Institutional members access full text with Ovid®

Share this article on:

What is “Effective Treatment” for a Schizophrenic Inpatient With Persistent Treatment-Resistant Psychosis and Severe Violent Behavior?: A Case of ECT

Isakov, Victoria MD; Tsvelikhovsky, Irena MD; Goldin, Vladimir MD; Silver, Henry MBBS, BMedSci, DPM, FRANZCP

doi: 10.1097/YCT.0b013e3182972ba6
Online Articles

Abstract: Aggressive behavior among treatment-resistant schizophrenic patients is a major clinical challenge whose prevalence is underestimated.

In our 420-bed psychiatric hospital, some 15% of patients exhibit active psychosis and high rates of verbal/physical aggression necessitating physical restraints. In addition to their condition, these individuals endanger staff and other patients, consume extensive resources, and induce a sense of clinical helplessness.

Physicians managing such complex patients face dilemmas regarding choice of treatment, criteria for treatment decisions, treatment goals, and outcome assessments. We address some of these by following the progress of a persistently psychotic severely aggressive treatment-resistant inpatient treated with repeated electroconvulsive therapy (ECT). The motivation for this report was our desire to examine whether there was objective evidence to support our clinically based treatment decisions.

To this end, we compiled a retrospective chronological life chart recording ECT administrations and aggression using case note information. Physical restraint was chosen as the outcome measure, as it was accurately documented. Because it was used only after all other means failed, a recorded incident represents an extreme peak of ongoing aggressive behavior.

From the Brain Behavior Laboratory, Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel and Sha’ar Menashe Mental Health Center, Hadera, Israel.

Received for publication February 7, 2013; accepted April 12, 2013.

Reprints: Victoria Isakov, MD, Department A-3, Sha’ar Menashe Mental Health Center, Mobile Post Hadera 37806, Israel (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

© 2013 by Lippincott Williams & Wilkins