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ELECTROCONVULSIVE THERAPY AND SCHIZOPHRENIA 1

Psychology Disorder Analysis of Schizophrenia


Electroconvulsive Therapy for Schizophrenia
and
The Efficacy of Electroconvulsive Therapy in Treatment of Schizophrenia
Sarah McFadden
Front Range Community College/Polaris
Yaromy, PSY102
2013






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Abstract
According to the DSM 4, the criteria for Schizophrenia are the experience of two of the
following symptoms: delusions, hallucinations, grossly disorganized speech or catatonic
behavior, and negative symptoms. The disorder is associated with a genetic predisposition, and
arises in the development of the brain. Around 20% of people diagnosed with schizophrenia do
not improve with antipsychotic medication alone (Kumari, Madhu, & Zaheer, 2011). These
medications can have many negative side effects with long term use, and dont always work
(Poublon & Haagh, 2011). When electroconvulsive alternatives have been tried, along with
Sham-ECT treatments, both sometimes show an improvement that was not achieved before with
antipsychotic medication (Tharyan & Adams, 2005). ECT treatments and Sham-ECT treatments
also tend to speed up improvement and may have fewer side effects (Tharyan & Adams, 2005).









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Introduction
The articles The efficacy of ECT in the treatment of schizophrenia, by Nathan A. Poublon and
Marieke Haagh, from Erasmus MC University Medical Center in the Netherlands and
Electroshock therapy for schizophrenia by P. Tharyan and C.E. Adams from Christian Medical
College, in India, explore how electroconvulsive therapy (ECT) effects schizophrenia or
schizophrenic symptoms. The purpose of ECT is to cause small therapeutic seizures. It acts as a
sort of reboot to the brain. ECT is when electricity is applied on specific places of the head, at
low frequencies, with electrodes. The hypothesis of these works was if ECT is given to people
diagnosed with Schizophrenia, then the symptoms associated with schizophrenia will diminish.
In the article by Poublon and Haagh, the purpose of their experiments was to become more
familiar with how schizophrenic patients react to ECT. This was done through specifically
observing how patients responded to ECT and sham- ECT (equivalent to a placebo), by reading
other articles on which the experiment was executed. The article by Taryan and Adams was
determined to decide if ECT clinically improves schizophrenic symptoms and is practical to
perform. They attempted to conclude this by also observing several different research articles
and speaking to the relevant authors of said articles, that had been experimenting ECT on
Schizophrenic people. ECT is only used as a last option, when a patient is not adequately
responding to other treatment (Poublon &Haagh, 2011).




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Methods and Results
Poublon and Haagh reviewed other studies previously conducted. They collected their studies by
searching MED-LINE/ PubMed using the key terms schizophrenia, Electroconvulsive
Therapy, sham, placebo, simulated, control, Clinical Trial, and Randomized
Controlled Trial. Randomized, human, placebo trials were focused on. Complete research was
wanted, so the articles were reviewed by hand. The overall validity of these experiments was
also assessed thoroughly through many factors. Trials were ECT vs. Sham-ECT with people who
had already been diagnosed with schizophrenia disorder. Patients within the trials were analyzed
before, during, and after trials. 16 trials were reviewed for this assessment. 11 of these trials were
not valid for the comparison review due to missing criteria factors. Within the remaining 5 trials,
there were 132 subjects tested over the course of 1980 to 2003, 69 of which received ECT and 63
of which received Sham-ECT. There was a large range of severity of illness and amount of
medication given within trials. Immediately after, both ECT subjects and Sham-ECT subjects
experienced improvement. When compared with Sham-ECT trials, actual ECT treatment
effectively diminishes the degree of schizophrenic symptoms in subjects. However, when
subjects were analyzed during follow-up, these differing degrees of improvement between ECT
subjects and Sham-ECT subject were no longer present.(poublon&haagh, 2011)
Tharyan and Adams conducted their study using other works done by other researchers as well.
These articles were specifically taken from medical databases (Biological abstracts, EMBASE,
MEDLINE, PsycLIT, SCISEARCH, and the Cochrane Schizophrenia Group's Register). To
make sure the sources were credible the references of each article were reviewed. The studies
focused on clinical trials involving Electroconvulsive treatment, alternative ways of applying
ECT, antipsychotics and placebo trials with people experiencing schizophrenia, schizoaffective
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disorder or chronic mental disorder. The studies that were used also received high praise from
critics in the area of expertise. From these studies, Poublon and Haagh were able to discern that
more patients that were given real ECT treatment improved than patients that were given sham-
ECT. This was decided due to the evidence that ECT patients had fewer relapses than sham-ECT
patients. However, long term effects and comparisons were inconclusive. Even though ECT
seemed to help improve patients, when put up against antipsychotic prescriptions, medication
seemed to have better results. Some indication hints that the two together work better for a
patient than just medication on its own.( Tharyn & Adams, 2005)











