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    ECT in Schizophrenia Need For Reappraisal

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    This article discusses the use of electroconvulsive therapy (ECT) in treating schizophrenia. While its use has declined in Western countries, ECT is still used more liberally in India. The authors argue that ECT, when used in combination with neuroleptics, can effectively reduce symptoms and improve functioning in schizophrenic patients. They call for a reappraisal of ECT and more positive attitudes towards its use among physicians.

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    ECT in Schizophrenia Need For Reappraisal

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    anettewill
    27 views3 pages
    This article discusses the use of electroconvulsive therapy (ECT) in treating schizophrenia. While its use has declined in Western countries, ECT is still used more liberally in India. The authors argue that ECT, when used in combination with neuroleptics, can effectively reduce symptoms and improve functioning in schizophrenic patients. They call for a reappraisal of ECT and more positive attitudes towards its use among physicians.

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    ECT in Schizophrenia Need for Reappraisal

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    ECT in Schizophrenia Need for Reappraisal

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    This article discusses the use of electroconvulsive therapy (ECT) in treating schizophrenia. While its use has declined in Western countries, ECT is still used more liberally in India. The authors argue that ECT, when used in combination with neuroleptics, can effectively reduce symptoms and improve functioning in schizophrenic patients. They call for a reappraisal of ECT and more positive attitudes towards its use among physicians.

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    ECT in Schizophrenia Need For Reappraisal

    Uploaded by

    anettewill
    This article discusses the use of electroconvulsive therapy (ECT) in treating schizophrenia. While its use has declined in Western countries, ECT is still used more liberally in India. The authors argue that ECT, when used in combination with neuroleptics, can effectively reduce symptoms and improve functioning in schizophrenic patients. They call for a reappraisal of ECT and more positive attitudes towards its use among physicians.

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    ECT in schizophrenia: need for reappraisal?

    P J Saju and K S Jacob


    BJP 1993, 162:573-574.
    Access the most recent version at DOI: 10.1192/bjp.162.4.573

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    http://bjp.rcpsych.org/ on July 27, 2014
    Published by The Royal College of Psychiatrists

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    573

    CORRESPONDENCE

    ECT in 1991 were examined. There were 51 women


    and 22 men. The average age was 63.3 years. ECT

    was given according to the recognised advice in the


    UK (Royal College ofPsychiatrists, 1989). A total of
    646 applications of ECT were given (an average of
    8.85 per course). Following stimulation, 295 fits
    lasting longer than 25 seconds occurred; however,
    315 fits of less than 25 seconds and 36 complete
    failures to fit were noted. A consultant anaesthetist

    and clinical assistant on regular attachment gave the


    anaesthetic agent which was always methohexitone
    and suxamethonium. Seizures were observed and

    timed by the psychiatrist and nurse in charge. No


    variables such as the patient's age and sex, the con
    current prescription of drugs with anticonvulsant

    properties, and the machine setting (ECT1 or ECT2)


    were found to influence seizure duration.
    At this point a new Ectron Series 5 machine was
    purchased and used in the ECT department. This
    machine has a larger electrical output. A repeat
    prospective audit was performed to see what effect
    this new machine would have on seizure length. The
    treatment of 30 patients was audited. There were 24

    women and 6 men with an average age of 54.6 years.


    A total of 217 applications of ECT were given (an
    average of 7.2 per patient, per course): 169 appli
    cations resulted in fits of greater than 25 seconds, 46
    in fits of less than 25 seconds, and 2 in no fit at all. The

    average length of seizure induced on each application


    increased from 25.6 seconds in the first audit, to
    36.3 in the second audit (standard deviation of the
    difference of the means = 2.55), and a comparison
    using the two-tailed t-test gave this a P value of less
    than 0.001.

    There was no statistical difference between the two


    groups of patients in sex ratios, or in the proportion
    of patients receiving drugs with anticonvulsant side
    effects. There was, however, a difference in the
    average age: in the original sample this had been
    63.32 years but in the follow-up audit was 54.6 years
    (standard deviation of the difference of the means
    = 3.54).

