Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with treatment-resistant schizophrenia ᵃ
Intervention: Electroconvulsive (ECT) plus standard care (antipsychotics)
Comparison: Standard care (antipsychotics)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Response to treatment at 8 to 12 weeks | Favours intervention | Moderate |
Cognitive functioning: memory deterioration at 3 to 4 weeks | Favours comparison | Very Low |
Cognitive functioning: memory at 8 to 12 weeks | No statistically significant difference | GRADE assessment not performed for this outcome |
Satisfaction and acceptability of treatment: leaving the study early at 8 to 12 weeks | No statistically significant difference | Very Low |
Mental state at 8 to 12 weeks: Brief Psychiatric Rating Scale (BPRS) | Favours intervention | Low |
Mental state at 8 to 12 weeks: Positive and Negative Syndrome Scale (PANSS) | Favours intervention | GRADE assessment not performed for this outcome |
General functioning at 12 weeks to 6 months | Favours intervention | Very Low |
Adverse events (8 to 12 weeks): Treatment Emergent Symptom Scale (TESS) total score; breathing discomfort; constipation; insomnia; TESS behavioural toxicity domain; symptoms of cardiovascular system | Occurs more commonly with standard care alone compared with ECT plus standard care (favours intervention) | GRADE assessment not performed for this outcome |
Adverse events (8 to 12 weeks): headache | Occurs more commonly with ECT plus standard care compared with standard care alone (favours comparison) | GRADE assessment not performed for this outcome |
Hospitalisation | - | None of the studies identified by the review assessed this outcome |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) notes that the evidence was insufficient in terms of evaluating the long-term benefits and harms of ECT. The review also states that due to weak evidence, comparison groups other than standard care could not be evaluated. ᵃ Mean age 18 to 46 years when reported; 55% male.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does haloperidol compare with first‐generation antipsychotics for improving outcomes in adults with schizophrenia?
- What are the benefits and harms of aripiprazole compared with other atypical antipsychotics in people with schizophrenia?
- How does cognitive‐behavioral therapy compare with other psychosocial treatments for individuals with schizophrenia?
- Can adding cognitive‐behavioral therapy (CBT) to standard care improve longer‐term outcomes for people with schizophrenia?
- What are the effects of maintenance treatment with antipsychotic drugs in people with schizophrenia?
- In people with chronic mental illnesses, how do life skills programs affect outcomes?
- In people with schizophrenia, is there randomized controlled trial evidence to support the use of psychoeducation?
- How do antipsychotic combinations compare with antipsychotic monotherapy for people with schizophrenia?
- What are the benefits and harms of electroconvulsive therapy for people with treatment‐resistant schizophrenia?
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