Why do we prescribe ECT to schizophrenia patients? Improvement of psychiatric symptoms after electroconvulsive therapy in young adults with intractable first-episode schizophrenia and schizophreniform disorder. Public attitudes towards electroconvulsive therapy in the Chuvash Republic Leicester ECT trial: results in schizophrenia. Double-blind randomized controlled study showing symptomatic and cognitive superiority of bifrontal over bitemporal electrode placement during electroconvulsive therapy for schizophrenia Effect of Antidepressant Medication Resistance on Short-term Response to Electroconvulsive Therapy Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia Electroconvulsive therapy (ECT) and aerobic exercise training (AET) increased plasma BDNF and ameliorated depressive symptoms in patients suffering from major depressive disorder.
Electroconvulsive therapy ( ECT ) is prescribed for schizophrenia patients for various indications , in our country . However , official guidelines in other countries have been cautious in prescribing ECT for schizophrenia . To study the indications for which patients with schizophrenia receive ECT . We studied records of schizophrenia in patients receiving ECT in one year ( 2005 ) ( n=101 ) retrospectively , as well as the consecutive data of patients between May 2007 and June 2008 ( n=101 ) prospect ively . The various indications for ECT in schizophrenia were studied by frequency analysis . Of the 202 schizophrenia patients who received ECT  , the most common reason was ‘ to augment pharmacotherapy ’ in ( n=116 ) cases . The target symptoms for which ECT was prescribed the most was catatonia ( n=72 ) . The mean number of ECTs ( SD ) received was 8.4 ( 2.8 ) . Augmentation of pharmacotherapy was the most common indication of ECT in patients with schizophrenia Schizophrenia is a serious psychiatric disorder that develops mainly in young adults .  Electroconvulsive therapy ( ECT ) is known to be effective and safe in patients with schizophrenia with acute psychotic exacerbation . Because of the shortage of systematic studies , we conducted a prospect i ve naturalistic study to examine the short-term effects of acute ECT and its safety in young adults with medically intractable first-episode schizophrenia . Subjects were seven consecutive patients , 15 - 35 years of age , with first-episode schizophrenia or schizophreniform disorder ( Diagnostic and Statistical Manual of Mental Disorders , 4th edition ; DSM-IV ) , who had failed to respond to neuroleptics . The seven patients were treated with a first course of ECT , and their clinical symptoms were evaluated on the basis of the Brief Psychiatric Rating Scale ( BPRS ) ( 18 items , rated 0 - 6 ) and Global Assessment of Functioning ( GAF ) Scale . The GAF Scale is presented in DSM-IV as a means of assessing global functioning of a psychiatric patient . Scores range from 1 - 100 ; the higher GAF score indicates the higher global functioning . Adverse effects result ing from acute ECT were also evaluated . The total BPRS score 1 week after the final session improved significantly compared to the total pre-ECT BPRS score . The GAF score also improved significantly compared to the pre-ECT GAF score . There were no adverse effects during the acute ECT course , except for mild delirium . We conclude that ECT may be an effective and safe treatment option for young adults with intractable first-episode schizophrenia Background : Public attitudes towards a given medical procedure can have a significant influence on the employment of that method . Electroconvulsive therapy ( ECT ) is a medical procedure that has received an exceptionally ambiguous public reception since its inception . Aim : To survey the level of information about and attitudes towards ECT in a general population sample of the Chuvash Republic of the Russian Federation . Methods : A r and omly selected cohort of 5,373 people was contacted by telephone .  The respondents were asked three closed and three open questions . Results : The response rate was 74.7 % . Only 35.2 % of those interviewed said they knew anything about ECT . Health professionals and younger respondents were better informed . The two main sources of information about ECT were foreign films and the mass media . The main indication of ECT was thought to be schizophrenia . The majority ( 63.3 % ) of the respondents had negative opinions and emotions about ECT .  