The indications for electroconvulsive therapy in the Netherlands have been restricted to treatment-resistant depression and lethal catatonia since the beginning of the 1980's. However, in other countries including the United States, ECT may also be considered as relatively indicated in the treatment of schizophrenia, mania and schizoaffective disorder.

This article reviews outcomestudies performed in the latter disorders which satisfy certain methodological criteria. ECT is an effective treatment for schizophrenia but because of its intensive nature and the temporary nature of its effect, neuroleptic medication is generally considered the treatment of choice. ECT may be indicated for a small group of severely ill patients who are resistant to, or intolerant of neuroleptic medication. ECT can likewise be of use in the treatment of mania and schizoaffective disorder where there is treatment-resistance to neuroleptic medication and/or lithium.

In conclusion, ECT deserves a place in the management of schizophrenia, mania and schizoaffective disorder as the final step following a protocol of pharmacological treatment, with attention to the issue of informed consent.