Schizophrenia – Biological Therapies 1 Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) How is it administered? (AO1) Lie down on bed Given muscle relaxant and put to sleep Electrodes on non-dominant side of brain 0.6A applied for ½ sec Induces seizure of up to 1 minute

Electroconvulsive Therapy (ECT) Why use it? Many positive symptoms of schizophrenia (hallucinations, delusions etc) seem to involve deficient functioning of the cognitive system Negative symptoms (lack of motivation and emotion etc) presumably involve deficient functioning of the brain as a whole So it can be argued that it is worth considering forms of therapy having direct effects on brain functioning, eg. electroconvulsive therapy to treat schizophrenia.

Electroconvulsive Therapy (ECT) Involves passing an electric current through the head to produce brain seizures. Used to result in broken bones, patient terror, and bad memory loss. However, improvements have been made over the years, eg. strong muscle relaxants to minimise the magnitude of convulsions a move away from administering ECT to both brain hemispheres to applying it only to the non-dominant hemisphere to reduce memory loss To address anxiety, anaesthetic is used so that patients are asleep while receiving ECT.

Electroconvulsive Therapy (ECT) Important: ECT is used in the treatment of schizophrenia, but much less frequently than in the treatment of depression AQA have specified in a recent Examiner’s Report that “There are some treatments which were used for schizophrenia in the past but are no longer considered suitable in most cases, eg ECT. Descriptions of such treatments are creditworthy but top band answers should make clear that ECT is now rarely used to treat Schizophrenia as part of their description.”

ECT - Effectiveness Adams (2005) undertook a meta-analysis of recent studies on use of ECT for S Found beneficial effects in the short-term, but smaller than those obtained with drugs They suggested ECT be used on those with schizophrenia who show limited response to medication alone Supported by Braga (2005) who reviewed 42 articles in which ECT had been used in combination with neuroleptic drugs to treat schizophrenia, found it an effective combo

ECT - Effectiveness Real-world benefits: Chanpattana (2007) found that ECT plus drug therapy actally led to significant improvements in quality of life and social functioning Often produces good symptom reduction in those who have had little success with drug therapy Can reduce positive symptoms of S more quickly than other therapies

ECT - Effectiveness But: - Less effective when used on its own rather than in combination with drug therapy - Relatively ineffective in treating the negative symptoms of depression, such as lack of motivation and emotion - Less effective in the long-term than in the short-term - ECT reduces the symptoms of schizophrenia, but does not produce a cure. Thus, it is a palliative rather than a curative treatment.

ECT - Appropriateness Appropriate: Very apt therapy: much evidence that biological factors are of particular importance in S, and ECT is a biological form of treatment S historically regarded as a mental disorder that was especially difficult to treat, and this made it appropriate to think in terms of radical forms of therapy such as ECT

ECT - Appropriateness Inappropriate: Possible side effects memory loss cognitive impairments neurological damage. over 60% of those who have undergone ECT report feelings of anxiety afterwards (Batley, 1998) However in the majority of cases, side effects are mild and temporary.

ECT - Appropriateness Inappropriate: Because we don't have a clear understanding of why it is effective. It is probable that it affects neurotransmission and produces structural changes, but we don't know the details. Because it raises ethical issues. Most patients dislike receiving ECT, and some might be put under excessive pressure to become involved in this form of therapy.