Conclusion : Limited information about and generally negative attitudes towards  ECT  were found in the general population of the Chuvash Republic . Gender , age , education level , employment in the health industry , and information source were found to be the determining factors in the knowledge of and attitudes towards ECT As part of the Leicester electroconvulsive therapy ( ECT ) study , the role of ECT in schizophrenia was investigated in a double-blind trial . The Present State Examination criteria for schizophrenia were fulfilled by 22 patients , of whom 19 gave consent and entered the trial . Neuroleptic medication was restricted during the trial period . Patients were r and omly allocated to eight real ECT or eight simulated ECT . At the end of the four-week trial period , patients receiving real ECT showed a significantly greater improvement when measured on the Montgomery-Asberg Schizophrenia Scale ( MASS ) , the visual analogue global psychopathology scale , and the depression scale . The differences on the MASS and visual analogue global psychopathology scale were not due to improvement in depressive symptoms . The superiority of real ECT was not demonstrated at the 12- and 28-week follow-up , when treatment was not controlled BACKGROUND Several studies show that bifrontal electrode placement produces relatively fewer cognitive adverse effects than bitemporal placement during electroconvulsive therapy ( ECT ) in depression . There are no reports comparing these electrode placements in schizophrenia . OBJECTIVES This study compared the clinical and cognitive effects of bifrontal and bitemporal electrode placements in schizophrenia patients referred for electroconvulsive therapy ( ECT ) .  METHODS 122 schizophrenia patients who were prescribed ECT were r and omized to receive ECT with either bifrontal ( BFECT ; n = 62 ) or bitemporal ( BTECT ; n = 60 ) placement . Their concomitant anti-psychotic medications and the number of ECT sessions were not controlled . Psychopathology was assessed using the Brief Psychiatric Rating Scale ( BPRS ) , Bush-Francis Catatonia Rating Scale ( BFCRS ) , and the Nurse Observation Scale for Inpatient Evaluation ( NOSIE ) . Cognitive functions were assessed 24-h after the final ECT using a battery of tests . Clinical improvement was compared using chi-square test , repeated measures ANOVA and analysis of covariance ( ANCOVA ) . Cognitive adverse effects were compared using t-test . RESULTS At the end of 2 weeks ( after 6 ECT sessions ) 63 % and 13.2 % of BFECT and BTECT patients respectively had met the response criterion for BPRS ( 40 % reduction in total score ; OR = 20.8 ; 95 % CI = 3.61 - 34.33 ) . BFECT patients showed significantly faster clinical response on BPRS ( Time × Group interaction effect : P = 0.001 ) , BFCRS ( P < 0.001 ) and the NOSIE total assets score ( P = 0.003 ) . ANCOVA using baseline scores as covariates and treatment-resistance status as between-subject factor showed that BFECT patients had significantly greater improvement in all measures . BFECT patients had significantly higher PGI-memory-scale total score than BTECT patients ( t = 5.16 ; P < 0.001 ) . They also showed superior performance in other cognitive measures . CONCLUSIONS BFECT results in superior clinical and cognitive outcomes than BTECT in schizophrenia patients referred for ECT Abstract : This prospect i ve study assessed the influence of resistance to antidepressant pharmacotherapy on the short-term response to subsequent electroconvulsive therapy ( ECT ) . Previous research has shown that patients with medication resistance were less likely to respond to ECT . This finding may be applicable to the population of depressed in patients in The Netherl and s , where ECT is often preceded by several medication trials . Eighty-five patients ( 61 female and 24 male patients ) with DSM-IV criteria for depressive disorder , both with and without mood congruent psychotic features , were included for analysis . Medication resistance was rated with the Antidepressant Treatment History Form . Medication resistance was predefined in accordance with the previous research in this field . When a reduction of at least 50 % on the 17-item version of the Hamilton Rating Scale for Depression ( HRSD ) between pre- and post-ECT is used as response criterion , medication-resistant patients were equally likely to respond to subsequent ECT ( 30/48 = 82.5 % ) than patients without medication resistance ( 30/37 = 81.1 % ) . Even when post-ECT HRSD score ≤7 was used ( full remission ) , there was no significant difference between medication-resistant patients ( 21/48 = 43.8 % ) and patients without medication resistance ( 15/37 = 40.5 % ) . When potential confounding variables were taken into account , these differences remain nonsignificant . In contrast to earlier research , medication resistance does not influence short-term response to subsequent ECT and it can still be of considerable efficacy BACKGROUND Although electroconvulsive therapy ( ECT ) has been shown to be extremely effective for the acute treatment of major depression , it has never been systematic ally assessed as a strategy for relapse prevention . OBJECTIVE To evaluate the comparative efficacy of continuation ECT ( C-ECT ) and the combination of lithium carbonate plus nortriptyline hydrochloride ( C-Pharm ) in the prevention of depressive relapse . DESIGN Multisite , r and omized , parallel design , 6-month trial performed from 1997 to 2004 . SETTING Five academic medical centers and their outpatient psychiatry clinics . PATIENTS Two hundred one patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar depression who had remitted with a course of bilateral ECT .  