BACKGROUND Electroconvulsive therapy (ECT) has been shown to be effective in schizophrenia (SZ), particularly in drug-refractory cases or when rapid symptom relief is needed. However, its precise mechanisms of action remain largely unclear. To clarify the mechanisms underlying modified electroconvulsive therapy (mECT) for SZ, we conducted a longitudinal cohort study evaluating functional connectivity of the thalamus before and after mECT treatment using sub-regions of thalamus as regions of interest (ROIs). METHODS Twenty-one SZ individuals taking only antipsychotics (DSZ group) for 4 weeks and 21 SZ patients receiving a regular course of mECT combining with antipsychotics (MSZ group) were observed in parallel. All patients underwent magnetic resonance imaging scans at baseline (t1) and follow-up (t2, ~4 weeks) time points. Data were compared to a matched healthy control group (HC group) consisting of 23 persons who were only scanned at baseline. Group differences in changes of thalamic functional connectivity between two SZ groups over time, as well as in functional connectivity among two SZ groups and HC group were assessed. RESULTS Significant interaction of group by time was found in functional connectivity of the right thalamus to right putamen during the course of about 4-week treatment. Post-hoc analysis showed a significantly enhanced functional connectivity of the right thalamus to right putamen in the MSZ group contrasting to the DSZ group. In addition, a decreased and an increased functional connectivity of the thalamus to sensory cortex were observed within the MSZ and DSZ group after 4-week treatment trial, respectively. CONCLUSION Our findings suggest that changes in functional connectivity of the thalamus may be associated with the brain mechanisms of mECT for schizophrenia.

中文翻译：

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精神分裂症改良电休克疗法引起丘脑功能连接的改变

背景 电惊厥疗法 (ECT) 已被证明对精神分裂症 (SZ) 有效，尤其是在药物难治性病例或需要快速缓解症状时。然而，其确切的作用机制在很大程度上仍不清楚。为了阐明 SZ 改良电休克疗法 (mECT) 的潜在机制，我们进行了一项纵向队列研究，使用丘脑亚区作为感兴趣区域 (ROI)，评估 mECT 治疗前后丘脑的功能连通性。方法平行观察21例仅服用抗精神病药4周的SZ患者（DSZ组）和21例接受常规mECT联合抗精神病药治疗的SZ患者（MSZ组）。所有患者在基线（t1）和随访（t2，~4 周）时间点都接受了磁共振成像扫描。将数据与匹配的健康对照组（HC 组）进行比较，该对照组由 23 名仅在基线时进行扫描的人组成。评估了两个 SZ 组之间丘脑功能连接随时间变化的组差异，以及两个 SZ 组和 HC 组之间的功能连接。结果 在大约 4 周的治疗过程中，在右侧丘脑与右侧壳核的功能连接中发现了组与时间的显着相互作用。事后分析显示，与 DSZ 组相比，MSZ 组右侧丘脑与右侧壳核的功能连接性显着增强。此外，在 4 周的治疗试验后，分别在 MSZ 和 DSZ 组中观察到丘脑与感觉皮层的功能连接减少和增加。