Improvement of psychiatric symptoms after electroconvulsive therapy in young adults with intractable first-episode schizophrenia and schizophreniform disorder. ECT FOR SCHIZOPHRENIA The therapeutic efficacy of electroconvulsive therapy (ECT). A double blind controlled trial of ECT and simulated ECT. Effectiveness of electroconvulsive therapy in community settings Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis — A case–control study A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression. Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. The effects of electroconvulsive therapy on quantitative electroencephalograms. Relationship to clinical outcome. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. A pilot study of the comparative efficacy of 100 Hz magnetic seizure therapy and electroconvulsive therapy in persistent depression The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study. Effects of electroconvulsive therapy on amygdala function in major depression - a longitudinal functional magnetic resonance imaging study. Cognitive-Behavioral Therapy as Continuation Treatment to Sustain Response After Electroconvulsive Therapy in Depression: A Randomized Controlled Trial THE NORTHWICK PARK ELECTROCONVULSIVE THERAPY TRIAL Bilateral versus unilateral electroconvulsive therapy: efficacy in melancholia. Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects. Why do we prescribe ECT to schizophrenia patients?
Schizophrenia is a serious psychiatric disorder that develops mainly in young adults .  Electroconvulsive therapy ( ECT ) is known to be effective and safe in patients with schizophrenia with acute psychotic exacerbation . Because of the shortage of systematic studies , we conducted a prospect i ve naturalistic study to examine the short-term effects of acute ECT and its safety in young adults with medically intractable first-episode schizophrenia . Subjects were seven consecutive patients , 15 - 35 years of age , with first-episode schizophrenia or schizophreniform disorder ( Diagnostic and Statistical Manual of Mental Disorders , 4th edition ; DSM-IV ) , who had failed to respond to neuroleptics . The seven patients were treated with a first course of ECT , and their clinical symptoms were evaluated on the basis of the Brief Psychiatric Rating Scale ( BPRS ) ( 18 items , rated 0 - 6 ) and Global Assessment of Functioning ( GAF ) Scale . The GAF Scale is presented in DSM-IV as a means of assessing global functioning of a psychiatric patient . Scores range from 1 - 100 ; the higher GAF score indicates the higher global functioning . Adverse effects result ing from acute ECT were also evaluated . The total BPRS score 1 week after the final session improved significantly compared to the total pre-ECT BPRS score . The GAF score also improved significantly compared to the pre-ECT GAF score . There were no adverse effects during the acute ECT course , except for mild delirium . We conclude that ECT may be an effective and safe treatment option for young adults with intractable first-episode schizophrenia Electroconvulsive therapy ( ECT ) in the treatment of schizophrenia was evaluated in a double-blind trial ; the clinical change after ECT was compared with that after a treatment procedure identical to it but for two exceptions -- no electricity was used and no convulsion was induced . All patients had paranoid schizophrenia according to Present State Examination criteria and all received st and ard doses of neuroleptics for at least 2 weeks before r and om assignment to the two groups . 20 patients completed the trial : 10 had ECT and 10 were in the control group .  Treatment was given three times a week , with a minimum of eight treatments and a maximum of twelve . Clinical change was assessed by the Comprehensive Psychiatric Rating Scale . Both groups improved but the improvement of patients receiving ECT was significantly greater than that of controls both after six treatments ( p=0.02 ) and at the end of treatment ( p=0.004 ) . Thus the group receiving ECT gained a clear and early advantage compared with the control group , although by 16 weeks there was little difference between the two groups . Possible reasons for this are discussed A double-blind controlled trial of ECT versus simulated ECT is described . The results show that real ECT is significantly superior to simulated ECT in the treatment of depressive illness BACKGROUND Clinical trials indicate that electroconvulsive therapy ( ECT ) is the most effective treatment for major depression , but its effectiveness in community setting s has not been examined . METHODS In a prospect i ve , naturalistic study involving 347 patients at seven hospitals , clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables . RESULTS The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes . In contrast to the 70%-90 % remission rates expected with ECT , remission rates , depending on criteria , were 30.3%-46.7 % . Longer episode duration , comorbid personality disorder , and schizoaffective disorder were associated with poorer outcome . Among remitters , the relapse rate during follow-up was 64.3 % . Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders . Only 23.4 % of ECT nonremitters had sustained remission during follow-up . CONCLUSIONS The remission rate with ECT in community setting s is substantially less than that in clinical trials . Providers frequently end the ECT course with the view that patients have benefited fully , yet formal assessment shows significant residual symptoms . Patients who do not remit with ECT have a poor prognosis ; this underscores the need to achieve maximal improvement with this modality OBJECTIVE Previous studies have demonstrated the effectiveness of electroconvulsive therapy ( ECT ) in pharmacotherapy-resistant neuropsychiatric conditions . This study aim ed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis . METHOD This case-control study was conducted in in patients aged 13 - 20 years with first-episode psychosis . Every three similar age and same gender patients consecutively recruited were r and omly allocated to control and ECT group at a ratio of 1:2 , while they had antipsychotic treatment . ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions . The endpoint was discharge from hospital . Clinical outcomes were measured using hospital stay days , the Positive and Negative Syndrome Scale ( PANSS ) and response rate . Polysomnography ( PSG ) was conducted at baseline and at week 2 . Safety and tolerability were also evaluated . RESULTS Between March 2004 and November 2009 , 112 eligible patients were allocated to control ( n=38 ) and ECT ( n=74 ) group .  Additional ECT treatment significantly reduced hospital stay compared to controls ( 23.2±8.2 days versus 27.3±9.3 days , mean±SD , P=0.018 ) . Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls ( 74.3 % versus 50 % , relative risk (RR)=1.961 , P=0.001 ) . Additional ECT also produced significantly greater improvement in sleep efficiency , rapid eye movement ( REM ) latency and density than control condition . The PSG improvement significantly correlated with reduction in scores on overall PANSS , positive symptoms , and general psychopathology . No patients discontinued ECT treatment regimen during hospital stay . The incidence of most adverse events was not different in the two groups , but ECT-treated group had more complaints of transient headache and dizziness than controls . CONCLUSIONS ECT is an effective and safe intervention used in adolescents with first-episode psychosis . Its antipsychotic effects are associated with improved PSG variables . ECT can be considered as an early psychosis intervention OBJECTIVE Repetitive transcranial magnetic stimulation ( rTMS ) has been reported to be as effective as electroconvulsive therapy ( ECT ) for major depression . The authors conducted a multicenter r and omized , controlled trial to test the equivalence of rTMS with ECT . METHOD Forty-six patients with major depression referred for ECT  were r and omly assigned to either a 15-day course of rTMS of the left dorsolateral prefrontal cortex ( N=24 ) or a st and ard course of ECT ( N=22 ) . The primary outcome measures were the score on the 17-item Hamilton Depression Rating Scale ( HAM-D ) and the proportion of patients with remissions ( Hamilton score , < or=8 ) at the end of treatment . Secondary outcomes included mood self-ratings on the Beck Depression Inventory-II and visual analogue mood scales , Brief Psychiatric Rating Scale ( BPRS ) score , and both self-reported and observer-rated cognitive changes . The patients were followed up after 6 months . RESULTS HAM-D scores at the end of treatment were significantly lower for ECT , with 13 patients ( 59.1 % ) achieving remission in the ECT group and four ( 16.7 % ) in the rTMS group . However , at 6 months the HAM-D scores did not differ between groups . Beck scale , visual analogue mood scale , and BPRS scores were lower for ECT at the end of treatment and remained lower after 6 months . Self- and observer-rated cognitive measures were similar in the two groups . CONCLUSIONS rTMS was not as effective as ECT , and ECT was substantially more effective for the short-term treatment of depression Major depression is a common mental health problem and associated with significant morbidity and mortality , including impaired social and physical functioning and increased risk for suicide . Electroconvulsive therapy ( ECT ) is highly efficacious in treatment-resistant depressive disorders , but cognitive side effects are frequently associated with the treatment . Magnetic seizure therapy ( MST ) is a form of convulsive therapy , using magnetic fields in order to induce therapeutic seizures . First studies suggested that cognitive side effects of MST , including postictal recovery time , are more benign than those result ing from ECT treatment . In this open-label study we tested the hypothesis that MST is associated with clinical ly significant antidepressant effects in treatment-resistant depression ( TRD ) as an add-on therapy to a controlled pharmacotherapy . Twenty patients suffering from TRD were r and omly assigned to receive either MST or ECT  starting from July 2006 until November 2008 . Primary outcome measure was antidepressant response assessed by Montgomery Åsberg Depression Scale . Secondary outcome measures included Hamilton Depression Rating Scale , Hamilton Anxiety Scale , Beck Depression Inventory and 90-Item Symptom Checklist . Antidepressant response ( improvement of 50 % in MADRS ratings ) was statistically significant and of similar size in both treatment groups . Cognitive side effects were observed in neither group . Characteristics in MST- and ECT-induced seizures were comparable , especially regarding ictal activity and postictal suppression . Thus , MST may be a potential alternative to ECT if efficacy and safety are vali date d in larger clinical trials BACKGROUND The efficacy of electroconvulsive therapy ( ECT ) is determined by stimulus electrical intensity and electrode placement . Three theories offer different accounts for why increasing the stimulus dosage of right unilateral ECT enhances antidepressant effects . This study examined the effects of ECT on interictal quantitative electroencephalograms ( EEGs ) , contrasting these theories in their predictions regarding global , lateralized , and topographic changes in ECT-induced slow-wave activity . The time course of EEG changes and associations with efficacy were also determined . METHODS Sixty-two in patients with major depressive disorder were r and omized to ECT conditions that differed in stimulus intensity  ( low vs high dosage ) and electrode placement  ( right unilateral vs bilateral ) . Resting , eyes closed , 19-lead EEG recordings were obtained at pretreatment , following a single treatment , following an average of 7 treatments , during the week following the ECT course , and after a 2-month follow-up period . RESULTS Electroconvulsive therapy produced a marked short-term increase in delta and theta power . At a 2-month follow-up , there were no significant alterations in any frequency b and . The ECT treatment conditions differed markedly in efficacy . Global and lateralized EEG effects did not distinguish effective and ineffective forms of treatment . Effective forms of ECT result ed in increased delta power in prefrontal regions , and this change was associated with the magnitude of symptomatic improvement . CONCLUSION The induction of slow-wave activity in prefrontal cortex is linked to the efficacy of ECT CONTEXT Medication resistance is the leading indication for use of electroconvulsive therapy ( ECT ) in major depression . The practice of stopping antidepressant medications prior to ECT derived from studies in the 1960s and 1970s in nonresistant sample s. There is also continuing controversy regarding the relative efficacy and adverse effects of right unilateral and bilateral ECT . OBJECTIVE To test the hypotheses that , compared with placebo , concomitant treatment with nortriptline or venlafaxine during the ECT course enhances short-term efficacy without a meaningful effect on adverse effects and reduces the rate of post-ECT relapse , and to test the hypotheses that high-dose , right-sided , unilateral ECT is equivalent in efficacy to moderate-dosage bilateral ECT and retains advantages with respect to cognitive adverse effects . DESIGN Prospect i ve , r and omized , triple-masked , placebo-controlled study conducted from 2001 through 2005 . SETTING Three university-based hospitals . PATIENTS Of approximately 750 consecutive patients referred for ECT , 319 with a major depressive episode consented , were r and omized to pharmacological or ECT treatment conditions , and received at least 1 ECT treatment . MAIN OUTCOME MEASURES Scores on the Hamilton Rating Scale for Depression , remission rate following completion of ECT , and selective measures of cognitive adverse effects . RESULTS Treatment with nortriptyline enhanced the efficacy and reduced the cognitive adverse effects of ECT relative to placebo . Venlafaxine result ed in a weaker degree of improvement and tended to worsen cognitive adverse effects . High-dosage right unilateral ECT did not differ or was superior to bilateral ECT in efficacy and result ed in less severe amnesia . CONCLUSIONS The efficacy of ECT is substantially increased by the addition of an antidepressant medication , but such medications may differ in whether they reduce or increase cognitive adverse effects . High-dose , right-sided , unilateral ECT is at least equivalent to moderate-dosage bilateral ECT in efficacy , but retains advantages with respect to cognitive adverse effects BACKGROUND Magnetic seizure therapy ( MST ) is a novel brain stimulation technique that uses a high-powered transcranial magnetic stimulation device to produce therapeutic seizures . Preliminary MST studies have found antidepressant effects in the absence of cognitive side effects but its efficacy compared to electroconvulsive therapy ( ECT ) remains unclear . The aim of this study was to investigate the therapeutic efficacy and cognitive profile of MST compared to st and ard right unilateral ECT treatment . METHODS Thirty-seven patients completed a course of at least nine ECT or MST treatments in a r and omized double-blind protocol . Assessment s of depression severity and cognition were performed before and after treatment . RESULTS No difference in the antidepressant effectiveness between the treatments was seen across any of the clinical outcome measures , although the overall response rates in both groups were quite low . In regards to cognition , following MST there were significant improvements in tests of