INTERVENTIONS R and om assignment to 2 treatment groups receiving either C-ECT ( 10 treatments ) or C-Pharm for 6 months . MAIN OUTCOME MEASURE Relapse of depression , compared between the C-ECT and C-Pharm groups . RESULTS In the C-ECT group , 37.1 % experienced disease relapse , 46.1 % continued to have disease remission at the study end , and 16.8 % dropped out of the study . In the C-Pharm group , 31.6 % experienced disease relapse , 46.3 % continued to have disease remission , and 22.1 % dropped out of the study . Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups . Mean + /- SD time to relapse for the C-ECT group was 9.1 + /- 7.0 weeks compared with 6.7 + /- 4.6 weeks for the C-Pharm group ( P = .13 ) . Both groups had relapse proportions significantly lower than a historical placebo control from a similarly design ed study . CONCLUSIONS Both C-ECT and C-Pharm were shown to be superior to a historical placebo control , but both had limited efficacy , with more than half of patients either experiencing disease relapse or dropping out of the study . Even more effective strategies for relapse prevention in mood disorders are urgently needed BACKGROUND In treatment-resistant schizophrenia a combination of ECT with antipsychotics has been reported to have superior outcomes compared to other strategies , however the results were inconsistent . We investigated the long-term effects of the combination of unilateral , non-dominant hemisphere ECT with three antipsychotics . SUBJECTS AND METHODS The clinical study was a naturalistic , prospect i ve , open-labeled , active-controlled study in adult out patients of both genders suffering from treatment-resistant schizophrenia with a follow up of 2 years . The patients received sulpiride ( n=17 , 100 - 400mg/day , PO ) , risperidone ( n=26 , 2 - 8 mg/day , PO ) or olanzapine ( n=27 , 5 - 10mg/day , PO ) . Unilateral ECT was applied in 1 unit ( 0.5A , 0.8 mS ) in six single applications , once a week and further according to the clinical need , in fortnight steps . Clinical efficacy was established using the PANSS and CGI psychometric scales . RESULTS According to the results , the most effective treatment mode was olanzapine plus ECT , then risperidone plus ECT , while sulpiride plus ECT had lower clinical efficacy . Olanzapine plus ECT was significantly superior in all scale scores vs sulpiride plus ECT , as well as risperidone plus ECT except for PANSS-P ( t=1.85 , p>0.05 ) . During the study , 38 of 70 patients were withdrawn due to treatment failure ( n=21 ) , side effects ( n=6 ) and non-compliance ( n=11 ) . CONCLUSION The combination of novel antipsychotics and ECT can be used safely and effectively in treatment-resistant schizophrenia CONTEXT Medication resistance is the leading indication for use of electroconvulsive therapy ( ECT ) in major depression . The practice of stopping antidepressant medications prior to ECT derived from studies in the 1960s and 1970s in nonresistant sample s. There is also continuing controversy regarding the relative efficacy and adverse effects of right unilateral and bilateral ECT . OBJECTIVE To test the hypotheses that , compared with placebo , concomitant treatment with nortriptline or venlafaxine during the ECT course enhances short-term efficacy without a meaningful effect on adverse effects and reduces the rate of post-ECT relapse , and to test the hypotheses that high-dose , right-sided , unilateral ECT is equivalent in efficacy to moderate-dosage bilateral ECT and retains advantages with respect to cognitive adverse effects . DESIGN Prospect i ve , r and omized , triple-masked , placebo-controlled study conducted from 2001 through 2005 . SETTING Three university-based hospitals . PATIENTS Of approximately 750 consecutive patients referred for ECT , 319 with a major depressive episode consented , were r and omized to pharmacological or ECT treatment conditions , and received at least 1 ECT treatment . MAIN OUTCOME MEASURES Scores on the Hamilton Rating Scale for Depression , remission rate following completion of ECT , and selective measures of cognitive adverse effects . RESULTS Treatment with nortriptyline enhanced the efficacy and reduced the cognitive adverse effects of ECT relative to placebo . Venlafaxine result ed in a weaker degree of improvement and tended to worsen cognitive adverse effects . High-dosage right unilateral ECT did not differ or was superior to bilateral ECT in efficacy and result ed in less severe amnesia . CONCLUSIONS The efficacy of ECT is substantially increased by the addition of an antidepressant medication , but such medications may differ in whether they reduce or increase cognitive adverse effects . High-dose , right-sided , unilateral ECT is at least equivalent to moderate-dosage bilateral ECT in efficacy , but retains advantages with respect to cognitive adverse effects Background & objectives : In recent years , health-related quality