Long-acting injectable vs. oral antipsychotics during electroconvulsive therapy in psychosis: a retrospective comparative study

Psychoses are often characterized by relapse and treatment resistance. Patients receiving electroconvulsive therapy (ECT) represent a high-risk subgroup. Although long-acting injectable (LAI) antipsychotics improve adherence compared with oral formulations, studies regarding their effectiveness when combined with ECT remain limited. Our study compared clinical outcomes between LAI and oral antipsychotics administered during ECT to patients with psychosis. We conducted a retrospective chart review of 65 patients, grouped according to antipsychotic formulation. Treatment response was defined by improvement on the Clinical Global Impression-Severity scale. Symptom changes were assessed using the Positive and Negative Syndrome Scale (PANSS). The LAI-ECT group showed a significantly higher response rate compared with the oral-ECT group (72.7 vs. 37.5%, P = 0.004). In multivariable analyses, LAI use remained significantly associated with treatment response (P = 0.007). In the subgroup analysis of 48 patients, the LAI-ECT group exhibited greater reductions in total PANSS scores (P = 0.014), which remained significant after adjustment for baseline severity (P = 0.034). Greater symptom reductions were observed in the PANSS negative and general psychopathology subscales. These findings suggest an association between concurrent LAI antipsychotic administration during ECT and clinical outcomes, warranting further prospective validation.