psychomotor speed , verbal memory , and cognitive inhibition , with no reductions in cognitive performance . Following ECT there was significant improvement in only one of the cognitive inhibition tasks . With respect to the between-group comparisons , the MST group showed a significantly greater improvement on psychomotor speed than ECT . CONCLUSIONS MST showed similar efficacy to right unilateral ECT in patients with treatment-resistant depression without cognitive side effects but in a sample that was only of sufficient size to demonstrate relatively large differences in response between the two groups . Future research should aim to optimize the methods of MST administration and compare its efficacy to ECT in large r and omized controlled trials The efficacy of ECT was investigated in a double-blind trial . Twenty-two patients with schizophrenia received trifluoperazine and were r and omly allocated to receive eight real or eight simulated ECTs . In the first eight weeks , the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale . However , the groups showed no significant differences from the twelfth week onwards . The superiority of real ECT was not confirmed at the end of six months BACKGROUND Electroconvulsive therapy ( ECT ) is one of the most effective treatments for severe depression . However , little is known regarding brain functional processes mediating ECT effects . METHOD In a non-r and omized prospect i ve study , functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice , about 6 weeks apart , in patients with major depressive disorder ( MDD ) before and after treatment with ECT ( ECT , n = 24 ) . Additionally , a control sample of MDD patients treated solely with pharmacotherapy ( MED , n = 23 ) and a healthy control sample ( HC , n = 22 ) were obtained . RESULTS Before therapy , both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC . After treatment , a decrease in amygdala activity to negative stimuli was discerned in both patient sample s indicating a normalization of amygdala function , suggesting mechanisms potentially unspecific for ECT . Moreover , a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample ( r spearman = -0.48 , p = 0.044 ) , and by tendency also for the MED sample ( r spearman = -0.38 , p = 0.098 ) . However , we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement , neither for the ECT sample , nor for the MED sample . CONCLUSIONS In sum , the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design , thus validating and extending our knowledge gained from previous treatment studies . A limitation was that ECT patients received concurrent medication treatment BACKGROUND Although electroconvulsive therapy ( ECT ) is the most effective acute antidepressant intervention , sustained response rates are low . It has never been systematic ally assessed whether psychotherapy , continuation ECT , or antidepressant medication is the most efficacious intervention to maintain initial treatment response . METHODS In a prospect i ve , r and omized clinical trial , 90 in patients with major depressive disorder ( MDD ) were treated with right unilateral ultra-brief acute ECT . Electroconvulsive therapy responders received 6 months guideline -based antidepressant medication ( MED ) and were r and omly assigned to add-on therapy with cognitive-behavioral group therapy ( CBT-arm ) , add-on therapy with ultra-brief pulse continuation electroconvulsive therapy ( ECT-arm ) , or no add-on therapy ( MED-arm ) . After the 6 months of continuation treatment , patients were followed-up for another 6 months . The primary outcome parameter was the proportion of patients who remained well after 12 months . RESULTS Of 90 MDD patients starting the acute phase , 70 % responded and 47 % remitted to acute ECT . After 6 months of continuation treatment , significant differences were observed in the three treatment arms with sustained response rates of 77 % in the CBT-arm , 40 % in the ECT-arm , and 44 % in the MED-arm . After 12 months , these differences remained stable with sustained response rates of 65 % in the CBT-arm , 28 % in the ECT-arm , and 33 % in the MED-arm . CONCLUSIONS These results suggest that ultra-brief pulse ECT as a continuation treatment correlates with low sustained response rates . However , the main finding implicates cognitive-behavioral group therapy in combination with antidepressants might be an effective continuation treatment to sustain response after successful ECT in MDD patients 70 patients with endogenous depression , defined by strict criteria , who fulfilled the Newcastle indications for electroconvulsive therapy ( ECT )  were r and omly allocated either to a course of eight simulated ECTs or to a course of eight real ECTs . The improvement in terms of psychiatrists ' ratings in the group of patients given real ECT was significantly greater ( p < 0.01 ) than that in those given simulated ECT , but the difference between the two groups was small in relation to the considerable improvement of both groups over the 4-week treatment period . No differences were found between the two groups at one-month and six-month follow-up . The therapeutic benefits of electrically induced convulsions in depression were of lesser magnitude and were more transient than has sometimes been cl aim ed . In the real-ECT group memory was impaired during treatment but memory tests revealed no difference between the groups at six-month follow-up The authors compared the therapeutic efficacy of bilateral and unilateral electroconvulsive therapy ( ECT ) in 51 patients with endogenous depression who were r and omly assigned to bilateral ( N = 24 ) or unilateral ( N = 27 ) ECT .  