Overview 

Schizophrenia is a mental disorder marked by the occurrence of hallucinations or delusions, leading individuals to struggle with distinguishing these false perceptions from actual reality. Diverse symptoms, including hallucinations, delusions, social disengagement, and cognitive deficits, present themselves within this illness. Schizophrenia has several distinct causes; it can be inherited or brought on by environmental triggers and stem from either a neurochemical or environmental basis. 

The treatment landscape for schizophrenia is highly personalised and tailored to target the specific symptoms experienced by each individual. This approach includes interventions that range from antipsychotic medications to cognitive-behavioural therapy and even electroconvulsive therapy (ECT). Often, a combination of therapies is utilised as a treatment strategy to achieve more successful effects. 

ECT is a notable intervention that has generated controversy and major interest. ECT is a controversial approach in the scientific community regarding its efficacy and appropriateness in treating schizophrenia. This is due to its potential side effects and the ethical considerations. However, ECT can be a valuable approach in more severe situations where other treatment options have not been sufficient. 

Schizophrenia and its symptoms

Schizophrenia is usually treated with antipsychotic medications and can be associated with bipolar disorder and depressive disorder. In schizophrenia, a person has impaired cognitions and the physical manifestation differs between individuals, each person experiences a unique set of symptoms. Clinical diagnosis includes the evaluation of whether a person has positive or negative symptoms. 

Positive symptoms represent an excess of function but negative symptoms represent a loss or attenuation of normal functioning. Perceptual disturbances, and thought disorders such as paranoia, disorganised speech, disorganised behaviour or catatonia are all manifestations of positive symptoms. Negative symptoms include blunt emotions, poverty of thought and reduced speech (alogia) as well as difficulties with goal-directed behaviours such as hygiene due to avolition. 

A hallmark of schizophrenia is that those suffering usually have selective attention and cannot differentiate between significant and non-significant stimuli. Due to impaired cognition, people usually suffer problems with attention and memory.

Causes of schizophrenia 

Evidence supports both the genetic and biological basis of the disease. The biological basis stems from the theories that propose the dysregulation of certain neurotransmitters including serotonin, dopamine and glutamate. Neurotransmitters are chemicals that allow the communication of important signals in our bodies. 

From a pharmacological basis, any substance that stimulates the serotonin receptor, 5-HT2A/2C, is extremely psychedelic; low serotonin levels are hypothesised to be involved in schizophrenia. Evidence of the involvement of dopamine in the brain comes from the fact that dopamine antagonist activity is present in all neuroleptic medications to some extent. 

Amphetamine-induced dopamine release in the brain is important because amphetamine-induced psychosis resembles the positive symptoms of schizophrenia.¹ There isn't any solid proof that schizophrenia has an overactive dopamine function, though. Moreover, abnormal transmission of the glutamate neurotransmitter is involved in producing negative symptoms of schizophrenia.²

Genetic evidence from twin studies supports the notion that this mental disorder is inherited. Many different genes have been highlighted in the possible involvement in schizophrenia manifestation. Symptoms can also occur due to recreational drug use such as from steroid drugs or the side effects of certain prescribed drugs, like as depression. 

Electroconvulsive therapy - how it works

Severe, psychotic, or treatment-resistant depression responds successfully to ECT. This therapy can be targeted to the treatment of depression, bipolar disorder, and schizophrenia.³ Under general anaesthetic, a regulated electrical current to the brain is applied and this causes a generalised seizure.⁴ Patients with unipolar or bipolar depression who have not reacted well to antidepressants are reported to benefit from the treatment.⁵

Other severe mental disorders such as catatonia, malignant neuroleptic syndrome, intractable psychosis, mania, and particular types of delirium are also treated with ECT.⁶ Although the precise ways by which ECT operates are ambiguous, treatment is thought to alter the brain in a way that relieves symptoms of mental illnesses.

ECT is an uncommon choice because of worries about side effects and the requirement for general anaesthesia. Adverse effects of ECT include disruptions in some significant cognitive processes such as memory. Furthermore, recent studies have focused on the possible cardiac events and deaths linked to ECT.⁷ But it's crucial to remember that ECT is regarded as a safe therapy option for mental health problems under medical care.

Is ECT effective in treating schizophrenia? 

Since the introduction of antipsychotics, Electroconvulsive Therapy (ECT), which was previously used to treat schizophrenia, has experienced a decrease in use.⁸ Since its introduction in 1938 as a viable treatment for schizophrenia and other psychotic diseases, ECT has been less and less common due to the availability of other less invasive therapy choices. 

With a focus on brain consequences, recent research has reignited interest in ECT's potential role in schizophrenia. The key modulation sites in the regions have been identified as the insula and hippocampal regions of the brain.⁹ The body of research available generally suggests that ECT is a secure and effective therapy option for people who are suffering from schizophrenia.⁸ 

Generally, the use of ECT as an intervention occurs in:⁸

• Clozapine resistant individuals 
• Reducing suicidal thoughts 
• Increasing effectiveness of drugs prescribed for schizophrenia

Side effects of ECT

Many studies and clinical considerations have been conducted on the side effects of electroconvulsive therapy (ECT). Patients are nevertheless impacted by adverse effects of ECT treatments, which are mainly temporary but occasionally debilitating. More severe effects of ECT include but are not limited to: ¹⁰

• Headaches and Nausea: These side effects are reported as the most common side effects of ECT ⁷
• Cognitive impairment: ECT can have different effects on aspects of memory
• Cardiovascular abnormalities: The most frequent cause of morbidity when using ECT, however now this is less of a problem because of the use of diagnostics such as the electrocardiogram (ECG) to monitor cardiac health

FAQs

What is schizophrenia?

Schizophrenia is defined by delusions or hallucinations that make it difficult to tell the difference between reality and perceptual illusions. A variety of manifestations, including hallucinations, delusions, social disengagement, and cognitive impairments, are among the symptoms.

What causes schizophrenia?

Biochemical and genetic factors contribute to schizophrenia. The biological basis is characterised by dysregulation of neurotransmitters such as glutamate, dopamine, and serotonin. There is evidence for a hereditary propensity to the condition from twin studies. 

How is schizophrenia treated?

The management of schizophrenia involves a customised approach that encompasses both cognitive-behavioural therapy and antipsychotic medicines. In cases of severe agitation, catatonia, treatment resistance, and clozapine-resistant schizophrenia, electroconvulsive therapy (ECT) is taken into consideration.

What is electroconvulsive therapy (ECT)?

Under general anaesthesia, a regulated electrical current is applied to the brain as part of the ECT procedure. It works well for schizophrenia, bipolar disorder, and depression when they manifest as severe and unresponsive to treatment. It is thought that ECT modifies brain chemistry, alleviating mental disease symptoms. 

Is ECT effective in treating schizophrenia?

The use of ECT for schizophrenia has declined since antipsychotics became available, but new research highlights its potential advantages. All things considered, the data so far indicates that ECT is a secure and successful treatment for certain cases of schizophrenia.

What are the side effects of ECT?

Temporary but occasionally incapacitating adverse effects are possible with ECT. There is evidence of cognitive impairment, especially in memory and a risk of cardiovascular issues. 

Summary 

ECT is a treatment for serious mental illnesses, including schizophrenia, bipolar disorder and depression, and it has demonstrated effectiveness in cases where other treatments have failed. ECT is known to cause physiological and molecular changes in the brain, which may contribute to its therapeutic effects even though its exact mechanisms of action are yet elusive. Medical practitioners will best know when this therapy is most suitable for a patient's condition.