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Transient Insight Induction With Electroconvulsive Therapy in a Patient With Refractory Schizophrenia: A Case Report and Systematic Literature Review

Gerretsen, Philip MD, MSW*†; Diaz, Pablo MD, FRCPC†‡; Mamo, David MD, MSc, FRCPC*†§; Kavanagh, Doug BSEng; Menon, Mahesh PhD*‡; Pollock, Bruce G. MD, PhD, FRCPC†§∥; Graff-Guerrero, Ariel MD, PhD*†‡

doi: 10.1097/YCT.0b013e3181f816f6
Case Reports

Anosognosia or lack of illness awareness is a clinical manifestation of both schizophrenia and right hemispheric lesions associated with stroke, neurodegeneration, or traumatic brain injury. It is thought to result from right hemispheric dysfunction or interhemispheric disequilibrium, which provides a neuroanatomical model for illness unawareness in schizophrenia. Lack of insight contributes to medication nonadherence and poor treatment outcomes and is often refractory to pharmacological and psychological interventions. We present the first report of transient illness awareness (<8 hours) after individual bilateral electroconvulsive therapy treatments in the case of a 39-year-old man with antipsychotic refractory schizophrenia. Electroencephalography demonstrated frontal slow wave activity with shifting frontotemporal predominance, which was concurrent with the patient's transient level of insight. A systematic review of the literature on electroconvulsive therapy-induced illness awareness in schizophrenia and psychotic disorders produced zero relevant results. Future research should focus on the prospective role of focal interventions, such as transcranial magnetic stimulation, in the development of a neurophysiological model for anosognosia reversal in schizophrenia that may, in turn, contribute to novel therapeutic developments targeting lack of illness awareness.

From the *Multimodal Imaging Group, Centre for Addiction and Mental Health; †Department of Psychiatry, University of Toronto; ‡Schizophrenia Program and §Geriatric Mental Health Program, Centre for Addiction and Mental Health; and ∥Rotman Research Institute, Toronto, Ontario, Canada.

Received for publication July 30, 2010; accepted August 11, 2010.

Reprints: Ariel Graff-Guerrero, MD, PhD, CAMH PET Centre, 250 College St, M5T 1R8, Toronto, Ontario, Canada (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.