CLINICAL HANDBOOK OF SCHIZOPHRENIA

20. Electroconvulsive Therapy 203(Chanpattana, Chakrabhand, Buppanharun, & Sackeim, 2000). Thus, a trend in researchwill be to find both the optimal ECT dosing strategy and electrode placement site to increaseefficacy and minimize adverse cognitive effects.TREATMENT GUIDELINESThe following treatment guidelines are adapted from the APA’s The Practice of ElectroconvulsiveTherapy (see References and Recommend Readings) and the second edition ofAPA Practice Guidelines for the Treatment of Patients with Schizophrenia (2004,www.psych.org).1. ECT should be considered in patients with persistent and severe psychosis, suicidalideation, and or behaviors for which prior treatments failed.2. ECT should be considered in patients whose catatonic features have not respondedto acute pharmacotherapy.3. ECT should be considered in patients with schizophrenia and comorbid depressivesymptomatology with treatment resistance.4. The number of ECT treatments to administer varies between a minimum of 12and a maximum of 20 treatments. If more than 20 treatments are to be administered,a new consent should be obtained from the patient.5. The comparative efficacies of unilateral and bilateral ECT have not been establishedin patients with schizophrenia; thus, either lead placement can be used.KEY POINTS• ECT is generally a safe and effective procedure in patients with schizophrenia. Immediatemedical side effects include headache and muscle ache, and occasionally temporary orlong-standing cognitive side effects.• Initial indications for ECT were catatonia and dementia praecox. Presently, the main psychiatricindications for ECT are affective disorders, including unipolar and bipolar disorder thatare severe, debilitating, and treatment resistant.• Before ECT is initiated, a comprehensive evaluation should include a patient’s medical andpsychiatric history, laboratory exams, as well previous and current treatment history. It is importantthat certain medications, such as anticonvulsants, not be used due to interferencewith seizure activity.• Safety and efficacy of the ECT procedure are increased by preparing the patient to receiveECT, using anesthesia, and monitoring body functions such as EEG, blood pressure, andmotoric movement.• The three main types of electrode placement include BT, which has the highest efficacy rateand the highest cognitive side effect profile; BF, which has a high efficacy rate and a mild-tomoderatecognitive side effect profile; and RUL, which, depending on the stimulus dosage,has a low-to-high efficacy rate and a mild-to-moderate cognitive side effect profile.• Predictors of a positive response to ECT in patients with schizophrenia include acuteschizophrenia onset, short duration of schizophrenia episode, and presence of delusions,hallucinations, or catatonic features.• Predictors of a negative response to ECT in patients with schizophrenia include long lengthof schizophrenic episode, prior treatment failure with neuroleptic pharmacotherapy, paranoidfeatures, and high negative symptom severity.