title: Indications for electroconvulsive treatment in schizophrenia: a systematic review.
abstract: 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 settings 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.
  
  
  OBJECTIVE
  Evaluate the main indications of ECT in subjects suffering from schizophrenia.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  A systematic review of the literature was conducted on the use of ECT for schizophrenia. Thirty one articles from peer-reviewed journals were identified, and the most relevant articles were selected for this review.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy. maurizio.pompili@uniroma1.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.forename: David
authors.initials: D
authors.lastname: Lester
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dominici
authors.forename: Lucia
authors.initials: L
authors.lastname: Longo
authors.forename: Giulia
authors.initials: G
authors.lastname: Marconi
authors.forename: Alberto
authors.initials: A
authors.lastname: Forte
authors.forename: Gianluca
authors.initials: G
authors.lastname: Serafini
authors.forename: Mario
authors.initials: M
authors.lastname: Amore
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D012559:Schizophrenia / Q000628:therapy*; D016896:Treatment Outcome