Electroconvulsive Therapy for Obsessive-Compulsive Symptoms in Schizophrenia Spectrum Disorders: A Systematic Review

Obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) can co-occur with schizophrenia spectrum disorders. There is limited research on electroconvulsive therapy (ECT) for this particular comorbidity. This systematic review assessed the efficacy of ECT for OCS/OCD in patients with schizophrenia spectrum disorders. A systematic literature search was conducted using multiple databases. Inclusion criteria for articles included those involving patients with both OCS/OCD and schizophrenia spectrum disorders treated with ECT. Out of 10 studies, 11 patients met the inclusion criteria. Nine were case reports and one was a retrospective study. Seven out of 11 patients experienced improvement in OCS after ECT, including four with complete remission. Additionally, two acutely suicidal patients due to OCS/OCD had remission of suicidality. The mean reduction in Yale-Brown Obsessive Compulsive Scale scores across four patients was 29.5±7.7. Maintenance ECT was effective in preventing relapse in three patients. No worsening of symptoms or major adverse effects were reported. ECT may offer a potentially beneficial treatment option for OCS/OCD in patients with schizophrenia spectrum disorders, particularly those with treatment-resistant or severe symptoms. The small number of patients, predominance of case studies, and heterogeneous evidence limit conclusions and treatment guidance. Further studies are necessary to determine efficacy, adverse effects, and optimal use of ECT in this population.