Seizures were monitored by oscilloscope . After 6 treatments blind assessment on a modified Hamilton depression scale showed an 81.1 % improvement in the bilateral group compared with a 55.5 % improvement in the unilateral group . Additional treatments were prescribed ad libitum by a hospital psychiatrist who was unaware of each patient 's electrode placement . The unilateral group received more total treatments and were more frequently switched to bilateral ECT . These results were independent of age , severity of illness , or sedative drug administration OBJECTIVE The cognitive side-effects of bifrontal ( BF ) and right unilateral ( UL ) ultra-brief pulse ( 0.3 ms ) electroconvulsive therapy ( ECT ) were compared , in the treatment of patients with a depressive episode . METHOD Neuropsychological functioning in patients with a medication refractory depressive episode , that were treated with a course of BF ultra-brief ECT at 1.5 times seizure threshold ( ST ) or UL ultra-brief ECT at 6 times ST , by r and om assignment , was assessed before treatment , and 1 and 6 weeks after the treatment course , by a blinded rater . RESULTS Of the 64 patients that were included , 32 ( 50 % ) received BF ECT , and 32 ( 50 % ) received UL ECT , by r and om assignment . Neuropsychological testing 1 and 6 weeks after treatment was performed by 30 ( 93.75 % ) and 19 ( 59.37 % ) patients , respectively , in the BF-group and 29 ( 90.62 % ) and 20 ( 62.50 % ) , respectively , in the UL-group . There was no deterioration in any of the neuropsychological measures . Patients rated their memory as clearly improved after treatment . There were no significant differences between the patients given BF ECT and those given UL ECT . CONCLUSIONS Ultrabrief pulse ECT , used either in combination with a UL electrode position and a stimulus of 6 times ST , or a BF electrode position with a stimulus of 1.5 times ST , are effective antidepressant techniques , that do not have a deleterious effect on cognitive function Electroconvulsive therapy ( ECT ) is prescribed for schizophrenia patients for various indications , in our country . However , official guidelines in other countries have been cautious in prescribing ECT for schizophrenia . To study the indications for which patients with schizophrenia receive ECT . We studied records of schizophrenia in patients receiving ECT in one year ( 2005 ) ( n=101 ) retrospectively , as well as the consecutive data of patients between May 2007 and June 2008 ( n=101 ) prospect ively . The various indications for ECT in schizophrenia were studied by frequency analysis . Of the 202 schizophrenia patients who received ECT  , the most common reason was ‘ to augment pharmacotherapy ’ in ( n=116 ) cases . The target symptoms for which ECT was prescribed the most was catatonia ( n=72 ) . The mean number of ECTs ( SD ) received was 8.4 ( 2.8 ) . Augmentation of pharmacotherapy was the most common indication of ECT in patients with schizophrenia
RESULTS The most common indication for using ECT for schizophrenia patients was to augment pharmacotherapy , while the most common accompanying symptoms were , in order , catatonia , aggression and suicide .
Catatonic patients responded significantly better to ECT than patients with any other subtype of schizophrenia .
The combination of ECT with pharmacotherapy can be useful for drug-resistant patients .
The use of an ECT-risperidone combination or ECT-clozapine combination in patients non-responsive to prior pharmacotherapy was found to be most effective .
This review indicates that ECT , combined with pharmacotherapy , may be a viable option for a selected group of patients with schizophrenia .
In particular , the use of ECT is recommended for drug-resistant patients , for schizophrenic patients with catatonia , aggression or suicidal behavior  , and when rapid global improvement and reduction of acute symptomatology are required
BACKGROUND Electroconvulsive therapy ( ECT ) is a medical treatment that is most effective for mood disorders ( Bipolar Disorder and Major Depression ) .
It has also been shown to be an effective treatment for schizophrenia accompanied by catatonia , extreme depression , mania and other affective components .
ECT is currently under-used in many psychiatric setting s due to its stigmatized perception by patients and mental health professionals .
However , many unanswered questions remain regarding its role in the management of patients with schizophrenia .
AIM Evaluate the main indications of ECT in subjects suffering from schizophrenia .
OBJECTIVES Investigate the efficacy and the main indications of  ECT in the treatment of schizophrenic patients , evaluate its effects in the short-term and the long-term , compare ECT treatment with pharmacotherapy , and assess the effects of treatment with ECT .