[Use of ECT in drug-refractory schizophrenia--a survey of the current literature]

Abstract

Since its introduction in the 1930s, electroconvulsive therapy (ECT) has maintained an important role as an efficacious and evidence-based somatic treatment option in affective or schizophrenic diseases. As opposed to major depressive disorder, ECT is commonly used to a substantially lesser extent for patients with schizophrenia in the USA, UK and most parts of Europe. Accordingly there is comparably little evidence regarding the clinical effectiveness and tolerability of ECT in schizophrenia. Recent clinical studies, meta-analyses and surveys point to the combination of ECT and antipsychotic medication as being advantageous in the treatment of schizophrenia, particularly in those patients who have shown inadequate responses to psychotropic medication alone. Clinical features considered to be predictive for ECT outcome are delusions, hallucinations, presence of affective and catatonic symptoms and absence of negative symptoms as well as a short duration of the current episode. National and international guidelines suggest ECT as an augmentation strategy in treatment-refractory schizophrenia in acute exacerbation and continuation therapy. Considering the fact that a substantial part of schizophrenic patients does not respond sufficiently to pharmacotherapy there still is a lack of well designed, controlled and randomised clinical trials to improve evidence for the promising role of ECT in schizophrenia.