Objective: The management of middle-aged and elderly catatonic schizophrenia has been a major problem in clinical geriatric psychiatry. Most cases are intractable because of medication resistance, medication intolerance, or severe medical conditions. ECT is one of the most efficacious therapies for catatonic schizophrenia. However, there have not been studies on the efficacy of ECT in middle-aged and elderly patients with catatonic schizophrenia. Thus, we conducted a prospective phase I study of the short- and long-term effect of acute ECT in middle-aged and elderly patients with intractable catatonic schizophrenia and a prospective phase II study of the effect of continuation ECT on relapse-prevention after response to a second acute ECT treatment in relapsed participants of the phase I study. Subjects and Methods: The phase I study subjects comprised nine consecutive patients (3 men and 6 women) older than 45 years who had fulfilled the DSM-W criteria for catatonic schizophrenia and had been referred to Tohoku University Hospital between January 1998 and March 2002 for first-time acute ECT after other treatments had failed. We evaluated the clinical response of them to acute ECT and 6-month outcome under neuroleptic continuation treatment following response to acute ECT. Evaluation was according to BPRS (18 items, rated 0-6). The phase II study comprised consecutive relapsed participants of the phase I study. Inclusion criterion was that the patient responded to a second acute ECT treatment soon after relapse in the phase I study. The patients were given continuation ECT combined with continuation neuroleptics. The first four ECT sessions were at weekly intervals, the second four ECT occurred every 2 weeks, and the final three ECT sessions occurred every 4 weeks. The patients' BPRS scores were evaluated weekly for 24 weeks or until relapse. Clinical response of acute ECT was defined as a BPRS score 25 during the first week after the last ECT session. Relapse was defined as a BPRS score37 that persisted for at least 3 days. Results: All nine patients completed the phase I study. All of them (100%) responded to acute ECT. Five of nine (55.6%) patients relapsed after response to acute ECT. All five relapsed patients (100%) in the phase I study responded to the second acute ECT. All of them completed the phase II study. Two of the five (40%) patients relapsed. Conclusions: The short-term efficacy of acute ECT for middle-aged and elderly patients with intractable catatonic schizophrenia is good. However, the 6-month relapse rate after response to acute ECT is high despite the use of neuroleptic continuation pharmacotherapy. Continuation ECT is efficacious for sustaining remission in middle-aged and elderly patients with intractable catatonic schizophrenia who relapsed after response to acute ECT despite the use of continuation neuroleptics.
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