J Med Assoc Thai 1998; 81 (1):17

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Maintenance ECT in Schizophrenia : A Pilot Study
Chanpattana W Mail

Maintenance electroconvulsive therapy (M-ECT) has been used to control schizophrenic
patit:nts 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 suferred 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.

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