Combined electroconvulsive and neuroleptic therapy in schizophrenia refractory to neuroleptics

The results of treatment in 13 schizophrenic patients (nine males, four females) who underwent electroconvulsive therapy (ECT) because of varying degrees of therapy resistance to neuroleptics (therapy failures, renewed and in some cases catatonic exacerbation under neuroleptic therapy, neuroleptic intolerance) are reported. The single treatments, which were carried out on average 12 times (between six and 20 times), led from very good to good remission in a period of between 10 and 7 years in nine patients. Four patients did not respond adequately: the small improvement of psychopathology on discharge correlated with unfavorable outcome. In three of these patients, the asthenic syndrome was found on admission and persisted. In patients with good remission, neuroleptics could be reduced after ECT by over 70%, and over 50% in patients with poor remission. This result confirms corresponding literature data with regard to neuroleptics. The results in this highly selected group also confirm Bleuler's 'one third rule' of remissions, also the fact that global outcome does not correlate with response to neuroleptics, as well as confirming the relevance of the psychopathological state on discharge as an outcome predictor.