of life ( QOL ) has been regarded as the most important dimension of outcome in schizophrenia . Recent research has shown that atypical antipsychotics improve QOL in patients with schizophrenia . Importance of electroconvulsive therapy ( ECT ) has been demonstrated in restoring function and health related quality of life in depressed patients . However , there are no data on patients of schizophrenia . The objective of the present study was therefore , to assess the improvement in quality of life after ECT in treatment resistant schizophrenia . Methods : Thirty consecutive patients of treatment resistant schizophrenia were given ECT sessions twice a week and assessment s were made with Positive and Negative Syndrome Scale of Schizophrenia ( PANSS ) , WHO QOL Bref , Global Assessment of Functioning Scale and Clinical Global Impressions . Results : The group improved significantly on all the domains of quality of life scale except the domain named satisfaction with social relations . There was also significant change in the total score of PANSS after 6 ECT sessions ( mean at baseline = 86.7 , mean after 6 ECT = 65.5 , P < 0.001 ) as well as on different subscales of PANSS . The score on the global assessment of functioning also changed significantly ( mean 26.3 at baseline to 44.5 after 6 ECT sessions ) . Interpretation & conclusions : The present findings showed that ECT in addition to improvement in symptomatology led to improvement in QOL in patients of treatment resistant schizophrenia BACKGROUND To treat patients suffering from major depressive disorder ( MDD ) , research has focused on electroconvulsive therapy ( ECT ) and aerobic exercise training ( AET ) . Brain derived neurotrophic factor ( BDNF ) seems to be key in MDD . The aims of the present study were therefore two-fold , to investigate in a three-arm interventional study the differential effects of ECT , ECT plus AET , and AET alone in patients suffering from TR-MDD on 1 . depressive symptoms and 2 . plasma BDNF ( pBDNF ) . METHODS 60 patients with MDD ( mean age : 31 years ; 31.6 % female patients ) were r and omly assigned either to the ECT , ECT + AET , or AET condition . The AET condition consisted of treadmill exercise for 45 min , three times a week . Both depression severity and pBDNF levels were assessed at baseline and 4 weeks later . All patients were further treated with an SSRI st and ard medication . RESULTS pBDNF levels increased over time in all three study conditions , though , highest increase was observed in the ECT + EAT condition , and lowest increase was observed in the AET condition . Depressive symptoms decreased in all three conditions over time , though , strongest decrease was observed in the ECT + AET condition . The combination of ECT + AET led to significantly greater remission rates than in either the ECT or AET alone conditions . BDNF levels were not associated with symptoms of depression . CONCLUSIONS The pattern of results suggests that ECT , AET and particularly their combination are promising directions for the treatment of patients suffering from MDD , and that it remains unclear to what extent pBDNF is key and a reliable biomarker for MDD
RESULTS The most common indication for using ECT for schizophrenia patients was to augment pharmacotherapy , while the most common accompanying symptoms were , in order , catatonia , aggression and suicide .
Catatonic patients responded significantly better to ECT than patients with any other subtype of schizophrenia .
The combination of ECT with pharmacotherapy can be useful for drug-resistant patients .
The use of an ECT-risperidone combination or ECT-clozapine combination in patients non-responsive to prior pharmacotherapy was found to be most effective .
This review indicates that ECT , combined with pharmacotherapy , may be a viable option for a selected group of patients with schizophrenia .
In particular , the use of ECT is recommended for drug-resistant patients , for schizophrenic patients with catatonia , aggression or suicidal behavior  , and when rapid global improvement and reduction of acute symptomatology are required
BACKGROUND Electroconvulsive therapy ( ECT ) is a medical treatment that is most effective for mood disorders ( Bipolar Disorder and Major Depression ) .
It has also been shown to be an effective treatment for schizophrenia accompanied by catatonia , extreme depression , mania and other affective components .
ECT is currently under-used in many psychiatric setting s due to its stigmatized perception by patients and mental health professionals .
However , many unanswered questions remain regarding its role in the management of patients with schizophrenia .
AIM Evaluate the main indications of ECT in subjects suffering from schizophrenia .
OBJECTIVES Investigate the efficacy and the main indications of  ECT in the treatment of schizophrenic patients , evaluate its effects in the short-term and the long-term , compare ECT treatment with pharmacotherapy , and assess the effects of treatment with ECT .