Schizophrenia? 27

Schizophrenia is a clinical syn-drome of extraordinary impor-tance and complexity. Its early identification is difficult, and our concepts of its main character-istics have undergone many changes in the past century. Electroconvulsive therapy (ECT) was introduced as a treatment for dementia praecox. The initial reports were salutary, and the treatment was widely applied until it was replaced by psy-choactive drugs. ECT was rein-troduced in the 1970s in the treatment of therapy-resistant disorders. The initial reviews argued that ECT was not appli-cable in patients with schizo-phrenia, a conclusion based mainly on experience with chronic forms of the disorder. This article assesses the role of ECT in schizophrenia today. We find it to be an effective treat-ment for psychosis. ECT is par-ticularly applicable in patients with first-break episodes, espe-cially those marked by excite-ment, overactivity, delusions, or delirium; in young patients, to avoid the debilitating effects of chronic illness; and in patients with syndromes characterized by catatonia, positive symptoms of psychosis, or schizoaffective features