1.

1 Efektifitas TEK
Pada skizofrenia, penggunaan kombinasi TEK dengan obat antipsikotik untuk pasien yang
mempunyai respon yang baik terhadap TEK adalah lebih unggul untuk pengobatan lanjutan
daripada monoterapi hanya dengan obat antipsikotik atau dengan TEK saja dalam mencegah
kambuh. Pasien dengan gambaran prognosis yang lebih baik membutuhkan frekuensi TEK
pemeliharaan yang lebih sedikit. TEK pada fase akut dan pemeliharaan yang dikombinasikan
dengan obat antipsikotik, efektif dalam meningkatkan fungsi sosial dan kualitas hidup pada
pasien dengan Treatment Resistant Schizophrenia (TRS) yang memiliki riwayat respon yang
baik
terhadap TEK (Chanpattana, 2007).
Chanpattana, Worrawat, 2007, ‘Electroconvulsive Therapy for Schizophrenia’, Current
Psychiatry Reviews, vol. 3, no. 1. pp.: 15-24, journal article.

More importantly, the findings of the present study indicated that the combination of clozapine
and ECT was effective in patients with TRS who did not respond to several antipsychotics. 63%
of patients responded to the combined treatment. Patients who do not respond to two adequate
trials of non- clozapine antipsychotics should be treated with clozapine without delay.
Additionally, if patients do not respond to an adequate trial of clozapine, the addition of ECT
may prove useful as an option for augmentation of clozapine non-response.
Grover S, Chakrabarti S, Hazari N, Avasthi A. Effectiveness of electroconvulsive therapy in patients with
treatment resistant schizophrenia: A retrospective study. Psychiatry Research. 2017;249:349-353.

American Psychiatric Association menyatakan dalam guideline tahun 2001, bahwa ECT efektif pada
gangguan psikotik yang berkaitan dengan skizofrenia. ECT efektif untuk psikotik yang mengalami : (1)
eksaserbasi pada penderita skizofrenia, (2) terjadi skizofrenia tipe katatonik, (3) saat gejala psikotiknya
mendadak/onsetnya baru, (3) bila memiliki riwayat berespon baik terhadap terapi ECT

The American Psychiatric Association states in their guidelinefrom 2001, that ECT is effective for
psychotic exacerbations in schizophrenic patients, when the illness is of the catatonic type, when the
psychotic symptoms were abrupt or recent in onset, or when there is a past history of favorable response
to ECT and ‘ECT is effective for psychotic disorders related to schizophrenia’ American Psychiatric
Association, (2001) The Practise of ECT: Recommendations for Treatment, Training and
Privileging (2nd edn), American Psychiatric Press

Tinjauan Cochrane dari tahun 2005 yang berfokus pada ECT dan Skizofrenia, meliputi literatur dari tahun
1934 sampai 2005 dan termasuk 26 percobaan (n = 800), menyimpulkan 'bukti dalam hal ini review
menunjukkan bahwa ECT, dikombinasikan dengan antipsikotik mungkin menjadi pilihan bagi penderita
skizofrenia khususnya. Saat perbaikan global yang cepat dan pengurangan gejala diinginkan Ini juga
berlaku untuk pasien dengan refrakter pengobatan
A Cochrane review from 2005 focusing on ECT and Schizophrenia,
covering the literature from 1934 to 2005 and
including 26 trials (n = 800), concludes ‘the evidence in this
review suggests that ECT, combined with antipsychotics may
be an option for the schizophrenic patients, particularly
when rapid global improvement and reduction of symptoms
is desired. This also goes for the treatment-refractory patients’

Tharyan, P. and Adams, C.E. (2005) Electroconvulsive therapy for schizophrenia. Cochrane
Database Syst Rev CD000076