    This

    was

    a clear-cut

    difference,

    and

    using

    the

    two-tailed t-test had a P value of less than 0.01.


    It is also interesting to note that in the second audit
    it was found that there was a significant negative

    correlation between age and length of seizure. This


    was analysed using the rank order of correlation
    (Spearman): the rho value was 0.478,
    giving a P
    value on a one-tailed t-test of less than 0.02. Looking
    at the data of the second audit more closely, it was
    apparent that the average seizure length was greater
    for all age groups except for the one patient aged over
    80 years. It therefore seems unlikely that the overall

    increase in successful convulsions was simply due to


    an age difference between the two samples.

    It seems probable that the higher proportion of


    patients having ultra-short convulsions prior to the
    introduction of the new ECT machine was due to the
    use of the Ectron Series 3 machine. This produces a
    relatively low electrical output, which is likely to

    be below the stimulation threshold in a significant


    proportion of subjects, and should be replaced by
    newer models.
    Here is an example of the completion of a cycle of
    audit and the successful introduction of a change in
    patient management.
    R0YALC0LLEGE0FPSYCnATEJSrs(1989)
    ThePractical
    Administration

    of ElectroconvulsiveTherapy.London: Gaskell.
    STEPHEN ARNOTr
    ELLEN WILKINSON

    Glenside Hospital
    Stapleton
    Bristol BSJ6 JDD

    ECT in schizophrenia: need for reappraisal?


    Sut: Introduced for the treatment of schizophrenia,
    the use of electroconvulsive
    therapy (ECT) has
    declined over the past few decades in the West
    (Weiner, 1989). Its lessdramatic response in alleviating

    symptoms and the absence of long-term superiority


    over neuroleptics have been highlighted in literature.
    Coupled with this, the negative attitude towards
    ECT in the society

    and among

    physicians

    has

    resulted in a reduction in its prescription.


    Currently, its usein schizophrenia remainsrestricted
    to acute presentations, especially with catatonic and

    affective symptoms (Weiner, 1989). Physicians who


    employ this treatment modality often regard it as a
    last resort when the disturbance is unmanageable,
    and neuroleptics used sequentially or in combination
    have failed. Fortunately in India, a more liberal use
    of ECI' in schizophrenia exists (Shukla, Journal,
    December 1981, 139, 569571).This may be due to a
    positiveattitudeamongpsychiatrists(gained
    through
    experience) and benefit in terms of cost and reduced
    admissions. In addition, the sociocultural context
    and its implications on patient consent (Jacob &

    Rajan, Journal, April 1991, 158, 576) does not


    impede its usage. In our experience, ECT employed
    with concomitant neuroleptic medication in the
    treatment of schizophrenia results in a decrease in
    symptoms and an improvement in functioning in a
    significant number of individuals. Improvement is
    seen in positive psychotic attributes

    which seems to

    be independent of depressive manifestations. We


    note an accelerated reduction in symptoms when
    ECT isemployedincombination
    withneuroleptics,
    even in chronic patients. The rapidity of response

    CORRESPONDENCE

    574

    with the attendant reduction in cost (in terms of

    increased for schizophrenics, even leading to the

    subjective

    assertion

    distress,

    burden

    on the family,

    and

    that

    it is one

    of the

    few

    areas

    of schizo

    finance) and shortened hospital stay justifies its use.


    Maintenance neuroleptics are employed to sustain
    the improvement gained. The average number of
    ECTs required are greater than the amount
    employed for depression. We also use it as an early

    phrenia research in which there is an impressive


    concordance of results (Kinnell, Journal, February
    1983, 142, 204).

    treatment option in patients with acute psychotic


    episodes and in neuroleptic non-responders.
    The
    difficulty in identifying the responsive subgroup

    clusions were derived after comparing

    among chronic schizophrenic patients necessitates a


    trial for those individuals who remain symptomatic
    on adequate neuroleptics. The lack of long-term
    side-effects, the lowered dose of concomitant anti

