Which statement best describes the role of electroconvulsive therapy (ECT) in schizophrenia?

• A. First-line treatment for all patients with schizophrenia
• B. Considered for severe, treatment-resistant psychosis or catatonia when medications are ineffective or rapid response is needed
• C. Used only for mood disorders with psychosis
• D. Never used due to risks

Answer: (B)

Electroconvulsive therapy in schizophrenia is used when symptoms are not adequately controlled by medications or when rapid stabilization is needed. It’s not the initial approach for most patients because antipsychotic medicines are usually started first. ECT can produce a rapid improvement, which is especially valuable in severe, treatment-resistant psychosis or when catatonia is present and poses medical risks. In catatonia, ECT often leads to a faster and more reliable reversal of symptoms than drugs alone. It’s also used as an adjunct in difficult cases, such as clozapine-resistant schizophrenia, to help stabilize the patient while continuing antipsychotic treatment. While there are risks with anesthesia and temporary memory effects, the benefits in these specific, high-need situations outweigh the risks.