ECT for treatment-resistant schizophrenia: A response from the far east to the UK. NICE report

Background: There is controversy about the proper place of electroconvulsive therapy (ECT) in the management of the schizophrenic patient, and the important issues related to theory and practice remain to be resolved, especially in the context of medication-resistant schizophrenia. Method: We briefly summarize existing research in the field. We next use a narrative method to describe in a single article the large body of research from Thailand that, during the past decade, has systematically studied issues related to the use of ECT in medication-resistant schizophrenia. We integrate the findings of the Thai efforts with the results of other research and consider the theoretical and practical importance of the reviewed work. Results: The ECT treatment data validate a BRPS cutoff of 25 as a definition of recovery in patients with treatment-refractory schizophrenia, and a cutoff of 37 as a definition of subsequent relapse or suitability for entry into a treatment protocol. A 3-week post-ECT stabilization period identifies patients who maintain improvement and who can be legitimately considered to have sustained response to ECT. Clinical characteristics of such responders and symptoms responsive to ECT are described. Higher stimulus dose hastens response to ECT but does not improve responsiveness. Continuation ECT (C-ECT) combined with maintenance-neuroleptic medication is associated with better treatment outcome than either treatment alone. The combined treatment also improves quality of life and functioning in the long-term. Conclusions: These findings convey several useful thoughts for research into and the practice of ECT for schizophrenia.