From the Guidelines
Electroconvulsive therapy (ECT) can be a useful treatment option for patients with resistant psychosis, particularly when other treatments have failed, as it can provide rapid symptom relief and improve quality of life. According to the most recent and highest quality study available, which is from 2017 1, ECT is considered after trials of at least two different antipsychotic medications at adequate doses for sufficient duration have failed. The procedure involves applying brief electrical stimulation to the brain while the patient is under anesthesia, inducing a controlled seizure. For resistant psychosis, ECT is typically administered 2-3 times per week for 6-12 treatments, though some patients may require more sessions.
Key Considerations
- ECT works by altering neurotransmitter activity, particularly affecting dopamine, serotonin, and GABA systems, which are implicated in psychotic disorders.
- It can be particularly effective when psychosis is accompanied by catatonia, severe agitation, or high suicide risk.
- While ECT can provide rapid symptom relief, maintenance treatment with antipsychotic medication is typically still necessary after an ECT course.
- Side effects may include temporary memory problems, confusion, headache, and muscle pain, but serious complications are rare with modern ECT techniques.
- The treatment requires informed consent and is performed by a specialized team including a psychiatrist and anesthesiologist in a controlled medical setting.
Clinical Guidelines
The American Journal of Psychiatry study from 2017 1 emphasizes the importance of using operationalized criteria to define treatment-resistant schizophrenia, which can help improve the quality and reproducibility of research in this area. However, it is essential to note that these criteria are not intended to govern clinical practice, and clinicians should consider individual patient needs and circumstances when making treatment decisions.
Patient Selection
Patient selection for ECT should be based on a thorough evaluation of their medical history, current symptoms, and previous treatment responses. The study from 2001 1 highlights the importance of balancing the relative risks and benefits of ECT treatment against the morbidity of the disorder, the attitudes of the patient and family, and the availability of other treatment options.
Informed Consent
Obtaining informed consent from patients or their families is crucial before proceeding with ECT, as it involves a detailed discussion of the potential cognitive deficits and other risks associated with the treatment. The study from 2017 1 emphasizes the need for clear criteria and reporting standards to aid comparisons across studies and improve the design of future research.
From the Research
Efficacy of Electroconvulsive Therapy in Resistant Psychosis
- Electroconvulsive therapy (ECT) has been found to be effective in treating resistant psychosis, particularly when combined with clozapine 2, 3, 4, 5.
- Studies have shown that the combination of ECT and clozapine can lead to significant improvements in symptoms, including reductions in positive and negative symptoms 2, 4, 5.
- A meta-analysis found that ECT augmentation with clozapine was more effective than ECT augmentation with non-clozapine antipsychotics in reducing psychotic symptoms 5.
Safety and Tolerability
- The combination of ECT and clozapine has been found to be safe and well-tolerated, with no significant adverse effects reported 2, 4.
- However, the long-term impact of ECT on the course of schizophrenia is not fully understood, and further research is needed to determine its effectiveness and safety in the long term 2, 3.
Comparative Effectiveness
- A comparative meta-analysis found that clozapine plus ECT was more effective than non-clozapine antipsychotics plus ECT in treating treatment-resistant schizophrenia 5.
- The study found that clozapine maintained its stance as the most effective treatment for treatment-resistant schizophrenia, followed by flupenthixol 5.
Limitations and Future Research
- The evidence for the effectiveness of ECT in resistant psychosis is largely based on small-scale studies and meta-analyses, and further research is needed to fully establish its efficacy and safety 3, 6.
- Future studies should focus on the use of ECT as a synergistic therapy to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence 6.