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Electroconvulsive Therapy in Treatment-Resistant Schizophrenia: Prediction of Response and the Nature of Symptomatic Improvement

Chanpattana, Worrawat MD*; Sackeim, Harold A. PhD†‡§

doi: 10.1097/YCT.0b013e3181cb5e0f
Original Studies

Background: The clinical features of patients with schizophrenia who respond to electroconvulsive therapy (ECT) are uncertain. There is a longstanding belief that the duration of illness and/or the presence of affective symptoms associate with good prognosis. There is also little information on the nature of symptomatic improvement with this treatment.

Objectives: We examined the demographic and clinical history features associated with response, the symptom profile predictive of response, and the profile of symptomatic improvement.

Method: Using a standardized protocol, 253 patients with treatment-resistant schizophrenia were prospectively treated with a combination of ECT and flupenthixol.

Results: Of this group, 138 patients (54.5%) met the response criteria. Independence of sex, longer duration of current episode, and greater severity of baseline negative symptoms were predictive of poorer outcome. Duration of illness had weak relations with outcome only among females. There were marked sex differences in other clinical features and symptoms associated with response. In contrast, no sex differences were observed in the nature of symptomatic improvement. Treatment resulted in marked improvement in specific positive symptoms, with an intermediate effect on affective symptoms and no effect or worsening of specific negative symptoms.

Conclusions: The findings challenge recommendations that long duration of illness or absence of affective symptoms portends poor response to ECT in patients with treatment-resistant schizophrenia. Sex may play a critical role in determining the features of the illness that predict outcome.

Abbreviations: BPRS, Brief Psychiatric Rating Scale; CPZE, chlorpromazine equivalents; ECG, electrocardiogram; EEG, electroencephalogram; GAF, Global Assessment of Functioning; MMSE, Mini-Mental State Examination

From the *Department of Psychiatry, Samitivej Srinakarin Hospital, Bangkok, Thailand; †Department of Biological Psychiatry, New York State Psychiatric Institute; and Departments of ‡Psychiatry, and §Radiology, College of Physicians and Surgeons of Columbia University, New York, NY.

Received for publication August 2, 2008; accepted October 9, 2009.

Reprints: Worrawat Chanpattana, MD, Department of Psychiatry, Samitivej Srinakarin Hospital, 488 Srinakarin Rd, Suanluang, Bangkok 10250, Thailand (e-mail:

Worrawat Chanpattana conducted this study while he was working at the Department of Psychiatry, Srinakharinwirot University, Bangkok, Thailand.

This study was partially supported by grants SWU 1112544 from Srinakharinwirot University and BRG 3980009 from the Thailand Research Fund, Office of the Prime Minister, Bangkok, Thailand.

© 2010 Lippincott Williams & Wilkins, Inc.