upload/iblock/eaa/psi_akatisia2. pdf (In Russ.)

33. Hermesh H, Aizenberg D, Friedberg G, Lapidot M, Munitz H. Electroconvulsive therapy for persistent neuroleptic-induced akathisia and parkinsonism: A case report. Biol Psychiatry. 1992; 31(4): 407-411. doi: 10.1016/0006-3223(92)90235-r

34. Caspi N, Levine J. Treatment of resistant akathisia with ECT: a case report. Isr J Psychiatry Relat Sci. 1993; 30(3): 175-178.

35. Van Harten PN, Kahn RS. Tardive dystonia. Schizophrenia Bull. 1999; 25(4): 741-748. doi: 10.1093/oxfordjournals.schbul.a033415

36. Havaki-Kontaxaki BJ, Kontaxakis VP, Margariti MM, Paplos KG, Christodoulou GN. Treatment of severe neuroleptic-induced tardive torticollis. Ann Gen Hosp Psychiatry. 2003; 2(1): 9. doi: 10.1186/1475-2832-2-9

37. Besson JAO, Palin AN. Tardive dyskinesia, depression and ECT. Br J Psychiatry. 1991; 159(3): 446. doi: 10.1192/bjp.159.3.446a

38. Gupta S, Mosnik D, Black DW, Berry S, Masand PS. Tardive dyskinesia: review of treatments past, present, and future. Ann Clin Psychiatry. 1999; 11(4): 257-266. doi: 10.1023/a:1022369614773

39. Kennedy R, Mittal D, O'Jile J. Electroconvulsive therapy in movement disorders: an update. J Neuropsychiatry Clin Neurosci. 2003; 15(4): 407-421. doi: 10.1176/jnp.15.4.407

40. Byne W, White L, Parella M, Adams R, Harvey PD, Davis KL. Tardive dyskinesia in a chronically institutionalized population of elderly schizophrenic patients: prevalence and association with cognitive impairment. Int J Geriatr Psychiatry. 1998; 13(7): 473-479. doi: 10.1002/(sici)1099-1166(199807)13:7<473::aid-gps800>3.0.co;2-z

41. Woerner MG, Alvir JMJ, Saltz BL, Lieberman JA, Kane JM. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998; 155(11): 1521-1528. doi: 10.1176/ajp.155.11.1521

42. Yasui-Furukori N, Kikuchi A, Katagai H, Kaneko S. The effects of electroconvulsive therapy on tardive dystonia or dyskinesia induced by psychotropic medication: a retrospective study. Neuro-psychiatr Dis Treat. 2014; 10: 1209-1212. doi: 10.2147/NDT.S62490.

43. Chacko RC, Root L. ECT and tardive dyskinesia: two cases and a review. J Clin Psychiatry. 1983; 44(7): 265-266.

44. Gosek E, Weller R. Improvement of tardive dyskinesia associated with electroconvulsive therapy. J Nerv Ment Dis. 1988; 176(2): 120-122. doi: 10.1097/00005053-198802000-00009

45. Malek-Ahmadi P, Weddige R. Tardive dyskinesia and electroconvulsive therapy. Convuls Ther. 1988; 4(4): 328-331.

46. Roth SD, Mukherjee S, Sackeim HA. Electroconvulsive therapy in a patient with mania, parkinsonism, and tardive dyskinesia. Convuls Ther. 1988; 4(1): 92-97.

47. Hay DP, Hay L, Blackwell B, Spiro HR. ECT and tardive dyskinesia. J Geriatr Psychiatry Neurol. 1990; 3(2): 106-109. doi: 10.1177/089198879000300209

48. Sandyk R. The relationship between ECT responsiveness and subtypes of tardive dyskinesia in bipolar patients. Int J Neurosci. 1990; 54(3-4): 315-319. doi: 10.3109/00207459008986650

49. Hanin B, Lerner Y, Srour N. An unusual effect of ECT on drug-induced parkinsonism and tardive dystonia. Convuls Ther. 1995; 11(4): 271-274.

50. Ufok A, Ufok G. Maintenance ECT in a patient with catatonic schizophrenia and tardive dyskinesia. Convuls Ther. 1996; 12(2): 108-112.

51. Nobuhara K, Matsuda S, Okugawa G, Tamagaki C, Kinoshita T. Successful electroconvulsive treatment of depression associated with a marked reduction in the symptoms of tardive dyskinesia. J ECT. 2004; 20(4): 262-263. doi: 10.1097/00124509200412000-00014

52. Sienaert P, Peuskens J. Remission of tardive dystonia (blepharospasm) after electroconvulsive therapy in a patient with treatment-refractory schizophrenia. J ECT. 2005; 21(2): 132-134. doi: 10.1097/01.yct.0000167464.79327.0d

53. Sharma A, Hammer S, Egbert M, Sorrell JH. Electroconvulsive therapy and ocular dystonia. J ECT. 2007; 23(3): 181-182. doi: 10.1097/YCT.0b013e31806548e4

54. Delay J, Pichot P, Lemperiere T, Elissalde B, Peigne F. A non-phenothiazine and non-reserpine major neuroleptic, haloperidol, in the treatment of psychoses. Ann Med Psychol. 1960; 118(1): 145-152.

55. Bekker RA, Bykov YuV, Morozov PV. Prominent psychiatrists of the 20th century. Moscow: Gorodets Publishing; 2019. (In Russ.)

56. Ruiz P. Addressing co-occurring disorders. Focus (Am Psychiatr Publ). 2017; 15(4): 9s-10s. doi: 10.1176/appi.focus.154S11

57. Wysokinski A. Intensive electroconvulsive therapy in drug resistant neuroleptic malignant syndrome - case report. Psychiatr Danub. 2012; 24(2): 219-222.

