Electroconvulsive Therapy and Neuroleptic Medication in Therapy-Resistant Positive-Symptom Psychosis

Eight patients with persistent psychosis and positive symptoms, who had not improved with at least two courses of neuroleptic medications, were treated with electroconvulsive therapy (ECT) combined with an antipsychotic medication. Seven of the eight patients improved; the improvement was sustained in five patients after 6 and 12 months. ECT and neuroleptic drugs appear to be synergistic in antipsychotic activity. This enhancement may result from greater brain levels of neuroleptic drugs secondary to increased permeability of the blood-brain barrier accompanying seizures. Our experience is consistent with other recent clinical reports, and encourages trials of ECT combined with neuroleptic medications in therapy-resistant psychotic patients, including those classified as having schizophrenic disorders.