ECT in medication resistant schizoaffective disorder

Abstract

For the clinician, schizoaffective patients are a formidable challenge. They are usually the most disturbed, agitated, and difficult to control on the ward. Because they are often young, retain affect (though it may be bizarre) and may have functioned relatively well between episodes and/or prior to hospitalization, ECT is often considered a last resort or may not be given at all. This is unfortunate given the excellent response to ECT and Tsuang's 3 finding that schizoaffective patients not treated with ECT had higher suicide and mortality rates compared with those who had received ECT. The present study and review concludes that: (1) ECT is a very effective acute treatment in schizoaffective disorder; (2) whether called schizoaffective or affective disorder with psychosis there appears to be a subgroup of young patients with prominent confusion and lack of response to medications for whom ECT is particularly effective; (3) lithium should be considered as a prophylactic treatment with these patients; and (4) patients with schizoaffective disorder (as described) should be considered as a separate group in future ECT and/or lithium treatment response studies.