58. Strawn JR, Keck PE Jr, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry. 2007; 164 (6): 870-876. doi: 10.1176/ajp.2007.164.6.870

59. Caroff SN, Mann SC, Campbell EC. Atypical antipsychotics and neuroleptic malignant syndrome. Psychiatric Annals. 2000; 30(5): 314-321. doi: 10.3928/0048-5713-20000501-09

60. Caroff SN, Mann SC. Neuroleptic malignant syndrome. Psychopharmacol Bull. 1988; 24(1): 25-29.

61. Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am. 1993; 77(1): 185-202. doi: 10.1016/s0025-7125(16)30278-4

62. Stubner S, Rustenbeck E, Grohmann R, Wagner G, Engel R, Neundorfer G, et al. Severe and uncommon involuntary movement disorders due to psychotropic drugs. Pharmacopsychiatry. 2004; 37(Suppl 1): S54-64. doi: 10.1055/s-2004-815511

63. Caroff SN, Mann SC, Lazarus A. Neuroleptic malignant syndrome. Arch Gen Psychiatry. 1987; 44(9): 838-840. doi: 10.1001/archpsyc.1987.01800210090015

64. Harland CC, O'Leary MM, Winters R, Owens J, Hayes B, Melikian V. Neuroleptic malignant syndrome: a case for electroconvulsive therapy. Postgrad Med J. 1990; 66(771): 49-51. doi: 10.1136/pgmj.66.771.49

65. Verwiel JM, Verwey B, Heinis C, Thies JE, Bosch FH. Successful electroconvulsive therapy in a pregnant woman with neuroleptic malignant syndrome. Ned Tijdschr Geneeskd. 1994; 138(4): 196-199.

66. McKinney P, Kellner C. Multiple ECT late in the course of neuroleptic malignant syndrome. Convuls Ther. 1997; 13(4): 269-273.

67. Trollor JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry. 1999; 33(5): 650-659. doi: 10.1080/j.1440-1614.1999.00630.x

68. Nisijima K, Ishiguro T. Electroconvulsive therapy for the treatment of neuroleptic malignant syndrome with psychotic symptoms: a report of five cases. J ECT. 1999; 15(2): 158-163.

69. Kucia K, Warchala A. The application of electroconvulsive therapy in neuroleptic malignant syndrome treatment in a patient with catatonic schizophrenia. Wiad Lek. 2005; 58(9-10): 572-574.

70. Pandya HN, Keyes MJ, Christenson BC. Electroconvulsive therapy in a schizophrenic patient with neuroleptic malignant syndrome and pulmonary embolism: a case report. Psychiatry (Edgmont). 2007; 4(4): 21.

71. Patel AL, Shaikh WA, Khobragade AK, Soni HG, Joshi AS, Sahastrabuddhe GS. Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome. J Assoc Physicians India. 2008; 56: 49-50.

72. San Gabriel MC, Eddula-Changala B, Tan Y, Longshore CT. Electroconvulsive in a schizophrenic patient with neuroleptic malignant syndrome and rhabdomyolysis. J ECT. 2015; 31(3): 197-200. doi: 10.1097/YCT.0000000000000184

73. Foguet-Boreu Q, Coll-Negre M, Serra-Millas M, Cavalleria-Verdaguer M. Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion. Clin Pract. 2018; 8(1): 1044. doi: 10.4081/cp.2018.1044

74. Hill SK, Bishop JR, Palumbo D, Sweeney JA. Effect of second-generation antipsychotics on cognition: current issues and future challenges. Expert Rev Neurother. 2010; 10(1): 43-57. doi: 10.1586/ern.09.143

75. Biedermann F, Pfaffenberger N, Baumgartner S, Kem-mler G, Fleischhacker WW, Hofer A. Combined clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia: clinical and cognitive outcomes. J ECT. 2011; 27(4): e61-e62. doi: 10.1097/YCT.0b013e31821a8f05

76. Rayikanti R, Lentowicz I, Birur B, Li L. Combined antipsychotics and electroconvulsive therapy in an acutely psychotic patient with treatment-resistant schizophrenia. Psychopharmacol Bull. 2017; 47(2): 57-62.

77. Pawetczyk A, Kotodziej-Kowalska E, Pawetczyk T, Rabe-Jabtonska J. Is there a decline in cognitive functions after combined electroconvulsive therapy and antipsychotic therapy in treatmentrefractory schizophrenia? J Nerv Ment Dis. 2015; 203(3): 182-186. doi: 10.1097/NMD.0000000000000259

78. Vuksan Cusa B, Klepac N, Jaksic N, Bradas Z, Bozicevic M, Palac N, et al. The effects of electroconvulsive therapy augmentation of antipsychotic treatment on cognitive functions in patients with treatment-resistant schizophrenia. J ECT. 2018; 34(1): 31-34. doi: 10.1097/YCT.0000000000000463

79. Buckley NA, Sanders P. Cardiovascular adverse effects of antipsychotic drugs. Drug Saf. 2000; 23(3): 215-228. doi: 10.2165/00002018-200023030-00004

80. Nahshoni E, Manor N, Bar F, Stryjer R, Zalsman G, Weiz-man A. Alterations in QT dispersion in medicated schizophrenia patients following electroconvulsive therapy. Eur Neuropsychophar-macol. 2004; 14(2): 121-125. doi: 10.1016/S0924-977X(03)00098-1

81. Gambhir S, Sandersfeld N, D'Mello D. A case of severe, refractory antipsychotic-induced orthostatic hypotension. Medical Student Research Journal. 2014; 4(Fall): 15-17. doi: 10.3402/msrj.v3i0.201337