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In Denmark, over 2500 people are in psychiatric treatment in forensic mental health services at any one time, most suffering
from schizophrenia. Many of them have illnesses that are resistant to medication. There is evidence of the effectiveness of
electroconvulsive therapy (ECT) for schizophrenia, but not explicitly for this complex forensic group.
Aims: The aim of this study was to describe the outcome of using ECT as augmentation therapy in a cohort of forensic
psychiatric patients with schizophrenia who were failing to respond to antipsychotic medication.
Methods: In one university-based psychiatric clinic, data were extracted from the medical records of all patients treated with
ECT during a 6-year period. Fifty-nine of these patients were diagnosed within the schizophrenia spectrum and eight were in
specialist forensic hospital services.
Results: The mean duration of illness for the forensic cohort was 16 years (range 3?33 years), with the index episode having
lasted a mean of 34 months (3 weeks to 8 years) in spite of treatment with at least two antipsychotic drugs. Psychotic symptoms
were accompanied by seriously assaultive behavior in all cases. All but one of these patients had an excellent or good symptomatic
and behavioral response to ECT. Half (four) went on to maintenance ECT. No adverse effects were documented.
Conclusion: ECT is rarely used in specialist secure services, but should not be forgotten as a treatment that may enable
medication-resistant, assaultive psychotic patients to progress safely out to the community.
Diana Kristensen, M.D. is a specialist in Psychiatry at the Psychiatric Centre of Copenhagen, the capital city of Denmark. She has performed
research within the field of cognitive impairment following anesthesia as a member of the ISPOCDII study group. Her latest field of research is the
use of Electroconvulsive therapy for Schizophrenia, Metabolic Syndrome and arrhythmias following the use of psychotropic drug. She was a section
Editor for the 2011 theme number ?treatment of schizophrenia? in Drug Discoveries Today, therapeutic strategies, and she is a member of the NACT
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