Research projects

Schizophrenia is a serious mental illness that affects around one percent of the population. Although antipsychotics help many patients, around 15 to 30 percent do not respond to these drugs – not even to clozapine, an antipsychotic that is considered the best treatment option. Those affected suffer from so-called clozapine-resistant schizophrenia (CRS) and sometimes experience severe impairments, including limited ability to think and speak, hallucinations or delusions. There are currently no sufficient evidence-based treatment alternatives for this particularly difficult-to-treat patient group.

Scientific investigation of maintenance ECT

Electroconvulsive therapy (ECT), which was used in the past to treat schizophrenia, is rarely used today despite its proven effectiveness. In ECT, a brief neuronal overexcitation is triggered in the brain with the help of an electrical impulse lasting a few seconds. The patient is unaware of this, as the treatment is carried out under brief anesthesia. ECT releases various neurotransmitters in the brain and stimulates the growth of nerve cells in certain areas of the brain.

In particular, maintenance electroconvulsive therapy (mECT), which is intended to prevent relapses after successful initial ECT in schizophrenia, has hardly been scientifically investigated to date. The Central Institute of Mental Health (CIMH) in Mannheim, together with the Department of General Psychiatry at Heidelberg University Hospital (UKHD), is therefore launching a large study on maintenance electroconvulsive therapy, which is being conducted in 14 psychiatric clinics in Germany. The Federal Ministry of Education and Research (BMBF) is funding the study with around two million euros. The effectiveness of maintenance ECT is being investigated in patients who continue to be treated with clozapine after an initial successful series of ECT. The aim is to examine whether maintenance ECT prolongs the time to relapse and increases the number of relapse-free patients.

Far-reaching consequences for clinical practice

In addition to the primary goal of reducing the relapse rate, other aspects such as quality of life, independence and the symptoms of schizophrenia are also examined by interviewing those affected and their environment. Particular attention is paid to ensuring that patients' cognitive performance is not impaired by maintenance ECT.

“If the study confirms our hypothesis that maintenance ECT significantly improves treatment outcomes in clozapine-resistant schizophrenia, this could have far-reaching implications for clinical practice. The results could trigger a change in international treatment guidelines and promote wider use of ECT in schizophrenia. This would be a major step forward for patients who have previously received inadequate treatment,” says Prof. Dr. Alexander Sartorius, Senior Physician at the Department of Psychiatry and Psychotherapy at the CIMH. “The accompanying interviews with patients and their relatives also help us to better understand expectations, hopes and possible reservations about ECT. This gives us important insights that can also help with the urgently needed destigmatization of this serious mental illness,” says Robert Christian Wolf, Deputy Medical Director of the Clinic for General Psychiatry at the UKHD and Professor at the Heidelberg Medical Faculty.

Patient participation and support

The German Center for Mental Health (DZPG) actively supports the study and promotes cooperation between the various institutions and experts involved. A central element of the study is the close cooperation with patients and their representatives. Two patient advisory boards have been set up to ensure that the needs and perspectives of those affected are taken into account throughout the duration of the study. Among other things, these advisory boards support the recruitment of study participants and offer advice on the conduct of the study. Both advisory boards have also pledged their support for the period after completion of the study in order to transfer the knowledge gained into practice and improve patient care in the long term.