title: Why do we prescribe ECT to schizophrenia patients? Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis — A case–control study Improvement of psychiatric symptoms after electroconvulsive therapy in young adults with intractable first-episode schizophrenia and schizophreniform disorder. Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia Schizophrenia--a follow-up study of results of treatment. An exploratory evaluation of ECT in haloperidol-treated DSM-IIIR schizophreniform disorder. The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study. ECT FOR SCHIZOPHRENIA Double-blind randomized controlled study showing symptomatic and cognitive superiority of bifrontal over bitemporal electrode placement during electroconvulsive therapy for schizophrenia Leicester ECT trial: results in schizophrenia. Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia.
abstract: 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 OBJECTIVE Previous studies have demonstrated the effectiveness of electroconvulsive therapy ( ECT ) in pharmacotherapy-resistant neuropsychiatric conditions . This study aim ed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis . METHOD This case-control study was conducted in in patients aged 13 - 20 years with first-episode psychosis . Every three similar age and same gender patients consecutively recruited were r and omly allocated to control and ECT group at a ratio of 1:2 , while they had antipsychotic treatment . ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions . The endpoint was discharge from hospital . Clinical outcomes were measured using hospital stay days , the Positive and Negative Syndrome Scale ( PANSS ) and response rate . Polysomnography ( PSG ) was conducted at baseline and at week 2 . Safety and tolerability were also evaluated . RESULTS Between March 2004 and November 2009 , 112 eligible patients were allocated to control ( n=38 ) and ECT ( n=74 ) group .  Additional ECT treatment significantly reduced hospital stay compared to controls ( 23.2±8.2 days versus 27.3±9.3 days , mean±SD , P=0.018 ) . Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls ( 74.3 % versus 50 % , relative risk (RR)=1.961 , P=0.001 ) . Additional ECT also produced significantly greater improvement in sleep efficiency , rapid eye movement ( REM ) latency and density than control condition . The PSG improvement significantly correlated with reduction in scores on overall PANSS , positive symptoms , and general psychopathology . No patients discontinued ECT treatment regimen during hospital stay . The incidence of most adverse events was not different in the two groups , but ECT-treated group had more complaints of transient headache and dizziness than controls . CONCLUSIONS ECT is an effective and safe intervention used in adolescents with first-episode psychosis . Its antipsychotic effects are associated with improved PSG variables . ECT can be considered as an early psychosis intervention 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 & 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 This is the second article from a study of the outcome of five different methods of treatment for schizophrenia ; patients were followed up over a period of two to five years after first admission and the first release . Patients who had been originally treated in hospital with psychotherapy alone  stayed longer in hospital over the follow-up period than those who had received electroconvulsive therapy ( ECT ) , drug alone , or drug plus psychotherapy . Those who had been treated with milieu therapy also had a longer stay date d from the time of admission . Patients treated initially with drugs or ECT showed a trend toward spending less time in hospital after their release In a double-blind , prospect i ve study , 30 consecutive treatment-naive adult men with first-onset psychosis and DSM-IIIR provisional schizophreniform disorder ( without good prognostic features ) were r and omized into true electroconvulsive therapy ( ECT ) and sham ECT groups . Both groups received haloperidol in a fixed dose of 15 mg at night . The ECT schedule comprised six bilateral , sinusoidal wave treatments administered on alternate days , thrice a week . Weekly ratings for the first 6 weeks showed an absence of significant difference between the groups in the number of patients responding and in the rate of attenuation of psychosis ; severity of depression , while less in the true ECT group after the first 3 weeks , did not differ between the groups at any subsequent time point . Clinical ratings were repeated at 6 months , and social functioning was assessed ; again , no group differences emerged . It is concluded that ECT does not meaningfully improve response in unselected schizophreniform disorder that is treated with an adequate dose of neuroleptic The efficacy of ECT was investigated in a double-blind trial . Twenty-two patients with schizophrenia received trifluoperazine and were r and omly allocated to receive eight real or eight simulated ECTs . In the first eight weeks , the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale . However , the groups showed no significant differences from the twelfth week onwards . The superiority of real ECT was not confirmed at the end of six months Electroconvulsive therapy ( ECT ) in the treatment of schizophrenia was evaluated in a double-blind trial ; the clinical change after ECT was compared with that after a treatment procedure identical to it but for two exceptions -- no electricity was used and no convulsion was induced . All patients had paranoid schizophrenia according to Present State Examination criteria and all received st and ard doses of neuroleptics for at least 2 weeks before r and om assignment to the two groups . 20 patients completed the trial : 10 had ECT and 10 were in the control group .  Treatment was given three times a week , with a minimum of eight treatments and a maximum of twelve . Clinical change was assessed by the Comprehensive Psychiatric Rating Scale . Both groups improved but the improvement of patients receiving ECT was significantly greater than that of controls both after six treatments ( p=0.02 ) and at the end of treatment ( p=0.004 ) . Thus the group receiving ECT gained a clear and early advantage compared with the control group , although by 16 weeks there was little difference between the two groups . Possible reasons for this are discussed 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 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 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
target: 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: 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 .