The results of quantitative electroencephalography (qEEG) studies on electroconvulsive therapy (ECT) have been inconsistent, and indicators of the efficacy of ECT have not been clearly identified. In this study, we examined whether qEEG could be used as an indicator of the effect of ECT by measuring it during the course of treatment. We analyzed qEEG data before and after acute-phase ECT in 18 patients with schizophrenia, mood disorders, and other psychiatric disorders. We processed the qEEG data and compared the spectral power between the data acquired before and after ECT. The spectral power increased significantly after ECT in the delta, theta, and alpha bands. There was a strong significant correlation between the increase in the spectral power of the alpha band after acute ECT and improvement in the Brief Psychiatric Rating Scale score. Our results suggest that an increase in the alpha-band spectral power may be useful as an objective indicator of the treatment effect of acute ECT.

Background: Clozapine is the only antipsychotic medication proven effective in patients with treatment-resistant schizophrenia (TRS). However, many patients have serum concentrations outside the recommended therapeutic window, and clozapine exhibits substantial interindividual variability. This study aimed to (1) examine clozapine dosage and blood concentrations in patients with TRS; (2) investigate the effects of sex and age on dosage and blood concentrations; (3) assess clinical response to clozapine treatment; and (4) develop a random forest (RF) model to predict therapeutic response using clinical and therapeutic drug monitoring (TDM) data. Methods: Dried blood spots were used to measure concentrations of clozapine, norclozapine, and clozapine N-oxide. Clinical symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). The RF algorithm was applied to analyze the relationships between biochemical and demographic factors and clinical response to clozapine. Results: A total of 754 blood samples from 167 patients were analyzed. Men received higher doses than women, and glucose levels were elevated in both sexes. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.986 for the training set and 0.852 for the testing set. Accuracy, precision, recall, and F1-score (training/testing) were 0.938/0.786, 0.936/0.736, 0.934/0.780, and 0.935/0.757, respectively. The SHapley Additive exPlanations (SHAP) analysis indicated that baseline BPRS score, treatment duration, age, and clozapine concentration were important variables contributing to the output of the model. Conclusions: Our model achieved satisfactory predictive performance for clinical response and provides valuable insights into personalized prediction of clozapine efficacy.

Objective: Electroconvulsive therapy (ECT) is utilized for treating psychiatric disorders, such as schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). We aimed to compare pre- and post-ECT treatment outcomes between patients with SCZ and a combined group of patients with MDD and BD (MDD+BD) to assess the distinction between the antipsychotic and antidepressant effects of ECT. Methods: ECT was administered to patients with SCZ (n = 17) and those with MDD+BD (n = 7). Symptoms were evaluated using the brief psychiatric rating scale (BPRS), clinical global impression scale (CGI), and global assessment of functioning (GAF). Plasma brain-derived neurotrophic factor (BDNF) levels were also measured. Results: The BPRS, CGI, and GAF scores significantly differed after ECT compared with those before ECT in each patient group. However, no significant differences were observed between the groups for each disorder. No significant differences were observed in plasma BDNF levels between the groups at baseline and during ECT. At baseline, only depression scores were more favorable in the SCZ group, whereas positive symptoms and disorganization scores were higher in the MDD+BD group. During treatment, positive symptoms, activation, and disorganization items were significantly more favorable in the MDD+BD group compared with the SCZ group. Total BPRS scores were not associated with plasma BDNF levels; however, rating scores of the several items related to activation, resistance, and disorganization were positively correlated with BDNF levels. Conclusion: ECT effects on several clinical outcomes in the MDD+BD group were associated with plasma BDNF levels. These findings suggest that ECT may be more effective for treating MDD than SCZ.

Electroconvulsive therapy (ECT) is utilized for treating psychiatric disorders such as schizo-phrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). To assess the comparative clinical efficacy and acceptability of ECT, pre- and post-treatment comparisons were conducted between groups of patients with SCZ and combined groups of patients with depression plus bipolar disorder (MDD+BD). ECT was administered to SCZ (n = 17), and MDD+BD (n = 7) patients. Symptom were evaluated using the Brief Psychiatric Rating Scale (BPRS), and plasma brain-derived neurotrophic factor (BDNF) levels were measured. While statistically significant differences were observed in the rating scales before ECT compared to those after ECT for each patient group, no significant change between the groups for each disorder was observed. Additionally, there were no significant differences in plasma BDNF levels between the groups at baseline and during the ECT. To estimate the difference between the SCZ and MDD + BD groups, we reanalyzed the 24 individual BPRS items. At baseline, only depression scores indicated favor towards SCZ, while positive symptoms and disorganization scores suggested a favorable condition in the MDD + BD group. During treatment, positive symptoms, activation and disorganization items showed favor in the MDD + BD groups compared to the SCZ group. The total BPRS scores were not associated with the plasma BDNF levels; however, rating scores of the several items in the activation, resistance and disorganization were positively correlated with BDNF levels. In conclusion, although ECT was effective for patients with both SCZ and MDD+BD, the pos-itive symptoms, activation, and disorganization responses to ECT were statistically higher in MDD+BD than in SCZ, with the exception of depressive behavior. Additionally, the ECT ef-fects for several clinical outcomes of MDD+BD were associated with plasma BDNF levels. These findings suggest that ECT may be even more effective for MDD than for SCZ.