Hou L, Chen R, Huang CB, Shi WJ, Wu LL. Clinical symptom improvement following modified electroconvulsive therapy is associated with modulation of peripheral inflammatory markers in schizophrenia. World J Psychiatry 2026; 16(3): 114036 [DOI: 10.5498/wjp.v16.i3.114036]
Corresponding Author of This Article
Wen-Jie Shi, Academic Fellow, Chief Physician, Department of Psychiatry, Huai’an Third People’s Hospital, No. 272 Huaihai West Road, Huai’an 223001, Jiangsu Province, China. shiwenjie197948@126.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 19, 2026 (publication date) through Feb 27, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Psychiatry
ISSN
2220-3206
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Hou L, Chen R, Huang CB, Shi WJ, Wu LL. Clinical symptom improvement following modified electroconvulsive therapy is associated with modulation of peripheral inflammatory markers in schizophrenia. World J Psychiatry 2026; 16(3): 114036 [DOI: 10.5498/wjp.v16.i3.114036]
World J Psychiatry. Mar 19, 2026; 16(3): 114036 Published online Mar 19, 2026. doi: 10.5498/wjp.v16.i3.114036
Clinical symptom improvement following modified electroconvulsive therapy is associated with modulation of peripheral inflammatory markers in schizophrenia
Lu Hou, Ru Chen, Cheng-Bing Huang, Wen-Jie Shi, Li-Li Wu
Lu Hou, Ru Chen, Cheng-Bing Huang, Wen-Jie Shi, Li-Li Wu, Department of Psychiatry, Huai’an Third People’s Hospital, Huai’an 223001, Jiangsu Province, China
Co-first authors: Lu Hou and Ru Chen.
Co-corresponding authors: Wen-Jie Shi and Li-Li Wu.
Author contributions: Hou L and Chen R contributed equally to this manuscript and are co-first authors. Shi WJ and Wu LL designed the study, and they contributed equally to this manuscript and are co-corresponding authors; Hou L analysed the data and wrote the manuscript; Chen R and Huang CB collected the relevant data and provided technological support; Shi WJ provided financial support; Hou L and Shi WJ edited the manuscript. All authors have read and approved the final manuscript.
Supported by the Huai’an Municipal Health Commission’s Natural Science Project, No. HAB202214.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee at Huai’an Third People’s Hospital (No. 2022-23).
Informed consent statement: All participants enrolled on this study provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Corresponding author: Wen-Jie Shi, Academic Fellow, Chief Physician, Department of Psychiatry, Huai’an Third People’s Hospital, No. 272 Huaihai West Road, Huai’an 223001, Jiangsu Province, China. shiwenjie197948@126.com
Received: September 11, 2025 Revised: October 21, 2025 Accepted: December 2, 2025 Published online: March 19, 2026 Processing time: 170 Days and 18.3 Hours
Abstract
BACKGROUND
Schizophrenia is a severe neuropsychiatric disorder with unclear pathogenesis, although immune-inflammatory pathways are being increasingly implicated. Elevated proinflammatory cytokines are consistently observed in patients with schizophrenia, suggesting a state of chronic low-grade inflammation. Modified electroconvulsive therapy (MECT) is an effective biological intervention for treatment-resistant schizophrenia, but its mechanisms remain incompletely understood.
AIM
To examine the association between MECT-induced changes in immunoinflammatory markers and clinical improvement in schizophrenia.
METHODS
In this prospective study, 619 patients with schizophrenia underwent MECT. Peripheral immunoinflammatory markers, including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammatory index (SII), were measured before and after treatment. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Correlation and logistic regression analyses were applied to evaluate associations, and receiver operating characteristic analysis was used to assess predictive performance.
RESULTS
After MECT, significant reductions were observed in PANSS scores and most peripheral inflammatory markers (MLR, NLR and SII; all P < 0.05). The decreases in MLR, NLR, and SII showed a significant positive correlation with the PANSS score reduction rate (P < 0.05). Patients with marked clinical improvement showed greater decreases in inflammatory markers. Logistic regression identifies the change in MLR before and after treatment (ΔMLR) as a strong predictor of treatment response, with each 0.1-unit increase associated with a 57% greater probability of clinical symptom improvement (odds ratios = 1.57, P < 0.001). Receiver operating characteristic analysis demonstrated that ΔMLR had significant predictive value for MECT efficacy (area under the curve = 0.731, P < 0.001), with an optimal cutoff value of 0.075.
CONCLUSION
MECT modulates peripheral immune inflammation in schizophrenia, and these changes correlate with clinical improvement. ΔMLR may serve as a valuable predictor of MECT treatment response.
Core Tip: This study demonstrates that modified electroconvulsive therapy significantly improves clinical symptoms and reduces peripheral inflammatory markers - including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio, and systemic immune-inflammatory indices - in patients with schizophrenia. Reductions in MLR were strongly correlated with clinical improvement and served as a robust predictor of treatment response. Specifically, each 0.1-unit increase in ΔMLR was associated with a 57% higher likelihood of significant symptom improvement. These findings suggest an immunomodulatory mechanism of modified electroconvulsive therapy and support the use of MLR as a potential biomarker for predicting treatment efficacy.
