The Role of ECT in Schizophrenia

Abstract

Objective:To review the place of electroconvulsive therapy (ECT) in the treatment of schizophrenia. Conclusions:ECT is as effective, if not more so, than the antipsychotic drugs in certain clinical settings. It can be rapidly effective in acute episodes. When used alone, antipsychotics have comparable or superior efficacy to ECT alone in the short term. However, ECT possibly confers better long-term outcome. Combination treatment with antipsychotic medications and ECT is superior to either treatment alone, and is safe and effective, notably in medication resistant schizophrenia. Benefits of acute courses of ECT may be short-lived unless maintenance ECT is instituted, although there are limited data on the subject. Clinically, patients with acute onset, shorter episodes are more likely to respond to ECT. Catatonia, preoccupation with delusions and hallucinations, and a relative absence of premorbid schizoid and paranoid personality traits, are other clinical factors less strongly predictive of positive response. The presence of affective symptoms is often thought to be predictive of clinical response. However, there is little research evidence for this. While medications remain the mainstay of treatment in schizophrenia, ECT does have a clear and increasingly recognised role which requires further evaluation.

Revisiting the role of electroconvulsive therapy in schizophrenia: Where are we now?

“…14,15 In addition to the expanding evidence base for efficacy and safety, there have been several recent studies helping define whom to consider for ECT. In line with the conclusions from the review by Keuneman et al, 1 it appears that patients who have affective symptoms do not necessarily respond better to ECT, as was once previously thought. In a study of 253 patients, Chanpattana and Sackeim found that presence of affective symptoms did not predict an improved response.…”

“…Given the earlier finding, 1 that those patients with shorter episode duration of psychosis are more likely to respond and the commonly held view of a need to intervene early in the treatment of psychosis, arguably, as clinicians we should consider ECT as a therapy earlier rather than later in the disease course. In this context, the purpose of this article is to revisit what the recent evidence base now tells us in terms of clinical messages for patients with schizophrenia.…”

“…A little over 15 years ago, the role of electroconvulsive therapy (ECT) in schizophrenia was considered in a review published in Australasian Psychiatry. 1 The somewhat controversial key message being that ECT was ‘as effective, if not more so, than antipsychotics’ in certain settings and in patients with schizophrenia may lead to rapid success, as well as better long-term outcomes. However, not surprisingly, ECT alone was less effective than in combination with antipsychotics.…”

Descrição do consumo de psicofármacos na atenção primária à saúde de Ribeirão Preto, São Paulo, Brasil

“…Com relação às diferenças nas doses médias usadas por homens e mulheres, estas podem ser explicadas pelas características hormonais de cada sexo. As mulheres apresentam maior propensão biológica e psicossocial a terem mais transtornos de humor e de ansiedade, já os homens são mais susceptíveis à esquizofrenia 28,29 . Isso pode explicar por que as mulheres usaram doses maiores de diazepam e os homens clorpromazina.…”