CLINICAL HANDBOOK OF SCHIZOPHRENIA

20. Electroconvulsive Therapy 197TABLE 20.1. Symptoms of Acute Exacerbation and Catatoniafor Which ECT Is RecommendedAcute exacerbation symptomsDelusionsHallucinationsDisorganized thoughtsDisorganized behaviorExcitement andOveractivityCatatonia symptomsMutismStuporWaxy flexibilityPosturingStereotypiesRigidityNote. From Keuneman, Weerasundera, and Castle (2002). Copyright 2002 byBlackwell Publishing. Adapted by permission.ECT is generally a safe procedure, with a documented mortality rate of 0.002% (i.e.,similar to patients receiving brief anesthesia). Two broad side effect categories for ECTinclude medical sequelae and cognitive impairments. Common medical side effects includehyper- or hypotension, tachy- or bradycardia, headache, muscle ache, and nausea(usually related to anesthesia). Less common side effects include myocardial infarctionand prolonged seizure activity (status epilepticus). The major cognitive impairments resultingfrom ECT include anterograde and retrograde amnesia. For many patients thesecognitive impairments are mild and transient; however, for some, the side effects may belong term.Indications for ECTMajor Depressive DisorderTREATMENTECT is indicated for major depressive disorder that is severe, chronic, and debilitating.The presence of psychotic or melancholic features is predictive of positive treatment outcome.ECT is also indicated when the depression is considered to be treatment resistant.Bipolar DisorderECT is indicated for the treatment of severe, acute mania, as well as the depressive episodein the context of bipolar disorder. ECT is also indicated when the bipolar depressionis determined to be treatment resistant.SchizophreniaECT is indicated for schizophrenia that has an acute onset and presence of hallucinationsor delusions, and that has been found to be nonresponsive to psychotropic medications.Schizoaffective DisorderECT is indicated for schizoaffective disorder that has an acute onset, presence of hallucinationsor delusions, and acute and severe mania, and that has been found to benonresponsive to psychotropic medications.