    In

    previous

    studies

    (Hare

    &

    Moran,

    Journal,

    February 1979, 134, 169177;


    Kinnell, 1983) con
    the age of

    mother and father of patients, with those of a control


    population. The way the control population was
    constructed varies among studies but in no case was
    there a case-control

    method,

    and we have shown

    previously (Faans
    et al, 1989) that a proper strati
    fication of the control

    population

    is a key issue

    psychotics, reduction in hospital stay, and its


    cost-effectiveness make it an attractive treatment

    in making appropriate comparisons. We report the


    results of a study carried out in Barcelona, where the

    alternative.
    A careful review ofWestern literature also supports

    controls were selected according

    been generalised'to suggest that the treatment

    s.d. = 6.88 for controls; Student's t = 0.38, P= 0.71).

    to the sociodemo

    graphic variables of the patients in a case-control


    method.
    many of these inferences (Taylor & Fleminger,
    1980;
    The results refer to a sample of 120 patients and
    Brandonetal,Journal, February 1985,146,177183;
    Dodwell & Goldberg, Journal, May 1989, 154, 635 176 controls (see Faanset al, 1989 for a description
    of the two populations and the method) and are clear
    639; Christison et al, 1991). However, their emphasis
    seems to be lost amidst the prevalent negative point cut: there is no significant difference between patients
    of view. The general reduction in the use of ECT in and controls in either the age of the mother (mean =
    the West appears to have resulted in an inadequate
    29.94 years, s.d. = 6.07 for patients, and mean = 29.61
    evaluation of its potential. Results from studies years, s.d. = 6.12 for controls; Student's t = 0.46,
    of few patients (fewer number of ECTs) without
    P=0.64), or the age of the father (mean = 33.47 years,
    adequate maintenance neuroleptic medication have s.d. = 7.48 for patients, and mean = 33.15 years,
    is

    not useful in the management of schizophrenia.


    Considering the safety of the procedure and the sig
    nificant non-response

    to antipsychotics,

    a trial of

    ECT in schizophrenia would have to be actively con


    templated. There is a definite need for a reappraisal
    of its potential and of attitudes among physicians
    towards this modality of treatment.
    CHRISTISON,G. W., KRICH, D. G. & WYATr, R. J. (1991) When
    symptoms persist: choosing alternative somatic treatments for
    schizophrenia. Schizophrenia Bulletin, 17(2), 217248.
    TAYLOR, P. J. & FLEMINGER, J. J. (1980)

    ECT

    for schizophrenia.

    Lancet, I, 13801382.
    WEINER, R. D. (1989)

    Electroconvulsive

    therapy.

    In Comprehensive

    Textbookof Psychiatry
    (5thedn) (edsH. I.Kaplan & B. J.

    Heterogeneity is widely accepted in the under


    standing of schizophrenia, and many papers have
    addressed the question by analysing subgroups of
    patients according to several variables (family
    history, age of onset, sex). When splitting our sample

    into two groups according to these criteria (presence


    or absence of family history of schizophrenia, early
    or late age of onset, female or male) no divergence
    was observed in the age of either parent when
    compared with controls.
    In this study, the age of the parents is shown to be
    independent of the presence of schizophrenia and of
    the variables that may define biological subgroups.

    Sadock).Baltimore:Williams&Wilkins.
    FA@ANAS,L., MARTI-TUSQUETS,J. L. & BERTRANPETIT,J. (1989)

    P. J SAJU
    K s JACOB
    Department of Psychiatry
    Christian Medical College
    Veiore 632002, India

    Parental age in schizophrenia in a case-controlled


    study
    SIR: Several studies have shown that both maternal
    and paternal ages at the birth of their child are

    Scasonalityof birth in schizophrenia.


    An insufficient
    stratifi
    cationof controlpopulation?SocialPsychiatryandPsychiatry
    Epidemiology, 24,266-270.

    JAUME BERTRANPETIT
    LOURDES FAi@ANAs

    Laboratory of Anthropology
    Faculty of Biology
    University of Barcelona
    Diagonal 645, 08028 Barcelona
    Spain

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