Qiong Xiang,1,2,* Peiwei Xu,3,* Zhaolin Zhai,1,2,4 Yuping Jia,1,2 Chunbo Li,1,2,5 Dengtang Liu1,2,4– 6 

1Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People’s Republic of China; 2Clinical Center for Psychotic Disorders, National Center for Mental Disorders, Shanghai, 200030, People’s Republic of China; 3Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China; 4Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China; 5Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People’s Republic of China; 6Institute of Mental Health, Fudan University, Shanghai, 200030, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Dengtang Liu, Email liudengtang@smhc.org.cn

Objective: The study aims to compare the clinical efficacy and cognitive side effect of magnetic seizure therapy (MST) and modified electroconvulsive therapy (MECT) on clozapine resistant schizophrenia (CRS).
Methods: Sixteen patients with CRS were enrolled in this randomized, parallel-group, controlled clinical trial. Patients were randomly allocated to receive 10 sessions of add-on MST or MECT over 4 weeks (1:1 ratio) and continued clozapine therapy during the study. Efficacy and neurocognition were assessed at baseline, 4-week and 8-week follow-up.
Results: (1) Clinical efficacy: MST significantly improved symptoms of schizophrenia from baseline to 4 weeks, as shown in PANSS total (p = 0.009), PANSS positive (p = 0.026), PANSS negative (p = 0.031) and PANSS general psychopathology (p = 0.023); we also observed significant reductions in PANSS total (p = 0.049) and PANSS positive (p = 0.037) at 8-week follow-up. MECT group also witnessed clinical improvement from baseline to 4-week in PANSS total (p = 0.035) and PANSS positive (p = 0.001); significant reduction in PANSS positive was also observed at 8-week follow-up (p = 0.041). From baseline to 8 weeks, PANSS negative had greater reduction in MST group compared with MECT group (p = 0.042). (2) Neurocognition: Pre-and post-treatment data showed no significant cognitive adverse effects in both groups. Immediate memory is better in patients who received MST than MECT at 4-week follow-up (p = 0.030).
Conclusion: In this pilot study, MST and MECT equally improved positive symptoms of CRS, while MST was more effective in relieving negative symptoms. Evidence showed negligible cognitive side effects in MST, with less adverse effect on immediate memory than MECT. As a promising alternative to MECT, MST requires further research in larger clinical population.

Keywords: clozapine resistant schizophrenia, CRS, modified electroconvulsive therapy, MECT, magnetic seizure therapy, MST, clinical efficacy, neurocognition