Tori Rodriguez, MA, LPC

June 06, 2017

Schizophrenia Treatment Can Benefit

From Electroconvulsive Therapy
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A current study investigated the effectiveness and cognitive effect of electroconvulsive

therapy in conjunction with pharmacotherapy.
A retrospective study reported in the Journal of Clinical Psychiatry
supports the effectiveness of electroconvulsive therapy (ECT) as an
adjunctive treatment for schizophrenia, and identifies characteristics
associated with treatment response.1
For the estimated 1% of the population who have schizophrenia,
antipsychotic medication is the first-line treatment. However,
nonresponse rates with first- and second-line antipsychotics are as
high as 25% and 83%, respectively.2 Although clozapine is
recommended for patients who have been unresponsive to 2 complete
trials of antipsychotics, there is no available guidance on treatment
options for the 25% of patients who also fail to respond to clozapine. 3

In addition, some patients are unable to take clozapine because of

adverse effects or the frequent blood monitoring required because of
the risk for severe neutropenia. A potential option for these patients is
ECT, which some findings have shown to be an effective adjustment
treatment for schizophrenia, including in patients who did not respond
to clozapine.4,5 Although such data support the technique's
effectiveness, research on the topic has various limitations, and
results are mixed regarding the cognitive effects of ECT.
The current study investigated the effectiveness and cognitive effect of
ECT in conjunction with pharmacotherapy, as well as clinical and
other characteristics that may be predictive of treatment response and
cognitive Impairment. The sample consisted of 144 patients with
schizophrenia or schizoaffective disorder, who had received a
combined 171 courses of ECT.
The results show a response rate of 76.7% with ECT, with the
following factors linked to a better response: absence of treatment
with antiepileptic medication (17.9% vs 3.9%; P =.007), a previous
good response to ECT (36.4% vs 15.4%; P =.017), and primary
indication for ECT referral other than failed pharmacotherapy (89.7%
vs 69.8%; P =.012). Age and treatment with clozapine and
benzodiazepine were not associated with response (P >.05). The
findings further reveal that transient cognitive impairment resulting
from ECT occurred in 9% of cases, and there were no factors
associated with this outcome.
These findings suggest that "ECT can be a clinically effective
treatment for patients with severe forms of schizophrenia," wrote
the study authors. "Future work should involve prospective trials,
incorporation of biological markers, and development of novel
stimulation technologies."

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References
1 Kaster TS, Daskalakis ZJ, Blumberger DM. Clinical effectiveness
and cognitive impact of electroconvulsive therapy for
schizophrenia: a large retrospective study. J Clin
Psychiatry. 2017;78(4):e383-e389. doi: 10.4088/JCP.16m10686
2 Agid O, Arenovich T, Sajeev G, et al. An algorithm-based
approach to first-episode schizophrenia: response rates
over 3 prospective antipsychotic trials with a retrospective
data analysis. J Clin Psychiatry. 2011;72(11):1439-1444. doi:
10.4088/JCP.09m05785yel
3 Lehman AF, Lieberman JA, Dixon LB, et al; American Psychiatric
Association; Steering Committee on Practice Guidelines.
Practice guideline for the treatment of patients with
schizophrenia, second edition. Am J Psychiatry. 2004;161(2
suppl):1-56.
4 Tharyan P, Adams CE. Electroconvulsive therapy for
schizophrenia. Cochrane Database Syst Rev.
2005;18(2):CD000076. doi: 10.1002/14651858.CD000076.pub2
Petrides G, Malur C, Braga RJ, et al. Electroconvulsive therapy
augmentation in clozapine-resistant schizophrenia: a
prospective, randomized study. Am J Psychiatry. 2015;172(1):52-
58. doi: 10.1176/appi.ajp.2014.13060787