Indications for ECT in schizophrenia: Schiz Research.May.2013

01.07.2013

Studies have suggested that a combination of ECT and antipsychotics has a significant advantage in terms of rapidity and quality of response.APA guidelines  support the use of ECT in the treatment of schizophrenia for catatonia, in patients with a past history of a good response to ECT, and for treatment-resistance to medication. However NICE guidance do not recommend ECT for schizophrenia.

Maurizio Pompili  and colleagues review the evidence for ECT in schizophrenia in this systematic review.31 studies met all inclusion criteria.Seven studies have compared ECT plus antipsychotics against sham ECT plus antipsychotics in schizophrenia patients.Three studies did not use antipsychotics in combination with ECT or sham ECT/placebo.

Resistant schizophrenia: There are reports of success with ECT plus risperidone and ECT plus clozapine in resistant cases.The ECT Clozapine study showed that  ( 28 patients), the combination was safe and equally effective, but patients treated with ECT-clozapine had a lower rate of rehospitalizations

Catatonia: following an algorithm ( lorazepam-antipsychotics – ECT), a study with 50 patients showed that all 17 who received ECT recovered where as only 1/41 responded completely to lorazepam.

Suicidal behaviour in psychosis- no clear evidence that suggest decrease in suicidal acts.

This review suggest better efficacy for real ECT compared to sham-ECT in the short -term .This is in line with the metatanalysis by Tharyam and Adams (2005). There is no evidence that this early advantage for ECT is maintained over the long term. Catatonic patients respond better and faster to ECT.Patients refractory to medications might benefit from ECT.

Limitations– No meta analysis carried out.

Comment: Even though the authors claim that this review suggest ECT to be effective in reducing suicidal behaviour in schizophrenia, the evidence presented do not support this.

Summary of the article: 

Indications for electroconvulsive treatment in schizophrenia: a systematic review.

Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, Serafini G, Amore M, Girardi P.

Schizophr Res. 2013 May;146(1-3):1-9

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