Acute electroconvulsive therapy in the elderly with schizophrenia and schizoaffective disorder: a literature review

Abstract

Objectives: This study reviewed the evidence regarding the efficacy of acute electroconvulsive therapy for primary psychotic conditions in the elderly. Methods: A literature search was performed using the Medline, Embase and Cochrane databases. Results: Acute electroconvulsive therapy resulted in an improvement of psychotic symptoms in almost all elderly patients, a large proportion of whom had treatment-resistant conditions. No electroconvulsive therapy related fatalities or severe medical complications were encountered. Conclusions: Acute electroconvulsive therapy may present a valuable treatment modality for elderly patients with primary psychotic conditions who do not respond adequately to antipsychotic medications.

Acute electroconvulsive therapy in the elderly with schizophrenia and schizoaffective disorder: A case series

“…The provenance of electroconvulsive therapy (ECT) was as a treatment for schizophrenia in 1938, and it was subsequently rapidly adopted worldwide to treat a broad range of psychiatric conditions (Chanpattana, ; Leiknes, Jarosh‐von Schweder, & Høie, ). The progressive introduction of effective psychopharmacotherapy in the 1950s, however, oversaw a prominent reduction in its utilization and a narrowing of its indications to mental illnesses that were primarily affective in nature, severe, medication‐resistant, or life‐threatening (Chanpattana, , ; Kramer, ; Kristensen, Bauer, Hageman, & Jorgensen, ; Kumagaya & Halliday, ; Leiknes et al, ). Although the use of ECT is well established in affective disorders, particularly major depressive disorder, its utility in primary psychotic conditions, such as schizophrenia and schizoaffective disorder, has remained more abstruse (Chanpattana, ; Kumagaya & Halliday, ).…”

“…The progressive introduction of effective psychopharmacotherapy in the 1950s, however, oversaw a prominent reduction in its utilization and a narrowing of its indications to mental illnesses that were primarily affective in nature, severe, medication‐resistant, or life‐threatening (Chanpattana, , ; Kramer, ; Kristensen, Bauer, Hageman, & Jorgensen, ; Kumagaya & Halliday, ; Leiknes et al, ). Although the use of ECT is well established in affective disorders, particularly major depressive disorder, its utility in primary psychotic conditions, such as schizophrenia and schizoaffective disorder, has remained more abstruse (Chanpattana, ; Kumagaya & Halliday, ). Internationally, this is reflected by conspicuous variations in clinical practice between countries and regions—whereas affective disorders are the leading indications for treatment in Australia, the United Kingdom, and the United States, ECT is most commonly a treatment for schizophrenia and schizoaffective disorder across Asia, Africa, and parts of Europe (Leiknes et al, ).…”

“…Internationally, this is reflected by conspicuous variations in clinical practice between countries and regions—whereas affective disorders are the leading indications for treatment in Australia, the United Kingdom, and the United States, ECT is most commonly a treatment for schizophrenia and schizoaffective disorder across Asia, Africa, and parts of Europe (Leiknes et al, ). Data specific to Australia show schizophrenia and schizoaffective disorder to represent uncommon diagnostic indications for ECT (2%‐21%), with treatment utilization particularly lower in the elderly compared with those below the age of 65 (5% vs 23%) (Chanpattana, ; Kumagaya & Halliday, ; Leiknes et al, ; Wood & Burgess, ).…”

“…Factors contributing to the lower ECT utilization rates in the elderly with primary psychotic conditions are manifold (Kumagaya & Halliday, ). Foremost, there is a notable absence of literature specific to this population—at the time of writing, this was limited to one case series of five patients and five single case reports (Hassamal, Jolles, & Pandurangi, ; Kramer, ; Meyen, Acevedo‐Diaz, & Reddy, ; Selvadurai, Farahmand, Jain, & Alvarado, ; Suzuki, Shindo, et al, ; Tang & Park, ).…”

“…Interest in ECT as a treatment for primary psychotic conditions has grown as the limitations of antipsychotic medications have become more recognized (Chanpattana, ; Kumagaya & Halliday, ). Such interest has been complemented by robust emerging evidence that countenances the efficacy of ECT in adults with treatment‐ and clozapine‐resistant schizophrenia (Chanpattana et al, ; Grover, Hazari, & Kate, ; Petrides et al, ; Tharyan & Adams, ).…”