ECT effective for treatment-refractory schizophrenia
MedWire News: Electroconvulsive therapy (ECT) is an effective treatment for severely ill patients with schizophrenia who have failed to respond to other treatments, say Danish researchers.
ECT was used extensively throughout the 1940s and 1950s for a variety of psychiatric disorders, but national guidelines on the indications for ECT are now quite restrictive, although they suggest the use of ECT in special circumstances, explain Diana Kristensen (Glostrup University Hospital, Copenhagen) and team.
They add: "A Cochrane review from 2006 concluded that 'ECT, combined with antipsychotics, may be an option for schizophrenic patients, particularly when rapid global improvement and reduction in symptoms is desired. This also goes for the treatment-refractory patients.'"
To examine the use and effectiveness of ECT in patients with schizophrenia, Kristensen and colleagues studied data on 79 individuals with schizophrenia-spectrum disorders who received ECT between 2003 and 2008 at one of two hospitals in Copenhagen.
All of the patients had been hospitalized due to an increase in acute episodes or an increase in symptom severity, despite using antipsychotics.
The patients received between two and 26 ECT sessions, and 18 received maintenance ECT for up to 12 years.
The researchers found that most of the patients (n=66, 84%) had "excellent" or "good" outcomes, defined as a resolution or significant reduction in prominent psychotic symptoms and a transfer from a secure ward to an open ward facility, or discharge, within 1-2 weeks.
Of the remaining patients, eight had moderate outcomes, defined as some reduction in psychotic symptoms but with continuing hospitalization, and five had poor outcomes, defined as experiencing? no treatment benefit.
The researchers did not identify any factors that predicted treatment response, however.
Kristensen and team conclude in the European Archives of Psychiatry and Clinical Neuroscience: "ECT proved to be effective in a population of patients that were severely ill with treatment-refractory schizophrenia. This does not imply that the patients were cured from schizophrenia. Rather, it reflects the degree of relief from psychosis and disruptive behavior."
They add: "Together with more recent controlled studies, our results raised the question of whether ECT has been underused in treatment-refractory patients with schizophrenia. This should be investigated in future randomized studies of ECT that include monitoring the effects of ECT on symptoms, quality of life, and side effects in long-term follow-ups."
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By Mark Cowen