Convulsive therapy in schizophrenia?

Schizophrenia is a clinical syndrome of extraordinary importance and complexity. Its early identification is difficult, and our concepts of its main characteristics have undergone many changes in the past century. Electroconvulsive therapy (ECT) was introduced as a treatment for dementia praecox. The initial reports were salutary, and the treatment was widely applied until it was replaced by psychoactive drugs. ECT was reintroduced in the 1970s in the treatment of therapy-resistant disorders. The initial reviews argued that ECT was not applicable in patients with schizophrenia, a conclusion based mainly on experience with chronic forms of the disorder. This article assesses the role of ECT in schizophrenia today. We find it to be an effective treatment for psychosis. ECT is particularly applicable in patients with first-break episodes, especially those marked by excitement, overactivity, delusions, or delirium; in young patients, to avoid the debilitating effects of chronic illness; and in patients with syndromes characterized by catatonia, positive symptoms of psychosis, or schizoaffective features.