there is a high comorbidity of schizophrenia and obsessive - compulsory disorder ( ocd ) associated with more severe symptoms . we report about a 48-old women treated for depression which developed successively psychotic symptoms ( ideas of reference , psychotic worries ) , negative symptoms ( blunted affect , impoverished thinking , difficulties in planning ) , and obsessive - compulsive symptoms ( mainly repeating rituals , avoidance behaviour , collecting and hoarding ) . she did not respond to combined treatment with neuroleptics and high dose selective serotonin re - uptake inhibitors . she acutely improved during a course of electroconvulsive therapy ( ect ) and was maintained on outpatient ects fortnightly together with 12 mg sertindol and 45 mg mirtazapine for 42 weeks . maintenance ect is not an approved therapy in ocd but might be an option in pharmacotherapy refractory cases of comorbid ocd and schizophrenic / schizoaffective disorder . the frequency of obsessive and compulsive ( oc ) symptoms in patients with schizophrenia is ranging from 3.5% to 26% and is higher than in the general population of less than 3% . patients with comorbidity of schizophrenia and obsessive - compulsive disorder ( ocd ) were shown to have greater impairments in executive functions , vigilance , negative , and emotional discomfort symptoms than those patients without oc . first line strategies in the treatment of ocd with high - dose selective serotonin re - uptake inhibitors ( ssri ) , venlafaxine , or clomipramine , and congnitive behavioural therapy achieve symptom improvement in approximatly 60% only . up to date there are only a few single case reports about electroconvulsive therapy ( ect ) for comorbid ocd and schizophrenia . we report about a patient successfully treated with maintenance ect in comorbid ocd and unipolar schizoaffective disorder . the now 48-year old caucasian female nurse had been in psychotherapeutic treatment for several years . she was admitted to hospital for the first time at the age of 46 for a severe depressive episode treated with mirtazapine 45 mg . during the following weeks the patient developed psychotic symptoms as psychotic worries ( debasement of her personality ) , helplessness , and ideas of reference treated with 25 mg olanzapine , than 1400 mg quetiapine due to resistancy . later on compulsive symptoms occurred ( repeated checking ; picking up and collecting waste ) . both schizodepressive and compulsive symptoms were only partially remitting under treatment with fluvoxamine 150 mg and clozapine 400 mg at time of discharge . negative symptoms as difficulties in scheduling the day and deficits in concentration , attention , and comprehension were persisiting . she was able to live independently , but could not return to her occupation . over the following months the patient 's oc symptoms , mainly compulsions , were exacerbating and spreading . it included contamination obsessions ( confined to toilets ) , checking compulsions ( checking lockers and cooker several times , following other persons or cars ) , repeating rituals ( passing door- and stairways several times or in a ritualized way , touching items several times as door handles and handshaking ) , hoarding / collecting compulsions ( picking up things from the street including waste and dog excrements , and hoarding these items ) , and avoidance behaviour ( restricted to toilets ) . before readmission it used to take her up to 4 hours to leave the outpatients department or home [ y - bocs ( yale - brown obsessive compulsory scale ) score : 40 , cgi ( clinical global impression ) severity score : 4 ] . panss ( negative and negative syndrome scale ) showed a t - score and percentile equal to 99th percentile for negative syndromes , general psychopathology , and the cluster activation and depression and equal to 65th percentile for anergia . combinations of clozapine ( up to 1000 mg ) with amisulpride ( 400 mg ) , and antidepressants ( sertraline 200 mg ) for two months did not significantly improve oc and schizophrenic symptoms . after informed consent and discontinuation of all oral medication the patient underwent 10 unilateral ect treatments administered twice a week with no side effects . there was an immediate effect after the first to two sessions leading to the short - term complete remission of oc . maintenance ect was necessary because follow - up after one month showed reoccurrence of oc and schizophrenic symptoms ( ybocs score : 25 , cgi severity : 3 , improvement : 5 ; panss t - scores equal to 96th percentile for depression , and t - scores slightly above average for general psychopathology and activation ) . maintenance ect once in a fortnight in combination with 12 mg sertindol and 45 mg mirtazapine resulted in stable remission for 42 weeks ( y - bocs score : 6 , cgi severity : 1 ; panss t - scores for all items within the average range ) , which allowed her to live independently at home but did not enable her to re - enter her previous job or to start any other occupation due to passivity , affect blunting , and some problems in problem solving . there are only anecdotal reports of individual cases   and a few open trials with case series   with ect in pharmacotherapy refractory ocd showing a reduction of oc symptoms and a remission from one to 12 months . as for other indications and however , neither a placebo - controlled ( sham - controlled procedure ) nor pharmacotherapy - controlled trial is available for ect in ocd . ect has not received the approval of food and drug adinistration for the treatment of ocd . more published data are available for ect in schizophrenia   but scarcely for schizoaffective disorders . the evidence of a cochrane review suggested that ect is superior to placebo and medication alone in patients with drug - resistant schizophrenia especially when combined with antipsychotic drugs . however , this initial beneficial effect may not last beyond the short - term despite pharmacotherapy and maintenance ect therapy might be necessary . substantial improvement after ect in schizophrenia patients treated with clozapine persisted beyond 4 months in only 22.7% . it has been proposed that atypical antipsychotic drugs like risperdone and olanzapine are highly beneficial in augmentating the response to ssris for the treatment of ocd . however , it has also been anaecdotecally reported that atypical neuroleptics ( clozapine , olanzapine , riperidone ) , when given as monotherapy , have caused the symptoms of ocd to appear or to worsen . in retrospective studies the number of newly occurring ocd under treatment with clozapine was given with 2.4% - 21% and did emerge with other atypical antipsychotics ( olanzapine , risperidone ) in less than 2% . in the present case we can not rule out that the oc symptoms were induced and aggravated by atypical neuroleptics .