Maintenance ECT in schizophrenia: a pilot study.

Maintenance electroconvulsive therapy (M-ECT) has been used to control schizophrenic patients for more than 50 years. In spite of this, there has been no prospective study made of this treatment. Most of the available information comprises naturalistic studies or case reports. As a result many unanswered questions concerning M-ECT remain, including its therapeutic efficacy. This pilot study was done prospectively on 11 schizophrenic patients suffering acute exacerbations, in order to determine the merits of M-ECT. After acute treatment, using only ECT, in 16 patients, 11 were able to pass the 3-week-stabilization-period. They were identified as ECT responders and enrolled into the M-ECT study. M-ECT was started one week after the last treatment in the stabilization period using a tapering regimen, fixed interval schedule, beginning with weekly intervals for 1 month (4 treatments), then biweekly intervals for 2 months (4 treatments) and with monthly intervals thereafter. No neuroleptic drugs were used. Benzodiazepines were the only medications prescribed to control agitation on a prn basis. The duration of the study was one year. Bilateral ECT was used throughout the study. Global Assessment of Functioning (GAF), Brief Psychiatric Rating Scale (BPRS) and the Thai Mental State Exam (TMSE) were used to measure the outcome. A total of 8 patients completed the study or stayed until relapse and 3 dropped out. At the 6-month-evaluation there were no relapses. After this, however, 5 patients suffered relapses. Only 3 could complete the one year study. There were no serious side effects. This study indicates that M-ECT may have a role in the maintenance of some schizophrenic patients. Further studies are needed to determine the optimum frequency and the role of concurrent neuroleptic use.