Aims and method: To evaluate the real-world effectiveness of electroconvulsive therapy (ECT) in schizophrenia and schizoaffective disorder, and to identify clinical predictors of response. We conducted a naturalistic study using routinely collected data from the Scottish ECT Accreditation Network between 2009 and 2018. Individuals with schizophrenia or schizoaffective disorder who had complete pre- and post-treatment Clinical Global Impression ratings were included. Clinical improvement and associations with demographic and clinical variables were examined.
Results: A total of 153 patients were included (94 with schizophrenia, 59 with schizoaffective disorder). Overall, 86% showed clinical improvement following ECT. Marked improvement ('much' or 'very much improved') was observed in 65% of patients with schizophrenia and in 78% with schizoaffective disorder. In schizophrenia, younger age, greater baseline depressive symptoms and receipt of emergency treatment were associated with higher likelihood of improvement.
Clinical implications: These findings indicate robust effectiveness of ECT for schizophrenia and schizoaffective disorder in routine National Health Service practice and highlight clinically relevant predictors of response, suggesting that current guideline positions may warrant re-evaluation.
Keywords: Electroconvulsive therapy; National Audit; clinical outcomes measures; psychotic disorders/schizophrenia; treatment resistance.