Chanpattana Worrawat, Andrade Chittaranjan
Department of Psychiatry, Bangkok Hospital, Bangkok, Thailand.
J ECT. 2006 Mar;22(1):4-12. doi: 10.1097/00124509-200603000-00002.
There is controversy about the proper place of electroconvulsive therapy (ECT) in the management of the schizophrenic patient, and the important issues related to theory and practice remain to be resolved, especially in the context of medication-resistant schizophrenia.
We briefly summarize existing research in the field. We next use a narrative method to describe in a single article the large body of research from Thailand that, during the past decade, has systematically studied issues related to the use of ECT in medication-resistant schizophrenia. We integrate the findings of the Thai efforts with the results of other research and consider the theoretical and practical importance of the reviewed work.
The ECT treatment data validate a BRPS cutoff of 25 as a definition of recovery in patients with treatment-refractory schizophrenia, and a cutoff of 37 as a definition of subsequent relapse or suitability for entry into a treatment protocol. A 3-week post-ECT stabilization period identifies patients who maintain improvement and who can be legitimately considered to have sustained response to ECT. Clinical characteristics of such responders and symptoms responsive to ECT are described. Higher stimulus dose hastens response to ECT but does not improve responsiveness. Continuation ECT (C-ECT) combined with maintenance-neuroleptic medication is associated with better treatment outcome than either treatment alone. The combined treatment also improves quality of life and functioning in the long-term.
These findings convey several useful thoughts for research into and the practice of ECT for schizophrenia.
在精神分裂症患者的治疗中，电休克疗法（ECT）的恰当地位存在争议，与理论和实践相关的重要问题仍有待解决，尤其是在难治性精神分裂症的背景下。
我们简要总结该领域现有的研究。接下来，我们采用叙述方法，在一篇文章中描述泰国在过去十年中对难治性精神分裂症患者使用ECT相关问题进行系统研究的大量研究成果。我们将泰国研究的结果与其他研究的结果相结合，并考虑所综述工作的理论和实践重要性。
ECT治疗数据验证了将BRPS临界值25作为难治性精神分裂症患者康复的定义，将临界值37作为后续复发或适合进入治疗方案的定义。ECT后3周的稳定期可识别出维持改善且可被合理认为对ECT有持续反应的患者。描述了此类有反应者的临床特征以及对ECT有反应的症状。较高的刺激剂量可加速对ECT的反应，但不会提高反应性。与单独使用任何一种治疗相比，维持性ECT（C-ECT）联合维持性抗精神病药物治疗的效果更好。联合治疗还能长期改善生活质量和功能。
这些发现为精神分裂症ECT的研究和实践提供了一些有益的思路。