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Discussion Summary
Both Sham-ECT and ECT treatments decrease the degree of schizophrenic symptoms. In
comparison with Sham-ECT, actual ECT seems to have a better effect overall on schizophrenic
symptoms. Directly after treatment is when these symptoms seem to lessen more drastically for
patients undergoing real ECT treatment. However, when patients came in for a follow up
analysis, all patients had the same amount of improvement. The extra improvement seen in trials
with ECT was lost in comparison with Sham-ECT trials. This said, lasting improvement for both
trial groups was seen conclusively from both studies. These results suggest that improvement is
somewhat a placebo effect (Tharyn &Adams, 2005) and (Poublon & Haagh, 2011).










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Reflection
Schizophrenia is still a very unknown field. This is what initially drew me to researching this
specific disorder. I wanted to more fully understand the components of the disorder. I found
this subject very fascinating. Using ECT to treat Schizophrenia is something I never would have
considered to be a possibility. The fact that some results were seen in trials must tell us
something about the illusive nature of Schizophrenia. The validity of these assessments is fairly
valid. The Efficacy of ECT in the treatment of Schizophrenia was conducted by medical students
at a medical university, in the department of psychiatry which is highly relevant.
Electroconvulsive Therapy for Schizophrenia was published on PubMed.org, the US National
Library of medicine National Institutes of Health. However, some improvements could be made
in both works. Electroconvulsive Therapy for Schizophrenia is very short. The background
information provided is very vague. Nothing specific is shared about how ECT is performed or
what it does to the brain. Background information about schizophrenia is also not included.
Where the original studies were conducted was not also specified. Results may vary in different
parts of the world. The amount of studies reviewed however was much larger than The Efficacy
of ECT in the Treatment of Schizophrenia. This selection allowed for more accurate results while
under review. These works that were reviewed are very specific and relevant for the purpose of
the study. The efficacy of ECT in the treatment of schizophrenia involved less studies. However,
the article presented more details about the process assessing the hypothesis and coming to a
conclusion. The study could of also provided more Background information about ECT,
schizophrenia, and ECT in relation to Schizophrenia. Even though there was a small selection of
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cases reviewed, each review was thorough and concise. However, they could also have
included what groups (i.e. nationality, location, gender, ect.) these subjects came from.





















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References
Kumari, Reena, Kaundal, Madhu, Ahmad, Zaheer, Ashwalayan, V. D. (2011). Herbal and
Deitary Suppliments in Treatement of Scizpoherina: An Approach to Improve
Therapeudics. School of Pharmaceutical Sciences, Shobhit University, Meerut (U.P)
India. Volume 10, Issue 1, September -October 2011; Article-035.

Poublon, Nathan A.,& Haagh, Marieke. (2011)The efficacy of ECT in the treatment of
schizophrenia: A systematic review. Department of Psychiatry, Erasmus MC University
Medical Center Rotterdam, the Netherlands. Eramus Journal of medicine, vol 2 , no 1,
June 2011.

Tharyan, P,& Adams, C. (2005). Electroconvulsive therapy for schizophrenia.
Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu,
India.Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000076