A meta-analysis from India found that ECT-antipsychotic

combinations might be better than either ECT or antipsychotic
drugs used alone in the first few weeks of treatment of
schizophrenia; the main benefit seemed to be an acceleration
of treatment response [17].
Painuly, N. and Chakrabarti, S. (2006) Combined use of electroconvulsive therapy and
antipsychotics in schizophrenia: the Indian evidence. A review and a meta-analysis. J ECT 22,
59–66
Another study from Turkey, including 90 first-episode schizophrenia patients where 13
received ECT treatment found
In conclusion, the effect did not last during the 1-year follow-up.
Ucok, A. and Cakr, S. (2006) Electroconvulsive therapy in first-episode schizophrenia. J ECT
22, 38–42

In a review of the
ECT experience in a large Dutch teaching hospital, van
Waarde et al. [19] identified 27 catatonia patients among
the 285 ECT-treated patients for an 18-year period. Pharmacotherapy
had failed in 85% of the patients and with ECT,
59% improved. Daily ECT was essential to the recovery of the
patients with malignant catatonia, those with severe autonomic
dysregulation and highest fever

Van Waarde, J.A. et al. (2010) Electroconvulsive therapy for catatonia:

treatment characteristics and outcomes in 27 patients. J ECT 26, 248–252

It has been the opinion that ECT does not work very well for
patients with treatment-refractory schizophrenia [4]. However,
many studies and chart reviews show that ECT treatment
might be especially effective in the treatment-refractory group of schizophrenia patients. One of
the largest prospective,
clinical trials comes from Thailand, and included 253 treatment-
resistant schizophrenic patients. All patients scored >37
in BPRS at baseline. 54.6% responded to ECT treatment [13,20].
The retrospective chart review by Kristensen et al. examined
the use of ECT in 79 treatment-refractory patients, and
found that 66/79 patients, with an average duration of
untreated psychosis of 4–5 months, showed excellent or good
treatment response, after an average of 9–10 ECT treatment
sessions. Only five patients were non-responders. No specific
predictors for outcome could be identified [

 Kristensen D, Jorgensen M. Treatment of schizophrenia with electroconvulsive therapy.

Drug Discovery Today: Therapeutic Strategies. 2011;8(1-2):53-56.

 Chanpattana, W. and Sackeim, H.A. (2010) Electroconvulsive therapy in treatment-

resistant schizophrenia: prediction of response and the nature of symptomatic
improvement. J ECT 26, 289–298
ECT telah digunakan untuk pengobatan skizofrenia lebih banyakdari 70 tahun Dokumentasi
yang solid untuk kemanjurannya ada. inidirekomendasikan dalam kebanyakan pedoman.
Penggunaannya terbatas, terutamakarena dirasakan risiko efek samping kognitif dan sangatcitra
publik negatif Pemilihan pasien yang tepat adalah penting untuk respon pengobatan yang
berhasil. Luas penelitian telah menunjukkan prediktor yang berbeda untuk yang positif respon
pengobatan Sebagian besar bukti divergen. Namun;durasi penyakit dan durasi psikosis yang
tidak diobati Sepertinya tidak menjadi faktor pembatas. Sebaliknya, untuk apilih kelompok
dengan skizofrenia resisten pengobatan, ECT tampaknya efektif dalam mengobati gejala inti
skizofrenia. Karena itu, terlepas dari kronisitasnya, penderita skizofrenia pasien yang sudah
kehabisan alternatif farmakologis layak mendapatkan kursus ECT.

ECT has been used for treatment of schizophrenia for more

than 70 years. Solid documentation for its efficacy exists. It is
recommended in most guidelines. The use is limited, mainly
due to the perceived risk of cognitive side effects and a very
negative public image. Selection of the appropriate patient is
essential for the successful treatment response. Extensive
research has pointed to different predictors for a positive
treatment response. Much of the evidence is divergent. However;
duration of disease and duration of untreated psychosis
do not seem to be the limiting factors. On the contrary, for a
select group with treatment-resistant schizophrenia, ECT
seems to be is effective in treating the core symptoms of
schizophrenia. Therefore, regardless of chronicity, schizophrenic
patients who have exhausted pharmacological alternatives
deserve a course of ECT.